This is an opportunity for a PhD project. To apply contact us via https://hashirtinnitusclinic.com/contact-us/
Background
Global prevalence of tinnitus is estimated to be about 14% of the world population (Jarach et al., 2022). A European study indicated that more than 1 in 7 adults in the EU have tinnitus (Biswas et al., 2022).
The average cost of tinnitus treatment per patient per year is £717, equating to an NHS healthcare bill of £750 million per year (Stockdale et al., 2017). If tinnitus is not managed properly it can lead to insomnia and mental illness in about 60% of the sufferers and to suicidal ideations in about 13% of the sufferers (Aazh et al., 2019a, Aazh et al., 2019c, Aazh and Moore, 2018).
In the absence of a definitive cure, there are several rehabilitative interventions that can minimise the impact of tinnitus on patient’s life e.g., tinnitus retraining therapy (Henry et al., 2006, Aazh et al., 2008), various forms of sound therapy (Tyler et al., 2020), and specialised cognitive behavioural therapy (CBT) (Aazh et al., 2020). According to a recent Cochrane review, specialised CBT has the highest evidence-base as management strategy for tinnitus (Fuller et al., 2020). However, CBT for tinnitus is not widely available given the lack of expertise among audiologists and psychologists (Aazh et al., 2019b). As a solution, a recent NICE guideline recommended the use of self-help methods namely internet CBT (iCBT) for tinnitus management (National Institute for Health and Care Excellence, 2020). However, according to a recent survey by the British Tinnitus Association, only 1.8% of tinnitus sufferers believe the NICE guidance has had a positive impact on them and 88% of those surveyed said that they were not happy with options presented to them by their GP, and that CBT or iCBT get presented as an option only in a fraction of cases (British Tinnitus Association, 2021). Although iCBT is more cost-effective than face-to-face CBT sessions and has strong evidence-base for tinnitus management (Beukes et al., 2019), it is not widely available and is costly compared to other methods of self-help such as books. In the post-covid era, the NHS is under significant pressures due to backlog of patients and limitations in resources and finances (Mahase, 2021). This is probably the key reason that tinnitus-focused CBT or iCBT have not been adopted widely in the NHS. Use of self-help CBT books for tinnitus management could be one quick and cost-effective solution. In Sweden, Kaldo et al. (2007) reported that reading a self-help book and seven weekly phone calls led to significant reduction in tinnitus distress as measured via self-report questionnaires both immediately following treatment and at 1-year follow-up in a randomised controlled trial (RCT). In the UK, Reading Well Books on Prescription is a reading scheme which encourages healthcare professionals to prescribe self-help books for management of certain chronic conditions. There are several RCTs suggesting that reading self-help books is effective for management of anxiety (Kocovski et al., 2019, Krafft et al., 2020, Redding et al., 2008). There is no study in the UK on self-help CBT books for tinnitus. The main reason is that such books in English was not available until recently. Living Well with Tinnitus is a new self-help guide using CBT which was published in October 2022 (Aazh and Moore, 2022). This book is written for patients and published by Robinson who has several titles listed with Reading Well Books on Prescription scheme. In this book, CBT is presented in three overarching parts and ten self-help steps comprising:
Objectives
The aim of this project is to assess feasibility of using this book as a tinnitus management intervention in the NHS. The key objectives comprise: (1) performing systematic review and meta- analysis of studies on CBT self-help for ear and hearing disorders, (2) explore perspectives of primary care team members of self-help CBT book for tinnitus management and their willingness to recruit participants to a future substantive trial, (3) explore patients’ perspectives and expectations from a CBT programme using a self-help book, (4) design the intervention and its method of delivery, (5) perform a pilot study to evaluate the recruitment, retention and completion rates and acceptability of the intervention, (6) determine the sample size required for a future multicentre RCT.
References
AAZH, H., BAGULEY, D. M. & MOORE, B. C. J. 2019a. Factors Related to Insomnia in Adult Patients with Tinnitus and/or Hyperacusis: An Exploratory Analysis. J Am Acad Audiol, 30, 802-809.
AAZH, H., BRYANT, C. & MOORE, B. C. J. 2020. Patients’ perspectives about the acceptability and effectiveness of audiologist-delivered cognitive behavioral therapy for tinnitus and/or hyperacusis rehabilitation. American Journal of Audiology, 28, 973-985.
AAZH, H., LANDGREBE, M., DANESH, A. & MOORE, B. C. J. 2019b. Cognitive behavioral therapy for alleviating the distress caused by tinnitus, hyperacusis and misophonia: Current perspectives. Psychology Research and Behavior Management 23, 991-1002.
AAZH, H., LANDGREBE, M. & DANESH, A. A. 2019c. Parental mental illness in childhood as a risk factor for suicidal and self-harm ideations in adults seeking help for tinnitus and/or hyperacusis. American Journal of Audiology, 28, 527-533.
AAZH, H. & MOORE, B. C. J. 2018. Thoughts about suicide and self-harm in patients with tinnitus and hyperacusis. Journal of American Academy of Audiology, 29, 255-261.
AAZH, H. & MOORE, B. C. J. 2022. Living Well with Tinnitus: A Self-help Guide Using Cognitive Behavioural Therapy, Little, Brown Book Group.
AAZH, H., MOORE, B. C. J. & GLASBERG, B. R. 2008. Simplified form of tinnitus retraining therapy in adults: a retrospective study. BMC Ear Nose & Throat Disorders, 8, 1-7.
BEUKES, E. W., MANCHAIAH, V., ALLEN, P. M., BAGULEY, D. M. & ANDERSSON, G. 2019. Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis. Trends Hear, 23, 1-22.
BISWAS, R., LUGO, A., AKEROYD, M. A., SCHLEE, W., GALLUS, S. & HALL, D. A. 2022. Tinnitus prevalence in Europe: a multi-country cross-sectional population study. Lancet Reg Health Eur, 12, 100250.
BRITISH TINNITUS ASSOCIATION 2021. THE SOUND OF SCIENCE, UK, BTA.
FULLER, T., CIMA, R., LANGGUTH, B., MAZUREK, B., VLAEYEN, J. W. & HOARE, D. J. 2020. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev, 1, Cd012614.
HENRY, J. A., SCHECHTER, M. A., ZAUGG, T. L., GRIEST, S., JASTREBOFF, P. J., VERNON, J. A., KAELIN, C., MEIKLE, M. B., LYONS, K. S. & STEWART, B. J. 2006. Outcomes of clinical trial: tinnitus masking versus tinnitus retraining therapy. J Am Acad Audiol, 17, 104-132.
JARACH, C. M., LUGO, A., SCALA, M., VAN DEN BRANDT, P. A., CEDERROTH, C. R., ODONE, A., GARAVELLO, W., SCHLEE, W., LANGGUTH, B. & GALLUS, S. 2022. Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta-analysis. JAMA Neurology.
KALDO, V., CARS, S., RAHNERT, M., LARSEN, H. C. & ANDERSSON, G. 2007. Use of a self-help book with weekly therapist contact to reduce tinnitus distress: a randomized controlled trial. Journal of psychosomatic research, 63, 195-202.
KOCOVSKI, N. L., FLEMING, J. E., BLACKIE, R. A., MACKENZIE, M. B. & ROSE, A. L. 2019. Self-Help for Social Anxiety: Randomized Controlled Trial Comparing a Mindfulness and Acceptance-Based Approach With a Control Group. Behav Ther, 50, 696-709.
KRAFFT, J., TWOHIG, M. P. & LEVIN, M. E. 2020. A Randomized Trial of Acceptance and Commitment Therapy and Traditional Cognitive-Behavioral Therapy Self-Help Books for Social Anxiety. Cognitive Therapy and Research, 44, 954-966.
MAHASE, E. 2021. Under pressure: when does the NHS reach “breaking point”? Bmj, 375, n2664.
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE 2020. Tinnitus: assessment and management: NICE guideline [NG155], UK, National Institute for Health and Care Excellence.
REDDING, R. E., HERBERT, J. D., FORMAN, E. M. & GAUDIANO, B. A. 2008. Popular self-help books for anxiety, depression, and trauma: How scientifically grounded and useful are they? Professional Psychology: Research and Practice, 39, 537-545.
STOCKDALE, D., MCFERRAN, D., BRAZIER, P., PRITCHARD, C., KAY, T., DOWRICK, C. & HOARE, D. J. 2017. An economic evaluation of the healthcare cost of tinnitus management in the UK. BMC Health Serv Res, 17, 577.
TYLER, R. S., PERREAU, A., POWERS, T., WATTS, A., OWEN, R., JI, H. & MANCINI, P. C. 2020. Tinnitus Sound Therapy Trial Shows Effectiveness for Those with Tinnitus. J Am Acad Audiol, 31, 6-16.
To apply contact us via https://hashirtinnitusclinic.com/contact-us/
