PreprintCited by 33Hearing, Cochlea, Tinnitus, GeneticsArtificial Intelligence in HealthcareNoise Effects and Management

Exploratory Data Mining Techniques (Decision Tree Models) for Examining the Impact of Internet-Based Cognitive Behavioral Therapy for Tinnitus: Machine Learning Approach (Preprint)

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Rodrigo, Hansapani, Beukes, Eldré W, Andersson, Gerhard, Manchaiah, Vinaya·2021·Journal of Medical Internet Research

Abstract

BACKGROUND: There is huge variability in the way that individuals with tinnitus respond to interventions. These experiential variations, together with a range of associated etiologies, contribute to tinnitus being a highly heterogeneous condition. Despite this heterogeneity, a “one size fits all” approach is taken when making management recommendations. Although there are various management approaches, not all are equally effective. Psychological approaches such as cognitive behavioral therapy have the most evidence base. Managing tinnitus is challenging due to the significant variations in tinnitus experiences and treatment successes. Tailored interventions based on individual tinnitus profiles may improve outcomes. Predictive models of treatment success are, however, lacking. OBJECTIVE: This study aimed to use exploratory data mining techniques (ie, decision tree models) to identify the variables associated with the treatment success of internet-based cognitive behavioral therapy (ICBT) for tinnitus. METHODS: Individuals (N=228) who underwent ICBT in 3 separate clinical trials were included in this analysis. The primary outcome variable was a reduction of 13 points in tinnitus severity, which was measured by using the Tinnitus Functional Index following the intervention. The predictor variables included demographic characteristics, tinnitus and hearing-related variables, and clinical factors (ie, anxiety, depression, insomnia, hyperacusis, hearing disability, cognitive function, and life satisfaction). Analyses were undertaken by using various exploratory machine learning algorithms to identify the most influencing variables. In total, 6 decision tree models were implemented, namely the classification and regression tree (CART), C5.0, GB, XGBoost, AdaBoost algorithm and random forest models. The Shapley additive explanations framework was applied to the two optimal decision tree models to determine relative predictor importance. RESULTS: Among the six decision tree models, the CART (accuracy: mean 70.7%, SD 2.4%; sensitivity: mean 74%, SD 5.5%; specificity: mean 64%, SD 3.7%; area under the receiver operating characteristic curve [AUC]: mean 0.69, SD 0.001) and gradient boosting (accuracy: mean 71.8%, SD 1.5%; sensitivity: mean 78.3%, SD 2.8%; specificity: 58.7%, SD 4.2%; AUC: mean 0.68, SD 0.02) models were found to be the best predictive models. Although the other models had acceptable accuracy (range 56.3%-66.7%) and sensitivity (range 68.6%-77.9%), they all had relatively weak specificity (range 31.1%-50%) and AUCs (range 0.52-0.62). A higher education level was the most influencing factor for ICBT outcomes. The CART decision tree model identified 3 participant groups who had at least an 85% success probability following the undertaking of ICBT. CONCLUSIONS: Decision tree models, especially the CART and gradient boosting models, appeared to be promising in predicting ICBT outcomes. Their predictive power may be improved by using larger sample sizes and including a wider range of predictive factors in future studies.

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  • Studies that ranked high for selective reporting bias tended to report only user satisfaction data and treatment adherence, despite their methods considering collection and assessment of psychiatric scale data and other effectiveness outcomes.

    “The studies that ranked high for selective reporting bias tended to report only user satisfaction data and treatment adherence, despite their methods considering the collection and assessment of psychiatric scale data and other effectiveness outcomes (29, 76, 79, 85–88, 92).”

    From Examining the role of AI technology in online mental healthcare: opportunities, challenges, and implications, a mixed-methods review (2024) · cites this paper as [92]

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  • The studies reporting on the use of ML algorithms found significant success in outcome prediction and feature detection to support online therapy delivery.

    “Additionally, the studies reporting on the use of ML algorithms found significant success in outcome prediction and feature detection to support online therapy delivery (6, 19, 28, 29, 31, 33, 83, 85, 86, 92–94).”

    From Examining the role of AI technology in online mental healthcare: opportunities, challenges, and implications, a mixed-methods review (2024) · cites this paper as [92]

    The Discussion (Predictors of ICBT Outcomes; page unavailable) identifies factors associated with outcomes of internet-based cognitive behavioral therapy for tinnitus. But the Results (Decision Tree Model Performance Evaluations; page unavailable) report AUCs of 0.52–0.69 and say none of the models was robust, so “significant success” in outcome prediction overstates this study’s findings. (LLM, conf=0.89)

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  • The relevant studies highlighted the importance of analyzing the large datasets produced by online mental healthcare interventions and the efficiency and accuracy of AI algorithms, which in some cases were comparable to or better than human assessors.

    “As such, the relevant studies highlighted the importance of analyzing the large datasets produced by online mental healthcare interventions and the efficiency and accuracy of AI algorithms which in some cases were comparable to or better than human assessors (6, 19, 28, 29, 31, 33, 83, 85, 86, 92–94).”

    From Examining the role of AI technology in online mental healthcare: opportunities, challenges, and implications, a mixed-methods review (2024) · cites this paper as [92]

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  • Rodrigo et al. (2021 & 2022) identified higher education level (master's degree and above) as a strong predictor of treatment response applying a DL approach, noting that this result may also underly additional factors in the way that the studied treatments were delivered and accessed.

    “As an example, the two studies by Rodrigo et al. (2021 & 2022) identified higher education level (master’s degree and above) as a strong predictor of treatment response applying a DL approach, noting that this result may also underly additional factors in the way that the studied treatments were delivered and accessed (92, 93).”

    From Examining the role of AI technology in online mental healthcare: opportunities, challenges, and implications, a mixed-methods review (2024) · cites this paper as [92]

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  • Rodrigo et al. (2021) determined that education level (master's degree or higher, 88% chance of treatment success), baseline tinnitus severity, and depression and anxiety symptoms were predictors of treatment response with around 70% accuracy.

    “Rodrigo et al. (2021) applied decision trees models and determined that education level (master’s degree or higher education level 88% chance of treatment success), baseline tinnitus severity, and depression and anxiety symptoms were predictors of treatment response with around 70% accuracy (92).”

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Research works printed but not linked: 1

  1. [46]Lundberg SM Lee SI A unified approach to interpreting model predictions 2017 12 The 31st International Conference on Neural Information Processing Systems December 4-9, 2017 Long Beach, California, USA 4768 4777

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Authors
Rodrigo, H., Beukes, E. W., Andersson, G., & Manchaiah, V.
Affiliations
  • The University of Texas Rio Grande Valley (US)
  • Linköping University (SE)
  • Manipal Academy of Higher Education (IN)
Corresponding author
Rodrigo, Hansapani
Venue
Journal of Medical Internet Research
Published
2021-03-21
Volume
23
Issue
11
Pages
e28999-e28999
ISSN
1438-8871 (ISSN-L)
OpenAlex
W3201242635
Cited by
33
References
63
Citations by year
2026: 8 · 2025: 6 · 2024: 9 · 2023: 4 · 2022: 5 · 2021: 1
FWCI
2.65
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ScholarWorks @ UTRGV (The University of Texas Rio Grande Valley) (submittedVersion, cc-by)
  • Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
  • UpSpace Institutional Repository (University of Pretoria) (submittedVersion, cc-by)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion, cc-by-nc-nd)
Funders
Anglia Ruskin University
Topics
  • Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
  • Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
  • Health Sciences › Health Professions › Speech and Hearing › Noise Effects and Management
Keywords
tinnitus, internet-based cognitive behavioral therapy, treatment response prediction, tinnitus severity, Tinnitus Functional Index, decision tree, SHAP, predictor importance, hyperacusis, hearing handicap, anxiety, depression, insomnia, life satisfaction, cognitive function, personalized treatment, treatment effect heterogeneity, gradient boosting, random forest, XGBoost, AdaBoost, C5.0
MeSH terms
Machine Learning, Decision Trees, Humans, Tinnitus, Cognitive Behavioral Therapy, Internet, Data Mining

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