A Comparison of Three Psychoeducational Group Interventions for Veterans With Tinnitus

Tinnitus (i.e., ringing in the ears) is currently the most prevalent disability in the VA
system. Numerous clinical interventions have been created to systematically address the range
of issues caused by tinnitus. Only a few tinnitus interventions have focused on coping
strategies. Coping strategies are cognitive, affective, and behavioral attempts to master new
events, such as the onset of a disability or an impairment like tinnitus, that are
overwhelming to an individual, and that because of their newness, an individual does not
necessarily have automatic, adaptive responses. Evidence suggests that CET is effective in
facilitating adaptive coping strategies among individuals with several types of impairments
or disabilities. The proposed study will be the first application of CET to a tinnitus
population.

The present study proposes a development of a CET protocol for tinnitus and a pilot study
that assesses the effectiveness of the CET and ACT interventions compared to the current
clinical practice of using a CBT intervention. All 3 psycho-educational interventions will be
compared to a usual care group. The overarching goal of the proposed pilot study is to gain
information that can be used to provide individuals with tinnitus with the best care for
helping them to more successfully cope with tinnitus.

The aims of this research are to: 1) develop a CET protocol for tinnitus by means of
information gathered from two focus groups and from CET consultants; 2) to examine whether a
3-session CET psycho-educational intervention is more effective than a 3-session CBT
psycho-educational intervention or a 3-session ACT psycho-educational intervention, as
compared to a usual care, in increasing coping strategies among individuals with tinnitus.

Inclusion Criteria:

Development Phase (Phase 1)-focus groups:

Inclusion criteria are the following (more details are provided below):

- 1) Veterans;

- 2) have chronic tinnitus that is sufficiently bothersome to warrant intervention-see
below for explanation;

- 3) able to communicate in English;

- 4) willing and able to give written informed consent;

- 5) use hearing aids if needed; and

- 6) have participated in the PTM program at the VA Portland Healthcare System.

Testing Phase (Phase 2)-interventions:

Inclusion criteria are the following:

- 1) Veterans and civilians;

- 2) have a score of at least 25 on the Tinnitus Functional Index ([TFI]; Meikle, J.A.
Henry, et al., 2012);

- 3) have two errors or less on a six-item cognitive screening instrument (Callahan,
Unverzagt, Hui, Perkins, & Hendrie, 2002);

- 4) able to communicate in English;

- 5) willing and able to give written informed consent; and

- 6) use hearing aids if needed.

Exclusion Criteria:

Development Phase (Phase 1)-focus groups:

Exclusion criteria are:

- Not meeting inclusion criteria 1-6,

- nor have any other factor that would preclude full participation in the study.

Testing Phase (Phase 2)-interventions:

Exclusion criteria are:

- Not meeting inclusion criteria 1-6,

- having participated in the PTM program or Phase 1 of this study,

- or having any other factor that would preclude full participation in the study.
Recruitment for Phase 2 will begin in year 1 once the CET protocol is finalized.