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Use of a self-help book with weekly therapist contact to reduce tinnitus distress: a randomized controlled trial
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University Hospital, Department of Audiology.
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2007 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 63, no 2, 195-202 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Tinnitus distress can be reduced by means of cognitive-behavior therapy (CBT). To compensate for the shortage of CBT therapists, we aimed, in this study, to investigate the effects of a CBT-based self-help book guided by brief telephone support. Methods: Seventy-two patients were randomized either to a self-help book and seven weekly phone calls or to a wait-list control condition, later on receiving the self-help book with less therapist support. The dropout rate was 7%. Follow-up data 1 year after completion of treatment were also collected (12% dropout). The Tinnitus Reaction Questionnaire (TRQ) was the main outcome measure, complemented with daily ratings of tinnitus and measures of insomnia, anxiety, and depression. Results: On the TRQ, significant reductions were found in the treatment group both immediately following treatment and at 1-year follow-up. In the treatment group, 32% reached the criteria for clinical significance (at least 50% reduction of the TRQ) compared to 5% in the wait-list group. Directly after treatment, two out of five measures showed significant differences in favor of the treatment with more therapist support compared with the group who, after their waiting period, received little therapist support. The self-help treatment was estimated to be 2.6 (seven phone calls) and 4.8 (one phone call) times as cost-effective as regular CBT group treatment. Conclusions: Guided self-help can serve as an alternative way to administer CBT for tinnitus. Preliminary results cast some doubts on the importance of weekly therapist contact. The effect size was somewhat smaller than for regular CBT, but on the other hand, the self-help seems far more cost-effective. Future studies should compare treatment modalities directly and explore cost-effectiveness more thoroughly.

Place, publisher, year, edition, pages
2007. Vol. 63, no 2, 195-202 p.
Keyword [en]
Audiology, Bibliotherapy, Cognitive-behavior therapy, Self-help, Tinnitus
National Category
URN: urn:nbn:se:uu:diva-97348DOI: 10.1016/j.jpsychores.2007.04.007ISI: 000248644300013PubMedID: 17662757OAI: oai:DiVA.org:uu-97348DiVA: diva2:172243
Available from: 2008-05-22 Created: 2008-05-22 Last updated: 2011-01-21Bibliographically approved
In thesis
1. Cognitive Behavioural Therapy as Guided Self-help to Reduce Tinnitus Distress
Open this publication in new window or tab >>Cognitive Behavioural Therapy as Guided Self-help to Reduce Tinnitus Distress
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tinnitus is common, and some individuals with tinnitus display high levels of distress. Cognitive behavioural therapy (CBT) is effective in reducing tinnitus distress, but is rarely available. CBT-based self-help, with or without guidance, has yielded positive results in other problem areas, and one initial randomized controlled trial (RCT) has shown promising results for tinnitus.

This thesis is based on four studies;

Study I showed that Internet-based self-help treatment with e-mail guidance alleviated tinnitus distress among consecutive patients and was rated as credible as traditional treatments. Active participation in treatment predicted outcome.

Study II, an RCT, showed that an extended and more interactive version of the Internet-based self-help treatment with e-mail therapist support appeared to be equally effective as a group treatment. In study III, another RCT, a self-help book with weekly telephone support was superior to a wait-list control group. No strong evidence for the importance of telephone contact on outcome was found. In both study II and III, the positive outcome remained after one year and self-help approaches appeared more therapist time-effective compared to group treatment. Also, the received treatment-dose for patients in guided self-help was not lower than in the group treatment.

Study IV found that the ‘Stages of Change’, from the transtheoretical model, are probably not the right theoretical framework to use with tinnitus patients. Predictors of outcome were found, but they were not in line with the theory behind the Stages of Change. The predictors were better understood when conceptualized as coping, showing that helplessness and less coping before treatment correlated with better outcome.

In sum, guided cognitive behavioural self-help can decrease tinnitus distress. It appears to be therapist time-effective and shows effects comparable to or slightly below traditional CBT for tinnitus. Effects remain one year after treatment and generalize to a routine clinical setting.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. viii, 89 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 40
Psychology, Tinnitus, Cognitive Behavioural Therapy, Self-help, Internet, Stages of Change, Psykologi
urn:nbn:se:uu:diva-8927 (URN)978-91-554-7235-1 (ISBN)
Public defence
2008-06-13, Sal IX, Universitetshuset, Uppsala, 13:15
Available from: 2008-05-22 Created: 2008-05-22Bibliographically approved

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