***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Using a r and omized group design , the efficacy of an outpatient cognitive-behavioral Tinnitus Coping Training ( TCT )  was compared to two minimal-contact ( MC ) interventions . METHODS TCT was conducted in a group format with 11 sessions ( total n=43 ) . One MC [ MC-E ( education ) , n=16 ] consisted of two group sessions in which education on tinnitus was presented and self-help strategies were introduced . The second MC [ MC-R ( relaxation ) , n=16 ] comprised four sessions . Besides education , music-supported relaxation was suggested as self-help strategy and audiotapes with relaxing music were provided . Furthermore , a waiting-list control group was installed ( WC , n=20 ) . Data were assessed at baseline ( pretherapy ) and at posttherapy period . Only  TCT  was additionally evaluated at a 6-month and a 12-month follow-up . Several outcome variables ( e.g. , awareness of tinnitus ) were recorded in a tinnitus diary . Tinnitus coping and disability due to tinnitus were assessed by question naires . Subjective ratings of improvement were also requested from the patients . Furthermore , inventories of psychopathology were given to the patients . RESULTS Findings reveal highly significant improvements in  TCT  in comparison to the control group ( WC ) . MC interventions do not differ significantly from each other , but are superior to WC in a few domains of outcome . Outcome in TCT is somewhat superior to combined MC interventions in two domains of data , but not regarding disability reduction . Effect sizes , nevertheless , indicate distinct differences in degree of improvement , with TCT achieving the best results . CONCLUSIONS A sequential scheme for the treatment of chronic tinnitus  is discussed on the basis of cost-effectiveness considerations Many tinnitus sufferers believe that their tinnitus has an organic basis and thus seek medical rather than psychological treatments . Tinnitus has been found to be associated with negative appraisal , dysfunctional attention shift , and heightened psychophysiological arousal , so cognitive-behavioral interventions and biofeedback are commonly suggested as treatments . This study developed and investigated the efficacy of a biofeedback-based cognitive-behavioral treatment for tinnitus . In total , 130 tinnitus patients were r and omly assigned to an intervention or a wait-list control group . Treatment consisted of 12 sessions of a biofeedback-based behavioral intervention over a 3-month period . Patients in the wait-list group participated in the treatment after the intervention group had completed the treatment . Results showed clear improvements regarding tinnitus annoyance , diary ratings of loudness , and feelings of controllability . Furthermore , changes in coping cognitions as well as changes in depressive symptoms were found . Improvements were maintained over a 6-month follow-up period in which medium-to-large effect sizes were observed . The treatment developed and investigated in this study is well accepted and leads to clear and stable improvements . Through demonstration of psychophysiological interrelationships , the treatment enables patients to change their somatic illness perceptions to a more psychosomatic point of view Twenty-four patients with moderately severe ( grade 2 ) to severe ( grade 3 ) subjective tinnitus  participated in an experimental group study . The patients were r and omly assigned to a treatment group and a waiting-list control group . Treatment was given with a coping technique and comprised 10 one-hour sessions . Following a corresponding period without treatment , the control group was treated similarly . Daily self-recording of the subjective tinnitus loudness , the discomfort from the tinnitus , depression and irritation was performed before and after treatment . In addition , psychoacoustic measurement was undertaken on three occasions . The treatment group improved significantly more than the waiting-list control group . After treatment of the latter group , combined data of both groups showed statistically significant improvements in all variables . The results show that tinnitus annoyance can be treated by psychological methods This study is a r and omized , waitlist-controlled trial testing the effect of a brief , " manualized " cognitive-behavioral group therapy on  distress associated with tinnitus , quality of well-being , psychological distress including depression , and internal focus .  Cognitive-behavioral therapy ( CBT ) included training in activity planning , relaxation training and , primarily , cognitive restructuring .  Sixty-five participants were recruited , and 41 completed treatment . Participants were r and omly assigned to receive 8 weeks of manualized group CBT either immediately or after an 8-week waiting period . Participants completed outcome measures at the time of their r and om assignment and at 8 , 16 , and 52 weeks later . Repeated-measure analysis of covariance revealed significant group-by-time interactions on measures of tinnitus distress and depression , indicating that CBT led to greater improvement in those symptoms . The current results suggest that CBT , applied in a group format using a manual , can reduce the negative emotional distress , including depression , associated with tinnitus Objective The aim of this study was to investigate if cognitive behavior therapy ( CBT ) provided via the Internet results in significant decreases of distress in individuals with tinnitus . Methods Participants were recruited through Web pages and newspaper articles and thereafter r and omly allocated to a CBT self-help manual in six modules or to a waiting-list control group ( WLC ) . All treatment and contact with participants were conducted via the Internet with Web pages and E-mail correspondence . Participants were 117 individuals with tinnitus of duration of more than 6 months . In the first r and omized controlled phase of the study , 26 completed all stages of treatment ( 51 % dropout ) , and 64 of the WLC group completed measures . At 1-year follow-up , all participants had been offered the program and 96 provided outcome measures ( 18 % dropout rate from baseline ) . Tinnitus-related problems were assessed before and after treatment and at the 1-year follow-up . Daily diary ratings were included for 1 week before and 1 week following the treatment period . Results Tinnitus-related distress , depression , and diary ratings of annoyance decreased significantly . Immediately following the r and omized controlled phase ( with a WLC ) , significantly more participants in the treatment group showed an improvement of at least 50 % on the Tinnitus Reaction Question naire . At the uncontrolled follow-up , 27 ( 31 % ) of all participants had achieved a clinical ly significant improvement . Conclusions CBT via the Internet can help individuals decrease annoyance associated with tinnitus . High dropout rates or delay in completing treatment can be a characteristic of treatment studies using the Internet but should be contrasted with the cost effectiveness and accessibility of the Internet Disabling  tinnitus in 27 patients was treated in an experimental setting with two different type of therapy aim ing at the development of coping behaviour . One was focused on behavioural control procedures , while the other aim ed at more cognitive control methods such as distraction . The results of the two forms of therapy were compared with each other and with observations of the untreated control subjects . Assessment s of subjective loudness , discomfort from tinnitus and controllability were made on analogue scales and at a question naire follow-up . Psychoacoustic measures such as personal loudness units ( PLU ) were used in connection with these self-recordings and for evaluation of treatment effects . The results confirmed favourable reports on behavioural methods in tinnitus . However , no differences were found between therapies . The results are discussed in the light of the coping and adaptation theory Sixty subjects with chronic tinnitus were r and omly allocated to one of three experimental conditions : ( 1 ) cognitive coping skills training ( attention diversion , imagery training and thought management skills ) combined with education . ( 2 ) education-only , or ( 3 ) waiting-list control . The two treatment groups improved significantly more than the waiting-list control on measures of frequency of use of coping strategies , benefits derived from the use of coping strategies , irrational beliefs and knowledge about tinnitus . Subjects who received the combined cognitive/education intervention demonstrated significantly greater reductions in distress and h and icaps associated with tinnitus , and engagement in dysfunctional cognitions , than the subjects who received education alone . No significant effects were obtained on measures of depression , locus of control , or on daily ratings of subjective loudness , noticeability or bothersomeness of the tinnitus . At the 12-month follow-up , the differential treatment effects had dissipated . Although the treatment result ed in statistically significant effects , the size of the clinical effects is rather modest . Implication s for the further development of treatment techniques are discussed OBJECTIVE  Tinnitus distress can be reduced by means of cognitive-behavior therapy ( CBT ) . To compensate for the shortage of CBT therapists , we aim ed , in this study , to investigate the effects of a CBT-based self-help book guided by brief telephone support . METHODS Seventy-two patients were r and omized either to a self-help book and seven weekly phone calls or to a wait-list control condition , later on receiving the self-help book with less therapist support . The dropout rate was 7 % . Follow-up data 1 year after completion of treatment were also collected ( 12 % dropout ) . The Tinnitus Reaction Question naire ( TRQ ) was the main outcome measure , complemented with daily ratings of tinnitus and measures of insomnia , anxiety , and depression . RESULTS On the TRQ , significant reductions were found in the treatment group both immediately following treatment and at 1-year follow-up . In the treatment group , 32 % reached the criteria for clinical significance ( at least 50 % reduction of the TRQ ) compared to 5 % in the wait-list group . Directly after treatment , two out of five measures showed significant differences in favor of the treatment with more therapist support compared with the group who , after their waiting period , received little therapist support . The self-help treatment was estimated to be 2.6 ( seven phone calls ) and 4.8 ( one phone call ) times as cost-effective as regular CBT group treatment . CONCLUSIONS Guided self-help can serve as an alternative way to administer CBT for tinnitus . Preliminary results cast some doubts on the importance of weekly therapist contact . The effect size was somewhat smaller than for regular CBT , but on the other h and , the self-help seems far more cost-effective . Future studies should compare treatment modalities directly and explore cost-effectiveness more thoroughly Three thous and six hundred r and omly selected adults in the city of Gothenburg ( 425,000 inhabitants ) stratified by age and gender , were question ed by mail  concerning tinnitus . We received 66 % useful answers , 14.2 % suffered from tinnitus ' often ' or ' always ' . Tinnitus was more common in males than in females . Tinnitus was much more common in the left than in the right ear . 2.4 % of the whole population suffered from the worst severity degree , ' tinnitus plagues me all day ' . Tinnitus was clearly more common with hearing loss than with subjectively normal hearing . Sleep disturbances were common and increased with tinnitus severity . A majority of the question ed subjects wanted further examination and treatment Using a r and omized control group trial the long-term efficacy of a habituation-based treatment as conceived by Jastreboff , and a cognitive-behavioural tinnitus coping training were compared . An educational intervention was administered as a control condition . Both treatments were conducted in a group format ( habituation-based treatment , 5 sessions ; tinnitus coping training , 11 sessions ) . Educational intervention was delivered in a single group session . Patients were categorized according to their level of disability due to tinnitus ( low , high ) , age and gender and then r and omly allocated to the treatment conditions ( habituation-based treatment , n = 30 ; tinnitus coping training , n = 27 ; educational intervention , n = 20 )  . Data assessment included follow-ups of up to 21 months . Several outcome variables including disability due to tinnitus were assessed either by question naire or diary . Findings reveal highly significant improvements in both tinnitus coping training and habituation-based treatment in comparison with the control group . While tinnitus coping training and habituation-based treatment do not differ significantly in reduction of tinnitus disability , improvement in general well-being and adaptive behaviour is greater in tinnitus coping training than habituation-based treatment . The decrease in disability remains stable throughout the last follow-up in both treatment conditions Two non-medical treatment strategies for chronic idiopathic tinnitus were evaluated in a r and omized control group design . A cognitive-behavioural tinnitus coping training ( TCT ) was developed and compared to yoga and a self-monitoring control condition .  Forty-three chronic tinnitus patients , were assessed at baseline , directly after therapy , and at 3 months follow-up . For evaluation , differential psychoacoustic variables were registered , a tinnitus diary as well as the Tinnitus Question naire and different measures of general well-being were used . Statistical analyses showed effects favouring the TCT treatment in comparison to the control and yoga treatment . The TCT-treated patients reported more satisfaction with the training than the yoga group . Participants in the self-monitoring control group were treated either by TCT or yoga after a waiting period . The outcome in this group was even better than in the experimental groups while yoga again showed rather poor effects The aim of the study was to investigate the effects of cognitive behavioral therapy ( CBT ) in elderly people with tinnitus ( < 65 years ) . Thirty-seven patients were called in for a structured interview . Following exclusion , twenty-three participated in the trial . All participants underwent medical ear , nose , and throat ( ENT ) examination , audiometry , and tinnitus matchings . A r and omized controlled design with a waiting list control group was used . A CBT treatment package was delivered in six weekly two hour group sessions . Outcome was measured using vali date d self-report inventories and daily diary ratings of annoyance , loudness and sleep quality for one week pre-treatment , post-treatment . A three 
    Output:
    
The average weighted pre-to-follow-up effect size for the CBT group suggested that these effects were maintained over time .
Smaller but yet statistically significant effects of CBT were found for mood outcome measures .
The results suggest that CBT is an effective treatment of tinnitus distress .