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Cited by 10Mindfulness and Compassion InterventionsHearing, Cochlea, Tinnitus, GeneticsHearing Loss and Rehabilitation

A Systematic Review and Meta-Analysis Exploring Effects of Third-Wave Psychological Therapies on Hearing-Related Distress, Depression, Anxiety, and Quality of Life in People With Audiological Problems.

Open access
Wang, Belinda, Gould, Rebecca L., Kumar, Pavithra, Pikett, Liam, Thompson, Benjamin, Gonzalez, Sergi Costafreda, Bamiou, Doris-Eva·2022·American Journal of Audiology
DOI 10.1044/2022_aja-21-00162
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Abstract

Purpose: There is growing evidence supporting the use of third-wave psychological therapies, such as mindfulness-based interventions (MBIs) and acceptance and commitment therapy (ACT), for people with long-term or chronic physical health conditions. We conducted a systematic review and meta-analysis to critically evaluate the effectiveness of third-wave interventions for improving hearing-related distress and psychological well-being in people with audiological problems. Method: We searched online bibliographic databases and assessed study quality. We conducted random-effects meta-analyses if at least two randomized controlled trials (RCTs) examined hearing-related distress, depression, anxiety, or quality of life in people with audiological problems. Findings of pre--post studies were summarized narratively. Results: We identified 15 studies: six RCTs and nine pre--post studies. The methodological quality of studies was mostly poor to moderate, and sample sizes were typically small (overall n = 750). Most studies focused on tinnitus (n = 12), MBIs (n = 8), and ACT (n = 6). Statistically significant improvements in hearing-related distress were found with ACT and MBIs versus controls and other treatments at post-intervention in people with tinnitus, while improvements in depression and anxiety were only found for ACT versus controls at postintervention. However, gains were either not maintained or not examined at follow-up, and there was no evidence for improvements in quality of life. Conclusions: At present, there is insufficient evidence to recommend the use of third-wave interventions for improving hearing-related distress or psychological well-being in people with audiological problems. There is some evidence that ACT and MBIs may be useful in addressing hearing-related distress in people with tinnitus, but only in the short term. However, findings should be interpreted with caution given the small number of studies with generally small sample sizes and mostly poor-to-moderate methodological quality. More high-quality, adequately powered, double-blind RCTs, particularly in audiological problems other than tinnitus, are needed to draw firm conclusions and meaningful clinical recommendations.

Integrity signals

Registry

Crossref · 10.1044/2022_aja-21-00162

Cites

62 of 62 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

12 of 37 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    All three pre-post studies of mindfulness-based interventions that included a follow-up assessment reported that 58% (7/12), 52.8% (96/182) and 62% (8/13) of participants showed reliable improvements at follow-ups.

    “All three pre-post studies of MBIs that included a follow-up assessment reported that 58% (7/12), 52.8% (96/182) and 62% (8/13) of participants showed reliable improvements at follow-ups (Husain et al., 2019;McKenna et al., 2018;Roland et al, 2015).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Husain et al., 2019 source
    • cites McKenna et al., 2018 source
    • cites Roland et al, 2015 source
  • Findingcitation

    Clinically significant changes at post-intervention were seen for both pre-post studies of mindfulness-based interventions: 60% (9/15) and 50% (91/182) of participants.

    “Clinically significant changes at post-intervention were seen for both pre-post studies of MBIs: 60% (9/15) and 50% (91/182) of participants (Husain et al., 2019;McKenna et al., 2018, respectively).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Husain et al., 2019 source
    • cites McKenna et al., 2018 source

      Table 1 (Demographic variables; page unavailable) reports that 91 of 182 participants (50%) had reliable improvement in tinnitus distress after MBCT. It does not call that result clinically significant change; the paper uses that term for a separate psychological-distress measure, for which it reports 33.5%. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    The findings of the current review are consistent with previous meta-analysis and systematic reviews of third-wave therapies for tinnitus, chronic pain, and neurological conditions.

    “Overall, the findings of the current review are consistent with previous meta-analysis and systematic reviews of third-wave therapies for tinnitus (Rademaker et al., 2019), chronic pain (Hughes et al., 2017) and neurological conditions (Robinson et al., 2019).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Rademaker et al., 2019 source
    • cites Hughes et al., 2017 source
    • cites Robinson et al., 2019 source
  • Premisecitation

    Studies that are hard to locate tend to have lower methodological quality.

    “We chose not to do this as this may have introduced further bias as studies that are hard to locate tend to have lower methodological quality (Egger et al., 2003).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Egger et al., 2003 source
  • Premisecitation

    There is low certainty to support the use of cognitive behavioral therapy for depression and anxiety in people with tinnitus due to the methodological quality of evidence.

    “there is low certainty to support its use for depression and anxiety in people with tinnitus due to the methodological quality of evidence (Fuller et al., 2020).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Fuller et al., 2020 source

      The Authors’ conclusions (page unavailable) report a possible small benefit for depression, with uncertainty due to concerns about evidence quality. They describe evidence for improving anxiety as limited, and the Implications for practice say there is insufficient evidence to recommend tinnitus-focused CBT when improving anxiety is the primary aim. The claim therefore overstates support for its use for anxiety and treats the certainty for both outcomes as uniformly low. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 40
  • May combine two claims. 31
  • The quote only partly states this claim. 5

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Measures of quality of life are often criticized for not being sensitive to specific aspects of quality of life for different health conditions.

    “Measures of quality of life are praised to be multi-dimensional and broadly applicable, but are often criticized for not being sensitive to specific aspects of quality of life for different health conditions (Pequeno et al., 2020).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Pequeno et al., 2020 source

  • May combine two claims.

    Findingown data

    The methodological quality of pre-post studies was generally moderate, with the exception of one study rated as weak and one study rated as strong.

    “The methodological quality of pre-post studies was generally moderate (see Table 5), with the exception of one study rated as weak (Dehnabi et al., 2017) and one study rated as strong (McKenna et al., 2018).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Dehnabi et al., 2017

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites McKenna et al., 2018 source

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The methodological quality of randomized controlled trials was evaluated using the Cochrane Collaboration Risk of Bias tool 2 (RoB 2).

    “The methodological quality of RCTs was evaluated using the Cochrane Collaboration Risk of Bias tool 2 (RoB 2; Sterne et al., 2019)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Sterne et al., 2019 source

  • May combine two claims.

    Findingreasoning

    The quality of studies in the current review was mostly consistent with other reviews, except Rademaker et al. (2019) reported moderate to high quality while the current review reported poor-to-moderate quality.

    “The quality of studies of the current review was mostly consistent with other reviews, with the exception of Rademaker et al. (2019) which reported moderate to high quality, while an overall poor-tomoderate quality was reported here.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Rademaker et al., 2019 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Adverse effects of mindfulness-based approaches, including exacerbated psychological problems, have been reported.

    “This area requires further investigation as adverse effects of mindfulness-based approaches, including exacerbated psychological problems, have been reported (Farias & Wikholm, 2016).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Farias & Wikholm, 2016 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Pre-post standardized mean differences were summarized in a narrative synthesis because it is not recommended to analyze them within a meta-analysis.

    “As it is not recommended to analyze pre-post standardized mean differences within a metaanalysis (Cuijpers et al., 2017), the findings of pre-post studies were summarized in a narrative synthesis.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Cuijpers et al., 2017 source

  • May combine two claims.

    Findingown data

    Depression and anxiety were examined in six pre-post studies, and four reported statistically significant pre-post changes in depression and/or anxiety.

    “Depression and anxiety were examined in six pre-post studies.Four reported statistically significant pre-post changes in depression and/or anxiety”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Two pre-post studies included follow-up assessments for depression/anxiety, and only one reported maintenance of treatment benefits for anxiety but not depression at 3 months post-intervention.

    “Two studies included follow-up assessments and only one of these reported maintenance of treatment benefits for anxiety but not depression at 3 months post-intervention (Ferraro et al., 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ferraro et al., 2019 source

  • May combine two claims.

    Findingown data

    Quality of life was examined in two pre-post studies, and findings were mixed.

    “Quality of life was examined in two pre-post studies.Findings were mixed”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sample sizes of the included studies were typically small, with an overall n of 750.

    “sample sizes were typically small (overall n=750).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    One study examining mindfulness-based intervention chose to report effect sizes instead of significance levels due to small sample size and found moderate to large improvements for both depression and anxiety.

    “One study examining MBI chose to report effect sizes instead of significance levels due to small sample size and found moderate to large improvements for both depression and anxiety (Gans et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gans et al., 2014 source

  • May combine two claims.

    Findingown data

    The review identified 15 studies: 6 randomized controlled trials and 9 pre-post studies.

    “We identified 15 studies: 6 RCTs and 9 pre-post studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most included studies focused on tinnitus (n=12), mindfulness-based interventions (n=8) and acceptance and commitment therapy (n=6).

    “Most studies focused on tinnitus (n=12), MBIs (n=8) and ACT (n=6).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Seven pre-post studies examined the effectiveness of third-wave therapies on measures of hearing-related distress, and all seven reported statistically significant pre-post changes.

    “the effectiveness of third-wave therapies on measures of hearing-related distress was examined in seven pre-post studies.All seven studies reported statistically significant pre-post changes in hearing-related distress measures”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Sample sizes were small in ten studies (n<15 participants per condition), and only four out of the fifteen studies performed a sample size calculation.

    “sample sizes were small in ten studies (n<15 participants per condition), while only four out of the fifteen studies performed a sample size calculation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The effects of ACT and MBIs on hearing-related distress were either not maintained at follow-up or not examined in enough studies to permit a meta-analysis.

    “but the effects were either not maintained at follow-up or not examined in enough studies to permit a meta-analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Effect sizes for maintenance of treatment gains were generally smaller than effect sizes at post-intervention, and the strength of evidence was weaker at follow-ups.

    “Other similarities between Hughes et al. (2017) and the current review include effect sizes for maintenance of treatment gains were generally smaller than the effect sizes at post-intervention and the strength of evidence was weaker at follow-ups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Reliable deterioration was reported in two studies, with reported rates being low.

    “Reliable deterioration was reported in two studies, with reported rates being low.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Adverse events were only reported in two studies: no adverse events were reported in one study, while two events were reported in the other and considered unrelated to the intervention.

    “Adverse events were only reported two studies: no adverse events were reported in one study (Gans et al., 2014), while two events were reported in the other study, though these were considered to be unrelated to the intervention (McKenna et al., 2017).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Gans et al., 2014 source
    • cites McKenna et al., 2017 source

  • May combine two claims.

    Findingown data

    The effects of ACT on depression and anxiety were not maintained at follow-up or were not observed when ACT was compared to other treatments at post-intervention.

    “However, again, these effects were not maintained at follow-up or were not observed when ACT was compared to other treatments at post-intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The majority of studies included in the review focused on MBIs and ACT.

    “With regards to interventions, the majority of studies focused on MBIs and ACT.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Participants were typically self-referred, mostly males in their early 50s with tinnitus, and ethnicity was rarely reported.

    “Participants were typically self-referred, hence may have been self-motivated to engage in treatment, and were mostly males in their early 50s with tinnitus, with ethnicity being rarely reported.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No study provided information regarding blinding of outcome assessors, leading to a rating of moderate according to the EPHPP tool.

    “No study provided information regarding blinding of outcome assessors, leading to a rating of moderate according to the EPHPP tool.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    No tests of publication bias were conducted because these are not recommended for meta-analyses that include less than ten studies.

    “No tests of publication bias were conducted as these are not recommended for meta-analyses that include less than ten studies (Higgins & Green, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Higgins & Green, 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review was conducted and reported according to PRISMA guidelines.

    “This review was conducted and reported according to PRISMA guidelines (Page et al., 2021; see Appendix A for the PRISMA checklist)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Page et al., 2021

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review was registered with Open Science Framework (OSF; ref: osf.io/cqte7).

    “was registered with Open Science Framework (OSF; ref: osf.io/cqte7).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Study design and conductnone given

    In Molander et al (2018), the sample was unrepresentative due to demographic characteristics (33% men).

    “| al (2018) | | (33% men) | | | | | | | | |”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    There is some evidence that acceptance and commitment therapy and mindfulness-based interventions may be useful in addressing hearing-related distress in people with tinnitus, but only in the short-term.

    “There is some evidence that ACT and MBIs may be useful in addressing hearing-related distress in people with tinnitus, but only in the short-term.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Titles and abstracts were independently screened by two reviewers to identify potentially eligible studies.

    “titles and abstracts were independently screened to identify potentially eligible studies for retrieval.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Whether ACT and MBIs are beneficial in people with audiological problems other than tinnitus, or whether other forms of third-wave therapies are beneficial for audiological conditions, remains unclear.

    “Whether ACT and MBIs are beneficial in people with audiological problems other than tinnitus, or indeed whether other forms of thirdwave therapies are beneficial for audiological conditions remains unclear.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In Gans et al (2014) (2015), missing values were not imputed.

    “| Gans et al | Yes | Yes | Yes | No | Unclear | Unclear | Unclear | Unclear | Yes | No imputation of missing |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductown data

    In McKenna et al (2017), the sample was unrepresentative due to demographic characteristics (80% white).

    “| al (2017) | | (80% white) | | | | | | | | the presence of significant |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In Philippot et al (2012), missing values were not imputed.

    “| Philippot et | Yes | Unclear | Yes | No | Unclear | Unclear | Unclear | Yes | Yes | No imputation of missing |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In Arif et al (2017), missing values were not imputed.

    “| Arif et al | Yes | Unclear | Yes | Unclear | Unclear | Unclear | Unclear | Unclear | No | No imputation of missing |”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Random-effects meta-analyses using a DerSimonian and Laird estimator based on inverse variance weights were conducted due to anticipated heterogeneity in treatment effects.

    “Random-effects meta-analyses using a DerSimonian and Laird estimator based on inverse variance weights were conducted due to anticipated heterogeneity in treatment effects as a result of between-study variations in clinical and study factors.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Study design and conductown data

    In Dehnabi et al (2017), the sample was unrepresentative due to demographic characteristics (67% men).

    “| et al (2017) | | (67% men) | | | | | | | | controlling for group |”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The findings of the review may not generalize to broader or ethnically diverse populations, those who might be less self-motivated to engage in treatment, and those with clinically significant audiological problems.

    “As a result, the findings of the review may not generalize to broader or ethnically diverse populations, those who might be less self-motivated to engage in treatment, and those with clinically significant audiological problems.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Study, demographic and intervention characteristics, as well as study results, were independently extracted by two reviewers.

    “Study, demographic and intervention characteristics, as well as study results (including means, standard deviations, etc.) were independently extracted by two reviewers”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In Dehnabi et al (2017), no analysis examined or controlled for group differences at baseline (a cohort study).

    “| Dehnabi | Unclear | Yes | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Yes | No analysis examining or |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Random-effects meta-analyses were performed with two or more studies, following guidance.

    “Fourth, our random-effects meta-analyses were performed with two or more studies, following guidance (e.g.Cochrane Consumers and Communication Review Group, 2016;Valentine et al., 2010)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Cochrane Consumers and Communication Review Group, 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Valentine et al., 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The grey literature search was limited to Open Grey, and more unpublished studies may have been identified if the search had extended beyond this.

    “In line with this, the grey literature search was limited to Open Grey and more unpublished studies may have been identified if this search had extended beyond this.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Studies that did not use validated tools to measure hearing-related distress, depression, anxiety or quality of life were not included in the meta-analyses.

    “Studies that did not use validated tools to measure the abovementioned outcomes were not included in the meta-analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Publication bias was estimated using funnel plots for meta-analyses that included at least ten studies.

    “Publication bias was estimated using funnel plots (test of asymmetry) for meta-analyses that included at least ten studies, as previously recommended (Higgins & Green, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Higgins & Green, 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In McKenna et al (2017), participants were selected for the presence of significant psychological distress (score >10 on the Clinical Outcomes in Routine Evaluation -Non-Risk).

    “| McKenna et | No | Yes | Yes | Unclear | Unclear | Unclear | Unclear | Yes | No | Selected participants for |”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A systematic review and meta-analysis of randomized controlled trials reported that cognitive behavioral therapy significantly decreased tinnitus distress.

    “Although a systematic review and meta-analysis of randomized controlled trials (RCTs) reported that CBT significantly decreased tinnitus distress (Hesser et al., 2011)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hesser et al., 2011 source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Full texts of retrieved articles were independently screened for eligibility against inclusion and exclusion criteria by two reviewers.

    “Full texts of retrieved articles were then screened for eligibility against the inclusion and exclusion criteria.These processes were completed by two independent reviewers”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Third-wave psychological therapies aim to change how a person relates to their internal experiences such as thoughts, feelings and bodily sensations.

    “third-wave psychological therapies such as mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR), acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), compassion-focused therapy (CFT) and meta-cognitive therapy (MT) aim to change how a person relates to their internal experiences such as thoughts, feelings and bodily sensations (Hayes, 2004”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hayes, 2004 source

  • May combine two claims.

    Study design and conductown data

    Publication bias and causes of heterogeneity could not be assessed due to the small number of studies included in the meta-analyses.

    “Third, publication bias and causes of heterogeneity could not be assessed due to the small number of studies included in the meta-analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Some evidence tentatively suggests that ACT and MBIs may be useful in addressing hearing-related distress in people with tinnitus, but only in the short term.

    “Some evidence tentatively suggests that ACT and MBIs may be useful in addressing hearing-related distress in people with tinnitus, but only in the short term.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Findings cannot be generalized to other third-wave therapies or other audiological problems.

    “First, as meta-analytic findings only applied to ACT and MBIs in people with tinnitus, findings cannot be generalized to other third-wave therapies or other audiological problems.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In Westin et al (2011), treatment and control conditions differed in duration (ACT for 10 weeks, TRT for 18 months; WLC for 10 weeks).

    “| Westin et al | Yes | Unclear | Yes | Unclear | No | Yes | Unclear | Yes | No | Treatment and control |”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    There is insufficient evidence at present to suggest that treatment gains are maintained at follow-up, or that ACT and MBIs are superior to other treatments in addressing these outcomes.

    “However, there is insufficient evidence at present to suggest that these treatment gains are maintained at follow-up, or that ACT and MBIs are superior to other treatments in addressing these outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent meta-analysis of ACT for chronic pain did not find a significant difference in quality of life.

    “In keeping with our findings, a recent metaanalysis of ACT for chronic pain did not find significant difference in quality of life (Hughes et al., 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hughes et al., 2017 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Third-wave therapies share three common components and processes: greater psychological openness to one's experiences, greater awareness of the present moment, and motivation for meaningful action.

    “the approaches share three common components and processes: to produce greater psychological openness to one's experiences, to become more aware of the present moment, and to motivate meaningful action (Hayes et al., 2011).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hayes et al., 2011 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Quality assessment was completed by two independent reviewers and disagreements were resolved through discussion with a third reviewer.

    “The quality of studies was completed by two independent reviewers and disagreements were resolved through discussion with a third reviewer”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The methodological quality of non-randomized controlled trials was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies.

    “The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies (EPHPP, 2009) was used to assess the methodological quality of non-RCTs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites EPHPP, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In Ferraro et al (2019), missing values were not imputed.

    “| Ferraro | Yes | Unclear | Unclear | No | Unclear | No | Unclear | Unclear | Yes | No imputation of missing |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    In Ferraro et al (2019), the sample size was small (n < 15 per group).

    “| Ferraro | Yes | Unclear | Unclear | No | Unclear | No | Unclear | Unclear | Yes | No imputation of missing |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    In Dehnabi et al (2017), the sample size was small (n < 15 per group).

    “| Dehnabi | Unclear | Yes | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Yes | No analysis examining or |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Study design and conductown data

    In Gans et al (2014) (2015), the sample was unrepresentative due to demographic characteristics (75% men).

    “| (2014) | | (75% men) | | | | | | | | values |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    In Philippot et al (2012), the sample size was small (n < 15 per group).

    “| Philippot et | Yes | Unclear | Yes | No | Unclear | Unclear | Unclear | Yes | Yes | No imputation of missing |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    In Gans et al (2014) (2015), the sample size was small (n < 15 per group).

    “| Gans et al | Yes | Yes | Yes | No | Unclear | Unclear | Unclear | Unclear | Yes | No imputation of missing |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductown data

    In Drey (2017), the sample was unrepresentative due to demographic characteristics (100% men; 71% white).

    “| | | (100% men; | | | | | | | | |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    In Drey (2017), the sample size was small (n < 15 per group).

    “| Drey (2017) | Yes | Yes | Yes | Unclear | No | Yes | Unclear | Yes | Yes | _ |”
    Quote in the paperNot a substantial claim
64 of 64

  • The paper relies on this without support.

    Psychological therapies cannot directly treat physiological conditions such as hearing loss or tinnitus.

    “psychological therapies cannot directly treat such physiological conditions.”

  • The paper relies on this without support.

    There is little research on cognitive behavioral therapy for audiological problems other than tinnitus.

    “Furthermore, there is little research on CBT for other audiological problems.”

  • The paper relies on this without support.

    Relatively little is known about the effectiveness of mindfulness-based interventions for audiological problems other than tinnitus or other types of third-wave therapies for tinnitus and other audiological conditions.

    “However, relatively little is known about the effectiveness of MBIs for audiological problems other than tinnitus (e.g.hearing loss and deafness) or other types of third-wave therapies for tinnitus and other audiological conditions.”

  • The paper relies on this without support.

    This systematic review and meta-analysis is the first to evaluate the effectiveness of third-wave therapies in people with audiological problems.

    “To the authors' knowledge, this systematic review and meta-analysis is the first to evaluate the effectiveness of third-wave therapies in people with audiological problems.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reliable-improvement results are attributed to ACT pre-post studies

    Minor

    The discussion attributes reliable improvements of 50%-60% to pre-post studies of ACT and MBIs. The results identify the pre-post studies reporting those proportions as MBI studies only.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Cochrane Collaboration. (2020). Review Manager (RevMan) [Computer program] .

Cited by

Sorted by citations

Related

Authors
Wang, B., Gould, R. L., Kumar, P., Pikett, L., Thompson, B., Gonzalez, S. C., & Bamiou, D.-E.
Affiliations
  • University College London (GB)
  • University of Sheffield (GB)
  • Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
ORCID
Venue
American Journal of Audiology
Publisher
American Speech Language Hearing Association
Published
2022-06-02
Volume
31
Issue
2
Pages
487-512
ISSN
  • 1059-0889 (ISSN-L)
  • 1558-9137
DOI
10.1044/2022_aja-21-00162
OpenAlex
W4280559004
Semantic Scholar
658a24ac2e7b1cfff947ca565b40dac99bfe45a5
Cited by
10
References
59
Citations by year
2025: 5 · 2024: 2 · 2023: 3
FWCI
0.42
Type
journal article
Language
en
Open access
Locations
  • American Journal of Audiology (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
Keywords
mindfulness-based interventions, acceptance and commitment therapy, tinnitus, depression, anxiety, quality of life, psychological well-being
MeSH terms
Anxiety, Chronic Disease, Depression, Hearing, Humans, Quality of Life, Tinnitus, Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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