Metacognitive Interpersonal Therapy for Misophonia: A Single-Case Study.

BACKGROUND: Misophonia is a chronic condition in which the exposure to specific sounds increases the arousal and recurrence of specific intense negative emotions. We hypothesized that misophonia may be strongly related to maladaptive interpersonal schemas that create difficulties in interpersonal relationships. Subjects with maladaptive interpersonal schemas think that other people try to subjugate, criticize, dominate, exploit, deceive, disregard, and humiliate them. Furthermore, these patients typically endorse a representation of self as mistreated, constricted, harmed, damaged, humiliated, impotent, inadequate, or fragile. METHODS: We describe the course of a treatment of Metacognitive Interpersonal Therapy (MIT) in a young man presenting misophonia and co-occurrent obsessive-compulsive personality disorder (OCPD) and avoidant personality disorder (AvPD), with narcissistic traits and normal hearing. We collected qualitative and quantitative data at the beginning of the intervention and at 2 years follow-up. RESULTS: The therapy aimed at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. The results reported a significant decrease in misophonia; behavioural experiments were used to increase the quality of social relationships and tolerance to the trigger sounds. CONCLUSIONS: MIT can be an effective therapy for the treatment of misophonia.

Impact of the COVID-19 Lockdown on Patients with Chronic Tinnitus-Preliminary Results.

The COVID-19 pandemic and the lockdown measures are both causes of psychological distress. The aim of the current study was to evaluate the psychological effects of lockdown measures on patients with subjective chronic tinnitus diagnosed before the COVID-19 pandemic. A sample of n = 77 patients with chronic tinnitus was contacted by mail/phone for a survey between June 2021 and September 2021. All patients filled out questionnaires on tinnitus distress (Tinnitus Handicap Inventory, THI), anxiety (Beck Anxiety Inventory, BAI) and depression (Beck Depression Inventory, BDI) and eight items of the Tinnitus Sample Case History (TSCH) about tinnitus history (i.e., loudness, pitch, perception, tinnitus location), stress, and related conditions (noise annoyance, vertigo/dizziness, headache). Forty patients with chronic tinnitus filled out the survey. No significant differences of total THI mean scores (p > 0.05) were found compared to the results obtained before the COVID-19 pandemic and after lockdown. Regarding depression and anxiety, the female population showed a significant increase in scores obtained from the BDI (p < 0.0170) and the BAI (p < 0.049). Only two patients (0.5%) were infected by COVID-19 (positive RT-PCR), and they did not report any worsening of tinnitus. According to the data of the literature, our patients experienced a heterogeneous course of tinnitus, and the severity of tinnitus was not significantly affected by lifestyle changes during the COVID-19 pandemic and lockdown.

Tinnitus and Metacognitive Beliefs-Results of a Cross-Sectional Observational Study.

Recent research has highlighted the role of metacognitions as a moderator for psychological distress in patients with chronic diseases. The present study investigates the role of metacognitions and worry in the association between tinnitus distress, anxiety, and depression. A cross-sectional study was carried out with a sample of tinnitus-outpatients who completed the Tinnitus-Handicap Inventory, Beck Anxiety Inventory, Beck Depression Inventory, Metacognition Questionnaire-30, Penn-State-Worry-Questionnaire. Associations of metacognitions, worries, tinnitus distress, anxiety and depression were investigated using structural equation models (SEMs). A sample of n = 107 patients was included in the study. In the first SEM, tinnitus distress significantly predicted depression (ß = 0.68, p < 0.001) and anxiety (ß = 0.47, p < 0.001). In the second model, worries and meta-cognitions were added as moderators. The explained variance substantially increased for depression (46 to 53%) and anxiety (22 to 35%) and the association of tinnitus distress with depression (ß = 0.57, p < 0.001) and anxiety was weakened (ß = 0.32, p < 0.001). Negative beliefs significantly predicted worries (ß = 0.51, p < 0.001) and explained 41% of its variance. A good model fit for the final model was found (comparative fit index (CFI) = 0.98; (Tucker Lewis index) TLI = 0.96; root mean square error of approximation (RMSEA) = 0.067). Anxiety and depression in tinnitus patients might be influenced by worries, which is mainly predicted by negative beliefs about uncontrollability and danger of worries. Thus, psychotherapeutic approaches focused on alterations of metacognitions in patients with tinnitus should be investigated in future studies.3 (List three to ten pertinent keywords specific to the article yet reasonably common within the subject discipline.).

Gender Comparison of Psychological Comorbidities in Tinnitus Patients - Results of a Cross-Sectional Study.

BACKGROUND: In the last decades, research focused on gender-related features in patients with tinnitus has often led to controversial results. The complex clinical picture of tinnitus patients often consists of an interdependent relationship between audiological symptoms and co-occurrent psychological disorders, which can complicate the diagnostic evaluation. METHODS: Therefore, we studied 107 patients with tinnitus, investigating their psychological comorbidities in the light of gender differences. All patients were evaluated with ENT/audiological and psychological examination to consider presence/absence, type and gender distribution of psychopathological comorbidities. Patients completed questionnaires on tinnitus distress (Tinnitus Handicap Inventory, THI), anxiety (Beck Anxiety Inventory, BAI), depression (Beck Depression Inventory, BDI), metacognition (Metacognition Questionnaire-30, MCQ-30) and worry (Penn State Worry Questionnaire). The influence of gender on the relationship between tinnitus distress and psychological comorbidities was investigated with simple moderation analyses using the SPSS PROCESS macro. RESULTS: The total sample included 65 male and 42 female patients (60.7 vs. 39.3%), matched for age and duration of tinnitus. We found no significant differences for tinnitus distress (THI total score, THI subscales) and MCQ-30 subscales, except for the control over thoughts, where men showed significantly higher scores than women (p = 0.045). Also, in our sample women showed significantly higher values for depression (BDI total score, p = 0.019), anxiety (BAI total score, p = 0.010) and worries (PSQW total score, p = 0.015). Moderation analyses revealed a significant influence of gender on the relationship of tinnitus distress with depression: higher scores of tinnitus distress were associated with significantly elevated levels of depression amongst men. No further gender influences could be observed in our sample. DISCUSSION: In conclusion, our results indicate general gender differences for psychological comorbidities in tinnitus patients, with women reporting more depression, anxiety and worries. Men, on the other hand, showed a higher need to control their thoughts. Additionally, our results indicate that men might have more coping problems with increasing levels of tinnitus distress, leading to increased depressive symptoms. Nevertheless, several gender related aspects in tinnitus patients remain unclear, thus warranting the need future studies in this field.

Validation of the Italian Tinnitus Questionnaire Short Form (TQ 12-I) as a Brief Test for the Assessment of Tinnitus-Related Distress: Results of a Cross-Sectional Multicenter-Study.

Objectives: The use of reliable and valid psychometric tools to assess subjectively experienced distress due to tinnitus is broadly recommended. The purpose of the study was the validation of the Italian version of Tinnitus Questionnaire 12 item short form (TQ 12-I) as a brief test for the assessment of patient reported tinnitus-related distress. Design: Cross-sectional multicenter questionnaire study. Setting: Tinnitus Center, European Hospital (Rome), the Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital (Piacenza), and the Department of Audiology and Phoniatry, "Mater Domini" University Hospital (Catanzaro). Participants: One hundred and forty-three outpatients with tinnitus treated at one of the participating medical centers. Main Outcome Measures: Tinnitus Questionnaire Short Form (TQ 12-I), compared to the Tinnitus Handicap Inventory (THI), Brief Symptom Inventory (BSI), and Short Form (SF-36) Health Survey. Results: Our factor analysis revealed a two-factor solution (health anxiety, cognitive distress), accounting for 53.5% of the variance. Good internal consistency for the total score (α = 0.86) and both factors (α = 0.79-0.87) was found. Moderate correlations with the THI (r = 0.65, p < 0.001) indicated good convergent validity. Tinnitus distress was further correlated to increased psychological distress (r = 0.31, p < 0.001) and reduced emotional well-being (r = -0.34, p < 0.001). Conclusion: The study clearly showed that the TQ 12-I is a reliable and valid instrument to assess tinnitus-related distress which can be used in clinical practice as well as for research.