A systematic review of techniques and effects of self-help interventions for tinnitus: Application of taxonomies from health psychology

Figures & data

Figure 1. PRISMA flow chart of study selection process.

Figure 2. Cochrane risk of bias summary table including risk of bias judgements across studies for each criterion. Key:? unclear risk of bias; + low risk.

Table 1. Study characteristics and quality assessment for included studies.

Reference	Country	Sample size	Study design; Trial type	Intervention	Control	Assessment points			Outcome measures		Quality assessment
						BL	P-I	FU	Primary	Other
						Loumidis et al (1991)	UK	33^a	NRCT; Parallel	Information Leaflet	Waiting list*	×	1 month	×	TEQ	−	13
Kaldo et al (2007)	Sweden	72	RCT; Parallel, cross-over	Self-help book	Therapist-guided self-help book**	✓	6 weeks	1 year	TRQ	THI, HADS, ISI	17
Malouff et al (2010)	Australia	162	RCT; Parallel, cross-over	Self-help book	Waiting list*	✓	2 months	***	TRQ^b	GHQ-12	14
Nyenhuis et al (2013b)	Germany	304	RCT; Parallel	Self-help book; Internet intervention	Information leaflet*; Group therapy**	✓	3 months	1 year	TQ	PHQ-D	19
Kaldo et al (2013)	Sweden	374	NRCT; Effectiveness trial	Internet intervention	Therapist-guided internet intervention**	✓	ns	×	TRQ	−	13

Note: Quality assessment was carried out using Downs and Black’s (1998) quality checklist. The reported score is out of a total score of 28.

Key: ^aOnly post-intervention sample size was given; ^bPrimary outcome not stated; *Passive control; **Active control; ***Only within-group comparisons made at follow-up; RCT: Randomized controlled trial; NRCT: Non-randomized controlled trial; BL: Baseline; P-I: Post-intervention; FU: Follow-up; ns = not specified; TEQ: Tinnitus effects questionnaire (Hallam et al, 1988); TRQ: Tinnitus reaction questionnaire (Wilson et al, 1991); TQ: Tinnitus questionnaire (German version; Goebel & Hiller, 1998); THI: Tinnitus handicap inventory (Newman et al, 1996); HADS: Hospital anxiety and depression scale (Zigmond & Snaith, 1983); ISI: Insomnia severity index (Bastien et al, 2001); GHQ-12: General health questionnaire (Goldberg & Williams, 1988); PHQ-D: Patient health questionnaire (Gräfe et al, 2004).

Table 2. Presence of between-group effects for studies comparing levels of tinnitus distress and depression between self-help interventions and passive controls.

Reference	Intervention	Control	Tinnitus distress		Depression
			P-I	FU	P-I	FU
			Loumidis et al (1991)	Information leaflet	Waiting list	No effect^a	−	−	−
Malouff et al (2010)	Self-help book	Waiting list	No effect^b	−	Effect^c	−
Nyenhuis et al (2013b)	Self-help book	Information leaflet	No effect	Effect^b	No effect	No effect
	Internet intervention		Effect	Effect^b	No effect	No effect

Key: P-I: Post-intervention; FU: Follow-up;.^aOnly post-intervention scores compared between groups. No pre-intervention scores collected; ^bThese results should be interpreted with caution as complete case analysis showed opposite effect; ^cComplete case analysis. Intention-to-treat not reported.

Table 3. Presence of between-group effects for studies comparing levels of tinnitus distress, depression, anxiety, and sleep quality between self-help interventions and active controls.

Reference	Intervention	Control	Tinnitus distress^a		Depression		Anxiety		Sleep quality
			P-I	FU	P-I	FU	P-I	FU	P-I	FU
			Kaldo et al (2007)	Self-help book	Therapist-guided self-help book	No effect	No effect	No effect	No effect	Effect	No effect	No effect	No effect

Key: P-I: Post-intervention; FU: Follow-up; ^aOnly effects for primary outcome measure of tinnitus distress are reported.

Table 4. Number of self-management components and behaviour change techniques across studies.

Behaviour change techniques taxonomy	Number of studies
1.4. Action planning	4^b-e
4.1. Instruction on how to perform the behaviour	4^b-e
8.1. Behavioural practice/rehearsal	4^b-e
1.1 Goal setting (behaviour)	3^b,c,e
2.3. Self-monitoring of behaviour	3^b-d
2.4. Self-monitoring of outcome(s) of behaviour	2^b,c
3.2. Social support (practical)	2^b,c
5.6. Information about emotional consequences	2^b,c
12.5. Adding objects to the environment	2^b,e
1.2. Problem solving	1^b
1.5. Review behaviour goal(s)	1^c
7.1. Prompt/cues	1^b
8.3. Habit formation	1^b
8.6. Generalization of target behaviour	1^b
8.7. Graded tasks	1^b
PRISMS Self-management components taxonomy	Number of studies
Education about condition and management	5^a-e
Training/rehearsal for psychological strategies	4^b-e
Lifestyle advice and support	4^b-e
Information about available resources	3^a,c,e
Provision of / agreement on specific action plans and/ or rescue medication	2^b,d
Monitoring of condition with feedback to the patient	1^c
Practical support with adherence (medication or behavioural)	1^b
Provision of equipment	1^e

Key: ^aLoumidis et al (1991); ^bKaldo et al, (2007); ^cMalouff et al, (2010); ^dKaldo et al, (2013); ^eNyenhuis et al, (2013b).

Loumidis K.S., Hallam R.S., & Cadge B. 1991. The effect of written reassuring information on out-patients complaining of tinnitus. Br J Audiol, 25, 105–109.

 PubMedGoogle Scholar

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. J Psychosom Res, 63, 195–202.

 PubMed Web of Science ®Google Scholar

Malouff J.M., Noble W., Schutte N.S. & Bhullar N. 2010. The effectiveness of bibliotherapy in alleviating tinnitus-related distress. J Psychosom Res, 68, 245–251.

 PubMed Web of Science ®Google Scholar

Nyenhuis N., Zastrutzki S., Weise C., Jäger B. & Kröner-Herwig B. 2013b. The efficacy of minimal contact interventions for acute tinnitus: A randomised controlled study. Cogn Behav Ther, 42, 127–138.

 PubMed Web of Science ®Google Scholar

Kaldo V., Haak T., Buhrman M., Alfonsson S., Larsen H.C. et al. 2013. Internet-based cognitive behaviour therapy for tinnitus patients delivered in a regular clinical setting: Outcome and analysis of treatment dropout. Cogn Behav Ther, 42, 146–158.

 PubMed Web of Science ®Google Scholar

Downs S.H. & Black N. 1998. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health, 52, 377–384.

 PubMed Web of Science ®Google Scholar

Hallam R.S., Rachman S. & Hinchcliffe R. 1988. Cognitive variables in tinnitus annoyance. Br J Clin Psychol, 27, 213–222.

 PubMed Web of Science ®Google Scholar

Wilson P.H., Henry J.L., Bowen M. & Haralambous G. 1991. Tinnitus reaction questionnaire: Psychometric properties of a measure of distress associated with tinnitus. J Speech Hear Res, 34, 197–201.

 PubMedGoogle Scholar

Goebel G. & Hiller W. 1998. Tinnitus-Fragebogen. Göttingen: Hogrefe.

 Google Scholar

Newman C.W., Jacobson G.P. & Spitzer J.B. 1996. Development of the Tinnitus Handicap Inventory. Arch. Otolaryngol. Head Neck Surg. 122, 143–148.

 PubMed Web of Science ®Google Scholar

Zigmond A.S. & Snaith R.P. 1983. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand, 67, 361–370.

 PubMed Web of Science ®Google Scholar

Bastien C.H., Vallières A. & Morin C.M. 2001. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med, 2, 297–307.

 PubMed Web of Science ®Google Scholar

Goldberg D. & Williams P. 1988. A User’s Guide to the General Health Questionnaire. Windsor, Berkshire, UK: NFER-Nelson.

 Google Scholar

Gräfe K., Zipfel S., Herzog W. & Löwe B. 2004. Screening for psychiatric disorders with the Patient Health Questionnaire (PHQ). Results from the German validation study. Diagnostica, 50, 171–181.

 Web of Science ®Google Scholar