A cognitive therapy program for hearing-impaired employees suffering from mental distress

Figures & data

Table 1. Pretest comparison of the intervention and the TAU group; demographic variables and levels of hearing impairment.

Variable	Intervention group (n = 15)		TAU group (n = 25)
	n	Mean (SD)	n	Mean (SD)
Male	7		7
Female	8		18
Age	15	49.2 (8.4)	25	52.6 (9.4)
Hearing impairment
Unilateral	3	7.5 (13) dB	3	19.4 (4.2) dB
Slight	2	32.5 (2.15) dB	4	34.2 (5) dB
Moderate	6	47.8 (6.3) dB	10	48.7 (5.3) dB
Severe	1	70 (−) dB	4	67.9 (7.5) dB
Profound	2	82.5 (2.1) dB	1	100 dB

Table 2. Overview: CBT program.

Session curriculum	Case #1	Case #2	Case #3
Description of negative consequences	Difficulties at work	Social withdrawal	Painful emotional reactions
	↓	↓	↓
Description of negative cognitions	I misinterpret messages. They see me as incompetent	I don't laugh when they do. I’m a party pooper	My grandchildren will get frustrated if I ask for repetitions
	↓	↓	↓
Identification of cognitive processing	I should absolutely not make any mistakes at any time (all-or-nothing-thinking)	I should never be a bore Always the entertainer! (perfectionism)	I’m an old nuisance (jumping to conclusions)
	↓	↓	↓
Identification of avoidant strategies	Keep the hearing problem secret. Not wear/hide hearing aids	Pretend to understand. Laugh just because others do	Mentally disconnect. Not ask for repetitions
	↓	↓	↓
Challenge negative cognitions	What is the evidence that they see you as incompetent?	Why is it so important that others should always see you as fun-loving?	What are the (immediate) benefits and (long-term) costs associated with not asking them to repeat?
	What would be the worst case scenario if you let them know that you have impaired hearing?
		What evidence suggests that they find you to be dull?
	What is the most likely scenario if you wore hearing aids at meetings?	Are you always dull all the time in all social encounters? No exceptions?
	↓	↓	↓
Test non-avoidant strategies (experiential learning)	Wearing hearing aids at meetings	Not pretending to understand at upcoming lunch	Ask for repetitions twice
	Ally with colleague who can give hints about the topic under discussion		Explain to them that Granny has bad hearing
		Not laugh when having not understood what the joke was about
	Make a request that minutes be made at meetings
		Planned participation in upcoming social event
	↓	↓	↓
Share experiences with peers and therapist	Wearing my hearing aid at work was a great help and nobody seemed to react. I felt that I was burdening my colleague, but she was really helpful and gave me clues. My secretary will make minutes from meetings from now on	It felt so risky not paying close attention to everything. But it was a great stress relief not trying so hard! Helped me grasp more of what they were saying!	Unbelievable! In contrast to what usually happens when I explain my hearing problem to adults, the children remember to always show their face while speaking to me - and they keep reminding the grownups when they forget!
	↓	↓	↓
Conclusion/consolidation phase	My diehard preconception turned faulty. I will request accomodations if needed.	My personal standards were unrealistic. Now they are high and better calibrated.	Experimenting with coping strategies gave me access to new information.

Table 3. Overview: The TAU program.

	Course topic
Day 1	Lectures on hearing and hearing loss
Day 2	Balance training and psycho-motor stress reduction
	Lectures on technical hearing devices and on how to use them
	Lectures on psychosocial consequences of hearing loss
Day 3	Experience-exchange between peers; group activities
Day 4	Experience-exchange between peers; group activities
	Balance training and psycho-motor stress reduction
Day 5	Lectures on legislation, employee rights, governmental support services
Day 6	Lectures on legislation, employee rights, governmental support services
	Experience-exchange between peers; group activities
Day 7	Experience-exchange between peers; group activities
	Lectures on psychosocial consequences of hearing loss
Day 8	Lectures on psychosocial consequences of hearing loss
	Lectures on use of efficient communication strategies
	Balance training and psycho-motor stress reduction
Day 9	Experience-exchange between peers; group activities
	Lectures on hearing and hearing loss

Table 4. Conversation tactics checklist: AVOID items.

Item	Description
3	Give up trying to understand and switch off
9	Pretend to understand what the talker is saying
19	Make the minimum amount of effort and withdraw into your own thoughts
24	Try to look interested when you are not hearing clearly
32	End the conversation if the other person looks irritated
34	Avoid having the conversation altogether if you think it will be difficult
36	Decide that what you are saying is not important enough to keep repeating it
45	Give up and leave if conversing is too difficult
47	Just keep on talking so you don't have to listen
49	Keep quiet to avoid the effort of conversing

Table 5. Changes of HAD anxiety, HAD depression, and use of avoidant communication strategies CONV(AVOID) from start to end of treatment in the pilot group (score = 1) and the TAU group (score = 0). Multivariate and univariate analyses. MANOVA, N = 33. Multivariate test: Wilks lambda = 0.518, p = 0.003.

	Change	T	p	Effect size*	F	p
HAD anxiety					10.03	< 0.001
Pilot	− 2.40	− 3.70	0.001	0.310
TAU	1.50	2.53	0.017	0.170
HAD depression					0.13	0.879
Pilot	0.07	0.14	0.894	0.001
TAU	0.22	0.49	0.627	0.008
CONV(AVOID)					4.59	0.018
Pilot	− 2.33	− 2.62	0.013	0.182
TAU	1.22	1.51	0.142	0.068

*Partial eta squared