Costs of suppressing emotional sound and countereffects of a mindfulness induction: an experimental analog of tinnitus impact

Psychological Acceptance in Adults With Hearing Loss—Psychometric Evaluation and Validation of the Hearing Acceptance Questionnaire

OBJECTIVES

Hearing loss is common and a major contributor to the global number of years lived with disability. An increasing number of studies have begun to consider the specific psychological processes by which distressing thoughts, emotional experiences and non-adaptive behaviours exert an influence on functioning and health among those who suffer from audiological disorders. Psychological acceptance has recently been proposed to be a core process but has to date not been systematically examined among individuals with hearing problems. This study examined the reliability, factor structure and the validity of the Hearing Acceptance Questionnaire (HAQ).

DESIGN

The HAQ was developed from similar questionnaires for other chronic health conditions and was evaluated using data from an online screening of hearing ability (N=1351). Measures included a hearing test (speech-in-noise), standardized and validated self-report measurements of anxiety and depression symptoms (the Hospital Anxiety and Depression scale), hearing related disability (the Amsterdam Inventory of Hearing Disability and Handicap), and quality of life (the Quality of Life Inventory). Factor structure of the HAQ was evaluated with confirmatory factor analysis, and the unique contribution of psychological acceptance in accounting for variance in hearing disability was examined by hierarchical multiple regression analyses.

RESULTS

Findings supported the reliability, factor structure and validity of the HAQ. Confirmatory factor analysis supported a two-factor model with one subscale measuring Avoidance with 9 items; alpha = 0.84) and the other Activity Engagement (3 items; alpha = 0.76). Both subscales of the HAQ explained unique variance in disability after hearing ability, depression and anxiety symptoms were statistically taken into account. Theoretical and clinical implications of psychological acceptance in adults with hearing problems are discussed.

CONCLUSIONS

This paper evaluated the psychometric properties of a new measure of hearing loss acceptance, the HAQ, to measure psychological acceptance among individuals with hearing problems. Regression analysis revealed that lack of psychological acceptance was strongly positively correlated with hearing disability, even after accounting for other psychological factors and hearing ability. Taken together, the findings provide preliminary support for HAQ as a psychometrically sound measure of psychological acceptance among individuals with hearing problems.

No sound is more distracting than the one you're trying not to hear: delayed costs of mental control of task-irrelevant neutral and emotional sounds

Background

Suppressing intrusive thoughts can result in a post-suppression rebound effect where the same thoughts become hyperaccessible. The current study aimed to investigate if similar so-called rebound effects could be observed when people attempted to mentally suppress awareness of nonsensical auditory stimuli. Based on previous research on thought suppression and mental control in other domains, we hypothesized that attempting to suppress awareness of a task-irrelevant sound while under cognitive load would impact evaluations of the sound on affective dimensions and loudness, and result in increased general vigilance, as evidenced by faster responding on subsequent tasks.

Methods

We performed two experiments where participants in a suppression condition were initially instructed to mentally suppress awareness of a sound while performing a mentally challenging task. Participants in a control condition performed the same task without receiving any instructions regarding the sound. In Experiment 1, the sound was affectively neutral, while in Experiment 2 participants were presented with an inherently aversive (tinnitus-like) sound. After this initial phase, participants performed tasks measuring vigilance and attention, and were also asked to give subjective ratings of the sounds on a number of affective dimensions and loudness.

Results

In Experiment 1, participants in the suppression condition showed faster response times on both a visual search task and an auditory spatial cueing task, as compared to participants in the control condition. Contrary to our predictions, participants in the suppression condition did not rate the distractor sound as louder than participants in the control condition, and there were no differences on affective dimensions. In Experiment 2, results revealed that participants in the suppression condition made more errors on a visual search task, specifically on trials where the previously suppressed sound was presented. In contrast to results from Experiment 1, participants in the suppression condition also rated the targeted sound as louder.

Conclusions

The findings provide preliminary support for a post-suppression rebound effect in the auditory domain and further suggest that this effect may be moderated by the emotional properties of the auditory stimulus.

Mindfulness-Based Cognitive Therapy for Chronic Tinnitus: Evaluation of Benefits in a Large Sample of Patients Attending a Tinnitus Clinic

OBJECTIVES

Mindfulness-based approaches may benefit patients with chronic tinnitus, but most evidence is from small studies of nonstandardized interventions, and there is little exploration of the processes of change. This study describes the impact of mindfulness-based cognitive therapy (MBCT) in a "real world" tinnitus clinic, using standardized MBCT on the largest sample of patients with chronic tinnitus to date while exploring predictors of change.

DESIGN

Participants were 182 adults with chronic and distressing tinnitus who completed an 8-week MBCT group. Measures of tinnitus-related distress, psychological distress, tinnitus acceptance, and mindfulness were taken preintervention, postintervention, and at 6-week follow-up.

RESULTS

MBCT was associated with significant improvements on all outcome measures. Postintervention, reliable improvements were detected in tinnitus-related distress in 50% and in psychological distress in 41.2% of patients. Changes in mindfulness and tinnitus acceptance explained unique variance in tinnitus-related and psychological distress postintervention.

CONCLUSIONS

MBCT was associated with significant and reliable improvements in patients with chronic, distressing tinnitus. Changes were associated with increases in tinnitus acceptance and dispositional mindfulness. This study doubles the combined sample size of all previously published studies. Randomized controlled trials of standardized MBCT protocols are now required to test whether MBCT might offer a new and effective treatment for chronic tinnitus.

Altered inhibitory control and increased sensitivity to cross-modal interference in tinnitus during auditory and visual tasks

Tinnitus is the perception of sound in the absence of external stimulus. Currently, the pathophysiology of tinnitus is not fully understood, but recent studies indicate that alterations in the brain involve non-auditory areas, including the prefrontal cortex. In experiment 1, we used a go/no-go paradigm to evaluate the target detection speed and the inhibitory control in tinnitus participants (TP) and control subjects (CS), both in unimodal and bimodal conditions in the auditory and visual modalities. We also tested whether the sound frequency used for target and distractors affected the performance. We observed that TP were slower and made more false alarms than CS in all unimodal auditory conditions. TP were also slower than CS in the bimodal conditions. In addition, when comparing the response times in bimodal and auditory unimodal conditions, the expected gain in bimodal conditions was present in CS, but not in TP when tinnitus-matched frequency sounds were used as targets. In experiment 2, we tested the sensitivity to cross-modal interference in TP during auditory and visual go/no-go tasks where each stimulus was preceded by an irrelevant pre-stimulus in the untested modality (e.g. high frequency auditory pre-stimulus in visual no/no-go condition). We observed that TP had longer response times than CS and made more false alarms in all conditions. In addition, the highest false alarm rate occurred in TP when tinnitus-matched/high frequency sounds were used as pre-stimulus. We conclude that the inhibitory control is altered in TP and that TP are abnormally sensitive to cross-modal interference, reflecting difficulties to ignore irrelevant stimuli. The fact that the strongest interference effect was caused by tinnitus-like auditory stimulation is consistent with the hypothesis according to which such stimulations generate emotional responses that affect cognitive processing in TP. We postulate that executive functions deficits play a key-role in the perception and maintenance of tinnitus.

Does a brief state mindfulness induction moderate disgust-driven social avoidance and decision-making? An experimental investigation

In this experimental study, we evaluated whether manipulated disgust and mindfulness predicted social avoidance in bowel health contexts. Community participants (n = 101) were randomised to conditions in which disgust and/or state mindfulness were experimentally induced. Tasks assessing social avoidance and perceptions of available social networks in the context of bowel/health problems were conducted. Manipulation checks confirmed the elicitation of disgust and state mindfulness in the applicable conditions. As expected, persons in the disgust condition were more likely to exhibit immediate social avoidance (rejecting a glass of water). State disgust predicted greater socially avoidant decision-making, less decisional conflict, and smaller social network maps. State mindfulness predicted fewer names on inner network circles and amplified the effect of disgust on creating smaller social network maps. This report furthers understanding of disgust and avoidance in bowel health contexts, and suggests the need for caution in mindfulness interventions that raise awareness of emotion without also providing skills in emotional regulation.