Psychological mediators of chronic tinnitus: The critical role of depression

- Anxiety was associated with tinnitus handicap, validating the 'vicious cycle'.
- Depressive symptoms however, fully mediated the 'vicious cycle' of chronic tinnitus.
- Thus disruption of specific neurocognitive networks may maintain tinnitus awareness.
- Self-blame and avoidant behaviours were identified as maladaptive coping strategies.
- Psychological treatment targets are identified to improve the wellbeing of people with tinnitus.

BackgroundMaintenance of chronic tinnitus has been proposed to result from a vicious cycle of hypervigilance occurring when a phantom sound is associated with anxiety and limbic system overactivity. Depression, obsessive-compulsiveness, illness attitudes and coping strategies are known to impact tinnitus, but their relationship with the vicious cycle is unknown. As such, we aimed to identify psychological mediators of the vicious cycle. We also examined the relationship between coping strategies and any identified mediators to facilitate the translation of our research to treatment settings.MethodsWe comprehensively assessed a heterogeneous community sample of 81 people with chronic tinnitus who completed measures assessing their tinnitus and psychological wellbeing. Specifically, we examined the mediating role of depressive symptoms, illness attitudes, and obsessive-compulsiveness in the vicious cycle.ResultsWhile the predicted relationship between tinnitus handicap and anxiety was observed, this was fully mediated by depressive symptoms. In addition, we identified avoidant behaviours and self-blame as maladaptive coping strategies in people with chronic tinnitus and depressive symptoms, identifying potential new treatment targets.LimitationsThis work requires replication in a clinical cohort of people with chronic tinnitus, and further investigations of the role of coping strategies.ConclusionsThese results extend our understanding of the complex role of psychology in the experience of tinnitus, highlighting the importance of depressive symptoms that may be underpinned by functional disruption of specific neurocognitive networks. We have also identified depressive symptoms and maladaptive coping strategies as new treatment targets to improve the health wellbeing of people with chronic tinnitus.