Tinnitus and Acceptance

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Tinnitus and Acceptance

• Vendela Westin
• Ph.D. student,
• The Swedish Institute for Disability Research
  (SIDR)
• Department of Behavioral Sciences and Learning
• Linköping University
• Department of Audiology,
• Linköping University Hospital

vendela.westin_at_liu.se
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Tinnitus treatment

• Many treatment options have been considered
• CBT has the best empirical support so far
• Cohens d.80 (Andersson Lyttkens, 1999)
• Based on a cognitive model as well as a model of
  habituation
• Adresses the distress and complaints rather than
  the cause
• Enhancing the treatment by including acceptance

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Why acceptance in tinnitus?

• Chronic condition with no evident cure
• Tinnitus patients who have had treatment success
  report acceptance of tinnitus as an outcome
• Seems to work with pain
• Mindfulness and autobiographical memories in
  tinnitus patients
• Tinnitus and control of background sounds

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Control
No Control
Control over background sounds experiment
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Acceptance

• Third wave behavioral therapies
• Private events Skinners black box
• Relational Frame Theory language and cognition
• The willingness to remain in contact with private
  events which may follow functional overt behavior
• Not a trait

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Research on acceptance

• Experimental studies (Hayes, Bissett et al.,
  1999), (Guiterez, Luciano, Fink, 2004),
  (Feldner, Zvolensky, Eifert Spira, 2003),
  (Levitt, Brown, Orsillo, Barlow, 2004)
• Correlational studies (Batten, Folette, Abban,
  2001), (Bond Bunce, 2000), (McCracken et al.,
  2004), (Norberg et al, 2007).
• Treatment studies (Hayes et al, 2007)
• Process studies (Acceptance mediator)

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Two studies conducted

• Experimental design
• n47
• Acceptance/ Thought suppression
• Attention task Imagery

• Longitudinal correlational studie
• n47
• 7 months
• Self-report measures
• Mediation

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ExperimentÖstergren, Westin Andersson, 2007

• Acceptance/Thought suppression/Neutral
  instruction
• 5 min instruction
• Attend to imagery
• Maximum 300 sec
• Dependent variables
• Time / Number of times - lost attention/ Changes
  in masking level
• Self-report of tinnitus strength and tinnitus
  distress

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Results

• After excluding participants due to ceiling
  effects
• A one-way ANOVA showed a significant effect for
  the variable time.
• Post hoc tests showed a significant difference
• Acceptance/control

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Correlational studyWestin, Hayes Andersson,
2007

• Develop a tinnitus specific self-report measure
  of acceptance
• Investigate if this measure could mediate the
  relationship over time between tinnitus distress
  and life quality, depression, tinnitus distress
  and anxiety.

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Tinnitus Acceptance Questionnaire

• First we developed a tinnitus specific
  self-report measure of acceptance
• Tinnitus Acceptance Questionnaire (n77)
• CPAQ-R
• Good internal consistency (a.89)
• Two factors
• Acceptable test-retest reliability (r .77)

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Correlational studyMeasures

• Tinnitus Handicap Inventory
• Hospital Anxiety and Depression Scale
• Quality of Life Inventory
• Tinnitus Acceptance Questionnaire

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Mediationa) Illustration of a total effect b)
Mediation analysis model. X affects Y indirectly
through M
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Statistical analyses

• Baron and Kenny (1982)
• X signicicantly predicts Y
• X significantly predicts M
• M significantly predicts Y controlling for X
• Sobel (Preacher Hayes, 2004)

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Hierachical regression analysis Tinnitus
acceptance (M) mediating the effects of tinnitus
distress (X) on life quality and depression.
plt 0.01, plt 0.05
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• Sobel test
• The inclusion of acceptance significantly
  decreased the influence of tinnitus distress at
  baseline on
• Life Quality (Sobel z -2.48, p .013)
• Depression (Sobel z 2.69, p.007)
• Tinnitus distress (Sobel z 2.62, p.009)
• at follow up.

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Results

• Perfect mediation for the variables depression
  and life quality. Patial mediation for tinnitus
  distress.

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On going projectRCT on tinnitus distress

• Comparing Acceptance and Commitment Therapy to
  Tinnitus Retraining Therapy (maskers) and a wait
  list control.

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Discussion

• Importance of acceptance for mental well-being of
  tinnitus patients
• Imagery task - reliability
• Acceptance differentiated from tinnitus distress?
• How best to measure acceptance