Individuals with Tinnitus are severely distressed by the condition with psychological factors affecting their distress levels. Tinnitus may be very distressing and/or debilitating, due to hearing unwanted sounds such as ringing or buzzing. Many aspects of daily life, such as sleep, mood, and concentration may be affected as a result of having tinnitus. Nearly 50 million people in the U.S. experience tinnitus, whereas about 20 million people struggle with burdensome chronic tinnitus. Ensuring readily- accessible, specialized clinical services specific to tinnitus throughout the country is desirable, but difficult to implement due to the burdens on the current health care system. Innovative ways to help those with tinnitus and proactively manage the related health care burden are required. There are several approaches to tinnitus management, but the one with the best evidence - cognitive behavioral therapy (CBT) - is rarely offered (less than 1% in the U.S.). There is a lack of trained audiologists who can deliver this treatment. Psychological management options such as CBT are mainly offered in English, and many people who speak other languages such as Spanish have limited options. One partial solution is to offer CBT via the Internet as a guided self-help program (i.e., iCBT) customizing it to meet individual needs both in terms of language and time of usage. Evidence from European studies clearly suggests that this is as effective as seeing a clinician with medium to large effects. However, not all patients are suitable and it is important to assess medical aspects before starting online CBT. T he long-term goal of this initiative is to develop an accessible and affordable self-help program that can improve health outcomes in individuals with tinnitus. The central hypothesis is that iCBT will result in reduced tinnitus related distress, decreased sleep disturbance, decreased anxiety and depression, and improved general health in a treatment group as compared to control- group in the U.S. population and these results will be stable in both short- and long-term post intervention. The proposed study aims to adapt an Internet-based self-help program for the U.S. population that has been developed and tested in Europe. The Internet-based cognitive behavioral therapy (iCBT) promotes self-management to facilitate coping and adaptation in individuals with tinnitus to reduce tinnitus distress, thereby improves health outcomes. The research will involve two phases. Phase 1 will involve ePlatform adaptation, cultural and linguistic adaptation of self-help materials to the U.S. population, and the conducting of a pilot study. Phase 2 will involve running an efficacy trial using the two-armed delayed-treatment randomized controlled trail (RCT). This project has direct and immediate practice implications as it focuses upon improving patient experiences by developing additional accessible services and excellence in care for adults with tinnitus.
The proposed research will develop an Internet-based self-help program for tinnitus sufferers, while increasing fundamental knowledge needed to reduce the burden of this hidden disability. The project treatment strategy reaches beyond the clinical population (i.e., reaches tinnitus sufferers living in the general population instead of focusing on those who make clinical consultations) and the direct-to- consumer approach of self-management reduces service delivery time without compromising the outcome, if proven to be effective. The use of computer and Internet technologies can help to overcome the need for large numbers of trained professionals to offer services, significantly reducing healthcare costs and improving access to services.
