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Application of the Behavior Change Wheel within the context of internet-based cognitive behavioral therapy for tinnitus management

journal contribution
posted on 13.01.2022, 11:57 by Eldré W. Beukes, Vinaya Manchaiah, Gerhard Andersson, David MaidmentDavid Maidment
Purpose: Although experiencing tinnitus can lead to many difficulties, these can be reduced by using techniques derived from cognitive behavioral therapy. Internet-based cognitive behavioral therapy (ICBT) intervention has been developed to provide an accessible intervention. The aim of this study was to describe how ICBT can facilitate tinnitus management by identifying the active ingredients of the intervention from the perspective of health behavior change.
Method: The ICBT intervention was evaluated using the Behavior Change Wheel in eight steps across the following three stages: (1) understanding the behavior, (2) identifying intervention options, and (3) identifying content and implementation options.
Results: Target behaviors identified to reduce tinnitus distress, as well as additional problems associated with tinnitus, included goal setting, an increased understanding of tinnitus, encouraging deep breathing and progressive muscle relaxation, identifying and restructuring unhelpful thoughts, engaging in positive imagery, and reducing avoidance behaviors. ICBT provided the required components for individuals to be physically and psychologically capable of adapting to tinnitus, providing social and environmental opportunities to manage hearing loss through practice and training, and facilitated automatic and reflective motivation.
Conclusions: Understanding the ICBT in the context of the Behavior Change Wheel has helped identify how its effectiveness can be improved and can be used for future tinnitus intervention planning.


National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health (NIH) under the award number R21DC017214



  • Sport, Exercise and Health Sciences

Published in

American Journal of Audiology: a journal of clinical practice


American Speech-Language-Hearing Association


AM (Accepted Manuscript)

Publisher statement

This paper was accepted for publication in the journal American Journal of Audiology: a journal of clinical practice and the definitive published version is available at .....

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Dr David Maidment. Deposit date: 11 January 2022