Emotional states as mediators between tinnitus loudness and tinnitus distress in daily life: Results from the "TrackYourTinnitus" application

Abstract

The psychological process how tinnitus loudness leads to tinnitus distress remains unclear. This cross-sectional study investigated the mediating role of the emotional state "stress level" and of the two components of the emotional state "arousal" and "valence" with N = 658 users of the "TrackYourTinnitus" smartphone application. Stress mediated the relationship between tinnitus loudness and tinnitus distress in a simple mediation model and even in a multiple mediation model when arousal and valence were held constant. Arousal mediated the loudness-distress relationship when holding valence constant, but not anymore when controlling for valence as well as for stress. Valence functioned as a mediator when controlling for arousal and even when holding arousal and stress constant. The direct effect of tinnitus loudness on tinnitus distress remained significant in all models. This study demonstrates that emotional states affect the process how tinnitus loudness leads to tinnitus distress. We thereby could show that the mediating influence of emotional valence is at least equally strong as the influence of stress. Implications of the findings for future research, assessment, and clinical management of tinnitus are discussed.

Figure 1. Path diagram of the simple mediation model: Investigating stress level as a mediator between tinnitus loudness and tinnitus distress.

c = direct effect of tinnitus loudness on tinnitus distress; ab = indirect effect of tinnitus loudness on tinnitus distress through stress level.

Figure 2. Path diagram of the first multiple mediation model: Investigating arousal and valence as mediators between tinnitus loudness and tinnitus distress.

f = direct effect of tinnitus loudness on tinnitus distress; d₁e₁ = indirect effect of tinnitus loudness on tinnitus distress through arousal; d₂e₂ = indirect effect of tinnitus loudness on tinnitus distress through valence.

Figure 3. Path diagram of the second multiple mediation model: Investigating stress level, arousal, and valence as mediators between tinnitus loudness and tinnitus distress.

i = direct effect of tinnitus loudness on tinnitus distress; g₁h₁ = indirect effect of tinnitus loudness on tinnitus distress through stress; g₂h₂ = indirect effect of tinnitus loudness on tinnitus distress through arousal; g₃h₃ = indirect effect of tinnitus loudness on tinnitus distress through valence.