Peter H. Wilson

A critical analysis of directive counselling as a component of tinnitus retraining therapy

Tinnitus retraining therapy (TRT) has been presented as a new approach to tinnitus management. In this paper a number of theoretical and practical problems with TRT are identified. These problems relate to the distinction between directive counselling and cognitive therapy, the adequacy of the cognitive therapy components, the nature of the outcome data which have been presented to date, the theoretical basis for the treatment, and the conceptual clarity of terms such as perception, attention and coping. The stated goal of removal of the perception of tinnitus may lead to confusion about the likely outcome of TRT for most patients. Methodological limitations in the research which has been published to date preclude any claims about the efficacy of TRT at the present time. It is suggested that randomized, controlled studies which include no-treatment and placebo conditions need to be undertaken. Studies are required in which the efficacy of the counselling and white noise components can be clearly isolated. Suggestions are made about the role of psychologists and non-psychologists in the provision of counselling and cognitive therapy services to tinnitus patients.

An Evaluation of Two Types of Cognitive Intervention in the Management of Chronic Tinnitus

Abstract Fifty-four subjects with chronic distressing tinnitus were randomly allocated to one of four experimental treatment conditions: (1) attention control and imagery training (AC1); (2) cognitive restructuring (CR); (3) combined attention control and imagery training plus cognitive restructuring (ACI + CR); and (4) a waiting list control (WLC). Significant overall improvements were found on measures of distress associated with tinnitus, and on a number of other measures of cognition and coping strategies. These improvements were maintained at the six-month follow-up. Relative to the WLC, the three treatment conditions (combined) were associated with improvements in tinnitus-related distress, reductions in tinnitus-related dysfunctional cognitions and an increase in the frequency of use of coping strategies. There was a significant effect in favour of the ACI group compared to the CR group on the measure of irrational beliefs. The analyses also revealed that the combined treatment condition (ACI + CR)...

Cognitive methods in the management of chronic pain and tinnitus

Abstract An overview is provided of recent contributions of cognitive theory and therapy to the understanding and management of chronic pain and tinnitus. These two disorders have several features in common, including a chronic course; low efficacy associated with conventional treatments; negative employment, interpersonal, and other consequences of the disorder; little external manifestation of the problem; and a complex set of interrelationships between perception, psychological distress, and environmental events. There has been considerable development of cognitive approaches to the understanding and management of pain, and, to a lesser extent, tinnitus. However, most of the empirical findings can be viewed as descriptions of pain-related phenomena rather than providing strong indications of causal processes. Controlled treatment-outcome studies have revealed significant effects associated with cognitive and behavioural approaches to pain, especially on measures of psychological adjustment. Most studie...

Partners of problem drinkers: moving into the 1990s

The literature on partners of problem drinkers is reviewed. Originally research and treatment viewed partners of problem drinkers from a pathological perspective. This paper suggests an alternative stress and coping perspective as less stigmatizing and more realistic in terms of the experiences of these individuals.

Relapse Prevention: Overview of Research Findings in the Treatment of Problem Drinking, Smoking, Obesity and Depression

The aim of this paper is to provide an overview of developments in the area of relapse prevention for selected psychological disorders: problem drinking; smoking; obesity; and depression. Relapse prevention methods, including booster sessions, have been associated with mixed outcomes, although there are some encouraging findings, particularly in the treatment of obesity and alcohol problems. A number of recommendations are made for research and/or clinical practice. In the treatment of alcohol problems it is recommended that more attention be paid to reducing co-existent marital problems and mood disorders. In obesity, there is a need for evaluations of intensive, long-term therapist contact with the severely obese, particularly those with serious medical problems. Studies of the complete relapse prevention approach advocated by Marlatt and Gordon (1985) are needed in the evaluation of smoking cessation programmes. It is concluded that maintenance of gains in smoking, obesity and problem drinking comes at a considerable cost in time and therapist contact. To date, there has been little application of relapse prevention methods to depression, and further empirical work is needed to identify the determinants of relapse and the efficacy of specific maintenance-enhancement strategies. Consistent themes in the prediction of relapse are identified, including low social support, ongoing interpersonal difficulties, and low self-efficacy.

The Application of Cognitive-Behaviour Therapy to Tinnitus

Abstract The aim of this paper is to introduce clinical psychologists to the subject of tinnitus (ringing in the ears). An overview of the audiological and psychological characteristics of tinnitus is provided, followed by a guide to the interviewing and assessment of people who present with tinnitus. It is suggested that assessment should particularly focus on the content of cognitions, the emotional reactions to tinnitus, stressful life events or daily hassles, suicidal thoughts and behaviours, and sleep disturbance. The principal types of cognitive-behavioural interventions for the reduction of tinnitus-related distress are described, including cognitive restructuring, attention control and relaxation training. The outcomes obtained in controlled studies are briefly surveyed. It is concluded that cognitive-behavioural interventions have considerable promise for clients who experience severe, unrelenting tinnitus.