Dauman Nicolas, Erlandsson Soly I, Albarracin Dolorès, Dauman René
CAPS-EA4050, Department of Psychology, University of PoitiersPoitiers, France.
Department of Social and Behavioural Studies, University WestTrollhättan, Sweden.
Front Aging Neurosci. 2017 Aug 10;9:272. doi: 10.3389/fnagi.2017.00272. eCollection 2017.
Qualitative research can help to improve the management of patients, meet their expectations and assist physicians in alleviating their suffering. The perception of moment-to-moment variability in tinnitus annoyance is an emerging field of exploration. This study sought to enlighten variability in tinnitus-induced disablement using a qualitative approach. Twelve participants (six females, six males, aged 51-79) were recruited via the French Tinnitus Association Journal for participation in recorded semi-structured interviews. Each participant had three interviews lasting 1 h, the sessions being separated one from the other by 2 weeks. Following recommendations of Charmaz (2014), the second and third interviews were aimed at gathering rich data, by enhancing the participants' reflexivity in the circumstances of distress caused by tinnitus. After transcription, the data ( = 36 interviews) were analyzed using the approach to Grounded Theory proposed by Strauss and Corbin (1998). Tinnitus as persistent frustration emerged as being the core category uniting all the other categories of the study. Hence, the core category accounted for the broader scope in participants' experience of chronic tinnitus. It is suggested that tinnitus-induced disablement varied according to the degree of frustration felt by the participants in not being able to achieve their goals. The implications of this were analyzed using the following categories: "Losing body ownership," "Lacking perspectives," and "Persevering through difficulties." Based on these findings, we draw a substantive theory of tinnitus tolerance that promotes an active, disciplined and individualized approach to tinnitus-induced disablement. The model distinguishes pathways from sustained suffering to reduced annoyance (i.e., emerging tolerance). It accounts for difficulties that the participants experienced with a perceived unchanged annoyance over time. Furthermore, this model identifies a set of new attitudes toward oneself and others that tinnitus tolerance would entail. The subjective experience of frustration enlightens tinnitus-induced disablement, offering new perspectives for long-term self-management. Modulation of frustration, rather than moderation of tinnitus interference, is suggested as a new approach to the clinical management of tinnitus-related distress.
定性研究有助于改善患者管理，满足患者期望，并协助医生减轻患者痛苦。对耳鸣烦恼的即时变异性的认知是一个新兴的探索领域。本研究旨在采用定性方法阐明耳鸣所致残疾的变异性。通过法国耳鸣协会期刊招募了12名参与者（6名女性，6名男性，年龄在51 - 79岁之间）参与有记录的半结构化访谈。每位参与者进行了三次时长为1小时的访谈，访谈之间间隔2周。根据查马兹（2014年）的建议，第二次和第三次访谈旨在通过增强参与者在耳鸣引起的痛苦情境中的反思性来收集丰富的数据。转录后，使用施特劳斯和科尔宾（1998年）提出的扎根理论方法对数据（共36次访谈）进行分析。耳鸣作为持续的挫折感成为将研究的所有其他类别联系在一起的核心类别。因此，核心类别涵盖了参与者慢性耳鸣经历的更广泛范围。研究表明，耳鸣所致残疾根据参与者在无法实现目标时所感受到的挫折程度而有所不同。使用以下类别对其影响进行了分析：“失去身体掌控感”、“缺乏前景”和“在困难中坚持”。基于这些发现，我们得出了一种耳鸣耐受性的实质性理论，该理论提倡对耳鸣所致残疾采取积极、有纪律且个性化的方法。该模型区分了从持续痛苦到烦恼减轻（即逐渐形成的耐受性）的途径。它解释了参与者随着时间推移在烦恼感未改变的情况下所经历的困难。此外，该模型确定了耳鸣耐受性所需要的一系列对自己和他人的新态度。挫折的主观体验阐明了耳鸣所致残疾，为长期自我管理提供了新的视角。建议将调节挫折感而非减轻耳鸣干扰作为耳鸣相关痛苦临床管理的新方法。
