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Background: People with troublesome tinnitus often experience emotional distress. Therefore a psychometrically sound instrument which can evaluate levels of distress and change over time is necessary to understand this experience. Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of emotional distress which has been widely used in mental health research. Although originally designed as a 4-factor questionnaire, factor analyses have not supported this structure and a number of alternative factor structures have been proposed in different samples. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience.Methods: The CORE-OM was completed by 342 people experiencing tinnitus who self-rated their tinnitus on a 5-point scale from 'not a problem' to 'a very big problem'. Confirmatory factor analysis was used to test all ten factor models which have been previously derived across a range of population samples. Model fit was assessed using fit criterion and theoretical considerations. Mean scores on the full questionnaire and its subscales were compared between tinnitus problem categories using one-way ANOVA.Results: The best fitting model included 33 of the 34 original items and was divided into three factors: negatively worded items, positively worded items and risk. The full questionnaire and each factor were found to have good internal consistency and factor loadings were high. There was a statistically significant difference in total CORE-OM scores across the five tinnitus problem categories. However there was no significant difference between those who rated their tinnitus 'not a problem', and 'a small problem' or 'a moderate problem.'Conclusion: This study found a 3-factor structure for the CORE-OM to be a good fit for a tinnitus population. It also found evidence of a relationship between emotional distress as measured by CORE-OM and perception of tinnitus as a problem. Its use in tinnitus clinics is to be recommended, particularly when emotional distress is a target of therapy. [ABSTRACT FROM AUTHOR]

The cognitive model of tinnitus distress (McKenna, Handscomb et al. 2014) is a theoretical model which describes the interaction between thoughts, emotions, behaviour and attention that may cause tinnitus to become, and be maintained as, a distressing problem. It consists of a series of testable hypotheses and this project set out to investigate these systematically in order to test the model's accuracy. A survey was compiled from existing questionnaires which provided measures of each separate component of the model. This was made available online and on paper. Members of the public with tinnitus were recruited from a volunteer database and from tinnitus organisations. The survey was completed by 342 adults who reported varying degrees of overall tinnitus distress. Factor analysis of all the questionnaires was carried out and 12 different versions of the cognitive model were created based on questionnaire results, existing literature and theory. These were then tested using path analysis. A satisfactory factor structure was found for all questionnaires and the resulting 15 factor scores were used to test the full model. All 12 models tested were at least an acceptable fit to the data (RMSEA <0.080). The two best fitting models had comparable fit indices (model 1: RMSEA=0.071, CFI=0.982, TLI=0.966; model 2: RMSEA= 0.066, CFI=0.991, TLI=0.975). They differed primarily in the placement of tinnitus magnitude, which was a product of attention in model 1, but an exogenous variable in model 2. Additionally, model 1 included tinnitus control beliefs while model 2 did not. These findings add to existing evidence which indicates that emotional distress, negative thinking and avoidance behaviour contribute to a worse experience of tinnitus. They also shed new light on the role of attention and monitoring in tinnitus distress and increase understanding of how emotional, cognitive and behavioural responses to tinnitus interact. Questions remain as to the role of beliefs in tinnitus distress and as to whether and to what degree perceived magnitude is influenced by psychological processes. The predictions made by the cognitive model of tinnitus distress appear to be largely accurate and it is to be recommended as a solid foundation for psychological therapy for tinnitus. The need for further research in the areas of beliefs and perceived magnitude is highlighted. [ABSTRACT FROM AUTHOR]