A Systematic Review and Meta-Analysis on the Efficacy of Self-Help Interventions in Tinnitus

This study is a review and meta-analysis on the efficacy of cognitive-behavioural therapy (CBT) self-help interventions for tinnitus. Randomized controlled trials were identified by searching in databases (e.g. ISI Web of Knowledge, PubMed, Cochrane Library, and PSYNDEX) and by manual search. Ten studies with 1188 participants in total were included in the meta-analysis. Participants were 49.2 years old and had tinnitus for 5.2 years. Self-help interventions significantly reduced tinnitus distress (d = 0.48) and depressiveness (d = 0.25) when compared with a passive control (e.g. information only and discussion forums) at post-assessment. There was no difference to the face-to-face controls (group treatment). The presence of therapists and the methodological quality of the studies did not influence the results. Sensitivity analysis revealed that there might be a publication bias regarding the comparison to the face-to-face control. However, the results suggest that CBT self-help interventions are an effective treatment for tinnitus distress. Since few studies were identified, this conclusion must be supported by future meta-analyses.     

The Efficacy of Minimal Contact Interventions for Acute Tinnitus: A Randomised Controlled Study

Acute tinnitus can lead to substantial distress and eventually result in long-lasting impairment. The aim of this study was to compare the efficacy of a cognitive-behavioural intervention (delivered as Internet self-management, bibliotherapy or group training) to the information-only control condition.

Applicants suffered from subjective tinnitus for up to six months, were between 18 and 75 years old and received no other tinnitus-related psychological treatment. A total of 304 participants were randomly assigned to one of the four study arms. Tinnitus distress, depressive symptoms, psychosomatic discomfort and treatment satisfaction were assessed.

At the post-assessment tinnitus distress was significantly lower in the Internet and the group training conditions compared to the control condition. Inter-group effect sizes were moderate to large. At follow-up, all active training conditions showed significantly reduced tinnitus distress compared to the control condition (intention-to-treat analysis). An additional completer analysis showed a significant reduction in tinnitus distress only for the group condition. All effect sizes were moderate. There were no differences regarding psychosomatic discomfort, but depressive symptoms were reduced in the group condition at the post-assessment (intention-to-treat analysis). Treatment satisfaction was significantly higher in the training conditions. The dropout rate was 39%.

The present study shows that distress can be reduced as early as the acute stadium and that minimal-contact interventions are a promising way to do this. In particular, the Internet and group conditions led to a large, immediate decrease in distress, and the participants were highly satisfied with the training.     

Efficacy of an internet-based intervention for burnout: a randomized controlled trial in the German working population

Background and Objectives: Internet-based interventions are a viable treatment option for various mental problems. However, their effects on the burnout syndrome yielded mixed results. In this paper, we examine the efficacy of a structured and therapist-guided internet intervention, based on solution-focused and cognitive-behavioral therapy, for individuals with symptoms of burnout.

Design: Two-arm, Internet-based, randomized, wait-list controlled trial (RCT).

Methods: Participants were recruited through in-house events and online advertising. They were randomly assigned to the intervention or a wait-list. Group comparison was conducted three months after randomization. Outcomes were the burnout level according to the Maslach Burnout Inventory (MBI-GS) and the levels of depression, anxiety and stress according to the DASS-21.

Results: Thirty-nine participants were included in the trial; 36 (92.3%) took part at the 3-months-follow-up. Intention-to-treat analyses revealed significant group differences in favor of the intervention group in depression (d?=?0.66), cynicism (d?=?0.87) and personal accomplishment (d?=?0.75).

Conclusions: The intervention helped ameliorate symptoms of work-related stress and burnout. Although limited by a small sample size, the study suggests that the program provides effective support for affected individuals. However, further studies with bigger sample sizes should be conducted to examine the effects of such programs more precisely.     

Internet-Based Cognitive Behaviour Therapy for Tinnitus Patients Delivered in a Regular Clinical Setting: Outcome and Analysis of Treatment Dropout

Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n = 293) and a low-intensity version of ICBT (n = 81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.     

College Characteristics Associated with Freshman Attrition

100 randomly selected four-year institutions with very low freshman dropout rates were compared with a comparable group of institutions that had freshman attrition rates that were not “low,” in order to determine whether the two types of institutions differed in respect to 22 selected variables. It was found that colleges with low freshman dropout rates did differ significantly from the comparison group on 15 of the 22 characteristics analyzed. 10 of the 15 variables were personal (i.e., they related to student characteristics), whereas the remaining 5 were nonpersonal (e.g., the size of the institution and the cost of attending it). The general conclusion reached was that administrators who seek to understand and to cope with the freshman dropout problem must take into consideration both personal and nonpersonal factors associated with the phenomenon of freshman attrition.     

Internet-based self-help treatment for panic disorder: a randomized controlled trial comparing mandatory versus optional complementary psychological support

Panic disorder (PD) is one of the most common psychiatric disorders. Web-based self-help treatments for PD have had promising results. These online treatments seem to have larger effect sizes (ESs) when professional support is added. However, the amount of support or how it should be administered is not yet clear. The aim of this trial was to study two ways of administering psychological support provided by phone as a part of Internet-based self-help treatment for PD based on cognitive behavioral therapy. Seventy-seven participants diagnosed with PD were randomly assigned to one of three experimental conditions: a waiting list control group; a treatment group with non-scheduled psychological support; or a treatment group with scheduled psychological support. PD symptoms of participants who received treatment improved significantly compared to the control group (mean ES d = 1.18, p < .05). In addition, there were statistically and clinically significant differences between treatment groups (Mean difference = ?3.20, p = .005, 95% CI [?5.62, ?.79]). The scheduled group showed a larger ES, a lower dropout rate, and better adherence to treatment than the non-scheduled group. Scheduled support seems to be indicated for patients who seek Web-based treatment for PD, and their symptoms of panic, anxiety, and depression improve at post-treatment and six-month follow-up. In contrast, when support depends on patient demand, they receive less support and so, the therapeutic effect is poorer.     

A Comparison of the Effects of Prejob Training and Job Experience on Nonprofessional Telephone Crisis Counselors

ABSTRACT: This study, carried out in a telephone crisis intervention program in which nonprofessional volunteer counselors received 55 hours of prejob training, isolates the effects of prejob training and on-the-job experience. Participants in the study were evaluated on several parameters including knowledge, counseling skills, acceptance of others, and dogmatism. Three groups of volunteers were measured: group 1—measured immediately before and after prejob training, group 2—measured just after prejob training, and group 3—measured after five months of telephone counseling experience. Results indicate that counselor skills and knowledge significantly increased with prejob training, but did not show further improvement as a result of five months of experience. Attitudes such as acceptance of others and dogmatism did not change either as a result of training or experience. Dogmatism was found to be inversely related to both counselor skill and knowledge.     

Internet Versus Group Cognitive-Behavioral Treatment of Distress Associated With Tinnitus: A Randomized Controlled Trial

Tinnitus distress can be reduced by means of cognitive-behavior therapy (CBT), and the treatment can be delivered in different ways. The most recent format is Internet-based self-help. The aim of this study was to compare this treatment (n = 26) with standard group-based CBT (n = 25) in a randomized controlled trial. Outcomes on self-report inventories measuring tinnitus distress were evaluated immediately after and 1 year after treatment. Results showed that both groups had improved, and there were few differences between them. The effect size for the Internet treatment was d = 0.73 (95% CI = 0.16–1.30) and for the group treatment was d = 0.64 (95% CI = 0.07–1.21). The Internet treatment consumed less therapist time and was 1.7 times as cost-effective as the group treatment. At pretreatment patients rated the Internet treatment as less credible than the group treatment. In conclusion, Internet treatment for tinnitus distress merits further investigation, as the outcomes achieved are promising.     

Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact

Tinnitus is an experience of sound in the absence of an appropriate external source. A symptom that can accompany most central or peripheral dysfunctions of the auditory system, tinnitus can lead to significant distress, depression, anxiety, and decreases in life quality. This paper investigated the construct of psychological acceptance in a population of tinnitus patients. First, a cross-sectional study (N = 77) was conducted in which a tinnitus specific acceptance questionnaire was developed. Results showed that a Tinnitus Acceptance Questionnaire (TAQ) generated good internal consistency. A factor solution was derived with two factors: activity engagement and tinnitus supression. Second, a longitudinal study (N = 47) investigated the mediating role of acceptance on the relationship between tinnitus distress at baseline and tinnitus distress, anxiety, life quality, and depression at a 7-month follow-up. The results showed full mediation of activity engagement for depression and life quality at follow-up, partial mediation for tinnitus distress, and no mediation for anxiety. The role of acceptance in the negative impact of tinnitus distress merits further investigation.     

An Event History Analysis of First-Term Soldier Attrition

The study of attrition has largely focused on identifying demographic or biographic characteristics that predict whether soldiers complete their enlistment term. As a result, much is known about who attrites. Less is known about why soldiers attrite. This research assessed the influence of two psychological factors on U.S. Army soldier attrition: self-reported confidence that one could complete one’s term of service and ambivalence regarding the decision to enlist. The study sample consisted of first-term enlisted soldiers (N = 14,808) who were respondents to Army surveys. Results of fitting three longitudinal models indicated that confidence in being able to complete one’s term of obligation was more predictive of attrition for those reporting greater ambivalence regarding the decision to enlist. This effect was significant throughout a 3-year period. This work adds to our understanding of attrition by highlighting the role of confidence and ambivalence. Implications for strategies to reduce attrition are discussed.     

A pragmatic trial evaluating the effectiveness of web versus live training in functional behavior assessment and interventions among special educators

This study adopted a pragmatic trial with randomization to investigate the relative effectiveness of web versus live training on special educators' competence and perceived skills in functional behavior assessments (FBA) and behavior interventions. Pragmatic trials seek to determine the effectiveness of an intervention in a real-world setting to ensure better application and generalizability in routine practice conditions. The live training group received an in-person workshop delivered in a lecture format via powerpoint slides. The web training group received asynchronous online instruction via a secure website. The same training content was delivered to both groups. Participants were randomly assigned across both instructional modalities and completed two pre- and post-test measures. Results indicated that participants (N = 104) in both groups showed a significant increase in theoretical competence of FBA and behavior interventions post training. Only participants in the live workshop group reported a significant increase in perceived skill scores. When comparing outcomes across groups, the live training group gained significantly more theoretical competence in FBA and behavior interventions than that in the web training group. These results shed light on the practical implications of online platforms for professional development among in-service teachers in behavior management for schools with children having disabilities and challenging behavior.     

Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial

The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60 min sessions. The TRT treatment consisted of one 150 min session, one 30 min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8 h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen’s d = 1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen’s d = 0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.     

Development of an Attitudes and Intentions Scale for Construction Skills Training Programs

Attrition is a major problem in construction skills training programs for young adults, with dropout rates ranging between 45% and 65%. Training resources could be used more efficiently if trainees' completion rates were increased. Understanding and measuring the psychological characteristics contributing to attrition allows training practitioners to implement interventions to reduce dropout. This article reports the development of an instrument designed to measure constructs that inform participants' performance and success within the construction training domain. Instrument reliability and validity as well as areas of further research are discussed.     

Effectiveness of Two Cognitive Interventions Promoting Happiness with Video-Based Online Instructions

A 3-month experimental online study examined the short-term and 1 month follow-up effects of regularly practicing one of two cognitive interventions on subjective well-being. Participants were 435 self-selected adults (366 female, 69 male, aged 18–63) randomly assigned to one of three conditions: writing about best possible selves in the future (n = 135), making gratitude lists (n = 150) or writing to-do-lists as a control condition (n = 150). The study was fully self-administered and exercise instructions were given in online videos. Repeated-measures MANOVA revealed that both interventions significantly increased subjective well-being in comparison to the control condition. Effect sizes for the different components of subjective well-being ranged from r = .09–.13 (η² = .01–.02) for the 2 months intervention period. These effects were maintained until the 1-month follow-up. Enjoyment and interest regarding the exercise as indicators of perceived person-intervention-fit moderated the effect; participants of the happiness interventions who perceived a better fit showed greater increases in subjective well-being. These findings confirm previous research on these interventions and encourage further studies on online interventions, especially regarding possibilities to increase participants’ motivation and reduce dropout attrition.     

Spaced Retrieval Enhances Memory in Older Adults with Probable Alzheimer's Disease

We used the spaced retrieval method to improve recall of everyday objects in older adults with probable Alzheimer's Disease. Three training sessions were administered on alternate days over a week. On each training trial, participants selected a designated object from an array of items at increasingly longer retention intervals. Implicit and explicit memory for the target item was assessed after each session. Results indicated that spaced-retrieval training enhanced retention of the target item within and across sessions for all participants. Implications of these findings for current views on memory interventions for cognitively impaired older adults are discussed. affiliated with the Menorah Park Center for the Aging     

Effects of incentives in web-based prevention for adolescents: Results of an exploratory field study

This study examines if the willingness of adolescents to participate in a web-based prevention program can be increased by providing an incentive for participation. Eighth graders (n = 166) were instructed to work on an online stress-prevention program via the internet from home. A subgroup of n = 80 subjects from three school classes were told that they would take part in a raffle if they completed the program. The remaining n = 86 participants (again three classes) served as a control group. The school classes were randomly allocated to the training conditions. During the 8-week intervention period, compliance rates were recorded by means of an online tracking system. In addition, self-reported compliance and training acceptance were assessed. The application of an incentive had considerable effects on retention rates, on training acceptance and self-assessed effectiveness of the intervention. Adolescents in the ‘incentive condition’ completed three times as many program lessons as control subjects did, and–as their self-reports suggest–they worked as attentively. Validity of self-reported compliance was higher among participants of the incentive group and they reported significantly higher program acceptance. As a consequence, the application of incentive systems is recommended for future implementation of web-based prevention programs targeting adolescents.     

Participation and Attrition in a Coping Skills Intervention for Adolescent Girls with Inflammatory Bowel Disease

The current study examined factors associated with adolescent and parent participation in a coping skills intervention for adolescent girls with inflammatory bowel disease (IBD) and examined factors associated with attrition related to intermittent missing data. Thirty-one adolescent girls with IBD and their parents enrolled in the intervention. Psychosocial and disease factors related to participation in the 6-week web component of the coping skills intervention were examined as were baseline group differences between those who provided post-treatment data and those who did not. Adolescents experiencing more difficulties related to their disease and psychosocial functioning participated less in the web component of the treatment intervention. Families who attrited had higher baseline levels of parental catastrophic thoughts, parenting stress, and adolescent depression. Families experiencing greater levels of psychological and disease-related difficulties may be at risk for low participation and eventual dropout from pediatric IBD psychological treatment interventions.     

Role of social skills training in adolescents with social anxiety disorder

Background/Objective: Social skills training (SST) is frequently included in the treatment of social anxiety disorder (SAD) in both children and adolescents, although there is no empirical evidence to support it. Consequently, our objective is to study the role and effects of SST in the treatment of a sample of adolescents with SAD. Method: A total of 108 adolescents diagnosed with generalized social phobia were randomly assigned to two treatment conditions (with and without SST) and a control group waiting list (WLCG). The evaluation included self-report measures, observational tests and blind evaluators. Results: Both interventions significantly reduced the number of social situations feared/avoided with respect to the WLCG, which worsened. Likewise, both interventions were effective but the group with SST obtained better results in the post-test and follow-ups, as well as a lower dropout rate (6:1). Conclusions: The use of SST reduces the dropout rate of treated adolescents and increases the effectiveness of the Intervention Program for Adolescents with Social Phobia.     

Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial

Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n = 31) or wait-list control (n = 30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly – S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohen’s d = 0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohen’s d = 0.61, 95% CI [0.04, 1.19], and quality of life, Cohen’s d = 0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.     

Differential outcomes of skill training,group counseling,and individual cognitive therapy for persons with acquired visual impairment

As part of the Living Skills Training Program, group counseling and individual cognitive therapy were implemented to decrease psychological distress for adults with acquired visual impairment. This quasi‐experimental design study compared the outcomes of a 6‐month skill training program combined with a group counseling program (n = 37), with (n = 9) or without (n = 10) individual cognitive therapy, and with a control group (n = 42). The outcome measures were the Profile of Mood States and the Nottingham Adjustment Scale Japanese Version. The results showed that participants with low psychological distress decreased anxiety and increased acceptance of disability, even when they did not participate in group counseling. However, among the participants with high distress, they did not show any improvement without group counseling or individual therapy. The participants with high distress who engaged in group counseling showed an improving trend in attitudes toward others. Moreover, the participants who chose to engage in individual therapy in addition to group counseling showed decreased tension‐anxiety, depression, and fatigue, and significantly improved acceptance of disability. These results suggest that group counseling, combined with individual cognitive therapy, can be an effective part of rehabilitation treatment for clients who have high psychological distress.