Looking Beyond – Psychosomatic Characteristics of Chronic Tinnitus-Related Distress

Chronic Tinnitus denotes the longstanding, conscious awareness of a tonal or composite noise for which there is no identifiable external acoustic source. Depending on the psychological makeup of affected individuals, tinnitus can be highly distressing. Current guidelines view the symptom together with its cognitive-emotional processing as a psychosomatic phenomenon – and suggest (1) medico-audiological treatment for underlying medical influences – if known, and (2) psychological treatment for highly distressed individuals. Anchored within a psychosomatic vulnerability-stress-coping framework, the present thesis sets out to examine chronic tinnitus-related distress. It asks two questions: 1. In how far do direct or indirect psychological factors – that may or may not correlate with ‘somatic’ variables – influence individuals’ experience of a tinnitus symptom as distressing? And: 2. In how far are psychosomatic (i.e. psychologically or medico-audiologically anchored) treatment approaches effective in ameliorating tinnitus-related distress? Chapter 1 [Introduction] briefly reviews evidence on vulnerability-stress-coping contributors to chronic tinnitus symptomatology and related distress-reactions. Chapter 2 [Vulnerability] presents the first two studies of the thesis, which examine chronic tinnitus-related distress at the junctions of (1) biological markers of tinnitus symptom vulnerability or perceived stress experiences and (2) psychological vulnerability-stress interactions. Chapter 3 [Stress] presents the third study, which investigates, whether transdiagnostically relevant psychological variables underlie chronic tinnitus- and pain-related distress experiences. Chapter 4 [Coping] examines the efficacy of psychosomatic treatment approaches. The final three studies of this thesis examine (1) whether a transdiagnostic psychological treatment approach ameliorates different functional symptom clusters, (2) whether a ‘somatic’ treatment approach (hearing amplification) bears psychological benefit, and (3) psychological effects on hearing amplification via hearing aid use-time. Chapter 5 [General Discussion] summarizes the presented papers and discusses theoretical and clinical implications.