Supplementary Material for: Metaanalysen als Königsweg für die Formulierung von Therapieleitlinien?

Effects of Distraction and Relaxation Training in Chronic Tinnitus and Impact of Individual Case Complexity. Background: In the case of complex chronic tinnitus many experts recommend inpatient rather than outpatient psychological treatment. Severe tinnitus-related distress and psychopathology are supposed to make treatment success difficult and are to be compensated by increased treatment efforts. Yet, evidence for the impact of case complexity on treatment effects is weak or equivocal. Patients and Methods: In a prospective randomized controlled trial with 139 tinnitus patients we investigated if previous findings on the effectiveness of an outpatient computer-aided and machine-assisted distraction and relaxation training (DRT) can be corroborated and to what extent case complexity is relevant for the short- to long-term success of the training. Treatment success was assessed by use of reliable and valid instruments for tinnitus-related distress, tinnitus coping and emotional distress not related to tinnitus. Furthermore, we analyzed whether outpatient DRT is also effective in patients with similarly complex tinnitus as in most of the inpatient population. The effect of DRT in these outpatients was contrasted with that of inpatient treatment. Results: DRT yielded a longlasting reduction of tinnitus-related distress and increased utilization of self-encouragement, relaxation, and attention diversion to cope with tinnitus. Intervention-specific changes in emotional distress not related to tinnitus were non-certifiable. There was no evidence that increased case complexity curtailed treatment success. The contrast of the effects of inpatient treatment and DRT indicated no advantage of the former. Conclusions: Recommending different therapeutic approaches according to tinnitus complexity seems rather eminence- than evidence-based. Further research on differential treatment indication and on dose-response relationship is required.