Outcomes and experiences of delivering an internet-based intervention for tinnitus during the COVID-19 pandemic

Eldre Beukes1,2, Gerhard Andersson3, Marc Fagelson4, Vinaya Manchaiah5

1 Lamar University, Texas, US; 2 Anglia Ruskin University, Cambridge, UK; 3 Linköping University, Sweden; 4 East Tennessee State University, US

Background: Internet-based cognitive behavioral therapy (ICBT) for tinnitus has the potential of improving accessibility to tinnitus care. As the efficacy of ICBT in the US is unknown as study was planned. As the COVID-19 pandemic unfolded, this study was ready to be launched.  Together with identifying the intervention effects, insights where obtained regarding delivering ICBT during the COVID-19 pandemic.

Methods: A randomized controlled trial including 158 participants using a delayed treatment design was undertaken. The primary outcome was a change in tinnitus distress as measured by the Tinnitus Functional Index (TFI). Secondary outcome measures included measures of anxiety, depression, insomnia, tinnitus cognitions, hearing-related difficulties, and health-related quality of life. Treatment engagement variables included monitoring engagement regarding the number of logins, number of modules opened and number of messages sent.

Results: Undertaking the ICBT led to large improvements of tinnitus severity which were maintained at follow up. There was furthermore a greater reduction for secondary effects such as insomnia and tinnitus cognitions.  Results were maintained 2 months post-intervention. The intervention was very beneficial to help individuals cope, and helped them better manage the anxiety associated with the pandemic.

Conclusion: ICBT supported tinnitus individuals during the pandemic. Although results are comparable to results found using ICBT in Europe, participant engagement was much lower. For some participants, the pandemic or having COVID-19 impacted on their ability to focus on the trial. Ways of improving intervention compliance and engagement are required as well as evaluating the long-term effects that both the intervention and COVID-19 has had requires monitoring. Creative solutions are required to improve accessibility of ICBT due to its proved efficacy.

Beukes et al
Outline of the RCT