Application of behavior change for tinnitus (Beukes et al., 2022)

Purpose: Although experiencing tinnitus can lead to many difficulties, these can be reduced by using techniques derived from cognitive behavioral therapy. Internet-based cognitive behavioral therapy (ICBT) has been developed to provide an accessible intervention. The aim of this study was to describe how ICBT can facilitate tinnitus management by identifying the active ingredients of the intervention from the perspective of health behavior change.

Method: The ICBT intervention was evaluated using the Behavior Change Wheel in eight steps across the following three stages: (1) understanding the behavior, (2) identifying intervention options, and (3) identifying content and implementation options.

Results: Target behaviors identified to reduce tinnitus distress, as well as additional problems associated with tinnitus, included goal setting, an increased understanding of tinnitus, encouraging deep breathing and progressive muscle relaxation, identifying and restructuring unhelpful thoughts, engaging in positive imagery, and reducing avoidance behaviors. ICBT provided the required components for individuals to be physically and psychologically capable of adapting to tinnitus, providing social and environmental opportunities to manage hearing loss through practice and training, and facilitated automatic and reflective motivation.

Conclusion: Understanding ICBT in the context of the Behavior Change Wheel has helped identify how its effectiveness can be improved and can be used for future tinnitus intervention planning.

Supplemental Material S1. Defining the tinnitus behavior in behavioral terms.

Supplemental Material S2a. Candidate behaviors relevant to the problem behavior identified in Step 1. 

Supplemental Material S2b. Criteria for prioritizing the identified candidate behaviors. 

Supplemental Material S3. Describe the target behavior according to who needs to do what, when, where, how often, and with whom.

Supplemental Material S4. Behavioral analysis of what needs to change for the target behavior to occur.

Supplemental Material S5. Consideration of the candidate intervention functions using the APEASE criteria.

Supplemental Material S6. Policy categories that might support the identified intervention functions.

Supplemental Material S7. Behavior Change Techniques BCTs identified based in intervention functions selected in Step 5.

Supplemental Material S8. Identification of the mode(s) through which the intervention could be delivered.

Beukes, E. W., Manchaiah, V., Andersson, G., & Maidment, D. W. (2022). Application of the behavior change wheel within the context of Internet-based cognitive behavioral therapy for tinnitus management. American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2022_AJA-21-00160