Positive and Negative Thinking in Tinnitus: Factor Structure of the Tinnitus Cognitions Questionnaire

Abstract

Objectives:Researchers and clinicians consider thinking to be important in the development and maintenance of tinnitus distress, and altering thoughts or thinking style is an object of many forms of psychological therapy for tinnitus. Those working with people with tinnitus require a reliable, psychometrically robust means of measuring both positive and negative thinking related to it. The Tinnitus Cognitions Questionnaire (TCQ) was designed as such a measure and its authors showed it to be reliable, with good psychometric properties. However, no research teams have yet carried out independent validation. This study aimed to use the TCQ to investigate thinking amongst members of the general population with both bothersome and nonbothersome tinnitus and also to verify its factor structure.Design:Three hundred forty-two members of the public with tinnitus completed the TCQ online or on paper. They also rated their tinnitus on a scale as “not a problem,” “a small problem,” “a moderate problem,” “a big problem,” or a “very big problem.” The authors tested the original factor structure of the TCQ using confirmatory factor analysis and then calculated the mean scores for each item, comparing mean total scores across “problem categories” for the full questionnaire and for the positive and negative subscales.Results:The original two-factor structure of the TCQ was a good fit to the data when the correlation between positive and negative factors was fixed at zero (root mean square error of approximation = 0.064, 90% confidence interval = 0.058 to 0.070). Items pertaining to wishing the tinnitus would go away and despairing that it would ever get better had the highest mean scores. The mean total score for the “no problem” group (M = 31.17, SD = 16.03) was not significantly different from the mean total score for the “small problem” group (M = 34.00, SD = 12.44, p = 0.99). Differences between mean scores for all other groups were statistically significant. For the negative subscale, differences were statistically significant between all problem categories. For the positive subscale, the differences between mean scores were only statistically significant for the “no problem” group (M = 28.40, SD = 17.11) compared with the “moderate problem” group (M = 18.55, SD = 8.64, p = 0.02) and for the “moderate problem” group compared with the “very big problem” group (M = 26.79, SD = 11.66, p = 0.002). Positive and negative factors were uncorrelated (ρ = −0.03.)Conclusions:The TCQ is a valid measure of positive and negative thinking in tinnitus, and the authors recommend its use in research and therapeutic settings. Negative thinking appears to be associated with more problematic tinnitus, but positive thinking is not associated with unproblematic tinnitus, suggesting that reducing negative thinking may be more important than teaching positive thinking in therapy.

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

“…In particular, the ATT could be adapted to help patients shift attention from tinnitus to other stimuli. The finding that negative thoughts and dysfunctional cognitions appears to be linked to a worse experience of tinnitus was recently investigated by other authors using the Tinnitus Cognitions Questionnaire (TCQ) [ 55 ] and the Tinnitus Cognitions Scale (T-Cog) [ 56 ]. In the present study we focused our attention on the thought process using the MCQ to demonstrate that worry and metacognition play a fundamental role in maintaining the disorder even in patients with tinnitus.…”

“…The items are scored on a 5-point Likert-type scale (1-not at all typical of me, to 5-very typical of me). Based on the final total score, the patients' worries can be classified as low , moderate (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59) and high (60-80).…”

Different Teams, Same Conclusions? A Systematic Review of Existing Clinical Guidelines for the Assessment and Treatment of Tinnitus in Adults

“…In 1–3% of cases tinnitus causes severe health problems, with a wide range of effects on daily life functioning (Davis and Refaie, 2000 ; Fujii et al, 2011 ; Kim et al, 2015 ). Evidence corroborates that the aversive psychological reactions, such as cognitive problems, negative emotions, and dysfunctional attentional processes are of main importance in leading to a severe tinnitus condition (Erlandsson and Hallberg, 2000 ; Andersson et al, 2006 ; Cima et al, 2011 ; Kleinstauber et al, 2013 ; McKenna et al, 2014 ; Handscomb et al, 2017 ).…”

Quality of Life and Psychological Distress in Portuguese Older Individuals with Tinnitus

“…Most troublesome tinnitus cases arise from the fact that patients focus too much attention on tinnitus, so this would seem likely in those individuals with higher obsessive–compulsive tendency. Moreover, catastrophic and negative thinking may be presented and can be related to higher severity of tinnitus, and consequently lower QoL [ 6 , 34 , 42 , 43 ].…”