An internet intervention for tinnitus

Objectives: Creative approaches to improve access to evidence-based tinnitus interventions are required. The purpose of this thesis was to address this need by developing an Internet-based cognitive behavioural therapy intervention (iCBT) specifically for those with tinnitus in the United Kingdom (UK). A unique aspect was providing audiological, instead of psychological guidance for those undertaking the intervention. Further objectives were to evaluate whether audiologist-guided iCBT could reduce tinnitus distress and tinnitus-associated comorbidities in a UK population. Method: Initially an innovative iCBT tinnitus intervention adapted for a UK population was developed. The intervention was assessed for functionality and acceptability by both tinnitus professionals (n = 5) and adults with tinnitus (n = 29). A three-phase audiologist-guided clinical trial followed to evaluate feasibility (n = 39), efficacy (n = 146) and effectiveness (n = 92). In addition, the longer-term outcomes and unwanted effects were investigated (n = 104). A process evaluation was conducted parallel to the efficacy trial. Standardised self-reported assessment measures for tinnitus distress, insomnia, anxiety, depression, hearing disability hyperacusis, cognitive failures and life satisfaction were included. Results: The developed intervention was rated as acceptable by both professionals and adults experiencing tinnitus. In Phase I, feasibility was established in terms of recruitment potential, attrition and adherence rates. In Phase II, efficacy was evident as undertaking iCBT led to a significant reduction in tinnitus distress and tinnitus-related comorbidities (insomnia, depression, hyperacusis, cognitive failures and increase in life satisfaction). These results remained stable up to 1 year post-intervention. Unwanted treatment effects were reported by 11% of participants. Process evaluation identified intervention aspects that facilitated and hampered the outcomes obtained. Phase III results were comparable regardless of receiving iCBT or individualised face-to-face care. Conclusion: An acceptable iCBT tinnitus intervention was developed for a UK population. Original research has been undertaken, which has indicated the acceptability, feasibility, efficacy and effectiveness of audiologist-guided iCBT in reducing tinnitus distress and tinnitus-associated comorbidities in a UK population

Application of the Behavior Change Wheel within the context of internet-based cognitive behavioral therapy for tinnitus management

Purpose: Although experiencing tinnitus can lead to many difficulties, these can be reduced by using techniques derived from cognitive behavioral therapy. Internet-based cognitive behavioral therapy (ICBT) has been developed to provide an accessible intervention. The aim of this study was to describe how ICBT can facilitate tinnitus management by identifying the active ingredients of the intervention from the perspective of health behavior change. Method: The ICBT intervention was evaluated using the Behavior Change Wheel in eight steps across the following three stages: (1) understanding the behavior, (2) identifying intervention options, and (3) identifying content and implementation options. Results: Target behaviors identified to reduce tinnitus distress, as well as additional problems associated with tinnitus, included goal setting, an increased understanding of tinnitus, encouraging deep breathing and progressive muscle relaxation, identifying and restructuring unhelpful thoughts, engaging in positive imagery, and reducing avoidance behaviors. ICBT provided the required components for individuals to be physically and psychologically capable of adapting to tinnitus, providing social and environmental opportunities to manage hearing loss through practice and training, and facilitated automatic and reflective motivation. Conclusion: Understanding ICBT in the context of the Behavior Change Wheel has helped identify how its effectiveness can be improved and can be used for future tinnitus intervention planning.</p