Individual research recommendation details

Recommendation ID

NG155/1

Question

What is the clinical and cost effectiveness of cognitive behavioural therapy (CBT) for adults with tinnitus delivered by appropriately trained healthcare professionals other than psychologists (for example, audiologists)?

Any explanatory notes
(if applicable)

Why the committee made the recommendation
The evidence suggests that cognitive behavioural therapy (CBT), mindfulness-based CBT and acceptance and commitment therapy (ACT) are effective interventions for managing tinnitus-related distress. CBT can be delivered in different formats such as digital (for example, internet based), group and individual face-to-face sessions.

The cost effectiveness of specific therapies is uncertain. However, economic analyses suggested that it would be less costly to use digital or group therapy first line, and individual therapy for people who are still distressed after their first-line psychological intervention.

Mindfulness-based cognitive therapy should be delivered by appropriately trained and supervised practitioners. The committee agreed that all psychological therapies should be supervised by psychologists.

The committee noted that with face-to-face psychological interventions (such as group CBT), people may sometimes not attend sessions. People may be more likely to complete the full intervention with digital CBT than with face-to-face sessions, as they would be able to participate according to their lifestyle, rather than having to travel to a session at a designated time. Digital CBT for tinnitus is currently only available in research, with evidence suggesting that it is clinically effective. While digital CBT is unavailable or when it is not suitable, group CBT should be used as the first-line psychological therapy. In current practice, the selection of group CBT or individual CBT is made on a case-by-case basis and mainly dependent on the availability of CBT services and individual preferences. The committee noted that some people may be hesitant about group CBT at first but may find it a more meaningful and positive experience.

CBT and ACT should be delivered by psychologists because this is considered important for achieving good patient outcomes. Taking into account the clinical and economic evidence, together with a lack of direct evidence of cost effectiveness, the committee agreed that a stepped approach for adults with tinnitus-related distress could be considered.

The committee noted that no evidence was identified that evaluated psychological therapies in children and young people. Access to psychological therapies for children and young people with tinnitus is currently limited. The committee agreed that further research is needed, and made a research recommendation on psychological therapies for children and young people.

How the recommendation might affect practice
In some regions of the UK there is limited access to psychological therapies for people with tinnitus, with few healthcare professionals trained in delivering them. The committee noted that implementing the recommended psychological therapies will lead to a significant change in practice in regions where access is limited. However, to help providers in widening access to psychological therapies for people with tinnitus, the committee recommended that digital CBT be considered as a first-line intervention. This intervention would allow people with tinnitus to receive their treatment faster and help to reduce waiting lists. It is expected that some providers, working alongside clinicians (including psychologists) with experience in working with people with tinnitus, will take the initiative to adapt existing digital CBT tools available for other conditions.

The recommendation could result in cost savings for services that are currently offering individual-based psychological therapies as a first-line psychological treatment for tinnitus. This is because of the committee's view that these expensive interventions should only be used when other methods (digital CBT and group-based interventions) have been exhausted. Therefore, although some providers may incur additional expenditure as a result of implementing these recommendations, other providers might achieve cost savings. Furthermore, the committee recommended a number of different group-based psychological strategies as there is no clear evidence that 1 psychological intervention is more clinically effective than another. Providers can therefore adopt those interventions that are easiest to implement based on their existing staff and skills, and this would further minimise the resource impact.

As there is limited access to psychology services, the committee recommended that research is needed to assess the effectiveness of CBT delivered to people with tinnitus by appropriately trained and supervised healthcare practitioners other than psychologists (for example, audiologists; see research recommendation 1). This research could further help to widen access to psychological services as more clinicians would be available to provide the interventions listed in this recommendation.

Source guidance details

Comes from guidance

Tinnitus: assessment and management

Number

NG155

Date issued

March 2020

Other details