A new study has found that a smartphone app that uses a chatbot to deliver cognitive behavioral therapy can significantly reduce the distress caused by tinnitus, as well as the anxiety and depression that often accompanies it. The tool provides an easy way of accessing treatment to manage the debilitating condition.
For tinnitus sufferers, the conscious perception of sound without an external source can be distressing. Negatively affecting sleep, cognition, communication, and a person’s sense of control, about two-thirds of people with tinnitus experience clinical depression, and 10% report a significant reduction in quality of life.
Managing this incurable condition can be a challenge. However, there’s growing evidence that cognitive behavioral therapy (CBT) can alleviate tinnitus-related distress. A new study led by researchers at Waipapa Taumata Rau, University of Auckland in New Zealand, tested the clinical effectiveness of CBT delivered by a conversational or ‘chatbot’ smartphone app in reducing the debilitating impact of tinnitus.
“About 1.5 million people in Australia, 4 million in the UK and 20 million in the USA have severe tinnitus,” said Fabrice Bardy, the study's lead author. “One of the most common misconceptions about tinnitus is that there is nothing you can do about it; that you just have to live with it. This is simply not true. Professional help from those with expertise in tinnitus support can reduce the fear and anxiety attached to the sound [that] patients experience.”
The researchers recruited 28 adults with tinnitus to a randomized, two parallel-group trial to compare the clinical effectiveness of internet-based CBT (iCBT) alone or iCBT plus video calls with a clinical psychologist (hybrid group). Both groups had an average age was 57, mild symptoms of anxiety and depression, and no severe complaints of hyperacusis, a reduced tolerance to sound.
The iCBT was delivered by a smartphone app called MindEar, developed by an international multidisciplinary team of audiologists, psychologists and ear, nose and throat specialists. Using a chatbot, the app incorporates traditional CBT practices of identifying and challenging negative thoughts and behavior activation, as well as elements of mindfulness-based CBT (MCBT). In addition, it provides users with soundscapes and self-care tools such as podcasts, guided relaxation exercises and breathing techniques to help manage tinnitus.
“Cognitive behavioral therapy is known to help people with tinnitus, but it requires a trained psychologist,” said Suzanne Purdy, a study co-author. “That’s expensive and often difficult to access. MindEar uses a combination of cognitive behavioral therapy, mindfulness and relaxation exercises as well as sound therapy to help you train your brain’s reaction so that we can tune out tinnitus. The sound you perceive fades in the background and is much less bothersome.”
Participants engaged with the MindEar app for 10 minutes daily for eight weeks. The hybrid group had four video calls of 30 minutes each over that period. The Tinnitus Functional Index (TFI), a self-report questionnaire measuring the severity and negative impacts of tinnitus across multiple domains, was the primary outcome measure. TFI scores range from zero to 100. Scores less than 25 indicate mild tinnitus, 25 to 50 indicate significant tinnitus, and greater than 50 indicate severe tinnitus. A change in the TFI score of 13 points or more is considered clinically significant. Anxiety, depression, and hyperacusis scores were secondary assessment measures.
The TFI decreased significantly over time in both groups. Post-eight-week treatment, 42% of the MindEar-only group and 64% of the hybrid group had a clinically significant improvement. At a 16-week follow-up, it was 64% for both groups. The greatest improvements were in the relaxation, emotional, sense of control, and sleep TFI subscales. The researchers also observed a significant improvement in anxiety and depression symptoms among participants. The intervention did not have a significant effect on hyperacusis.
“In our trial, two-thirds of users of our chatbot saw improvement after 16 weeks,” Bardy said. “This was shortened to only eight weeks when patients additionally had access to an online psychologist.”
However, that both groups achieved a clinically significant reduction in tinnitus severity suggests that the addition of online counselling sessions may be beneficial but not essential to the effectiveness of the treatment. Further research is needed to determine whether there is any relationship between the characteristics of tinnitus patients and the success of the different therapy delivery modes.
The MindEar app is available for Apple or Android smartphones in North America, Australia, New Zealand, the UK, Ireland, and select other countries. MindEar plans to expand the app’s availability to other countries.
The study was published in the journal Frontiers in Audiology and Otology, and the below video, produced by MindEar, explains what the app provides.
Source: Science in Public
