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Cramer L, Vogt F, McKenna L, Marks E. How people with tinnitus-related insomnia experience group CBT-for-insomnia (CBTi): a thematic analysis. Int J Audiol 2024; 63:190-198. [PMID: 36645178 DOI: 10.1080/14992027.2022.2161016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 01/17/2023]
Abstract
Objective: Although insomnia often compounds tinnitus, sleeping problems in people experiencing tinnitus are rarely treated. This study investigates the experiences of participants receiving Cognitive Behavioural Therapy for insomnia (CBTi) as part of a randomised controlled trial for managing tinnitus-related insomnia. The aim of this study is to gain detailed insight into participants' perceptions and experiences of this treatment.Design: Semi-structured interviews were conducted via phone or in-person by one of the two clinical psychologists who facilitated the CBTi sessions. Reflexive thematic analysis with semantic inductive approach was used for analysis to keep the research question theoretically flexible.Study samples: Eight participants (three females, age range 32-69 years) were interviewed six months after CBTi completion.Results: Three superordinate themes were identified: "Common humanity and transcending individual distress," "Changing the things I can" and "Accepting the things I cannot change." The group environment helped participants to normalise their experiences. Reliable tinnitus/sleep information and robust behavioural change techniques helped participants to respond and relate to their condition differently.Conclusion: Generally, participants reported long-term benefits from CBTi to treat tinnitus-related insomnia, particularly increased confidence, and getting on with life. CBTi is multi-component, so clinicians need to respond to individual preferences and lifestyles.
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Affiliation(s)
| | - Florian Vogt
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Laurence McKenna
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK
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Kutyba J, Jedrzejczak WW, Gos E, Bieńkowska K, Raj-Koziak D, Skarżyński PH. Self-help interventions chosen by subjects with chronic tinnitus - a retrospective study of clinical patients. Int J Audiol 2021; 61:686-691. [PMID: 34410211 DOI: 10.1080/14992027.2021.1964040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Self-help (without specialist support) can play an important role in tinnitus therapy. The purpose of this study was to investigate what fraction of subjects with tinnitus use self-help, what techniques are most commonly used to reduce tinnitus severity, and what distinguishes patients that use self-help from others. DESIGN retrospective, observational study. STUDY SAMPLE Adult patients admitted to our hospital clinic (460 participants) aged 19-83 years and reporting chronic tinnitus. The survey concerned therapy attempts prior to the clinic visit as well as self-help techniques chosen freely by the patient to reduce tinnitus severity. RESULTS Data showed that 40.9% of the respondents chose some action themselves to reduce their tinnitus severity. Among the reported self-help techniques, acoustic stimulation was the most popular. In addition, patients chose distraction attention, relaxation, meditation, yoga, and physical activity. The likelihood of undertaking self-help increases with better education and higher tinnitus severity. CONCLUSIONS Knowledge about patients' preferences of forms of self-help may help the health practitioner suggest a more suitable form of therapy. Due to the great interest in using sound therapy in tinnitus, it would be worthwhile looking at new forms of this therapy, for example increasingly popular mobile applications.
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Affiliation(s)
- Justyna Kutyba
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | | | - Elżbieta Gos
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Katarzyna Bieńkowska
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Danuta Raj-Koziak
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Piotr Henryk Skarżyński
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Heart Failure and Cardiac Rehabilitation Department, 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Institute of Sensory Organs, Warsaw, Poland
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Greenwell K, Sereda M, Bradbury K, Geraghty AWA, Coulson NS, Hoare DJ. Intervention Planning for the Tinnitus E-Programme 2.0, an Internet-Based Cognitive Behavioral Intervention for Tinnitus. Am J Audiol 2021; 30:241-254. [PMID: 34038162 DOI: 10.1044/2021_aja-20-00131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose The purpose of this study is to comprehensively describe the intervention planning process for the Tinnitus E-Programme 2.0, an Internet-based cognitive behavioral intervention for tinnitus. Method Theory-, evidence-, and person-based approaches to intervention development were used. In Phase 1, quantitative systematic reviews were used to identify potentially effective intervention techniques and design features. Primary mixed-methods research involving adults with tinnitus explored the acceptability of the first version of the intervention. In Phase 2, person-based guiding principles highlighted key intervention design objectives and features to address needs of the intervention's target group (identified in Phase 1) to maximize its acceptability, feasibility of delivery, and effectiveness. Theory-based "behavioral analysis" and "logic modeling" comprehensively described intervention content and potential mechanisms of action. From this planning work, a prototype intervention was developed. Results The intervention design objectives outlined in the guiding principles were to (a) normalize tinnitus, (b) support users to maintain a regular relaxation practice, (c) minimize the worsening of users' tinnitus sensation, and (d) ensure the intervention is accessible to those with hearing loss. Behavioral analysis and logic modeling identified intervention processes (e.g., illness perceptions, beliefs about consequences, skills, goals) and purported mediators (acceptance of tinnitus, negative thinking, use of the cognitive skills tools for managing negative thoughts, and practicing regular relaxation) hypothesized to facilitate reductions in tinnitus symptom severity. Conclusions The guiding principles highlight key design objectives and features to consider when developing interventions for tinnitus. The logic model offers hypothesized mechanisms of action that can be tested in future process analyses.
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Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Magdalena Sereda
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom
| | - Adam W. A. Geraghty
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, United Kingdom
| | - Neil S. Coulson
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
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Lan T, Zhao F, Xiong B. The Acceptability and Influencing Factors of an Internet-Based Tinnitus Multivariate Integrated Sound Therapy for Patients With Tinnitus. EAR, NOSE & THROAT JOURNAL 2020; 101:680-689. [PMID: 33258696 DOI: 10.1177/0145561320973768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To explore the acceptability and influencing factors of an Internet-based Tinnitus Multivariate Integrated Sound Therapy (iT-MIST). The individually tailored sound therapy used narrowband noise centered on the patient's tinnitus frequency in combination with natural sounds and relaxing music. DESIGN Patients with tinnitus were given a 1-week trial of iT-MIST. Semistructured interviews were then carried out and a thematic analysis used to analyze, identify, organize, and report factors discovered in the data. STUDY SAMPLE Semistructured interviews were carried out with 11 participants, 2 women and 9 men, mean age 39.82 years. RESULTS The first theme identified from patient interview analysis was their motivation to undertake and expectations of iT-MIST. Nearly half of the participants indicated that advice from the physician was considered very important and professional. Benefits acknowledged by most participants from their iT-MIST experience were accessibility, convenience, time- and cost-effectiveness, and emotional benefit. However, a few participants with poor understanding of tinnitus and iT-MIST showed a negative acceptability with doubtful thoughts and complaints about technical issues such as being easily interrupted by messages and phone calls. CONCLUSION Patients with tinnitus in this study were not universally accepting of the iT-MIST therapy. Concerns about their tinnitus and ability to comply with doctor's recommendations were the main influencing factors. Attitude or willingness to explore new therapies facilitated its use. Emotional benefits, for example, relaxation and comfort, were seen to sustain motivation, while doubtful thoughts and technical problems negatively affected acceptability.
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Affiliation(s)
- Tianxiang Lan
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, 11352Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, 11352Cardiff Metropolitan University, Cardiff, United Kingdom.,Department of Hearing and Speech Science, 11352Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Binbin Xiong
- Department of Otolaryngology, 558113Shenzhen University General Hospital, Shenzhen, Guangdong, China
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Greenwell K, Sereda M, Coulson NS, Geraghty AWA, Bradbury K, Hoare DJ. ‘That’s just how I am’: a qualitative interview study to identify factors influencing engagement with a digital intervention for tinnitus self‐management. Br J Health Psychol 2020; 26:727-747. [DOI: 10.1111/bjhp.12486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology School of Psychology University of Southampton UK
- Division of Clinical Neuroscience National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre Hearing Sciences Group School of Medicine University of Nottingham UK
| | - Magdalena Sereda
- Division of Clinical Neuroscience National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre Hearing Sciences Group School of Medicine University of Nottingham UK
| | - Neil S. Coulson
- Division of Rehabilitation, Ageing and Wellbeing School of Medicine University of Nottingham UK
| | - Adam W. A. Geraghty
- School of Primary Care, Population Sciences and Medical Education University of Southampton UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology School of Psychology University of Southampton UK
| | - Derek J. Hoare
- Division of Clinical Neuroscience National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre Hearing Sciences Group School of Medicine University of Nottingham UK
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Manchaiah V, Vlaescu G, Varadaraj S, Aronson EP, Fagelson MA, Munoz MF, Andersson G, Beukes EW. Features, Functionality, and Acceptability of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States. Am J Audiol 2020; 29:476-490. [PMID: 32880499 DOI: 10.1044/2020_aja-20-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective Although tinnitus is one of the most commonly reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related to accessibility of care and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence-based interventions are necessary. Internet-based cognitive behavioral therapy (ICBT) demonstrates potential as a means of delivering this support but is not currently available in the United States. This article discusses the adaptation of an ICBT intervention, originally used in Sweden, Germany, and the United Kingdom, for delivery in the United States. The aim of this study was to (a) modify the web platform's features to suit a U.S. population, (b) adapt its functionality to comply with regulatory aspects, and (c) evaluate the credibility and acceptability of the ICBT intervention from the perspective of health care professionals and patients with bothersome tinnitus. Materials/Method Initially, the iTerapi ePlatform developed in Sweden was adopted for use in the United States. Functional adaptations followed to ensure that the platform's functional and security features complied with both institutional and governmental regulations and that it was suitable for a U.S. population. Following these adaptations, credibility and acceptance of the materials were evaluated by both health care professionals (n = 11) and patients with bothersome tinnitus (n = 8). Results Software safety and compliance regulatory assessments were met. Health care professionals and patients reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability, and exercises provided in the ICBT platform. Modifications to the features and functionality of the platform were made according to user feedback. Conclusions Ensuring that the ePlatform employed the appropriate features and functionalities for the intended population was essential to developing the Internet-based interventions. The favorable user evaluations indicated that the intervention materials were appropriate for the tinnitus population in the United States.
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Affiliation(s)
- Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal, Karnataka, India
| | - George Vlaescu
- Department of Behavioral Sciences and Learning, Linköping University, Sweden
| | - Srinivas Varadaraj
- Information Technology Services and Support, Lamar University, Beaumont, TX
| | | | - Marc A. Fagelson
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City
- Audiologic Rehabilitation Laboratory, Auditory Vestibular Research Enhancement Award Program, Veterans Affairs Medical Center, Mountain Home, TN
| | - Maria F. Munoz
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Sweden
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eldré W. Beukes
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
- Department of Vision and Hearing Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
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Brown P, Waite F, Lambe S, Rosebrock L, Freeman D. Virtual Reality Cognitive Therapy in Inpatient Psychiatric Wards: Protocol for a Qualitative Investigation of Staff and Patient Views Across Multiple National Health Service Sites. JMIR Res Protoc 2020; 9:e20300. [PMID: 32667897 PMCID: PMC7471884 DOI: 10.2196/20300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients in psychiatric wards typically have very limited access to individual psychological therapy. Inpatients often have significant time available, and an important transition back to everyday life to prepare for-but historically, there have been few trained therapists available on wards for the delivery of evidence-based therapy. Automated virtual reality (VR) therapy may be one route to increase the provision of powerful psychological treatments in psychiatric hospitals. The gameChange automated VR cognitive therapy is targeted at helping patients overcome anxious avoidance and re-engage in everyday situations (such as walking down the street, taking a bus, or going to a shop). This treatment target may fit well for many patients preparing for discharge. However, little is known about how VR therapy may be viewed in this setting. OBJECTIVE The objectives of the study are to explore psychiatric hospital staff and patients' initial expectations of VR therapy, to gather patient and staff views of an automated VR cognitive therapy (gameChange) after briefly experiencing it, and to identify potential differences across National Health Service (NHS) mental health trusts for implementation. Guided by an implementation framework, the knowledge gained from this study will be used to assess the feasibility of VR treatment adoption into psychiatric hospitals. METHODS Focus groups will be conducted with NHS staff and patients in acute psychiatric wards at 5 NHS mental health trusts across England. Staff and patients will be interviewed in separate groups. Individual interviews will also be conducted when preferred by a participant. Within each of the 5 trusts, 1 to 2 wards will be visited. A total of 8-15 staff and patients per ward will be recruited, with a minimum total of 50 staff and patients recruited across all sites. Focus group questions have been derived from the nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) framework. Focus groups will discuss expectations of VR therapy before participants are given the opportunity to briefly try the gameChange VR therapy. Questions will then focus on opinions about the therapy and investigate feasibility of adoption, with particular consideration given to site specific issues. A thematic analysis will be conducted. RESULTS As of May 15, 2020, 1 patient focus group has been conducted. CONCLUSIONS The study will provide unique insight from patients and staff into the potential for implementing automated VR therapy in psychiatric wards. Perspectives will be captured both on the use of immersive technology hardware and therapy-specific issues in such settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20300.
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Affiliation(s)
- Poppy Brown
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Sinéad Lambe
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Laina Rosebrock
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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