(PS2-D76) Treatment of Tinnitus Among Veterans with Posttraumatic Headache: A Secondary Analysis of a Randomized Clinical

Introduction: Tinnitus may be a function of traumatic brain injury (TBI), along with other symptoms including dizziness, fatigue, psychological distress, and posttraumatic headache (PTH; McAllister & Arciniegas, 2002). Tinnitus and posttraumatic stress disorder can influence PTH severity (Jaramillo et al., 2016; Rosenthal et al., 2013). Taken together, there is a need to investigate whether gold-standard therapeutic approaches for PTH or PTSD may also serve to simultaneously improve tinnitus-related distress. One pilot study suggested that by addressing PTSD, using Cognitive Processing Therapy (CPT; Resick et al., 2017), tinnitus-related distress was also decreased, with high effect sizes (Moring et al., 2022). CPT usually consists of 12 sessions, each lasting 50-60 minutes. Cognitive Behavioral Therapy for headache (CBT-H) consists of eight 1-hour sessions that provides patients with skills to prevent headaches, as well as decrease headache frequency, duration, and intensity. The current study aimed to compare tinnitus outcomes among individuals who received CPT for PTSD versus CBT-H, compared to treatment as usual (TAU). It was expected that individuals who received CPT and CBT-H experienced significant reductions in tinnitus-related distress, compared to those randomized to TAU, at the 1-month posttreatment follow-up.

Methods: Participants were either self-referred or referred by a VA physician to participate in the study. All participants met criteria for persistent or delayed-onset headache attributable to mTBI and clinically significant PTSD symptoms, based on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013). Those who described having chronic tinnitus were included in this study. Participants completed the Tinnitus Functional Index (TFI; Meikle et al., 2012) at baseline and one-month follow-up. A 3 x 2 general linear mixed model was conducted, with fixed effects of group (CBT-H, CPT, TAU) and time (baseline; 1 month follow-up) and their interaction, to determine the effects of intervention on tinnitus-related distress.

Results: One hundred twelve veterans and active-duty service members completed the TFI at baseline, and sixty-nine participants completed the one-month follow-up assessment. There was a significant main effect of time, in which participants experienced a decrease in tinnitus-related distress from baseline to posttreatment F (1, 3) = 5.74, p < .001. Pairwise comparisons showed that those randomized to receive CBT-H experienced significantly greater declines in tinnitus-related distress, compared to those assigned to CPT, or TAU, p = .006.

Discussion: Veterans and active-duty service members are at higher risk for developing tinnitus, which can significantly impact psychological well-being, especially when combined with PTSD and PTH. Based on the biopsychosocial model, we hypothesized that by addressing psychological distress related to PTSD and PTH, that tinnitus-related distress would decrease. This was partially supported, in that only CBT-H caused reductions in tinnitus impact. However, only 14 participants with tinnitus completed CPT; and therefore, further studies are warranted to investigate the relationship between tinnitus and PTSD.