No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Illness Representations, Acceptance, Coping and Psychological Distress in Chronic Tinnitus
Abstract
Thesis submitted for the degree of Doctor of Clinival Psychology at the University of. Awarded 2007. Tinnitus is a prevalent condition which is associated with significant distress and disability in a substantial proportion of the population. The variance in distress is not adequately explained by audiological characteristics of the symptom and it has been widely accepted that other variables are influential in determining the relationship between the stimulus and distress. A review of the literature highlights significant relationships between many psychosocial variables and tinnitus severity (impact on life). However, conclusions based on existing research are limited due to methodological weaknesses and widespread neglect of coherent theoretical foundations. The review identifies a need for further research with comprehensive theoretical underpinning to provide a greater understanding of adaptation to chronic tinnitus. One theoretical framework which has been applied extensively to explore the process of adaptation to chronic conditions is Leventhal's Self Regulation Model (SRM). This model has not yet been applied to the study of chronic tinnitus with sufficient methodological rigour to draw firm conclusions on its utility for this patient group. Existing research on tinnitus suggests that coping efforts (integral to the SRM) are often associated with increased distress with the notable exception of strategies indicative of acceptance. Recent research into chronic pain has indicated a role for acceptance in predicting adaptation, however it has not been investigated in the context of tinnitus to date. Therefore, research was undertaken to investigate the relationships between cognitive illness representations, coping, acceptance and psychological distress in patients with chronic tinnitus. The findings suggest that cognitive illness representations predict variance in psychological distress and that coping and acceptance variables enhance the explanatory power of the models. The clinical implications of the findings and the limitations of the study are discussed. Finally, an account of the process of undertaking the research and reflections on this experience is presented.
... Apart from this issue, the expectation of certain coping strategies might have had a minor influence on which strategies participants actually used (because this is likely to be more dependent on what is suggested by the treatment). In the literature there are suggestions that predominantly acceptance-based coping is associated with lower tinnitus distress (Moreland, 2007), while other coping strategies do not lead to the intended outcome . One problem with the regulation approach could be that attempts to control the tinnitus might hinder acceptance of and habituation to the noise (Moreland, 2007). ...
... In the literature there are suggestions that predominantly acceptance-based coping is associated with lower tinnitus distress (Moreland, 2007), while other coping strategies do not lead to the intended outcome . One problem with the regulation approach could be that attempts to control the tinnitus might hinder acceptance of and habituation to the noise (Moreland, 2007). ...
... Our results provide some evidence that it is beneficial to focus on these consequences of the tinnitus, rather than on the tinnitus itself. This is in line with the idea that it is not the tinnitus itself that bothers affected persons, but the perceived consequences and related fears of what the tinnitus might be a sign of (Dobie, 2004;Moreland, 2007). Similarly, it is also consistent with the suggestion that it is only beneficial to control things that can be controlled . ...
Background: Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs.
Aims: Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes.
Method: 112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs.
Results: Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up.
Conclusion: There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results.
... Auszüge davon für das Störungsbild chronischer Tinnitus adaptiert [ 27 ] . Analog zu einer englischsprachigen Version des CPAQ von Moreland [ 28 ] wurde in Innsbruck eine deutschsprachige Adaptierung des CPAQ für Tinnituspatienten (Akzeptanzfragebogen für chronischen Tinnitus -AFCT) [ 29 ] vorgenommen, dessen Validierung nun hier vorliegt. Für ein weiteres Instrument namens TAQ (Tinnitus Acceptance Questionnaire) [ 16 ] wurde kürzlich eine Validierung vorgelegt [ 24 ] . ...
... Der Faktor "Tinnitusbereitschaft" erhebt das Ausmaß der Bereitschaft der Patienten zu erkennen, dass Versuche, den Tinnitus zu kontrollieren, häufi g wirkungslos sind und eine Orientierung auf andere Lebensbereiche sinnvoller ist [ 30 ] . Moreland [ 28 ] konnte für die Adaption des englischen CPAQ (das Wort "pain" wurde durch "tinnitus" ersetzt) für die Gesamtskala ein Cronbach Alpha = 0,902 und für die Subskala "CTAQ engagement" ein Cronbach Alpha = 0,875 bzw. für "CTAQ willingness" ein Cronbach Alpha = 0,848 erheben. ...
... Die Ergebnisse stehen in Übereinstimmung mit Nicholas & Asghari [ 36 ] , die in ihrer Studie zum CPAQ die Subskala "Schmerzbereitschaft" als nicht stabil bezeichneten und deren Ausschluss empfohlen hatten. Da Moreland [ 28 ] in ihrer englischsprachigen Adaption des CPAQ für Tinnitus aufgrund ihrer Ergebnisse gegen den Ausschluss der Subskala "Tinnitusbereitschaft" argumentierte, wurde die Subskala in unserer Untersuchung beibehalten. [ 16 ] auf. ...
... Auszüge davon für das Störungsbild chronischer Tinnitus adaptiert [ 27 ] . Analog zu einer englischsprachigen Version des CPAQ von Moreland [ 28 ] wurde in Innsbruck eine deutschsprachige Adaptierung des CPAQ für Tinnituspatienten (Akzeptanzfragebogen für chronischen Tinnitus -AFCT) [ 29 ] vorgenommen, dessen Validierung nun hier vorliegt. Für ein weiteres Instrument namens TAQ (Tinnitus Acceptance Questionnaire) [ 16 ] wurde kürzlich eine Validierung vorgelegt [ 24 ] . ...
... Der Faktor "Tinnitusbereitschaft" erhebt das Ausmaß der Bereitschaft der Patienten zu erkennen, dass Versuche, den Tinnitus zu kontrollieren, häufi g wirkungslos sind und eine Orientierung auf andere Lebensbereiche sinnvoller ist [ 30 ] . Moreland [ 28 ] konnte für die Adaption des englischen CPAQ (das Wort "pain" wurde durch "tinnitus" ersetzt) für die Gesamtskala ein Cronbach Alpha = 0,902 und für die Subskala "CTAQ engagement" ein Cronbach Alpha = 0,875 bzw. für "CTAQ willingness" ein Cronbach Alpha = 0,848 erheben. ...
... Die Ergebnisse stehen in Übereinstimmung mit Nicholas & Asghari [ 36 ] , die in ihrer Studie zum CPAQ die Subskala "Schmerzbereitschaft" als nicht stabil bezeichneten und deren Ausschluss empfohlen hatten. Da Moreland [ 28 ] in ihrer englischsprachigen Adaption des CPAQ für Tinnitus aufgrund ihrer Ergebnisse gegen den Ausschluss der Subskala "Tinnitusbereitschaft" argumentierte, wurde die Subskala in unserer Untersuchung beibehalten. [ 16 ] auf. ...
Background:
Tinnitus is a widely spread symptom, which is perceived chronically by approximately 10% of the population. The vast majority of the tinnitus patients doesn´t feel impaired through the ear noise, but about 5-30% of the tinnitus patient are suffering in their everyday life. Whether severe distress is experienced cannot be explained by the quality of the ear noise itself (i. e. loudness or duration). Newer research tends to explain the difference in the experienced strain by the concept of acceptance. The aim of this study was to analyze the psychometric quality of a German Version of the "Chronic Pain Acceptance Ques-tionnaire" (CPAQ), namely the "Akzeptanzfragebogen bei chronischem Tinnitus" (AFCT) which has been adapted for tinnitus.
Methods:
97 patients with chronic tinnitus have been tested at the start of an outpatient tinnitus group therapy. The following questionnaires were used: "Akzeptanzfragebogen bei chronischem Tinnitus" (AFCT) and "Tinnitusfragebogen" (TF). The structure of the AFCT was determined by a factor analysis. The reliability was evaluated by the estimation of the internal consistency (Cronbach Alpha).
Results:
Due to psychometric weakness and unclear factorial loadings 8 items have been removed. Out of the remaining 12 items the AFCT-12 has been developed. The AFCT-12 consists of 2 factors, which explain a variance of 54.9%. Both AFCT-12 and AFCT have a satisfactory reliability and validity.
Conclusion:
The results demonstrate that the AFCT-12 is a reliable and valid instrument to measure the acceptance of patients suffering from chronic tinnitus.
... The results related to the benefit of avoidant coping show opposite to regular understanding of this coping style as maladaptive. Though, it is debated that due to the nature of condition and the aim of acclimatizing to the stimulus, it is not surprising that this coping technique would be effective for tinnitus patients (Moreland, 2007). ...
... Further a repeated factor analysis in a study has emphasized on two different coping styles in use by tinnitus patients known as "Avoidant Coping" and "Positive coping". Use of active and positive coping strategies were associated with lower levels of perceived handicap, whilst maladaptive behavior and escape coping or avoidant coping were associated with increased perceptions of handicap (Moreland, 2007;Sullivan et al., 1994). ...
... 24 Tinnitus Experience Questionnaire (Carol Bauer, 2006). 25 Chronic Tinnitus Acceptance Questionnaire (Jessica Moreland, 2007). 26 Tinnitus Acceptance Questionnaire (Vendela Westin, 2008). ...
... 25 Chronic Tinnitus Acceptance Questionnaire (Jessica Moreland, 2007). 26 Tinnitus Acceptance Questionnaire (Vendela Westin, 2008). 27 Fear of Tinnitus Questionnaire (Rilana Cima, 2011). ...
Introduction
Over 70 million people in Europe and >50 million people in the USA are reported to experience tinnitus (the sensation of noise in the absence of any corresponding sound source). Tinnitus is a multidimensional concept. Individual patients may report different profiles of tinnitus-related symptoms which may each require a tailored management approach and an appropriate measure of therapeutic benefit. This systematic review concerns the patient perspective and has the purpose to find what symptoms are reported by people who experience tinnitus and by their significant others.
Methods and analysis
This protocol lays out the methodology to define what dimensions of tinnitus-related symptoms patients and their significant others report as being a problem. Methods are defined according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 and data will be collated in a narrative synthesis. Findings will contribute to the eventual establishment of a Core Domain Set for clinical trials of tinnitus.
Ethics and dissemination
No ethical issues are foreseen. Findings will be reported at national and international ENT and audiology conferences and in a peer-reviewed journal.
Trial registration number
CRD42015020629.
... In the treatment of chronic pain, acceptance oriented instruments such as the "Chronic Pain Acceptance Questionnaire" (CPAQ) [24] have already been developed and validated. Due to the similarities often described between pain and tinnitus, [19,25] CPAQ has been adapted for tinnitus in English [26] as well as German. [27] The German version of this adaptation -The "Chronic Tinnitus Acceptance Questionnaire" (CTAQ-G) was recently validated in a clinical sample. ...
Recent findings show the importance of acceptance in the treatment of chronic tinnitus. So far, very limited research investigating the different levels of tinnitus acceptance has been conducted. The aim of this study was to investigate the quality of life (QoL) and psychological distress in patients with chronic tinnitus who reported different levels of tinnitus acceptance. The sample consisted of outpatients taking part in a tinnitus coping group (n = 97). Correlations between tinnitus acceptance, psychological distress, and QoL were calculated. Receiver operating characteristic (ROC) curves were used to calculate a cutoff score for the German "Tinnitus Acceptance Questionnaire" (CTAQ-G) and to evaluate the screening abilities of the CTAQ-G. Independent sample t-tests were conducted to compare QoL and psychological distress in patients with low tinnitus acceptance and high tinnitus acceptance. A cutoff point for CTAQ-G of 62.5 was defined, differentiating between patients with "low-to-mild tinnitus acceptance" and "moderate-to-high tinnitus acceptance." Patients with higher levels of tinnitus acceptance reported a significantly higher QoL and lower psychological distress. Tinnitus acceptance plays an important role for patients with chronic tinnitus. Increased levels of acceptance are related to better QoL and less psychological distress.
Objective: Chronic tinnitus is effectively treated through cognitive-behavioral therapy (CBT). Both group and individual CBT for tinnitus are effective, but no study has directly compared the two. The current study explores group versus individual CBT for tinnitus. Design: A multiple-baseline single-case experimental design was employed to observe changes within/between individual and group treatments. Six participants started a 10-week CBT protocol and were equally divided into individual or group treatment. Participants were exchanged between treatments at random time points. Diary data included 14 variables on tinnitus experience (e.g. annoyance and distraction) and wellbeing (e.g. happiness and stress). Five male participants (59-to 67-year-old) completed treatment. Results: Randomization tests comparing means between individual and group treatments did not reveal significant differences. Analysis of data overlap and trend (Tau-U) revealed minor significant improvements for seven variables (50%) in group treatment as compared to individual treatment. Diminished happiness and activity levels were observed in participants who went from group to individual treatment. Conclusions: Low effect sizes and homogeneity of sample restrict the generalizability of data. Group CBT indicated potential benefits when compared to individual CBT. Social learning may be an underlying process in group delivery boosting tinnitus recovery. Findings are limited to male patients with chronic disabling tinnitus.
Objective:
Chronic tinnitus is effectively treated through cognitive-behavioral therapy (CBT). Both group and individual CBT for tinnitus are effective, but no study has directly compared the two. The current study explores group versus individual CBT for tinnitus.
Design:
A multiple-baseline single-case experimental design was employed to observe changes within/between individual and group treatments. Six participants started a 10-week CBT protocol and were equally divided into individual or group treatment. Participants were exchanged between treatments at random time points. Diary data included 14 variables on tinnitus experience (e.g. annoyance and distraction) and wellbeing (e.g. happiness and stress). Five male participants (59- to 67-year-old) completed treatment.
Results:
Randomization tests comparing means between individual and group treatments did not reveal significant differences. Analysis of data overlap and trend (Tau-U) revealed minor significant improvements for seven variables (50%) in group treatment as compared to individual treatment. Diminished happiness and activity levels were observed in participants who went from group to individual treatment.
Conclusions:
Low effect sizes and homogeneity of sample restrict the generalizability of data. Group CBT indicated potential benefits when compared to individual CBT. Social learning may be an underlying process in group delivery boosting tinnitus recovery. Findings are limited to male patients with chronic disabling tinnitus.
ResearchGate has not been able to resolve any references for this publication.