The effect of waiting: a meta-analysis of wait-list control groups in trials for tinnitus distress
Abstract
Objective The response rates and effects of being placed on a wait-list control condition are well documented in psychiatric populations. Despite the usefulness of such estimates and the frequent use of no-treatment controls in clinical trials for tinnitus, the effect of waiting in a tinnitus trial has not been investigated systematically. The aim of the present study was to quantify the overall effect of wait-list control groups on tinnitus distress.Methods Studies were retrieved via a systematic review of randomised controlled trials of cognitive behaviour therapy for tinnitus distress. Outcomes of psychometrically robust tinnitus-specific measures (Tinnitus Handicap Inventory, Tinnitus Questionnaire, Tinnitus Reaction Questionnaire) from wait-list control groups were quantified using meta-analytic techniques. Percentage of change and standard mean difference effect sizes were calculated using the pre and post wait period.Results Eleven studies involving 314 wait-list subjects with tinnitus were located. The analysis for a waiting period of 6 to 12 weeks revealed a mean decrease in scores on tinnitus-specific measures of 3% to 8%. Across studies, a statically significant small mean within-group effect size was obtained (Hedges' g=.17). The effects were moderated by methodological quality of the trial, sample characteristics (i.e., age, tinnitus duration), time of the wait-list and how diagnosis was established.Conclusion Subjects in a tinnitus trial improve in tinnitus distress over a short waiting phase. The effects of waiting are highly variable and depend on the characteristics of the sample and of the trial.
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A meta-analysis by Hesser et al. (2011) on tinnitus distress treatment found smaller effect sizes with advancing age in the waiting condition.
“a meta-analysis by Hesser et al. (2011) on tinnitus distress treatment found smaller effect sizes with advancing age in the waiting condition.”
From Feasibility, acceptability, and preliminary efficacy of an internet-based CBT intervention for loneliness in older adults: A pilot RCT (2024) · cites this paper as Hesser et al. (2011)
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“Conditions such as depression, generalized anxiety disorder, post-traumatic stress disorder (PTSD), and sleeplessness have been consistently observed among tinnitus sufferers [8–11].”
Schiele, M. A., Vietz, M., Gajewska, A., Unterecker, S., Gottschalk, M. G., Deckert, J., Neufang, S., Schmidt, N. B., & Domschke, K. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.08.265 · Cited by 11 · see citing works
Mechanisms for the testing effect on patient-reported outcomes
Jones, S. M. W., Shulman, L., Richards, J. A., & Ludman, E. J. (2020) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2020.100554 · Cited by 10 · see citing works
Strengths-based CBT: Internet-Based Versus Face-to-Face Therapy in A Randomized Controlled Trial
Victor, P. P., Krug, I., Vehoff, C., Lyons, N., & Willutzki, U. (2018) · Journal of Depression & Anxiety · doi:10.4172/2167-1044.1000301 · Cited by 10 · see citing works
“On the one hand, the effect could be explained by a spontaneous remission of symptoms as reported by meta-analyses for tinnitus and major depressive symptoms [55,56].”
BackgroundFirst assessment of sophrology for the treatment of subjective tinnitus
Grevin, P., Ohresser, M., Kossowski, M., Duval, C., & Londero, A. (2020) · European Annals of Otorhinolaryngology Head and Neck Diseases · doi:10.1016/j.anorl.2020.03.007 · Cited by 10 · see citing works
Placebo, usual care and wait-list interventions for all mental health disorders
Faltinsen, E., Todorovac, A., Hróbjartsson, A., Gluud, C., Kongerslev, M. T., Simonsen, E., & Storebø, O. J. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.mr000050 · Cited by 9 · see citing works
Intratympanic Steroid Injection in Tinnitus Management
Shim, H. J. (2016) · Hanyang Medical Reviews · doi:10.7599/hmr.2016.36.2.125 · Cited by 8 · see citing works
“Only a meta-analysis of 314 wait-list subjects with tinnitus as control groups in 11 randomized controlled studies revealed a significant decrease in scores on tinnitus-specific measures of 3% to 8% [20].”
MethodBasharpoor, S., Zakibakhsh Mohammadi, N., Heidari, F., Azarkolah, A., Vicario, C. M., & Salehinejad, M. A. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.089 · Cited by 7 · see citing works
Li, W., Liu, X., Lin, J., Huang, J., Li, S., Xu, N., Fu, W., & Liu, J. (2025) · Journal of Pain Research · doi:10.2147/jpr.s515679 · Cited by 7 · see citing works
“17,18 However, delaying acupuncture treatment may have negative consequences for CNP patients, such as worsening symptoms or increased psychological stress.”
Tao, Y., Chen, K., Li, D., Yin, K., Li, Y., Long, J., & Hui, L. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2022.1085684 · Cited by 6 · see citing works
“Similarly, subjects assigned to a “waiting list” control group in certain clinical trials showed a modest but significant reduction in tinnitus distress (8).”
BackgroundMacDonald, D. E., & Cassin, S. E. (2015) · Psychopathology Review · doi:10.5127/pr.037014 · Cited by 6 · see citing works
Patel, N., Malicka, A. N., McGinnity, S., Anderson, R. B., Paolini, A. G., & Crosland, P. (2021) · Ear and Hearing · doi:10.1097/aud.0000000000001112 · Cited by 5 · see citing works
“This result is consistent with previously conducted meta-analysis showing small, statistically significant improvements in tinnitus severity for those in a waitlist condition (Hesser et al. 2011; Phillips et al. 2018).”
ResultThe Analogy between Tinnitus and Chronic Pain: A Phenomenological Approach
Noreña, A. J. (2023) · Brain Sciences · doi:10.3390/brainsci13081129 · Cited by 5 · see citing works
“Tinnitus is disturbing for only 20% of subjects, and many of them get better with time [87].”
BackgroundBuizza, C., Franco, E., & Ghilardi, A. (2023) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-023-09588-0 · Cited by 4 · see citing works
A fülzúgás csoportos kognitív viselkedésterápiás kezelése
Bencsik, B., Bokk, O., Vajda, D., & Judit Szigeti, F. (2024) · Orvosi Hetilap · doi:10.1556/650.2024.32934 · Cited by 3 · see citing works
A psychological intervention for caries active young adults, a randomized controlled trial
Hagman, J., Wide, U., Werner, H., & Hakeberg, M. (2021) · Clinical and Experimental Dental Research · doi:10.1002/cre2.513 · Cited by 3 · see citing works
Psychotherapy for PTSD and stress disorders
Sikkema, K. J., & Coleman, J. N. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814932-4.00009-4 · Cited by 3 · see citing works
Jiang, S. (2016) · UC Research Repository (University of Canterbury) · doi:10.26021/6257 · Cited by 3 · see citing works
Jackson, J. G., & Woolmer, C. D. (2024) · Mindfulness · doi:10.1007/s12671-024-02357-y · Cited by 2 · see citing works
“Further, in their meta-analysis of 11 studies, Hesser et al. (2011) have previously noted that being in a waiting list control group can reduce tinnitus distress by 3–8%, with the authors suggesting that waiting can increase awareness of tinnitus symptoms, making it more likely that patients will…”
Mui, B., Muzaffar, J., Chen, J., Bidargaddi, N. P., & Shekhawat, G. S. (2025) · Speech Language and Hearing · doi:10.1080/2050571x.2025.2526235 · Cited by 2 · see citing works
“Interestingly, previous research has noted possibilities of improvement in tinnitus distress in wait-list control groups (Hesser et al., 2011).”
Outcomes of Tinnitus Interventions: An Umbrella Review of Systematic Reviews with Meta-Analysis
Chen, K., Monaghan, N. P., Nguyen, S. A., Chun, W. B., Mills, J. F., Brennan, E., & Meyer, T. A. (2025) · Annals of Otology Rhinology & Laryngology · doi:10.1177/00034894251394754 · Cited by 2 · see citing works
Première évaluation de la prise en charge sophrologique des acouphènes subjectifs
Grevin, P., Ohresser, M., Kossowski, M., Duval, C., & Londero, A. (2020) · Annales françaises d Oto-rhino-laryngologie et de Pathologie Cervico-faciale · doi:10.1016/j.aforl.2019.07.002 · Cited by 2 · see citing works
Multidisciplinary group information for patients with tinnitus
Zarenoe, R., Eriksson, T. B., Dahl, J., Ledin, T., & Andersson, G. (2018) · Hearing Balance and Communication · doi:10.1080/21695717.2018.1453176 · Cited by 2 · see citing works
“Patients evaluated the effect of the group information a short time after the meeting (4 weeks), and it is possible that the symptom reductions reflect regression to the mean [30].”
BackgroundTinnitracks – Erste Ergebnisse einer Anwenderbefragung
Löhler, J., & Dobel, C. (2019) · Laryngo-Rhino-Otologie · doi:10.1055/a-1007-1858 · Cited by 2 · see citing works
Weise, C., Kaiser, G., & Kleinstäuber, M. (2019) · Psychotherapy and Psychosomatics · doi:10.1159/000500169 · Cited by 2 · see citing works
Tinnitus in Context A Contemporary Contextual Behavioral Approach
Hesser, H. (2013) · DiVA (Linkoping University) · Cited by 2 · see citing works
Ponting, C., Baer, R. J., Blackman, K. C. A., Blebu, B. E., Felder, J. N., Oltman, S. P., Tabb, K. M., & Jelliffe‐Pawlowski, L. L. (2025) · JMIR Research Protocols · doi:10.2196/70627 · Cited by 1 · see citing works
“RenderX asked to wait to receive treatment [39].”
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“The reason for the use of a waiting list control group is that psychologists consider it to be a cost-effective and ethical alternative group compared to a no-treatment control group when studying the effects of psychological interventions (VandenBos, 2007; Hesser et al., 2011; Kinser and Robins, 2013; Schimelpfening,…”
BackgroundCognitive-Behavioral Treatment of Childhood Anxiety: Examining a Parent Consultation Model
Smith, A. (2013) · doi:10.23860/diss-smith-allison-2013 · Cited by 1 · see citing works
“There are also ethical considerations regarding withholding treatment from clinical populations and unanticipated detrimental effects due to disappointment or suspicion (Hesser et al., 2011).”
BackgroundTreatment of depression and anxiety in Parkinson’s Disease
Troeung, L. (2013) · eSpace (Curtin University)
Stimulation magnétique transcrânienne et acouphène subjectif. Revue 2014–2016
Londero, A., Bonfils, P., & Lefaucheur, J. P. (2018) · Annales françaises d Oto-rhino-laryngologie et de Pathologie Cervico-faciale · doi:10.1016/j.aforl.2017.08.009
Acouphènes associés aux surdités
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The feasibility of a novel group self-management intervention for stroke
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Complementary and Alternative Therapies
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Kloos, T., Elßner, A. C., Berlin, P., Rief, W., & Riecke, J. (2025) · Mindfulness · doi:10.1007/s12671-025-02621-9
“It is possible that expectation effects from participating in a study resulted in long-term physical health improvements in the control groups (Hesser et al., 2011; Zernicke et al., 2013).”
Tang, D., Gu, D., Gong, J., Liu, G., Zhou, L., Dai, A., Huo, Y., Guan, P., Zhang, J., Huang, X., et al. (2025) · EClinicalMedicine · doi:10.1016/j.eclinm.2025.103671
“Prior evidence suggests that while short waiting periods may yield modest reductions in tinnitus-related questionnaire scores, 30 extended waiting generally results in significantly poorer outcomes relative to active treatment groups.”
Mechanisms of Subjective Tinnitus
Ma, X., Tao, Y., & Yu, L. (2026) · Experts' Perspectives on Medical Advances. · doi:10.1007/978-981-95-5102-6_11
Trimpop, L. F., Bielinski, L. L., Schürmann‐Vengels, J., Appelbaum, S., Berger, T. M., & Willutzki, U. (2026) · Journal of Medical Internet Research · doi:10.2196/83917 · Cited by 1 · see citing works
“This might have greatly affected our findings, as the information of being on a waiting list alone can influence the reduction of symptoms or improvement of protective factors [103,104].”
- Authors
- Hesser, H., Weise, C., Rief, W., & Andersson, G.
- Affiliations
- Linköping University (SE)
- Philipps University of Marburg (DE)
- Corresponding author
- Hesser, Hugo
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2011-04
- Volume
- 70
- Issue
- 4
- Pages
- 378-384
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2147341530
- Cited by
- 95
- References
- 41
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 4 · 2021: 10 · 2020: 4 · 2019: 9 · 2018: 6 · 2017: 8 · 2016: 10 · 2015: 4 · 2014: 2 · 2013: 7 · 2012: 8
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
- Health Sciences › Health Professions › Speech and Hearing › Noise Effects and Management
- Keywords
- tinnitus distress, waitlist control, Tinnitus Handicap Inventory, Tinnitus Questionnaire, methodological quality of trials, tinnitus duration, age effects
- MeSH terms
- Clinical Trials as Topic, Humans, Research Design, Tinnitus, Waiting Lists, Placebo Effect, Control Groups
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