Vestibular disorder and emotional distress.

A standardised test of psychopathology (CCEI) was administered to tinnitus sufferers some of whom also complained of dizziness. It was predicted that the complaint of dizziness would be associated with higher scores on the anxiety scales of the CCEI and this was confirmed. Subjects complaining of dizziness obtained much higher scores on 'phobic' and 'somatic' anxiety scales in particular. However, the complaint of dizziness was completely uncorrelated with objective assessments of balance and there was no effect of balance, objectively assessed, in moderating the association between the complaint of dizziness and 'anxiety'. The results highlight the complex relationship between vestibular dysfunction and complaint behaviour.

Emotional stability; its relationship to confidence in maintaining balance.

Previous failures to find an association between postural test results and the complaints of dizziness/imbalance were further investigated in neuro-otology out-patients, testing in a range of everyday situations requiring balance. Three matched groups of patients were compared: those complaining of dizziness/imbalance; those reporting but not complaining of dizziness/imbalance; and those who had never experienced these symptoms as noteworthy. No difference was found between the groups in measures of postural performance, self-reported confidence in balance, or in several trait measures of fear/anxiety. However, confidence in balance was significantly correlated with fear/anxiety measures across the sample. The correlations were strongest in complaining patients and weakest in patients reporting but not complaining of dizziness/imbalance. The results suggest that psychological characteristics are likely to influence the reporting of symptoms of dizziness/imbalance. The contribution of vestibular and other balance disorders is unclear given that the three groups performed equally well on postural tests.

Cognitive variables in tinnitus annoyance.

Two new questionnaires were devised to investigate dimensions of complaint about tinnitus. Following a factor analysis of data provided by a sample of tinnitus patients who were administered the first questionnaire, the second questionnaire was developed. This included questions concerning coping attitudes and beliefs about tinnitus. The results of the two analyses were similar and they indicated the presence of three main dimensions of complaint (emotional distress, auditory perceptual difficulties, and sleep disturbance). However several smaller factors suggested that complaint was more complex than originally predicted. The second questionnaire successfully discriminated complaining from non-complaining patients.

A comparison of different methods for assessing the 'intensity' of tinnitus.

Questions are raised about the technical and psychological interpretation of loudness match measures in the assessment of tinnitus "intensity". The effect of hearing threshold on loudness matches expressed in sensation level (SL) was investigated by selecting subjects with different degrees of hearing loss. The loudness match expressed in SL was found to be a function of threshold. Correlations were then determined between psychological scales of tinnitus complaint (reported loudness, distress, intrusiveness, and others) and loudness match expressed in HL, SL, sones, or personal loudness units (PLUs). Only matches expressed in PLUs were significantly correlated with reported loudness or other psychological scales. The PLU transformation, derived from an individually determined loudness function, produces values that are generally independent of other audiometric measures. It is therefore recommended for assessing tinnitus "intensity".

A dialogical approach to obsessions.

Cognitive conceptualizations of obsessions based on the information-processing metaphor are contrasted with a dialogical approach to understanding obsessive compulsive disorder (OCD). The dialogical approach views obsessions as one-sided conversations. The unit of analysis is the narrative or 'voice', which engages the person in the neutralizing behaviour. The dialogical approach accommodates well the apparent paradox that obsessions are both self and other generated, and that people can be positioned differently regarding the senselessness of their obsessions at different times. Also, people themselves characterize their obsessions in dialogical terms as: voice, conversation, or argument. The focus of therapy is the language and power of the narrative rather than discrete cognitive biases or representations, and dialogical therapy emphasizes role-play and narrative techniques. Cognitive therapy has already shown signs of adopting a narrative turn, and cognitive and dialogical conceptualizations of OCD are alternative perspectives rather than competing explanations.

Agoraphobia: a critical review of the concept.

Phobic avoidance has been widely accepted as the central feature of the agoraphobic syndrome, and the presence of agoraphobia has been used to define groups of subjects for clinical research. A review of the evidence suggests that agoraphobia should not be classified with the phobias; several lines of inquiry point to the conclusion that it is a variable feature of patients suffering from anxiety neurosis. Implications for research and problems with the present classification of neurotic affective disorders are noted.

Correlates of sleep disturbance in chronic distressing tinnitus.

Sleep disturbance was recorded for a 1-week period prior to a follow-up assessment of 26 patients who had completed a study of psychological therapy reported elsewhere (Davies et al., 1995). The absence of reported sleep disturbance was associated with essentially normal hearing over the range 250 Hz to 2 kHz; hearing impairment was present in mild or severe sleep disturbance. Patients whose sleep was most disturbed rated significantly greater tinnitus annoyance in the evening. Measures of mood and emotional distress did not relate to degree of sleep disturbance.

The Crown-Crisp Experiential Index in patients complaining of tinnitus.

The Crown-Crisp Experiential Index (CCEI) was administered to 472 patients complaining of tinnitus who took part in a multi-centre study on tinnitus masking (Hazell et al., 1985). This inventory includes scales of anxiety, phobic anxiety, obsessionality, somatic anxiety, depression and hysteria. The scores on the CCEI scales for patients with and without 'dizziness' as an additional symptom were compared. In the non-dizzy patients, scores on the anxiety and depression scales were consistently elevated compared with the published normative values. In the dizzy patients scores on all scales except Hysteria were elevated. The most pronounced and consistent difference between the dizzy and non-dizzy patients was in the Somatic Anxiety scale. The presence of dizziness also obscured the relationship between the CCEI scales and measures of tinnitus. In contrast, however, hearing disability did not appear to influence the results.

Development of the Hearing Attitudes in Rehabilitation Questionnaire (HARQ).

A questionnaire devised by Brooks to measure attitudes towards hearing impairment and provision of a hearing aid in older people was factor analysed and subsequently enlarged and modified into a new 40 item self-report scale. The Hearing Attitudes in Rehabilitation Questionnaire (HARQ) assesses three attitudes towards hearing impairment (personal distress/inadequacy, hearing loss stigma and minimization of loss) and four attitudes towards provision of a hearing aid (hearing aid stigma, aid-not-wanted, pressure to be assessed and positive expectation). Scale development, reliability and other psychometric properties are reported. Potential uses of the scale include identification of patients who may require counselling, evaluation of audiological rehabilitation and further empirical investigations of attitudes in this area.

Attitudes to hearing difficulty and hearing aids and the outcome of audiological rehabilitation.

First time hearing aid candidates (N = 135) in a NHS setting were administered the Hearing Attitudes in Rehabilitation Questionnaire (HARQ) designed to assess attitudes to acquired hearing loss and hearing aids and 92% of them were followed up 3-9 months after fitting. Attitude scores, age, sex and sensory thresholds were related to six self-report outcome measures by use of logistic regression. The major findings were that patients who were least distressed by their hearing difficulties and reported not wanting or needing a hearing aid used their aids least frequently and evaluated them less highly in listening situations. An attitude that wearing a hearing aid was stigmatizing was not predictive of outcome except a report of more difficulty in handling the aid. There were some low but significant correlations between attitudes and sensory thresholds and thresholds also contributed to the prediction of outcome in a few instances.

The effect of written reassuring information on out-patients complaining of tinnitus.

The study investigated the effect of a two-page leaflet designed to reassure patients complaining of tinnitus. One half of new attenders at a tinnitus clinic received the leaflet while the other half did not. Clinic staff were blind to the condition to which patients were assigned. Tinnitus distress was assessed at the second appointment by means of a standardized questionnaire. Results indicated that questionnaire scores for the informed and non-informed subjects did not differ. However the informed group reported having significantly fewer 'unfulfilled needs'. They were less likely to want a medical cure or professional guidance. The level of general emotional distress as measured by the General Health Questionnaire did not moderate these effects.