{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:45:28Z","timestamp":1789055128995,"version":"build-2803163510"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"\n Importance<\/jats:title>\n Determining the durability of treatment effects extending more that 1 year postintervention is crucial for sustainability of health care services for tinnitus. Tinnitus is often disabling and can result in a considerable economic burden. Identifying tinnitus interventions with stable long-term positive effects can improve health care outcomes. Due to the lack of research focused on outcomes longer than 1 year postintervention, the current study was undertaken.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To investigate the durability of treatment effects over a 6-year period following internet-based cognitive behavior therapy (ICBT) for tinnitus.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this follow-up of a nonrandomized clinical trial, an online study where participants undertook an internet-based intervention was undertaken. A repeated-measured study design with 6 time points was selected to assess 6-year long-term outcomes of ICBT. Recruitment started January 2016. Participants were those with significant tinnitus who undertook an online tinnitus intervention. Participants from the original trial were invited to partake at 1, 4, 5, and 6 years of follow-up. Assessment of tinnitus distress and associated difficulties regarding anxiety, depression, insomnia, cognitive failures, satisfaction with life, and hearing disability was conducted. Given a delayed intervention group design, the control group had also received the intervention at the 6-year follow-up. There was no active control condition. Analysis was conducted in May to September 2023 and redone in May to July 2025 prior to submission.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n A guided ICBT intervention consisting of 21 modules was presented over 8 weeks.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Reduction in tinnitus distress was the primary outcome together with measuring the secondary outcomes of reductions in anxiety, depression, insomnia, cognitive failures, hyperacusis, hearing disability, and increases with satisfaction with life.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 138 from the original trial who were invited to partake at 1, 4, 5, and 6 years of follow-up, 49 participants (35.5%) completed the 6-year postintervention assessment (mean [SD] age, 54.49 (13.29) years; 18 female individuals [37%]; 31 male individuals [63%]). Undertaking ICBT for tinnitus was associated with significant improvements with little variability over the 6-year period, with large within-group effect sizes (eg, Cohen\n d<\/jats:italic>\n \u2009=\u20091.00; 95% CI, 0.80-1.32) at 6 years postintervention. Small effects were found on measures of anxiety, depression, insomnia, satisfaction with life, and hyperacusis. At 6-year follow-up clinical significance was obtained by 19 of 49 participants (39%), using the Reliable Change Index (RCI) criterion of a 23.86 points (95% CI, 7.96-39.76) score improvement, and 27 of 49 participants (55%) when using the minimal clinically important difference (MCID) of 14 points (95% CI, 1.9-29.9). When looking at posttreatment results, durability of treatment effects were present for tinnitus distress and measures of anxiety, depression, insomnia, and satisfaction with life, but not for auditory-related effects of hearing disability and hyperacusis.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and relevance<\/jats:title>\n In this follow-up of a nonrandomized clinical trial, the results indicate potential for informing health care services and reducing health care costs caused by tinnitus over 6 years. The results are significant in indicating ICBT may improve accessibility to evidence-based care and reduce resources required to deliver clinical care.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02370810<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoto.2026.0094","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:30:48Z","timestamp":1773934248000},"page":"503","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Outcomes of an Internet-Based Cognitive Behavior Therapy Intervention for Tinnitus"],"prefix":"10.1001","volume":"152","author":[{"given":"Eldre","family":"Beukes","sequence":"first","affiliation":[{"name":"Centre For Better Living, Anglia Ruskin University, Cambridge, United Kingdom"},{"name":"Virtual Hearing Lab, Collaborative initiative between the University of Colorado and the University of Pretoria, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Behavioural Sciences and Learning, Link\u00f6ping University, Link\u00f6ping, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Health, Education and Technology, Lule\u00e5 University of Technology, Lule\u00e5, Sweden"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Lus\u00f3fona University HEI-Lab: Digital Human-Environment Interaction Labs, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinaya","family":"Manchaiah","sequence":"additional","affiliation":[{"name":"Virtual Hearing Lab, Collaborative initiative between the University of Colorado and the University of Pretoria, Aurora"},{"name":"University of Colorado Anschutz Medical Campus, Aurora"},{"name":"UCHealth Hearing and Balance, University of Colorado Hospital, Aurora"},{"name":"Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa"},{"name":"Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"ooi260008r1","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1177\/0018720821998110","article-title":"Investigating popular mental health mobile application downloads and activity during the COVID-19 pandemic.","volume":"65","author":"Wang","year":"2023","journal-title":"Hum Factors"},{"issue":"6","key":"ooi260008r2","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1093\/abm\/kaae021","article-title":"Effectiveness of interventions for changing more than one behavior at a time to manage chronic conditions: a systematic review and meta-analysis.","volume":"58","author":"Silva","year":"2024","journal-title":"Ann Behav Med"},{"issue":"9","key":"ooi260008r3","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1001\/jamaneurol.2022.2189","article-title":"Global prevalence and incidence of tinnitus: a systematic review and meta-analysis.","volume":"79","author":"Jarach","year":"2022","journal-title":"JAMA Neurol"},{"key":"ooi260008r4","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100250","article-title":"Tinnitus prevalence in Europe: a multi-country cross-sectional population study.","volume":"12","author":"Biswas","year":"2021","journal-title":"Lancet Reg Health Eur"},{"issue":"1","key":"ooi260008r5","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s41669-021-00273-8","article-title":"The utility of economic measures to quantify the burden of tinnitus in affected individuals: a scoping review.","volume":"6","author":"Daoud","year":"2022","journal-title":"Pharmacoecon Open"},{"issue":"5","key":"ooi260008r6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-096995","article-title":"Pharmacotherapy options for the management of subjective tinnitus: a systematic review and network meta-analysis.","volume":"15","author":"Li","year":"2025","journal-title":"BMJ Open"},{"issue":"18","key":"ooi260008r7","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.3390\/diagnostics14182028","article-title":"The long-term effect of cochlear implantation on tinnitus: a systematic review and meta-analysis.","volume":"14","author":"Li","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"ooi260008r8","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1016\/bs.pbr.2020.12.005","article-title":"Towards a unification of treatments and interventions for tinnitus patients: The EU research and innovation action UNITI.","volume":"260","author":"Schlee","year":"2021","journal-title":"Prog Brain Res"},{"issue":"1","key":"ooi260008r9","article-title":"Cognitive behavioural therapy for tinnitus.","volume":"1","author":"Fuller","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"ooi260008r10","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1097\/MAO.0000000000002472","article-title":"Systematic review and network meta-analysis of cognitive and\/or behavioral therapies (CBT) for tinnitus.","volume":"41","author":"Landry","year":"2020","journal-title":"Otol Neurotol"},{"issue":"5","key":"ooi260008r11","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1001\/jamaoto.2025.0052","article-title":"Clinical practice guideline for management of tinnitus: recommendations from the US VA\/DOD Clinical Practice Guideline Work Group.","volume":"151","author":"Sherlock","year":"2025","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"9","key":"ooi260008r12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-072754","article-title":"Analysis and comparison of clinical practice guidelines regarding treatment recommendations for chronic tinnitus in adults: a systematic review.","volume":"13","author":"Meijers","year":"2023","journal-title":"BMJ Open"},{"issue":"2","key":"ooi260008r13","first-page":"S1","article-title":"Clinical practice guideline: tinnitus.","volume":"151","author":"Tunkel","year":"2014","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"3S","key":"ooi260008r14","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1044\/2022_AJA-21-00245","article-title":"Internet-delivered psychological treatments for tinnitus: a brief historical review.","volume":"31","author":"Andersson","year":"2022","journal-title":"Am J Audiol"},{"issue":"2","key":"ooi260008r15","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1089\/tmj.2024.0050","article-title":"Short- and long-term outcomes of e-health and internet-based psychological interventions for chronic tinnitus: a systematic review and meta-analysis.","volume":"31","author":"Sattel","year":"2025","journal-title":"Telemed J E Health"},{"key":"ooi260008r16","doi-asserted-by":"publisher","DOI":"10.1177\/2331216519851749","article-title":"Internet-based interventions for adults with hearing loss, tinnitus, and vestibular disorders: a systematic review and meta-analysis.","volume":"23","author":"Beukes","year":"2019","journal-title":"Trends Hear"},{"issue":"3S","key":"ooi260008r17","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1044\/2018_AJA-IMIA3-18-0004","article-title":"Long-term efficacy of audiologist-guided internet-based cognitive behavior therapy for tinnitus.","volume":"27","author":"Beukes","year":"2018","journal-title":"Am J Audiol"},{"key":"ooi260008r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2022.100583","article-title":"Long-term efficacy of audiologist-guided Internet-based cognitive behaviour therapy for tinnitus in the United States: a repeated-measures design.","volume":"30","author":"Beukes","year":"2022","journal-title":"Internet Interv"},{"issue":"3","key":"ooi260008r19","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1097\/AUD.0000000000000505","article-title":"Audiologist guided internet-based cognitive behavior therapy for adults with tinnitus in the United Kingdom: a randomized controlled trial.","volume":"39","author":"Beukes","year":"2018","journal-title":"Ear Hear"},{"issue":"2","key":"ooi260008r20","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1097\/AUD.0b013e31822f67c0","article-title":"The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus.","volume":"33","author":"Meikle","year":"2012","journal-title":"Ear Hear"},{"key":"ooi260008r22","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.invent.2016.08.002","article-title":"Development and technical functionality of an Internet-based intervention for tinnitus in the UK.","volume":"6","author":"Beukes","year":"2016","journal-title":"Internet Interv"},{"issue":"10","key":"ooi260008r23","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7.","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"issue":"3","key":"ooi260008r24","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1097\/MLR.0b013e318160d093","article-title":"Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.","volume":"46","author":"L\u00f6we","year":"2008","journal-title":"Med Care"},{"issue":"18","key":"ooi260008r25","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1001\/jama.282.18.1737","article-title":"Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders: Patient Health Questionnaire.","volume":"282","author":"Spitzer","year":"1999","journal-title":"JAMA"},{"issue":"4","key":"ooi260008r26","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/S1389-9457(00)00065-4","article-title":"Validation of the Insomnia Severity Index as an outcome measure for insomnia research.","volume":"2","author":"Bastien","year":"2001","journal-title":"Sleep Med"},{"issue":"1","key":"ooi260008r27","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1207\/s15327752jpa4901_13","article-title":"The satisfaction with life scale.","volume":"49","author":"Diener","year":"1985","journal-title":"J Pers Assess"},{"issue":"6","key":"ooi260008r28","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1159\/000067570","article-title":"Psychometric normalization of a hyperacusis questionnaire.","volume":"64","author":"Khalfa","year":"2002","journal-title":"ORL J Otorhinolaryngol Relat Spec"},{"issue":"5","key":"ooi260008r29","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1097\/00003446-199110000-00009","article-title":"Test-retest reliability of the hearing handicap inventory for adults.","volume":"12","author":"Newman","year":"1991","journal-title":"Ear Hear"},{"issue":"1","key":"ooi260008r30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.2044-8260.1982.tb01421.x","article-title":"The cognitive failures questionnaire (CFQ) and its correlates.","volume":"21","author":"Broadbent","year":"1982","journal-title":"Br J Clin Psychol"},{"issue":"6","key":"ooi260008r31","doi-asserted-by":"publisher","first-page":"726","DOI":"10.3390\/brainsci12060726","article-title":"Integrating distribution-based and anchor based techniques to identify minimal important change for the tinnitus functional index (TFI) questionnaire.","volume":"12","author":"Fackrell","year":"2022","journal-title":"Brain Sci"},{"issue":"13","key":"ooi260008r32","doi-asserted-by":"publisher","first-page":"6881","DOI":"10.3390\/ijerph18136881","article-title":"Systematic review on healthcare and societal costs of tinnitus.","volume":"18","author":"Trochidis","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"ooi260008r33","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1186\/s12913-018-2914-3","article-title":"Tinnitus services in the United Kingdom: a survey of patient experiences.","volume":"18","author":"McFerran","year":"2018","journal-title":"BMC Health Serv Res"},{"issue":"13","key":"ooi260008r34","doi-asserted-by":"publisher","first-page":"2763","DOI":"10.3390\/jcm10132763","article-title":"The impact of COVID-19 and the pandemic on tinnitus: a systematic review.","volume":"10","author":"Beukes","year":"2021","journal-title":"J Clin Med"},{"issue":"2","key":"ooi260008r35","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1044\/2021_AJA-20-00188","article-title":"Coping with tinnitus during the COVID-19 pandemic.","volume":"30","author":"Beukes","year":"2021","journal-title":"Am J Audiol"},{"issue":"4","key":"ooi260008r36","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/j.beth.2007.10.003","article-title":"Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: a randomized controlled trial.","volume":"39","author":"Kaldo","year":"2008","journal-title":"Behav Ther"},{"issue":"4","key":"ooi260008r37","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1037\/a0027021","article-title":"A randomized controlled trial of Internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus.","volume":"80","author":"Hesser","year":"2012","journal-title":"J Consult Clin Psychol"},{"issue":"4","key":"ooi260008r38","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1097\/PSY.0000000000000310","article-title":"Internet-delivered cognitive-behavior therapy for tinnitus: a randomized controlled trial.","volume":"78","author":"Weise","year":"2016","journal-title":"Psychosom Med"},{"issue":"10","key":"ooi260008r39","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.1176\/ajp.161.10.1872","article-title":"Six-year outcome of cognitive behavior therapy for prevention of recurrent depression.","volume":"161","author":"Fava","year":"2004","journal-title":"Am J Psychiatry"},{"issue":"2","key":"ooi260008r40","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1080\/16506070410005410","article-title":"Cognitive behaviour therapy for panic disorder: long-term follow-up.","volume":"34","author":"Kenardy","year":"2005","journal-title":"Cogn Behav Ther"},{"issue":"S1","key":"ooi260008r41","doi-asserted-by":"publisher","first-page":"S111","DOI":"10.1016\/j.eurpsy.2017.01.1887","article-title":"Long-term effect of CBT in patients with health anxiety.","volume":"41","author":"Veddegjaerde","year":"2017","journal-title":"Eur Psychiatry"},{"issue":"1","key":"ooi260008r42","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1080\/16506073.2021.2009019","article-title":"Very long-term outcome of CBT for insomnia: one- and ten-year follow-up of an RCT.","volume":"51","author":"Jernel\u00f6v","year":"2022","journal-title":"Cogn Behav Ther"},{"issue":"5","key":"ooi260008r43","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s10162-024-00960-3","article-title":"The current state of tinnitus diagnosis and treatment: a multidisciplinary expert perspective.","volume":"25","author":"Kleinjung","year":"2024","journal-title":"J Assoc Res Otolaryngol"},{"issue":"13","key":"ooi260008r44","doi-asserted-by":"publisher","first-page":"6881","DOI":"10.3390\/ijerph18136881","article-title":"Systematic review on healthcare and societal costs of tinnitus.","volume":"18","author":"Trochidis","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ooi260008r21","volume-title":"Cognitive Behavioral Therapy for Tinnitus","author":"Beukes","year":"2020"}],"container-title":["JAMA Otolaryngology\u2013Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2846030\/jamaotolaryngology_beukes_2026_oi_260008_1778044139.40077.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T15:00:28Z","timestamp":1778770828000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2846030"}},"subtitle":["Follow-Up Analysis of a Nonrandomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":44,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2026.0094","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}