Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom.
Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, United Kingdom.
Am J Audiol. 2022 Jun 2;31(2):487-512. doi: 10.1044/2022_AJA-21-00162. Epub 2022 May 12.
There is growing evidence supporting the use of third-wave psychological therapies, such as mindfulness-based interventions (MBIs) and acceptance and commitment therapy (ACT), for people with long-term or chronic physical health conditions. We conducted a systematic review and meta-analysis to critically evaluate the effectiveness of third-wave interventions for improving hearing-related distress and psychological well-being in people with audiological problems.
We searched online bibliographic databases and assessed study quality. We conducted random-effects meta-analyses if at least two randomized controlled trials (RCTs) examined hearing-related distress, depression, anxiety, or quality of life in people with audiological problems. Findings of pre-post studies were summarized narratively.
We identified 15 studies: six RCTs and nine pre-post studies. The methodological quality of studies was mostly poor to moderate, and sample sizes were typically small (overall = 750). Most studies focused on tinnitus ( = 12), MBIs ( = 8), and ACT ( = 6). Statistically significant improvements in hearing-related distress were found with ACT and MBIs versus controls and other treatments at post-intervention in people with tinnitus, while improvements in depression and anxiety were only found for ACT versus controls at post-intervention. However, gains were either not maintained or not examined at follow-up, and there was no evidence for improvements in quality of life.
At present, there is insufficient evidence to recommend the use of third-wave interventions for improving hearing-related distress or psychological well-being in people with audiological problems. There is some evidence that ACT and MBIs may be useful in addressing hearing-related distress in people with tinnitus, but only in the short term. However, findings should be interpreted with caution given the small number of studies with generally small sample sizes and mostly poor-to-moderate methodological quality. More high-quality, adequately powered, double-blind RCTs, particularly in audiological problems other than tinnitus, are needed to draw firm conclusions and meaningful clinical recommendations.
越来越多的证据支持使用第三波心理疗法，如正念干预（MBI）和接受与承诺疗法（ACT），来治疗患有长期或慢性身体健康问题的人群。我们进行了一项系统综述和荟萃分析，以批判性地评估第三波干预措施在改善听力相关困扰和心理幸福感方面对有听力问题的人群的有效性。
我们搜索了在线书目数据库并评估了研究质量。如果至少有两项随机对照试验（RCT）检查了有听力问题的人群的听力相关困扰、抑郁、焦虑或生活质量，我们则进行了随机效应荟萃分析。对前后研究的结果进行了叙述性总结。
我们确定了 15 项研究：6 项 RCT 和 9 项前后研究。研究的方法学质量大多较差到中等，样本量通常较小（总样本量为 750）。大多数研究集中于耳鸣（=12）、MBI（=8）和 ACT（=6）。与对照组和其他治疗方法相比，ACT 和 MBI 在耳鸣患者中显示出在干预后听力相关困扰有统计学显著改善，而在抑郁和焦虑方面仅发现 ACT 与对照组相比在干预后有改善。然而，在随访时，改善要么没有维持，要么没有被检查，并且没有证据表明生活质量有所改善。
目前，没有足够的证据推荐使用第三波干预措施来改善有听力问题的人群的听力相关困扰或心理幸福感。有一些证据表明，ACT 和 MBI 可能有助于解决耳鸣患者的听力相关困扰，但仅在短期有效。然而，由于研究数量较少，样本量通常较小，且方法学质量大多较差到中等，因此应谨慎解释这些发现。需要更多高质量、充分有力、双盲 RCT，特别是在除耳鸣以外的听力问题方面，以得出明确的结论和有意义的临床建议。
