Paradoxical relationship between distress and functional network topology in phantom sound perception

Distress is a domain-general symptom that accompanies several disorders, including tinnitus. Based on previous studies, we know that distress is encoded by changes in functional connectivity between cortical and subcortical regions. However, how distress relates to large-scale brain networks is not yet clear. In the current study, we investigate the relationship between distress and the efficiency of a network by examining its topological properties using resting state fMRI collected from 90 chronic tinnitus patients. The present results indicate that distress negatively correlates with path length and positively correlates with clustering coefficient, small-worldness, and efficiency of information transfer. Specifically, path analysis showed that the relationship between distress and efficiency is significantly mediated by the resilience of the feeder connections and the centrality of the rich-club connections. In other words, the higher the network efficiency, the lower the resilience of the feeder connections and the centrality of the rich-club connections, which in turn reflects in higher distress in tinnitus patients. This indicates a reorganization of the network towards a paradoxically more efficient topology in patients with high distress, potentially explaining their increased rumination on the tinnitus percept itself.