Internet-Based Mindfulness-Based Cognitive Therapy (iMBCT) for Chronic Tinnitus Patients

Tinnitus, the perception of sound without an external source, affects about 10-15% of people worldwide, with 2-3% experiencing severe distress. Large studies estimate that around 14% of adults report tinnitus, and about 2% suffer from a disabling form. In Europe, roughly one in seven adults is affected. Tinnitus often occurs alongside anxiety, depression, insomnia, and reduced quality of life. Even mild tinnitus has been linked to poorer sleep and higher levels of anxiety and depression.

Despite extensive research, there is no universal medical cure for tinnitus. As a result, treatment increasingly focuses on psychological and behavioral methods that aim to reduce distress and promote habituation. Cognitive Behavioral Therapy (CBT) is the current gold standard, reliably easing distress and improving coping, though it is not effective for everyone and access remains limited. This has led to growing interest in mindfulness-based approaches, such as Mindfulness-Based Cognitive Therapy (MBCT), which combine mindfulness practices with cognitive strategies focused on acceptance rather than control of symptoms.

Mindfulness-based treatments target the negative thoughts, catastrophic interpretations, and avoidance behaviors that sustain tinnitus distress. Acceptance of tinnitus has been shown to improve quality of life and reduce depression and distress. By fostering non-judgmental awareness of the present moment, MBCT helps patients shift from struggling against tinnitus toward acceptance.

Clinical research shows that mindfulness approaches can reduce tinnitus severity, psychological distress, and negative thinking. Trials demonstrate that MBCT and Mindfulness-Based Stress Reduction (MBSR) are effective, with some studies finding MBCT more beneficial than relaxation therapies, and benefits lasting for months. Online versions of mindfulness-based tinnitus programs have also proven feasible and helpful, particularly during the COVID-19 pandemic. Ongoing studies directly comparing MBCT with CBT further highlight the expanding role of mindfulness in tinnitus care.

Mindfulness-Based Cognitive Therapy (MBCT) MBCT is an eight-week, group-based psychological program originally developed to prevent relapse in recurrent depression. It combines mindfulness meditation practices with cognitive-behavioral therapy strategies, fostering non-judgmental awareness of present-moment experience, greater cognitive flexibility, and reduced reactivity to negative thoughts and emotions.

Mechanistic research suggests that MBCT works by:

Increasing cognitive defusion - the ability to step back from and observe thoughts without automatically believing or reacting to them. Reducing experiential avoidance - the tendency to suppress or avoid difficult emotions and sensations. Enhancing self-compassion - a kinder, more understanding stance toward oneself in times of suffering.

Internet-Delivered MBCT (iMBCT) Internet-delivered psychological interventions (IPIs) have the potential to greatly expand access to evidence-based care. Online MBCT (iMBCT) can be delivered synchronously (live sessions with a facilitator) or asynchronously (self-paced, unguided), with evidence supporting effectiveness in reducing distress and improving resilience. Unguided iMBCT programs are especially promising for public health implementation due to their low delivery cost and scalability, but high-quality trials in specific clinical groups remain rare.

Study Objectives The main objective of the planned research is to evaluate the effectiveness of an iMBCT intervention for tinnitus distress, depression, and anxiety symptoms among chronic tinnitus patients.

More specific objectives are as follows: (1) evaluate the effectiveness of the intervention relative to waiting-list according to self-reported measures; (2) conduct an examination of predictors and mediators of treatment response; (3) evaluate the maintenance of tinnitus distress alleviation as well as anxiety and depression symptoms at 1-month and 6-month follow-up.

Study design and setting This study is a two-arm, parallel-group, randomized controlled trial (RCT) comparing iMBCT with a waiting list control. A CONSORT-compliant flowchart (Figure 1) depicts participant progression. The participants will be allocated to either a 6-week iMBCT intervention, or (2) waiting-list control group (WLC).

Participants will be instructed to contact the research team in the event of a crisis, at which point they will be assessed by a study-affiliated psychotherapist or psychiatrist and referred to appropriate clinical services as necessary.

All assessments will be conducted via an online data collection platform provided by the investigators (terapiawszumach.pl) at the following time points: (1) screening, (2) baseline (prior to randomization), (3) upon completion of the 6-week online program or waitlist period, (4) one month post-treatment (for participants in the active intervention groups), and (5) six months post-treatment.

Inclusion criteria

• Willingness and ability to participate in online therapy.
• Polish language proficiency.
• 18 years or older.
• Suffering from chronic tinnitus for at least 3 months.
• A score of ≥32 on the TFI. Exclusion criteria

• Mentally incapable patients. 2) Patients who have already completed structured mindfulness training.