Psychological Aspects of Tinnitus: A Comparison With Hearing Loss and Ear,Nose and Throat Disorders

Abstract

It is well established that tinnitus is sometimes associated with marked psychological distress, including anxiety and depression. As yet, however, it is unclear whether the problems are specific to tinnitus or may occur in other hearing disorders too. A total of 95 patients with tinnitus were compared with 73 people with hearing loss but no tinnitus, and with a further 80 people attending an out-patient clinic for a variety of other ear, nose and throat (ENT) problems. The principal measures were the Hospital Anxiety and Depression Scale and the Eysenck Personality Questionnaire. The tinnitus patients were significantly more anxious, depressed, and neurotic than the hearing loss group, but were equivalent to the ENT group; and, like the hearing loss group, they were significantly less extraverted than the ENT controls. There were no differences between tinnitus patients with severe hearing loss, mild hearing loss, and no hearing loss. Results from Hallam's Short Tinnitus Questionnaire revealed that tinnitus patients without hearing loss reported significantly fewer difficulties with auditory perception than either of the other tinnitus groups, and significantly fewer irrational beliefs than the group with severe hearing loss. It is concluded that patients with tinnitus were more distressed than people with hearing loss, but that their distress was shared by patients with a variety of other ENT problems. People who reported the greatest problems with their tinnitus were generally those who also had severe hearing loss.     

Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact

Tinnitus is an experience of sound in the absence of an appropriate external source. A symptom that can accompany most central or peripheral dysfunctions of the auditory system, tinnitus can lead to significant distress, depression, anxiety, and decreases in life quality. This paper investigated the construct of psychological acceptance in a population of tinnitus patients. First, a cross-sectional study (N = 77) was conducted in which a tinnitus specific acceptance questionnaire was developed. Results showed that a Tinnitus Acceptance Questionnaire (TAQ) generated good internal consistency. A factor solution was derived with two factors: activity engagement and tinnitus supression. Second, a longitudinal study (N = 47) investigated the mediating role of acceptance on the relationship between tinnitus distress at baseline and tinnitus distress, anxiety, life quality, and depression at a 7-month follow-up. The results showed full mediation of activity engagement for depression and life quality at follow-up, partial mediation for tinnitus distress, and no mediation for anxiety. The role of acceptance in the negative impact of tinnitus distress merits further investigation.     

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.     

An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety

Background and Objectives: Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.

Methods: Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; M_age?=?19.53, SD?=?3.16, Range?=?18–45) who completed self-report measures for course credit.

Results: Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.

Conclusions: These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.     

The role of optimism in patients with tinnitus and in patients with hearing impairment

Abstract

Optimism was investigated in a sample of audiology clinic patients, consisting of one group of tinnitus sufferers (N = 30) and one group of hearing impaired subjects not experiencing tinnitus (N = 44). Optimism was measured by the Life Orientation Test (LOT). In the tinnitus group the LOT correlated significantly with measures of tinnitus related distress and in the hearing impaired group with measures of disability and emotional reactions due to the hearing impairment. Cronbach's alphas for the measures used were generally high. Principal components analysis of the LOT confirmed earlier findings by showing two separate factors; one with the positively worded LOT items reflecting the presence of optimism and one with the negatively worded LOT items reflecting the presence of pessimism. The results indicate that dispositional optimism is an usable concept in research with audiological samples, and that optimism is related with tinnitus distress and experienced disability and emotional reactions due to hearing impairment. Further research should investigate the possible role of personality factors in tinnitus and hearing impairment.     

Why is the receipt of social support associated with increased psychological distress? an examination of three hypotheses

Abstract

Although there is a great deal of research linking social support with favourable psychological well-being outcomes a number of contradictory findings have been published showing support to be associated with increased psychological distress. These contrary findings arise when social support is measured as the receipt of supportive behavior rather than perceptions of support availability and quality. This paper examines three hypotheses that have been advanced to explain why the receipt of support is associated with distress. The first of these hypotheses (the support mobilisation hypothesis) argues that the relationship is a spurious one, and that it is a product of distressing circumstances which increase both support receipt and psychological distress. The other two hypotheses (the inequity hypothesis and the esteem threat hypothesis) both argue that receiving support actually causes distress. We tested these hypotheses in two samples. One sample was a group of individuals who reported having some form of disability (N = 106). the other sample was a 'healthy' comparison group (N = 134). Our analyses showed that in both groups the receipt of support was significantly and positively related to reports of anxiety, but not to reports of depression. Among the 'healthy' sample, controlling for subjects' sex largely explained the positive association between support receipt and anxiety. This was not the case among the 'disabled sample, where the inequity hypothesis received the strongest support. The implications of these findings for interventions based around the provision of social support are examined.     

The Role of Fear-Avoidance Cognitions and Behaviors in Patients with Chronic Tinnitus

The current study investigated the role of fear-avoidance—a concept from chronic pain research—in chronic tinnitus. A self-report measure the “Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)” was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-avoidance. To analyze the psychometric properties, principal component analysis with parallel component extraction and correlational analyses were used. To examine a possible mediating effect, hierarchical regression analysis was applied. The principal component analysis resulted in a three-factor solution: Fear-avoidance Cognitions, Tinnitus-related Fear-Avoidance Behavior, and Ear-related Fear-Avoidance Behavior. Internal consistency was satisfactory for the total scale and all subscales. High correlations between tinnitus-related handicap scales, depressive and anxiety symptoms, and the T-FAS were found, whereas associations with personality factors were low. Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.     

Coping strategies used by middle-aged males with noise-induced hearing loss,with and without tinnitus

Abstract

The aim of this study was to examine the relationship between general coping strategies and specific communication strategies, adopted by males with noise-induced hearing loss (NIHL) in order to deal with stressful events and demanding auditory situations. The sample included 72 males with NIHL; 22 without tinnitus, 26 with mild tinnitus, and 24 with severe tinnitus. The following variables were measured: “active coping” “escape coping” and “passive acceptance” (general coping strategies), and “maladaptive behaviours”, “verbal strategies” and “nonverbal strategies” (specific communication strategies). The results showed that males without tinnitus or with mild tinnitus combined “active coping” and “passive acceptance”, whereas males with severe tinnitus supplemented these strategies with “escape coping”. The relationship between general coping and specific communication strategies was weak, although giving a significant correlation between “escape coping” and “maladaptive behaviours”. The results indicate that the hypothesis that a person's general pattern of coping has influence on his/her ability to cope effectively with a hearing impairment can not be supported. Further research should concentrate on the contribution of personality factors as well as environmental factors to the variance in coping with NIHL and tinnitus.     

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.     

Social anxiety and interpersonal stress generation: the moderating role of interpersonal distress

Background and Objectives: Existing models of social anxiety scarcely account for interpersonal stress generation. These models also seldom include interpersonal factors that compound the effects of social anxiety. Given recent findings that two forms of interpersonal distress, perceived burdensomeness and thwarted belongingness, intensify social anxiety and cause interpersonal stress generation, these two constructs may be especially relevant to examining social anxiety and interpersonal stress generation together.

Design: The current study extended prior research by examining the role of social anxiety in the occurrence of negative and positive interpersonal events and evaluated whether interpersonal distress moderated these associations.

Methods: Undergraduate students (N?=?243; M?=?20.46 years; 83% female) completed self-report measures of social anxiety, perceived burdensomeness, and thwarted belongingness, as well as a self-report measure and clinician-rated interview assessing negative and positive interpersonal events that occurred over the past six weeks.

Results: Higher levels of social anxiety were associated only with a higher occurrence of negative interpersonal dependent events, after controlling for depressive symptoms. This relationship was stronger among individuals who also reported higher levels of perceived burdensomeness, but not thwarted belongingness.

Conclusions: It may be important to more strongly consider interpersonal stress generation in models of social anxiety.     

Trajectory of change in anxiety sensitivity in relation to anxiety,depression, and quality of life among persons living with HIV/AIDS following transdiagnostic cognitive-behavioral therapy

ABSTRACT

Persons living with HIV/AIDS (PLHIV) disproportionately suffer from anxiety and depressive symptoms and disorders. Although past work has examined the efficacy of cognitive-behavioral therapy (CBT) for depression, and to a lesser extent anxiety, among PLHIV, little is known regarding potential mechanisms underlying improvement in anxiety/depression among this group. Anxiety sensitivity is a well-established risk/maintenance factor for anxiety and depressive disorders and is hypothesized to play an important role in maintaining anxiety among PLHIV. Past work has identified anxiety sensitivity as a mechanism of action underlying changes in various anxiety domains yet it is unknown whether changes in anxiety sensitivity relate to changes in anxiety symptoms among PLHIV undergoing transdiagnostic CBT for anxiety. The current study sought to examine treatment-related changes in anxiety sensitivity and how the trajectory of change relates to anxiety and depressive symptoms as well as overall quality of life. Individuals (n = 35) with HIV/AIDS and elevated anxiety symptoms received CBT for anxiety. Results indicated that reductions in anxiety sensitivity were significantly related to changes in anxiety, depression, and quality of life. Together, these data suggest that changes in anxiety sensitivity are significantly related to changes in anxiety/depression and quality of life among PLHIV seeking treatment.     

Children's self-reported coping strategies: The role of defensiveness and repressive adaptation

Abstract

This study examined differences in self-reported coping strategies across children classified according to Weinberger et al.'s (1979) adaptive style paradigm. Consistent with the larger literature, it was hypothesized that repressors (i.e. characterized by high self-reported defensiveness and low self-reported distress) would endorse fewer behaviorally and cognitively avoidant coping strategies than other adaptive style groups. Participants included 134 children, ranging in age from 10 to 13 (M=11.26, sd=.59), who completed measures of defensiveness, trait anxiety, and coping. Consistent with the hypotheses, results indicated significantly lower endorsement of avoidant coping strategies, and significantly higher endorsement of approach-oriented strategies among repressors, but no significant differences across adaptive style groups for other forms of coping. Results indicate that, consistent with other indicators of psychological functioning, the measurement of coping strategies is subject to the effects of socially desirable responding. Further, results provide evidence that measures of coping may be contaminated by items reflecting adjustment problems.     

Exploring correlations between positive psychological resources and symptoms of psychological distress among hematological cancer patients: a cross-sectional study

Hematological cancer patients experience high levels of psychological distress during diagnoses and intensive treatments. The aim of the present study is to explore the effects of positive psychological resources on depressive and anxiety symptoms in hematological cancer patients. This survey was conducted in a hospital during the period from July 2013 to April 2014. A total of 300 inpatients were recruited and finally 227 of them completed the questionnaires. Questionnaires included demographic and clinical variables, the Center for Epidemiologic Studies Depression Scale, the Self-Rating Anxiety Scale, the Life Orientation Scale-Revised, the General Perceived Self-Efficacy Scale, and the Resilience Scale-14. Results showed that the prevalence of depressive and anxiety symptoms was 66.1 and 45.8%, respectively. Both optimism (β = ?.479, p < .001) and resilience (β = ?.174, p < .05) were negatively associated with depressive symptoms, and optimism (β = ?.393, p < .001) was negatively associated with anxiety symptoms. However, resilience (β = ?.133, p > .05) was not significantly associated with anxiety symptoms, and self-efficacy was not significantly associated with depressive (β = ?.032, p > .05) or anxiety symptoms (β = ?.055, p > .05). The results suggest that hematological cancer patients who possess high levels of positive psychological resources may have fewer symptoms of psychological distress. The findings indicate that enhancing positive psychological resources can be considered in developing intervention strategies for decreasing depressive and anxiety symptoms.     

The role of self-compassion during difficult economic times

Background and objectives: The negative effects of the financial crisis of 2007/2008 are still being felt today as seen in the relatively high levels of youth unemployment in many countries. As a result, many young people experience high stress levels when facing an uncertain and precarious job market.

Methods: Participants were 178 undergraduate students (79% female; M_age?=?20.00, SD?=?4.29) who were randomly assigned to read a news article that documented an uncertain financial future with limited job opportunities (the economic stress group), or an article that documented a tour of the Royal Canadian Mint (the control group). The role of self-compassion was explored in its relation to distress.

Results: Correlational and hierarchical regression analyses indicated that, in the economic stress group, self-compassion negatively predicted anxiety above and beyond self-esteem and familial support. In the control group, however, self-compassion did not negatively predict anxiety above and beyond self-esteem and familial support. Additionally, structural equation modeling indicated that self-compassion was directly associated with lower anxiety and indirectly related to anxiety through perceptions of financial threat.

Conclusions: These findings suggest that self-compassion may be an important resource that is associated with less distress during times of economic threat.     

Smoking and Non-Clinical Panic Attacks: An Initial Empirical Test of Panic-Relevant Cognitive Processes

The present study evaluated panic-relevant cognitive processes in a sample of persons ( n = 70) who met criteria for either: (a) a positive panic attack history and regular smoking (smoking at least 10 cigarettes per day for S 12 months); (2) a positive panic attack history but no history of smoking; or (3) regular smoking history alone (smoking at least 10 cigarettes per day for S 12 months). As hypothesized, participants in group (a) demonstrated significantly greater bodily vigilance and anxiety sensitivity Mental Incapacitation Concerns compared with persons in either groups (b) or (c). Effects involving other dimensions of anxiety sensitivity, suffocation fear and trait anxiety did not discriminate between panickers as a function of smoking status. The observed effects could not be attributed to self-reported physical health status or history of medical problems. The implication of the present findings for understanding the potential role of smoking in panic pathology is discussed.     

Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress

Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710 min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients’ in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.     

On anxiety-specific actions of tranquilizers

Abstract

This study examined the role of social support in the relationship between work demand and psychological distress (GHQ 12) in correctional officers (N=419), a high stress occupational group. Work demands were positively associated with strain. There was no evidence that social support buffered the negative impact of work demands. Rather, consistent with most previous research findings, support showed direct benefits and these were discussed in the context of worker participation and control. The hypothesis that officers high in negative affectivity, as measured by trait anxiety would show greater reactivity to work demands was not supported. However, trait anxiety appeared to inflate the relationship between work stressors (work demand and work support) and psychological distress supporting recent suggestions that the role of trait anxiety in occupational stress should not be disregarded. Trait anxiety combined additively with work demand to predict individual differences in psychological distress, however social support moderated the impact of trait anxiety on strain.     

The Relation Between Emotional Dysregulation and Anxiety and Depressive Symptoms, Pain-Related Anxiety, and HIV-Symptom Distress Among Adults with HIV/AIDS

The current study investigated the relations between emotional dysregulation and anxiety and depressive symptoms, pain-related anxiety, and HIV-symptom distress among individuals living with HIV/AIDS. This research is important in its explanatory value regarding the unique effects of emotional dysregulation as it relates to psychological and disease-specific distress given high rates of distress specific to HIV infection (e.g. medicatin side-effects, stigma). Participants included 164 adults (17.1 % female, Mage = 48.40, SD?=?9.57) with HIV/AIDS. Results indicated that emotional dysregulation was significantly and positively related to anxiety and depressive symptoms, pain-related anxiety, and HIV-symptom distress. All emotional dyregulation effects were evidenced above and beyond the variance accounted for by demographic and HIV-specific characteristics, and the main effects of anxiety sensitivity and distress intolerance. Findings are discussed in terms of the importance of emotional dysregulation in negative affective experiences within the HIV/AIDS population.     

Self-efficacy conception of anxiety

Abstract

In social cognitive theory, perceived self-efficacy to exercise control over potential threats plays a central role in anxiety arousal. Threat is a relational property reflecting the match between perceived coping capabilities and potentially hurtful aspects of the environment. People who believe they can exercise control over potential threats do not engage in apprehensive thinking and are not perturbed by them. But those who believe they cannot manage threatening events that might occur experience high levels of anxiety arousal. Experimental analyses of the microrelation between perceived self-efficacy and anxiety arousal reveal that perceived coping inefficacy is accompanied by high levels of subjective distress, autonomic arousal and catecholamine secretion. Environmental events are not always completely under personal control and most human activities contain some potential risks. The exercise of control over anxiety arousal, therefore, requires not only development of behavioral coping efficacy but also efficacy in controlling dysfunctional apprehensive cognitions. It is not frightful cognitions per se but the perceived self-inefficacy to turn them off that is the major source of anxiety arousal. Analyses of the causal structure of self-protective behavior show that anxiety arousal and avoidant behavior are mainly co-effects of perceived coping inefficacy.