Tinnitus, anxiety and automatic processing of affective information: an explorative study.

Anxiety is found to play an important role in the severity complaint of tinnitus patients. However, when investigating anxiety in tinnitus patients, most studies make use of verbal reports of affect (e.g., self-report questionnaires and/or interviews). These methods reflect conscious appraisals of anxiety, but do not map underlying processing mechanisms. Nonetheless, such mechanisms, like the automatic processing of affective information, are important as they modulate emotional experience and emotion-related behaviour. Research showed that highly anxious people process threatening information (e.g., fearful and angry faces) faster than non-anxious people. Therefore, this study investigates whether tinnitus patients process affective stimuli (happy, sad, fearful, and angry faces) in the same way as highly anxious people do. Our sample consisted out of 67 consecutive tinnitus patients. Relationships between tinnitus severity, pitch, loudness, hearing loss, and the automatic processing of affective information were explored. Results indicate that especially in severely distressed tinnitus patients, the severity complaint is highly related to the automatic processing of fearful (r = 0.37, p < 0.05), angry (r = 0.44, p < 0.00) and happy (r = -0.44, p < 0.00) faces, and these relationships became even stronger after controlling for hearing loss. Furthermore, in contrast with findings on the relation between audiological characteristics (pitch and loudness) and conscious report of anxiety, we did find that the audiological characteristic, loudness, tends to be in some degree related to the automatic processing of fearful faces (r = 0.25, p = 0.08). We conclude that tinnitus is an anxiety-related problem on an automatic processing level.

Tinnitus severity and its association with cognitive and somatic anxiety: a critical study.

Tinnitus has been defined as a phantom auditory perception. Research indicates the necessity to make a distinction between the physical symptom and the subjective severity of the tinnitus symptom, since especially the latter seems to vary among patients. The relationship between tinnitus severity and psychological variables has been well established. Anxiety is considered to be an important variable for understanding the differences in the subjective tinnitus severity. Although many studies confirm the relationship between anxiety and tinnitus severity, most studies do not take the possibility of shared method variance and content overlap between questionnaires into account. Furthermore, anxiety is a broad concept and contains both a cognitive and somatic dimension. Research including both dimensions of anxiety in tinnitus population is rare. According to us two conditions must be fulfilled before theorization on the relation is useful: (1) the presence of clinically relevant cognitive and/or somatic anxiety, (2) evidence of a substantial or "real" relationship. In our sample, almost 60% reported more than average cognitive anxiety and 40.8% reported clinical relevant somatic anxiety. After controlling for content overlap between the questionnaires used, the relation between tinnitus severity and cognitive and somatic anxiety remains significant. Two hypothetical models concerning this relationship that deserve future research attention are described.

Tinnitus severity and the relation to depressive symptoms: a critical study.

OBJECTIVE: In this study, the authors investigated whether tinnitus severity is a problem related to depression. If so, the following 2 conditions should be fulfilled: first, there should be evidence for the presence of moderate to severe depressive symptomatology in a substantial group of tinnitus patients; second, there should be evidence of a substantial relationship between depressive symptoms and tinnitus severity. STUDY DESIGN: Cross-sectional. SETTING: Ear, Nose, and Throat (ENT) Department of the Ghent University Hospital. SUBJECTS AND METHODS: In total, 136 consecutive help-seeking tinnitus patients were seen by a psychologist, an audiologist, and an ENT specialist. All patients filled in the Beck Depression Inventory II (BDI-II) and the Tinnitus Handicap Inventory (THI) and underwent psychoacoustic measurement. RESULTS: Mean scores indicate the presence of no or minimal depressive symptoms. There was a positive correlation (P < .01) between the BDI-II and the THI. No correlations were found between psychoacoustic measures and the self-report questionnaires. Linear regression analysis was performed to examine the predictive role of the 3 components of depression (cognitive, somatic, and affective) in tinnitus severity. Results show that only the somatic depression subscale of the BDI-II significantly predicted tinnitus severity, which can be explained because of content overlap between the BDI-II and the THI. CONCLUSION: Tinnitus does not appear to be a problem related to depression. The authors did not find a substantial group of tinnitus patients with moderate to severe depressive symptoms. The relation between depressive symptoms and tinnitus severity seems to be an artifact of content overlap between the BDI-II and the THI.