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Health Psychology / Behavioral Medicine - Adult

(PS6-B50) Voices from the Field: A Mixed Methods Approach to Update Progressive Tinnitus Management

Friday, November 17, 2023
4:00 PM – 5:00 PM PST
Location: Regency Ballroom, Level 7


Purpose:  Tinnitus is a common health condition in the general population, with increased prevalence among Veteran populations. In fact, tinnitus is the most common service-connected disability among Veterans. Although there is no cure for tinnitus, interventions help reduce the psychological impact of the auditory disorder; and therefore, increase quality of life. Progressive Tinnitus Management (PTM) is one such intervention that is a stepped-care, interdisciplinary method of providing tinnitus clinical services. PTM was endorsed by national Veterans Affairs (VA) audiology leadership in 2009, and has also been rolled-out among DoD military treatment facilities (MTFs). Given new clinical insights and research since the roll-out of PTM, it remained necessary to improve and update the protocol using feedback from stakeholders. The goal of this study was to gain important quantitative and qualitative data from patients and providers of PTM, to inform the necessary alterations of the protocol for increased relevancy and optimal treatment outcomes.


Method: This two-phase quality improvement project obtained quantitative and qualitative feedback from VA clinicians, Department of Defense (DoD) audiologists, mental health providers, VA patients, and civilians regarding their perspectives on necessary revisions of the clinician- and patient-facing PTM materials. A convergent parallel mixed methods design was used to integrate the quantitative and qualitative data, and consensus methods were used to adjudicate any discrepant findings. In Phase I, 21 VA and DoD clinicians and patients completed semi-structured interviews and quantitative measures on the PTM handbook and workbook revisions. In Phase II, six non-Veteran patients pilot tested PTM presentation materials used by clinicians in PTM skills education sessions. 


Results:  The feedback gathered from VA clinicians and patients on PTM materials led to recommendations on content, format, and content. Feedback from providers recommended replacing previous tinnitus outcome measures with newer measures, such as the Tinnitus Functional Index (TFI), which was developed since the original PTM materials were compiled and has been shown to be a more sensitive and specific measure. Providers' enthusiasm for some CBT components, including "Changing Thoughts," was diminished. However, Phase 2 findings from tinnitus sufferers indicated that CBT interventions, such as relaxation exercises and behavioral activation were deemed very useful. Overall, the revised PTM presentation slides were useful and clinically acceptable.


Conclusion: The findings from this study are being used to update the materials and methods in the PTM skills education sessions. The importance of interdisciplinary care was a prominent theme among providers. PTM is often delivered by audiologists who do not necessarily have the training in cognitive behavioral therapy (CBT). It is recommended that mental health providers train audiologists in important skills that they may impart to patients, such as cognitive restructuring, relaxation, and mindfulness techniques. Alternatively, mental health providers can play a more prominent role within the PTM course to achieve optimal tinnitus outcomes.