EMDR as a treatment for tinnitus
John Phillips, Sally Erskine and a team from the Norfolk and Norwich University Hospital recently published their research study Eye movement desensitization and reprocessing as a treatment for tinnitus, which was funded by the British Tinnitus Association. This small scale study followed encouraging work completed in Germany, Vancouver Canada and the Netherlands. There were fourteen participants who completed this UK based study.
What is EMDR?
Eye movement desensitization and reprocessing (EMDR) is a psychotherapy that involves various elements and attention to the past, present and future. Part of the treatment includes bilateral stimulation, such as rapid movements of the eyes from side to side. EMDR is gaining popularity as an effective treatment for an increasing number and broad range of conditions. Since its introduction in 1989, numerous controlled studies have been conducted to evaluate EMDR’s utility as a treatment for various forms of trauma-related complaints, particularly post-traumatic stress disorder (PTSD).
Objective
The aim of this study was to determine the effectiveness of eye movement desensitization and reprocessing (EMDR) as a treatment for tinnitus.
Methods
Participants were provided with a maximum of 10 sessions of EMDR. This is a bespoke EMDR protocol that was developed specifically to treat individuals with tinnitus at Norfolk and Norwich University Hospital NHS Foundation Trust in the United Kingdom. Outcome measures including tinnitus questionnaires and mood questionnaires were recorded at baseline, discharge, and at 6 months postdischarge.
Results
To measure the participants results the Tinnitus Handicap Inventory and Beck Depression Inventory questionnaires were used before the study, once the study was completed and 6 months after. Tinnitus Handicap Inventory and Beck Depression Inventory scores demonstrated a statistically significant improvement at discharge after EMDR intervention (P = .0005 and P = .0098, respectively); this improvement was maintained at 6 months postdischarge. There was also a moderate but not significant (P = .0625) improvement in Beck Anxiety Inventory scores.
Limitations
This study is limited as it is a small study, but despite the small numbers of participants taking part, the results are of significance both clinically and statistically. As emphasized above, a placebo effect is particularly prevalent in tinnitus studies, so these results do have to be reviewed with caution. Only well-designed randomized controlled clinical trials can truly demonstrate benefit of tEMDR in comparison to an appropriate control group. However, the degree of improvement in symptoms in a group of individuals, some of whom suffering from tinnitus for a very long time, should not be overlooked.
Conclusions
This study has demonstrated that the provision of tEMDR has resulted in a clinically and statistically significant improvement in tinnitus symptoms in the majority of those participants who took part. Furthermore, the treatment effect was maintained at 6 months after treatment ceased. This study is of particular interest, as the study protocol was designed to be purposefully inclusive of a diverse range of tinnitus patients. However, as a small uncontrolled study, these results do not consider the significant effects of placebo and therapist interaction. Larger high-quality studies are essential for the verification of these preliminary results.
Implications for the future
The success of this small clinical trial provides data to support the design and execution of a larger, formal, randomized controlled clinical trial. The data acquired from this study will allow appropriate estimates to be made regarding sample sizes. Evolutions in the methods employed to measure tinnitus will also be considered. For future evolutions of this current trial, great caution would need to be heeded regarding the use of a fair control group. A multitude of trial design options exist, all requiring a balanced consideration of scientific merit and ethical issues. A trial that avoids a control group that involves interaction with a clinician or therapist should be strongly considered. Interest in applying EMDR for a variety of new indications is increasing.
This current study builds on a foundation of scientific evidence that is evolving. From a pathophysiological perspective, if EMDR is ultimately found to be an effective treatment for tinnitus, this will further our understanding of the pathways that initiate, propagate, and maintain tinnitus perception, stimulating further research to explore these pathways in more detail.
About the author
John Phillips is a consultant ENT surgeon working at the Norfolk and Norwich University Hospitals NHS Foundation Trust as well as the Chair of the BTA Professional Adviser' Committee. John trained at St. Bartholomew's Hospital, London and was awarded a degree in Neuroscience at University College London.
John took up his consultant position in Norwich after completing a fellowship in Otology and Neurotology at St. Paul's Hospital in Vancouver, Canada. John's current practice is based around adult and paediatric otology and neurotology. John has a particular interest in patients with tinnitus and dizziness, and these two conditions are the focus of much of his research.