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.     

Selecting the Right Tool For the Job

There are competing ethical concerns when it comes to designing any clinical research study. Clinical trials of possible treatments for Ebola virus are no exception. If anything, the competing ethical concerns are exacerbated in trying to find answers to a deadly, rapidly spreading, infectious disease. The primary goal of current research is to identify experimental therapies that can cure Ebola or cure it with reasonable probability in infected individuals. Pursuit of that goal must be methodologically sound, practical and consistent with prevailing norms governing human subjects research. Some maintain that only randomized controlled trials (RCTs) with a placebo or standard-of-care arm can meet these conditions. We maintain that there are alternative trial designs that can do so as well and that sometimes these are preferable to RCTs.     

Why aggression?2

On the basis of a formalised view of metapsychology, the author briefly considers the problems inherent in the Freudian notion of a death drive or aggressive drive and then goes on to develop a new theoretical conception of aggression. Aggression is understood as an affect, action or affective action and, in relation to these, as an expression of the intensity with which a drive'whether it be the sexual drive with its libidinal cathexes or the self‐preservative drive with its lethic cathexes'seeks to attain its object. In this context the author regards the regulation of closeness and distance with respect to the ‘psychogeometric locus’ of the relevant drive object as being of central importance. She contends that neurotic personalities suffer from specific distortions in the perception of the psychogeometric locus of their drive objects, which may give rise to an intensification of the drive tendencies prevailing in these individuals at any given time so that these tendencies take on an aggressive character. The author presents two clinical vignettes to show how her approach allows aggression and its occurrence to be conceptualised without resorting to the idea of a primary aggressive drive, and draws attention to the resulting technical consequences for interpretation.     

Behavioral and social development of children born extremely premature: 5-year follow-up

A cohort of extremely prematurely born children and matched term controls was assessed at 5 years of age. The parents completed a questionnaire on their behavioral and social development. The purpose was to illuminate whether the children's general intellectual ability and parental sensitivity were associated with behavioral and social development. The index children exhibited more hyperactive behavior and had poorer social skills than the controls. Lower Full Scale IQ (FSIQ) was associated with outward reacting and hyperactive behavior and poorer social skills. Sensitive parenting was associated with less outward reacting and less hyperactive behavior. When controlling for differences in FSIQ and parental sensitivity, the index children persisted to have an increased risk of exhibiting hyperactive behavior but not poorer social skills. The index children with normal intellectual development, however, did not exhibit more behavioral problems or poorer social skills than the control children did.     

The future of analysis

The aim of analysis is to enable our patients to differentiate themselves from their past. The question we face as analysts is whether we are in fact neurotically bound to repeat the past. This paper addresses this question by considering some of the reasons that there is a 'crisis in analysis'. Two central problems within the practice of analysis are identified as contributing to this 'crisis': 1) a view of the patient as 'enemy', or as innately destructive; and 2) a trend towards here-and-now interpretations within the transference which disregards history and the role of external reality. The danger of such an approach is that it does not allow patients to separate from their hateful primal scenes and to become free of neurotic guilt. When we are anxious about our own destructiveness and aggression and do not link this to a failure to form a loving relation, we run the risk of fostering compliance and conformity within our patients and within our own professional societies. In contrast, it is the recognition of the past and its influence on the present that makes analysis a tool for revolution.     

The Hofgeismar Lectures: A Contemporary Overview of Horneyan Psychoanalysis

Part I of this paper describes Karen Horney's theory of neurosis. In the 1930s, Horney repudiated Freud's view of female developmental psychology. She argued that cultural factors rather than anatomy or innate biological drives were the primary determinants not only of female development but of personality, as well. When genetic and environmental circumstances together lead to basic anxiety early in life, she believed a deep inner conflict emerges in the individual leading to the need for elaborating layers of rigidified protective defenses. She called this the neurotic process. This process can result in discrete symptoms of mental disorder as well as the more generalized problems of alienation from the person's real self and reliance on neurotic solutions. In Part II, the practical application of Horney's theory to clinical work is demonstrated in a case presentation of a notably timid and perfectionistic man. Part III points up elaborations of Horney's theories by later workers of her school, the American Institute for Psychoanalysis, and provides a history of her school within the broader context of American psychoanalysis. The author's emphasis on postmodern and narrativist elements of Horneyan psychoanalysis are illuminated, as well.     

Sales management control systems: review,synthesis, and directions for future exploration

Sales management control systems (SMCSs) are designed to align salespeople's activities and actions with organizational objectives. This article reviews and synthesizes over 50 SMCS articles published in sales, marketing, and management journals over the past 30 years. We begin by building a comprehensive framework that enables us to classify prior research into digestible categories (e.g., SMCSs as antecedents, SMCSs as consequences). Next, we present an analysis of gaps in the literature. Among other findings, our analysis reveals that there is an overwhelming focus on the use of formal (specifically behavior- and outcome-based) controls as compared to their informal control counterparts. Finally, we suggest avenues for future research: (1) mapping and understanding the full spectrum of control mechanisms, (2) developing a fuller understanding of the often-overlooked forms of control (e.g., input and cultural controls), and (3) more thoroughly analyzing how controls operate (or do not operate) as an integrated system.     

Characters on the Stage. Ibsen's “Life-Lie” Revisited

The authors inquire as to how far psychoanalysis uses its inherent capabilities to decipher the inner structure of subjectivity in present-day psychoanalytic practice and thinking. They maintain that in psychoanalytic practice, the analyst's unresolved neurotic conflicts cause him to create conscious mystifications of his own unconscious situation, thus distorting his understanding of the patient's unconscious in a systematic manner.     

The effect of situation familiarity on the establishment of co-references between mother and infant

The purpose of this study was to determine whether the familiarity or the novelty of play objects available during mother-infant interaction has an effect on the mother's ability to capture and maintain the infant's attention. Twelve mother-infant dyads with 5- and 9-month-old infants were filmed during two 5-minute sessions with familiar or unfamiliar toys. Changes in the infant's visual orientation preceded by a maternal behaviour within a 3-sec interval were studied. In the familiar toy situation, the infants focused more frequently on the maternal referent than with the unfamiliar toys. The mother's verbal and non-verbal interventions were more effective at initiating and maintaining co-reference, because the infant was more frequently in an receptive state. Conversely, when the toys were unfamiliar, the baby was often the initiator. Unfamiliar objects, which appear more attractive, may compete with the mother's attempts to gain the child's attention.     

A human laboratory test of eysenck's theory of incubation: A search for the resolution of the neurotic paradox

A number of recent attempts have been made by neobehaviorists to resolve the neurotic paradox by incorporating a nontraditional learning principle. Eysenck's concept of incubation represents one of these attempts and is the subject matter of this paper. Incubation theory states that under certain conditions exposure to a fear-provoking conditioned stimulus (CS) can result in a substained growth of fear. This concept is used to explain extreme avoidance (symptom) maintenance in extinction. To test this theory, three conditions identified by Eysenck and considered critical to the development of incubation were manipulated in a classical conditioning paradigm: unconditioned stimulus (UCS) intensity, duration of CS exposure, and individual differences in neuroticism/introversion. Both physiological and self-report fear measures were taken. Results indicated that, contrary to incubation theory, fear extinguished in all groups. Long durations of CS exposure were found to be more effective than brief exposure in reducing fear of highly fearful subjects. Clinical implications for therapies using fear exposure such as flooding and implosion were discussed, as well as the resolution of the neurotic paradox via established learning principles.