Background

Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT.

Aims

This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression.

Methods

A parallel randomized controlled trial design (n = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken.

Results

Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes d = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group d = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group.

Conclusion

Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.

中文翻译：

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拆除基于互联网的耳鸣认知行为疗法。应用放松的贡献：一项随机对照试验

背景

基于互联网的耳鸣认知行为疗法 (ICBT) 是一种循证干预。然而，ICBT 治疗耳鸣的成分尚未被分解，因此不同治疗成分的有效性尚不清楚。此外，不知道异质耳鸣亚群对 ICBT 的反应是否不同。

目标

这项拆解研究旨在探索 ICBT 中应用放松对减少耳鸣困扰和与耳鸣相关的合并症的贡献。次要目的是评估三个耳鸣亚组的结果是否不同，即耳鸣严重程度显着、耳鸣严重程度低和抑郁程度显着的亚组。

方法

平行随机对照试验设计 ( n  = 126) 用于比较听力学家指导的应用放松与完整的 ICBT 干预。招聘是在线和通过干预平台进行的。评估在四个时间点完成，包括 2 个月的随访期。主要结果是通过耳鸣功能指数测量的耳鸣严重程度。次要结局包括焦虑、抑郁、失眠、负性耳鸣认知、健康相关生活质量、听力障碍和听觉过敏。治疗参与变量包括登录次数、打开的模块数和发送的消息数。进行了意向治疗分析和完成者唯一分析。

结果

由于很少有参与者进行了全面干预，因此参与度很低，这影响了结果。ICBT 和应用放松都导致耳鸣严重程度大大降低（组内效应大小d  = 0.87 和 0.68，分别用于完成者分析），在随访中得到维持或进一步改善。ICBT 组耳鸣困扰的这些减少更大，效果大小差异很小（组间d = 0.15 支持 ICBT 仅用于完成者分析）。对于基线时有显着抑郁症的患者，干预后耳鸣困扰减少最多。ICBT 和应用放松都有助于大多数次要结果测量的显着降低，没有组间差异，除了 ICBT 组的听觉过敏有更大的减少。

结论

由于部分归因于 COVID-19 大流行的合规性差，结果受到影响。需要进一步研究采用策略来提高合规性和参与度。干预的有效性随着耳鸣困扰的初始水平而增加；那些在入学时得分最高的人在结果测量方面经历了最实质性的变化。这可能建议根据耳鸣严重程度调整干预措施。需要更大的样本来证实这一点。