Appraisals of cognitions and distress: Investigating the effectiveness of psychological interventions to reduce tinnitus distress, and the experience of obsessive intrusive thoughts and involuntary musical imagery

Research has indicated that maladaptive appraisals of cognitions and cognitive experiences (such as intrusive thoughts and auditory hallucinations) can maintain distress. Theories suggest this mechanism can explain why such experiences can fall on a continuum from unproblematic to distressing. This thesis focused on three involuntary cognitive experiences prevalent in nonclinical and clinical populations where this mechanism of distress has been hypothesised: tinnitus; obsessive intrusive thoughts (OITs); and involuntary musical imagery (INMI). Evaluation of the effectiveness of psychological interventions to reduce tinnitus distress, and investigation into appraisals of OITs and INMI and what might have influence over these was conducted. A systematic review and meta-analysis was conducted on 21 studies to identify and evaluate the effectiveness of psychological interventions for reducing tinnitus distress in adults. Large treatment effects emerged for cognitive-behavioural therapy (CBT) in both therapist-delivered and self-help formats. A very large treatment effect emerged for ‘other’ approaches including multidisciplinary combinations of sound therapy techniques with psychological intervention, mindfulness, and psychoeducation. It was concluded that cross-disciplinary combined interventions and those aimed at addressing maladaptive appraisals of tinnitus could facilitate a reduction in distress. Study limitations and clinical implications were discussed. The empirical chapter investigated OITs and INMI. Ninety-one UK university staff and students completed measures of OIT and INMI appraisal, perceived thought control and self-reported thought suppression. Additionally, the predictive influence of working memory on these measures was also explored. Participants completed a computerised operation span task to test working memory capacity (WMC). Significant relationships emerged between both negative OIT and INMI appraisal. Negative appraisal for both OITs and INMI were significantly associated with low perceived thought control, but this was weak for INMI. Negative OIT appraisal was significantly related to higher self-reported thought suppression. WMC did not significantly explain the variance in these variables. Study limitations and implications for clinical practice were discussed. In conclusion, the literature review highlighted effectiveness of interventions which challenge maladaptive appraisals in reducing tinnitus distress; and the empirical chapter drew associations between negative appraisals of involuntary cognitions, and beliefs about thought control. Together, the findings suggest commonalities in mechanisms of distress which may be extended across a range of experiences, including those traditionally considered to be unproblematic and which have only recently started to be explored (such as INMI). It is recommended that appraisals of other experiences which can cause distress, and potential interventions which target such appraisals, continue to be explored in future research.