Predictors of Response to Cognitive Behavioral Therapy in Patients With Tinnitus.

IF 6 1区医学 Q1 OTORHINOLARYNGOLOGY

JAMA otolaryngology-- head & neck surgery Pub Date : 2024-09-01 DOI:10.1001/jamaoto.2024.2264

Lauren Mueller, Dorina Kallogjeri, Madelyn R Frumkin, Karmela Dizdar, Jin Shin, Thomas Rodebaugh, Jay F Piccirillo

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引用次数: 0

Abstract

Importance: Clinical guidelines recommend cognitive behavioral therapy (CBT) as a treatment for tinnitus. However, patient response to CBT is variable, and currently, there are no known predictors of response to CBT treatment for tinnitus.

Objective: To identify the clinical predictors of patient response to CBT for treatment of tinnitus.

Design, setting, and participants: This was a secondary cohort analysis of a single-arm clinical study including adults with chronic bothersome tinnitus recruited from Washington University School of Medicine in St Louis (Missouri) from September 2019 to February 2023. Participants completed an 8-week group CBT program with a licensed clinical psychologist. Each week consisted of 2.5 hours of CBT, amounting to 20 hours of total CBT participation, primarily delivered through a virtual platform. Conjunctive consolidation was used to create a predictive classification system for response to CBT based on tinnitus bother and anxiety levels.

Main outcome and measure: Response to CBT was predefined as a 13-point or greater decrease in the Tinnitus Functional Index (TFI) survey score.

Results: The study sample included 88 adult patients (median [IQR] age, 59 [49-66] years; 47 [53%] females and 41 [47%] males) with chronic bothersome tinnitus, of whom 53 (60%) had at least 13-point decrease in TFI and were considered to be responders. In univariable and multivariable logistic regression analyses, high to moderate anxiety level and severe tinnitus bother were associated with treatment response (adjusted odds ratio: anxiety, 3.33; 95% CI, 0.90-12.30; tinnitus bother, 12.08; 95% CI, 1.48-98.35). The clinical stratification system showed good predictive and discriminative ability (χ2 for linear trend = 20.0; C statistic = 0.75; 95% CI, 0.65-0.85).

Conclusions and relevance: The findings of this study show that assessment of bother and anxiety levels in patients with tinnitus may be useful for identifying those who are more likely to respond to CBT. Before incorporation into clinical practice, future research should externally validate this finding in a separate population.

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耳鸣患者对认知行为疗法反应的预测因素

重要性：临床指南建议采用认知行为疗法（CBT）治疗耳鸣。然而，患者对 CBT 的反应却不尽相同，而且目前还没有已知的预测耳鸣患者对 CBT 治疗反应的指标：目的：确定耳鸣患者对 CBT 治疗反应的临床预测因素：这是一项单臂临床研究的二次队列分析，研究对象包括2019年9月至2023年2月期间从圣路易斯（密苏里州）华盛顿大学医学院招募的患有慢性困扰性耳鸣的成年人。参与者在一名持证临床心理学家的指导下完成了为期 8 周的小组 CBT 项目。每周进行 2.5 小时的 CBT，总计 20 小时的 CBT，主要通过虚拟平台进行。在耳鸣困扰和焦虑水平的基础上，采用联合巩固法创建了CBT反应预测分类系统：对 CBT 的反应预先定义为耳鸣功能指数（TFI）调查得分下降 13 分或更多：研究样本包括88名患有慢性耳鸣的成年患者（中位数[IQR]年龄为59[49-66]岁；女性47[53%]，男性41[47%]），其中53人（60%）的耳鸣功能指数（TFI）至少下降了13分，被认为是应答者。在单变量和多变量逻辑回归分析中，高度至中度焦虑水平和严重耳鸣困扰与治疗反应相关（调整后的几率比：焦虑，3.33；95% CI，0.90-12.30；耳鸣困扰，12.08；95% CI，1.48-98.35）。临床分层系统显示出良好的预测和鉴别能力（线性趋势 χ2 = 20.0；C 统计量 = 0.75；95% CI，0.65-0.85）：本研究的结果表明，对耳鸣患者的烦恼和焦虑水平进行评估，有助于确定哪些患者更有可能对 CBT 作出反应。在将其应用于临床实践之前，未来的研究应在单独的人群中对这一发现进行外部验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA otolaryngology-- head & neck surgery OTORHINOLARYNGOLOGY-

CiteScore

9.10

自引率

5.10%

发文量

230

期刊介绍： JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.