Effects of Internet-based and mobile device-based cognitive behavioral therapy on tinnitus intervention: a systematic review and meta-analysis

Abstract

Background

Tinnitus is a common auditory disorder that seriously affects the quality of life and is often accompanied by psychological problems such as depression and anxiety. Existing therapies have problems such as side effects or high costs. Internet-based cognitive behavioral therapy (i-CBT), due to its low cost and flexibility, has become a new option. This study uses a meta-analysis to systematically assess the potential intervention effects of i-CBT on patients with tinnitus, supporting its potential value in clinical application.

Methods

This study conducted a systematic review and meta-analysis, including randomized controlled trials (RCTs). The study protocol was registered in Prospero (ID: CRD42025646698). Four databases were searched from their inception to January 2025.

Results

A total of 9 studies were included. The results indicated that i-CBT significantly improved the symptom distress, insomnia, anxiety and depression of tinnitus patients: Tinnitus Functional Index(MD = -12.48, 95 % CI -16.43, -8.54), Tinnitus Questionnaire(MD = -5.52, 95 % CI -8.15, -2.88), Insomnia Severity Index (MD = -2.65, 95 % CI -3.64, -1.67), Generalized Anxiety Disorder-7 (MD = -1.33, 95 % CI -2.37, -0.30), Hospital Anxiety and Depression Scale – Anxiety(MD = -1.92, 95 % CI -2.72, -1.12), Hospital Anxiety and Depression Scale - Depression (MD = -1.40, 95 % CI -2.18, -0.61), Patient Health Questionnaire (MD = -1.46, 95 % CI -2.87, -0.06); however, there was no significant improvement in the Tinnitus Handicap Inventory(MD = -2.98, 95 % CI -12.03, 6.07) and the tinnitus cognition questionnaire(MD = -9.09, 95 % CI -23.46, 5.28).

Conclusion

i-CBT may have beneficial effects in reducing tinnitus severity and alleviating related symptoms such as insomnia, anxiety, and depression. As an expandable and low-cost treatment approach, i-CBT offers a new direction for tinnitus management, especially in regions with limited medical resources. However, future research still needs to optimize the intervention design, standardize measurement criteria, and conduct large-scale, multi-center, and long-term follow-up studies to verify its sustained efficacy and clarify its mechanism of action.