VA National Center for Rehabilitative Auditory Research, Portland, OR 10/25/2010

Self-Efficacy for Managing Reactions to Tinnitus (SMRT)

Please circle your answer.

1. How confident are you that you can keep the fatigue caused by your tinnitus from interfering with 

the things you want to do? 

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

2. How confident are you that you can keep the discomfort of your tinnitus from interfering with the 

things you want to do? 

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

3. How confident are you that you can keep the emotional distress caused by your tinnitus from 

interfering with the things you want to do? 

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

4. How confident are you that you can keep any other symptoms or health problems you have from 

interfering with the things you want to do? 

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

5. How confident are you that you can do the different tasks and activities needed to manage your 

tinnitus so as to reduce your need to see a doctor? 

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

6. How confident are you that you can do things other than taking medication to reduce how much 

your tinnitus affects your everyday life? 

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

7. How confident are you that you can use sound to take your mind off your tinnitus?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident
VA National Center for Rehabilitative Auditory Research, Portland, OR 10/25/2010

8. How confident are you that you can find a way to relax when your tinnitus is bothering you?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

9. How confident are you that you can reduce stress caused by tinnitus?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

10. How confident are you that you can do things to take your mind off your tinnitus?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

11. How confident are you that you can do things to keep your tinnitus from affecting your daily 

activities?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

12. How confident are you that you can concentrate when your tinnitus is bothering you?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

13. How confident are you that you can do things to keep your tinnitus from affecting your sleep?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

14. How confident are you that you can do things to help yourself fall asleep or stay asleep, even when 

you hear your tinnitus?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident
VA National Center for Rehabilitative Auditory Research, Portland, OR 10/25/2010

When your tinnitus is bothering you...

15. ...how confident are you that you can use sound to make yourself feel better?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

16. ...how confident are you that you can manage your reactions to tinnitus?

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident

17. ...how confident are you that you can change the way you think about your tinnitus to make 

yourself feel better? 

1 2 3 4 5 6 7 8 9 10

Not at all 

confident

Totally 

confident