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Web-based CBT equally effective as face-to-face care for tinnitus
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Web-based cognitive behavioral therapy was as effective as standard, individualized face-to-face care for reducing tinnitus distress and most tinnitus-related difficulties, according to findings recently published in JAMA–Otolaryngology Head & Neck Surgery.
“Cognitive behavioral therapy has the most evidence of effectiveness in reducing tinnitus distress but is rarely offered in clinical practice,” Eldré W. Beukes, PhD, department of vision and hearing sciences at Anglia Ruskin University in the U.K. told Healio.com/Family Medicine.
“Previous comparisons have been to group-based therapy. [Our study] is the first to compare online cognitive behavior therapy interventions to individualized tinnitus therapy and also the first to investigate the health professional’s time to obtain an effective outcome between having online guidance vs. individualized tinnitus care,” she continued.
Beukes and colleagues randomly assigned 92 patients in a 1:1 ratio to receive either 8 weeks of guided web-based CBT or either two or three individualized face-to-face appointments in a tinnitus clinic.
Researchers found the between-group difference in the Tinnitus Functional Index scores after intervention were 5.18 (95% CI, –4.17 to 14.53) at the initial assessment and 5.52 (95% CI, –4.6 to 15.61) at follow-up. Patients’ anxiety, depression, hearing disability, sound sensitivity, attention and quality of life outcomes all improved.
“Surprisingly, those undertaking the internet intervention had a significantly greater weekly reduction in tinnitus distress indicating that they started improving faster than the face-to-face group,” Beukes said in the interview.
Researchers also found web-based CBT was 2.68 times more time-effective to the health professional than individualized face-to-face care when taking only clinician time into account and with an assumption that audiology professionals involved would identically grade patient outcomes.
Beukes told Healio.com/Family Medicine the “positive effects” of the web-based intervention were maintained for 2 months after the current study’s conclusion and that previous studies found that these positive results were maintained for at least 1 year.
“Such an intervention may help the effects of tinnitus to be reduced in the long term,” she said in the interview. “This means fewer patients will visit their doctors with the same complaints a few months later.”
Beukes said she hopes the findings steer conversations when patients present with “troublesome tinnitus” in a new direction.
“The take-home message these patients often receive is ‘There is nothing that can be done to take away your tinnitus, just learn to live with it.’ This can be very damaging,” she said in the interview.
“Where available, patients should be given the option to see professionals providing evidence-based tinnitus interventions such as cognitive behavioral therapy. This approach incorporates various aspects including helping people understand tinnitus better and strategies to empower them to minimize the devastating effects tinnitus has. Conversations need to give hope that there are things that can help,” she added.
In a related editorial, Thomas L. Rodebaugh, PhD, of the department of psychological and brain sciences at Washington University in St. Louis said Beukes and colleagues’ findings are the tip of the iceberg to understanding how web-based therapy can help patients with tinnitus.
“One important question is whether [internet] CBT for tinnitus is also noninferior compared with face-to-face CBT. ... A second important issue is determining what factors predict who will respond to internet CBT, who might benefit more from face-to-face CBT, and who would benefit more from an entirely different approach (eg, mindfulness and acceptance-based approaches). Determining what psychotherapy treatments work for whom will be an essential part of a personalized medicine approach moving forward,” he wrote. – by Janel Miller
Disclosures : None of the authors report any relevant financial disclosures.