Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients' in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.

Behav Res Ther. 2009 Jun;47(6):523-8. Hesser H, Westin V, Hayes SC, Andersson G. Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden. Hugo.Hesser@liu.se

by Robert DeMaria DC, DABCO, FASBE, NHD

Imagine that you are a ten-year-old child. You have a child's nervous, excited energy...even more so than other children your age. You are just as bright as your classmates, but your grades don't reflect it. You just can't seem to focus on your classes. While your teacher is talking, your eyes dart around the room. Perhaps your foot taps anxiously or you doodle incessantly when you should be taking notes. You are frequently called down in your class for being disruptive. Your teachers and parents become frustrated with you--you become frustrated with yourself. You begin to feel that you're just stupid. Try as you might, you just can't seem to pay attention.

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