The role of “on demand” therapist guidance vs. no support in the treatment of tinnitus via the internet: a randomized controlled trial
Open accessAbstract
Internet-based cognitive behavioral self-help treatments (iCBT) have been shown to successfully reduce the distress associated with tinnitus. Despite this success, little is known about the mechanisms that make iCBT for tinnitus sufferers work. Availability of minimal therapeutic support is assumed to positively influence treatment outcome in iCBT, but the lower limit of required support is not known. In face-to-face therapy, patients' positive outcome expectations have demonstrated an advantageous effect on outcome. The first aim of our study was thus to investigate the role of ‘on demand’ therapeutic guidance vs. no therapeutic support on treatment outcome in an iCBT for tinnitus sufferers. Our second aim was to investigate whether positive outcome expectations can predict treatment outcome. A total of 112 tinnitus patients were randomly assigned to one of two groups (support-on-demand or non-support). Both groups received an established iCBT treatment for tinnitus. While participants in the support group (n = 56) could ask a therapist for additional support, those in the other (n = 56) received no therapeutic guidance. Tinnitus distress was assessed pre- and post-treatment via the Tinnitus Handicap Inventory (THI) and the Mini-Tinnitus Questionnaire (Mini-TQ). Pre-treatment outcome expectations were assessed using the Patient Questionnaire on Therapy Expectation and Evaluation (PATHEV). We observed significantly less tinnitus distress in the THI (support: t(55) = 7.51, p ≤ .001; non-support: t(55) = 7.68, p ≤ .001) and Mini-TQ (support: t(55) = 8.24, p ≤ .001; non-support: t(55) = 8.46, p ≤ .001) in both groups from pre- to post-treatment, but no significant differences between the groups or interactions. The PATHEV subscale “Hope of Improvement” significantly predicted treatment outcome as measured by the THI (β = 0.28, p = .027). The iCBT self-help program is a good treatment option for tinnitus sufferers whether or not support-on-demand is provided. Furthermore, our results show the importance of outcome expectations to the efficacy of iCBT in tinnitus patients. Future research should focus on discovering further predictors of treatment outcome.
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Intervention dropout in the two GoD studies was rather low and comparable in all conditions (20-30%).
“In line with this, intervention dropout in the two studies was rather low and comparable in all conditions (20–30%).”
From StudiCare mindfulness-study protocol of a randomized controlled trial evaluating an internet- and mobile-based intervention for college students with no and "on demand" guidance. (2020) · cites this paper as [36]
Section 3.1 reports comparable treatment dropout between this study’s support-on-demand and non-support groups, with no statistically significant difference. But its stated dropout counts are 9 and 11 out of 56 participants (about 16% and 20%), not 20–30% in both conditions. This paper also cannot establish the rate in the other study mentioned by the citing sentence. (LLM, conf=0.86)
Experimental — accuracy not yet measurediCBT effectively reduced tinnitus distress regardless of therapist support.
“Conversely, a randomized controlled trial comparing on-demand guided iCBT with unguided iCBT for tinnitus showed that iCBT effectively reduced tinnitus distress regardless of therapist support (Rheker et al., 2015).”
From Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis (2025) · cites this paper as Rheker et al., 2015
Both GoD-IMI trials did not find any significant differences in efficacy or adherence of GoD-IMIs compared to unguided IMIs.
“Contrary to what one would expect, both studies did not find any significant differences in efficacy or adherence of GoD-IMIs compared to unguided IMIs.”
Only two trials have examined GoD-IMIs, delivering CBT to people with social phobia and tinnitus.
“So far, only two trials examined GoD-IMIs, delivering cognitive behavioral therapy (CBT) to people with social phobia [35] and tinnitus [36].”
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Størksen, H. T., Haga, S. M., Hammerstrøm, K. T., Jacobsen, H., & Drozd, F. (2022) · Acta Paediatrica · doi:10.1111/apa.16569 · Cited by 5 · see citing works
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Self-citationOscarsson, M., Hammarbäck, S., Wiberg, K. B., Rozental, A., Ginsberg, Y., Carlbring, P., Andersson, G., & Jönsson, F. U. (2025) · JMIR Formative Research · doi:10.2196/66388 · Cited by 3 · see citing works
Self-citationSelf-Care practices for anxiety during the COVID-19 pandemic in the UK in adults
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Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis
He, Y., Liu, J., Cheng, H., Ye, H., Li, C., Gao, Y., & Xu, X. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2025.1536224 · Cited by 2 · see citing works
Promoting Acceptance of Differences: A Web‐Based Intervention for South Korean Couples
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Behandlungsansätze bei Tinnitus
Weise, C., Kleinstäuber, M., Kaldo, V., & Andersson, G. (2016) · Springer eBooks · doi:10.1007/978-3-642-54763-8_5
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Käll, A. (2021) · Linköping studies in behavioural science · doi:10.3384/9789179290580
3 Internet-Delivered Guided Self-Help Treatments for Tinnitus
(2022) · Thieme Publishers New York eBooks · doi:10.1055/b-0042-189034
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Clinical Practice Guideline: Tinnitus Update
Adams, M. E., Cramer, J. D., Tunkel, D. E., Lee, V. S., Bourgeois, J. A., Eshraghi, A. A., Fagelson, M. A., White, K. B., Juliano, A. F. T., Kim, H., et al. (2026) · Otolaryngology · doi:10.1002/ohn.70417 · Cited by 1 · see citing works
- Authors
- Rheker, J., Andersson, G., & Weise, C.
- Affiliations
- Philipps University of Marburg (DE)
- Linköping University (SE)
- Corresponding author
- Rheker, Julia
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 2
- Issue
- 2
- Pages
- 189-199
- ISSN
- 2214-7829 (ISSN-L)
- OpenAlex
- W2019991991
- Cited by
- 38
- References
- 73
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 5 · 2015: 2
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- German Research Foundation (RI 574/22-1)
- Topics
- Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
- Keywords
- tinnitus, internet-based cognitive behavioral therapy, outcome expectations, treatment outcome predictors, tinnitus distress, self-help treatment, Tinnitus Handicap Inventory
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