| 1. |
- Beukes, Eldre W., et al.
(författare)
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Application of the Behavior Change Wheel Within the Context of Internet-Based Cognitive Behavioral Therapy for Tinnitus Management
- 2022
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Ingår i: American Journal of Audiology. - : AMER SPEECH-LANGUAGE-HEARING ASSOC. - 1059-0889 .- 1558-9137. ; 31:2, s. 433-444
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 2. |
- Beukes, Eldre W., et al.
(författare)
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Development and psychometric validation of a questionnaire assessing the impact of tinnitus on significant others
- 2022
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Ingår i: Journal of Communication Disorders. - : ELSEVIER SCIENCE INC. - 0021-9924 .- 1873-7994. ; 95
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Despite evidence showing that tinnitus can have a detrimental impact on significant others (SOs), no standardized self-reported measure is currently available that specifically as-sesses the presence of third-party disability for tinnitus. The aim of this study was to develop and assess the psychometric properties of a newly developed self-reported measure for SOs of tinnitus and assess how scores could be meaningfully interpreted. Methods: The research consisted of two phases. During Phase I, the Consequences of Tinnitus on Significant Others Questionnaire (CTSOQ) was developed using the The COnsensus-based Stan-dards for the selection of health Measurement INstruments (COSMIN) guidance. Phase II included the assessment of psychometric properties of the CTSOQ including the construct validity, internal consistency, interpretability, and responsiveness. Pairs of 194 individuals with tinnitus and their SOs completed a series of online questionnaires. SOs completed the CTSOQ measure while in-dividuals with tinnitus completed measures related to tinnitus distress, anxiety, depression, insomnia, and quality of life. Results: A 25 item CTSOQ was developed using a formative model. The questionnaire validation process indicated good psychometric properties with an internal consistency of 0.93 and inter-item correlation of 0.60. Support was found for the construct and discriminative validity of the measure. Floor and ceiling effects were negligible. Scores can be meaningfully interpreted to indicate mild, significant, or severe effect of tinnitus on SOs. The questionnaire was also found to be responsive to treatment-related changes. Conclusions: The CTSOQ was found to have sufficient measurement properties suggesting that it is a suitable measure of third-party disability for SOs of individuals with tinnitus. Further research should be initiated to measure face validity and what scores reflect clinically meaningful change.
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| 3. |
- Beukes, Eldre W, et al.
(författare)
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Experiential Characteristics among Individuals with Tinnitus Seeking Online Psychological Interventions : A Cluster Analysis
- 2022
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Ingår i: Brain Sciences. - : MDPI. - 2076-3425. ; 12:9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study was designed to gain insights regarding patterns of social representations (values, ideas, beliefs) of tinnitus and their relation to demographic and clinical factors.METHOD: A cross-sectional survey design was used including 399 adults seeking help and reporting interest in internet-based cognitive behavior therapy for tinnitus. Data were collected using a free association task and analysis used qualitative (content analysis) and quantitative (cluster analysis and chi-square analysis) using the Iramuteq software.RESULTS: The social representations identified the negative impact of tinnitus and included the way it sounded (descriptions of the way tinnitus sounds (18%), annoyance (13.5%), and persistence (8%)). Four clusters were identified representing four levels of tinnitus severity, namely debilitating tinnitus (24%), distressing tinnitus (10%), annoying tinnitus (46%), and accepting tinnitus (20%). Cluster identity was associated with demographic and clinical variables.DISCUSSION: The identified clusters represented tinnitus severity experience in four stages, ranging from debilitating tinnitus to acceptance of tinnitus. These findings are important for clinical practice where tinnitus descriptions can indicate the stage of the tinnitus experience and which intervention pathway may be most appropriate.
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| 4. |
- Beukes, Eldre W., et al.
(författare)
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Internet-Based Audiologist-Guided Cognitive Behavioral Therapy for Tinnitus : Randomized Controlled Trial
- 2022
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc. - 1438-8871. ; 24:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. Objective: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. Methods: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. Results: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. Conclusions: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers.
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| 5. |
- Beukes, Eldre W., et al.
(författare)
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Internet-based cognitive behavioural therapy for tinnitus in Spanish: a global feasibility trial
- 2022
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Ingår i: International Journal of Audiology. - : TAYLOR & FRANCIS LTD. - 1499-2027 .- 1708-8186. ; 61:8, s. 632-641
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Tidskriftsartikel (refereegranskat)abstract
- Objective Internet-based cognitive behavioural therapy (ICBT) for tinnitus is an evidence-based intervention, but only available in a few languages. To increase accessibility, ICBT was translated into Spanish. This studys objective was to determine the feasibility of ICBT for Spanish speakers. Design A single-group pre-test post-test design was used. Compliance, engagement, acceptance and outcome feasibility were measured. Study Sample Forty-six Spanish speakers with tinnitus were screened. There were 32 participants meeting the eligibility criteria, with a mean age of 47 (+/- 11) years. Of these 91% were Hispanic or Latino with 66% living in Spain and 34% living in South America. Results Outcome feasibility was established, as a large pre- and post-test within-group effect size of d = 0.90 was found for tinnitus severity. Large pre- and post-test effect sizes were also present for the secondary outcomes of anxiety and depression with a medium effect for insomnia, health-related quality of life, and tinnitus cognitions. Intervention engagement and compliance were not optimal although no participants withdrew. Intervention acceptance rates indicated scope for improvement. Conclusions ICBT for Spanish communities appears to be feasible. A randomised controlled trial is required to further investigate the effects and identify ways of improving engagement and attracting Spanish speakers from different countries.
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| 6. |
- Beukes, Eldre W., et al.
(författare)
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Long-term efficacy of audiologist-guided Internet-based cognitive behaviour therapy for tinnitus in the United States: A repeated-measures design
- 2022
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Ingår i: Internet Interventions. - : ELSEVIER. - 2214-7829. ; 30
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study investigated the long-term outcomes 1-year after undertaking an Internet-based cognitive behavioural therapy (ICBT) for tinnitus distress in a US population. Secondary aims were to identify the effects on additional difficulties associate with tinnitus and any unwanted events related to ICBT for tinnitus. Methods: A repeated-measures design with 4 time points was used. Participants previously undertaking two randomized ICBT efficacy trials for tinnitus in the US were invited to participate. Of the 200 invited, 132 (66 %) completed the 1-year follow-up questionnaire. The primary outcome was a change in tinnitus distress from baseline at one year post-intervention, as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for anxiety, depression, insomnia, hearing disability, hyperacusis, tinnitus cognitions and health-related quality of life. Results: Undertaking ICBT for tinnitus led to significant improvements 1-year post-intervention for tinnitus severity, with a large effect size (d = 1.06; CI: 0.80 to 1.32). Medium effects were found for anxiety (d = 0.54; CI: 0.29 to 0.79), depression (d = 0.46; CI: 0.21 to 0.70), insomnia (d = 0.47; CI: 0.22 to 0.72), and tinnitus cognitions (d = 0.43, CI: 0.18 to 0.68). Small effect sizes were found for hearing disability, hyperacusis and healthrelated quality of life. Adverse events related to the intervention were only reported by 1 participant. Conclusions: The benefits of audiologist-guided ICBT for tinnitus and tinnitus-related difficulties were maintained 1-year post-intervention with very few adverse events reported. Ways of disseminate evidence-based easily accessible interventions to the general population with bothersome tinnitus should be sought.
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| 7. |
- Manchaiah, Vinaya, et al.
(författare)
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Examining the consequences of tinnitus using the multidimensional perspective
- 2022
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Ingår i: Acta Oto-Laryngologica. - : Taylor & Francis. - 0001-6489 .- 1651-2251. ; 142:1, s. 67-72
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Tidskriftsartikel (refereegranskat)abstract
- Background: Tinnitus is one of the most frequent chronic conditions in adults with wide range of consequences.Aims/Objectives: The aim of the current study was to determine the problems and life effects reported by individuals with tinnitus using the International Classification of Functioning, Disability and Health (ICF) framework.Material and Methods: The study used a cross-sectional survey design. A total of 344 individuals with tinnitus completed a series of questionnaires. The responses to open-ended questions were linked to ICF categories.Results: Activity limitations and participation restrictions were most dominant consequence of tinnitus followed by effect on the body function with limited emphasis on the contextual factors. Frequently reported responses to body function involved emotional functions (b152), attention function (b140), and sleep functions (b134). Commonly reported responses to activity limitations and participation restrictions were recreation and leisure (d920), conversation (d350), communicating with—receiving—spoken messages (d310), listening (d115), and remunerative employment (d850). Sound intensity (e2500) and sound quality (e2501) were the frequently reported responses to environmental factors. Coping styles, past and present experiences, and lifestyle were the most frequently occurring personal factors.Conclusions and significance: The study highlighted some key influencing factors of tinnitus in different ICF domains which can be helpful in rehabilitation planning.
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| 8. |
- Manchaiah, Vinaya, et al.
(författare)
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Use of open-ended questionnaires to examine the effects of tinnitus and its relation to patient-reported outcome measures
- 2022
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Ingår i: International Journal of Audiology. - : TAYLOR & FRANCIS LTD. - 1499-2027 .- 1708-8186. ; 61:7, s. 592-599
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Tidskriftsartikel (refereegranskat)abstract
- Objective The primary aim of the study was to examine the automated linguistic analysis of the open-ended problem (PQ) and life-effects (LEQ) questionnaires to understand the psychological effects of tinnitus. Design The study used a cross-sectional design. Participants completed online questionnaires which included demographic questions, several standardised patient-reported outcome measures (PROMs), and two open-ended questions focussing on PQ and LEQ related to tinnitus. The response to open-ended questions was analysed using the Linguistic Inquiry Word Count (LIWC) software to identify the frequency of text on various linguistic dimensions relevant to tinnitus. Study sample 336 individuals with tinnitus. Results The study results point to two broad findings. First, although PQ and LEQ have some similarities with PROMs (e.g. the linguistic dimension negative emotions having a weak positive correlation with anxiety and depression), no correlation with the number of dimensions suggests that the open-ended questions identify additional elements that are not captured in PROMs. Second, more linguistic dimensions from the PQ correlate with PROMs compared to LEQ suggesting that the current PROMs are problem-oriented. Conclusions The study results support the idea that the use of open-ended questions in addition to PROMs may help optimise the efforts in examining the effects of chronic conditions such as tinnitus.
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| 9. |
- Rodrigo, Hansapani, et al.
(författare)
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Predicting the Outcomes of Internet-Based Cognitive Behavioral Therapy for Tinnitus : Applications of Artificial Neural Network and Support Vector Machine
- 2022
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Ingår i: American Journal of Audiology. - : AMER SPEECH-LANGUAGE-HEARING ASSOC. - 1059-0889 .- 1558-9137. ; 31:4, s. 1167-1177
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Internet-based cognitive behavioral therapy (ICBT) has been found to be effective for tinnitus management, although there is limited understanding about who will benefit the most from ICBT. Traditional statistical models have largely failed to identify the nonlinear associations and hence find strong predic-tors of success with ICBT. This study aimed at examining the use of an artificial neural network (ANN) and support vector machine (SVM) to identify variables associated with treatment success in ICBT for tinnitus.Method: The study involved a secondary analysis of data from 228 individuals who had completed ICBT in previous intervention studies. A 13-point reduction in Tinnitus Functional Index (TFI) was defined as a successful outcome. There were 33 predictor variables, including demographic, tinnitus, hearing-related and treatment-related variables, and clinical factors (anxiety, depression, insom-nia, hyperacusis, hearing disability, cognitive function, and life satisfaction). Pre-dictive models using ANN and SVM were developed and evaluated for classifi-cation accuracy. SHapley Additive exPlanations (SHAP) analysis was used to identify the relative predictor variable importance using the best predictive model for a successful treatment outcome.Results: The best predictive model was achieved with the ANN with an average area under the receiver operating characteristic value of 0.73 +/- 0.03. The SHAP analysis revealed that having a higher education level and a greater baseline tin-nitus severity were the most critical factors that influence treatment outcome positively.Conclusions: Predictive models such as ANN and SVM help predict ICBT treat-ment outcomes and identify predictors of outcome. However, further work is needed to examine predictors that were not considered in this study as well as to improve the predictive power of these models.Supplemental Material: https://doi.org/10.23641/asha.21266487
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