Tinnitus Distress: The Psychological Constructs
Psychometric instruments described below assess the psychological constructs of importance as predictors for tinnitus-related distress and typically used when providing CBT for tinnitus. These instruments have all been used in previous research and have been clinically tested. They serve as examples to be used for psychological screening purposes, to measure treatment effects, as well as to monitor changes in psychological distress over time.
Measuring Tinnitus Catastrophizing
In the context of the FA model, catastrophic (mis)interpretations of the tinnitus signal trigger a cycle that leads to elevated levels of fear. Fear of tinnitus may lead to safety behaviors, which in the long run increase interference in daily life activities and result in severe disability. The Tinnitus Catastrophizing Scale (TCS) was developed to assess the level of overly negative (catastrophic) misinterpretations of the tinnitus. The TCS, a modification of the Pain Catastrophizing Scale (Sullivan et al. 1995), is a 13-item self-report measure that allows respondents to indicate the extent to which a series of statements applies to them on a five-point Likert scale as follows: 0 = not at all, 1 = to a small extent, 2 = to some extent, 3 = to a large extent, and 4 = always. The TCS is a reliable and valid measure to assess the extent to which people catastrophically misinterpret tinnitus perceptions. The TCS is a unitary measure, and evidence indicates that catastrophizing about tinnitus is a strong predictor of daily interference (Cima et al. 2011a). The TCS is sensitive and responsive over time (Cima et al. 2012) and has good test-test reliability. See Appendix 1.
Weise and colleagues (2008) used the subscale “catastrophizing” (H. Flor et al. 1993) included in the pain-related self-statements scale (Flor et al. 1993). This subscale was adapted to fit the tinnitus population, has nine items, assesses situation- specific catastrophic cognitions, and has been used in other studies (Flor et al. 2004).