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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]

Objectives: The Covid-19 pandemic led the British Tinnitus Association to offer more online support to people with tinnitus. The aim of this study was to understand how low-intensity group-based digital interventions could benefit people with tinnitus., Design: Semi-structured interviews explored participants' experiences and views on receiving support via an online group., Study Sample: Sixteen people with tinnitus who had attended a recent online tinnitus group and/or workshop were recruited using convenience sampling., Results: Three overarching themes were extrapolated from the data: feeling part of a community, being reliably informed, and living better with tinnitus., Conclusions: Participants reported significant benefits from both types of online group. There was appreciation for the accessibility of help during lockdown, and participants felt that this type of support would continue to be valuable post-pandemic. As seen in research on face-to-face groups, benefits came from a supportive community of people with tinnitus and knowledgeable, skilled and trustworthy facilitation and information provision. Outcomes focussed on feeling less isolated, more informed and hopeful. Online groups could offer an accessible ongoing resource supporting people on their journey with tinnitus.

Objectives: There is a great deal of variation in the extent to which people with tinnitus find it distressing, which cannot be explained solely by differences in perceived loudness. The Cognitive Behavioral Model of Tinnitus Distress proposes that tinnitus becomes and is maintained as a distressing problem due to a process of interaction between negative thoughts, negative emotions, attention and monitoring, safety behavior, and beliefs. This study used path analysis to assess how well different configurations of this model fit using questionnaire data obtained from people with tinnitus., Design: This was a cross-sectional study. Three hundred forty-two members of the public with tinnitus volunteered to complete a survey comprising a series of questionnaires and subscales of questionnaires measuring each of the constructs contained within the Cognitive Behavioral Model of Tinnitus Distress. The optimum factor structure of each measure for the study population was established, and the resulting factors were used to construct a series of path models based on the theoretical model. Path analysis was conducted for each of these, and the goodness of fit of the models was assessed using established fit criteria., Results: Five of the six path models tested reached the threshold for adequate fit, and further modifications improved the fit of the three most parsimonious of these. The two best-fitting models had comparable fit indices which approached the criteria for good fit (Root Mean Square Error of Approximation = 0.061, Comparative Fit Index = 0.984, Tucker Lewis Index = 0.970 and Root Mean Square Error of Approximation = 0.055, Comparative Fit Index = 0.993, Tucker Lewis Index = 0.982). They differed principally in the placement of tinnitus magnitude and the inclusion/noninclusion of control beliefs., Conclusions: There are theoretical arguments to support both a beliefs-driven and a loudness-driven model, and it may be that different configurations of the Cognitive Behavioral Model of Tinnitus Distress are more appropriate to different groups of people with tinnitus. Further investigation of this is needed. This notwithstanding, the present study provides empirical support for a model of tinnitus distress which provides a clinical framework for the development of more effective psychological therapy.

Purpose: The purpose of this article is to describe data collection considerations, methods, and response rates for a survey available both online and on paper. Methodological issues in the design of online data collection, and advantages and disadvantages of different data collection methods are discussed., Method: A survey was compiled that included 9 full or partial clinical questionnaires designed to measure different components relevant to tinnitus distress. It was completed once by 342 members of the public with tinnitus. Respondents could choose whether to complete the survey online or on paper., Results: Ninety-five percent of participants chose to complete the survey online. The advantages of an online self-administered questionnaire include low numbers of unanswered questions, convenience (particularly in a longer survey such as this), a fast return rate, and reduced expense. Age emerged as an important variable, with those opting to complete the paper-based version of the survey being older., Conclusions: Online data collection has several advantages to both participants and researchers. However, cross-sectional studies such as that presented here should also offer paper questionnaires to avoid excluding certain subgroups of the population. Ethics and reporting guidelines for Internet-delivered questionnaire studies are available. These can usefully inform study design and guide high-quality reporting.

The importance of psychological factors in tinnitus distress has been formally recognized for almost three decades. The psychological understanding of why tinnitus can be a distressing condition posits that it becomes problematic when it acquires an emotive significance through cognitive processes. Principle therapeutic efforts are directed at reducing or removing the cognitive (and behavioral) obstacles to habituation. Here, the evidence relevant to a new psychological model of tinnitus is critically reviewed. The model posits that patients' interpretations of tinnitus and the changes in behavior that result are given a central role in creating and maintaining distress. The importance of selective attention and the possibility that this leads to distorted perception of tinnitus is highlighted. From this body of evidence, we propose a coherent cognitive-behavioral model of tinnitus distress that is more in keeping with contemporary psychological theories of clinical problems (particularly that of insomnia) and which postulates a number of behavioral processes that are seen as cognitively mediated. This new model provides testable hypotheses to guide future research to unravel the complex mechanisms underpinning tinnitus distress. It is also well suited to define individual symptomatology and to provide a framework for the delivery of cognitive-behavioral therapy.

Purpose: To investigate whether certain aspects of tinnitus tend to trouble people even when they are not severely affected by tinnitus in many ways., Method: A total of 274 patients who had requested a tinnitus clinic appointment were divided into 4 categories depending on their Tinnitus Handicap Inventory scores: no handicap (0-16), mild handicap (18-36), moderate handicap (38-56), or severe handicap (58-100). Mean scores for each of the 25 items on the questionnaire were calculated and compared within each group and between the 4 groups., Results: Two items concerning lack of control over tinnitus and inability to escape it had the highest mean score overall and in each category, and elicited positive responses from the majority of patients in all but the "no handicap" group. One item concerning the belief that tinnitus indicates a terrible disease was found to have the lowest mean score overall and in each category and elicited negative responses from the majority of patients in all but the "severe handicap" group., Conclusions: These findings indicate that only those who are severely handicapped by tinnitus tend to regard it as a terrible disease, and that lack of control and inability to escape are common feelings among many people with tinnitus, from the most to the least severely handicapped.