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

From the Department of Audiology, University Hospital (G.A., L.L.), Uppsala, Sweden; and the Department of Psychology, Uppsala University (G.A., T.S., L.S.), Uppsala, Sweden.

Address reprint requests to: Gerhard Andersson, Department of Psychology, Uppsala University, Box 12 25, SE-751 42 Uppsala, Sweden. Email: Gerhard.Andersson{at}psyk.uu.se

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Key Words: Internet, • self-help, • relaxation, • cognitive-behavior therapy.

Abbreviations: ASI = Anxiety Sensitivity Index;; CBT = cognitive behavior therapy;; CI = confidence interval;; HADS = Hospital Anxiety and Depression Scale;; TRQ = Tinnitus Reaction Questionnaire;; VAS = Visual Analogue Scale;; WLC = waiting-list control.

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