Does sound stimulation have additive effects on cognitive-behavioral treatment of chronic tinnitus?

Psychological and physiological habituation are major goals in the treatment of patients suffering from chronic tinnitus. This study evaluates whether sound stimulation provided by use of low level white noise generators (NG) enhances the effects of cognitive-behavioral treatment (CBT). 124 outpatients with tinnitus of >6 months received manualized group treatment and were randomly assigned to the NG/no NG conditions. Those with moderate tinnitus-related distress obtained four sessions focusing on education, while severely distressed subjects were treated according to a full 10-session CBT program. Outcome was assessed at post-treatment and at 6- and 18-month follow-up. No additive effects due to the NGs could be demonstrated. All groups improved significantly on measures of tinnitus-related distress, dysfunctional cognitions, general psychopathology, depression, hypochondriasis and psychosocial functioning. Beneficial effects of the NGs were only observed for patients with concurrent tinnitus and hyperacusis. As systematic physical stimulation of the auditory system does not further improve the effects of CBT, the importance and strength of psychological interventions are emphasized. The clinical relevance of recently developed "retraining" approaches accentuating physical stimulation should be reconsidered.     

Rational-emotive therapy and the reduction of interpersonal anxiety in junior high school students

This study evaluated the effectiveness of rational-emotive therapy and rational-emotive imagery. Fifty-nine junior high school students who volunteered to participate in treatment for interpersonal anxiety were randomly assigned to rational-emotive therapy without imagery (RET), rational-emotive therapy with imagery (REI), relationship-oriented counseling (ROC), and waiting-list control (WLC) groups. Groups met for seven 50-minute treatment sessions during a three-week period. Assessments were conducted at pretreatment, posttreatment, and three-week follow-up. Both self-report and sociometric measures were used to evaluate treatment outcome. At postassessment, both the RET and REI groups were rated on sociometric measures as significantly less interpersonally anxious than the WLC group. Mean scores favored the RET and REI groups, but no significant differences between these groups and the ROC group were obtained. The self-report measure did not significantly differentiate between groups, but the REI group demonstrated significant pre- to follow-up changes. Both the RET and REI groups yielded greater reductions in irrational thinking than did the ROC and WLC groups. In addition, the pattern of the results supported the use of rational-emotive imagery as a component of rational-emotive therapy. The practical implications of these findings are discussed.     

Cognitive-behavior therapy in the management of chronic, occupational pain of the upper limbs

Forty five subjects who experienced chronic, occupational pain of the upper limbs were randomly assigned to one of three conditions; individual cognitive-behaviour therapy (ICBT), group cognitive-behaviour therapy (GCBT) and WLC. Significant benefits were found for both ICBT and GCBT on measures of anxiety, depression, coping strategies, impact on daily living, pain and distress caused by pain. These gains were not evident in the WLC and were maintained at the 6 month follow-up Minimal difference was found between ICBT and GCBT on measures of pain and psychopathology, although client evaluation ratings at the end of treatment favoured ICBT.     

Psychological investigation of genital herpes recurrence: prospective assessment and cognitive-behavioral intervention for a chronic physical disorder

Previous studies suggest that anxiety and/or depressed mood are associated with recurrence of genital herpes lesions. The present study sought to extend the assessment of factors associated with genital herpes and to investigate the impact of psychological therapy on features of the disorder. Sixteen genital herpes patients received 5 weeks of either structured discussion or cognitive restructuring (CR) therapy in a group format. Measures of attitude about herpes, global coping, distress, loneliness, health locus of control, and recurrence frequency were administered at pretreatment, posttreatment, and 3 months follow-up. Patients also made daily reports during the 5 weeks of treatment from which information was extracted regarding their herpes symptoms, dysphoria, anxiety, and ongoing coping process. Therapy did not produce the expected reductions in reported distress or loneliness. The CR procedure, however, was associated with reduced frequency of lesion recurrence at follow-up. Avoidant coping was associated with lower recurrence rates, and loneliness scores were associated with higher recurrence rates. Prospective data indicated that recurrences were preceded by elevated anxiety that was independent of prodromal symptoms. These results provide support for the general proposals that psychological factors influence health status and that psychological intervention may reduce disease recurrence.     

Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial

The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60 min sessions. The TRT treatment consisted of one 150 min session, one 30 min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8 h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen’s d = 1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen’s d = 0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.     

A comparison of cognitive restructuring and cognitive defusion as strategies for resisting a craved food

The present study investigated the effectiveness of two cognitive strategies for resisting a craved food. One-hundred-and-ten self-identified chocolate cravers were randomised to a waiting list control condition or to receive a 60-minute standardised group intervention on cognitive restructuring (CR) or cognitive defusion (CD). All participants were provided with a bag of chocolates which they were instructed to carry with them for seven days and try to resist eating; uneaten chocolates were returned at the end of the study period. Measures included chocolate consumption and other behavioural, cognitive and evaluative self-reported outcomes. Overall, the odds of abstinence from chocolate were 3.26 times higher for participants in the CD than the CR condition. The effect of the interventions depended on baseline cognitive distress levels; for individuals at high levels of cognitive distress the CD condition led to significantly more restraint from chocolate than both the CR and control conditions. In addition, CD led to greater self-reported improvements in eating behaviours during the study period and was rated significantly easier to use and apply than CR. CD is discussed as a simple and efficient approach to manage food cravings and, potentially, other behavioural contributors to obesity.     

The Efficacy of Minimal Contact Interventions for Acute Tinnitus: A Randomised Controlled Study

Acute tinnitus can lead to substantial distress and eventually result in long-lasting impairment. The aim of this study was to compare the efficacy of a cognitive-behavioural intervention (delivered as Internet self-management, bibliotherapy or group training) to the information-only control condition.

Applicants suffered from subjective tinnitus for up to six months, were between 18 and 75 years old and received no other tinnitus-related psychological treatment. A total of 304 participants were randomly assigned to one of the four study arms. Tinnitus distress, depressive symptoms, psychosomatic discomfort and treatment satisfaction were assessed.

At the post-assessment tinnitus distress was significantly lower in the Internet and the group training conditions compared to the control condition. Inter-group effect sizes were moderate to large. At follow-up, all active training conditions showed significantly reduced tinnitus distress compared to the control condition (intention-to-treat analysis). An additional completer analysis showed a significant reduction in tinnitus distress only for the group condition. All effect sizes were moderate. There were no differences regarding psychosomatic discomfort, but depressive symptoms were reduced in the group condition at the post-assessment (intention-to-treat analysis). Treatment satisfaction was significantly higher in the training conditions. The dropout rate was 39%.

The present study shows that distress can be reduced as early as the acute stadium and that minimal-contact interventions are a promising way to do this. In particular, the Internet and group conditions led to a large, immediate decrease in distress, and the participants were highly satisfied with the training.     

A comparison of Guided Imaginal Coping and imaginal exposure in the treatment of panic disorder

The present study evaluated the efficacy of a new intervention, Guided Imaginal Coping (GIC), compared to imaginal exposure (IEX), and a waiting-list control (WLC) condition among 24 clinic outpatients meeting DSM-III-R criteria for panic disorder (PD) or PD with agoraphobia. GIC was the more consistently effective intervention, with individuals demonstrating significant improvement in frequency and severity of panic attacks (Pas) as well as significant reductions in physiological and subjective arousal to provocative imagery. Individuals in the IEX intervention demonstrated less consistent improvement on the dependent measures, while individuals in the WLC condition essentially remained unchanged. Both GIC and IEX were effective according to a composite measure of clinically significant improvement. However, only GIC was superior to the WLC condition when clinical improvement was defined as zero PAs at follow-up. These findings, while preliminary, suggest that GIC can be added to the armamentarium of effective approaches to treating PD.     

The psychological treatment of tinnitus: An experimental evaluation

Disabling tinnitus in 27 patients was treated in an experimental setting with two different types of therapy aiming at the development of coping behaviour. One was focused on behavioural control procedures, while the other aimed at more cognitive control methods such as distraction. The results of the two forms of therapy were compared with each other and with observations of the untreated control subjects. Assessments of subjective loudness, discomfort from tinnitus and controllability were made on analogue scales and at a questionnaire follow-up. Psychoacoustic measures such as personal loudness units (PLU) were used in connection with these self-recordings and for evaluation of treatment effects. The results confirmed favourable reports on behavioural methods in tinnitus. However, no differences were found between therapies. The results are discussed in the light of the coping and adaptation theory.     

Internet-Based Cognitive Behaviour Therapy for Tinnitus Patients Delivered in a Regular Clinical Setting: Outcome and Analysis of Treatment Dropout

Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n = 293) and a low-intensity version of ICBT (n = 81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.     

The role of illness perceptions in the attachment-related process of affect regulation

Abstract

Based on the predictions of the attachment theory and the Common Sense Model of illness perceptions, the current study focused on the role played by illness perceptions in explaining the path linking attachment orientations to negative affect during recovery from cardiac illness. We predicted two putative mechanisms: (1) illness perceptions would mediate the direct association between attachment-related insecurity (especially attachment anxiety) and levels of distress at follow-up and (2) illness perceptions would interact with attachment orientations (attachment avoidance in particular) in explaining patients' distress. The sample consisted of 111 male patients admitted to the Cardiac Care Unit of the Meir Medical Center, located in the central region of Israel. Patients completed a measure of attachment orientations during hospitalization (baseline). One month later, patients' illness perceptions were measured. Patients' depression and anxiety symptoms were measured at baseline and at the six-month follow-up. The associations between attachment-related anxiety and anxiety symptoms at follow-up were fully mediated by illness perceptions. Attachment-related avoidance was found to interact with illness perceptions in the prediction of depressive symptoms at follow-up. The findings shed light on the possible dynamics among personality, cognitive appraisals, and affect regulation efforts when coping with illness.     

Imagery-Enhanced Cognitive Restructuring of Hostile Beliefs: A Narrative Description

Cognitive restructuring (CR) is an efficacious intervention for reducing transdiagnostic hostility. However, evidence suggests that the efficacy of CR can be further improved. A promising candidate for improving the efficacy of CR is mental imagery. Previous work showed that enriching CR with mental imagery (I-CR) increased its efficacy in terms of reducing hostile beliefs and aggressive inclinations. In this article, we describe the rationale of the I-CR procedure, how to use it, and illustrate it with case examples. Our clinical experience underlines that imagery seems to capture both the hostile as well as helpful thoughts in a more effective way than verbal formulations. Future studies need to explore whether using this protocol is helpful for patients with clinical levels of hostility.     

Operant-behavioural and cognitive-behavioural treatment for chronic low back pain.

Fifty-eight outpatients with chronic low back pain were randomly allocated to one of six experimental conditions. Four conditions were designated as treatment conditions and two as control conditions. The four treatment groups consisted of: cognitive treatment (either with or without relaxation training) and behavioural treatment (either with or without relaxation training). The cognitive and behavioural groups also received physiotherapy. The two control conditions consisted of: attention (physiotherapy plus discussion sessions) and no-attention (physiotherapy-only) conditions. All conditions, including the two controls, received the same physiotherapy back-education and exercise program. For the sample as a whole, improvements were obtained on measures of affective distress, functional impairment, medication use, pain-related dysfunctional cognitions and use of active coping strategies. These improvements were generally maintained at 6- and 12-month follow-ups. The combined psychological/physiotherapy treatment conditions improved significantly more than the physiotherapy-only conditions from pre to posttreatment on measures of pain intensity, self-rated functional impairment and pain-related dysfunctional cognitions. However, these differences were only weakly maintained at 6- and 12-month follow-ups. The behavioural conditions improved significantly more than the cognitive conditions from pre to posttreatment on the self-rated measure of functional impairment, but this difference was not maintained at 6- and 12-month follow-ups. Progressive relaxation training was found to make little contribution to either cognitive or behavioural treatments.     

Coping and emotional distress in a sample of Swedish unemployed.

The study investigated the associations between coping and symptoms of emotional distress within a sample of 166 unemployed men and women (mean age 40 +/- 10 years, range 22 to 63 years, 52% males). All variables were measured with a questionnaire comprising sociodemographic background, length of unemployment, financial strain, coping style ("Ways of Coping Checklist"), and emotional distress (Hopkins Symptom Check List-25). Emotional distress was positively related to financial strain and more common among younger subjects, divorced subjects and those with foreign background, but less frequent among subjects who had been unemployed for more than three years. After controlling for age, gender, education, foreign background, length of unemployment and financial strain, hierarchical regression analyses showed that emotion-focused coping, i.e. self-blame and wishful thinking, was positively related to emotional distress. Problem-focused coping and cognitive restructuring were negatively associated with emotional distress. Younger subjects and divorced subjects made frequent use of both emotion-focused and problem-focused coping. Female subject and subjects with mandatory school made frequent use of emotion focused coping, if exposed to high financial strain. Problem-focused coping was less frequent among subjects with a low education coupled with low financial strain. Cognitive restructuring was less common among subjects who had been unemployed for more than three years. Younger subjects who were also divorced made less use of both problem-focused coping and cognitive restructuring. The results confirm that coping style has importance for the mental health of the unemployed, and indicate a differential use of coping strategies among subjects with different sociodemographic backgrounds and different levels of financial strain.     

Evaluation of the effectiveness of mindfulness-based cognitive therapy to treat chronic insomnia

IntroductionAs having positive effects on reducing distress and symptoms associated with different mental and physical disorders, many studies have focused on mindfulness-based cognitive therapy.ObjectiveIt is suggested that mindfulness-based cognitive therapy (MBCT) could help reducing insomnia by focusing on certain cognitive factors associated to insomnia.MethodA pre-experimental, pre-test protocol with a post-test and three month follow-up was used to measure the effect of a group intervention of eight sessions and 12 participants.ResultsThe intervention had a positive effect on participants’ subjective evaluation regarding their sleep and the gains were maintained after three months. However, after the intervention, no significant effect was found on the objective measures of sleep. Two factors associated to the maintenance of insomnia, such as dysfunctional beliefs and attitudes about sleep and mental control strategies were improved following treatment and these improvements were maintained during the follow-up.ConclusionThe results of this study suggest that mindfulness-based cognitive therapy might be an interesting addition in the treatment of insomnia, given that it focuses on certain cognitive factors that contribute to the maintenance of insomnia.     

Exploring the long-term experience of vasomotor instability: A 5 year follow-up study of distress,perceived control and catastrophizing

Some women experience vasomotor instability for many years post-menopause, but little is known about their appraisals of this health problem, their levels of distress or their coping strategies, and whether these change over time. This study followed up a group of women over 5 years, to examine changes and consistencies in frequency of flushing, flush-related distress/ discomfort, control beliefs and catastrophic thoughts. A further aim was to examine the validity of previously developed measures of perceived control and catastrophizing against conceptually relevant standardized scales. A questionnaire of 20 women (average age 53 years) was carried out, with follow-up 5 years later. Measures of flush distress, flush frequency, perceived control over hot flushes, and catastrophic thoughts about flushing was compared at Time 1 and Time 2. Additionally, multidimensional health locus of control (MHLC) and depression (CES-D) scores were taken at follow-up. All measure showed improvements in well-being. Nevertheless, there were many individual consistencies in scores on most variables at Time 1 and 2. Flush distress at Time 2 was most related to catastrophic thinking, and was slightly elevated in more depressed women. Flush distress was completely unrelated to health locus of control. Psychological responses to hot flushes seem to improve over a 5-year period, yet women show some consistency in their appraisals of this mid-life health problem. Counsellors may find that cognitive re-framing strategies are helpful for alleviating flush distress in women who are continue to be distressed by chronic vasomotor instability, as distress is so closely related to catastrophic thinking.     

Cognitive reappraisal and secondary control coping: associations with working memory,positive and negative affect,and symptoms of anxiety/depression

Abstract

The current study examined the relations of measures of cognitive reappraisal and secondary control coping with working memory abilities, positive and negative affect, and symptoms of anxiety and depression in young adults (N=124). Results indicate significant relations between working memory abilities and reports of secondary control coping and between reports of secondary control coping and cognitive reappraisal. Associations were also found between measures of secondary control coping and cognitive reappraisal and positive and negative affect and symptoms of depression and anxiety. Further, the findings suggest that reports of cognitive reappraisal may be more strongly predictive of positive affect whereas secondary control coping may be more strongly predictive of negative affect and symptoms of depression and anxiety. Overall, the results suggest that current measures of secondary control coping and cognitive reappraisal capture related but distinct constructs and suggest that the assessment of working memory may be more strongly related to secondary control coping in predicting individual differences in distress.     

Treating chronic tinnitus: comparison of cognitive-behavioural and habituation-based treatments

Using a randomized control group trial the long-term efficacy of a habituation-based treatment as conceived by Jastreboff, and a cognitive-behavioural tinnitus coping training were compared. An educational intervention was administered as a control condition. Both treatments were conducted in a group format (habituation-based treatment, 5 sessions; tinnitus coping training, 11 sessions). Educational intervention was delivered in a single group session. Patients were categorized according to their level of disability due to tinnitus (low, high), age and gender and then randomly allocated to the treatment conditions (habituation-based treatment, n = 30; tinnitus coping training, n = 27; educational intervention, n = 20). Data assessment included follow-ups of up to 21 months. Several outcome variables including disability due to tinnitus were assessed either by questionnaire or diary. Findings reveal highly significant improvements in both tinnitus coping training and habituation-based treatment in comparison with the control group. While tinnitus coping training and habituation-based treatment do not differ significantly in reduction of tinnitus disability, improvement in general well-being and adaptive behaviour is greater in tinnitus coping training than habituation-based treatment. The decrease in disability remains stable throughout the last follow-up in both treatment conditions.