Tinnitus and short-term serial recall in stable versus intermittent masking conditions

The relation between tinnitus and short-term memory performance in varying background sounds is not well understood. In the present study a sample of 18 persons with tinnitus completed a serial recall test in three conditions, silence, masking and intermittent masking. The performance of a matched control group without tinnitus was also investigated. Based on the literature on the "irrelevant sound effect" we expected that the tinnitus group would perform worse during intermittent masking and that they would score lower overall compared to the control group. Results revealed no statistically significant differences between the groups, nor any group interaction within sound conditions for the serial recall test. Groups did however differ regarding subjective measures of concentration problems, anxiety and depression. Results are discussed in relation to thought suppression and distraction from tinnitus.     

耳鸣的心理机制

现有研究表明, 耳鸣给患者带来的心理问题比机体自身的病理损伤更为严重, 其中最突出的是患者的注意与情绪问题。近年来, 研究者利用多种方法从多角度证实了耳鸣患者存在不同程度的注意障碍; 同时, 影像学研究也发现部分情绪脑区的活性增强与耳鸣患者的情绪障碍显著相关。这些研究成果不仅为耳鸣的客观评估提供了可行性依据, 也为心理治疗的进一步发展奠定了基础。随着耳鸣患者对生活质量要求的提高, 未来耳鸣研究应着重帮助患者缓解负性情绪, 纠正不良行为, 帮助其重新过上正常的生活。     

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.     

A Systematic Review and Meta-Analysis on the Efficacy of Self-Help Interventions in Tinnitus

This study is a review and meta-analysis on the efficacy of cognitive-behavioural therapy (CBT) self-help interventions for tinnitus. Randomized controlled trials were identified by searching in databases (e.g. ISI Web of Knowledge, PubMed, Cochrane Library, and PSYNDEX) and by manual search. Ten studies with 1188 participants in total were included in the meta-analysis. Participants were 49.2 years old and had tinnitus for 5.2 years. Self-help interventions significantly reduced tinnitus distress (d = 0.48) and depressiveness (d = 0.25) when compared with a passive control (e.g. information only and discussion forums) at post-assessment. There was no difference to the face-to-face controls (group treatment). The presence of therapists and the methodological quality of the studies did not influence the results. Sensitivity analysis revealed that there might be a publication bias regarding the comparison to the face-to-face control. However, the results suggest that CBT self-help interventions are an effective treatment for tinnitus distress. Since few studies were identified, this conclusion must be supported by future meta-analyses.     

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.     

Autobiographical Memory Specificity in Patients with Tinnitus Versus Patients with Depression and Normal Controls

Several studies show that patients with depression and post-traumatic stress disorder respond with fewer specific autobiographical memories in a cued memory task (i.e. the autobiographical memory test; AMT) compared to healthy controls. One previous study found this phenomenon among tinnitus patients as well (Andersson, Ingerholt, & Jansson, 2003). The aim of this study was to replicate the previous study with an additional control group of depressed patients and memory errors as measured with the AMT as an additional outcome. We included 20 normal hearing tinnitus patients, 20 healthy controls and 20 persons diagnosed with clinical depression. The AMT was administered together with self-report measures of depression, anxiety and tinnitus distress. Both the tinnitus and depression groups differed from the healthy control group in that they reported fewer specific autobiographical memories. There were, however, differences between the tinnitus and depression groups in terms of the errors made on the AMT. The depression group had more overgeneral memories than the normal control group, whereas the tinnitus group did not differ from the control group on this memory error. The tinnitus group had more semantic associations and non-memories than the other two groups, suggesting that executive functioning may play a role for the tinnitus group when completing the AMT. Clinical and theoretical implications of the findings are discussed.     

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.     

An Evaluation of Two Types of Cognitive Intervention in the Management of Chronic Tinnitus

Abstract

Fifty-four subjects with chronic distressing tinnitus were randomly allocated to one of four experimental treatment conditions: (1) attention control and imagery training (AC1); (2) cognitive restructuring (CR); (3) combined attention control and imagery training plus cognitive restructuring (ACI + CR); and (4) a waiting list control (WLC). Significant overall improvements were found on measures of distress associated with tinnitus, and on a number of other measures of cognition and coping strategies. These improvements were maintained at the six-month follow-up. Relative to the WLC, the three treatment conditions (combined) were associated with improvements in tinnitus-related distress, reductions in tinnitus-related dysfunctional cognitions and an increase in the frequency of use of coping strategies. There was a significant effect in favour of the ACI group compared to the CR group on the measure of irrational beliefs. The analyses also revealed that the combined treatment condition (ACI + CR) showed significantly greater improvement on a measure of psychological distress and achieved a higher clinical response rate compared to the two single treatments. There were significant improvements from pretreatment to follow-up on some measures, although the mean scores revealed that some of the gains had been lost at this stage on the main measure of tinnitus-related distress. There were no significant group X time effects for any of the dependent variables at the six-month follow-up. The results were interpreted as supporting the practice of combining the two cognitive approaches.     

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.     

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.     

An Internet-Based Cognitive-Behavioural Training for Acute Tinnitus: Secondary Analysis of Acceptance in Terms of Satisfaction,Trial Attrition and Non-Usage Attrition

Objectives: Recent studies on tinnitus have focused on the efficacy of Internet-based interventions. Other core features of the quality of service, e.g. acceptance and attrition, have often been overlooked. This study analyses Internet-based training regarding acceptance and attrition in a trial on minimal-contact interventions for acute tinnitus. Whenever possible, we give information on other forms of training for comparison. Methods: In a randomised controlled trial with 337 participants, 87 persons took part in the Internet training. Results: The participants were as satisfied with the Internet-based training as with a face-to-face group training. There was a 34.48% dropout from the Internet-based training (dropout attrition). The training attrition from the Internet-based training was even higher at 64.4%. Conclusions: Two out of three indicators for acceptance—satisfaction and dropout attrition—provide comparable results between the Internet-based training and a face-to-face group training. The third indicator, training attrition, shows a better result for the group training. Future research should focus on attrition in order to enhance the overall effectiveness of training.     

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.     

Anxiety Sensitivity in Patients with Chronic Tinnitus

Tinnitus is the perception of sounds (often ringing or buzzing) in the absence of any external auditory stimulation, hence sometimes called a ''phantom auditory perception''. Although most people tend to ignore their tinnitus, a significant proportion will show marked annoyance and reduced quality of life as a result of this complaint. It is difficult to predict those who are likely to develop severe problems with tinnitus, but psychosocial aspects such as anxiety and depression have been proposed as mediators. In this study we investigated the role of anxiety sensitivity defined as a trait tendency to fear anxietyrelated sensations. The study sample included 146 tinnitus patients with moderate to severe tinnitus. Results showed that anxiety sensitivity correlated significantly with tinnitus distress, but the association was significantly stronger in female participants who also displayed more signs of anxiety sensitivity. A multiple regression analysis revealed that anxiety sensitivity contributed to explained variance in tinnitus distress beyond audiological measures of tinnitus maskability and hearing thresholds. These results are discussed in light of related investigations on the role of anxiety sensitivity in somatic conditions.     

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.     

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.     

Cognitive-behavioural treatment for tinnitus: A difficult case

Abstract

Tinnitus is a commonly seen and difficult to cure symptom of ear disease. This case study describes an example of cognitive-behavioural treatment for tinnitus. The patient was a 66-year-old woman with prior medical and psychiatric history. Cognitive-behavioural assessment revealed that her thoughts about the cause of her tinnitus made her focus on it and experience annoyance. The aim of treatment was to decrease the annoyance associated with the tinnitus and consisted of applied relaxation and cognitive distraction techniques. Daily registrations of tinnitus distress and annoyance, and general well-being were collected at pretreatment, mid-treatment and post-treatment on visual analogue scales. No clear effects were found on these measures, although loudness showed a slight tendency to decrease. The patient also completed a questionnaire at pretreatment and post-treatment on which no benefits were found. Verbal report and an in-session behavioural test showed positive effects of treatment, but were not mirrored in the self-reported results. The importance of reporting treatment failures is emphasized.     

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.     

Unobtrusive measures in behavioral assessment

A major distinguishing characteristic of behavioral assessment is the direct assessment of overt behavior. Direct assessment is assumed to provide a sample of behavior that reflects client performance in the situation in which behavior is assessed, even if the assessment procedures were not implemented. Yet, in the majority of investigations, behavioral assessment procedures are obtrusive, i.e., subjects are aware that their behavior is being assessed. The potential problem with obtrusive assessment is that it may be reactive, i.e., affect how subjects perform. Recent research has demonstrated that obtrusive observations often are reactive and that behaviors assessed under obtrusive and unobtrusive conditions bear little relation. From methodological and applied perspectives, additional attention needs to be given to unobtrusive measures of behavior change. The present paper illustrates unobtrusive measures in behavior modification including direct observations, archival records, and physical traces of performance. In addition, validation and assessment problems, questions about the obtrusiveness of the measures, and ethical issues are discussed.     

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.     

Tinnitus als soziale Infektion?

Background

11 out of 35 male employees of a central alert team with rescue coordination function developed a tinnitus disorder. This clinical case-study highlights the psychodynamic background of this accumulation.

Methods

Employees were investigated by psychometric questionnaires and semistructured psychodynamic biografical interviews. Additionally aspects of group dynamics and organisational structure were assessed.

Results

All staff members reported adverse work conditions. Medical and psychometric examination of the tinnitus patients did not reveal severe pathological findings. The interviews identified psychodynamic conflicts dealing with autonomy and regulation of self-esteem. All tinnitus patients reported a very adverse or punitive father relation and difficulties in performing a stabile male role and self-image. Group dynamics was dominated by paranoid and regressive tendencies complicated by maladaptive coping, crude perception of external facts and a pronounced experience of aggressive impulses.

Conclusion

The remobilisation of infantile powerlessness, ineffectiveness and helplessness triggered by adverse work conditions and the introduction of a new culture of personal responsibility within the work organisation together with an impaired coping of separation conflicts enforced by traumatic aspects of the relation with the father may have promoted the tinnitus symptomatology. Additionally, due to the missing awareness of the importance of such group dynamical processes the employers contributed to an increasing psychosocial distress, which promoted the accumulated manifestation of tinnitus as a conflict expressive symptom.