Audiologist-delivered psychological intervention for tinnitus
Research type
Research Study
Full title
Manualisation and feasibility study of audiologist-delivered psychological intervention for tinnitus
IRAS ID
172091
Contact name
Derek J Hoare
Contact email
Sponsor organisation
Nottingham University Hospitals NHS Trust
ISRCTN Number
ISRCTN13059163
Duration of Study in the UK
1 years, 8 months, 27 days
Research summary
Research Summary
Chronic tinnitus is a common incurable condition often associated with reduced quality of life, depression, and anxiety. Historically in the UK, much of the counselling for people with tinnitus has been undertaken in audiology departments by hearing therapists. However, hearing therapy training is no longer supported and the care of people with tinnitus is most commonly delivered by audiologists. Whilst some audiologists will have undertaken some training in providing psychological support there is no standard training or reliable evidence that psychological interventions as delivered by audiologists are effective.\nIn the first part of this study we will determine what aspects or forms of psychological support are considered important and essential by people with tinnitus and the clinicians who care for them. We will do this using a standard (Delphi) survey approach involving a series of questionnaires. Patients who have received counselling and clinicians who have delivered counselling, for tinnitus, will be eligible to take part in the Delphi survey. We will combine the results of this survey with a summary of the scientific literature to develop a manual that audiologists can work from when providing psychological support to tinnitus patients. \nNext we will conduct a feasibility trial. The purpose of the feasibility trial is to determine whether the manual is appropriate and acceptable to patients and audiologists, and to assess the factors that will be important when designing a full-scale randomised clinical trial such as the rate at which participants can be recruited over a limited period of time. For the feasibility trial, participants will be randomly allocated to receive usual care, or to be seen by an audiologist who has been trained to deliver care according to the manual. Participants will be patients attending one of three NHS audiology departments. After treatment semi-structured interviews about the treatment will be conducted.Summary of Results
The aim of this study was to develop and test a treatment manual that could be used by audiologists to provide psychological support to people who have tinnitus. To do this we first did a thorough review of all previous research and publications about psychological support and counselling for tinnitus. From this we created an extensive list of all the types of psychological treatments for tinnitus that have been used previously, with a breakdown of the different elements (treatment components) used in each. Next, we did a study to understand what treatment components were considered most important and appropriate to use in a treatment that would be delivered by audiologists. We brought together a panel of 39 patients, audiologists, hearing therapists, and psychologists who took part in a set of three surveys designed to reach a consensus on this topic. We set a consensus level of agreement at 80% which meant that 80% of the panel needed to agree that an individual treatment component should definitely be included (or definitely excluded). We started out with a list of 160 treatment components, and after the surveys we had 76 components where there was consensus that they should definitely be included in the treatment manual. The results of this part of the study provided us with a tool to develop a treatment manual using components that both patients and clinicians agreed are important and appropriate to be delivered by an audiologist for adults with tinnitus-related distress. In the next stage of the study, we wrote the treatment manual, including all important treatment components. The manual was structured such that it provided guidance across the whole care process, from assessment through to essential and optional information and psychological support. Finally, we did a small clinical trial to test whether the treatment manual was useful, acceptable, and suitable for further study. In this small clinical trial, we randomly assigned tinnitus patients to receive either routine tinnitus care from an audiologist, or to receive care according to the new treatment manual, from an audiologist who had received brief training in its use. We wanted to recruit 30 patients but, in the time allocated, we only recruited 19, and only nine patients completed the study. Patients reported that the treatment was acceptable and helped reassure them about their tinnitus. Audiologists reported mixed feelings about using the kinds of psychological components in the manual. Audiologists also reported lacking confidence because the training they had was brief, and made suggestions for training and supervision they thought would be useful. The study indicated that further development work is needed before a big clinical trial of the new treatment. Positive reports from patients indicate that further developing the treatment would be worthwhile.REC name
North West - Preston Research Ethics Committee
REC reference
16/NW/0047
Date of REC Opinion
4 Feb 2016
REC opinion
Further Information Favourable Opinion