The Experience of Tinnitus and Its Interaction With Unique Life Histories-Life Events, Trauma and Inner Resources Narrated by Patients With Tinnitus

Stressful life events and tinnitus : Reflections and speculations

The role of life events has not been extensively studied in the context of tinnitus. There is, however, evidence about the psychological impact of tinnitus and about the influence of psychological processes as mediators of the tinnitus experience. On the basis of this evidence, the possibility that stressful life events can act as a trigger for tinnitus is discussed; although the evidence is fragmentary and indirect, the possibility cannot be discounted. It is argued that the onset of tinnitus and the associated clinical encounters can constitute an acute stressful life event, and the ongoing experience of tinnitus can be regarded as a chronic stressful life event. Interactions between ongoing tinnitus and other life events are discussed. Possible mechanisms in terms of stress influencing predictive processing and signal detection judgments are considered.

[Chronic tinnitus: An interplay between somatic and psychological factors]

Chronic tinnitus is a common, sometimes highly distressing phenomenon that can be triggered and maintained by an interplay of physical and psychological factors. Partnering with clinical psychology and psychosomatic medicine, modern otolaryngology integrates both medical (e.g., hearing loss) and psychological influences (e.g., interactions between biographical experiences, personality traits, subjective evaluation of intrapsychic and interpersonal stimuli, emotional states, and intrapsychic or interpersonal emotion regulation strategies). Both groups of variables can influence the intensity and course of chronic tinnitus symptomatology both directly and indirectly, whereby the quality and relative degrees of psychological and physical components in a person's self-experience can fluctuate. With this in mind, the present article distinguishes between chronic tinnitus symptomatology with or without hearing loss-and strongly advocates for an integrated understanding of the symptomatology within a holistic psychological frame of reference. After a brief introduction to the principles of psychosomatic medicine and psychotherapy, the article discusses psychological case conceptualization using a vulnerability-stress-coping (VSC) model as an example, outlines clinical aspects and diagnostics of chronic tinnitus symptomatology, and concludes with a conceptualization of chronic tinnitus-related distress as a function of person-centered VSC interactions.

Do you Hear what I Hear? A Qualitative Study Examining Psychological Associations Underlying Evaluations of Everyday Sounds in Patients with Chronic Tinnitus

Tinnitus is a multifactorial phenomenon and psychological, audiological, or medical factors can facilitate its onset or maintenance. A growing body of research investigates individuals' perceptions, associations, and experiences of living with tinnitus. This body of research examines tinnitus as a condition rather than a symptom. We examine a sample of chronic tinnitus patients in terms of associations that are induced by neutral sounds. In particular, we investigate how patients with chronic tinnitus ascribe meaning to those neutral sounds. The present study uses Mayring's content analysis to explore the content of psychological associations underlying valence ratings of everyday neutral sounds. Nine tinnitus patients completed a hearing exercise, during which they listened to seven neutral sounds, following which we examined their sound-induced associations using semi-structured interviews. Three groups of factors influenced patients' associations and valence ratings of neutral sounds: affect, episodic memory, and 'other'. The former two factors further comprised two subcategories. In line with previous psychoaudiological research designs, our findings suggest that neutral, everyday auditory stimuli evoke strong affective reactions-possibly through serving as retrieval cues for episodic memories. Based on these findings, we discuss our results in the context of previous psychoaudiological findings and propose further research concerning psychological associations that may specifically underlie the tinnitus sound.

What is the burden of tinnitus?

Introduction

Tinnitus is a complex experience that often occurs alongside other health conditions, including hearing loss. In the UK, as in other western countries, patterns of health are changing with a rise in multi-morbidity and complexity of health conditions. As we age, we can expect to live with multiple health conditions. Burden of illness has long been recognised. Less well recognised is the burden that accumulates from the treatment of health conditions.

Methods

This qualitative thematic analysis of patient accounts described the cumulative burdens of tinnitus, both the experience of hearing the tinnitus and from the treatments undertaken. Between 2017-8 we conducted interviews with 38 participants who were help-seekers in a range of contrasting UK clinical services (Physician led, Audiology led and Hearing Therapy led). We examined these interview data using reflexive thematic analysis methods to identify and explore the cumulative burdens for those who live with and seek help for their tinnitus. Specifically, we used six phased approach to determine and group themes.

Results

The themes provide a coherent description of the nature of the burden that people with tinnitus experience.

Discussion

In tinnitus, as with most chronic health conditions, the largest treatment workload is devolved to the patient. Patients are required to implement treatments, learn about tinnitus and find new ways of coping. Yet this work happens invisibly, without recognition from clinicians who measure outcomes but not the efforts made to achieve outcomes. Patient-centred care depends upon the recognition of the cumulative burdens that patients experience.

Towards a psychological framework on time perception in patients with chronic tinnitus

Although disabling tinnitus is a chronic auditory phantom sensation, current knowledge on time perception (i.e., subjective time) in sufferers is limited and unsystematic. This theoretical analysis provides a first approach to this topic, highlighting the heterogeneity of time perception in humans as shown in various research areas. This heterogeneity is inherently related to goal attainment. Our immediate perception of time is restricted to present moment and recent past, whereas our sense of time is mostly future-oriented and represented as our past in a mental time line. The heterogeneity of time translates into a tension between anticipated changes one wants to see happen and full commitment that is required to goal attainment. Tinnitus sufferers are intensely aware of this tension in their self-perception. Their most compelling desire is that they no longer perceive tinnitus, but they get closer to this goal only by avoiding to put all their thoughts into it. Our analysis provides new perspectives on acceptance of tinnitus in relation to this time paradox. Building on the Tolerance model and the role of self-awareness in time perception, we contend that the main way for patients to gain long-term self-confidence is to engage in the present moment. Attention to this attitude is obscured in chronic sufferers by worries and ruminations associated with the ongoing presence of tinnitus. We provide arguments that time perception is a social perception, emphasizing the role of rewarding interactions in helping sufferers to overcome the feeling of being prevented from living in the moment. In the course of improvement towards acceptance, different changes in time perception are hypothesized that promote individuals' disengagement from unattainable goal (i.e., tinnitus suppression). A framework for future research is proposed, which distinguishes individuals' behaviors and associated emotions in relation to the time paradox.

Two birds with one stone.-Addressing depressive symptoms, emotional tension and worry improves tinnitus-related distress and affective pain perceptions in patients with chronic tinnitus

BACKGROUND

Psychological factors link the co-occurrence of tinnitus-related distress and pain perceptions in patients with chronic tinnitus.

OBJECTIVE

This study examines, if treatment-related changes in these factors ameliorate both tinnitus-related distress and pain perceptions in a sample of patients with chronic tinnitus.

METHODS

N = 1238 patients with chronic tinnitus provided pre- and post-treatment ratings of tinnitus-related distress and affective or sensory pain perceptions alongside measures of depressive symptoms and perceived stress. Treatment comprised an intensive tinnitus-specific multimodal treatment program. Using serial indirect-effects analyses, we examined association patterns between baseline values and change rates of those variables that were found to respond to treatment.

RESULTS

Small effect sizes emerged for changes in tinnitus-related distress, affective (but not sensory) pain perceptions, depressive symptoms, emotional tension and worry. At pre- or post-treatment respectively, baseline values and change rates intercorrelated. Across timepoints, (1) baseline tinnitus-related distress and affective pain perceptions were positively associated with improvements in tinnitus-related distress, affective pain perceptions and depressive symptoms. (2) Baseline depressive symptoms or emotional tension mediated positive associations between baseline tinnitus-related distress and improvement in affective pain perceptions. (3) Change in depressive symptoms mediated the effect of baseline tinnitus-related distress on change in affective pain perceptions-partly through associated change in emotional tension or worry. Mood-independent aspects of emotional tension were negatively associated with improvement in affective pain perceptions.

CONCLUSIONS

Depressive symptoms, emotional tension and worry emerge as key predictors of treatment response and transdiagnostic treatment targets for alleviating tinnitus-related distress and functionally associated affective pain perceptions.

An Empowerment Model for Individuals with Chronic Tinnitus

OBJECTIVE

This qualitative study sought to construct a model of empowerment for clinical implementation, based on the first-hand experience of a sample of individuals with chronic tinnitus.

DESIGN

The study was conducted in accordance with the inductive approach to data in classic grounded theory (GT). GT aims to build a model of behavior that accounts for the main concern of individuals and how they strive to resolve it. Twenty-one participants with chronic tinnitus (10 females, 11 males, age 31-85, mean: 57.6 years, mean duration of tinnitus: 12 years) were recruited through the patient association France Acouphènes and ENT consultations. Open-ended, tape-recorded interviews addressed the variation in the intrusiveness of tinnitus in daily life. A constant comparison analysis was undertaken to identify a core category and to distinguish stages in behavioral changes toward the tolerance of tinnitus.

RESULTS

Participants' main concern was to limit the intrusiveness of tinnitus day in, day out. They continuously had to handle tinnitus-induced frustration, which was found to be the core category of the analysis accounting for how all the participants tried to deal with the condition. The more they managed to handle their frustration, the better they coped with the condition. Three behavior patterns were identified as facilitating the ongoing management of tinnitus-induced frustration: (1) searching for perspective upon tinnitus; (2) maintaining order in perception despite its interference; and (3) alleviating conflict arising from social interactions. A model of empowerment is presented that is based on four stages toward tolerance of tinnitus. They are dominated by lack of perspective upon tinnitus (circuit 1), preservation of energy through attempts to control its intrusiveness (circuit 2), attempts to detach oneself from the interference of tinnitus through constant activities (circuit 3), and self-induced relief through the fulfillment of meaningful goals (circuit 4).

CONCLUSION

Tolerance of tinnitus requires finding balance between limiting one's social participation and spontaneity in carrying out meaningful activities. Tolerance can be enhanced by the preservation of one's energy and the mediating role of enjoyment through the fulfillment of gratifying goals. In patient counseling, it is essential to address the individual's desire for direct relief from tinnitus through its elimination. Individuals should be made aware that such a desire will likely be thwarted, resulting in the worsening of intrusiveness. Improvement in tolerance is accompanied by the attenuation of niggling self-awareness, a change that is typical of full commitment with valued goals and that helps in alleviating the interference of tinnitus. By understanding the role of frustration, individuals may develop a sense of responsibility in dealing with disabling tinnitus.

The Tinnitus Retraining Therapy Trial's Standard of Care Control Condition: Rationale and Description of a Patient-Centered Protocol

Purpose The selection and design of control conditions are critical factors in minimizing the influence of unwanted variables in randomized controlled trials (RCTs). This article describes the rationale, design, and content of a standard of care control condition in a Phase III RCT of tinnitus retraining therapy. Method Existing tinnitus practices at military hospitals were identified and aligned with the American Speech-Language-Hearing Association's (2006) preferred practice patterns for tinnitus management and counseling and embedded in a patient-centered protocol to ensure uniformity and treatment fidelity. Results For those involved in the design of behavioral RCTs, the article identifies options and methods to consider in the selection and design of control conditions. Conclusion For those who provide tinnitus services, the standard of care protocol developed for the tinnitus retraining therapy trial constitutes a patient-centered approach to intervention that can be implemented clinically. Supplemental Material https://doi.org/10.23641/asha.9342503.