In a recent study published in the journal Frontiers in Audiology and Otology, researchers explored whether a chatbot providing cognitive behavioral therapy (CBT) guidance through a mobile app can help tinnitus sufferers manage their distress, anxiety, and depression associated with the condition.
Study: Delivery of internet-based cognitive behavioral therapy combined with human-delivered telepsychology in tinnitus sufferers through a chatbot-based mobile app. Image Cerdit: Thapana_Studio/Shutterstock.com
Their results indicate that the chatbot is effective in helping participants manage their symptoms and that a telepsychologist is not necessary for the intervention to be effective.
Background
There is no known cure for tinnitus, which is the perception of sound without any external stimuli. This common condition affects more than one in ten people, with nearly 20% reporting moderate to severe symptoms.
Many tinnitus sufferers also experience depression, while 10% report that it negatively affects their quality of life. When chronic, tinnitus can impact sleep, cognition, and social interaction, causing immense distress.
However, CBT can alleviate these effects while not addressing tinnitus itself. CBT, as well as the practices of mindfulness CBT (MCBT) and Acceptance and Commitment Therapy (ACT), can significantly improve quality of life and be more effective in reducing depression than other treatments. However, these forms of therapy are time-intensive and require multiple sessions with a trained provider, making them expensive and reducing accessibility.
Internet-based CBT (iCBT) interventions such as chatbots can increase access to care by allowing users to navigate difficult and stressful situations with the support and guidance of a virtual coach engagingly and conversationally. An iCBT application has been developed specifically for addressing tinnitus.
The mobile app guides users to identify and challenge negative thoughts and promotes relaxation through exercises and conversations. It also includes relaxing soundscapes. Strengthening the evidence on the effectiveness of such interventions can lead to better adherence and adoption rates, allowing more people to receive evidence-based care.
About the study
In this study, researchers evaluated the clinical difference in improvements in tinnitus-related functioning between the use of the chatbot alone, and the chatbot as well as consultations with a psychoeducational psychologist.
They conducted a two parallel-group randomized trial from September 2020 to February 2021 to compare a ‘hybrid’ group that received both video consultations and messages from the chatbot with a ‘chatbot only’ group. The intervention lasted for eight weeks with three rounds of assessments – pre-intervention, post-intervention, and a follow-up after two months.
Participants were included in the study if they did not have any major psychiatric or medical disorders or severe tinnitus that had not been medically investigated. They were randomly assigned to a treatment group after filling up an initial questionnaire for screening purposes.
All participants were told to interact with the virtual coach on the app for ten minutes daily for eight weeks. Additionally, members of the ‘hybrid’ group participated in four video call sessions with a psychologist lasting half an hour each during this time.
The primary outcome measure was tinnitus distress as measured by the Tinnitus Functional Index (TFI) with a score of 0-100 (mild tinnitus is indicated by a score <25 and severe tinnitus is considered if the score >50).
An intervention is considered to have a clinically significant effect if it changes the TFI score by 13 points or more. Other outcome measures included hyperacusis (score range – 0-42), depression (score – 0-27), and anxiety (score – 0-21). The data was analyzed using a repeated measures one-way analysis of variance (RM-ANOVA).
Findings
While 30 individuals were initially recruited for the study, only 28 participants (14 in each group) were included in the final analysis. The two groups were well-balanced in terms of sex. Participants were 57 years old on average and reported mild symptoms of anxiety and depression and no complaints of severe hyperacusis.
Before the intervention, there were no significant differences between the groups in terms of TFI, anxiety, depression, and hyperacusis.
In both groups, TFI showed significant decreases over time, indicating an improvement in quality of life for tinnitus patients. There was no significant decrease between the two groups. Interestingly, 42% of the chatbot-only group and 64% of the hybrid group showed significantly improved TFI during the post-treatment survey. During the follow-up, this proportion was 64% across both groups.
Changes in the TFI were largely associated with improvements in sleep, sense of control, emotional improvements, and relaxation. Depression and anxiety scores also decreased significantly, with no differences between the two groups. The intervention did not affect hyperacusis scores.
Conclusions
The results of this study indicate that including telepsychology sessions did not significantly improve tinnitus-related distress over the effect of using the chatbot.
While one limitation of this analysis is that it does not control for initial tinnitus severity, which may predict how beneficial treatments can be, this research has established that the condition can be alleviated without human interaction. This has the potential to significantly improve access to CBT care for underserved populations.
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