Tinnitus and Metacognitive Beliefs-Results of a Cross-Sectional Observational Study

Eleonora Natalini, Alessandra Fioretti, David Riedl, Roland Moschen, Alberto Eibenstein, Eleonora Natalini, Alessandra Fioretti, David Riedl, Roland Moschen, Alberto Eibenstein

Abstract

Recent research has highlighted the role of metacognitions as a moderator for psychological distress in patients with chronic diseases. The present study investigates the role of metacognitions and worry in the association between tinnitus distress, anxiety, and depression. A cross-sectional study was carried out with a sample of tinnitus-outpatients who completed the Tinnitus-Handicap Inventory, Beck Anxiety Inventory, Beck Depression Inventory, Metacognition Questionnaire-30, Penn-State-Worry-Questionnaire. Associations of metacognitions, worries, tinnitus distress, anxiety and depression were investigated using structural equation models (SEMs). A sample of n = 107 patients was included in the study. In the first SEM, tinnitus distress significantly predicted depression (β = 0.68, p < 0.001) and anxiety (β = 0.47, p < 0.001). In the second model, worries and meta-cognitions were added as moderators. The explained variance substantially increased for depression (46 to 53%) and anxiety (22 to 35%) and the association of tinnitus distress with depression (β = 0.57, p < 0.001) and anxiety was weakened (β = 0.32, p < 0.001). Negative beliefs significantly predicted worries (β = 0.51, p < 0.001) and explained 41% of its variance. A good model fit for the final model was found (comparative fit index (CFI) = 0.98; (Tucker Lewis index) TLI = 0.96; root mean square error of approximation (RMSEA) = 0.067). Anxiety and depression in tinnitus patients might be influenced by worries, which is mainly predicted by negative beliefs about uncontrollability and danger of worries. Thus, psychotherapeutic approaches focused on alterations of metacognitions in patients with tinnitus should be investigated in future studies.3 (List three to ten pertinent keywords specific to the article yet reasonably common within the subject discipline.).

Keywords: anxiety; depression; metacognition; tinnitus; tinnitus distress; worry.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Structural equation models to test the moderating effect of worries and meta-cognitions on the relationship of tinnitus distress with anxiety and depression. Model A depicts the direct association of tinnitus distress with the dependent variables (anxiety, depression). Model B depicts the model with worries as a moderator of the association of tinnitus distress with the dependent variables (anxiety, depression) and meta-cognitions as predictors for worries.
Figure 2
Figure 2
Structural equation model (SEM) for the direct influence of tinnitus distress on depression and anxiety. Rectangles represent variables and circles represent error terms (e). Arrows indicate paths, double arrows represent covariances. Numbers next to arrows in the model represent statistically significant standardized estimates, numbers next to factors represent the R2, i.e., the explained variance.
Figure 3
Figure 3
Structural equation model (SEM) for the moderated influence of tinnitus distress on depression and anxiety. Worries were added to the model as moderators for the two dependent variables and meta-cognitions as predictors for worries. Pos = positive beliefs about worry; neg = negative beliefs about the controllability of thoughts and danger of worry; CC = cognitive confidence; NC = beliefs about the need to control thoughts; CSC = cognitive self-consciousness. Rectangles represent variables and circles represent error terms (e). Numbers next to arrows in the model represent statistically significant standardized estimates, numbers next to factors represent the R2, i.e., the explained variance.

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