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What is CBT about & How can CBT help with tinnitus?
Here is a video explaining what Cognitive Behavioural Therapy (CBT) is, what it is about and how it can help with tinnitus. The video is an extract from a webinar for the British Tinnitus Association and its members on 30th March 2021.
The second video is a summary Case Study of a participant in the 12 module CBT for Tinnitus E-Programme that demonstrates her progress. This video is also an extract from the 30th March 2021 webinar for BTA.
About CBT for Tinnitus E-Programme 12
This course is an extended advanced version of the 6 module CBT for Tinnitus E-Programme. Rather than being a 6 module course, this 12 module course is for those with higher scores for the Tinnitus Functional Index (TFI) in Categories 4 and 5 (TFI 54%+)
- This course includes TWO 1-1 appointments
- All 1-1 appointments use Zoom
- Booking your first 1-1 appointment, choose your preferred day and I will do my best to accommodate you
- 4 step, 12 module course of Tinnitus Management with CBT (Cognitive Behavioural Therapy)
- Email support throughout the course
- PROMO-CODES: If you have a code that gives a discount on the full cost, enter it during checkout
- Book additional 1-1 time if you need it (£90 per appointment or £240 for 3 appointments)
What's Your TFI Score?
- Complete the Tinnitus Functional Index (TFI)
- Where your TFI score is greater than 135/250 (54%) your score is Category 4 or above
- There is also a Tinnitus Handicap Inventory (THI) that can be completed as a secondary measure for tinnitus distress and a measure for anxiety
- For a TFI score of 120/250 or over, this course - CBT for Tinnitus E-Programme 12 - is the more suitable of the two courses as it leads you through the process at a gentle pace and includes additional content to that needed by those with mild-moderate tinnitus distress
CBT for Tinnitus in brief
The twelve modules lead you through a FOUR-STEP CBT-based process from the start. It is essential to understand the physiology and neurobiology that cause the symptoms we experience as distress, alongside understanding the mechanism of tinnitus. They are intrinsically joined together.
It is because of how we feel about tinnitus that it causes distress. If we feel nothing for and about the noise we experience as tinnitus, we'd not react to it. In fact, we'd not bother to tune in and listen to it. It would be much the same as being used to traffic going about its business outside the house. You know it's there but so what? Most of us habituate to traffic noise and other sensory information in our environments. Think about the last time you were in a supermarket. Was there music playing? What noises did you NOTICE while you were in there? The likelihood is you don't remember, and another likelihood is that while you were there, you didn't think about it. Module 3 in the TEP discusses our 3 levels of hearing, "Significance of Sound", and the impact of "meaning" i.e. what a sound might mean to us.
These are all factors that are monitored subconsciously and when there is no significance and no meaning - positive or negative - the conscious part of us doesn't have to consider it. It is when there IS significance and meaning that our attention is drawn and we become conscious of what is happening. Being brain-based, this means that the pre-frontal cortex (PFC) has to make a decision - "how do I feel about this?" "I don't like it" so monitoring of the situation takes over - a joint effort by both the subconscious (limbic system) and conscious (PFC).
What makes us feel one way or another - 'not care about', 'care about and like', 'care about and dislike'? We feel what we do because of the meaning we attach to each given situation. Those meanings become BELIEFS. They come from subconscious 'filters' based on previous experience. Many of these filters have been there since childhood, but we are always adding, strengthening and changing filters. We only tend to weaken filters through being conscious of them. We can only challenge them by being conscious of them, allowing the PFC to challenge them to bring about a filter-change in the subconscious.
The 'filters' are called Cognitive Distortions: distorted understanding that gives rise to a distorted meaning/significance. There are more than a dozen of the most common Cognitive Distortions, but as individuals, we have a tendency to use the same 3 or 4 of them over and over. Probably the most common are "Predicting the Future", "All or Nothing Thinking", "Maximising the Negative" and "Mind Reading".
In my tinnitus clinics for example, guess how often I have heard people say things like: "I'll never feel normal again"; "Tinnitus has ruined my life"; "No one knows how bad this is"? Those statements are true for the person saying them - they BELIEVE them to be true. And BELIEFS are powerful.
But what happens once those very same people realise what BELIEFS are? That they come through "filters" from the subconscious....? In most cases, they recognise their Cognitive Distortions immediately. And this is covered during Modules 3 - 5 of Part One TEP, including using part one of a CBT Thought Record that helps identify these BELIEFS through using a structured process.
At the End of CBT for Tinnitus E-Programme
In Module 6 (mid-term) and again 4-6 weeks after completing the 12 modules, the measures used at the start (TFI etc) are repeated. This is where progress is measured and most scores have reduced by at least 1 TFI category by mid-term, and by 2 or more categories after completing the course.
Additional one-to-one appointments can be arranged at a much reduced rate (£90 per appointment/3 appointments for £240) at any point during the course. To date, there has been a need for additional 1-1 time by only 10% of users of the 12 module course.
Recent Feedback and Comments
Here are a few snippets of what's being said about the CBT for Tinnitus E-Programme (TEP):
“The Tinnitus E-Programme is a quality on-line programme for actively learning how to manage tinnitus. It is a game changer!”
“This course and all the support has really helped me to live with my tinnitus and I feel my life is now getting back to normal. I know that I couldn't get to where I am now without this programme. I feel ok now about my tinnitus. I can still hear the hissing sound sometimes but it doesn't really concern me.”
“CBT going well. Really like reading module 3 as this nicely focused the CBT towards tinnitus.”
"I am particularly impressed with the depth of the recorded relaxation programs. They do exactly what they are intended to do. I am also very satisfied with the responses to my emails I get from Debbie and her depth of skill and knowledge of working with people with tinnitus."
"I have been concerned about long-standing insomnia issues and how they impact on CBT for tinnitus. Debbie gave me reassurance that I was on track with the program and was making incremental progress in line with those who are currently taking and those who have taken the program."
"Now I understand the tinnitus more than ever, how to relax and I’m able to observe my thoughts. After using the breathing exercise and the relaxation (recordings), I feel different - quiet and relaxed"
"I have found the Tinnitus E-Programme to be great! Especially to understand why and how to be more rational about tinnitus, and less stressed about why I have it"
"Debbie explains everything thoroughly and simply. I use the breathing exercises and relaxation everyday"
"This course has done exactly what Debbie (Featherstone) told me it would do. My thanks to Debbie - it has been a life-saver being shown that there is a “way out”, a way of dealing with tinnitus, and also dealing with stress in general which is on-going."
"A well thought out course which covered many aspects of the cause of tinnitus and management of it."
"I find the switching between listening to the tinnitus and not listening very helpful"
"Over the past 10 weeks, again I have had a lot of stress with different circumstances. But even so, I amazed to see my (THI) score come down from 46 to 29. I know I will benefit more from working with Debbie using more CBT."
"Being able to talk to Debbie about tinnitus and her fully understanding the problems and impact it causes helped me a great deal."
"It helped me to relax more and helped me to get to sleep easier. I don’t feel as isolated and realise other people have the same feelings about having tinnitus."
"I particularly like having the four relaxation recordings to download and keep. Having 4 of them allows a good choice. I now have a much better understanding of the problem and realise how to deal with it."
"Has been beneficial and I can now relax a lot easier which therefore helps with getting to sleep which was one major problem for me!"
"Debbie has been most helpful answering queries and giving clear explanations. Her whole manner is relaxing in itself which generates a feeling of well-being. She shows great empathy."
"I love the way you write and how hopeful I feel after reading these modules. I'm hopeful, uninterested in tinnitus, very still."
"I've been falling asleep in less than 10 minutes. I find that I've become more bored of my tinnitus. I worry for a second 'what if I hear it again?' then I think of something else (automatically not forced) and give it no more thought. It just seems like my brain is finding it harder to focus on the tinnitus sounds."
"I feel a lot less anxious about the future living with tinnitus. I found the course very easy to cope with and enjoyed it!"
"The course was helpful. I feel less anxious now I have more information regarding the way tinnitus works."
"'Coursecraft' was easy to use."
- Enrol on CBT for Tinnitus E-Programme 12 - includes two 1-1 appointments plus email support, or
- Send in your Booking Form (current waiting time 2-10 working days, depending on the day/time you choose)
Here's What You Will Learn
The Tinnitus E-Programme is a tried and tested process of practical learning to manage your tinnitus in 6 - 10 weeks - stage by stage - in a structured, easy to follow way that leads to you to being able to manage your tinnitus effectively.
- Run as an online course of Tinnitus Management since 2009
- Independently evaluated by the NHS NIHR NHBRC (National Institute of Health Research, Nottingham Hearing Biomedical Research Centre) based at the University of Nottingham in the UK
- Includes neurochemistry and neurobiological systems affected and how to change them
Table of Contents
Aims & Objectives of the Tinnitus E-Programme
Mission Statement, Aims and Objectives for the CBT for Tinnitus E-Programme
The research informs us that one in ten of the population reports having tinnitus, yet there is no clearly defined approach to its treatment. The one single approach that the latest research has evidenced as very effective is Cognitive Behavioural Therapy. The Tinnitus E-Programme provides this.
While the research also informs us that 85% of the one in ten are not troubled by tinnitus, the remaining 15% are. For the 15%, reported tinnitus distress ranges from mild through to very severe tinnitus distress. A “cure” for tinnitus is evasive due to its complex nature, and the numerous possible ‘points of origin’ of the electrical activity that is experienced as tinnitus.
To make as widely available as possible a practical and easy-to-follow set of steps towards reducing tinnitus intrusiveness perception
The Tinnitus E-Programme is the title given to a structured process that includes education, practical daily exercises, and understanding of the psychology behind reaction to tinnitus that leads to the decrease of tinnitus intrusiveness perception within approximately 6 – 10 weeks.
- To alter mid-brain (paleomammalian area of the brain) limbic activity that drives emotional reactions. This reduces cortisol levels in the blood and improves blood flow to the pre-frontal cortex (PFC) allowing for improved sense of control and ability to think with clarity
- To impart information that educates the user about the mechanism of tinnitus and the systemic processes that drive reaction to tinnitus
- To support the user through the change process through one to one contact (including 1-1 using Zoom, user-to-therapist feedback mechanism at the end of each stage/module and email support) to address individual differences. A “one size fits all” approach is inappropriate and unhelpful
- To teach the user the principles of Cognitive Behavioural Therapy (CBT), what it is, how it works, and to introduce the user to “thought and meaning” identification using the Meaning Adjuster, and the later choice in Module 9 to use the original Beck Thought Record
- To evidence clear clinical outcomes using ‘before and after’ research-validated measures that reflect reduced levels of tinnitus distress
Frequently Asked Questions
How long do I have access to the course?
Once you've enrolled, you'll have access to the course material for as long as you need.
I have some questions about tinnitus. Where can I find answers?
There is a FAQs section in the Tinnitus E-Programme website that may well help. Go to www.tinnituseprogram.org/faqs.html