Randomized Controlled Trial of Internet-Based Cognitive Behavior Therapy for Distress Associated With Tinnitus

TLDR

The study examined whether Internet‑delivered CBT reduces tinnitus‑related distress by randomizing participants to a six‑module self‑help manual or a waiting‑list control. Participants received a six‑module CBT program delivered entirely online, with 117 adults with tinnitus enrolled, 26 completing the full course (51% dropout) and 64 controls completing measures, and outcomes assessed pre‑ and post‑treatment and at 1‑year follow‑up. Internet CBT led to significant reductions in tinnitus distress, depression, and annoyance, with a higher proportion of participants achieving ≥50% improvement on the Tinnitus Reaction Questionnaire and 31% showing clinically significant gains at 1‑year follow‑up, despite high dropout rates.

Abstract

The aim of this study was to investigate if cognitive behavior therapy (CBT) provided via the Internet results in significant decreases of distress in individuals with tinnitus.Participants were recruited through Web pages and newspaper articles and thereafter randomly allocated to a CBT self-help manual in six modules or to a waiting-list control group (WLC). All treatment and contact with participants were conducted via the Internet with Web pages and E-mail correspondence. Participants were 117 individuals with tinnitus of duration of more than 6 months. In the first randomized controlled phase of the study, 26 completed all stages of treatment (51% dropout), and 64 of the WLC group completed measures. At 1-year follow-up, all participants had been offered the program and 96 provided outcome measures (18% dropout rate from baseline). Tinnitus-related problems were assessed before and after treatment and at the 1-year follow-up. Daily diary ratings were included for 1 week before and 1 week following the treatment period.Tinnitus-related distress, depression, and diary ratings of annoyance decreased significantly. Immediately following the randomized controlled phase (with a WLC), significantly more participants in the treatment group showed an improvement of at least 50% on the Tinnitus Reaction Questionnaire. At the uncontrolled follow-up, 27 (31%) of all participants had achieved a clinically significant improvement.CBT via the Internet can help individuals decrease annoyance associated with tinnitus. High dropout rates or delay in completing treatment can be a characteristic of treatment studies using the Internet but should be contrasted with the cost effectiveness and accessibility of the Internet.