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Jownol ,<fP~vrhosomnr,c Resrorch. Vol. 35, No 415. pp 383-390, Prmted in Great Britam.

1991 0

0540-3999/91 53.00+ 00 1991 Pergamon Press plc

ANXIETY

AND DEPRESSION

IN TINNITUS

SUFFERERS

JONATHAN B. S. HALFORD* and STEWART D. ANDERSON
(Received 16 October 1990; accepted in revised

form 24

January

1991)

Abstract-This paper focuses upon the relationship between tinnitus and personality. One hundred and twelve members of a tinnitus self-help group completed psychological and tinnitus questionnaires. In line with prior studies we found that tinnitus was associated with elevated anxiety trait and depression. Unlike previous work, use of a validated subjective tinnitus scale allowed us to directly test the strength of association. Although both anxiety trait and depressive tendency were significantly correlated with overall tinnitus severity, the coefficients were of low magnitude. Advancing age was related to a reduction in depressive tendency; and being male was associated with lower anxiety and depression scores. While hypothesizing a bi-directional causality between personality and the impact of tinnitus, we acknowledge that only longitudinal research can unequivocally test this.

INTRODUCTION TINNITUS, is the experience of hearing sound from the ears or head where no external sound source is present. It does not fit a single disease structure model, but is a disorder of multiple causality [ 11. Noise exposure is a common cause, but many ear disorders can lead to tinnitus. The prevalence of sustained tinnitus, of a form likely to lead to medical consultation is estimated at 2-7 % of the adult population [2-41. Generally, tinnitus reflects no serious underlying pathology. Also in the vast majority of cases the sound level can not be objectively measured: however, it can be estimated by matching the intensity of the tinnitus to a noise produced by an audiometer. Using this technique the sensation level of the tinnitus is usually only slightly above threshold and bears little relation to the degree of subjective complaint [51. However, tinnitus can potentially cause psychological distress out of proportion to its relatively small sensation level. This potentially distressing aspect of tinnitus, Vernon has likened to Chinese water torture [61. Using the Crown-Crisp Experiential Inventory, Stephens and Hallam [71 found anxiety and depression elevated in ENT clinic attenders complaining of tinnitus, when compared with normative values. Whereas another study [81 found no differences in neuroticism (using the Eysenk Personality Inventory), between ENT clinic attenders specifically complaining of tinnitus, and those who acknowledged tinnitus upon questioning, but were referred for other reasons. Presenting graphic and illustrative data, Reich and Johnson [91 indicated that their tinnitus clinic patients showed increased psychopathology on the Minnesota Multiphasic Personality Inventory. A postal survey [lo] of a tinnitus self-help group found that 70% of 72 respondents included emotional problems in their list of common difficulties. Post hoc semantic analysis indicated that one third of respondents complained of tinnitus-related relaxation/irritation/annoyance and/or depression/despair/frustration problems (statistical significance levels not reported).

Department of Neurophysiology, *Author to whom correspondence Hospital, Cromwell Road, London

Cromwell Hospital, should be addressed SW5 OTU, U.K. 383

London. at: Department

of Neurophysiology,

Cromwell

with four binary (yes/no) items. The first entails 28 Inferential Depression Items (IDI) relating to cognitions and behaviour. where it correlates with the Hamilton Depression Rating Scale [ 191 (r? = 0. The STSS has a separate supplementary scale: Tinnitus Variability (TV). The internal consistency reliability is high (in this tinnitus study coefficient alpha = 0. ANDERSON In the above studies comparisons were made between differences in psychopathology between tinnitus patients and ‘normals’ (or tinnitus non-complainers). being 112 members of a local group of the British Tinnitus Association (BTA). with approximately 70% between 50-75 years old). selfperceived tinnitus variables (annoyance. This was measured using a 35. and hence poorer adaptation. p<O. Anxiety trait was measured using the trait section of Spielberger’s State-Trait Anxiety Inventory (STAI) 1131. It has been validated on a psychiatric out-patient sample (N = 3 1). TV being a neutral measure of how much the tinnitus fluctuates. While predicting this relationship.82). binary response (yes/no) Subjective Tinnitus Severity Scale (STSS). Tim&us severity. D. 1111 bridges both approaches. S. across a variety of tinnitus complaints. Questionnaire Amiety trait. The second section has six items making up the Professional Contact for . The mean age was 61. with a choice of four responses. 64 females. as this has been shown to be sensitive to sub-clinical depressive tendency 1141. Kirsch eb al. Depressive tendency. Tinnitus severity was assessed using the 16-item. in relation to anxiety trait and depressive tendency levels. depressive tendency and tinnitus severity. METHOD Subjects Forty-four males. with comparative groups and direct measures. We also wished to determine whether increased tinnitus variability would lead to heightened anxiety and depression. depression classification system 1201 (r’ = 0. directly related.9 yr (range 29-87 yr.58.OOl). Most were long-term tinnitus sufferers (82% had suffered for four years or more). we were also interested in examining the extent to which anxiety trait.item binary (yes/no) Depressive Tendency Questionnaire (DTQ).63. However these researchers were interested in assessing single. This being based on the premise that greater variability would lead to enhanced attentional focus. and 4 of unstated sex. we presumed that increased tinnitus severity would be related to higher anxiety and depression levels. B. This was measured by the trait component of Spielberger’s State-Trait Anxiety Inventory (STAI) form Y. can lack sensitivity in estimating depression in general health care settings 116-181 (for DTQ reliability and validity data: see Method).001) and the American Psychiatric Society’s DSM-III-R. and examined the relationship between the degree of tinnitus severity within this group. p < 0. This consists of 20 statements. A four-item scale of tinnitus variability (TV) was also employed. Clinical scales of depression while suitable for psychiatric screening [ 151. prominent and distressing is the tinnitus. This reflects both depressive history and current state. In contrast we employed a questionnaire to yield an overall total score. HALFORD and S.384 J. coping and loudness) using a visual analogue technique. A Depressive Tendency Questionnaire (DTQ) was employed. This is a method of estimating overall tinnitus severity according to how intrusive. Predictions and intentions In view of the above research. This measure (the Subjective Tinnitus Severity Scale [STSSI) is a reliable and clinically valid evaluation of tinnitus severity [ 121. Our approach was different in that we chose a sample of serious tinnitus sufferers (a self-help group). The DTQ comprises two sections. See Appendix for STSS and TV items.

99 -2.9 Male 9.05 2. Anxiety trait and depressive tendency correlated more highly with each other (9 = 0. while significant.05 Probability 2-tail. however. depression and tinnitus 385 Depression (PCD) sub-scale.4 vs 7. Procedure One hundred and fifty questionnaire data sheet were mailed to officials of were then passed on by post to the compliance. showed that elevated tinnitus severity was significantly associated with both higher mean anxiety trait (46.001). duced the results shown in Table I.Var. These regular fee-paying members along with literature encouraging the questionnaires anonymously. onetailed p < 0.p = NS Z-tail. DTQ.9. On two-way analysis of variance. There is. mailing them directly to the 112 was high at 75%.01) and depressive tendency levels (14. acting as intermediaries. correlation data demonstrates that the degree of direct association between either psychological variable and tinnitus. SEX AND THE MAIN STSS.1 9.5 42.9 12. p = NS 2-tail.76. 50 48. However. STSS STAI Overall DTQ STSS = 9.6 STAI = 43.-SHOWS THE RESULTS VARIABLES.001).3 vs 39. 60 40.0 for age Overall means are also given. one-tailed p < 0. STAI. The response rate of packages containing the STSS. p < 0. OF t-TESTS BETWEEN AND AGE.6 46.1 means: Younger 9. The full DTQ was administered.Var. It can be seen that no relationship is demonstrated between age and either the STSS or STAI. p = NS I-tail. Respondents completed research centre.15 t-obs 0.4 DTQ 56. STSWDTQ r* = 0.Var. 52 48. Sex Sex Sex Dep.1 p < 0. STSS STAI Older 9. 52 Ns 44.28. there was no interaction effect between anxiety and depression. depressive tendency.26 1.74 -3. STSS: Tinnitus severity. showing more depressive tendency than those over .6 44. 68 41.32. a seventh item relates to a past perceived need for professional help. and DTQ: age and sex effects pro- t-Tests examining the potential effects of age and sex on the main variables.Var. 60 Dep.Ol Ind. one-tailed p<O.4 DTQ = 12. fitness and adequacy of sleep).Anxiety. Age Age Age Ind. but three health-related questions were omitted from analysis to guard against an erroneously high correlation with tinnitus severity (perceived general health.2 12.6 39.Ol.p<O. STAI: anxiety trait.p<0.3 Female 9.Ol I-tail.p<O. STAI. STAI Ns DTQ t-obs 0. The median age of 65 years are used as a division groups. RESULTS The relationship between Tinnitus Depressive Tendency (DTQ) Severity (STSS) Anxiety Trait (STAI) and One-tailed t-tests with individuals grouped according to high or low STSS. TABLE I. was of low magnitude (STSSSTAI 6 = 0. an effect of age on the DTQ.06 Probability 2tai1. DTQ and a biographical a local tinnitus self-help group.3 9. The items are listed in the Appendix.001). STSS. with the younger division of this fairly elderly sample. with tinnitus severity as the dependent variable.

TV AND DTQ PCD 0. STAI: anxiety trait.32** 0. is indicative of the surface validity of the DTQ. Anxiety Trait (STAI) and It was noted that Tinnitus Variability did not prove a very discriminating scale on this sample.71**) 0. one can not make unequivocal causal statements on the basis of non-longitudinal research. no significant relationship was demonstrated between Tinnitus Variability and the STSS. (i.51** (0.51** 0. B. being items referring to cognitivebehavioural aspects of depression.02 STSS STSS STAI 0. with 73% scoring 3 or 4. However. a response range of 5) the median split divided at four or below.52** 0.32** 0.71**) 0. ANDERSON 65 yr.74** 0. Considering anxiety as a potential product. DTQ: depressive tendency. ** = one-tailed p < 0.28” 0. lXe relationship between Tinnitus Depressive Tendency (DTQ) Variability females display both higher (TV).16 0.17 0.12 0. Viewing enduring psychological change as a potential consequence of tinnitus is feasible in this sample.01.2s* 0. D.12 DTQ 0. one can envisage how the presence of an unwanted sound perceived within the ear or head can contribute to tension and cause irritation. S. TV: Tinnitus variability. PCD: professional contact for depression. TABLE II.32** 0. HALFORD and S. however.32** 0. (ii) PCD refers to actual contact with professionals associated with depression.19 DTQ ID1 PCD TV (i) IDI represents most of the DTQ. Sex has no bearing on STSS values. DISCUSSION The primary finding was a significant association between the severity of the tinnitus defined subjectively. * = one-tailed p < 0. DTQ.76** 0.16 ID1 0.-SHOWS CORRELATIONS BETWEEN THE STSS.02 TV 0. In any case it is the authors’ belief that the relationship between the psychological states of anxiety and depression are associated with tinnitus in a bi-directional fashion.386 J. as most had long-term tinnitus. As shown in Table II. IDI: inferential depression items. and the two psychological variables of anxiety trait and sub-clinical depressive tendency.e. The significant correlation between the inferential depression items (IDI) section of the DTQ and the actual professional contact component (PCD). Tinnitus patients often complain of interference with quiet recreation and . anxiety trait and depressive tendency scores.52** 0. Neither the STSS nor TV are associated with professional contact for depression.76** (0.17 0.001. Bracketed values are spurious being between the DTQ and its own sub-scales. Although individuals could score from O-4. STSS: Tinnitus severity.96**) 0.96**) (0. STAI or DTQ. the greater the likelihood the individual will have a more anxious personality and a tendency to sub-clinical depression. Our results suggest that the worse the tinnitus complaint.74** (0. The PCD correlates significantly with anxiety.07 0.07 STAI 0. THE TWO SUB-SCALES OF THE STAI.19 0.

if an individual is especially anxious. albeit to a highly significant extent. is likely to operate at a cognitive and motivational level. STAI scores were particularly elevated. at its worst making people feel tense and on edge. One can not control whether or not one has tinnitus.Anxiety. but one can control or influence the extent to which one attends to it. In relation to self-appraisal depression can also lead to selective recall. . anxiety trait scores were elevated. is less likely to register what is beneficial in reducing tinnitus primacy. We should remember that although potentially related. strategems that may offer relief from tinnitus. Suitable normative data for the DTQ was unavailable. for those females in our sample aged 50-69 yr (N = 36).221 is compatible. An individual with a negative cognitive set. In particular the prediction that increased variability would lead to a heightened cognitive focus. Either there is no linear relationship between these concepts or scale limitation was responsible. and hence more anxiety and depression was not proven. favouring negative over positive schemata 123. It is assumed that membership of such a group is likely to entail a sample of individuals with a more severe form of tinnitus than the general tinnitus population and/or a greater degree of psychological problems. The view that psychological state may exacerbate tinnitus is reinforced by the commonly reported problem. When tense and anxious. For the 60% of the sample for whom age related comparisons could be made. were members of a tinnitus self-help group. these are three separate variables. and perceive (accurately) that their tinnitus is unlikely to subside. see and smell better. The relationship between the degree of tinnitus severity. reflecting either pre-tinnitus personality or anxiety and depression brought on by tinnitus. may seem more intolerable. 241. as many tinnitus sufferers feel distressed at having a condition beyond their control. but ‘hear’ their tinnitus ‘better’ too. and can become depressed. However. Seligman’s model of depression 12 1. on this sample the scale was not sensitive enough to adequately test the hypothesis. Thus these psychological variables correlate with the STSS at low magnitude. reducing enjoyment of quiet recreation) or indirect (e. placing them at the 97th percentile of normal adults. sleeplessness is interfering with job performance and thus self-esteem). which would seem to reflect an above average history of depression. The STAI and DTQ scores here reflect anxiety trait and depressive tendency both associated with tinnitus and non-associated. Small numbers were involved for some age/sex groups. and (c) focus upon. (b) recall. depression and tinnitus 387 relaxation. tinnitus like pain. The role depressed mood can play.g. Frequently persons report difficulty in falling asleep or falling back to sleep. 23 % of the sample reported having seen a psychiatrist with a depressive illness.g. With the majority of subjects gaining maximum or nearmaximum score. that stress aggravates tinnitus. At a physiological level. The separate Tinnitus Variability (TV) measure did not relate to any of the psychological or tinnitus variables. as in the quiet of the night even a minor tinnitus can be aggravating. Unfortunately they will not just hear. anxiety and depression is a complex one. and less inclined to actively explore what may be beneficial. However. perceptual acuity will be heightened. Equally individuals may complain of the effect of tinnitus on their quality of life. this may make the depressed individual less likely to: (a) attend to. This can be direct (e. As part of a negative perspective. One notes that these subjects like Tyler and Baker’s 1101.

1983. Spielberger [131 reports similar findings in college students and military recruits. 1987. Our females with tinnitus scored higher on anxiety trait than their male counterparts. Vol. 6. GHS 8311. and with research using a psychiatric sample [261. 4. at the Institute of Hearing Research [271. TAYLOR-WALSH E. 147-153. is in agreement with a large general practice study [251. 10. both of whom helped in gaining data from members of the Basildon Branch of the British Tinnitus Association. Br J Audio1 1985. J Speech Hear Dis 1983. HAZELL JWP. It is considered that the causal relationship between these psychological variables and tinnitus severity. In Hazell. SMITH P. PARNES SM. 31-50. 23: 229-237. However it will be a great many years before this project reaches completion. (Edited by SHULMAN A). 59-72. much was not. hearing and vestibular disorders. HALL-AM RS. 1984. STEPHENS RDG. COLES R. I I KIRSCH CA. REICH GE. VERNON J. and express our thanks to his wife. CONCLUSION Tinnitus severity measured by a subjective scale was significantly associated with elevated anxiety trait and depressive tendency. In: Contributiom to Medical Psychology. versus the role that tinnitus plays in causing anxiety and depression will hopefully become clearer from this study’s findings. The Prevalence of Tinnitus 1981. Prevalence estimates of communicative disorder in the US: language. JOHNSON RM. London: OPCS Monitor. JWP op. J Lar. Ackr~o~~lrdgemenfs-This study was supported by the Ian Mactaggart Trust. 9: 17-21. (Edited by RACHMAN S). which is in keeping with research showing that mental wellbeing increases with age [16]. The Crown-Crisp Experiential Index in patients complaining of tinnitus.~n~ol Otol Sup 1984. HALLAM RS. A prospective project on psychological trait and ongoing tinnitus development has been incorporated into an existing longitudinal study on hearing and related disorders. with facilities provided by the Cromwell Hospital. Characteristics of tinnitus and related observations in over 1800 tinnitus clinic patients. Psychosom Med 1989. TYLER RS. OFFICE OF POPULATION CENSUSES AND SURVEY’S. 19: 151-158. BAKER LJ. HINCHCLIFFE R. 3. 1987. HALF~RD and S. but no such sex differences in high school students or working adults. Oxford: Pergamon Press. LESKE MC. J Laryngol Otol 1984. cit. MEIKLE M. The higher scores on the DTQ for females. In Proceedings of the Second International Tinnitus Seminar. The extent to which pre-existing personality factors may predispose an individual to poor adaptation to tinnitus. However. . pp. S. OPCS. Tin&us. 9. 2. 7. 5. Difficulties experienced by tinnitus sufferers. Edinburgh: Churchill Livingstone. Psychological aspects of tinnitus. depressive tendency was lower in those over 65. Psychological characteristics of individuals high and low in their ability to cope with tinnitus. Personality characteristics of tinnitus patients. Suppl. We also would like to pay tribute to the late John Brown. Karlruhe: Harsch 1987. RACHMAN S. BLANCHARD EB. Assessment of the tinnitus patient. General Household Survey. Editor. D. Asha 1981.388 J. 3. 9: 228-232. B. REFERENCES 1. Epidemiology of tinnitus: an update. 48: 150-154. In: Proceedings ofthe Third International Tinnitus Seminar (Edited by FELDMANN H) pp. 8. ANDERSON Despite the overall elderly nature of the sample. 51: 209-217. is likely to be bi-directional but that no definite conclusions can be drawn from non-longitudinal research. which found a higher prevalence of depression in females. age-related mental health differences manifested themselves. the low level of direct correlation between these variables underlines the point that although some of the anxiety and depression in this sample was tinnitus-related. With no effect on anxiety.

(1984) Psychosocial status in chronic illness: a comparative analysis of six diagnostic groups. Third 20. 105: 89-93. LUSHENE R. Question 35 is included in DTQ total score but excluded from PCD. HALFORD JBS. Have you ever thought that there is little point. 83-125. J Abnorm 23. Psycho1 Med 1981. COLES RRA. in Parkinson’s disease: a quantitative and 17. of a rating scale for primary depressive illness. ZIGMOND AS. Depression and learned helplessness. GOTHAM. TENAGLIN AN. WURTZ PJ BURDICK BM. 1989. Would you say that you were reasonably fit. DER GJ. 87: 49-74. ANDERSON SD. SELIGMAN MEP. J Laryngol Ofol 1991. 27. 62: 259-262. ABRAMSON LY. 1987. Psycho/ Med 1988. Depression qualitative analysis. 25. KUIPER NA. 14. Do you usually sleep well without drugs or alcohol? (No) 13. persisting over several weeks. AMERICAN PSYCHIATRIC SOCIETY. HAMILTON M. J Neural Neurosurg Psychiat 1986. MARSDEN CD. Questions 29-34 represent Professional Contact for Depression (PCD). TEASEDALE JD. In The Psychology ofDepression: Conrem21. CROSS PA. SELIGMAN MEP.5. Chichester: Wiley.Anxiety. B J Sot Clin Psycho1 19. BROWN RG. The Hospital Anxiety and Depression 67: 361-370. SPIELBERGER CD. 24. LUSK EJ. (Edited by FRIEDMAN RJ and KATZ MM). TEASEDALE JD. Do you cry quite often? (Yes) 5. depression scale scores of 26. 18: 49-55. Do you often think about your own death. 1974. When you are feeling unhappy does your interest in sex diminish? (Yes) 17. Depression in Parkinson’s disease: a follow-up of 132 cases. N Engl J Med 1984. depression and tinnitus 389 and 12. Questions: 12. GOTHAM A-M. or the idea of your no longer existing? (Yes) 10. Development 1967. 1. 11: 755-764. Are you glad to be alive? (No) 9. Have you ever totally lost the desire for sexual relations during an unhappy period? (Yes) 18. Is it common for you to wake up in the morning feeling unhappy? (Yes) 3. STROUSE TB. BROWN LL. Psychof Reporrs 1988. 26: 113-126. The natural history of depression in general practice: stochastic models. Have you ever contemplated suicide? (Yes) 11. GORSUCH RL. 6: 278-296. Learned helplessness reformulation. 49: 381-389. VAGG PR. MILLER DS. MARSDEN CD. Diagnostic and Statistical Manual of Mental Disorders. Have the last three years largely been very happy ones? (No) 2. Is it unusual for you to be sad all day? (No) 4. DUNN G. SNAITH RP. as related to general health. DERRY PA. Edition. data on undergraduate samples. A-M. 1983. in humans: critique and 22. 13. CASSILETH BR. while you were unhappy? (Yes) 14. audiometry clinical judgement. Tinnitus severity measured by a subjective scale. Have you ever tried to kill yourself? (Yes) 12. 311: 506-511. most of the time? (No) 15. Do you think that deep down most people are nice? (No) 7. COOPER BH. and disability 18. MACCARTHY B. 14. 16. Author’s unpublished scale. APPENDIX Depressive Tendency Questionnaire (DTQ) items Questions l-28 are Inferential Depression Items (IDI). porary Theory and Research. JACOBS GA. Washington DC: American Psychiatric Society. Palo Alto: Consulting Psychologists Press. and self-reference in clinical depression. Zung self-rating psychiatric outpatients by age and sex. Do you worry about poor health? (Yes) 16. 15 excluded from scoring. Have you ever had difficulty in sleeping. Manual for the State-Trait Amiery fnventory (Form Y). Have you ever lost the desire for food when you were unhappy? (Yes) . Pers. in you yourself living? (Yes) 8. Have you ever thought that basically. Cognitive vulnerability Br J Clin Psycho1 1987. people are selfish and rather unkind? (Yes) 6. 1. to depression: An investigation of two hypotheses. BROWN RG. FOUTY HE. SKUSE D. Schematic processing Psycho1 1981. Acra Psychiat Scand 1983. commun. The scoring response is bracketed. DENT J. 90 286-297. J &norm Psychol 1978. pp.

when you were unhappy? (Yes) 34. because you were feeling depressed? (If yes. Have you ever been prescribed sleeping tablets. do you ever sit and not speak to others present. Have you ever seen a psychiatrist. that most people find you enjoyable to be with? (No) 23. response is bracketed (Yes) Do you have periods when your tinnitus is much worse than it usually is? (Yes) Are there times. Is your tinnitus present for at least part of every day? (Yes) 12. Would you say that generally your tinnitus does not bother you? (No) 6. When you are busy. with depression as one of your major problems? (Yes) 31. tick Yes regardless of whether you took action or not) (Yes). HALFORD and S. analyst. when you are unhappy? (No) 28. for depression? (Yes) 33. other than in loudness (e. Do you think you are a fairly likeable person? (No) 20. 4. Does your tinnitus sometimes make it difficult for you to concentrate? (Yes) 2. Are you almost always aware of your tinnitus? (Yes) 3. Have you ever thought. Do you prefer to be with people. do you quite often forget about your tinnitus? (No) 11. Does your tinnitus often interfere with your ability to relax? (Yes) 13. B. Does your tinnitus frequently upset you? (Yes) 9. When you are unhappy. like dressing or gardening? (Yes) 4. do you ever decide you would prefer to be on your own? (Yes) 26. that although your tinnitus can be irritating. counsellor. to help you sleep.g. are you not content with the impression you make on people? (Yes) 25. Do you think. Have you ever received inpatient treatment in a hospital. it does not get you down’? (No) 14. S. you would have a much more enjoyable life. that people don’t find you interesting company? (Yes) 21. Is it unusual for your tinnitus to annoy you. instead of being by yourself. you were not a nice person? (Yes) 22.g. Do you feel dissatisfied at the way you come across. ANDERSON 19. Do you think that you get more love and friendship than you deserve? (Yes) 24. When you are unhappy. Have you ever thought that you could have done with some form of help from some form of professional. Does your tinnitus cause you problems in getting off to sleep? (Yes) 5. if you did not have tinnitus? (Yes) Tim&us Variability items The scoring 1. 1. Do you often have a day or more completely free from tinnitus? (No) 10. in tone)? (Yes) . Subjective Tinnitus Severity Scale (STSS) items The scoring response is bracketed. Would you say. have you ever stayed in bed for most of the day. When you are feeling unhappy. 3. Have you ever been to see your family doctor (GP) because you were depressed? (Yes) 30. when you are doing something physical. because you could not face people? (Yes) 29. Do you often talk about the problems your tinnitus causes to others? (Yes) 15. Do you sometimes go for hours without noticing your tinnitus? (No) 7. because to talk seems an incredible effort? (Yes) 27. when you hear your tinnitus. when you are trying to read or watch television? (No) 16. Would you say that. 2. Have you ever been seen by another form of therapist (e. psychologist or psychotherapist) when you were depressed? (Yes) 32. Have you ever rung a telephone help service because you were depressed? (Yes) 35. but it seems much quieter than usual? Does your tinnitus vary in loudness? (Yes) Does the sound of your tint&us change. Do you often think. D.J. Do you find that your tinnitus bothers you. Is your tinnitus very noisy? (Yes) 8.