"Eco-caring together" pro-ecological group-based community interventions and mental wellbeing: a systematic scoping review.

Background: Poor mental wellbeing is a challenge for societies across the world, as is the increasing threat of climate change, and emerging evidence suggests these challenges are interrelated. Green and social prescribing of non-clinical interventions hold promise as a cost-effective and widely accessible way to improve wellbeing, and interest is growing in whether pro-ecological communal activities have mutual benefits for both people and the planet. Objectives: Communal pro-ecological activities are growing in popularity, and research is gathering pace into whether participation influences mental wellbeing. The present systematic review scopes the existing evidence base to explore what is being done, what is being found, and what additional research is required. Methods: Electronic databases (PsychNET, PubMed, Scopus, and Web of Science) were searched for studies that involved groups of people undertaking pro-ecological activities, where components of mental wellbeing were assessed. Eligibility criteria were purposely broad, including all study designs and participants across the lifespan. Results: Thirty-seven eligible studies were identified. Nearly half of the studies used mixed-method designs, and most studies used surveys or interviews to evaluate outcomes. Most pro-ecological activities involved planting vegetation, and habitat creation, maintenance, or restoration. Methodological quality varied considerably. Among the perceived therapeutic mechanisms reported, the social elements of the interventions were prominent. Discussion: Coherent synthesis of the current evidence base is challenging given the heterogeneous range of methods, samples, and interventions within the studies. However, the results here demonstrate promise that with future research and better methodological rigor, pro-ecological group-based interventions hold the potential to improve mental wellbeing and influence sustainable behavior. Systematic review registration: https://osf.io/vmpr6/.

"I Really Felt the Feeling": A Systematic Review and Qualitative Thematic Synthesis of Healthcare Workers' Experiences of Acceptance and Commitment Therapy Training.

Purpose: Existing research suggests that Acceptance and Commitment Therapy (ACT) training is beneficial for healthcare workers' professional practice and personal well-being. This review aimed to further understanding of healthcare workers' experiences of ACT training by synthesizing existing qualitative studies.Methods: A systematic literature review identified papers published up until April 2022 using the Embase, Ovid MEDLINE, and PsycINFO databases as well as relevant studies within the gray literature. Nine studies were included in the review, which were analyzed using Thematic Synthesis (Thomas & Harden, 2008).Results: Three analytical themes were identified through the thematic synthesis: I am both the patient and the professional; a powerful and empowering experience; and it is not always comfortable.Conclusion: This review has highlighted the importance of experiential learning. The training was a powerful experience for staff, but as such, it was not always comfortable. Recommendations for the future delivery of ACT training are made.

How people with tinnitus-related insomnia experience group CBT-for-insomnia (CBTi): a thematic analysis.

Objective: Although insomnia often compounds tinnitus, sleeping problems in people experiencing tinnitus are rarely treated. This study investigates the experiences of participants receiving Cognitive Behavioural Therapy for insomnia (CBTi) as part of a randomised controlled trial for managing tinnitus-related insomnia. The aim of this study is to gain detailed insight into participants' perceptions and experiences of this treatment.Design: Semi-structured interviews were conducted via phone or in-person by one of the two clinical psychologists who facilitated the CBTi sessions. Reflexive thematic analysis with semantic inductive approach was used for analysis to keep the research question theoretically flexible.Study samples: Eight participants (three females, age range 32-69 years) were interviewed six months after CBTi completion.Results: Three superordinate themes were identified: "Common humanity and transcending individual distress," "Changing the things I can" and "Accepting the things I cannot change." The group environment helped participants to normalise their experiences. Reliable tinnitus/sleep information and robust behavioural change techniques helped participants to respond and relate to their condition differently.Conclusion: Generally, participants reported long-term benefits from CBTi to treat tinnitus-related insomnia, particularly increased confidence, and getting on with life. CBTi is multi-component, so clinicians need to respond to individual preferences and lifestyles.

Replacement of the Mouse LD50 Assay for Determination of the Potency of AbobotulinumtoxinA with a Cell-Based Method in Both Powder and Liquid Formulations.

Botulinum neurotoxins (BoNTs) are important therapeutic agents. The in vivo median lethal dose (LD50) assay has been commonly used to measure the potency of BoNT commercial preparations. As an alternative, we developed cell-based assays for abobotulinumtoxinA in both powder (Dysport®, Azzalure®) and liquid (Alluzience®) formulations using the in vitro BoCell® system. The assays demonstrated linearity over 50-130% of the expected relative potency, with a correlation coefficient of 0.98. Mean recoveries of 90-108% of the stated potency were observed over this range. The coefficients of variation for powder and liquid formulations, respectively, were 3.6% and 4.0% for repeatability and 8.3% and 5.0% for intermediate precision. A statistically powered comparability assessment of the BoCell® and LD50 assays was performed. Equivalence was demonstrated between the assays for the liquid formulation at release and end of shelf life using a paired equivalence test with predefined equivalence margins. For the powder formulation, the assays were also shown to be equivalent for release samples and when determining loss of potency following thermal degradation. The BoCell® assay was approved for establishing the potency of abobotulinumtoxinA for both powder and liquid formulations in Europe and for the powder formulation only in the USA.

Cognitive-behavioral factors in tinnitus-related insomnia.

Background: A significant proportion of individuals with distressing tinnitus also report insomnia. Limited, but emerging, evidence suggests that tinnitus-related insomnia cannot be explained only by the presence of tinnitus and that sleep-related cognitive-behavioral processes may play a key role in exacerbating tinnitus-related insomnia. Objectives: This study aimed to assess whether sleep-related cognitions and behaviors believed to maintain insomnia disorder are present in individuals with tinnitus-related insomnia. Methods: This between-groups study recruited 180 participants online for four groups: tinnitus-related insomnia (N = 49), insomnia disorder without tinnitus (N = 34), tinnitus sufferers who are good sleepers (N = 38), and controls (N = 59). They completed questionnaires assessing insomnia severity, sleep-related cognitions and behaviors, sleep quality, anxiety, and depression. People with tinnitus completed a measure of tinnitus severity and rated the loudness of their tinnitus on a subjective measure. Results: Linear regression demonstrated that group significantly predicted sleep related thoughts and behaviors, and sleep quality. Pairwise comparisons showed that the tinnitus-related insomnia group had significantly greater insomnia-related thoughts and behaviors and significantly worse sleep quality than tinnitus-good sleepers. No differences were seen between the tinnitus-related insomnia and the insomnia groups. The tinnitus-related insomnia group had significantly higher depression, anxiety, and tinnitus distress than tinnitus-good sleepers. Conclusion: Findings suggest that tinnitus-related insomnia may be maintained by cognitive-behavioral processes similar to those found in insomnia disorder. Such processes are more important than tinnitus severity when understanding sleep disturbance. People with tinnitus-related insomnia may benefit from treatments such as cognitive-behavioral therapy for insomnia.

Self-caught methodologies for measuring mind wandering with meta-awareness: A systematic review.

Mind wandering, also known as task-unrelated thought, refers to the drift of attention from a focal task or train of thought. Because self-caught measures of mind wandering require participants to spontaneously indicate when they notice their attention drift, self-caught methodologies provide a way to measure mind wandering with meta-awareness. Given the proposed role of meta-awareness in mental health and psychological interventions, an overview of existing self-caught methodologies would help clinicians and researchers make informed decisions when choosing or adapting a mind wandering or meta-awareness measure. This systematic review included 39 studies after 790 studies were assessed for eligibility. All studies operationalised mind wandering as instances of attention drift from a primary task. Three types of primary task were identified: (1) tasks adapted from computerised continuous performance tests (CPT) of sustained attention, (2) tasks involving focusing on the breath or a stream of aural beats, akin to in-vivo mindfulness meditation, (3) tasks involving an everyday life activity such as reading. Although data on mind wandering without meta-awareness (e.g., measured with probe-caught measures) was also obtained in many studies, such data was not always used in conjunction with self-caught mind wandering data to determine level of mind wandering meta-awareness. Few studies reported both reliability and validity of the measures used. This review shows that considerable methodological heterogeneity exists in the literature. Methodological variants of self-caught mind wandering methodologies are documented and examined, and suggestions for future research and clinical work are suggested.

"I can see a path forward now": a qualitative investigation of online groups for tinnitus in the time of Covid-19.

OBJECTIVES: The Covid-19 pandemic led the British Tinnitus Association to offer more online support to people with tinnitus. The aim of this study was to understand how low-intensity group-based digital interventions could benefit people with tinnitus. DESIGN: Semi-structured interviews explored participants' experiences and views on receiving support via an online group. STUDY SAMPLE: Sixteen people with tinnitus who had attended a recent online tinnitus group and/or workshop were recruited using convenience sampling. RESULTS: Three overarching themes were extrapolated from the data: feeling part of a community, being reliably informed, and living better with tinnitus. CONCLUSIONS: Participants reported significant benefits from both types of online group. There was appreciation for the accessibility of help during lockdown, and participants felt that this type of support would continue to be valuable post-pandemic. As seen in research on face-to-face groups, benefits came from a supportive community of people with tinnitus and knowledgeable, skilled and trustworthy facilitation and information provision. Outcomes focussed on feeling less isolated, more informed and hopeful. Online groups could offer an accessible ongoing resource supporting people on their journey with tinnitus.

Cognitive behavioural therapy for insomnia (CBTi) as a treatment for tinnitus-related insomnia: a randomised controlled trial.

Insomnia is a significant difficulty and is reported by large proportion of people with tinnitus. Although cognitive behavioural therapy for insomnia (CBTi) might be an effective treatment, no controlled studies had been conducted to date. This randomised controlled trial evaluated the benefits of CBTi on a sample of 102 people with tinnitus-related insomnia. Participants were randomised to 1) CBTi, 2) Audiology-Based Care (ABC) or 3) Sleep Support Group (SSG). Primary outcomes included insomnia, sleep efficiency and total sleep time. Secondary outcomes measured sleep onset latency, sleep quality, tinnitus distress, psychological distress, functioning and quality of life. CBTi was superior at reducing insomnia and increasing sleep efficiency compared to ABC post-intervention and at 6-month follow-up. ABC was superior at reducing insomnia and increasing sleep efficiency compared to SSG. Both CBTi and ABC reported increased total sleep time compared to SSG at 6-month follow. More than 80% of participants in the CBTi group reported clinically meaningful improvements compared to 47% in ABC and 20% for those receiving social support. CBTi was more effective in reducing tinnitus distress and improving sleep quality, functioning and some aspects of mental health. CBTi and ABC offer effective treatments for tinnitus-related sleep disorder but CBTi offers a sizeable benefit.

Understanding university student priorities for mental health and well-being support: A mixed-methods exploration using the person-based approach.

Poor student well-being at UK universities is overstretching institutional support services, highlighting a need for effective new resources. Despite extensive literature on mental health and well-being interventions, students' engagement with support remains unexplored. The study aimed to understand students' experience of engagement with well-being support, identify their well-being needs and form concrete recommendations for future intervention design and delivery. The Person-Based Approach to intervention design was followed to centralise users' experience, in turn maximising acceptability and effectiveness of resources. An online survey (N = 52) was followed by three focus groups (N = 14). Survey data were analysed descriptively, and reflexive thematic analysis was performed on qualitative data. Mixed-methods data integration produced four key student priorities for well-being resources - ease of access, inclusive and preventative approach, sense of community and a safe space, and applying skills to real-life contexts. Five actionable guiding principles for intervention design were produced through consultation with expert stakeholders. This work helps understand why and how students engage with support at university. The resulting recommendations can inform future intervention development, leading to more acceptable, engaging and effective student well-being resources.

The contribution of cognitive behavioural factors to social anxiety in Parkinson's disease.

BACKGROUND: Social anxiety is prevalent in idiopathic Parkinson's disease but why this is, is not yet well understood. Social cognitions, safety-seeking behaviours and internally focused attention are all known to predict social anxiety in the general population. These associated factors have not yet been explored in idiopathic Parkinson's disease, where disease severity and motor symptoms might also influence the experience of social anxiety. AIMS: This study aimed to explore the relationship between cognitive behavioural factors and social anxiety in Parkinson's disease. METHOD: Using a cross-sectional design, 124 people with Parkinson's disease completed self-report questionnaires including measures of Parkinson's disease severity, social anxiety, negative social cognitions, safety-seeking behaviours, internally focused attention, anxiety and depression. RESULTS: The final regression model accounted for 71.6% of variance in social anxiety. Cognitive behavioural variables accounted for the largest magnitude of unique variance (43.5%). Sex, anxiety and depression accounted for 23.4%, and Parkinson non-motor symptom severity for 4.7%. Negative social cognitions and safety-seeking behaviours were statistically significant predictors, while an internal focus of attention was not. CONCLUSIONS: Social anxiety in Parkinson's disease is associated with negative social cognitions and safety-seeking behaviours. Findings indicate the need for further research into cognitive behavioural approaches to social anxiety in Parkinson's disease.

Stories of hope created together: A pilot, school-based workshop for sharing eco-emotions and creating an actively hopeful vision of the future.

The climate and ecological crises challenge all communities across the world, with the greatest impact upon the most vulnerable and the youngest. There are multiple impacts on mental health, including the psychological burdens that arise with increasing awareness of the loss, threat and injustice caused by these crises. Large numbers of young people globally are understandably concerned and distressed about these crises, whilst simultaneously reporting that their concerns are regularly dismissed and ignored, particularly by those in power. This can increase feelings of isolation and distress, particularly if they have no recourse to effect change. This pilot project sought to explore how a schools-based, co-created workshop for school pupils aged 16 to 18 years could use a community-oriented space to explore their eco-emotions, address feelings of isolation and engender a sense of realistic, active hope, using storytelling and images of possible futures. A 3-h workshop for delivery in schools was co-designed with young people, researchers, educators and clinicians, using principles of Youth Participatory Action Research (YPAR). Six school pupils aged 16-18 years consented and four completed the workshop, which involved a range of group-based activities to explore their understanding of the climate and ecological crises, support emotional expression related to these and engage in storytelling about hopeful and realistic futures. A live illustrator in attendance created shared images of the participants' fears and hopes. The workshop was recorded, transcribed and analysed using Thematic Analysis and sentiment analysis. Feedback was sought from participants at 1 and 4 weeks after completion and analysed using content analysis. Results indicated that participants reported a range of painful and positive emotions about the crises. They highly valued having space to express their experience alongside others. Storytelling and creativity appeared to help them articulate their feelings and hopes for the future, and gave them greater motivation and confidence in talking to others about these topics. This innovative pilot study suggests that a school-based youth participatory group could offer a novel way of helping young people to engage more with the climate and ecological crises in a way that supports their wellbeing. It provides strong support for future, larger-scale projects in this area.

Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey.

BACKGROUND: Climate change has important implications for the health and futures of children and young people, yet they have little power to limit its harm, making them vulnerable to climate anxiety. This is the first large-scale investigation of climate anxiety in children and young people globally and its relationship with perceived government response. METHODS: We surveyed 10 000 children and young people (aged 16-25 years) in ten countries (Australia, Brazil, Finland, France, India, Nigeria, Philippines, Portugal, the UK, and the USA; 1000 participants per country). Invitations to complete the survey were sent via the platform Kantar between May 18 and June 7, 2021. Data were collected on participants' thoughts and feelings about climate change, and government responses to climate change. Descriptive statistics were calculated for each aspect of climate anxiety, and Pearson's correlation analysis was done to evaluate whether climate-related distress, functioning, and negative beliefs about climate change were linked to thoughts and feelings about government response. FINDINGS: Respondents across all countries were worried about climate change (59% were very or extremely worried and 84% were at least moderately worried). More than 50% reported each of the following emotions: sad, anxious, angry, powerless, helpless, and guilty. More than 45% of respondents said their feelings about climate change negatively affected their daily life and functioning, and many reported a high number of negative thoughts about climate change (eg, 75% said that they think the future is frightening and 83% said that they think people have failed to take care of the planet). Respondents rated governmental responses to climate change negatively and reported greater feelings of betrayal than of reassurance. Climate anxiety and distress were correlated with perceived inadequate government response and associated feelings of betrayal. INTERPRETATION: Climate anxiety and dissatisfaction with government responses are widespread in children and young people in countries across the world and impact their daily functioning. A perceived failure by governments to respond to the climate crisis is associated with increased distress. There is an urgent need for further research into the emotional impact of climate change on children and young people and for governments to validate their distress by taking urgent action on climate change. FUNDING: AVAAZ.

The effect of perceived life stress on posttraumatic stress disorder treatment outcome.

Life stress following trauma exposure is a consistent predictor of the development of posttraumatic stress disorder (PTSD). However, there is a dearth of research on the effect of life stress on PTSD treatment outcomes. The current study examined the effects of pretreatment levels of perceived life stress on treatment outcome in a sample of 200 individuals with PTSD who were randomized to receive either prolonged exposure (PE) therapy or sertraline as part of a clinical trial. Life stress over the year prior to treatment significantly interacted with treatment type to predict higher residual PTSD symptom severity, as assessed using the PTSD Symptom Scale-Interview, among participants who received sertraline but not those who received PE, ß = .24, p = .017, ∆R2 = .03. These findings were similar for self-reported depression severity, ß = .27, p = .008, ∆R2 = .04. Adherence to either PE homework or sertraline compliance did not mediate this association nor did life stress predict treatment retention for either treatment arm. Higher levels of perceived life stress may serve as a prescriptive predictor of PTSD treatment outcome, with PE remaining efficacious regardless of heightened pretreatment life stress. These findings encourage clinician confidence when providing PE to individuals with higher levels of life stress. Future researchers should examine the impact of PTSD treatment on perceived and objective measures of life stress to improve treatment for individuals who experience chronic stress.

A Case Report of Trevor's Disease in a Pediatric Patient with Hereditary Multiple Exostoses Disease.

Introduction: Hereditary multiple exostoses (HME) disease is hallmarked by cartilaginous osteochondromas secondary to an autosomal dominant mutation within the exostosin gene family. These outgrowths predominantly occur around the long bone physis. An associated disease is dysplasia epiphysealis hemimelica also known as Trevor's disease. Trevor's disease is hallmarked by intra-articular osteochondromas. While the two diseases are similar, they are not genetically related and often have differing patient presentations. Case Report: We report on a case of a 7-year-old female with a familial history significant for HME that presented with an isolated chief complaint of elbow extension block secondary to osteochondromas found both intra-articular and at the olecranon fossa. We present what could be one of the first cases of coexisting HME and Trevor's disease of the upper extremity. Conclusion: Our patient's unique presentation of an intra-articular osteochondroma speculated to be a result of Trevor's disease, in the presence of an established HME diagnosis. Management for this patient did not deviate heavily from the established approach for HME which entails conservative observation until symptomatic. Due to the substantial loss of range of motion (ROM), surgical intervention took place in the form of exostoses removal and necessary reconstruction of the fossa. The patient's ROM subsequently was restored to near normal.

Imaginal exposure exacerbation revisited: Deconstructing patient characteristics associated with worse reactions to the initiation of imaginal exposure in PTSD.

OBJECTIVE: This study examines whether imaginal exposure leads to symptom exacerbation, systematically comparing individuals who received prolonged exposure (PE) to those who received pharmacotherapy. The study also examined whether common clinical features increase the likelihood of symptom exacerbation. METHOD: In 151 men and women with PTSD, we examined rates of reliable exacerbation of PTSD and depression symptoms after initiation of imaginal exposure and compared it to those receiving sertraline. We also examined relationships between exacerbation, treatment outcome, dropout, imaginal distress, and specific clinical features, including co-occurring MDD, multiple co-occurring disorders, childhood sexual abuse as target trauma, and a history of childhood physical or sexual abuse. RESULTS: Symptom exacerbation was not more common in PE compared to sertraline, not associated with higher dropout, or predictive of worse outcome. Those with co-occurring depression or multiple disorders, a target trauma of child sexual abuse, or a history of child abuse reported functionally equivalent peak distress at onset of imaginal as those without these characteristics. These factors did not lead to more exacerbation or worse adherence. CONCLUSION: Exacerbation was not specific to PE and patients with and without symptom worsening showed comparable treatment gains, suggesting symptom exacerbation may reflect a common clinical process.

I Wasn't at War With the Noise: How Mindfulness Based Cognitive Therapy Changes Patients' Experiences of Tinnitus.

OBJECTIVES: Intrusive tinnitus is a challenging, life-changing experience for which traditional medical treatment does not yet have a cure. However, Mindfulness Based Cognitive Therapy for tinnitus (MBCT-t) is effective in reducing tinnitus-related distress, disability and intrusiveness. It is a priority to understand patients' experience of MBCT-t and active processes which they regarded as underpinning the changes they experienced. Semi-structured interviews were conducted 6 months after participants had completed MBCT as part of a randomized controlled trial (RCT), with a focus on exploring their experiences of the course, what they felt had changed and how they felt such changes had occurred. METHODS: Nine participants took part and Interpretative Phenomenological Analysis (IPA) was used to analyze the interview transcripts. RESULTS: Four overarching themes emerged: (1) Relating to Tinnitus in a New Way, (2) Holistic Benefits, (3) Connection, Kindness and Compassion, and (4) Factors Supporting Engagement and Change. CONCLUSION: All participants reported benefits from MBCT-t, based on a radically new relationship with tinnitus. It was no longer characterized by "fighting it" and was instead based on "allowing" tinnitus to be present. Changes were supported by the development of open, stable, present-moment awareness and attitudes of equanimity, kindness, and compassion. Practices encouraging focus on sound (including tinnitus) were challenging, but essential to learning this new way of being with tinnitus. MBCT-t had a huge range of benefits including reduced distress and enhanced wellbeing. The group nature of MBCT-t was an integral part of the therapeutic process. A number of clinical and research implications are discussed.

Current Validated Medical Treatments for Tinnitus: Cognitive Behavioral Therapy.

Tinnitus distress results from a weave of physical and psychological processes. Reducing the power of the psychological processes will therefore reduce the degree of suffering. The main psychological therapy in this context is cognitive behavioral therapy (CBT). This seeks to understand and change the influence of thinking processes, including information processing biases, and the behaviors that these motivate, on the experience of tinnitus. The results of systematic reviews and meta-analyses indicate that CBT is the tinnitus management approach for which there is the most robust evidence. In spite of this, it remains difficult to access for people with tinnitus.

Living with tinnitus and the health care journey: An interpretative phenomenological analysis.

OBJECTIVES: Tinnitus is a very common experience, and although usually mild, in a significant proportion of people, it is intrusive, persistent, and disabling. This paper explores the lived experience of chronic disabling tinnitus, with the aim of understanding how distress and chronicity occur, and what might help to reduce this. DESIGN: Nine individuals were interviewed 6 months after completing mindfulness-based cognitive therapy (MBCT) as part of a randomized controlled trial. The results reported here focus on their experiences of tinnitus before receiving MBCT. METHODS: Data were collected through semi-structured, face-to-face interviews with a clinical psychologist, and an interpretative phenomenological analysis approach was used. RESULTS: Two supraordinate themes emerged. 'Living with tinnitus' describes a range of significant and profound life changes that result from the condition. Tinnitus can be a life-altering condition affecting thoughts, emotions, attention, behaviour, and the social world. 'The health care journey' shows how chronic distress was intensified by unhelpful health communications and alleviated by helpful consultations. CONCLUSIONS: Tinnitus is a biopsychosocial condition, and associated distress is affected by cognitive, behavioural, attentional, and social factors. The individuals' initial reactions to tinnitus interact with the responses of others, including health care professionals. The burden of tinnitus could be reduced by developing early interventions that offer clear, helpful, and realistic information about tinnitus and appropriate treatments. Statement of contribution What is already known on this subject? Tinnitus is the experience of an internal sound without an external sound source. It can be troubling, disabling, and chronic and usually has no clear medical cause or medical treatment, but psychological interventions are promising. Cognitive, behavioural, and attentional factors play a role in distress and therapeutic outcome. Clinical encounters are improved by aligning patient and clinician and sharing decision-making. What does this study add? It is the first in-depth study exploring how tinnitus distress and health care systems interact. It shows how a biopsychosocial approach to tinnitus may reduce tinnitus burden more effectively than a biomedical, diagnostic-focused approach. It indicates how effective early health care information could be used to reduce chronic tinnitus distress.

Cognitive behavioural therapy for tinnitus-related insomnia: evaluating a new treatment approach.

OBJECTIVE: Insomnia frequently occurs alongside distressing tinnitus, and greater tinnitus severity is associated with more sleep disturbance. Insomnia and tinnitus probably share common underlying processes and sleep studies show striking similarities between primary and tinnitus-related insomnia. This is the first study to evaluate outcomes following insomnia-specific Cognitive Behavioural Therapy (CBTi) for tinnitus-related insomnia in a "real world" clinic. DESIGN: Treatment was six-sessions of group-based CBTi. Measures of insomnia, sleep diaries, tinnitus distress, psychological distress, anxiety and depression were completed pre-intervention, post-intervention and at six-weeks follow up. STUDY SAMPLE: Participants were 24 adults with chronic, distressing tinnitus and associated sleep disturbance. Twenty-two completed treatment. RESULTS: CBTi was associated with significant improvements from pre-intervention to post-intervention maintained at follow up in insomnia, sleep-diary measures, tinnitus distress, psychological distress, anxiety and depression, largely maintained at follow-up. Reliable improvements were reported in insomnia (by 67% of patients), tinnitus distress (by 50% of patients) and psychological distress (by 38% of patients) post-intervention. CONCLUSIONS: The results suggest that CBTi is associated with reduced insomnia and distress for patients reporting chronic and distressing tinnitus with related insomnia. Further research into CBTi for this population, using utilising robust, randomised controlled designs, is warranted.

The development of a decision aid for tinnitus.

OBJECTIVE: To develop a decision aid for tinnitus care that would meet international consensus for decision aid quality. DESIGN: A mixed methods design that included qualitative in-depth interviews, literature review, focus groups, user testing and readability checking. STUDY SAMPLE: Patients and clinicians who have clinical experience of tinnitus. RESULTS: A decision aid for tinnitus care was developed. This incorporates key evidence of efficacy for the most frequently used tinnitus care options, together with information derived from patient priorities when deciding which choice to make. CONCLUSION: The decision aid has potential to enable shared decision making between clinicians and patients in audiology. The decision aid meets consensus standards.