Treatment for PTSD and Tinnitus

The University of Texas Health Science Center at San Antonio160 enrolled

Overview

In this study, researchers are examining the best sequence of interventions for posttraumatic stress disorder (PTSD) and tinnitus. Participants will either receive psychotherapy for PTSD first (Cognitive Processing Therapy; CPT), followed by treatment for tinnitus (Cognitive Behavioral Therapy for Tinnitus; CBT-t); or vice-versa. We also aim to identify changes in brain functioning after receiving therapy.

After consenting to this study, study participants will be asked to speak with a study staff member about stressful or traumatic experiences, complete hearing assessments and questionnaires about exposure to traumatic events, PTSD symptoms, mental and physical health problems, such as depression and substance use, head injuries, and tinnitus. Participants who are able and willing may be asked to provide functional magnetic resonance imaging (MRI) scans before and after treatment. Participants will receive treatment for tinnitus and posttraumatic stress disorder (PTSD) in one of two ways: Cognitive Processing Therapy (CPT) first and then Cognitive Behavioral Therapy for Tinnitus (CBT-t) OR CBT-t first, followed by CPT.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

160

Conditions

PTSD - Post Traumatic Stress Disorder Posttraumatic Stress Disorder (PTSD)

Interventions

Cognitive Processing TherapyBEHAVIORAL

CPT (Resick, Monson, \& Chard, 2024) consists of 12 50-minute sessions conducted over a 6- to 12-week period (Resick, Monson, \& Chard, 2008). The three phases of CPT include psychoeducation, processing, and challenging beliefs and assumptions related to the trauma, oneself, and the world.

CBT-tBEHAVIORAL

The standard CBT-t protocol is gathered from the Progressive Tinnitus Management (PTM) program, and includes psychoeducation about how tinnitus can develop. CBT-t includes using behavioral principles to help manage tinnitus reactions, including the use of sounds: soothing sounds, background sound, and interesting sound. CBT-t teaches relaxation exercises, scheduling pleasant activities, and learn how to modify thoughts related to tinnitus. Therapists will also provide basic education on how to protect hearing health among participants in order to prevent worsening of tinnitus and to prevent exacerbation of any hearing loss.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult male and female active duty military personnel and veterans seeking treatment for PTSD * Diagnosis of PTSD * Person has experienced at least one mild traumatic brain injury (concussion) * Ability to speak and read English * Stable on any psychotropic medications * Meets criteria for chronic subjective and bothersome tinnitus * Chronic tinnitus is at least possibly related to head injury Exclusion Criteria: * Currently receiving other talk therapies * Severe hearing loss that would prevent the participant from benefiting from therapy * Current severe suicidal ideation * Psychiatric hospitalization in the last 12 months * Moderate to severe substance use that would prevent the participant form benefiting from therapy * Current manic episode or psychotic symptoms requiring immediate stabilization or hospitalization * Significant cognitive impairment * Moderate to severe brain damage * Neurobiological disorders * Temporomandibular joint disorders and/or Meniere's disease that cause acute pain

Outcomes

Primary Outcomes

PTSD Checklist

Assessment of PTSD Symptoms

Time frame: Baseline to 6-Month Follow-Up (approximately12 months)

Tinnitus Functional Index

Assessment of Tinnitus-Related Distress