Comprehensive behavioral management of complex tinnitus: a case illustration.

This paper describes a comprehensive program for behavioral management of complex tinnitus. The clinical characteristics and typical treatment of tinnitus are reviewed. Psychosocial sequelae are discussed in terms of their exacerbation of the symptom and their potential as foci of treatment. The management problems of tinnitus are considered analogous to those of chronic pain. A case illustration is provided with a description of the treatment process. The comprehensive behavioral program discussed in the present paper included biofeedback therapy, pain management training, social skills training, assertion training, in vivo exposure to being alone, cognitive treatment of depression, and marital therapy. Outcomes were monitored multidimensionally. Self-report of tinnitus severity decreased after the 6th treatment day and stabilized at a "mild" rating after the 9th day. Skin temperature readings at baseline increased and stabilized after the 8th day, and the patient was able to reliably increase skin temperature on request. Scores on the Beck Depression Inventory and the Willoughby Personality Schedule, and a self-rating of Fear of Being Alone dropped markedly by the end of treatment. Follow-up data at 3 months indicated maintenance of gains.