Hearing is one of the essential tools for language development, skills acquisition and social interaction. It determines the ability to relate, communicate effectively and subdue the pressure in one's environment. However, there are situations such as congenital defect, injury, disease and certain medications that could result in hearing impairment. The individuals with hearing impairment experience alteration to smooth process of information in form of acoustic stimuli traceable to dysfunctional hearing system. This may lead to communication breakdown and social isolation that could result into psychological distress.
Psychological distress represents a dimension of mental ill-health that has neither uniform definitions nor measures. Compared to mental disorder, which refers to categorical clinical diagnoses, psychological distress refers to psychopathology that is less specific and can be measured in a simple and cost effective way in the general population. It is defined as a non-specific syndrome that covers constructs such as depression, anxiety, cognitive problems, irritability, anger and obsession -compulsion
Insomnia represents actual inability to sleep one's usual amount of time -a condition characterised by any combination of difficulty with falling asleep, staying sleep, intermittent wakefulness and early morning awakenings
Individuals with hearing impairment, like any other persons, experience psychological distress. The problem of communication and social interaction associated with hearing impairment have significant impact on the cognitive and social functioning
Having presented the myriad of potential risk factors for exhibiting the symptoms of psychological distress among adolescents with hearing impairment, there is the need to evolve methods that could help these adolescents exhibit more effective interpersonal, cognitive and emotional behaviours that could lead to improved social and cognitive functioning. For the purpose of this study, cognitive therapy was employed because the technique has been gaining credence in recent years.
Cognitive therapy stems from the cognitive theory of depression, proposed by
During the therapy process, clients undergo an intake protocol consisting of a clinical interview and psychological test. The clinical interview provides a thorough history of the background factors contributing to the client's distress. The interview also assesses the current level of functioning, prominent symptoms and expectations for therapy. The initial interview has many purposes which include initiating relationship, providing a rationale for cognitive therapy, producing symptom relief, and eliciting important information. During the initial interview, the therapist starts to define the problems, using both functional and cognitive analyses. The functional analysis seeks to answer questions such as: 'What are the component parts of the problem?', 'How is it manifested?', 'In what situation does it occur?', 'What is its frequency, intensity and duration?', and 'What are its consequences?'
The cognitive analysis identifies the client's thoughts and images when emotion is triggered and the extent to which the client feels in control of thoughts and images. From the beginning, therapist trains client to monitor their feelings, thoughts and behavior and to cognise the connections between them. Homework is a feature throughout cognitive therapy. While the early stages of therapy may focus on symptom removal, middle and later stages are more likely to emphasise changing client's pattern of thinking
More importantly, both cognitive and behavioural interventions are used in cognitive therapy. The interventions selected should depend on such factors as the nature of the client's problem, the therapeutic goals and how well they are functioning. The cognitive interventions are used to replace client's distorted automatic thoughts and beliefs with more realistic ways of processing information. The interventions include eliciting and identifying automatic thoughts (e.g. questioning, focusing on imagery, self-monitoring of thought, encouraging clients to engage in feared activities), reality-testing and correcting automatic thoughts (e.g. conducting Socratic dialogues, identifying cognitive distortion, decatastrophising, reattribution, decentring, forming rational responses) and identifying and modifying underlying beliefs (e.g., hypothesis testing, refashioning beliefs). Behavioural interventions in cognitive therapy are used to: lay foundation for later cognitive work; assist clients in reality testing their automatic thoughts and beliefs; assist client engage in feared activities; and train clients in specific behavioural skills. The interventions include activity scheduling, rehearsing behavior and role-playing, assignment graded tasks and assigning homework
The following hypotheses were tested in the study at 0.05 level of significance. HO 1 : There is no significant main effect of treatment on participants' management of psychological distress. HO 2 : There is no significant interaction effect of (a) onset of hearing and (b) self-esteem on participants' management of psychological distress. HO 3 : There is no significant interaction effect of treatment, onset of hearing loss and self-esteem on participants' management of psychological distress.
The study was conducted in three integrated schools from two senatorial districts of Oyo State. These schools were chosen because they were considered adequate to provide opportunity for generalisation of the research findings. The pretest-posttest control group quasi-experimental design was adopted for the study. The population for this study consisted of adolescents with hearing impairment. Purposive sampling technique was used to select 53 adolescents with hearing impairment from the three integrated secondary schools purposively selected from the two senatorial districts. The Kessler Psychological Distress scale with index scores of 19 and above was the screening tool used to determine distressed adolescents with hearing impairment. The adolescent were in the 12-21 age range. The participants were randomly assigned to cognitive therapy (31) and control (22) groups. Three research instruments: Kessler Psychological Distress Scale, Clinical Outcomes in Routine Evaluation and Rosenberg Self-esteem Rating Scale were used in this study. Kessler Psychological Distress Scale (KIO)
The procedure for data collection was carried out in three phases -pre-treatment, treatment and post-treatment. During the pre-treatment, the major activity was the screening of the adolescents for study eligibility. In the treatment phase, the major activities included administering the Core 20 to the two groups for the purpose of obtaining pre-test scores and the Rosenberg Self-esteem Rating Scale to classify the participants. The participants in the experimental group were then subjected to ten 60 minutes-weekly sessions of cognitive therapy, while those in control group were managed with distress education counselling for ethical reasons. The cognitive therapy treatment protocol was adapted from
Hypothesis One: There is no significant main effect of treatment on participants' management of psychological distress.
The result from
Hypothesis Two: There is no significant main effect of: (a) onset of hearing loss, and (b) self-esteem on participants' management of psychological distress. The results from table 3 revealed that there was no significant main effect of onset of hearing loss (F (1,40) =0.563; p > 0.05, partial η 2 =0.012) on participants' management of psychological distress. This means that onset of hearing loss had no main effect on the management of psychological distress. Thus, the hypothesis 2(a) is accepted.
However, there was a significant main effect of self-esteem (F (2,40) =41.700; p < 0.05, partial η 2 =0.645) on participants' management of psychological distress. Thus, the hypothesis 2(b) is rejected which implies that self-esteem had a main effect on the participants' management of psychological distress. To ascertain the direction and determine the magnitude of the mean scores of the participants' (with high, moderate and how self-esteem) distress management in the treatment group, Bonferroni posthoc test analysis was calculated and presented in
The result from
Hypothesis Three: There is no significant interaction effect of treatment, onset of hearing loss and self-esteem on participants' management of psychological distress.
The result from
The result of the study revealed a significant difference among the experimental and control groups on the management of psychological distress. This result did not provide support for Hypothesis One, suggesting a non-significant main effect and hence, was rejected. Nonetheless, the data collected appear to provide evidence in favour of the experimental group as being superior over their counterparts in the control group in the management of psychological distress. Specifically, the intervention was found to have contributed significantly to the management of psychological distress among the participants. This results is consistent with the growing body of research that had used psychotherapeutic techniques such as cognitive therapy for the management of psychological distress among adolescents with hearing impairment
The finding of this study support Hypothesis 3 that there is no significant interaction effect of treatment, onset of hearing loss and self-esteem on participants' management of psychological distress. This result suggested that the effect of treatment did not depend on the other two factors (onset of hearing loss and self-esteem) to make a difference for both onset of hearing loss and self-esteem characteristics of the participants.
Based on the finding of this study, it is recommended that special educators, social workers, counselling psychologists and professional caregivers could use the cognitive therapy treatment protocol to manage psychological distress among adolescents with hearing impairment. The therapy could also be recommended for both types of onset of hearing loss (pre-lingual and post-lingual) and the three levels of self-esteem (high, moderate and low).
From the results of the present study, it is evident that cognitive therapy is effective for the management of psychological distress among adolescents with hearing impairment in Oyo State. And since the 3-way interaction effect of treatment, onset of hearing loss and self-esteem was not significant, it suggests the suitability of the therapy for both types of onset of hearing loss (pre-lingual and post-lingual) and levels of self-esteem (high, moderate and low).