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Tinnitus – an acceptance-based approach
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tinnitus is a highly prevalent health condition creating moderate or severe interference on mood, sleep and daily functioning for a group of those affected. The aims of this thesis were 1) to explore the role of acceptance and psychological flexibility in understanding tinnitus interference both experimentally and with a longitudinal design 2) to evaluate the immediate and long-term outcomes of an acceptance based behaviour therapy (Acceptance and Commitment Therapy; ACT) in the treatment of people with tinnitus and, 3) to investigate the relationship between treatment outcome and processes assumed to be the active ingredients of treatment (acceptance and cognitive defusion).

Study I (n=47) was an experiment comparing the impact of acceptance to that of thought suppression or a neutral instruction on the ability to maintain attention on an imagery task. Results indicated that participants could benefit from an acceptance strategy when performing the task. Study II (n=47) was a longitudinal trial studying the mediating role of acceptance on the relationship between tinnitus interference at baseline and tinnitus interference, anxiety, life quality, and depression at a seven-month follow-up. Full mediation was found for life quality and depression, and partial mediation for tinnitus interference. Study IV (n=64) was a randomised controlled trial evaluating the immediate and long-term effects of ACT in comparison to those of Tinnitus Retraining Therapy (TRT) and to a wait list control. Results showed that ACT had large immediate effects on tinnitus interference in comparison to wait list, and medium long-term effects in comparison to TRT. Results were also seen on secondary outcome. Self-reported tinnitus acceptance significantly mediated the immediate outcome of ACT. Study III (n=24) was a process study where the video recorded sessions of ACT from study IV were observed and rated with regard to client behaviour. Results showed that in-session acceptance and defusion behaviours rated early in therapy were predictors of sustained positive treatment effects of ACT. These associations continued to be substantial even when controlling for the prior improvement in outcome. This whereas prior symptom change could not predict process variables rated late in therapy. Participants in all trials were chronic tinnitus patients, mainly from different departments of audiology. These findings implicate that 1) acceptance and psychological flexibility may contribute to the understanding of tinnitus interference 2) ACT can reduce tinnitus interference in a group of normal hearing tinnitus patients and 3) acceptance and cognitive defusion are important processes in ACT, related to outcome.

Abstract [sv]

Tinnitus är ett mycket vanligt hälsoproblem där en grupp av de drabbade upplever påtagliga besvär såsom påverkan på sömn, välbefinnande och funktionsnivå. Denna avhandlings syften var att 1) utforska den roll acceptans och psykologisk flexibilitet har för förståelsen av tinnitusbesvär såväl experimentellt som med en longitudinell design 2) utvärdera de omedelbara och långsiktiga effekterna av en acceptansinriktad beteendeterapi (Acceptance and Commitment Therapy; ACT) vid behandling av personer med tinnitus samt 3) undersöka relationen mellan behandlingsutfall och processer som antas utgöra behandlingens aktiva komponenter (acceptans och kognitiv defusion).

Studie I (n=47) var ett experiment där man jämförde förmågan att bibehålla uppmärksamheten på en mental bild vid tre olika betingelser: acceptans, tankesuppression eller en neutral betingelse. Resultaten indikerade att deltagarna som slumpats till acceptans var hjälpta av denna strategi i genomförandet av uppgiften. Studie II (n=47) var en självrapportstudie med longitudinell design där det undersöktes om acceptans fungerade som en mediator i sambandet mellan tinnitusbesvär i baslinjen och livskvalitet, depression, ångest och tinnitusbesvär vid en uppföljning efter sju månader. För variablerna livskvalitet och depression visade resultaten en fullständig mediation och för tinnitusbesvär en partiell mediation. Studie IV (n=64) var en randomiserad kontrollerad prövning av de omedelbara och långsiktiga effekterna av ACT i jämförelse med Tinnitus Retraining Therapy (TRT) och en väntelistekontrollgrupp. Resultaten visade att ACT hade en stor omedelbar effekt på tinnitusbesvär i jämförelse med väntelistan och en medelstor effekt i jämförelse med TRT. Även sekundära utfallsmått visade på effekter. Utfallet i ACT medierades av självrapporterad acceptans av tinnitus. Studie III (n=24) studerade processer i ACT-behandlingen genom observation och skattning av klientbeteenden under de videoinspelade sessionerna. Resultaten visade att klienternas acceptans- och defusionbeteende under sessioner tidigt i terapin predicerade det långsiktiga utfallet i behandlingen. Dessa samband kvarstod även när man kontrollerade för symtomförbättring fram till den skattade sessionen. Detta medan tidigare symtomförbättring inte predicerade klientbeteende senare i behandling. Deltagare i samtliga studier var patienter med kronisk tinnitus, huvudsakligen rekryterade från reguljär hörselvård. Resultaten från dessa studier indikerar att 1) acceptans och psykologisk flexibilitet kan bidra till förståelsen av tinnitusbesvär 2) ACT kan minska tinnitusbesvär hos en grupp normalhörande patienter 3) acceptans och kognitiv defusion är viktiga processer i ACT vilka är relaterade till behandlingutfallet.

Place, publisher, year, pages
Linköping: Linköping University Electronic Press, 2011. 84 + appendices 1-4 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 547Studies from the Swedish Institute for Disability Research, ISSN 1650-1128 ; 40
Keyword [en]
Tinnitus, tinnitus interference, acceptance, defusion, Acceptance and Commitment Therapy
Keyword [sv]
Tinnitus, tinnitusbesvär, acceptans, defusion, Acceptance and Commitment Therapy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-71845 (URN)978-­91-­7393-­040-­6 (ISBN)oai:DiVA.org:liu-71845 (OAI)diva2:454486 (DiVA)
Public defence
2011-11-18, sal 1, Hus Key, Campus Valla, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from2011-11-07 Created:2011-11-07 Last updated:2014-10-09Bibliographically approved
List of papers
1. The effects of acceptance versus thought suppression for dealing with the intrusiveness of tinnitus
Open this publication in new window or tab >>The effects of acceptance versus thought suppression for dealing with the intrusiveness of tinnitus
2008 (English)In: International Journal of Audiology, ISSN 1499-2027, Vol. 47, S112-S118Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Tinnitus, Acceptance, Thought suppression
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16151 (URN)10.1080/14992020802301688 (DOI)
Available from2009-01-08 Created:2009-01-07 Last updated:2011-11-07
2. Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact
Open this publication in new window or tab >>Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact
2008 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, Vol. 46, no 12, 1259-1265Article in journal (Refereed) Published
Abstract [en]

Tinnitus is an experience of sound in the absence of an appropriate external source. A symptom that can accompany most central or peripheral dysfunctions of the auditory system, tinnitus can lead to significant distress, depression, anxiety, and decreases in life quality. This paper investigated the construct of psychological acceptance in a population of tinnitus patients. First, a cross-sectional Study (N = 77) was conducted in which a tinnitus specific acceptance questionnaire was developed. Results showed that a Tinnitus Acceptance Questionnaire (TAQ) generated good internal consistency. A factor Solution was derived with two factors: activity engagement and tinnitus supression, Second, a longitudinal study (N = 47) investigated the mediating role of acceptance on the relationship between tinnitus distress at baseline and tinnitus distress, anxiety, life quality, and depression at a 7-month follow-up The results. showed full mediation of activity engagement for depression and life quality at follow-up, partial mediation for tinnitus distress, and no mediation for anxiety. The role of acceptance in the negative impact of tinnitus distress merits further investigation.

Keyword
Tinnitus, Acceptance, Mediation analysis, Tinnitus distress, Defusion, Longitudinal
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16262 (URN)10.1016/j.brat.2008.08.008 (DOI)
Available from2009-01-12 Created:2009-01-09 Last updated:2011-11-07
3. Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress.
Open this publication in new window or tab >>Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress.
2009 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 47, no 6, 523-8Article in journal (Refereed) Published
Abstract [en]

Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients' in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18989 (URN)10.1016/j.brat.2009.02.002 (DOI)19268281 (PubMedID)
Available from2009-06-07 Created:2009-06-07 Last updated:2013-02-15Bibliographically approved
4. Acceptance and Commitment Therapy versus Tinnitus Retraining Therapy in the treatment of tinnitus
Open this publication in new window or tab >>Acceptance and Commitment Therapy versus Tinnitus Retraining Therapy in the treatment of tinnitus : A randomised controlled trial
Show others...
2011 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 49, no 11, 737-747Article in journal (Refereed) Published
Abstract [en]

The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60min sessions. The TRT treatment consisted of one 150min session, one 30min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen's d=1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen's d=0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.

Publisher, range
Elsevier, 2011
Keyword
Acceptance and commitment therapy; Stress; Social workers; Burnout; Randomized controlled trial; Stress management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-71844 (URN)10.1016/j.brat.2011.08.001 (DOI)000296941700003 ()21864830 (PubMedID)
Available from2011-11-07 Created:2011-11-07 Last updated:2013-02-15

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