Anxiety Sensitivity in Patients with Chronic Tinnitus

The Fear of Asthma Symptoms Scale and the Asthma Behavior Checklist: preliminary validity of two novel patient reported outcome measures

Objective: The aim of this study was to investigate the preliminary validity of two novel scales, the Fear of Asthma Symptoms scale (FAS) and the Asthma Behavior Checklist (ABC). Methods: Using cross-sectional design, data was collected online from 188 adult participants (Age 18-71 years) with a diagnosis of asthma and self-reported anxiety related to asthma, recruited through social media. Confirmatory factor analysis, internal consistency and test-retest reliability were ascertained to address validity.Results: The confirmatory factor analysis demonstrated convergent validity for both the FAS (average variance extracted; AVE=.57) and the item-reduced ABC-8 (AVE=.61) as well as divergent validity for both scales. Both scales demonstrated high internal consistency (FAS: α = 0.94; ABC-8: α = 0.92). Test-retest reliability assessed after 1 week was good (FAS: r=.85; ABC-8: r=.88).Conclusions: We observed promising psychometric properties of the FAS and the ABC-8. The two novel scales could be useful to identify excessive fear and avoidance in patients with asthma and to investigate putative mechanisms in clinical research on anxiety related to asthma. Further evaluation of psychometric properties in independent samples are needed.

Race/Ethnicity, Gender, and Socioeconomic Status Representation in U.S.-Based Randomized Controlled Trials of Tinnitus: A Systematic Review

PURPOSE

The purpose of this study was to investigate if peer-reviewed randomized controlled trials (RCTs) for the management/treatment of tinnitus conducted in the United States include diverse participants in terms of gender, race/ethnicity, education, occupation, and income.

METHOD

We performed a comprehensive and systematic literature search via PubMed, Web of Science, Clinical-Trials.gov, and the Cochrane Central Register of Controlled Trials. Our goal was to identify prospective RCTs of tinnitus intervention conducted in the United States from January 1994 to September 2021 and published in peer-reviewed journals.

RESULTS

A total of 2,584 studies were retrieved. Thirty-two peer-reviewed articles met all inclusion criteria. Of the included studies, approximately 96% reported participants' gender. Approximately 15% studies reported race/ethnicity information in alignment with the U.S. Census Bureau. However, an underrepresentation of both females and people of color was evident across studies. Reporting of socioeconomic status information of participants was also scarce, with only 25% studies reporting education and/or occupation of participants and 0% reporting income levels.

CONCLUSIONS

This study indicates underrepresentation and underreporting of diverse participant pools in tinnitus research. Reasons for such underrepresentation are explored. Additionally, this systematic review indicates that recent research in tinnitus portrays an optimistic trend in terms of reporting and recruitment of diverse participant groups. Sustainable strategies for including diverse research participants are essential for hearing health care equity. Research and strategies to promote this goal are discussed.

Bothersome tinnitus : Cognitive behavioral perspectives

Tinnitus is not traceable to a single disease or pathology, but merely a symptom, which is distressing to some but not all individuals able to perceive it. The experience of tinnitus does not equate to tinnitus distress. Tinnitus suffering might be understood as a function of tinnitus-related distress in that bothersome tinnitus is an illness rather than a disease. In bothersome (distressing) tinnitus, the perception of the characteristic sound is a very disturbing and bothersome experience because of maladaptive psychological responses. Several cognitive and behavioral theoretical frameworks attempting to explain the nature and cause of tinnitus suffering have been introduced in and will be summarized here. Current treatment approaches are generally based on models that aim to: alleviate the perceptional experience by focusing on the tinnitus perception for habituation or even soothing purposes; decrease awareness of the sound by attentional training and cognitive interventions; decrease the maladaptive responses and the resulting distress by behavioral methods (i. e., exposure). The cognitive behavioral fear-avoidance model may offer an integrative cognitive behavioral approach that can lead to a new set of paradigms for studying the underlying mechanisms explaining chronic tinnitus suffering as well for developing innovative strategies to treat bothersome tinnitus.

Severity of Tinnitus Distress Negatively Impacts Quality of Life in Patients With Vestibular Schwannoma and Mimics Primary Tinnitus

Objective: Quality of life (QoL) and subjective symptoms are predominantly used to evaluate treatment outcome of patients with vestibular schwannoma (VS). However, for patients undergoing conservative treatment-the most frequently used intervention-the association between QoL and subjective symptoms is unclear. Moreover, it is unknown whether VS-related tinnitus could be associated with the audiological and psychological status of the patient. Our overall aim is to provide objective evidence of this association to better guide treatment of VS. Methods: In a prospective study, we analyzed factors that influence VS-related tinnitus and QoL in 72 patients receiving conservative management of unilateral sporadic VS. This was done through questionnaires that assessed QoL, anxiety, depression, and audiological examinations. We used the SF-36 Short Form to assess QoL; the Tinnitus Handicap Inventory, Dizziness Handicap Inventory, Facial Clinimetric Evaluation Scale, Visual Analog Scale for hearing impairment to assess symptoms subjectively; and pure tone audiometry, the speech discrimination for hearing measurements. For psychological status, we used the Hospital Anxiety and Depression Scale. For analyses, we used Pearson correlation analysis and multiple regression between variables and QoL. Results: Correlation and regression analyses revealed that the severity of tinnitus distress had the largest negative impact on QoL in all domains of SF-36. The severity of tinnitus was significantly associated with subjective hearing impairment and the degree of depression and anxiety. Hearing thresholds had no statistical association with severity of tinnitus. Conclusions: To our knowledge, this is the first study to investigate VS-related tinnitus with respect to both patients' hearing status and psychological condition. Our results suggest that tinnitus distress strongly affects VS patients' QoL and that its characteristics are similar to primary tinnitus. An intervention for VS-related tinnitus, therefore, should assess to what extent tinnitus bothers patients, and it should reduce any unpleasant emotions that may exacerbate symptoms. This approach should improve their QoL.

Tinnitus, Traumatic Brain Injury, and Posttraumatic Stress Disorder in the Military

PURPOSE

Acoustic trauma is more prevalent in military settings, especially among individuals with combat-related military occupational specialties. Gunfire, improvised explosive devices, and mortar explosions are a few examples that may cause hearing degradation and tinnitus. It is possible that the same events that are associated with auditory problems can cause traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

METHOD

This paper reviews the distinct and overlapping symptoms of tinnitus, TBI, and PTSD, and how these disorders interact to synergistically promote negative outcomes.

RESULTS

Tinnitus may serve as a significant contributor to symptoms of TBI and PTSD. Therefore, tinnitus subtypes could be identified as physiologically or psychologically based, or both.

CONCLUSIONS

Additional research is warranted to determine the common and unique symptoms and associated neurological pathways of tinnitus, TBI, and PTSD. Brief treatment recommendations are provided, including a multidisciplinary approach for the physical and psychological distress associated with tinnitus.

Effects of Anxiety Sensitivity and Hearing Loss on Tinnitus Symptom Severity

OBJECTIVE

The aim of the present study was to examine the relative role of anxiety sensitivity and hearing loss on the tinnitus symptoms severity in a large clinical sample of patients with tinnitus.

METHODS

A total of 1,705 patients with tinnitus who visited the tinnitus clinic underwent the pure-tone audiometric testing and a battery of self-report questionnaires. Multiple linear regression analyses were performed to identify the relationship of anxiety sensitivity and hearing loss to tinnitus symptoms severity.

RESULTS

Both anxiety sensitivity and hearing loss were a significant association with of annoyance (anxiety sensitivity β=0.11, p=0.010; hearing loss β=0.09, p=0.005) and THI score (anxiety sensitivity β=0.21, p<0.001; hearing loss β=0.10, p<0.001) after adjusting for confounding factors. Meanwhile, the awareness time (β=0.19, p<0.001) and loudness (β=0.11, p<0.001) of tinnitus was associated with only the hearing loss but not with anxiety sensitivity.

CONCLUSION

Our results indicate that both hearing loss and anxiety sensitivity were associated with increased tinnitus symptom severity. Furthermore, these associations could be different according to the characteristics of tinnitus symptoms.

Behavioral Animal Model of the Emotional Response to Tinnitus and Hearing Loss

Increased prevalence of emotional distress is associated with tinnitus and hearing loss. The underlying mechanisms of the negative emotional response to tinnitus and hearing loss remain poorly understood, and it is challenging to disentangle the emotional consequences of hearing loss from those specific to tinnitus in listeners experiencing both. We addressed these questions in laboratory rats using three common rodent anxiety screening assays: elevated plus maze, open field test, and social interaction test. Open arm activity in the elevated plus maze decreased substantially after one trial in controls, indicating its limited utility for comparing pre- and post-treatment behavior. Open field exploration and social interaction behavior were consistent across multiple sessions in control animals. Individual sound-exposed and salicylate-treated rats showed a range of phenotypes in the open field, including reduced entries into the center in some subjects and reduced locomotion overall. In rats screened for tinnitus, less locomotion was associated with higher tinnitus scores. In salicylate-treated animals, locomotion was correlated with age. Sound-exposed and salicylate-treated rats also showed reduced social interaction. These results suggest that open field exploratory activity is a selective measure for identifying tinnitus distress in individual animals, whereas social interaction reflects the general effects of hearing loss. This animal model will facilitate future studies of the structural and functional changes in the brain pathways underlying emotional distress associated with hearing dysfunction, as well as development of novel interventions to ameliorate or prevent negative emotional responses.

Anxiety Sensitivity or Interoceptive Sensitivity

Abstract. The construct of anxiety sensitivity (AS) – the fear of anxiety-related symptoms – has been highly influential in current conceptualizations of anxiety disorders in general, and panic disorder specifically. However, given documented associations between AS and both non-anxiety psychological disorders as well as medical/health conditions, the extent to which measures of AS are assessing a specific fear or anxiety symptoms versus a broader fear of interoceptive or bodily sensations is unclear. Confirmatory factor analysis of data from 373 participants failed to suggest whether fears of anxiety-related symptoms were factorially distinct from fears of non-anxiety-related bodily sensations, although analyses indicated that while fears of anxiety-related symptoms were more closely associated with panic disorder severity than were fears of non-anxiety-related symptoms, both were similarly and strongly associated with hypochondriacal fears. Implications for the construct of AS, and the broader construct of somatic fears, are discussed.

Acceptance Mediates the Relationship Between Tinnitus-Related Cognitions and Anxiety Sensitivity

PURPOSE

Negative cognitions related to tinnitus sensation have been previously shown to affect the level of emotional distress. Anxiety sensitivity is another psychological factor that influences individuals to more closely monitor their own bodily sensations, resulting in increased negative cognitions and negative emotional responses among tinnitus patients. However, increasing acceptance of tinnitus sensation may attenuate emotional distress. The goal of this research was to investigate the relationship between negative tinnitus-related cognitions, acceptance, and anxiety sensitivity.

METHOD

Two hundred sixty-seven participants completed online measures of the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996), Acceptance and Action Questionnaire (Hayes, Follette, & Linehan, 2004), and the Anxiety Sensitivity Index-3 (Taylor et al., 2007).

RESULTS

Hierarchical regression analyses indicated that acceptance fully mediated the relationship between negative tinnitus-related cognitions and anxiety sensitivity.

CONCLUSIONS

On the basis of these results, it is suggested that practitioners improve acceptance of tinnitus sensation, duration, and intensity. More research is warranted on the clinical techniques to improve acceptance.

A confirmatory factor analytic validation of the Tinnitus Handicap Inventory

OBJECTIVE

Because the postulated three-factor structure of the internationally widely used Tinnitus Handicap Inventory (THI) has not been confirmed yet by a confirmatory factor analytic approach this was the central aim of the current study.

METHODS

From a clinical setting, N=373 patients with chronic tinnitus completed the THI and further questionnaires assessing tinnitus-related and psychological variables. In order to analyze the psychometric properties of the THI, confirmatory factor analysis (CFA) and correlational analyses were conducted.

RESULTS

CFA provided a statistically significant support for a better fit of the data to the hypothesized three-factor structure (RMSEA=.049, WRMR=1.062, CFI=.965, TLI=.961) than to a general factor model (RMSEA=.062, WRMR=1.258, CFI=.942, TLI=.937). The calculation of Cronbach's alpha as indicator of internal consistency revealed satisfactory values (.80-.91) with the exception of the catastrophic subscale (.65). High positive correlations of the THI and its subscales with other measures of tinnitus distress, anxiety, and depression, high negative correlations with tinnitus acceptance, moderate positive correlations with anxiety sensitivity, sleeping difficulties, tinnitus loudness, and small correlations with the Big Five personality dimensions confirmed construct validity.

CONCLUSION

Results show that the THI is a highly reliable and valid measure of tinnitus-related handicap. In contrast to results of previous exploratory analyses the current findings speak for a three-factor in contrast to a unifactorial structure. Future research is needed to replicate this result in different tinnitus populations.

A scientific cognitive-behavioral model of tinnitus: novel conceptualizations of tinnitus distress

The importance of psychological factors in tinnitus distress has been formally recognized for almost three decades. The psychological understanding of why tinnitus can be a distressing condition posits that it becomes problematic when it acquires an emotive significance through cognitive processes. Principle therapeutic efforts are directed at reducing or removing the cognitive (and behavioral) obstacles to habituation. Here, the evidence relevant to a new psychological model of tinnitus is critically reviewed. The model posits that patients' interpretations of tinnitus and the changes in behavior that result are given a central role in creating and maintaining distress. The importance of selective attention and the possibility that this leads to distorted perception of tinnitus is highlighted. From this body of evidence, we propose a coherent cognitive-behavioral model of tinnitus distress that is more in keeping with contemporary psychological theories of clinical problems (particularly that of insomnia) and which postulates a number of behavioral processes that are seen as cognitively mediated. This new model provides testable hypotheses to guide future research to unravel the complex mechanisms underpinning tinnitus distress. It is also well suited to define individual symptomatology and to provide a framework for the delivery of cognitive-behavioral therapy.

Electrophysiological and psychological studies in tinnitus

OBJECTIVES

Tinnitus can be accompanied by depression, anxiety, insomnia, problems with auditory perception and poor general and mental health. This work was designed to evaluate the cognitive and psychological status in tinnitus patients using different subjective and objective measures.

METHODS

This work included 40 patients complaining of tinnitus without any vestibular complaints. Those patients were compared with 40 healthy age and sex matched controls. All subjects were evaluated through: basic audiologic evaluation, electrophysiological test (P300), oculomotor tests (smooth-pursuit, optokinetic, gaze and saccadic eye movements) and psychological evaluation (Hamilton depression and anxiety scales, Mini Mental Status Examination and Trail making tests).

RESULTS

Patients with tinnitus showed abnormalities at both electrophysiological and psychological levels when compared with normal subjects.

CONCLUSION

This study provides evidences that different pathological mechanisms are involved in tinnitus generation which are more extensive than we thought.

The association between tinnitus and mental health in a general population sample: results from the HUNT Study

OBJECTIVES

Clinical studies indicate a strong association between tinnitus and mental health, but results from general population data are missing. The purpose of the study was to examine the association between tinnitus, mental health, and well-being in the general adult population and to identify factors that might mediate and moderate this association.

METHODS

Data from 51,574 adults participating in the Nord-Trøndelag Hearing Loss Study (1995-1997), part of the Nord-Trøndelag Health Study (HUNT-2), were analyzed. The association between tinnitus symptom intensity and symptoms of depression, anxiety, self-esteem, and subjective well-being was examined by multivariate ANOVA, stratified by age group and sex. Explanatory variables were age, marital status, education, hearing, dizziness, vision, physical disability, and somatic illness. In a subsample of participants with tinnitus, the effects of "time since onset," "predictability of tinnitus episodes," and "noise sensitivity" were tested.

RESULTS

Participants with tinnitus scored significantly higher on anxiety and depression and lower on self-esteem and well-being than people without tinnitus. The effect sizes were small and quite similar across levels of tinnitus symptom intensity. No significant effect of time since onset was found. A significant effect of predictability of tinnitus episodes and noise sensitivity was found in some groups.

CONCLUSION

A weak association between tinnitus and mental health was found in this general population study.

Evaluation of a model of distress related to tinnitus

This study tested a theoretical model of tinnitus-related distress and of general distress that involved acceptance of tinnitus symptoms and emotional intelligence as factors that may protect against such distress. One hundred and sixty-two tinnitus sufferers from throughout Australia completed measures of acceptance of tinnitus symptoms, emotional intelligence, tinnitus-related distress, and general distress. As hypothesized, greater acceptance of tinnitus symptoms was associated with less tinnitus-related distress. Emotional intelligence was not associated with tinnitus distress. Greater acceptance and less tinnitus distress were both associated with less general distress, and the association between acceptance and general distress was mediated by tinnitus-related distress. The findings, which provide partial support for the tested model, may have implications for efforts to assist distressed tinnitus sufferers.

Treatment of tinnitus in the elderly: a controlled trial of cognitive behavior therapy

The aim of the study was to investigate the effects of cognitive behavioral therapy (CBT) in elderly people with tinnitus (<65 years). Thirty-seven patients were called in for a structured interview. Following exclusion, twenty-three participated in the trial. All participants underwent medical ear, nose, and throat (ENT) examination, audiometry, and tinnitus matchings. A randomized controlled design with a waiting list control group was used. A CBT treatment package was delivered in six weekly two hour group sessions. Outcome was measured using validated self-report inventories and daily diary ratings of annoyance, loudness and sleep quality for one week pretreatment, post-treatment. A three month follow-up was included at which time all participants had received treatment, but in a shorter format for the control group. Results showed statistically significant reductions of tinnitus-related distress. Thus, CBT was better than no treatment, but the particular aspects of CBT that contributed to the effects can not be established. In conclusion, the findings give some support for the use of group CBT for elderly people with tinnitus.

Severe tinnitus and its effect on selective and divided attention

The effect of chronic, severe tinnitus on two visual tasks was investigated. A general depletion of resources hypothesis states that overall performance would be impaired in a tinnitus group relative to a control group whereas a controlled processing hypothesis states that only tasks that are demanding, requiring strategic processes, are affected. Eleven participants who had experienced severe tinnitus for more than two years comprised the tinnitus group. A control group was matched for age and verbal IQ. Levels of anxiety, depression, and high frequency average hearing level were treated as covariates. Tasks consisted of the say-word (easy) and say-color (demanding) conditions of the Stroop task, a single (baseline) reaction time (RT) task, and dual tasks involving word reading or category naming while performing a concurrent RT task. Results supported the general depletion of resources hypothesis: RT of the tinnitus group was slower in both conditions of the Stroop task, and in the word reading and category naming conditions of the dual task. Differences were not attributable to high frequency average hearing level, anxiety, or depression.

Questionnaires to evaluate anxiety and depressive levels in tinnitus patients

Objective: The aim of this study was to evaluate the correlation between the most common instruments used to quantify tinnitus and the level of anxiety and depression experienced by patients in order to provide a guideline for otolaryngologists.

Study Design: Cross-sectional survey.

Subjects and Methods: A total of 108 tinnitus patients were submitted to a series of instruments, including Visual Analogue Scales (VAS), Tinnitus Handicap Inventory (THI), State Trait Anxiety Inventory Form Y (STAI-T), and Beck Depression Inventory (BDI). These instruments were chosen based on their psychometric properties, time of administration, and validity in many countries.

Results: Of the patients studied, 24 percent had severe tinnitus, 35 percent had anxiety disorders, and 13 percent had a depressive pathosis. Significant correlations between STAI-T and THI scores ( P < 0.001), and between BDI and THI scores were shown ( P < 0.001). The same results were found with VAS.

Conclusion: If a patient reports a THI greater than 38, the otolaryngologist should supplement diagnostic studies with a psychological consultation.

Future thinking in tinnitus patients

OBJECTIVE

The purpose of the study was to investigate future thinking in a group of tinnitus patients. It was predicted that participants in the tinnitus group would report fewer positive future events.

METHODS

A cross-sectional design was used. Two groups of participants completed the test session: tinnitus patients (n=20) and healthy controls (n=20) without tinnitus. Participants completed measures of anticipation of future positive and negative experiences, anxiety and depression. In addition, participants with tinnitus completed a test of tinnitus annoyance.

RESULTS

Tinnitus participants generated a greater number of negative future events compared to the controls. There was no difference between the groups on positive future events or on self-reported anxiety, but the tinnitus group scored higher on a depression measure. Controlling for depression scores removed the group difference.

CONCLUSIONS

While the groups differed on future thinking, the difference concerned negative events, which suggests that anxious information processing might be important in explaining tinnitus annoyance. Levels of depressive symptoms should, however, be considered.

Antidepressant therapy in tinnitus

OBJECTIVE

Review the literature on the co-morbidity of depression and anxiety with tinnitus. Briefly consider proposed mechanisms by which antidepressants might be helpful for tinnitus, including treatment of co-morbid depression and anxiety and a more direct serotonergic mechanism of tinnitus. Survey the literature on antidepressants and tinnitus including tinnitus reported as a side effect of antidepressants (phenelzine, amitriptyline, protriptyline, doxepin, imipramine, fluoxetine, trazadone, bupropion, venlafaxine), tinnitus associated with withdrawal of antidepressants (venlafaxine and sertraline) and antidepressants as a treatment for tinnitus (case reports--fluoxetine and paroxetine, retrospective reviews--imipramine and selective serotonin reuptake inhibitors, single blind trials of amitriptyline and double blind placebo controlled trials of trimipramine, nortriptyline, paroxetine and sertraline). Provide suggestions on future directions, specifically replication of prior studies and a dose finding study of paroxetine for the treatment of tinnitus.

Tinnitus among Cambodian refugees: relationship to PTSD severity

Consecutive Cambodian refugees attending a psychiatric clinic were assessed for the presence and severity of current tinnitus (i.e., at least one episode in the last month). Fifty percent (52/104) of surveyed patients had tinnitus. Among the tinnitus patients, posttraumatic stress disorder (PTSD) rates were significantly more elevated than among nontinnitus patients (OR=13.5; 95% CI=5.8 to 39.4), as were Clinician-Administered PTSD Scale (CAPS) scores. In a hierarchical regression among tinnitus patients (n=52), tinnitus-related trauma associations and catastrophic cognitions accounted for variability in CAPS severity beyond a measure of tinnitus severity. Among tinnitus patients, tinnitus-related trauma associations and catastrophic cognitions mediated the effect of tinnitus severity on CAPS severity.

Tinnitus: Standard of Care, Personality Differences, Genetic Factors

We comment on three areas related to tinnitus. The standard of care should include counseling that is collaborative and that addresses the overall emotional well-being of the patient. Utilizing management and coping strategies is desirable. Our new tinnitus activities treatment is an example of such a protocol. We believe that the notions of fearfulness and acceptance have the potential to be integrated into tinnitus treatment. Some patients reject, control or accept their tinnitus. We believe in some instances there may be a common genetic cause of tinnitus and depression. A potential candidate is the serotonin transporter gene SLC6A4.

Tinnitus and its effect on working memory and attention

PURPOSE

In 2 experiments, the assumption that continual orienting to tinnitus uses cognitive resources was investigated. It was hypothesized that differences in performance of tinnitus and control groups would manifest during demanding or unfamiliar tasks that required strategic, controlled processing and that reduced performance was not related solely to levels of anxiety.

METHOD

Nineteen participants with chronic, moderate tinnitus-matched with a control group for age, education, and verbal IQ-completed auditory verbal working-memory and visual divided-attention tasks, with task order counterbalanced across participants.

RESULTS

As hypothesized, reading span of the tinnitus group was significantly shorter than that of the control group (Task 1). In Task 2, the tinnitus group recorded slower reaction times and poorer accuracy in the most demanding dual task context. Covariate analyses revealed that differences in task performance were not attributable to anxiety scale scores.

CONCLUSIONS

Complaints of the distracting effects of tinnitus have a basis in performance test outcomes. Future research should investigate effects of severe tinnitus and possible effects of hearing loss. At the level of theory development, results from this study suggest that tinnitus affects cognition to the extent that it reduces cognitive capacity needed to perform tasks that require voluntary, conscious, effortful, and strategic control.

Screening of psychiatric disorders via the Internet. A pilot study with tinnitus patients

Tinnitus has been associated with psychiatric disorders and more recently diagnostic tools have been used in a systematic manner. In the present study, we administered the World Health Organisation's Composite International Diagnostic Interview--Short form (CIDI-SF) in a computerized Internet-based version to a self-selected sample of tinnitus patients (n=48). Using the cut-off for 'probable case' (12-month prevalence), 69% of the tinnitus patients fulfilled the criteria for depression, 60% for generalized anxiety disorder, 83% for specific phobia, 67% for social phobia, 58% for agoraphobia, 21% panic attack, 83% obsessive-compulsive disorder, 2% alcohol dependence and 0% drug dependence. Decreased percentages were found for depression (4%), specific phobia (62%) and social phobia (27%) when applying a more conservative criteria (maximum case criteria). In conclusion, the findings suggest that the Internet version of CIDI-SF can be used as a screening tool for psychiatric disturbance in somatic patients, but that diagnostic criteria need to be adjusted for Internet use.

Psychological aspects of tinnitus and the application of cognitive-behavioral therapy

This article presents an overview of tinnitus (ringing or buzzing in the ears), its psychological effects, and the application of cognitive-behavioral therapy (CBT) for its treatment. Several studies have confirmed an association between psychological factors, such as anxiety and depression, and severe tinnitus and preliminary reports suggest that a proportion of tinnitus patients suffer from mental illness. Assessment strategies used in CBT for tinnitus include structured interviews, daily diary ratings, and validated self-report questionnaires. The treatment approach described in this article includes applied relaxation, imagery and distraction techniques, advice regarding environmental sounds, management of sleep, cognitive restructuring of thoughts and beliefs associated with tinnitus, and relapse prevention. The literature pertinent to CBT approaches to treating tinnitus is reviewed, and it is concluded that CBT shows promise as a treatment of tinnitus-related distress. Future research directions are discussed.