Illness Representations, Acceptance, Coping and Psychological Distress in Chronic Tinnitus

Tinnitus is a prevalent condition which is associated with significant distress and disability in a substantial proportion of the population. The variance in distress is not adequately explained by audiological characteristics of the symptom and it has been widely accepted that other variables are influential in determining the relationship between the stimulus and distress. A review of the literature highlights significant relationships between many psychosocial variables and tinnitus severity (impact on life). However, conclusions based on existing research are limited due to methodological weaknesses and widespread neglect of coherent theoretical foundations. The review identifies a need for further research with comprehensive theoretical underpinning to provide a greater understanding of adaptation to chronic tinnitus. One theoretical framework which has been applied extensively to explore the process of adaptation to chronic conditions is Leventhal's Self Regulation Model (SRM). This model has not yet been applied to the study of chronic tinnitus with sufficient methodological rigour to draw firm conclusions on its utility for this patient group. Existing research on tinnitus suggests that coping efforts (integral to the SRM) are often associated with increased distress with the notable exception of strategies indicative of acceptance. Recent research into chronic pain has indicated a role for acceptance in predicting adaptation, however it has not been investigated in the context of tinnitus to date. Therefore, research was undertaken to investigate the relationships between cognitive illness representations, coping, acceptance and psychological distress in patients with chronic tinnitus. The findings suggest that cognitive illness representations predict variance in psychological distress and that coping and acceptance variables enhance the explanatory power of the models. The clinical implications of the findings and the limitations of the study are discussed. Finally, an account of the process of undertaking the research and reflections on this experience is presented.