title: The role of fear-avoidance cognitions and behaviors in patients with chronic tinnitus.
abstract: The current study investigated the role of fear-avoidance-a concept from chronic pain research-in chronic tinnitus. A self-report measure the "Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)" was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-avoidance. To analyze the psychometric properties, principal component analysis with parallel component extraction and correlational analyses were used. To examine a possible mediating effect, hierarchical regression analysis was applied. The principal component analysis resulted in a three-factor solution: Fear-avoidance Cognitions, Tinnitus-related Fear-Avoidance Behavior, and Ear-related Fear-Avoidance Behavior. Internal consistency was satisfactory for the total scale and all subscales. High correlations between tinnitus-related handicap scales, depressive and anxiety symptoms, and the T-FAS were found, whereas associations with personality factors were low. Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg-University of Mainz, Germany. kleinsta@uni-mainz.de
authors.forename: Maria
authors.initials: M
authors.lastname: Kleinstäuber
authors.forename: Kristine
authors.initials: K
authors.lastname: Jasper
authors.forename: Isabell
authors.initials: I
authors.lastname: Schweda
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiller
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.forename: Cornelia
authors.initials: C
authors.lastname: Weise
mesh_terms: D001007:Anxiety / Q000150:complications / Q000523:psychology; D001362:Avoidance Learning; D002908:Chronic Disease; D003071:Cognition; D003863:Depression / Q000150:complications / Q000523:psychology; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D025341:Principal Component Analysis; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000150:complications / Q000175:diagnosis / Q000523:psychology*