Faculty of Psychology and Neuroscience
Development Of A Novel Measure To Assess
Avoidance Behaviour In Tinnitus Patients Jana V.P. Devos a b
(a, b),
Rilana F. F. Cima
(a, b, c),
Martina D’Agostini
Department of Clinical Psychological Science, Maastricht University Adelante, Centre for expertise in Rehabilitation & Audiology
(a, c),
Johan W.S. Vlaeyen C
(a, c)
Health Psychology, KU Leuven, University of Leuven, Belgium
Introduction
Methods
Based on earlier results, and the potential benefits of a fear-avoidance approach in treating chronic tinnitus suffering, avoidance behaviour is thought to play a key role in the suffering of patients with chronic tinnitus. Currently, a measure designed to inventorize, assess, and measure change over time in avoidance behaviour does not exist. Here we introduce a novel measure for this purpose. Tinnitus Source Disability;
Developmental phases of the ITAB Completed: PHASE I: In phase-I, 2 expert judges reviewed existing measures (TFAS, CONSTRUCTION TARX, CAQ) and evaluated avoidance items on usefulness and
Recovery
Generalization of sensitivity, Social withdrawal, Anxiety & Depressed mood
Based on existing measures & clinical expertise
Avoidance & Task interference
applicability in tinnitus. New items based on clinical experience were scripted and added, leading to a first draft-version ITAB 1.
Hypervigilance Exposure
Tinnitus perception
In phase-II, an online survey with 17 clinicians from 7 disciplines and 2 healthcare facilities in the Netherlands was carried out in order to assess face- and construct validity.
Tinnitus-related fear
Catastrophic mis-interpretation of the sound
Acceptance of tinnitus as benign signal
PHASE II: CLINICAL EXPERT OPINIONS
# Clinicians included in the online expert round per health care facility Health care facility 1 Health care facility 2 Audiologist 2 1 Researcher 1 0 Psychologist 3 2 Movement therapist 1 1 Physical therapist 2 1 Social worker 1 1 Speech therapist 1 0
Online survey (N = 17) & face-to-face Consensus round (N = 6)
Subsequently, 6 clinical expert judges evaluated the ITAB 1 items during an expert panel session to achieve consensus (>60%) on consistency, intelligibility, relevance, wording, domain (covert-, versus overt avoidance) and in-/exclusion of items.
Figure 1: The FA model
Types of avoidance behaviour Avoidance behaviour is hypothesized to be either observable (overt) or not (covert). It is also hypothesized to be one of 2 types of safety behaviours avoidance (= behaviours intended to prevent experiencing the tinnitus or its increase) and escape (= behaviours intended to decrease experiencing the tinnitus or to end it). Example items from the ITAB: • Overt avoidance: “I try to avoid silent environments because of my tinnitus.” • Overt escape: “I try to distract myself from the tinnitus by turning on the TV.” • Covert avoidance: “I try to supress negative thoughts about the tinnitus.” • Covert escape: “I try to ignore the tinnitus”
The items in the ITAB measure are hypothesized to assess 4 types of avoidance behaviour as judges by experts: • • • •
Objective Development and validation of a new self-report measure specifically aimed at measuring self-reported avoidance behaviors in patients with chronic and bothersome tinnitus; The Inventory of Tinnitus Avoidance Behaviours (ITAB).
Results Phase-I resulted in a preliminary experimental version of the ITAB containing 69 items. In phase-II, changes judged essential were made according to consensus voting rounds during the expert panel. All items were voted to be included in the inventory. This resulted in a second version of the ITAB Phase-III resulted in minor changes of phrasing and explanation of questions, The third version of the ITAB which is currently administered in a larger sample to address the psychometric properties of the ITAB.
In phase-III, expert opinions by tinnitus patients (N = 12, with mildsevere tinnitus-severity selected by clinical experts) were gathered via semi-structured interviews. Patients were be asked to evaluate the ITAB prototype on similar factors as the clinical experts did. PHASE III: PATIENT EXPERT Based on these comments minor changes were made to the questions, mostly pertaining to the clarity of the questions. OPINIONS Patient expert demographics
Semi-structured interviews with patients (N = 12)
Conclusions
N
Mean age
SD age
Male 8 56,25 yrs 12,99 yrs Female 4 47 yrs 14,09 yrs Total 12 53,17 yrs 14,06 yrs
Tinnitus suffering time 13,25 yrs 4,25 yrs 10,25 yrs
Currently in proces:
✓ This project aims to develop a novel self-report measure specifically aimed at measuring self-reported avoidance behaviors in patients with chronic and bothersome tinnitus References TARX: Based on the Physical Activity Readiness Questionnaire (PAR-Q) Chisholm, D. M., Collis, M. L., Kulak, L. L., Davenport, W., & Gruber, N. (1975). Physical activity readiness. British Columbia Medical Journal, 17(2), 375-378. Kleinstäuber, M., Jasper, K., Schweda, I., Hiller, W., Andersson, G., & Weise, C. (2013). The Role of Fear-Avoidance Cognitions and Behaviors in Patients with Chronic Tinnitus. Cognitive Behaviour Therapy, 42(2), 84–99. https://doi.org/10.1080/16506073.2012.717301 Sexton, K. A., & Dugas, M. J. (2008). The Cognitive Avoidance Questionnaire: Validation of the English translation. Journal of Anxiety Disorders, 22(3), 355–370. https://doi.org/10.1016/j.janxdis.2007.04.005
Correspondence to: Jana Devos
[email protected]
Covert avoidance (6 questions) Covert escape (5 questions) Overt escape (16 questions) Overt avoidance (42 questions)
PHASE IV: PSYCHOMETRIC VALIDATION
In phase-IV, the final draft of the ITAB will be administered to a large sample of patients in order to evaluate its psychometric properties.
Acknowledgments
We would like to acknowledge the work of Rachelle Lardinois who started this project. This research was supported by funding from SWOL Limburgs Fonds voor Revalidatie and Adelante, Centre for expertise in Rehabilitation and Audiology, The Netherlands. R.F.F. Cima is supported by NWO Veni grant number 016.165.105. J.W.S. Vlaeyen was supported by the “Asthenes” long-term structural funding Methusalem grant by the Flemish Government, Belgium.
Dept of Clinical Psychological Science T +31 43 388 1490
Maastricht University P.O. Box 616 6200 MD Maastricht, The Netherlands
