No sound is more distracting than the one you're trying not to hear: delayed costs of mental control of task-irrelevant neutral and emotional sounds.

BACKGROUND: Suppressing intrusive thoughts can result in a post-suppression rebound effect where the same thoughts become hyperaccessible. The current study aimed to investigate if similar so-called rebound effects could be observed when people attempted to mentally suppress awareness of nonsensical auditory stimuli. Based on previous research on thought suppression and mental control in other domains, we hypothesized that attempting to suppress awareness of a task-irrelevant sound while under cognitive load would impact evaluations of the sound on affective dimensions and loudness, and result in increased general vigilance, as evidenced by faster responding on subsequent tasks. METHODS: We performed two experiments where participants in a suppression condition were initially instructed to mentally suppress awareness of a sound while performing a mentally challenging task. Participants in a control condition performed the same task without receiving any instructions regarding the sound. In Experiment 1, the sound was affectively neutral, while in Experiment 2 participants were presented with an inherently aversive (tinnitus-like) sound. After this initial phase, participants performed tasks measuring vigilance and attention, and were also asked to give subjective ratings of the sounds on a number of affective dimensions and loudness. RESULTS: In Experiment 1, participants in the suppression condition showed faster response times on both a visual search task and an auditory spatial cueing task, as compared to participants in the control condition. Contrary to our predictions, participants in the suppression condition did not rate the distractor sound as louder than participants in the control condition, and there were no differences on affective dimensions. In Experiment 2, results revealed that participants in the suppression condition made more errors on a visual search task, specifically on trials where the previously suppressed sound was presented. In contrast to results from Experiment 1, participants in the suppression condition also rated the targeted sound as louder. CONCLUSIONS: The findings provide preliminary support for a post-suppression rebound effect in the auditory domain and further suggest that this effect may be moderated by the emotional properties of the auditory stimulus.

Return on investment of internet delivered exposure therapy for irritable bowel syndrome: a randomized controlled trial.

BACKGROUND: Irritable bowel syndrome (IBS) is a debilitating and costly disorder. Cognitive behavior therapy (CBT) is effective in the treatment of IBS, both when delivered over the internet and in face-to-face settings. CBT consists of different components and little is known about their relative importance. We have in an earlier study showed that inclusion of exposure in the CBT for IBS makes it even more effective. In the present study we wanted to evaluate the economic effects for society of inclusion vs exclusion of exposure in an internet delivered CBT for IBS. METHODS: We used data from a previous study with 309 participants with IBS. Participants were randomized to internet delivered CBT with (ICBT) or without exposure (ICBT-WE). We compared direct and indirect costs at baseline, after treatment, and 6 months after treatment (primary endpoint; 6MFU). Data was also collected on symptom severity and time spent by therapists and participants. The relative Incremental Cost Effectiveness Ratio (ICER) was calculated for the two treatment conditions and the return on investment (ROI). RESULTS: Results showed that ICBT cost $213.5 (20%) more than ICBT-WE per participant. However, ICBT was associated with larger reductions regarding both costs and symptoms than ICBT-WE at 6MFU. The ICER was - 301.69, meaning that for every point improvement on the Gastrointestinal Symptom Rating Scale-IBS version in ICBT, societal costs would be reduced with approximately $300. At a willingness to pay for a case of clinically significant improvement in IBS symptoms of $0, there was an 84% probability of cost-effectiveness. ROI analysis showed that for every $1 invested in ICBT rather than ICBT-WE, the return would be $5.64 six months after treatment. Analyses of post-treatment data showed a similar pattern although cost-savings were smaller. CONCLUSIONS: Including exposure in Cognitive Behavior Treatment for IBS is more cost-effective from a societal perspective than not including it, even though it may demand more therapist and patient time in the short term. TRIAL REGISTRATION: This study is reported in accordance with the CONSORT statement for non-pharmacological trials [1]. Clinicaltrials.gov registration ID: NCT01529567 (14/02/2013).

Efficacy and Cost-effectiveness of Acceptance and Commitment Therapy and Applied Relaxation for Longstanding Pain: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: To date, few studies have compared Acceptance and Commitment Therapy (ACT) for longstanding pain with established treatments. Only 1 study has evaluated the cost-effectiveness of ACT. The aim of the current study was to evaluate the efficacy and cost-effectiveness of ACT and applied relaxation (AR) for adults with unspecific, longstanding pain. MATERIALS AND METHODS: On the basis of the inclusion criteria 60 consecutive patients received 12 weekly group sessions of ACT or AR. Data were collected pretreatment, midtreatment, and posttreatment, as well as at 3- and 6-month follow-up. Growth curve modeling was used to analyze treatment effects on pain disability, pain intensity, health-related quality of life (physical domain), anxiety, depression, and acceptance. RESULTS: Significant improvements were seen across conditions (pretreatment to follow-up assessment) on all outcome measures. Pain disability decreased significantly in ACT relative to AR from preassessment to postassessment. A corresponding decrease in pain disability was seen in AR between postassessment and 6-month follow-up. Pain acceptance increased only in ACT, and this effect was maintained at 6-month follow-up. Approximately 20% of the participants achieved clinically significant change after treatment. Health economic analyses showed that ACT was more cost-effective than AR at post and 3-month follow-up assessment, but not at 6-month follow-up. DISCUSSION: More studies investigating moderators and mediators of change are needed. The present study is one of few that have evaluated the cost-effectiveness of ACT and AR and compared ACT with an established behavioral intervention, and the results provide additional support for behavioral interventions for longstanding pain.

Costs of suppressing emotional sound and countereffects of a mindfulness induction: an experimental analog of tinnitus impact.

Tinnitus is the experience of sounds without an appropriate external auditory source. These auditory sensations are intertwined with emotional and attentional processing. Drawing on theories of mental control, we predicted that suppressing an affectively negative sound mimicking the psychoacoustic features of tinnitus would result in decreased persistence in a mentally challenging task (mental arithmetic) that required participants to ignore the same sound, but that receiving a mindfulness exercise would reduce this effect. Normal hearing participants (N = 119) were instructed to suppress an affectively negative sound under cognitive load or were given no such instructions. Next, participants received either a mindfulness induction or an attention control task. Finally, all participants worked with mental arithmetic while exposed to the same sound. The length of time participants could persist in the second task served as the dependent variable. As hypothesized, results indicated that an auditory suppression rationale reduced time of persistence relative to no such rationale, and that a mindfulness induction counteracted this detrimental effect. The study may offer new insights into the mechanisms involved in the development of tinnitus interference. Implications are also discussed in the broader context of attention control strategies and the effects of emotional sound on task performance. The ironic processes of mental control may have an analog in the experience of sounds.

The role of catastrophizing in recent onset tinnitus: its nature and association with tinnitus distress and medical utilization.

OBJECTIVE: Persistent tinnitus affects 10 to 15% of adults. Little is understood about why only a small percentage of patients become severely affected. Catastrophic thinking has been suggested as one potentially relevant factor that might influence a patient's coping behavior, and thus tinnitus habituation. The current study investigates the concept of tinnitus catastrophizing and its relation with distress and medical utilization in recent onset tinnitus. DESIGN: Participants were administered a survey assessing catastrophizing, tinnitus distress, medical utilization, coping, and mood disturbance. Regression analyses investigated the nature of tinnitus catastrophizing and its contributions to distress and health care utilization. STUDY SAMPLE: 278 subjects with tinnitus for less than six months were recruited from Ear-Nose-Throat units, through the internet, and newspaper articles. RESULTS: Controlling for background variables, high subjective tinnitus loudness, low behavioral coping, and depressive symptoms were significantly associated with tinnitus catastrophizing. Furthermore, greater tinnitus catastrophizing was related to higher distress and more frequent medical visits. CONCLUSIONS: Tinnitus catastrophizing appears to be pivotal already at an early stage of tinnitus experience. Addressing catastrophizing by specific prevention and intervention programs might reduce the development of distress and medical utilization in the long term. Longitudinal studies are required to clarify cause-effect relations.