Charité-Universitaetsmedizin Berlin-Tinnitus Center, Berlin, Germany.
Division of Psychosomatic Medicine, Medical Department, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
PLoS One. 2021 Mar 11;16(3):e0246747. doi: 10.1371/journal.pone.0246747. eCollection 2021.
Psychological factors link the co-occurrence of tinnitus-related distress and pain perceptions in patients with chronic tinnitus.
This study examines, if treatment-related changes in these factors ameliorate both tinnitus-related distress and pain perceptions in a sample of patients with chronic tinnitus.
N = 1238 patients with chronic tinnitus provided pre- and post-treatment ratings of tinnitus-related distress and affective or sensory pain perceptions alongside measures of depressive symptoms and perceived stress. Treatment comprised an intensive tinnitus-specific multimodal treatment program. Using serial indirect-effects analyses, we examined association patterns between baseline values and change rates of those variables that were found to respond to treatment.
Small effect sizes emerged for changes in tinnitus-related distress, affective (but not sensory) pain perceptions, depressive symptoms, emotional tension and worry. At pre- or post-treatment respectively, baseline values and change rates intercorrelated. Across timepoints, (1) baseline tinnitus-related distress and affective pain perceptions were positively associated with improvements in tinnitus-related distress, affective pain perceptions and depressive symptoms. (2) Baseline depressive symptoms or emotional tension mediated positive associations between baseline tinnitus-related distress and improvement in affective pain perceptions. (3) Change in depressive symptoms mediated the effect of baseline tinnitus-related distress on change in affective pain perceptions-partly through associated change in emotional tension or worry. Mood-independent aspects of emotional tension were negatively associated with improvement in affective pain perceptions.
Depressive symptoms, emotional tension and worry emerge as key predictors of treatment response and transdiagnostic treatment targets for alleviating tinnitus-related distress and functionally associated affective pain perceptions.
心理因素将慢性耳鸣患者耳鸣相关困扰和疼痛感知的同时发生联系在一起。
本研究考察了在慢性耳鸣患者样本中，这些因素的治疗相关变化是否改善了耳鸣相关困扰和疼痛感知。
N=1238 名慢性耳鸣患者在治疗前后提供了耳鸣相关困扰和情感或感觉疼痛感知的评分，以及抑郁症状和感知压力的测量。治疗包括密集的耳鸣特异性多模式治疗计划。使用系列间接效应分析，我们检查了那些对治疗有反应的变量的基线值和变化率之间的关联模式。
耳鸣相关困扰、情感（而非感觉）疼痛感知、抑郁症状、情绪紧张和担忧的变化出现了较小的效应量。在治疗前或治疗后，基线值和变化率相互关联。在不同的时间点上，（1）基线的耳鸣相关困扰和情感疼痛感知与耳鸣相关困扰、情感疼痛感知和抑郁症状的改善呈正相关。（2）基线抑郁症状或情绪紧张在基线耳鸣相关困扰与情感疼痛感知改善之间的正相关中起中介作用。（3）抑郁症状的变化部分通过情绪紧张或担忧的相关变化，介导了基线耳鸣相关困扰对情感疼痛感知变化的影响。情绪紧张的与情绪无关的方面与情感疼痛感知的改善呈负相关。
抑郁症状、情绪紧张和担忧成为治疗反应的关键预测因素，也是减轻耳鸣相关困扰和功能相关情感疼痛感知的跨诊断治疗目标。
