BRING THE NOISE! Fear, assessment and treatment of tinnitus

Chronic disabling tinnitus is the unremitted perception of a sound (for at least 3 months) that is
without semantic meaning nor corresponding acoustic origin, which produces significant
emotional reactivity and related disability.
This thesis identified four objectives from three areas of interest, in which a novel contribution to
the field more likely results in direct progress in tinnitus research and treatment (Chapter 1). The
first objective was to adapt/create an associative learning model for the field of tinnitus to establish
a replicable fear learning paradigm with healthy human participants (Chapter 2). Two objectives
were drawn from the area of tinnitus assessment: (1) to investigate whether ecological momentary
assessment (EMA) negatively affects tinnitus experience (Chapter 3) and (2) to test whether EMA
provides a more accurate measure of tinnitus experience when compared to end-of-day diaries
(EDD) (Chapter 4). In the area of tinnitus treatment, the current cognitive-behavioural treatment
(CBT) approach and the desire to tailor treatment to the needs of the individual suffering chronic
disabling tinnitus inspired the investigation of group-based CBT as compared to individual CBT
for tinnitus (Chapter 5).
Chapter 2: Whereas fear associations to a previously neutral sound may explain the development
of chronic disabling tinnitus experience, replicable fundamental research of the associative
learning models at the core of development of chronic tinnitus is yet to be developed. This study
introduced a novel tinnitus relevant differential conditioning paradigm with healthy participants.
Support for the role of fear in the development and maintenance of tinnitus was found. The
paradigm sets the foundations for future research on the underlying mechanisms of chronic tinnitus
in healthy human participants.
Chapter 3: EMA is a method capable of assessing tinnitus experience throughout the day, enabling
the exploration of daily dynamic changes of tinnitus expression. However, the effects on patients’
tinnitus experience itself are still largely unknown. This chapter tested the hypothesis that the use
of EMA negatively influences tinnitus experience in participants with severe tinnitus. Findings of
this study refutes this idea and reveals that EMA assessment does not negatively affect tinnitus
experience. On the contrary, participants using EMA showed improvements on relevant outcomes.
Chapter 4: EMA may curb biases associated with traditional methods of self-report assessments
are susceptible to bias (i.e., memory, recall, recency). When high costs and participant burden may
however impede the use of EMA, EDD may provide an attractive alternative to EMA. This study
was the first to directly compare EMA to EDD in the tinnitus field. Results indicated supported
that EDD provides a viable alternative to EMA.
Chapter 5: Chronic tinnitus is best treated through CBT. Both group and individual CBT for
tinnitus are effective, but no study has directly compared both treatment forms. The current study
explored group vs individual CBT for tinnitus through a multiple-baseline single-case
experimental design (SCED). Results indicated that group CBT presents potential benefits when
compared to individual CBT, with social learning as a potential underlying process boosting
tinnitus recovery.