Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 2 of 3)

Version date: June 5, 2012

This workshop was developed by researchers at: The VA RR&D National Center for Rehabilitative

Auditory Research (NCRAR), located at the Portland, Oregon VA Medical Center

The VA Connecticut Healthcare System in West Haven, Connecticut

Materials Needed for This Meeting Changing Thoughts & Feelings Worksheet Your Workbook

Remember: Goals of Tinnitus Management (All Methods)

Negative emotional reactions are reduced Stress is reduced Little, if any, attention is given to tinnitus Tinnitus does not negatively affect any life activities in

a major way Further help for tinnitus management is not needed

or wanted

These goals can be reached even if the sound of your tinnitus doesn’t change!

Today’s Agenda1. Review and discuss the Changing Thoughts

and Feelings Worksheet2. Review homework

Two relaxation exercises: Deep Breathing and Imagery

Adding pleasant activities3. New topic: Becoming aware of your thoughts

12 most common negative thoughts Practice at home: identifying thoughts

Review The Changing Thoughts & Feelings Worksheet

Stress Management and Relaxation Exercises Deep Breathing Imagery

Planning Pleasant Activities

Look at your Changing Thoughts and Feelings Worksheet that you started to fill out at the last meeting

If you don’t have it, get out a clean Worksheet

Find your Worksheet from last week or tear out a copy of the Changing Thoughts and Feelings Worksheet from the back of your Workbook

Take a moment to…

Was it difficult to identify a problem for #1?

Discussion:Changing Thoughts and Feelings Worksheet

Remember: You can fill out a separate Changing

Thoughts and Feeling Worksheet for each problem you marked on the Tinnitus Problem Checklist

This is the same way you fill out #1 on the Sound Plan Worksheet with the audiologist

Did the Relaxation Exercises help you notice your tinnitus less? (Also review p. 43 – Relief Scale)

Discussion: #2 on the Worksheet

Skill Review: Relaxation Exercises

Why do they help? Many people say their tinnitus is worse when they

are stressed How do they help?

By giving you a sense of relief from tension and stress caused by tinnitus

When should I use them? Any time you are stressed and your tinnitus

bothers you

Relief Scale for Relaxation Exercises

Review of practice at home:Take a moment to discuss Deep Breathing page 43

Review of practice at home: Take a moment to discussImagery page 43

Planning Pleasant Activities:

Distraction

Did you plan any new pleasant activities? (Also review pages 46 and 47 – Tracking and Listing activities)

Discussion: #2 on the Worksheet

Skill Review: Planning Pleasant Activities

Review: Planning Pleasant Activities

What are pleasant activities? Activities you enjoy Activities you like to do but do not have to do

How can they help you manage your tinnitus? Helps you have more positive feelings Distracts you from your tinnitus Helps you feel better overall

Practice at home: Take a moment to discussTracking Activities page 46

Planning Pleasant Activities Step 1: Track Your Activities

Planning Pleasant Activities Step 2: List of Activities

Things to Remember

Tinnitus is less likely to get your attention when you manage your stress and stay busy

Use sound when practicing relaxation exercises You might not notice relaxation exercises helping

you right away—that doesn’t mean they’re not helping you. Keep practicing!

Increasing pleasant activities over weeks or months can help you get better at ignoring tinnitus

Changing ThoughtsPaying Attention to Thoughts

Skill you have not yet learned to manage your reactions to tinnitus

Review: #2 on the Worksheet

New skill you will begin to learn

today

New Skill: Introduction to Changing Thoughts

The CBT Cycle

Beliefs

Emotion

Behavior& Thoughts

What does “Changing Thoughts” mean?

First you identify thoughts or beliefs (B) you had just before feeling bad (C)

Then you work on changing that thought or belief to something more helpful

How can “Changing Thoughts” help?

Changing your thoughts about your tinnitus (A) can help you change the way you feel about it (C)

When can I use “Changing Thoughts?”

Any time you feel tension or stress when you think about your tinnitus

Thoughts Affect Feelings

What you think affects how you feel

Example: Imagine your dinner guests are late

Sometimes the way you feel is caused by the thoughts about the event, not the event itself

Feelings Affect Health

Your feelings affect your health

Stress and negative emotions can lead to health problems During stress, hormones are released Too much of these hormones is bad for health

It is important to learn to change your thoughts that cause negative feelings

Feelings Affect Health

“Thought Errors” are negative thoughts They are not helpful or are unhealthy Sometimes people get in the habit of having thoughts

that make them feel bad All people make Thought Errors from time to time Thought Errors make people feel sad or upset

A different thought might make them feel better You can control your thoughts If you are aware of your Thought Errors, you can catch

yourself and correct your thinking BEFORE YOU CAN CHANGE YOUR THOUGHTS

YOU NEED TO KNOW WHAT YOU ARE THINKING

What are “Thought Errors”?

Twelve Common Thought Errors:#1 – All-or-nothing thinking

Twelve Common Thought Errors #2 – Over-simplifying

Twelve Common Thought Errors #3 – Focusing on wrong details

Twelve Common Thought Errors #4 – Jumping to conclusions

Twelve Common Thought Errors #5 – Over-estimating

Twelve Common Thought Errors #6 – Under-estimating

Twelve Common Thought Errors #7 – Assuming the worst

Twelve Common Thought Errors #8 – Emotional thoughts

Twelve Common Thought Errors #9 – “Should” statements

Twelve Common Thought Errors #10 – Labeling

Twelve Common Thought Errors #11 – Making things personal

Twelve Common Thought Errors #12 – Blaming

Practice at home:

In your Workbook (pages 50-53) write down an example of each of the 12 Thought Errors Use examples related to tinnitus Use other examples if you can’t think of

tinnitus examples

Tell me in your own words:What must you do BEFORE you can

change your thoughts?

Describe the concept rather than giving an example

Practice at home - Continue to record your progress for the first two skills: Relaxation Exercises and Planning Pleasant Activities

Summary of Today’s HomeworkThought Errors

Write 12 personal examples of each of the Thought Errors

Changing Thoughts and Feelings Worksheet (back of Workbook) Relaxation Exercises Planning Pleasant Activities Wait to complete the Changing Thoughts sectionRelaxation Relief Scale for Relaxation Exercises:

Deep Breathing and ImageryPlanning Pleasant Activities Step 1: Track Your Activities Step 2: Make a List of Pleasant Activities Step 3: Schedule Pleasant Activities

Remember:

Continue to work on your Sound Plan for your next session with the audiologist

Next session

Next session with me you will discuss steps to change your negative thoughts

WAIT until the next session to complete the Changing Thoughts section on the Worksheet

WAIT: do not

complete yet

Other agenda items?

Questions?