{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:38:01Z","timestamp":1769020681903,"version":"3.49.0"},"reference-count":109,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Open Access Publication Fund of Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Psychological factors link the co-occurrence of tinnitus-related distress and pain perceptions in patients with chronic tinnitus.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study examines, if treatment-related changes in these factors ameliorate both tinnitus-related distress and pain perceptions in a sample of patients with chronic tinnitus.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p><jats:italic>N<\/jats:italic> = 1238 patients with chronic tinnitus provided pre- and post-treatment ratings of tinnitus-related distress and affective or sensory pain perceptions alongside measures of depressive symptoms and perceived stress. Treatment comprised an intensive tinnitus-specific multimodal treatment program. Using serial indirect-effects analyses, we examined association patterns between baseline values and change rates of those variables that were found to respond to treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Small effect sizes emerged for changes in tinnitus-related distress, affective (but not sensory) pain perceptions, depressive symptoms, emotional tension and worry. At pre- or post-treatment respectively, baseline values and change rates intercorrelated. Across timepoints, (1) <jats:italic>baseline<\/jats:italic> tinnitus-related distress and affective pain perceptions were positively associated with <jats:italic>improvements<\/jats:italic> in tinnitus-related distress, affective pain perceptions and depressive symptoms. (2) <jats:italic>Baseline<\/jats:italic> depressive symptoms or emotional tension mediated positive associations between <jats:italic>baseline<\/jats:italic> tinnitus-related distress and <jats:italic>improvement<\/jats:italic> in affective pain perceptions. (3) <jats:italic>Change<\/jats:italic> in depressive symptoms mediated the effect of baseline tinnitus-related distress on <jats:italic>change<\/jats:italic> in affective pain perceptions\u2013partly through associated change in emotional tension or worry. Mood-independent aspects of emotional tension were negatively associated with improvement in affective pain perceptions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Depressive symptoms, emotional tension and worry emerge as key predictors of treatment response and transdiagnostic treatment targets for alleviating tinnitus-related distress and functionally associated affective pain perceptions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0246747","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T18:38:41Z","timestamp":1615487921000},"page":"e0246747","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Two birds with one stone.\u2013Addressing depressive symptoms, emotional tension and worry improves tinnitus-related distress and affective pain perceptions in patients with chronic tinnitus"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8140-3332","authenticated-orcid":true,"given":"Benjamin","family":"Boecking","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Rose","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Brueggemann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Birgit","family":"Mazurek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"pone.0246747.ref001","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1067\/mhn.2001.114673","article-title":"Chronic tinnitus as phantom auditory pain","volume":"124","author":"RL Folmer","year":"2001","journal-title":"Otolaryngol Neck 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