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Ghodratitoostani I, Vaziri Z, Miranda Neto M, de Giacomo Carneiro Barros C, Delbem ACB, Hyppolito MA, Jalilvand H, Louzada F, Leite JP. Conceptual framework for tinnitus: a cognitive model in practice. Sci Rep 2024; 14:7186. [PMID: 38531913 DOI: 10.1038/s41598-023-48006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/21/2023] [Indexed: 03/28/2024] Open
Abstract
Tinnitus is a conscious attended awareness perception of sourceless sound. Widespread theoretical and evidence-based neurofunctional and psychological models have tried to explain tinnitus-related distress considering the influence of psychological and cognitive factors. However, tinnitus models seem to be less focused on causality, thereby easily misleading interpretations. Also, they may be incapable of individualization. This study proposes a Conceptual Cognitive Framework (CCF) providing insight into cognitive mechanisms involved in the predisposition, precipitation, and perpetuation of tinnitus and consequent cognitive-emotional disturbances. The current CCF for tinnitus relies on evaluative conditional learning and appraisal, generating negative valence (emotional value) and arousal (cognitive value) to annoyance, distress, and distorted perception. The suggested methodology is well-defined, reproducible, and accessible, which can help foster future high-quality clinical databases. Perceived tinnitus through the perpetual-learning process can always lead to annoyance, but only in the clinical stage directly cause annoyance. In the clinical stage, tinnitus perception can lead indirectly to distress only with experiencing annoyance either with ("I n d - 1 C " = 1.87; 95% CI 1.18-2.72)["1st indirect path in the Clinical stage model": Tinnitus Loudness → Attention Bias → Cognitive-Emotional Value → Annoyance → Clinical Distress]or without ("I n d - 2 C "= 2.03; 95% CI 1.02-3.32)[ "2nd indirect path in the Clinical stage model": Tinnitus Loudness → Annoyance → Clinical Distress] the perpetual-learning process. Further real-life testing of the CCF is expected to express a meticulous, decision-supporting platform for cognitive rehabilitation and clinical interventions. Furthermore, the suggested methodology offers a reliable platform for CCF development in other cognitive impairments and supports the causal clinical data models. It may also enhance our knowledge of psychological disorders and complicated comorbidities by supporting the design of different rehabilitation interventions and comprehensive frameworks in line with the "preventive medicine" policy.
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Affiliation(s)
- Iman Ghodratitoostani
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil.
- Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil.
- Adjunct Scholar, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Vaziri
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Milton Miranda Neto
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil
- Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil
| | - Camila de Giacomo Carneiro Barros
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil
- Department of Otorhinolaryngology, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Alexandre Cláudio Botazzo Delbem
- Neurocognitive Engineering Laboratory (NEL), Center for Engineering Applied to Health, Institute of Mathematics and Computer Science, University of Sao Paulo, Sao Carlos, Brazil
- Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil
| | - Miguel Angelo Hyppolito
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Hamid Jalilvand
- Department of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Francisco Louzada
- Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil
| | - Joao Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Hearing Aid Use Time Is Causally Influenced by Psychological Parameters in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss. J Clin Med 2022; 11:jcm11195869. [PMID: 36233736 PMCID: PMC9573609 DOI: 10.3390/jcm11195869] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Hearing aids (HAs) can improve tinnitus-related distress (TRD) and speech-comprehension (SC) in silence or at 55 dB level of noise-interference (SC_55 dB) in patients with chronic tinnitus and mild-to-moderate hearing loss. However, the role of HA use time in relation to psychological, audiological, or self-reported tinnitus characteristics is an under-investigated area. Methods: We examine 177 gender-stratified patients before (t1) and after an intervention comprising binaural DSLchild algorithm-based HA fitting and auditory training (t2) and at a 70-day follow up [t3]. HA use time was retrospectively retrieved (at t2) for the pre-post- and (at t3) post-follow up periods. General linear models investigated HA use time in relation to (1) general audiological, (2) tinnitus-related audiological, (3) tinnitus-related self-report, and (4) distress-related self-report indices before and after treatment, where applicable. Receiver operator characteristic analyses identified optimal HA use time for hereby-mediated treatment changes. Results: At t1 and t2, psychological, but not audiological indices causally influenced prospective HA use time—except for SC_55 dB at t1, which, however, correlated with patients’ anxiety, depressivity, and psychological distress levels. Correlations did not differ between patient subgroups defined by categorical tinnitus-related audiological or self-report indices. HA use time partly mediated treatment-related improvement in TRD, but not SC. Optimal use amounted to 9.5–10.5 h/day. Conclusions: An awareness of psychological influences may help clinicians facilitate HA use and, thereby, TRD improvement with hearing amplification.
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An Exploratory Investigation of Pupillometry As a Measure of Tinnitus Intrusiveness on a Test of Auditory Short-Term Memory. Ear Hear 2022; 43:1540-1548. [DOI: 10.1097/aud.0000000000001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang D(A, Hagger MS, Chatzisarantis NLD. Ironic Effects of Thought Suppression: A Meta-Analysis. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 15:778-793. [DOI: 10.1177/1745691619898795] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ironic effect of thought suppression refers to the phenomenon in which individuals trying to rid their mind of a target thought ironically experience greater levels of occurrence and accessibility of the thought compared with individuals who deliberately concentrate on the thought (Wegner, 1994, doi:10.1037/0033-295X.101.1.34). Ironic effects occurring after thought suppression, also known as rebound effects, were consistently detected by previous meta-analyses. However, ironic effects that occur during thought suppression, also known as immediate enhancement effects, were found to be largely absent. In this meta-analysis, we test Wegner’s original proposition that detection of immediate enhancement effects depends on the cognitive load experienced by individuals when enacting thought suppression. Given that thought suppression is an effortful cognitive process, we propose that the introduction of additional cognitive load would compete for the allocation of existing cognitive resources and impair capacity for thought suppression. Studies ( k = 31) consistent with Wegner’s original thought-suppression paradigm were analyzed. Consistent with our predictions, rebound effects were observed regardless of cognitive load, whereas immediate enhancement effects were observed only in the presence of cognitive load. We discuss implications in light of ironic-process theory and suggest future thought-suppression research.
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Affiliation(s)
| | - Martin S. Hagger
- Psychological Sciences, University of California, Merced
- Faculty of Sport and Health Sciences, University of Jyväskylä
| | - Nikos L. D. Chatzisarantis
- International Group for the Discovery of Fundamental Principles of Human Motivation, School of Psychology, Curtin University
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Cima RFF, Kikidis D, Mazurek B, Haider H, Cederroth CR, Norena A, Lapira A, Bibas A, Hoare DJ. Tinnitus healthcare: a survey revealing extensive variation in opinion and practices across Europe. BMJ Open 2020; 10:e029346. [PMID: 31969359 PMCID: PMC7045098 DOI: 10.1136/bmjopen-2019-029346] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
UNLABELLED Tinnitus remains a scientific and clinical problem whereby, in spite of increasing knowledge on effective treatment and management for tinnitus, very little impact on clinical practice has been observed. There is evidence that prolonged, obscure and indirect referral trajectories persist in usual tinnitus care. OBJECTIVE It is widely acknowledged that efforts to change professional practice are more successful if barriers are identified and implementation activities are systematically tailored to the specific determinants of practice. The aim of this study was to administer a health service evaluation survey to scope current practice and knowledge of standards in tinnitus care across Europe. The purpose of this survey was to specifically inform the development process of a European clinical guideline that would be implementable in all European countries. DESIGN A health service evaluation survey was carried out. SETTING The survey was carried out online across Europe. PARTICIPANTS Clinical experts, researchers and policy-makers involved in national tinnitus healthcare and decision-making. OUTCOME MEASURES A survey was developed by the study steering group, piloted on clinicians from the TINNET network and underwent two iterations before being finalised. The survey was then administered to clinicians and policy-makers from 24 European countries. RESULTS Data collected from 625 respondents revealed significant differences in national healthcare structures, use of tinnitus definitions, opinions on characteristics of patients with tinnitus, assessment procedures and particularly in available treatment options. Differences between northern and eastern European countries were most notable. CONCLUSIONS Most European countries do not have national clinical guidelines for the management of tinnitus. Reflective of this, clinical practices in tinnitus healthcare vary dramatically across countries. This equates to inequities of care for people with tinnitus across Europe and an opportunity to introduce standards in the form of a European clinical guideline. This survey has highlighted important barriers and facilitators to the implementation of such a guideline.
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Affiliation(s)
- Rilana F F Cima
- Department of Clinical Psychological Science, Universiteit Maastricht Faculteit der Psychologie en Neurowetenschappen, Maastricht, The Netherlands
- Centre of Knowledge and Expertise, Adelante, Hoensbroek, The Netherlands
| | - Dimitris Kikidis
- 1st Department of Otolaryngology, National and Kapodistrian University of Athens, Athens, Greece
| | - Birgit Mazurek
- Tinnitus Centre Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Haúla Haider
- ENT Department Nova Medical School, Hospital Cuf Infante Santo, Lisbon, Portugal
| | | | | | - Alec Lapira
- Otolaryngology, University of Malta, Msida, Malta
| | - Athanasios Bibas
- 1st Department of Otolaryngology, National and Kapodistrian University of Athens, Athens, Greece
| | - Derek J Hoare
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
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.
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Affiliation(s)
- R F F Cima
- Section Behavioural Medicine, Faculty of Psychology and Neuroscience, Maastricht University, 616, 6200 MD, Maastricht, The Netherlands.
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Neff P, Hemsley C, Kraxner F, Weidt S, Kleinjung T, Meyer M. Active listening to tinnitus and its relation to resting state EEG activity. Neurosci Lett 2019; 694:176-183. [DOI: 10.1016/j.neulet.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
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A systematic review and meta-analysis of psychological functioning in chronic tinnitus. Clin Psychol Rev 2018; 60:62-86. [DOI: 10.1016/j.cpr.2017.12.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 10/31/2017] [Accepted: 12/28/2017] [Indexed: 11/19/2022]
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Cima RF, van Breukelen G, Vlaeyen JW. Tinnitus-related fear: Mediating the effects of a cognitive behavioural specialised tinnitus treatment. Hear Res 2018; 358:86-97. [DOI: 10.1016/j.heares.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/02/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
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Fuller TE, Haider HF, Kikidis D, Lapira A, Mazurek B, Norena A, Rabau S, Lardinois R, Cederroth CR, Edvall NK, Brueggemann PG, Rosing SN, Kapandais A, Lungaard D, Hoare DJ, Cima RFF. Different Teams, Same Conclusions? A Systematic Review of Existing Clinical Guidelines for the Assessment and Treatment of Tinnitus in Adults. Front Psychol 2017; 8:206. [PMID: 28275357 PMCID: PMC5319986 DOI: 10.3389/fpsyg.2017.00206] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults. Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines. Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively. Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe.
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Affiliation(s)
- Thomas E. Fuller
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
- Adelante, Centre of Expertise in Rehabilitation and AudiologyHoensbroek, Netherlands
| | - Haula F. Haider
- ENT Department of Hospital, Cuf Infante Santo - Nova Medical SchoolLisbon, Portugal
| | - Dimitris Kikidis
- Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General HospitalAthens, Greece
| | - Alec Lapira
- ENT Specialist, Institute of Health Care, Mater Dei HospitalMalta, Malta
| | - Birgit Mazurek
- Tinnitus Center, Charite University HospitalBerlin, Germany
| | - Arnaud Norena
- Laboratory of Adaptive and Integrative Neuroscience, Centre National de la Recherche Scientifique, Fédération de Recherche, Aix-Marseille UniversitéMarseille, France
| | - Sarah Rabau
- Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of AntwerpAntwerp, Belgium
| | - Rachelle Lardinois
- Adelante, Centre of Expertise in Rehabilitation and AudiologyHoensbroek, Netherlands
| | | | - Niklas K. Edvall
- Department of Physiology and Pharmacology, Karolinska InstitutetStockholm, Sweden
| | | | - Susanne N. Rosing
- Department of Clinical Research, Faculty of Health Sciences, University of Southern DenmarkOdense, Denmark
| | - Anestis Kapandais
- Department of Nordic Studies and Linguistics, Copenhagen UniversityDenmark
| | - Dorte Lungaard
- Department of Clinical Research, Faculty of Health Sciences, University of Southern DenmarkOdense, Denmark
| | - Derek J. Hoare
- NIHR Nottingham Hearing Biomedical Research Unit, Division of Clinical Neuroscience, School of Medicine, University of NottinghamNottingham, UK
| | - Rilana F. F Cima
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
- Adelante, Centre of Expertise in Rehabilitation and AudiologyHoensbroek, Netherlands
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Vlaeyen JW, Morley S, Crombez G. The experimental analysis of the interruptive, interfering, and identity-distorting effects of chronic pain. Behav Res Ther 2016; 86:23-34. [DOI: 10.1016/j.brat.2016.08.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 02/07/2023]
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Golm D, Schmidt-Samoa C, Dechent P, Kröner-Herwig B. Tinnitus- related distress: evidence from fMRI of an emotional stroop task. BMC EAR, NOSE, AND THROAT DISORDERS 2016; 16:10. [PMID: 27499700 PMCID: PMC4975911 DOI: 10.1186/s12901-016-0029-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/21/2016] [Indexed: 11/28/2022]
Abstract
Background Chronic tinnitus affects 5 % of the population, 17 % suffer under the condition. This distress seems mainly to be dependent on negative cognitive-emotional evaluation of the tinnitus and selective attention to the tinnitus. A well-established paradigm to examine selective attention and emotional processing is the Emotional Stroop Task (EST). Recent models of tinnitus distress propose limbic, frontal and parietal regions to be more active in highly distressed tinnitus patients. Only a few studies have compared high and low distressed tinnitus patients. Thus, this study aimed to explore neural correlates of tinnitus-related distress. Methods Highly distressed tinnitus patients (HDT, n = 16), low distressed tinnitus patients (LDT, n = 16) and healthy controls (HC, n = 16) underwent functional magnetic resonance imaging (fMRI) during an EST, that used tinnitus-related words and neutral words as stimuli. A random effects analysis of the fMRI data was conducted on the basis of the general linear model. Furthermore correlational analyses between the blood oxygen level dependent response and tinnitus distress, loudness, depression, anxiety, vocabulary and hypersensitivity to sound were performed. Results Contradictory to the hypothesis, highly distressed patients showed no Stroop effect in their reaction times. As hypothesized HDT and LDT differed in the activation of the right insula and the orbitofrontal cortex. There were no hypothesized differences between HDT and HC. Activation of the orbitofrontal cortex and the right insula were found to correlate with tinnitus distress. Conclusions The results are partially supported by earlier resting-state studies and corroborate the role of the insula and the orbitofrontal cortex in tinnitus distress.
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Affiliation(s)
- Dennis Golm
- Department of Clinical Psychology and Psychotherapy, Georg-August-University, Georg-Elias-Mueller-Institute of Psychology, Gosslerstrasse 14, 37073 Goettingen, Germany ; University of Southampton, Academic Unit of Psychology, Developmental Brain Behaviour Laboratory, Highfield Campus, Building 44, SO17 1 BJ Southampton, UK
| | - Carsten Schmidt-Samoa
- Georg-August-University, UMG, MR-Research in Neurology and Psychiatry, Robert-Koch-Str. 40, 37075 Goettingen, Germany
| | - Peter Dechent
- Georg-August-University, UMG, MR-Research in Neurology and Psychiatry, Robert-Koch-Str. 40, 37075 Goettingen, Germany
| | - Birgit Kröner-Herwig
- Department of Clinical Psychology and Psychotherapy, Georg-August-University, Georg-Elias-Mueller-Institute of Psychology, Gosslerstrasse 14, 37073 Goettingen, Germany
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Schecklmann M, Lehner A, Gollmitzer J, Schmidt E, Schlee W, Langguth B. Repetitive transcranial magnetic stimulation induces oscillatory power changes in chronic tinnitus. Front Cell Neurosci 2015; 9:421. [PMID: 26557055 PMCID: PMC4617176 DOI: 10.3389/fncel.2015.00421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/04/2015] [Indexed: 11/13/2022] Open
Abstract
Chronic tinnitus is associated with neuroplastic changes in auditory and non-auditory cortical areas. About 10 years ago, repetitive transcranial magnetic stimulation (rTMS) of auditory and prefrontal cortex was introduced as potential treatment for tinnitus. The resulting changes in tinnitus loudness are interpreted in the context of rTMS induced activity changes (neuroplasticity). Here, we investigate the effect of single rTMS sessions on oscillatory power to probe the capacity of rTMS to interfere with tinnitus-specific cortical plasticity. We measured 20 patients with bilateral chronic tinnitus and 20 healthy controls comparable for age, sex, handedness, and hearing level with a 63-channel electroencephalography (EEG) system. Educational level, intelligence, depressivity and hyperacusis were controlled for by analysis of covariance. Different rTMS protocols were tested: Left and right temporal and left and right prefrontal cortices were each stimulated with 200 pulses at 1 Hz and with an intensity of 60% stimulator output. Stimulation of central parietal cortex with 6-fold reduced intensity (inverted passive-cooled coil) served as sham condition. Before and after each rTMS protocol 5 min of resting state EEG were recorded. The order of rTMS protocols was randomized over two sessions with 1 week interval in between. Analyses on electrode level showed that people with and without tinnitus differed in their response to left temporal and right frontal stimulation. In tinnitus patients left temporal rTMS decreased frontal theta and delta and increased beta2 power, whereas right frontal rTMS decreased right temporal beta3 and gamma power. No changes or increases were observed in the control group. Only non-systematic changes in tinnitus loudness were induced by single sessions of rTMS. This is the first study to show tinnitus-related alterations of neuroplasticity that were specific to stimulation site and oscillatory frequency. The observed effects can be interpreted within the thalamocortical dysrhythmia model assuming that slow waves represent processes of deafferentiation and that high frequencies might be indicators for tinnitus loudness. Moreover our findings confirm the role of the left temporal and the right frontal areas as relevant hubs in tinnitus related neuronal network. Our results underscore the value of combined TMS-EEG measurements for investigating disease related changes in neuroplasticity.
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Affiliation(s)
- Martin Schecklmann
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Judith Gollmitzer
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Eldrid Schmidt
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
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Amaral AA, Langers DR. Tinnitus-related abnormalities in visual and salience networks during a one-back task with distractors. Hear Res 2015; 326:15-29. [DOI: 10.1016/j.heares.2015.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 02/23/2015] [Accepted: 03/16/2015] [Indexed: 01/11/2023]
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Hesser H, Molander P, Jungermann M, Andersson G. Costs of suppressing emotional sound and countereffects of a mindfulness induction: an experimental analog of tinnitus impact. PLoS One 2013; 8:e64540. [PMID: 23675540 PMCID: PMC3651083 DOI: 10.1371/journal.pone.0064540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 04/16/2013] [Indexed: 11/18/2022] Open
Abstract
Tinnitus is the experience of sounds without an appropriate external auditory source. These auditory sensations are intertwined with emotional and attentional processing. Drawing on theories of mental control, we predicted that suppressing an affectively negative sound mimicking the psychoacoustic features of tinnitus would result in decreased persistence in a mentally challenging task (mental arithmetic) that required participants to ignore the same sound, but that receiving a mindfulness exercise would reduce this effect. Normal hearing participants (N = 119) were instructed to suppress an affectively negative sound under cognitive load or were given no such instructions. Next, participants received either a mindfulness induction or an attention control task. Finally, all participants worked with mental arithmetic while exposed to the same sound. The length of time participants could persist in the second task served as the dependent variable. As hypothesized, results indicated that an auditory suppression rationale reduced time of persistence relative to no such rationale, and that a mindfulness induction counteracted this detrimental effect. The study may offer new insights into the mechanisms involved in the development of tinnitus interference. Implications are also discussed in the broader context of attention control strategies and the effects of emotional sound on task performance. The ironic processes of mental control may have an analog in the experience of sounds.
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Affiliation(s)
- Hugo Hesser
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
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Weise C, Kleinstäuber M, Hesser H, Westin VZ, Andersson G. Acceptance of tinnitus: validation of the tinnitus acceptance questionnaire. Cogn Behav Ther 2013; 42:100-15. [PMID: 23627873 DOI: 10.1080/16506073.2013.781670] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The concept of acceptance has recently received growing attention within tinnitus research due to the fact that tinnitus acceptance is one of the major targets of psychotherapeutic treatments. Accordingly, acceptance-based treatments will most likely be increasingly offered to tinnitus patients and assessments of acceptance-related behaviours will thus be needed. The current study investigated the factorial structure of the Tinnitus Acceptance Questionnaire (TAQ) and the role of tinnitus acceptance as mediating link between sound perception (i.e. subjective loudness of tinnitus) and tinnitus distress. In total, 424 patients with chronic tinnitus completed the TAQ and validated measures of tinnitus distress, anxiety, and depression online. Confirmatory factor analysis provided support to a good fit of the data to the hypothesised bifactor model (root-mean-square-error of approximation = .065; Comparative Fit Index = .974; Tucker-Lewis Index = .958; standardised root mean square residual = .032). In addition, mediation analysis, using a non-parametric joint coefficient approach, revealed that tinnitus-specific acceptance partially mediated the relation between subjective tinnitus loudness and tinnitus distress (path ab = 5.96; 95% CI: 4.49, 7.69). In a multiple mediator model, tinnitus acceptance had a significantly stronger indirect effect than anxiety. The results confirm the factorial structure of the TAQ and suggest the importance of a general acceptance factor that contributes important unique variance beyond that of the first-order factors activity engagement and tinnitus suppression. Tinnitus acceptance as measured with the TAQ is proposed to be a key construct in tinnitus research and should be further implemented into treatment concepts to reduce tinnitus distress.
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Affiliation(s)
- Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Germany.
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Schecklmann M, Lehner A, Poeppl TB, Kreuzer PM, Rupprecht R, Rackl J, Burger J, Frank E, Hajak G, Langguth B, Landgrebe M. Auditory cortex is implicated in tinnitus distress: a voxel-based morphometry study. Brain Struct Funct 2013; 218:1061-70. [DOI: 10.1007/s00429-013-0520-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 02/04/2013] [Indexed: 01/04/2023]
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Wallhäusser-Franke E, Schredl M, Delb W. Tinnitus and insomnia: is hyperarousal the common denominator? Sleep Med Rev 2012; 17:65-74. [PMID: 22750224 DOI: 10.1016/j.smrv.2012.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
Abstract
Tinnitus is an auditory sensation that is generated by aberrant activation within the auditory system. Sleep disturbances are a frequent problem in the tinnitus population. They are known to worsen the distress caused by the tinnitus which in turn worsens sleep quality. Beyond that, disturbed sleep is a risk factor for mental health problems and distressing tinnitus is often associated with enhanced depressivity, anxiety, and somatic symptom severity. Moreover there is evidence that therapies which alleviate tinnitus-related distress have a positive influence on sleep quality and help interrupt this vicious cycle. This suggests that distressing tinnitus and insomnia may both be promoted by similar physiological mechanisms. One candidate mechanism is hyperarousal caused by enhanced activation of the sympathetic nervous system. There is increasing evidence for hyperarousal in insomnia patients, and animal models of tinnitus and insomnia show conspicuous similarities in the activation pattern of limbic and autonomous brain regions. In this article we review the evidence for this hypothesis which may have implications for therapeutic intervention in tinnitus patients with comorbid insomnia.
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Affiliation(s)
- Elisabeth Wallhäusser-Franke
- Medical Faculty Mannheim, Heidelberg University, Department of Phoniatrics and Audiology, Tridomus House C, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany.
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Wineland AM, Burton H, Piccirillo J. Functional connectivity networks in nonbothersome tinnitus. Otolaryngol Head Neck Surg 2012; 147:900-6. [PMID: 22722065 DOI: 10.1177/0194599812451414] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess functional connectivity in cortical networks in patients with nonbothersome tinnitus compared with a normal healthy nontinnitus control group by measuring low-frequency (<0.1 Hz) spontaneous blood oxygenation level-dependent (BOLD) signals at rest. DESIGN Case-control. SETTING Academic medical center. PARTICIPANTS Nonbothersome, idiopathic subjective tinnitus for at least 6 months (n = 18) and a normal healthy nontinnitus control group (n = 23). MAIN OUTCOME MEASURE Functional connectivity differences in 58 a priori selected seed regions of interest encompassing cortical loci in the default mode, attention, auditory, visual, somatosensory, and cognitive networks. RESULTS The median age of the 18 subjects was 54 years (interquartile range [IQR], 52-57), 66% were male, 90% were white, median Tinnitus Handicap Inventory (THI) score was 8 (IQR, 4-14), and a median Beck Depression Index score was 1 (IQR, 0-5). The median age for the control group was 46 years (IQR, 39-54), and 52% were male. Of the 58 seeds analyzed, no regions had significantly different functional connectivity among the nonbothersome tinnitus group when compared with the control group. CONCLUSION Among nonbothersome tinnitus patients, the tinnitus percept does not appear to alter the functional connectivity of the auditory cortex or other key cortical regions. Trial Registration ClinicalTrials.gov Identifier: NCT01049828.
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Affiliation(s)
- Andre M Wineland
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St Louis, MO, USA.
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Burton H, Wineland A, Bhattacharya M, Nicklaus J, Garcia KS, Piccirillo JF. Altered networks in bothersome tinnitus: a functional connectivity study. BMC Neurosci 2012; 13:3. [PMID: 22217183 PMCID: PMC3282646 DOI: 10.1186/1471-2202-13-3] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/04/2012] [Indexed: 12/12/2022] Open
Abstract
Background The objective was to examine functional connectivity linked to the auditory system in patients with bothersome tinnitus. Activity was low frequency (< 0.1 Hz), spontaneous blood oxygenation level-dependent (BOLD) responses at rest. The question was whether the experience of chronic bothersome tinnitus induced changes in synaptic efficacy between co-activated components. Functional connectivity for seed regions in auditory, visual, attention, and control networks was computed across all 2 mm3 brain volumes in 17 patients with moderate-severe bothersome tinnitus (Tinnitus Handicap Index: average 53.5 ± 3.6 (range 38-76)) and 17 age-matched controls. Results In bothersome tinnitus, negative correlations reciprocally characterized functional connectivity between auditory and occipital/visual cortex. Negative correlations indicate that when BOLD response magnitudes increased in auditory or visual cortex they decreased in the linked visual or auditory cortex, suggesting reciprocally phase reversed activity between functionally connected locations in tinnitus. Both groups showed similar connectivity with positive correlations within the auditory network. Connectivity for primary visual cortex in tinnitus included extensive negative correlations in the ventral attention temporoparietal junction and in the inferior frontal gyrus and rostral insula - executive control network components. Rostral insula and inferior frontal gyrus connectivity in tinnitus also showed greater negative correlations in occipital cortex. Conclusions These results imply that in bothersome tinnitus there is dissociation between activity in auditory cortex and visual, attention and control networks. The reciprocal negative correlations in connectivity between these networks might be maladaptive or reflect adaptations to reduce phantom noise salience and conflict with attention to non-auditory tasks.
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Affiliation(s)
- Harold Burton
- Department of Anatomy & Neurobiology, Washington University School of Medicine, St, Louis, Missouri 63110, USA.
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Pierce KJ, Kallogjeri D, Piccirillo JF, Garcia KS, Nicklaus JE, Burton H. Effects of severe bothersome tinnitus on cognitive function measured with standardized tests. J Clin Exp Neuropsychol 2011; 34:126-34. [PMID: 22168528 DOI: 10.1080/13803395.2011.623120] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Neurocognitive tests compared abilities in people with bothersome tinnitus against an age-, gender-, and education-matched normative population. Participants between 18 and 60 years had subjective, unilateral or bilateral, nonpulsatile tinnitus for >6 months and a Tinnitus Handicap Inventory score of ≥ 38. Results from a first testing session showed deficits in learning, learning rates, immediate recall of heard words, and use of a serial order encoding strategy. Initial reliance on serial order encoding and, later, increased intrusion of incorrect words towards normal levels might indicate a less demanding strategy to compensate for weakness in associative memory for semantic categories.
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Affiliation(s)
- Katherine J Pierce
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Weisz N, Hartmann T, Müller N, Lorenz I, Obleser J. Alpha rhythms in audition: cognitive and clinical perspectives. Front Psychol 2011; 2:73. [PMID: 21687444 PMCID: PMC3110491 DOI: 10.3389/fpsyg.2011.00073] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/05/2011] [Indexed: 11/23/2022] Open
Abstract
Like the visual and the sensorimotor systems, the auditory system exhibits pronounced alpha-like resting oscillatory activity. Due to the relatively small spatial extent of auditory cortical areas, this rhythmic activity is less obvious and frequently masked by non-auditory alpha-generators when recording non-invasively using magnetoencephalography (MEG) or electroencephalography (EEG). Following stimulation with sounds, marked desynchronizations can be observed between 6 and 12 Hz, which can be localized to the auditory cortex. However knowledge about the functional relevance of the auditory alpha rhythm has remained scarce so far. Results from the visual and sensorimotor system have fuelled the hypothesis of alpha activity reflecting a state of functional inhibition. The current article pursues several intentions: (1) Firstly we review and present own evidence (MEG, EEG, sEEG) for the existence of an auditory alpha-like rhythm independent of visual or motor generators, something that is occasionally met with skepticism. (2) In a second part we will discuss tinnitus and how this audiological symptom may relate to reduced background alpha. The clinical part will give an introduction into a method which aims to modulate neurophysiological activity hypothesized to underlie this distressing disorder. Using neurofeedback, one is able to directly target relevant oscillatory activity. Preliminary data point to a high potential of this approach for treating tinnitus. (3) Finally, in a cognitive neuroscientific part we will show that auditory alpha is modulated by anticipation/expectations with and without auditory stimulation. We will also introduce ideas and initial evidence that alpha oscillations are involved in the most complex capability of the auditory system, namely speech perception. The evidence presented in this article corroborates findings from other modalities, indicating that alpha-like activity functionally has an universal inhibitory role across sensory modalities.
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Affiliation(s)
- Nathan Weisz
- Department of Psychology, University of Konstanz Konstanz, Germany
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Langguth B, Kleinjung T, Landgrebe M, de Ridder D, Hajak G. rTMS for the treatment of tinnitus: The role of neuronavigation for coil positioning. Neurophysiol Clin 2010; 40:45-58. [DOI: 10.1016/j.neucli.2009.03.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 03/08/2009] [Indexed: 12/30/2022] Open
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ANDERSSON GERHARD, EDSJÖ LISA, KALDO VIKTOR, WESTIN VENDELA. Tinnitus and short-term serial recall in stable versus intermittent masking conditions. Scand J Psychol 2009; 50:517-22. [DOI: 10.1111/j.1467-9450.2009.00752.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Andersson G, Westin V. Understanding tinnitus distress: Introducing the concepts of moderators and mediators. Int J Audiol 2009; 47 Suppl 2:S106-11. [DOI: 10.1080/14992020802301670] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Adjamian P, Sereda M, Hall DA. The mechanisms of tinnitus: perspectives from human functional neuroimaging. Hear Res 2009; 253:15-31. [PMID: 19364527 DOI: 10.1016/j.heares.2009.04.001] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/02/2009] [Accepted: 04/05/2009] [Indexed: 10/20/2022]
Abstract
In this review, we highlight the contribution of advances in human neuroimaging to the current understanding of central mechanisms underpinning tinnitus and explain how interpretations of neuroimaging data have been guided by animal models. The primary motivation for studying the neural substrates of tinnitus in humans has been to demonstrate objectively its representation in the central auditory system and to develop a better understanding of its diverse pathophysiology and of the functional interplay between sensory, cognitive and affective systems. The ultimate goal of neuroimaging is to identify subtypes of tinnitus in order to better inform treatment strategies. The three neural mechanisms considered in this review may provide a basis for TI classification. While human neuroimaging evidence strongly implicates the central auditory system and emotional centres in TI, evidence for the precise contribution from the three mechanisms is unclear because the data are somewhat inconsistent. We consider a number of methodological issues limiting the field of human neuroimaging and recommend approaches to overcome potential inconsistency in results arising from poorly matched participants, lack of appropriate controls and low statistical power.
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Affiliation(s)
- Peyman Adjamian
- MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, United Kingdom.
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Westin V, Ostergren R, Andersson G. The effects of acceptance versus thought suppression for dealing with the intrusiveness of tinnitus. Int J Audiol 2009; 47 Suppl 2:S112-8. [PMID: 19012119 DOI: 10.1080/14992020802301688] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to examine the effect of acceptance versus suppression of disruptions on a mental imagery task in a sample of tinnitus patients. Previous research has indicated that acceptance can be an effective strategy for dealing with unpleasant experiences such as pain and anxiety. The study used a between-group design, including 47 participants who completed a task involving mental imagery in a sound-proof booth. Participants were randomly assigned to three instruction conditions: acceptance, suppression, or a control condition. The results showed a significant difference between the acceptance group and the control group in that participants in the acceptance group were able to focus on the imagery task for a longer time without being interrupted. The study provides preliminary support for the notion that acceptance can be a helpful strategy for tinnitus patients.
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Affiliation(s)
- Vendela Westin
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact. Behav Res Ther 2008; 46:1259-65. [DOI: 10.1016/j.brat.2008.08.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 08/19/2008] [Accepted: 08/27/2008] [Indexed: 11/21/2022]
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Henry JA, Zaugg TL, Myers PJ, Schechter MA. Using therapeutic sound with progressive audiologic tinnitus management. Trends Amplif 2008; 12:188-209. [PMID: 18664499 DOI: 10.1177/1084713808321184] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of tinnitus generally involves educational counseling, stress reduction, and/or the use of therapeutic sound. This article focuses on therapeutic sound, which can involve three objectives: (a) producing a sense of relief from tinnitus-associated stress (using soothing sound); (b) passively diverting attention away from tinnitus by reducing contrast between tinnitus and the acoustic environment (using background sound); and (c) actively diverting attention away from tinnitus (using interesting sound). Each of these goals can be accomplished using three different types of sound-broadly categorized as environmental sound, music, and speech-resulting in nine combinations of uses of sound and types of sound to manage tinnitus. The authors explain the uses and types of sound, how they can be combined, and how the different combinations are used with Progressive Audiologic Tinnitus Management. They also describe how sound is used with other sound-based methods of tinnitus management (Tinnitus Masking, Tinnitus Retraining Therapy, and Neuromonics).
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Kahlbrock N, Weisz N. Transient reduction of tinnitus intensity is marked by concomitant reductions of delta band power. BMC Biol 2008; 6:4. [PMID: 18199318 PMCID: PMC2254377 DOI: 10.1186/1741-7007-6-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 01/16/2008] [Indexed: 12/04/2022] Open
Abstract
Background Tinnitus is an auditory phantom phenomenon characterized by the sensation of sounds without objectively identifiable sound sources. To date, its causes are not well understood. Previous research found altered patterns of spontaneous brain activity in chronic tinnitus sufferers compared to healthy controls, yet it is unknown whether these abnormal oscillatory patterns are causally related to the tinnitus sensation. Partial support for this notion comes from a neurofeedback approach developed by our group, in which significant reductions in tinnitus loudness could be achieved in patients who successfully normalized their patterns of spontaneous brain activity. The current work attempts to complement these studies by scrutinizing how modulations of tinnitus intensity alter ongoing oscillatory activity. Results In the present study the relation between tinnitus sensation and spontaneous brain activity was investigated using residual inhibition (RI) to reduce tinnitus intensity and source-space projected magnetencephalographic (MEG) data to index brain activity. RI is the sustained reduction (criteria: 50% for at least 30 s) in tinnitus loudness after cessation of a tonal tinnitus masker. A pilot study (n = 38) identified 10 patients who showed RI. A significant reduction of power in the delta (1.3–4.0 Hz) frequency band was observed in temporal regions during RI (p ≤ 0.001). Conclusion The current results suggest that changes of tinnitus intensity induced by RI are mediated by alterations in the pathological patterns of spontaneous brain activity, specifically a reduction of delta activity. Delta activity is a characteristic oscillatory activity generated by deafferented/deprived neuronal networks. This implies that RI effects might reflect the transient reestablishment of balance between excitatory and inhibitory neuronal assemblies, via reafferentation, that have been perturbed (in most tinnitus individuals) by hearing damage. As enhancements have been reported in the delta frequency band for tinnitus at rest, this result conforms to our assumption that a normalization of oscillatory properties of cortical networks is a prerequisite for attenuating the tinnitus sensation. For RI to have therapeutic significance however, this normalization would have to be stabilized.
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Affiliation(s)
- Nina Kahlbrock
- Department of Psychology, University of Konstanz, Konstanz, Germany.
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Functional imaging of chronic tinnitus: the use of positron emission tomography. PROGRESS IN BRAIN RESEARCH 2007; 166:83-8. [DOI: 10.1016/s0079-6123(07)66008-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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