Family therapy Health Dictionary

Therapy designed to help individuals improve their independence in daily living activities through rehabilitation, exercises and the use of assistive devices. In addition, such therapy provides activities to promote growth, self-fulfilment and self-esteem.... occupational therapy

A form of psychiatric treatment based on learning theory. Symptoms are considered to be conditioned responses, and treatment is aimed at removing them, regardless of the underlying diagnosis. Desensitisation, operant conditioning, and aversion therapy are examples of behaviour therapy. (See MENTAL ILLNESS.)... behaviour therapy

Psychotherapy in which at least two, but more commonly up to ten, patients, as well as the therapist, take part. The therapist encourages the patients to analyse their own and the others’ emotional and psychological diffculties. Group therapy is also used to help patients sharing the same condition – for instance, alcoholism or compulsive gambling. They discuss their problems for perhaps an hour twice a week and explore ways of resolving them.... group therapy

Gene therapy is the transfer of normal GENES into a patient to combat the effects of abnormal genes which are causing disease(s). The GENETIC ENGINEERING technique used is SOMATIC cell gene therapy in which the healthy gene is put into somatic cells that produce other cells – for example, stem cells that develop into BONE MARROW. Descendants of these altered cells will be normal and, when su?cient numbers have developed, the patient’s genetic disorder should be remedied. The abnormal gene, however, will still be present in the treated individual’s germ cells (eggs or sperm) so he or she can still pass the inherited defect on to succeeding generations.

Gene therapy is currently used to treat disorders caused by a fault in a single recessive gene, when the defect can remedied by introducing a normal ALLELE. Treating disorders caused by dominant genes is more complicated. CYSTIC FIBROSIS is an example of a disease caused by a recessive gene, and clinical trials are taking place on the e?ectiveness of using LIPOSOMES to introduce the normal gene into the lungs of someone with the disorder. Trials are also underway to test the e?ectiveness of introducing tumour-suppressing genes into cancer cells to check their spread.

Gene therapy was ?rst used in 1990 to treat an American patient. Eleven European medical research councils (including the UK’s) recommended in 1988 that gene therapy should be restricted to correcting disease or defects, and that it should be limited to somatic cells. Interventions in germ-line cells (the sperm and egg) to e?ect changes that would be inherited, though technically feasible, is not allowed (see CLONING; HUMAN GENOME).... gene therapy

The treatment of speech and communication disorders.... speech therapy

Within a few years medical scientists have introduced into the domestic scene a steroid which has changed the whole course of female history. HRT has solved some basic medical problems by making good the loss of oestrogen in a woman’s body when menstruation is finished and her body learns to adjust.

A lack of oestrogen induces hot flushes, night sweats, thinning of the bones (osteoporosis) with possible fractures, and a wide range of physical and emotional disorders.

HRT also prevents the increased frequency of coronary disease which may follow the menopause. With oestrogen only, HRT appears to increase the incidence of cancer of the uterine body. Use of oestrogen and progestogen avoids this.

HRT is available as a tablet, transdermal patch, implant or topical cream. Most women notice temporary improvement in their appearance and hot flushes as long as treatment is continued. HRT is not prescribed by the herbal practitioner. Soya and Hops are a mild alternative.

Side-effects of such treatment include blood pressure rise, weight gain and periods probably continue with a monthly bleed. Elderly women taking HRT for osteoporosis may develop bleeding problems, the risk of blood clot and gall bladder diseases.

Helonias has proved a useful alternative, effective in eliminating excess fluids, reducing hot flushes, and relieving that bloated feeling, thus helping the older woman to live a normal life.

Damiana. 1 heaped teaspoon leaves to each cup boiling water; infuse 5-10 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Sarsaparilla. 1oz (30g) root in 1 pint (500ml) water; simmer gently 20 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Supplementation. Daily. Vitamin E, 400iu. Vitamin B-complex (high potency). Evening Primrose oil capsules, 500mg morning and evening. Dolomite, for Calcium and Magnesium, 2 tablets morning and evening.

Note: An extensive study of breast cancer risks with HRT revealed a positive link between the risk of cancer and length of use. Risk of the disease increased with all types of women using HRT with every year of use. Pre-menstrual women were more than twice at risk. It would appear that oestrogens cannot be taken without risk. (Centre for Disease Control, Atlanta, USA) See: OESTROGENS. ... hormone replacement therapy (hrt)

A form of psychological treatment in which such an unpleasant response is induced to his or her psychological aberration that the patient decides to give it up. Thus the victim of alcoholism is given a drug that makes the subsequent drinking of alcoholic liquors so unpleasant, by inducing nausea and vomiting, that he or she decides to give up drinking. (See ALCOHOL; DISULFIRAM.) Aversion therapy may help in the treatment of alcoholism, drug addiction, sexual deviations such as transvestism, and compulsive gambling.... aversion therapy

This comprises a photosensitising agent (one activated by light), which accumulates in malignant tissue, and a source of light that activates the photosensitiser, triggering it to generate highly reactive oxygen compounds that destroy malignant cells. One such photosensitiser is temopor?n. Photodynamic therapy is used to treat various types of malignancy; a recognised complication is photosensitivity, when a patient may suffer burns after transient exposure to sunlight. Photodynamic therapy is increasingly used and photosensitivity reactions may also become more common.... photodynamic therapy

This is a treatment in which patients are helped to reduce their levels of anxiety by reducing their muscle tone. It can be used on its own or in conjunction with a broader PSYCHOTHERAPY regime. The technique guides people on how to cope with stressful situations and deal with phobias – see PHOBIA.... relaxation therapy

The counselling and treatment of individuals with psychosexual dysfunction (see SEXUAL DYSFUNCTION). Around half of couples experience some type of sexual problem during their relationships, and for most of them the diffculties are psychological. Sexual therapy is usually given to both partners, but sometimes individual counselling is necessary. Couples may sometimes ?nd that group therapy is helpful. Therapy has proved e?ective especially for women with VAGINISMUS (spasm of vaginal muscles), men with PREMATURE EJACULATION or IMPOTENCE, and men and women who fail to achieve ORGASM.... sex therapy

See ELECTROCONVULSIVE THERAPY (ECT).... shock therapy

The treatment of injury or disease.... therapy

See ECT.... electroconvulsive therapy

The deliberate limitation or spacing of births. Strategies for family planning include the different methods of contraception. (See also birth control.)... family planning

See rehydration therapy.... oral rehydration therapy

A talking therapy that re-trains the mind to question and banish negative thoughts, change emotional responses and change behaviour. It is based on the theory that some people develop unduly negative and pessimistic thoughts (cognitions) about themselves, their future and the world around them, putting them at risk of depression and other mental-health problems. Put simply, the treatment involves several sessions with a trained therapist who helps to identify the negative patterns of thinking and show that they are not usually realistic.

Research has shown that cognitive therapy is very e?ective in depression and that it can also help in anxiety, OBSESSIVE COMPULSIVE DISORDER, and EATING DISORDERS such as anorexia and bulimia nervosa. This therapy is also proving useful in helping people cope with HALLUCINATIONS and other symptoms of SCHIZOPHRENIA.... cognitive behaviour therapy

The application of computer technology to therapy.... computer-assisted therapy

A charity which helps families with disabled children to obtain good-quality information, support and – most of all – contact with other families with children who have the same disorder. This includes children with speci?c and rare conditions and those with special educational needs. The charity has many local parent groups throughout the UK and publishes a comprehensive directory with brief descriptions of each condition followed by contact addresses, phone numbers and web addresses. It also has a central helpline and a team of parent advisers.

See www.cafamily.org.uk... contact a family

See “day care centre”.... day therapy centre

The use of drugs to treat a medical problem, to improve a person’s condition or to otherwise produce a therapeutic effect.... drug therapy

A controversial but sometimes rapidly e?ective treatment for cases of severe DEPRESSION, particularly where psychotic features are present (see PSYCHOSIS), or in high-risk patients such as suicidal or post-partum patients. ECT is only indicated after antidepressants have been tried and shown to be ine?ective; the full procedure of treatment should be explained to the patient, whose consent must be obtained.

Before treatment, the patient will have been fasted for at least eight hours. After checking for any potential drug ALLERGY or interactions, the patient is given a general anaesthetic and muscle relaxants. Depending on the side of the patient’s dominance, either unilateral (on the side of the non-dominant hemisphere of the BRAIN) or bilateral (if dominance is uncertain,

e.g. in left-handed people) positioning of electrodes is used. Unilateral ECT has the advantage of being associated with less anterograde AMNESIA. When the current passes, the muscles will contract for approximately 10 seconds, with further tonic spasms lasting up to a minute. The patient should then be put in the COMA or recovery position and observed until fully conscious. Up to 12 treatments may be given over a month, improvement usually showing after the third session. Widely used at one time, the treatment is now given only rarely. It can be extremely frightening for patients and relatives and is not recommended for children.... electroconvulsive therapy (ect)

A taxonomic group of similar, related, animals. The taxonomic group that is below Order, but above Genus.... family

A form of specialty practice in which medical practitioners provide continuing comprehensive primary care within the context of the family unit.... family practice

See under MENOPAUSE.... hormone replacement therapy(hrt)

This is the essential initial treatment for DIARRHOEA, and is particularly valuable for dehydrated children in developing countries ill with diseases such as CHOLERA. A litre of water containing one teaspoonful of salt and eight of sugar, taken by mouth, is readily absorbed. It replaces salts and water lost because of the diarrhoea and usually no other treatment is required.

In developed countries ORT is useful in treating gastroenteritis. There are a number of proprietary preparations, often dispensed as ?avoured sachets, including Dioralyte® and Rehydrate®.... oral rehydration therapy (ort)

Sometimes called an intensive care unit, this is a hospital unit in which seriously ill patients undergo resuscitation, monitoring and treatment. The units are sta?ed by doctors and nurses trained in INTENSIVE CARE MEDICINE, and patients receive 24-hour, one-to-one care with continuous monitoring of their condition with highly specialised electronic equipment that assesses vital body functions such as heart rate, respiration, blood pressure, temperature and blood chemistry. The average ITU in Britain has four to six beds, although units in larger hospitals, especially those dealing with tertiary-care referrals – for example, neurosurgical or organ transplant cases – are bigger, but 15 beds is usually the maximum. Annual throughput of patients ranges from fewer than 200 to more than 1,500 patients a year. As well as general ITUs, specialty units are provided for neonatal, paediatric, cardiothoracic and neurological patients in regional centres. The UK has 1–2 per cent of its hospital beds allocated to intensive care, a ?gure far below the average of 20 per cent provided in the United States. Thus patients undergoing intensive care in the UK are usually more seriously ill than those in the US. This is re?ected in the shortage of available ITU beds in Britain, especially in the winter. (See CORONARY CARE UNIT (CCU); HIGH DEPENDENCY UNIT.)... intensive therapy unit (itu)

1 Treatment of pain, disease or injury by physical means. 2 The profession concerned with promotion of health; prevention of physical disabilities; evaluation and rehabilitation of persons disabled by pain, disease or injury; and with treatment by physical therapeutic measures, as opposed to medical, surgical or radiologic measures.... physical therapy / physiotherapy

Treatment which aims to stimulate older people’s memories by means of old films, pictures, objects, music etc. It allows an older person to remember his or her life’s achievements and contribution and can enhance self-esteem.... reminiscence therapy

The diagnostic evaluation, management and treatment of the care of older persons with deficiencies and abnormalities of the cardiopulmonary (heart lung) system.... respiratory therapy

See IMMUNOLOGY.... serum therapy

The British Government supports freedom of the individual to make an informed choice of the type of therapy he or she wishes to use and has affirmed its policy not to restrict the sale of herbal medicines.

A doctor with knowledge of herbal medicine may prescribe them should he consider them a necessary part of treatment. ... freedom of individual to choose therapy

Also called recovered memory syndrome, this treatment was developed in the wake of the widespread exposure in the 1980s and 90s of the frequency of child sexual abuse. A controversial concept emerged in the USA, picked up later by some experts in the UK, that abused children sometimes suppress their unpleasant memories, and that subsequent PSYCHOTHERAPY could help some victims to recover these memories – thus possibly aiding rehabilitation. This recall of ‘repressed’ memories, however, was believed by some psychiatrists to be, in e?ect, a false memory implanted into the victim’s subconscious by the psychotherapy itself – or perhaps invented by the individual for personal motives.

In 1997 the Royal College of Psychiatrists in the UK produced a comprehensive report which was sceptical about the notion that the awareness of recurrent severe sexual abuse in children could be pushed entirely out of consciousness. The authors did not believe that events could remain inaccessible to conscious memory for decades, allegedly provoking vague non-speci?c symptoms to be recovered during psychotherapy with resolution of the symptoms. Supporting evidence pointed to the lack of any empirical proof that unconscious dissociation of unpleasant memories from conscious awareness occurred to protect the individual. Furthermore, experimental and natural events had shown that false memories, created through suggestion or in?uence, could be implanted. Many individuals who had claimed to have recovered memories of abuse subsequently withdrew and, often, non-speci?c symptoms allegedly linked to suppression worsened rather than improved as therapy to unlock memories proceeded. The conclusion is that recovered memory therapy should be viewed with great caution.... repressed memory therapy

GERSON CANCER THERAPY is described in A Cancer Therapy; Results of Fifty Cases, Gerson, Max; 3rd edition, 1977, Pub: The Gerson Institute Bonita, CA 92002, USA.

Basically, the therapy consists of a vegetarian diet with meals of vegetables, fruits and whole grains, fresh or freshly prepared. Drinking water is replaced by hourly, fresh, raw juices of vegetables and fruits. Refined, altered, denatured or enhanced foodstuffs are forbidden. The diet is sodium, chloride, fat and protein restricted. Supplemental potassium, iodine, thyroid and crude liver extract comprise the medical armamentarium. A repeatable choleretic, enemas of a solution of boiled coffee, is administered to lower serum toxin levels. Coffee is a potent enhancer of the carcinogen detoxifying enzyme system, glutathione S-translerase (Wattenburg). The Gerson cancer therapy reduces accumulated tissue sodium and chloride, promoting diuresis. Gerson Therapy Center: Hospital de Baja California, at La Gloria, Mexico

Diet. Lunch and dinner contain ample cooked food, mainly to act as a ‘blotter’ to the daily intake of 5.25 pints fresh raw fruit juices that are the backbone of the therapy. Ingredients of the juices include 41bs raw organic carrots a day, with no harm to the liver. (JAM, May 1991, p5. Beata Bishop on her recovery from metastasised malignant melanoma)

The Gerson therapy is based on the ‘holistic’ philosophy which states that cancer represents a clinical manifestation of an underlying toxic condition. Such condition should receive primary treatment that is lifestyle orientated. The theme is: detoxification through internal cleansing. The diet and supplements are re-inforced by ‘positive thinking’ and supported by meditation and emotional balance. ... gerson cancer therapy

A method of treating psychological disorders such as depression based on the idea that problems arise from a person’s faulty cognitions (erroneous ways of perceiving the world and oneself). In cognitive– behavioural therapy, the patient is helped to identify negative or false cognitions and then encouraged to try out new thought strategies.... cognitive–behavioural therapy

Treatment of a cancerous tumour in a body cavity or the cavity of a hollow organ by placing a radioactive implant or anticancer drugs within the cavity. Also called brachytherapy, intracavitary radiotherapy is mainly used to treat cancers of the uterus and cervix (see uterus, cancer of; cervix, cancer of). If implants (usually in the form of artificial radioisotopes embedded in wires or small tubes) are used, they are left there for a period of time.

The technique may be used to treat a malignant effusion (a collection of fluid that contains cancerous cells). A needle, sometimes with a catheter attached, is passed through the wall of the abdomen or the chest into the abdominal cavity or pleural cavity (the space around the lungs). As much of the fluid as possible is withdrawn from the cavity before anticancer drugs are injected directly into it. (See also interstitial radiotherapy.)... intracavitary therapy

Preparations containing nicotine that are used in place of cigarettes as an aid to stopping smoking.

Nicotine products are available in the form of sublingual tablets, chewing gum, skin patches, nasal spray, or inhaler.

Side effects may include nausea, headache, palpitations, cold or flu-like symptoms, hiccups, and vivid dreaming.

Nicotine replacement therapy should be used as part of a complete package of measures, including the determination to succeed.... nicotine replacement therapy

The process of supplying a person with oxygen-enriched air to relieve severe hypoxia (inadequate oxygen in body tissues). The oxygen is usually delivered through a face-mask or a nasal cannula (a length of narrow plastic tubing with two prongs that are inserted into the nostrils). Piped oxygen is used in hospitals; oxygen in cylinders can be used at home for acute attacks of hypoxia, such as those occurring in severe asthma. Long-term therapy for people with persistent hypoxia may involve the use of an oxygen concentrator.

(See also hyperbaric oxygen treatment.)... oxygen therapy

A method used in the psychoanalysis of young children, based on the principle that all play has some symbolic significance. Watching a child at play helps a therapist diagnose the source of the child’s problems; the child can then be helped to “act out” thoughts and feelings that are causing anxiety.... play therapy

The treatment of dehydration by administering fluids and salts by mouth (oral rehydration) or by intravenous infusion.

The amount of fluid necessary depends on age, weight, and the degree of dehydration.

Mild dehydration can usually be treated with oral solutions, which are available as effervescent tablet or powder to be made up at home.

In severe dehydration, or if the patient cannot take fluids by mouth because of nausea or vomiting, an intravenous infusion of saline and/or glucose solution may be given in hospital.... rehydration therapy

treatment given to patients after the primary therapy, which is usually surgical removal of the tumour, when there is a high risk of future recurrence based on tumour stage and histology. Adjuvant therapy is aimed at destroying these microscopic tumour cells either locally (e.g. adjuvant breast irradiation after breast-conserving surgery) or systemically (e.g. adjuvant chemotherapy may be recommended for patients with breast cancer, colorectal cancer, and other types of cancer). Compare neoadjuvant chemotherapy.... adjuvant therapy

(AVT) a technique for teaching deaf children to communicate that focuses on speech and residual hearing rather than sign language.... auditory verbal therapy

any treatment that facilitates the ability of the immune system to fight disease, as opposed to acting directly against the disease (compare chemotherapy; radiotherapy). Such treatments, most commonly used for cancer and rheumatic disease, include *biological response modifiers, *immunotherapy, *monoclonal antibodies, *cytokine inhibitors and modulators, and *targeted agents.... biological therapy

(CRT) a treatment for heart failure that involves ventricular pacing with multiple *leads. The aim is to restore coordinated ventricular contraction and hence improve cardiac function.... cardiac resynchronization therapy

(Rogerian therapy) a method of psychotherapy in which the therapist refrains from directing clients in what they should do and instead concentrates on communicating understanding and acceptance. Frequently the therapist reflects the clients’ own words or feelings back to them. The aim is to enable clients to solve their own problems.... client-centred therapy

(CBT) a *cognitive therapy that is combined with behavioural elements (see behaviour therapy). The patient is encouraged to analyse his or her specific ways of thinking around a problem. The therapist then looks at the resulting behaviour and the consequences of that thinking and tries to encourage the patient to change his or her cognition in order to avoid adverse behaviour or its consequences. CBT is successfully used to treat phobias, anxiety, and depression (it is among the recommended treatments for anxiety and depression in the NICE guidelines).... cognitive behavioural therapy

a form of *psychotherapy based on the belief that psychological problems are the products of faulty ways of thinking about the world. For example, a depressed patient may use wrongly negative automatic associations in everyday situations. The therapist assists the patient to identify these false ways of thinking and to avoid them. In *cognitive behavioural therapy this is combined with an analysis and retraining of unhelpful behaviours. In cognitive analytical therapy (CAT) there is an element of psychodynamic exploration of the patient’s problems; CAT is mostly used to treat personality disorders.... cognitive therapy

therapy that combines several types of treatment in order to improve results. It is usually a combination of surgery with radiotherapy and/or chemotherapy for the treatment of malignant tumours (see adjuvant therapy). See also sandwich therapy.... combined therapy

a form of *radiotherapy in which a radioactive substance is brought into close contact with the part of the body being treated. Needles or capsules of the isotope may be implanted in or around a tumour so that the radiation they emit will destroy it. Compare teletherapy.... contact therapy

an approach that combines many of the different treatments (such as compression and physiotherapy) used to minimize the pain and swelling associated with *lymphoedema following breast surgery and radiotherapy. There are two phases: reduction (which lasts up to 12 weeks) and maintenance (which continues for life).... decongestive therapy

(DOT) see tuberculosis.... directly observed therapy

(DAPT) aspirin prescribed at the same time as another oral *antiplatelet drug (e.g. clopidogrel, prasugrel, ticagrelor) for patients deemed to be at temporarily increased risk of coronary or stent thrombosis (typically following *acute coronary syndrome or new coronary stent implantation). After a prespecified time (usually 12 months), the aspirin is continued and the other antiplatelet drug is stopped.... dual antiplatelet therapy

(EMDR) a type of psychotherapy used for the treatment of significant anxiety or distress caused by traumatic events or in the context of *post-traumatic stress disorder. The aim is to separate the emotional from the actual memory of the event in order to reduce the anxiety related to the memory.... eye movement desensitization and reprocessing therapy

see general practitioner.... family doctor

see general practitioner.... family practitioner

the support and rehabilitation of people with hearing difficulties, tinnitus, or vertigo. It includes supplying help with acclimatizing to *hearing aids, teaching lip-reading, advising on *environmental hearing aids, and offering general information and advice regarding the auditory system. Other functions are to explain such conditions as *Ménière’s disease and *otosclerosis and to provide *tinnitus retraining therapy (TRT) and other forms of tinnitus management.... hearing therapy

(ITU, intensive care unit) a hospital unit designed to give intensive care, provided by specialist multidisciplinary staff, to a selected group of seriously ill patients or to those in need of special postoperative techniques (e.g. those patients undergoing complex heart or lung procedures).... intensive therapy unit

a form of *diathermy using electromagnetic waves of extremely short wavelength. In modern apparatus the electric currents induced in the tissues have frequencies of up to 25,000 million cycles per second.... microwave therapy

(PERT) a therapeutic approach using supplements of the digestive enzymes lipase, amylase, and protease (Creon, Pancrex), which are given when there is insufficient endogenous production of pancreatic enzymes: for example, to patients with pancreatic cancer or cystic fibrosis. The capsules must be taken with all meals and snacks to be effective. PERT treats the symptoms of *steatorrhoea.... pancreatic enzyme replacement therapy

a type of radiotherapy that uses a beam of protons. These charged particles are produced by a *cyclotron and penetrate only a predictable distance into the body depending on the proton energy. This is the radiotherapy treatment of choice for many childhood cancers, particularly brain and spinal tumours, as it can avoid more normal tissue and reduce the risk of long-term complications (including secondary malignancy) compared with photon (X-ray) beams.... proton therapy

a combination of treatments in which one type of therapy is ‘sandwiched’ between exposures to another therapy. For example, surgical removal of a tumour may be ‘sandwiched’ between pre- and postoperative courses of chemotherapy. See also combined therapy.... sandwich therapy

see radioembolization.... selective internal radiation therapy

the treatment of patients who have problems with communication or eating or drinking because of congenital causes, accidents, or illness (e.g. stroke). Speech and language therapists are *allied health professionals who have special training in this field.... speech and language therapy

provision of a less harmful alternative to a drug or remedy that a patient has been receiving. It is used when the patient has become addicted to a drug or is placing too much reliance upon a particular remedy. An example is the replacement of heroin in an opioid-dependent patient with methadone.... substitution therapy

(PRRT) a type of radiotherapy used to treat neuroendocrine tumours (NETs; see neuroendocrine system). A *radionuclide is combined with a relevant *peptide to create a so-called radiopeptide, which is injected into the patient’s bloodstream. Because NETs have an overexpression of peptide receptors, the radiopeptide binds to the tumour, delivering a high dose of radiation directly to the cancer cells. The chief merit of PRRT is this ability to target delivery of radionuclides for highly localized treatment. A similar technique, using a gamma emitter as the radionuclide, can be used for locating and imaging NETs.... peptide receptor radionuclide therapy

the administration of an estimated amount of the radioactive isotope iodine-131 as a drink in order to treat an overactive thyroid gland (see thyrotoxicosis). The iodine concentrates in the thyroid and thus delivers its beta radiation locally, with little effect on other tissues. The gland will shrink and become euthyroid over the succeeding 8–12 weeks but there is a high incidence of subsequent hypothyroidism (up to 80%), which requires lifetime treatment with thyroxine. The treatment cannot be used if there is any suspicion of pregnancy, and the patient must stay away from young children and pregnant women for around 10 days after administration. Despite these drawbacks, radioactive iodine remains a popular form of treatment for any cause of hyperthyroidism.... radioactive iodine therapy

(TRT) a method of treating *tinnitus that embraces a range of techniques, including explanation, counselling, relaxation techniques, meditation, and sound therapy.... tinnitus retraining therapy