CBT, Breathing Exercises, and Psychoeducation on Tinnitus-Related Distress

Tinnitus is a heterogeneous condition with multifactorial pathophysiology involving both auditory and non-auditory networks. Because no curative treatment exists, management focuses on reducing tinnitus-related distress and improving quality of life. Psychological and behavioral interventions have shown promise, but direct comparisons between approaches are limited.

This exploratory randomized controlled study compared three non-pharmacological interventions: cognitive behavioral therapy, the 4-7-8 breathing technique, and psychoeducation. Participants were assigned in a 1:1:1 ratio using a computer-generated randomization sequence. The sequence was generated before enrollment, and group assignment was withheld until after baseline assessments were completed.

The investigators hypothesized that cognitive behavioral therapy would produce the greatest improvement in tinnitus-related outcomes, followed by the 4-7-8 breathing technique, with psychoeducation producing the least improvement. Intervention intensity differed across groups, and this contact-time imbalance was considered when interpreting the findings.

Inclusion criteria

• Age between 18 and 65 years
• Diagnosis of subjective tinnitus
• Ability to read and complete questionnaires
• Voluntary participation

Exclusion criteria

• Delirium, dementia, intellectual disability, or other organic mental disorders
• Current psychiatric disorder according to DSM-5 criteria
• History of alcohol or substance use disorder
• Illiteracy
• Abnormal otoscopic findings
• History of otologic surgery
• Otologic or vestibular disorders (e.g., otosclerosis, Meniere's disease)
• Use of hearing aids
• History of hearing loss
• Respiratory diseases requiring ongoing treatment