Network Dysregulation Among Individuals with Comorbid Tinnitus and PTSD

Jan 22, 2022

Along with posttraumatic stress disorder (PTSD), one of the most common combat-related disorders is tinnitus, the illusory perception of noise or ringing in the ears when no actual external noise is present. Although these conditions are very different, they commonly occur together, and resting-state functional magnetic resonance imaging (rs-fMRI) shows that both are associated with abnormalities in similar brain networks.

It is anticipated, then, that the successful treatment of PTSD may also help alleviate the frequency, intensity, duration, and distress of chronic tinnitus. Likewise, a better understanding of the brain mechanisms involved in the cause and maintenance of both disorders, as well as in patient response to treatment, could guide efforts to cure them both, individually and jointly.

With these overarching goals in mind, this STRONG STAR-affiliated pilot study led by John Moring, PhD, of UT Health San Antonio will enroll 12 military veterans who deployed post-9/11 and who suffer from both PTSD and bothersome tinnitus. They will be assessed for tinnitus, tinnitus-related distress, and PTSD prior to undergoing Cognitive Processing Therapy (CPT), one of the gold-standard treatments for PTSD.

Each patient also will undergo rs-fMRI scans prior to starting treatment with CPT, midway through the six-week therapy period, and one month after completing treatment.

Through these assessments and neuroimaging scans, investigators have several aims. For one, they seek to identify symptoms that are shared and unique to PTSD and tinnitus-related distress. These findings could help clinicians better understand the distinct ways each disorder contributes to functional impairment as well as what it is like live with both disorders. That could improve their approach to patient care.

In addition, investigators want to test their hypothesis that, as CPT helps patients recover from PTSD, it also will help reduce tinnitus-related distress. This could provide support for the use of CPT for this purpose.

Importantly, with the neuroimaging scans, researchers also aim to identify the brain network dysregulation associated with tinnitus and PTSD, both in causing and maintaining the disorders, and gauge the impact of successful PTSD treatment with CPT, including whether and how it results in healthier activity within affected brain networks. These findings could be used to generate new and innovative treatments targeting specific brain regions to alleviate tinnitus and PTSD.

Conjoint Therapy for Pain Management: A Pilot Study

May 19, 2016

Chronic pain:

  • Affects approximately 100 million Americans, resulting in more than $600 billion in direct and indirect costs, making it a significant national health care concern.
  • Increases risk for psychological problems, such as depression, anxiety, and substance use, as well as interpersonal distress, particularly within romantic relationships.
  • Can cause distress for family members.

Family members of chronic pain patients report elevated caregiver burden, lower relationship quality and satisfaction, and decreased physical and psychological health. Marital distress and partners’ psychological maladjustment are problematic in pain management. Partners with depression/anxiety are less able to help their significant other cope with pain. Erosion of the quality of the relationship creates additional stress for patients.

Although research has shown a reciprocal relationship between chronic pain and relationship satisfaction, little has been done to develop treatments that include family members. Principal Investigators Tabatha Blount, PhD, and Cindy McGeary, PhD, the developers of this pilot study affiliated with the STRONG STAR Consortium, believe that chronic pain sufferers who are in a committed relationship may benefit from a couple-based pain management treatment.

First study of its kind

In what is believed to be the first pilot study of a couple-based treatment for chronic pain, the research team will test a treatment program called Conjoint Therapy for Pain Management in couples in which a partner has suffered from chronic pain for more than 12 weeks. Drs. McGeary and Blount, both members of the Psychiatry Department faculty in the School of Medicine at The University of Texas Health Science Center at San Antonio, will work with the UT Medicine Pain Consultants Clinic to recruit 10 patients and their spouses or cohabitating partners for this study.

The investigators will incorporate proven pain management interventions into a program similar to Cognitive-Behavioral Conjoint Therapy (CBCT) for PTSD, previously developed by Candice Monson, PhD, of Ryerson University, Toronto, Canada, and Steffany Fredman, PhD, of Pennsylvania State University (also STRONG STAR-affiliated investigators). That therapy simultaneously targets posttraumatic stress disorder symptoms and relationship distress. For couples, dealing with PTSD requires skills similar to those needed for dealing with pain, including communication training and overcoming fear-based avoidance of certain situations and activities.

Treatment in the CBCT for pain program will focus on managing chronic pain through:

  • psychoeducation about chronic pain and related relationship problems
  • communication skills training
  • breathing techniques
  • imagery
  • cognitive/behavioral interventions
  • acceptance, progressive muscle relaxation
  • mindfulness

CBCT will emphasize helping patients realize their potential to make progress gaining physical function, such as walking, bending, and lifting.

Expected results

The research group hypothesizes that including intimate partners in the treatment of chronic pain may improve patients’ adherence to treatment, improve their physical and social functioning, and improve overall couple’s satisfaction for both partners. The investigators expect that this pilot study will yield data relevant for the development of the first randomized controlled trial to systematically examine the role that others play in patients’ pain management treatments. That will inform improved therapies to ease the suffering of the millions of Americans and others worldwide living with chronic pain.