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Consequences of Controlling Background Sounds: The Effect of Experiential Avoidance on Tinnitus Interference
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Uppsala University, Department Psychol, Uppsala, Sweden .
Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0003-4753-6745
2009 (English)In: REHABILITATION PSYCHOLOGY, ISSN 0090-5550, Vol. 54, no 4, 381-389 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Masking by the use of sounds has been one of the most commonly applied means of coping with tinnitus. The ability to control auditory stimulation represents a potentially important process involved in tinnitus masking strategies. Little is, however, known about the consequences of control on tinnitus experience. The present study investigated the effects of control of background sounds (type and loudness) on perceived intrusiveness of tinnitus and cognitive performance. Design: Using an experimental design with a series of trials, participants with clinically significant tinnitus (N = 35) were randomly assigned to I of 2 experimental manipulation conditions (control of sounds vs. no control of sounds). Measures: Self-reported tinnitus interference and the Digit-Symbol subtest served as dependent measures. Results: Latent growth curve modeling showed that individuals assigned to the condition with control exhibited faster growth rates on tinnitus interference (increased interference) and demonstrated slower rates of improvement on cognitive performance measures over trials compared to individuals assigned to the condition with no control. Conclusion: These results suggest that efforts to control tinnitus through sounds can be associated with increased disability in individuals with tinnitus.

Place, publisher, year, edition, pages
2009. Vol. 54, no 4, 381-389 p.
Keyword [en]
tinnitus, control, tinnitus interference, cognitive functioning, experiential avoidance
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-52818DOI: 10.1037/a0017565OAI: oai:DiVA.org:liu-52818DiVA: diva2:285590
Available from: 2010-01-12 Created: 2010-01-12 Last updated: 2014-11-28
In thesis
1. Tinnitus in Context: A Contemporary Contextual Behavioral Approach
Open this publication in new window or tab >>Tinnitus in Context: A Contemporary Contextual Behavioral Approach
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tinnitus is the experience of sounds in the ears without any external auditory source and is a common, debilitating, chronic symptom for which we have yet to develop sufficiently efficacious interventions. Cognitive behavioral therapy (CBT) has evolved over the last 20 years to become the most empirically supported treatment for treating the adverse effects of tinnitus. Nevertheless, a significant proportion of individuals do not benefit from CBT-based treatments. In addition, the theoretical underpinnings of the CBT-model are poorly developed, the relative efficacy of isolated procedures has not yet been demonstrated, and the mechanisms of therapeutic change are largely unknown. These significant limitations preclude scientific progression and, as a consequence, leave many individuals with tinnitus suffering.

To address some of these issues, a contextual multi-method, principle-focused inductive scientific strategy, based on pragmatic philosophy, was employed in the present thesis project. The overarching aim of the thesis was to explore the utility of a functional dimensional process in tinnitus: Experiential avoidance—experiential openness/acceptance (EA). EA is defined as the inclination to avoid or alter the frequency, duration, or intensity of unwanted internal sensations, including thoughts, feelings or physical sensations. The thesis is based on experimental work (Study II, VI), process and mediation studies (Study I, III, V), and on randomized controlled trials (Study III, IV).

Three main sets of findings supported the utility of EA in tinnitus. First, an acceptance-based treatment (i.e.,Acceptance and Commitment Therapy, ACT) was found to be effective in controlled trials. Study III demonstrated that face-to-face ACT was more effective than a wait-list control and a habituation-based sound therapy. Study IV showed that internet-delivered ACT was more effective than an active control condition (internet-discussion forum) and equally effective as an established internet-delivered CBT treatment. Second, processes research (Study I, III, V) showed that key postulated processes of change were linked to the specific technology of ACT and that these changes in processes were associated with therapeutic outcomes. Specifically, Study V found evidence to that decreases in suppression of thoughts and feelings over the course of treatment were uniquely associated with therapeutic gains in ACT as compared with CBT. Third, experimental manipulations of experiential avoidance and acceptance processes provided support to the underlying dimension (Study II, VI). That is, Study II, employing an experimental manipulation, found that controlling background sounds were associated with reduced cognitive efficiency and increased tinnitus interference over repeated experimental trials. In addition, in normal hearing participants, experimentally induced mindfulness counteracted reduced persistence in a mentally challenging task in the presence of a tinnitus-like sound stemming from initial effortful suppression of the same sound (Study VI). It is concluded that a principle-, contextual-focused approach to treatment development may represent an efficient strategy for scientific progression in the field of psychological treatments of tinnitus severity.

Abstract [sv]

Tinnitus är upplevelsen av ljud i frånvaro av en extern ljudkälla och är ett vanligt, långvarigt och svårbehandlat hälsotillstånd. Kognitiv beteendeterapi (KBT) har det starkaste forskningsstödet för att behandla de negativa konsekvenserna av tinnitus. Detta till trots svarar inte en stor andel på KBT-baserade behandlingar för tinnitus. Behandlingsutvecklingen av KBT försvåras som konsekvens av att teorier som behandlingen vilar på är dåligt utvecklade, effekten av isolerade tekniker har inte bevisats, och att förändringsmekanismer är till största del okända.

Föreliggande avhandling avsåg att adressera några av ovanstående problem genom att tillämpa en induktiv, flermetod, principstyrd vetenskaplig strategi baserad på pragmatisk kontextuell filosofi. Det övergripande syftet med avhandlingen var att undersöka användbarheten i en funktionell processdimension vid tinnitus: upplevelsemässigt undvikande—upplevelsemässig acceptans (EA). EA definieras som benägenheten att undvika eller förändra frekvensen, durationen eller intensiteten av icke-önskade inre sensationer som tankar, känslor och fysiologiska sensationer. Avhandlingen är baserad på experimentella studier (Studie II, VI), process och mediationsstudier (Studie I, III, V) och randomiserade kontrollerade studier (Studie III, IV).

Tre övergripande fynd bekräftade användbarheten av EA vid tinnitus. För det första kunde det påvisas i randomiserade, kontrollerade studier att en acceptans-baserad behandling (Acceptance and Commitment Therapy, ACT) hade effekt på tinnitusbesvär. Studie III fann stöd för att ACT var mer effektiv än en väntelistekontroll och en habitueringsfokuserad ljudterapi. Studie IV fann stöd för att internet-förmedlad ACT var mer effektiv än en aktiv kontrollbetingelse (internet-diskussionsforum) och lika effektiv som en etablerad internet-förmedlad KBT-behandling. För det andra kunde processforskning (Studie I, III, V) påvisa att teoretiskt viktiga processer var relaterade till specifika tekniker i ACT och att dessa processer var i sin tur associerade med behandlingsutfall. Exempelvis kunde Studie V styrka att minskning i individers benägenhet att tränga undan tankar och känslor i relation till tinnitus var unikt associerat med behandlingsutfall i ACT i jämfört med KBT. För det tredje påvisade experimentella manipulationer av acceptans- och undvikande-processer användbarheten av EA (Studie II, VI). Studie II fann stöd för att kontroll över maskeringsljud var associerad med minskad kognitiv prestationsförmåga och ökade besvära av tinnitus över upprepade experimentella manipulationer i jämfört med att inte ha kontroll över maskeringsljudet. Slutligen visade Studie VI att bland normalhörande kunde experimentellt inducerad mindfulness motverka minskad förmåga att hålla ut i en mentalt krävande uppgift i närvaro av ett tinnitusliknande ljud till följd av initial suppression av samma ljud. Den övergripande konklusionen av vetenskapliga arbeten som sammanfattas i avhandlingen var att en principstyrd och kontextuell vetenskaplig strategi kan vara en framkomlig väg för att utveckla psykologiska behandlingar för tinnitusbesvär.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 106 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 570Studies from the Swedish Institute for Disability Research, ISSN 1650-1128 ; 45
Keyword
Tinnitus, acceptance, cognitive behavioral therapy, experiential avoidance, acceptance and commitment therapy
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-88416 (URN)978-91-7519-701-2 (ISBN)
Public defence
2013-03-15, I:101, Hus I, Campus Valla, Linköping University, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2013-02-15 Created: 2013-02-05 Last updated: 2014-11-28Bibliographically approved

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