Internet-based CBT for Tinnitus

The purpose of this study is to evaluate a internet-based cognitive behavioral therapy (CBT)
system as a method of treating patients with tinnitus. Tinnitus is a common symptom that is
defined as the perception of the sound in the ears without any external source. It is often
described by the patients as ringing or a buzzing sound, alone or more often as a mixture of
sounds. This symptom afflicts 10 to 15% of the adult population. It usually does not bother
patients significantly; however about 10% of the patients will suffer severe problems which
include insomnia, anxiety, depression and other emotional problems. The various forms of
treatment for tinnitus that have been tested in properly controlled trials can be classified
as pharmacological, sound therapy and psychological. In clinical trials, no pharmacological
agent has been shown to have lasting effect on the presence or severity of tinnitus. Despite
numerous available treatments for tinnitus, it is rarely curable and the sufferer must use
coping strategies to decrease the distress.

CBT is a psychological treatment that has emerged as consistently beneficial in terms of
affecting overall well-being and reducing the level of tinnitus-related annoyance. CBT is a
form of psychotherapy for tinnitus that intends to measure and improve the affected
individual's reaction to tinnitus. It does not eliminate the auditory perception, but
reduces or corrects negative responses to tinnitus. CBT identifies negative automatic
thought and determines its validity with the patient. It intends to modify negative
automatic thoughts to more positive and realistic ones. Using this method, the patients with
tinnitus can function better despite the presence of tinnitus.

One of the problems with CBT is the shortage of clinicians who are specialized in CBT for
tinnitus. For this reason, some programs have been developed which utilize guided or
therapist-supported self-help approach. Internet based CBT have been developed for patients
with tinnitus in several studies. Anderson and colleagues in Sweden compared pre and post
therapeutic effect of CBT in 117 participants with tinnitus duration of more than 6 months.
All subjects had been offered the CBT program and 96 provided outcome measures.
Tinnitus-related distress, depression, and diary ratings of annoyance decreased
significantly. Also in comparison to a control group, they found out that these patients
showed an improvement of at least 50% on the Tinnitus Reaction Questionnaire. They concluded
that CBT via the Internet can help individuals decrease annoyance associated with tinnitus.
In another study by Kaldo et.al., they evaluated the difference between internet-based CBT
and group-based CBT. The subjects in internet treatment consumed less therapist time and it
was 1.7 times as cost-effective as the group treatment. However some studies support the
utilization of self-help methods for treatment of tinnitus, but there are still some
problems with using these methods such as accessibility to internet, knowledge of the
patients on using computers and internet, interactivity and user friendly structure of the
software that is used for the program and time management of the patients for practicing
methods and exercises embedded in this program. By correcting and rectifying these 3 of 25
issues, internet-based self-help programs will better serve the patients with their
cost-effective and time saving benefits. Currently there is no web-based CBT for the
treatment of tinnitus available.

The objective of this study is to evaluate an internet-based CBT course for the treatment of
tinnitus. Adult patients (18+ years) with moderate-to-severe tinnitus (see additional
Inclusion Criteria) will be selected for enrollment and will take pre-course surveys and
undergo tinnitus-specific audiometry testing. The 8-week course will be completed by the
patients online, at home. Following completion of the course, enrollees will repeat the
surveys and tinnitus-specific audiometry tests.

Inclusion Criteria:

1. Subjects with the chief complaint of tinnitus for 6 months or more

2. 18 years or older

3. Male or Female

4. Internet and e-mail access at home

5. Adequate command of English to fill out the surveys and questionnaires in the website

Exclusion Criteria:

1. Aged less than 18 years

2. History of Psychosis

3. Subjects currently taking medications known to cause tinnitus (aspirin, ibuprofen,
naproxen) which cannot be stopped.

4. Active illicit drug use, alcohol dependence

5. Patients with severe depression based on the Beck's depression inventory survey
scores

6. Patients with severe anxiety based on the GAD-7 survey scores

7. Patients with severe Post Traumatic Stress Disorder (PTSD) based on the PTSD-
civilian version survey

8. Not currently undergoing CBT with a Psychologist

9. No other concurrent tinnitus therapy

10. Pregnant or breastfeeding.