title: Tinnitus- related distress: evidence from fMRI of an emotional stroop task.
abstract: BACKGROUND
  Chronic tinnitus affects 5 % of the population, 17 % suffer under the condition. This distress seems mainly to be dependent on negative cognitive-emotional evaluation of the tinnitus and selective attention to the tinnitus. A well-established paradigm to examine selective attention and emotional processing is the Emotional Stroop Task (EST). Recent models of tinnitus distress propose limbic, frontal and parietal regions to be more active in highly distressed tinnitus patients. Only a few studies have compared high and low distressed tinnitus patients. Thus, this study aimed to explore neural correlates of tinnitus-related distress.
  
  
  METHODS
  Highly distressed tinnitus patients (HDT, n = 16), low distressed tinnitus patients (LDT, n = 16) and healthy controls (HC, n = 16) underwent functional magnetic resonance imaging (fMRI) during an EST, that used tinnitus-related words and neutral words as stimuli. A random effects analysis of the fMRI data was conducted on the basis of the general linear model. Furthermore correlational analyses between the blood oxygen level dependent response and tinnitus distress, loudness, depression, anxiety, vocabulary and hypersensitivity to sound were performed.
  
  
  RESULTS
  Contradictory to the hypothesis, highly distressed patients showed no Stroop effect in their reaction times. As hypothesized HDT and LDT differed in the activation of the right insula and the orbitofrontal cortex. There were no hypothesized differences between HDT and HC. Activation of the orbitofrontal cortex and the right insula were found to correlate with tinnitus distress.
  
  
  CONCLUSIONS
  The results are partially supported by earlier resting-state studies and corroborate the role of the insula and the orbitofrontal cortex in tinnitus distress.
authors: Department of Clinical Psychology and Psychotherapy, Georg-August-University, Georg-Elias-Mueller-Institute of Psychology, Gosslerstrasse 14, 37073 Goettingen, Germany ; University of Southampton, Academic Unit of Psychology, Developmental Brain Behaviour Laboratory, Highfield Campus, Building 44, SO17 1 BJ Southampton, UK.
authors: Dennis
authors: D
authors: Golm
authors: Georg-August-University, UMG, MR-Research in Neurology and Psychiatry, Robert-Koch-Str. 40, 37075 Goettingen, Germany.
authors: Carsten
authors: C
authors: Schmidt-Samoa
authors: Georg-August-University, UMG, MR-Research in Neurology and Psychiatry, Robert-Koch-Str. 40, 37075 Goettingen, Germany.
authors: Peter
authors: P
authors: Dechent
authors: Department of Clinical Psychology and Psychotherapy, Georg-August-University, Georg-Elias-Mueller-Institute of Psychology, Gosslerstrasse 14, 37073 Goettingen, Germany.
authors: Birgit
authors: B
authors: Kröner-Herwig