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CC BY-NC-ND 4.0 · J Am Acad Audiol 2022; 33(07/08): 405-416
DOI: 10.1055/a-2087-0262
Research Article

The Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Tinnitus for Patients with Tinnitus Alone or Combined with Hyperacusis and/or Misophonia: A Preliminary Analysis

Hashir Aazh 
1   Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd., London, United Kingdom
2   Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, Florida
3   Faculty of Engineering and Physical Sciences, University of Surrey, United Kingdom
,
Lauren Taylor
1   Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd., London, United Kingdom
4   School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
,
Ali A. Danesh
2   Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, Florida
,
Brian C. J. Moore
5   Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
› Author Affiliations Funding This study was funded by the Blakeley Foundation.
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Abstract

Background In the United Kingdom, audiologist-delivered cognitive behavioral therapy (CBT) is a key intervention to alleviate the distress caused by tinnitus and its comorbid hyperacusis. However, the availability of face-to-face CBT is limited, and such therapy involves significant costs. CBT provided via the internet provides a potential solution to improve access to CBT for tinnitus.

Purpose The aim was to perform a preliminary assessment of the effect of a specific program of nonguided internet-based CBT for tinnitus, denoted iCBT(T), in alleviating the problems caused by tinnitus alone or tinnitus combined with hyperacusis.

Research Design This was a retrospective cross-sectional study.

Study Sample The data for 28 people with tinnitus who completed the iCBT(T) program and answered a series of questions about their tinnitus and hearing status were included in the study. Twelve patients also reported having hyperacusis (including five also with misophonia).

Data Collection and Analysis The iCBT(T) program has seven self-help modules. Anonymous data were collected retrospectively from patients' answers to the questions in the iCBT(T) initial and final assessment modules. Questionnaires administered within the iCBT(T) program were: 4C Tinnitus Management Questionnaire (4C), Screening for Anxiety and Depression in Tinnitus (SAD-T), and the CBT Effectiveness Questionnaire (CBT-EQ).

Results Responses to the 4C showed a significant improvement from pre- to posttreatment, with a medium effect size. The mean improvement was similar for those with and without hyperacusis. Responses to the SAD-T questionnaire also showed a significant improvement from pre- to posttreatment with a medium effect size. The improvement was significantly greater for participants with tinnitus alone than for participants who also had hyperacusis. For both the 4C and the SAD-T, the improvements were not significantly related to age or gender. Participants' views of the effectiveness of the iCBT(T) program were assessed using the CBT-EQ. The mean score was 50 out of a maximum of 80, indicating moderately high effectiveness. CBT-EQ scores did not differ for those with and without hyperacusis.

Conclusion Based on this preliminary analysis, the iCBT(T) program showed promising results in improving the ability to manage tinnitus and decreasing symptoms of anxiety and depression. Future studies with larger samples and control group(s) are required to further assess various aspects of this program.

Keywords

tinnitus - CBT - telehealth - hyperacusis - misophonia

Data Availability

The raw data will be made available on reasonable request to the corresponding author.




Publication History

Received: 21 August 2022

Accepted: 10 January 2023

Accepted Manuscript online:
05 May 2023

Article published online:
01 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Aazh H, Moore BCJ. Factors associated with depression in patients with tinnitus and hyperacusis. Am J Audiol 2017; 26 (04) 562-569
    CrossrefPubMedGoogle Scholar
  • 2 Aazh H, McFerran D, Salvi R, Prasher D, Jastreboff M, Jastreboff P. Insights from the First International Conference on Hyperacusis: causes, evaluation, diagnosis and treatment. Noise Health 2014; 16 (69) 123-126
    CrossrefPubMedGoogle Scholar
  • 3 Jastreboff MM, Jastreboff PJ. Decreased sound tolerance and tinnitus retraining therapy (TRT). Aust N Z J Audiol 2002; 24 (02) 74-84
    CrossrefGoogle Scholar
  • 4 Aazh H, Knipper M, Danesh AA. et al. Insights from the third international conference on hyperacusis: causes, evaluation, diagnosis, and treatment. Noise Health 2018; 20 (95) 162-170
    PubMedGoogle Scholar
  • 5 Aazh H, Moore BCJ, Lammaing K, Cropley M. Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: patients' evaluations of the effectiveness of treatments. Int J Audiol 2016; 55 (09) 514-522
    CrossrefPubMedGoogle Scholar
  • 6 Aazh H. Hyperacusis and misophonia. In: Deshpande AK, Hall III JW. eds. Tinnitus: Advances in Prevention, Assessment, and Management. San Diego, CA: Plural Publishing, Inc.; 2022: 287-310
    Google Scholar
  • 7 Rouw R, Erfanian M. A large-scale study of misophonia. J Clin Psychol 2018; 74 (03) 453-479
    CrossrefPubMedGoogle Scholar
  • 8 Aazh H, Erfanian M, Danesh AA, Moore BCJ. Audiological and other factors predicting the presence of misophonia symptoms among a clinical population seeking help for tinnitus and/or hyperacusis. Front Neurosci 2022; 16: 900065
    CrossrefPubMedGoogle Scholar
  • 9 Aazh H, Moore BCJ. Factors related to uncomfortable loudness levels for patients seen in a tinnitus and hyperacusis clinic. Int J Audiol 2017; 56 (10) 793-800
    CrossrefPubMedGoogle Scholar
  • 10 Cederroth CR, Lugo A, Edvall NK. et al. Association between hyperacusis and tinnitus. J Clin Med 2020; 9 (08) 2412
    CrossrefPubMedGoogle Scholar
  • 11 Aazh H, Bryant C, Moore BCJ. Patients' perspectives about the acceptability and effectiveness of audiologist-delivered cognitive behavioral therapy for tinnitus and/or hyperacusis rehabilitation. Am J Audiol 2019; 28 (04) 973-985
    CrossrefPubMedGoogle Scholar
  • 12 Aazh H, Moore BCJ. Proportion and characteristics of patients who were offered, enrolled in and completed audiologist-delivered cognitive behavioural therapy for tinnitus and hyperacusis rehabilitation in a specialist UK clinic. Int J Audiol 2018; 57 (06) 415-425
    CrossrefPubMedGoogle Scholar
  • 13 Aazh H, Moore BCJ. Effectiveness of audiologist-delivered cognitive behavioral therapy for tinnitus and hyperacusis rehabilitation: outcomes for patients treated in routine practice. Am J Audiol 2018; 27 (04) 547-558
    CrossrefPubMedGoogle Scholar
  • 14 Aazh H, Landgrebe M, Danesh AA, Moore BCJ. Cognitive behavioral therapy for alleviating the distress caused by tinnitus, hyperacusis and misophonia: current perspectives. Psychol Res Behav Manag 2019; 12 (12) 991-1002
    CrossrefPubMedGoogle Scholar
  • 15 Henry JA, Goodworth MC, Lima E, Zaugg T, Thielman EJ. Cognitive behavioral therapy for tinnitus: addressing the controversy of its clinical delivery by audiologists. Ear Hear 2022; 43 (02) 283-289
    CrossrefPubMedGoogle Scholar
  • 16 Aazh H, Moore BCJ. Living Well with Tinnitus: A Self-help Guide Using Cognitive Behavioural Therapy. Boston, MA: Little, Brown Book Group; 2022
    Google Scholar
  • 17 Andersson G, Strömgren T, Ström L, Lyttkens L. Randomized controlled trial of internet-based cognitive behavior therapy for distress associated with tinnitus. Psychosom Med 2002; 64 (05) 810-816
    PubMedGoogle Scholar
  • 18 Beukes EW, Vlaescu G, Manchaiah V. et al. Development and technical functionality of an Internet-based intervention for tinnitus in the UK. Internet Interv 2016; 6: 6-15
    CrossrefPubMedGoogle Scholar
  • 19 Beukes EW, Manchaiah V, Allen PM, Baguley DM, Andersson G. Internet-based interventions for adults with hearing loss, tinnitus, and vestibular disorders: a systematic review and meta-analysis. Trends Hear 2019; 23: 2331216519851749
    CrossrefPubMedGoogle Scholar
  • 20 Aazh H, Moore BCJ. Usefulness of self-report questionnaires for psychological assessment of patients with tinnitus and hyperacusis and patients' views of the questionnaires. Int J Audiol 2017; 56 (07) 489-498
    CrossrefPubMedGoogle Scholar
  • 21 Schecklmann M, Landgrebe M, Langguth B. TRI Database Study Group. Phenotypic characteristics of hyperacusis in tinnitus. PLoS One 2014; 9 (01) e86944
    CrossrefPubMedGoogle Scholar
  • 22 Aazh H, Danesh A. Internet-based cognitive behavioral therapy for tinnitus. Insights from health care professionals. Hear J 2021; 74 (02) 20-22
    CrossrefGoogle Scholar
  • 23 Aazh H, Allott R. Cognitive behavioural therapy in management of hyperacusis: a narrative review and clinical implementation. Audit Vestib Res 2016; 25 (02) 63-74
    Google Scholar
  • 24 Oinas-Kukkonen H, Harjumaa M. Persuasive systems design: key issues, process model, and system features. Comm Assoc Inform Syst 2009; 24 (01) 486-500
    Google Scholar
  • 25 Juniper EF, Langlands JM, Juniper BA. Patients may respond differently to paper and electronic versions of the same questionnaires. Respir Med 2009; 103 (06) 932-934
    CrossrefPubMedGoogle Scholar
  • 26 Caro Sr JJ, Caro I, Caro J, Wouters F, Juniper EF. Does electronic implementation of questionnaires used in asthma alter responses compared to paper implementation?. Qual Life Res 2001; 10 (08) 683-691
    CrossrefPubMedGoogle Scholar
  • 27 Bowling A, Ebrahim S. Handbook of Health Research Methods: Investigation, Measurement and Analysis. McGraw-Hill International; 2005
    Google Scholar
  • 28 Aazh H, Kartsonaki C, Moore BCJ. Psychometric evaluation of the 4C tinnitus management questionnaire for patients with tinnitus alone or tinnitus combined with hyperacusis. Int J Audiol 2024; 63 (01) 21-29
    CrossrefPubMedGoogle Scholar
  • 29 Meikle MB, Henry JA, Griest SE. et al. The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear 2012; 33 (02) 153-176
    CrossrefPubMedGoogle Scholar
  • 30 Newman CW, Sandridge SA, Jacobson GP. Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome. J Am Acad Audiol 1998; 9 (02) 153-160
    PubMedGoogle Scholar
  • 31 Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed.. New York, NY: The Guilford Press; 2013
    Google Scholar
  • 32 Ryan RM, Deci EL. Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. Guilford Publications; 2017
    CrossrefGoogle Scholar
  • 33 Smith SL, Fagelson M. Development of the self-efficacy for tinnitus management questionnaire. J Am Acad Audiol 2011; 22 (07) 424-440
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics 2009; 50 (06) 613-621
    PubMedGoogle Scholar
  • 35 Aazh H, Hayes C, Moore BCJ, Danesh AA, Vitoratou S. Psychometric evaluation of the Hyperacusis Impact Questionnaire (HIQ) and Sound Sensitivity Symptoms Questionnaire (SSSQ) using a clinical population of adult patients with tinnitus alone or combined with hyperacusis. J Am Acad Audiol 2022; 33 (05) 248-258
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Aazh H, Ballinger J, Hayes C. et al. Psychometric evaluation of a Patient Experience Questionnaire (PEQ) for outpatient appointments: analysis using data from a UK National Health Service Audiology Department. J Am Acad Audiol 2022; 33 (02) 82-91
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Cronbach LJ. Test reliability; its meaning and determination. Psychometrika 1947; 12 (01) 1-16
    CrossrefPubMedGoogle Scholar
  • 38 Delacre M, Lakens D, Leys C. Why psychologists should by default use Welch's t-test instead of Student's t-test. Rev Int Psychol Soc 2017; 30 (01) 92-101
    CrossrefGoogle Scholar
  • 39 Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods 2002; 7 (01) 105-125
    CrossrefPubMedGoogle Scholar
  • 40 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Mahwah, NJ: Lawrence Erlbaum Associates, Inc. Publishers; 1988
    Google Scholar
  • 41 StataCorp. Stata Statistical Software: Release 13. TX, USA: StataCorp LP; 2013
    Google Scholar
  • 42 Pannucci CJ, Wilkins EG. Identifying and avoiding bias in research. Plast Reconstr Surg 2010; 126 (02) 619-625
    CrossrefPubMedGoogle Scholar
  • 43 Pocock SJ. Clinical Trials: A Practical Approach. Chichester: Wiley; 1983
    Google Scholar
  • 44 McCambridge J, Kypri K, Elbourne D. Research participation effects: a skeleton in the methodological cupboard. J Clin Epidemiol 2014; 67 (08) 845-849
    CrossrefPubMedGoogle Scholar
  • 45 Aazh H. Patients' experience of motivational interviewing for hearing aid use: a qualitative study embedded within a pilot randomised controlled trial. J Phon Audiol 2016; 2 (01) 1-13
    Google Scholar
  • 46 Mehta S, Peynenburg VA, Hadjistavropoulos HD. Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med 2019; 42 (02) 169-187
    CrossrefPubMedGoogle Scholar
  • 47 Jaswal SM, De Bleser AKF, Handy TC. Misokinesia is a sensitivity to seeing others fidget that is prevalent in the general population. Sci Rep 2021; 11 (01) 17204
    CrossrefPubMedGoogle Scholar
  • 48 McCall HC, Hadjistavropoulos HD, Sundström CRF. Exploring the role of persuasive design in unguided internet-delivered cognitive behavioral therapy for depression and anxiety among adults: systematic review, meta-analysis, and meta-regression. J Med Internet Res 2021; 23 (04) e26939
    CrossrefPubMedGoogle Scholar
  • 49 Elarbed A, Fackrell K, Baguley DM, Hoare DJ. Tinnitus and stress in adults: a scoping review. Int J Audiol 2021; 60 (03) 171-182
    CrossrefPubMedGoogle Scholar