Tinnitus Retraining Therapy: Clinical Guidelines & Tinnitus Retraining Therapy: Patient Counselling Guide
RATING: (3 of 5 ears)
AUTHORS: James A. Henry, Dennis R. Trune, Michael J.A. Robb, and Pawel J. Jastreboff
PUBLISHER: Plural Publishing, San Diego
ISBN: 978-1-59756-154-9 & 978-1-59756-155-6
COST: $79.95 & $98
REVIEWER: David Baguley PhD, MBA, Director of Audiology, Cambridge University Hospitals, Cambridge, England
SYNOPSIS: Treating tinnitus patients remains a challenge for experienced audiologists, and for the new audiologist can be a daunting prospect indeed. For many years, the availability of tinnitus therapy was limited to a few specialist centers, but the introduction of Tinnitus Retraining Therapy (TRT) in the mid-1990’s stimulated much interest in the audiology community and for greater access to therapy.
These two companion books, one a clinical guide and the other a patient guide, aim to provide an introduction to, and summary of, the practice of TRT. The authors are experts in TRT. Pawel Jastreboff in particular is a pioneer of TRT and has synthesised existing knowledge about tinnitus into a proposed framework of understanding that is often described as the “Jastreboff Neurophysiological Model” (JNM). This model a scientific counterpart to the earlier clinical observations of the UK based Otologist, Dr. Jonathan Hazell (who writes the prefaces to both books).
REVIEW: The Clinical Guidelines volume takes the reader through descriptions of the basic principles of TRT, giving much more emphasis to systems of memory and attention than has previously been evident in TRT literature. Clinical guidelines for assessment, followed by treatment, are described in a “cook-book” approach, where if the reader follows the recipe, then the results will resemble those arrived at by the authors. The interview used in TRT assessment is carefully described, as is the structure and content of the “directive counselling” approach.
The Counselling Guide volume contains a set of illustrations that can be used in TRT, many of which will be familiar to attendees at TRT courses. The style is clear, and while a CD of the illustrations in PowerPoint would have added value, one can see how the book could be used in a TRT clinic.
If embarking on clinical work using TRT, these books would be useful, and represent the clearest statement to date of the TRT method and the reasoning underpinning TRT. Both books would be a useful purchase for the library of a clinic with a tinnitus practice.
CRITIQUE: There are a number of concerns however. Audiology clinicians recognize that tinnitus can be a symptom of significant pathology, but red flags for definitive imaging or neuro-otological referral are barely discussed. Widening the scope of TRT into cognitive psychology domains, such as attention and memory, is admirable – but perhaps misses the point that cognition (or belief) has major role to play in tinnitus. Perhaps most importantly, there is scant attention paid to what to do if TRT treatment fails (no evidence regarding efficacy is provided in these volumes). Nevertheless, both these books provide information and are a good source for budding TRT therapists.