VA National Center for Rehabilitative Auditory Research, Portland, OR 5/27/2016

Tinnitus Workshop Follow-up

1. Have you been using sound to manage your reactions to tinnitus?

YES NO

If yes, how often? If no, why not?

A. Very often

B. Often

C. Sometimes

D. Rarely

A. I don’t need to do this

B. It’s not worth the trouble

C. I don’t know what to do

D. I don’t think it helps

E. I don’t like to do this

F. Other:____________________________

2. Have you been practicing relaxation techniques (deep breathing and/or imagery) to manage your 

reactions to tinnitus?

YES NO

If yes, how often? If no, why not?

A. Very often

B. Often

C. Sometimes

D. Rarely

A. I don’t need to do this

B. It’s not worth the trouble

C. I don’t know what to do

D. I don’t think it helps

E. I don’t like to do this

F. Other:___________________________

3. Have you been planning more pleasant activities to help manage your reactions to tinnitus?

YES NO

If yes, how often? If no, why not?

A. Very often

B. Often

C. Sometimes

D. Rarely

A. I don’t need to do this

B. It’s not worth the trouble

C. I don’t know what to do

D. I don’t think it helps

E. I don’t like to do this

F. Other:___________________________

4. Have you been working on changing your thoughts about tinnitus to help you feel better?

YES NO

If yes, how often? If no, why not?

A. Very often

B. Often

C. Sometimes

D. Rarely

A. I don’t need to do this

B. It’s not worth the trouble

C. I don’t know what to do

D. I don’t think it helps

E. I don’t like to do this

F. Other:___________________________
VA National Center for Rehabilitative Auditory Research, Portland, OR 5/27/2016

5. Compared to how I felt before the tinnitus workshops, I now feel:

A. A lot more in control of my reactions to tinnitus

B. Somewhat more in control of my reactions to tinnitus

C. A little more in control of my reactions to tinnitus

D. The same (no change in control of my reactions to tinnitus)

6. Compared to before the tinnitus workshops, my ability to cope with tinnitus is now: 

A lot worse Somewhat 

worse

A little worse The same A little better Somewhat 

better

A lot better

1 2 3 4 5 6 7

7. Compared to before the tinnitus workshops, my quality of life is now:

A lot worse Somewhat 

worse

A little worse The same A little better Somewhat 

better

A lot better

1 2 3 4 5 6 7

8. Compared to before the tinnitus workshops, my tinnitus now bothers me:

A lot more Somewhat 

more

A little more The same

(just as much

as before)

A little less Somewhat

less 

A lot less

1 2 3 4 5 6 7

9. Would you recommend the tinnitus workshops to someone else who has bothersome tinnitus?

YES NO

If “no,” please explain:________________________________________________________

__________________________________________________________________________

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10. Please describe your overall experience learning how to manage your reactions to tinnitus.

___________________________________________________________________________

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