John C. Moring

The Emotional and Functional Impact of the Type of Tinnitus Sensation

One to three percent of individuals with tinnitus experience significant reduction in quality of life. Factors that contribute to distress include personality variables, intolerance to loud noises, external locus of control, and pre-existing anxiety. Characteristics of tinnitus itself, such as perceived loudness, can also cause functional impairment. It is unknown whether different tinnitus sensations have various effects on either emotional or functional impairment, which can reduce quality of life. While audiological tests can determine pitch and loudness of tinnitus, questionnaires also can be easily used to assess subjective characteristics of tinnitus. In this study, 370 participants, recruited via email from a national tinnitus organization, completed online surveys that assessed tinnitus-related distress and provided qualitative descriptions of their tinnitus sensation. Self-reports of tinnitus sensation were rated by five independent coders, with excellent agreement. Individuals who reported a combination of tinnitus sensations were found to experience significantly more functional impairment and avoidant behavior. Future research should utilize more sophisticated approaches to categorize individuals’ tinnitus sensation and to examine associated emotional and functional differences. Providers should appropriately refer patients for tinnitus management and empirically-supported therapies aimed at reducing tinnitus related distress and functional impairment.

Use of the Implicit Association Test for the Measurement of Tinnitus-Related Distress

PURPOSE A priming stimulus activates and increases an association with the target stimulus. The goal of this research was to investigate whether current tinnitus measures are susceptible to increased error due to priming and, if so, to examine the feasibility of using the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) for an alternative measurement of tinnitus-related distress. METHOD Participants completed 2 tinnitus-related questionnaires and the IAT online. RESULTS Although participants with tinnitus did not view sound-related words as significantly more negative and IAT scores did not predict scores on the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996), priming did affect negative implicit attitudes toward sound-related words. CONCLUSIONS On the basis of these results, it is suggested that current tinnitus measures may be susceptible to priming error and that future studies should continue to pursue how the IAT can be utilized in the measure of tinnitus-related distress. Moreover, researchers should develop overt-behavioral measurements that can assess the validity of a tinnitus IAT.

Tinnitus, Traumatic Brain Injury, and Posttraumatic Stress Disorder in the Military

PurposeAcoustic trauma is more prevalent in military settings, especially among individuals with combat-related military occupational specialties. Gunfire, improvised explosive devices, and mortar explosions are a few examples that may cause hearing degradation and tinnitus. It is possible that the same events that are associated with auditory problems can cause traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).MethodThis paper reviews the distinct and overlapping symptoms of tinnitus, TBI, and PTSD, and how these disorders interact to synergistically promote negative outcomes.ResultsTinnitus may serve as a significant contributor to symptoms of TBI and PTSD. Therefore, tinnitus subtypes could be identified as physiologically or psychologically based, or both.ConclusionsAdditional research is warranted to determine the common and unique symptoms and associated neurological pathways of tinnitus, TBI, and PTSD. Brief treatment recommendations are provided, including a multidisciplinary approach for the physical and psychological distress associated with tinnitus.

Acceptance Mediates the Relationship Between Tinnitus-Related Cognitions and Anxiety Sensitivity.

PURPOSE Negative cognitions related to tinnitus sensation have been previously shown to affect the level of emotional distress. Anxiety sensitivity is another psychological factor that influences individuals to more closely monitor their own bodily sensations, resulting in increased negative cognitions and negative emotional responses among tinnitus patients. However, increasing acceptance of tinnitus sensation may attenuate emotional distress. The goal of this research was to investigate the relationship between negative tinnitus-related cognitions, acceptance, and anxiety sensitivity. METHOD Two hundred sixty-seven participants completed online measures of the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996), Acceptance and Action Questionnaire (Hayes, Follette, & Linehan, 2004), and the Anxiety Sensitivity Index-3 (Taylor et al., 2007). RESULTS Hierarchical regression analyses indicated that acceptance fully mediated the relationship between negative tinnitus-related cognitions and anxiety sensitivity. CONCLUSIONS On the basis of these results, it is suggested that practitioners improve acceptance of tinnitus sensation, duration, and intensity. More research is warranted on the clinical techniques to improve acceptance.

Attitudes and Beliefs of Deployed United States Military Medical Personnel about Providing Healthcare for Iraqi Patients

Abstract This study surveyed 1,129 U.S. military medical personnel deployed to a combat support hospital in Iraq regarding their attitudes and beliefs about providing healthcare to Iraqi National Guard, civilian, and security detainee patients. A significant percentage of military medical personnel reported they were comfortable treating Iraqi patients. However, a notable proportion indicated discomfort in this role, especially when interacting with security detainees. Nearly half of the medical personnel did not feel adequately prepared or trained for this role. U.S. military medical personnel may benefit from enhanced predeployment cultural education and training tailored to care for the local civilian patient population.

Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast

Abstract Introduction Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2–30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure. The current study is the first large study to collect psychological and neuropsychological data from active duty service members within a few days after blast exposure. Materials and Methods Recruitment for blast-injured TBI patients occurred at the Air Force Theater Hospital, 332nd Air Expeditionary Wing, Joint Base Balad, Iraq. Patients were referred from across the combat theater and evaluated as part of routine clinical assessment of psychiatric and neuropsychological symptoms after exposure to an explosive blast. Four measures of neuropsychological functioning were used: the Military Acute Concussion Evaluation (MACE); the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); the Headminder Cognitive Stability Index (CSI); and the Automated Neuropsychological Assessment Metrics, Version 4.0 (ANAM4). Three measures of combat exposure and psychological functioning were used: the Combat Experiences Scale (CES); the PTSD Checklist-Military Version (PCL-M); and the Acute Stress Disorder Scale (ASDS). Assessments were completed by a deployed clinical psychologist, clinical social worker, or mental health technician. Results A total of 894 patients were evaluated. Data from 93 patients were removed from the data set for analysis because they experienced a head injury due to an event that was not an explosive blast (n = 84) or they were only assessed for psychiatric symptoms (n = 9). This resulted in a total of 801 blast-exposed patients for data analysis. Because data were collected in-theater for the initial purpose of clinical evaluation, sample size varied widely between measures, from 565 patients who completed the MACE to 154 who completed the CES. Bivariate correlations revealed that the majority of psychological measures were significantly correlated with each other (ps ≤ 0.01), neuropsychological measures were correlated with each other (ps ≤ 0.05), and psychological and neuropsychological measures were also correlated with each other (ps ≤ 0.05). Conclusions This paper provides one of the first descriptions of psychological and neuropsychological functioning (and their inter-correlation) within days after blast exposure in a large sample of military personnel. Furthermore, this report describes the methodology used to gather data for the acute assessment of TBI, PTSD, and ASD after exposure to an explosive blast in the combat theater. Future analyses will examine the common and unique symptoms of TBI and PTSD, which will be instrumental in developing new assessment approaches and intervention strategies.

Design of a clinical effectiveness trial of in-home cognitive processing therapy for combat-related PTSD

Approximately 14% of military personnel and veterans who have deployed to the combat theater are at risk for combat-related posttraumatic stress disorder (PTSD). The treatment of combat-related PTSD in active duty service members and veterans is challenging. Combat trauma may involve multiple high levels of exposure to different types of traumatic events (e.g., human carnage after explosive blasts, life threat/injuries to self/others, etc.). Many service members and veterans are unable or unwilling to receive treatment in government facilities due to avoidance, scheduling difficulties, transportation or parking problems, concerns about career advancement, or stigma associated with seeking treatment. Innovative treatment-delivery approaches are needed to help overcome these barriers. The present study is a randomized clinical trial to evaluate three versions of Cognitive Processing Therapy (CPT; [54]) for the treatment of combat-related PTSD in active duty military service members and veterans: (1) standard In-Office CPT, (2) In-Home Telebehavioral Health CPT from the providers office to the participants home, and (3) In-Home CPT in which the provider delivers treatment in the participants home. Use of an equipoise-stratified randomization design allows participants to decline one of the treatment arms. This research design partly overcomes the problems active duty military and veterans face when receiving PTSD treatment by allowing them to opt out of one inappropriate or unacceptable treatment modality and still permitting randomization to the two remaining treatment modalities. This manuscript provides an overview of the research design and methods for the study.

Do words matter? health care providers’ use of the term prediabetes

Communication of risk is not solely the transfer of information; it is an interaction and exchange of ideas between concerned individuals. Health care provider communication about type 2 diabetes risk status may influence individual participation in behaviours that prevent or delay the disease, which is concerning from a public health perspective. The term prediabetes is used to convey risk status and little is known about how health care providers view or use the term. In this article, we describe health care provider use and perceptions of the term prediabetes drawing on data from interviews conducted between August and November 2011 of 15 health care providers practicing in Southeast Wyoming and Northern Colorado USA. We used a grounded theory research design to guide data collection and analysis and in the interviews invited providers to describe their use and perception of the term prediabetes. We found that providers’ use of the term ‘prediabetes’ depended on their view of the term’s meaning (e.g. whether patients were likely to understand or be confused by it) and impact (in terms of motivating patients to mitigate risk). We found there were differences in providers’ perceptions of the negative and positive associations of the term and this influenced whether or not they used it. These findings are not surprising given the lack of consensus over definitions and diagnosis criteria for prediabetes. Given this lack of agreement, there are difficulties about the use of the term prediabetes and its use should take place within effective risk communication. Health care providers must consider essential aspects of risk communication in order to enable individuals at risk of type 2 diabetes to mitigate the risk and by doing so reduce incidence and prevalence rates of the disease.

Development of a revised generalized health-related self-concept inventory.

OBJECTIVES To replicate and validate the GHRSC-76, as well as to develop and validate an abbreviated version. METHODS An online survey was completed by 276 undergraduate students. Principal components and multiple regression analyses were used to replicate and validate the measure. RESULTS Health-protective motivation, vulnerability, and health-risky habits dimensions were predictive of symptom report. A 25-item inventory was created (R-GHRSC) and similar results were found. CONCLUSIONS Three dimensions of GHRSC were related to symptom report in this study but further research is needed to explore the relationship between GHRSC and health behavior.