Background: Tinnitus refers to the perception of sound in the absence of an external stimulus. It is often associated with other health problems including anxiety, depression, and insomnia. Receiving evidence-based treatments, such as cognitive behavioral therapy (CBT), can reduce the severity of the tinnitus and associated comorbidities, but such treatments are not always accessible. Internet-based cognitive behavioral therapy (ICBT) for tinnitus has been developed to increase accessibility of CBT. ICBT is available in only a few languages and needs to be translated and adapted to be accessible to more globally communities. With this in mind, ICBT was translated and adapted for Spanish communities. The feasibility of offering ICBT to Spanish communities has, however, not been established.
Objectives: The objective of this study was to determine the feasibility of ICBT adapted for Spanish speakers in terms of recruitment feasibility from different countries, outcome feasibility in reducing tinnitus distress and tinnitus related comorbidities was also investigated and acceptance, compliance and intervention engagement feasibility. It intended to refine the protocol prior to implementation of a larger randomized clinical trial.
Method: A single-group pretest posttest design was used. The primary outcome was a change in tinnitus distress. Secondary outcome measures included measures of anxiety, depression, insomnia, tinnitus cognitions, hearing-related difficulties, and health-related quality of life. Compliance feasibility was measured regarding the number of withdrawals from the study and questionnaire completion rates at post-intervention and follow-up. Intervention engagement was monitored by the number of logins into the intervention platform, number of modules opened, and number of messages sent.
Results: Recruitment feasibility on a small-scale was shown as 46 Spanish-speakers with tinnitus were screened. There were 32 participants meeting the eligibility criteria, with a mean age of 47 (± 11) years. Of these 91% were Hispanic or Latino with 66% living in Spain and 34% living in South America. Outcome feasibility was established, as a large pre-post test effect size of d = 0.9 was found for tinnitus severity. Large pre-post test effect sizes were also present for the secondary outcomes of anxiety and depression with a medium effect for insomnia, health-related quality of life, and tinnitus cognitions. Compliance rates were not optimal at 69% at post-intervention and 50% at follow-up, although no participants withdrew. Intervention engagement was variable, although all participants logged into the intervention and read at least 1 module. Intervention acceptance and satisfaction was evident, with scope for improvements.
Conclusions: ICBT for Spanish communities appears feasible. Protocol refinements are required to improve recruitment, compliance and engagement. A randomized controlled trial is required to further investigate the intervention effects in Spanish communities. Larger studies are required to identify ways of improving acceptability, accessibility and attracting Spanish speakers from different countries to undertake ICBT for tinnitus.