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Internet-based Guided Self-help for Chronic Tinnitus (TITUS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT01205919
Recruitment Status : Completed
First Posted : September 21, 2010
Last Update Posted : April 3, 2014
Linkoeping University
Information provided by (Responsible Party):
Cornelia Weise, Linkoeping University

Brief Summary:
The purpose of this study is to determine the efficacy of a cognitive behavioral guided self-help training provided via the internet on tinnitus distress in a German sample.

Condition or disease Intervention/treatment Phase
Tinnitus Behavioral: Internet-based guided self-help for tinnitus Other: Internet discussion forum Not Applicable

Detailed Description:
Long waiting periods and the deficiency of outpatient therapies stimulated the development of internet-based interventions for a variety of mental disorders during the last years. A Swedish research group developed an internet-based self-help training for patients with chronic tinnitus showing promising results (Andersson et al., 2002; Kaldo et al., 2007; Kaldo et al., 2008). This self-help training was now adapted for German-speaking patients. The present study evaluates the efficacy of this treatment in a randomized controlled trial conducted in Germany. Further aims are a process evaluation of the treatment and the identification of predictors of efficacy.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 124 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy of an Internet-based Guided Self-help Training for Chronic Tinnitus: A Randomized Controlled Trial
Study Start Date : May 2010
Actual Primary Completion Date : October 2010
Actual Study Completion Date : October 2011

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Tinnitus

Arm Intervention/treatment
Experimental: Internet-based self-help
This self-help training is exclusively provided via Internet over a period of 10 weeks. The treatment is based on the cognitive-behavioral approach and consists of 18 modules with helpful strategies to cope with tinnitus (e.g., applied relaxation, positive imagery, attention shift exercises, cognitive restructuring, sleep management, concentration management,). All modules include an information text, detailed practice instructions, worksheets and homework assignments. At the end of each treatment week, there is an e-mail contact between the participants and their therapist. The participants report on their work with the modules and if they had encountered any problems. The therapist provides feedback, support and recommendations on how to proceed.
Behavioral: Internet-based guided self-help for tinnitus
Internet-based guided self-help for tinnitus: provided via Internet, duration of 10 weeks

Active Comparator: Discussion forum group
To the participants of the control group the internet-based self-help after waiting time of 10 weeks is offered. During the waiting period participants receive access to a tinnitus online discussion forum.
Other: Internet discussion forum
Tinnitus-specific internet discussion forum over 10 weeks (no therapeutic intervention)

Primary Outcome Measures :
  1. Tinnitus Handicap Inventory (THI; Newman, Jacobson, & Spitzer, 1996; German version: Kleinjung et al., 2007) [ Time Frame: 18 months ]
    The measure assesses tinnitus-related disability and handicap.

  2. MINI-Tinnitus Questionnaire (Mini-TQ; Hiller & Goebel, 2004) [ Time Frame: 18 months ]
    The measure is a short version of the Tinnitus Questionnaire (TQ, Goebel & Hiller, 1998), to assess tinnitus-related psychological distress.

Secondary Outcome Measures :
  1. Hospital Anxiety and Depression Scale (HADS-D; Zigmond & Snaith, 1983; German version: Herrmann-Lingen, Buss, & Snaith, 2005) [ Time Frame: 18 months ]
    The measure assesses depression and anxiety.

  2. Insomnia Severity Index (ISI; Bastien, Vallière, & Morin, 2001; German version: Pillmann, 2004) [ Time Frame: 18 months ]
    The measure assesses the quality of sleep (sleep duration, sleep quality and negative impact on daily functioning).

  3. Tinnitus Cognitions Questionnaire (T-Cog; Hiller & Haerkötter, 2005) [ Time Frame: 18 months ]
    The measure assesses dysfunctional beliefs and cognitions regarding the tinnitus.

  4. Anxiety Sensitivity Index - 3 (ASI-3; Taylor et al., 2007; German version: Kemper, Ziegler, & Taylor, 2007) [ Time Frame: 18 months ]
    The measure assesses the fear of anxiety-related sensations.

  5. Fear Avoidance Questionnaire (FAQ; self-developed) [ Time Frame: 18 months ]
    The measure assesses fear-avoidance beliefs and behavior.

  6. Working Alliance Inventory - Short Revised (WAI-SR; Horvath & Greenberg, 1986, 1989; German version: Wilmers et al., 2008) [ Time Frame: 2 months ]
    The measure assesses three aspects of the therapeutic alliance (development of an affective bond, agreement on the tasks of therapy and agreement on the goals of therapy).

  7. Credibility Scale (Devilly & Borkovec, 2000; self-translated and adapted to an intervention for tinnitus) [ Time Frame: 6 months ]
    The scale assesses treatment credibility.

  8. Therapy Expectancy Scale (self-developed) [ Time Frame: baseline ]
    The scale assesses treatment expectancy.

  9. Therapy Satisfaction Scale (self-developed) [ Time Frame: week 10 ]
    The scale assesses treatment satisfaction.

  10. Web Screening Questionnaire for Common Mental Disorders (WSQ; Donker, van Straten, Marks, & Cuijpers, 2009; self-translated German version) [ Time Frame: 3 months ]
    The questionnaire screens for depressive disorder, alcohol abuse/dependence, generalized anxiety disorder, posttraumatic stress disorder, social phobia, panic disorder, agoraphobia, specific phobia, and obsessive-compulsive disorder.

  11. Big Five Inventory (BFI-10; Rammstedt & John, 2007; German version: Rammstedt & John, 2007) [ Time Frame: baseline ]
    The measure is the short version of the Big Five Inventory (BFI; John, Donahue, & Kentle, 1991) and assesses the five personality traits extraversion, agreeableness, conscientiousness, neuroticism, and openness.

  12. Process evaluation items (self-developed) [ Time Frame: 18 months ]
    10 items assess tinnitus loudness, tinnitus annoyance, perceived control, general mood, tinnitus acceptance, social functioning, behavioral avoidance and fear of sounds as well as the use of learned methods during the last week.

  13. Tinnitus Acceptance Questionnaire (TAQ; Westin, Hayes, & Andersson, 2008; self-translated) [ Time Frame: 18 months ]
    The measure assesses psychological acceptance of the tinnitus.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age of at least 18 years
  • Chronic tinnitus for at least 6 months
  • Medical examination of tinnitus by an ear, nose and throat physician (ENT)
  • Scoring 38 or above on the Tinnitus Handicap Inventory (THI) or scoring 13 or above on the Mini-Tinnitus Questionnaire (Mini-TQ)
  • Not currently receiving psychological treatment for tinnitus
  • Being able to access the Internet and print instructions
  • Sufficient knowledge of the German language to read and follow the Internet-based self-help program

Exclusion Criteria:

  • Tinnitus caused by any other general medical condition or otologic disease (e.g., active Meniere's Disease)
  • Clinical diagnosis of any severe mental disorder (especially a severe depressive disorder, suicidality, acute psychosis)
  • Clinical diagnosis of Dementia or another severe organic cerebral disorder
  • Clinical diagnosis of substance-related addiction/abuse

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01205919

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Department of Behavioural Sciences and Learning, Linkoeping University
Linköping, Sweden, SE-58183
Sponsors and Collaborators
Johannes Gutenberg University Mainz
Linkoeping University
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Study Chair: Gerhard Andersson, Ph.D. Linkoeping University
Principal Investigator: Cornelia Weise, Ph.D. Linkoeping University
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Cornelia Weise, Ph.D., Linkoeping University
ClinicalTrials.gov Identifier: NCT01205919    
Other Study ID Numbers: TITUS-110510
First Posted: September 21, 2010    Key Record Dates
Last Update Posted: April 3, 2014
Last Verified: April 2014
Keywords provided by Cornelia Weise, Linkoeping University:
Internet Training
Cognitive-Behavior Therapy
Additional relevant MeSH terms:
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Hearing Disorders
Ear Diseases
Otorhinolaryngologic Diseases
Sensation Disorders
Neurologic Manifestations
Nervous System Diseases