From Detection to Intervention Psychological Aspects of Online Hearing Rehabilitation

Hearing problems are among the most common causes of disability worldwide for adults. It is currently classified as one of the top five causes of years lived with disability. Between the years 2005 and 2015 the global prevalence of hearing loss increased with about 26 %. The negative impact of hearing loss on those affected is not limited to communication problems, as a range of other negative effects can be present, such as increased levels of social isolation, problems in the work-place and psychological distress. The different studies of the thesis can be summarized in three overall research questions. The first question was if hearing loss can be detected through automated online screening procedures, and what are the characteristics of those who participate in online screening (Study I and II)? The second question focused on development and testing of a measure dealing with psychological acceptance of hearing loss (Study III). Finally, the third research question concerned if online administered guided self-help based on Acceptance and Commitment Therapy could help persons with hearing loss and psychological distress (Study IV)? In the screening studies (Study I and II) an online speech-in-noise hearing test was initially developed and later updated. Screening for hearing problems with this test was found to be feasible, and 16.7 (Study I) and 19% (Study II) of the participants were recommended to seek professional care for their potential hearing loss. These participants had more cognitive problems, were more likely to be of male gender, and had lower levels of education than those without measured hearing problems. Study III showed that it was possible to measure hearing-related acceptance with a new questionnaire and that this measure was a better predictor of disability than instruments measuring anxiety, depression, or measured hearing performance. In Study IV, people with hearing loss and comorbid psychological distress were offered an eight-week long internet-based therapist-guided self-help treatment inspired by ACT. After treatment ended, the intervention group had lower levels of perceived hearing disability, increased ratings of quality of life and reduced depressive symptoms in relation to the wait-list control group. This thesis suggests that the internet can be used to assist early detection, measuring acceptance of hearing loss and finally as a treatment modality for persons who experience distress in relation to their hearing loss