Acceptance and commitment therapy for patients with chronic tinnitus resistant to tinnitus retraining therapy: A case series.

Background: Tinnitus retraining therapy (TRT) promotes habituation in chronic tinnitus but is less effective in patients under psychological distress. Acceptance and commitment therapy (ACT) offers an alternative by enhancing psychological flexibility rather than targeting symptom reduction. Case Presentation: Five patients with chronic tinnitus unresponsive to TRT completed the ACT program. Among them, four completed the 6-month follow-up and are presented in detail. While Case 1 was previously reported, this analysis includes all four to explore ACT's broader application. The intervention targeted ACT's six core processes. Outcomes were measured using the Tinnitus Handicap Inventory (THI), Cognitive Fusion Questionnaire-7 (CFQ-7), Valuing Questionnaire (VQ), and Hospital Anxiety and Depression Scale (HADS). After 6 months, three patients showed a clinically meaningful THI reduction. Those without hearing loss improved more in CFQ-7 and HADS. VQ scores showed minimal change. Conclusion: ACT may help patients with TRT-resistant tinnitus, particularly those without hearing loss.