This program of research investigated the role of cognitive factors in adjustment to cochlear implantation. A cochlear implant is a medical device for severe to profoundly deaf individuals that simulates sound in the cochlea by electrically stimulating the hearing nerve. The audiological benefits of implantation have shown to be highly variable and difficult to predict. This has led to the utilisation of psychological factors to predict adjustment. The aim of this thesis was to develop an understanding of the psychological factors influencing adjustment to implantation within a cognitive framework. Three studies were conducted that investigated the central hypothesis that individuals with a maladaptive cognitive style are more likely to experience poorer psychological adjustment following implantation. Study 1 was a cross-sectional survey that aimed to identify the main predictors of post-implant adjustment in a large representative sample of adult cochlear implant recipients. Participants completed measures of hearing-related cognitions, anxious and depressive symptomatology, emotional reaction to the implant, and hearing-related demographic characteristics. Psychological adjustment was assessed as stress and coping in relation to hearing impairment. The tendency to engage more frequently in negative hearing-related cognitions was found to be the strongest predictor of adjustment. This finding was consistent with the hypothesis that a maladaptive cognitive style plays a key role in determining psychological outcomes following implantation. Study 2 extended Study 1 by experimentally investigating the impact of a specific maladaptive cognitive process, rumination, on cochlear implant recipients' response to an auditory task. Based on the Study 1 finding that negative cognitions predicted poorer adjustment, participants engaged in either a positive or negative rumination task. During rumination, participants focussed on a series of either positive or negative self-statements. Following rumination, participants completed an auditory (story listening) task. Participants then rated their mood, extent of negative cognitions, and the perceived difficulty of the auditory task. Inconsistent with predictions, participants who engaged in negative rumination did not respond more negatively on any of the ratings than participants who engaged in positive rumination. A correlational analysis, however, showed that greater perceived task difficulty was associated with lower frequency of engagement in positive cognitions about hearing. Study 3 employed a thought suppression paradigm to investigate in cochlear implant recipients the effects of suppressing thoughts about hearing difficulty during an auditory task. It was predicted that participants instructed to suppress would experience an increased frequency of target thoughts and greater negative mood, both during and after suppression. During the first (baseline) experimental period, both suppression and non-suppression participants monitored their thoughts by pressing a button when they experienced a thought about hearing difficulty. In the second (suppression) period, suppression participants suppressed their thoughts about hearing difficulty. In the third (post-suppression) period, suppression participants were instructed to no longer suppress their thoughts. Participants who suppressed had an increased frequency of target thoughts subsequent to, but not during, suppression. There were no differences between suppression and non-suppression participants for mood, either during or after suppression. The finding of a delayed increase in target thoughts indicated that attempting to suppress thoughts about hearing difficulty may be a maladaptive cognitive strategy for managing unwanted negative cognitions about hearing in cochlear implant recipients. In concluding, the thesis proposes a cognitive model of adjustment to cochlear implantation that synthesises the findings of the studies conducted and takes into account the cognitive theories that informed the program of research. The major components of this model include the tendency to engage in negative hearing-related cognitions, the maladaptive cognitive processes employed to manage negative hearing-related cognitions, and cognitive load factors. While far from conclusive, the model presents an initial framework within which the current findings can be understood and further hypotheses generated. Methodologically, the model also provides an empirically informed framework for future investigations into the cognitive factors associated with adjustment in cochlear implant users.
| Identifer | oai:union.ndltd.org:ADTP/229923 |
| Date | January 2005 |
| Creators | Lim, Debbie K., Psychology, Faculty of Science, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Psychology |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Debbie K. Lim, http://unsworks.unsw.edu.au/copyright |
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