Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 1 of 3) Version date: June 5, 2012

Managing Your Tinnitus: Changing Your Thoughts and Feelings(Session 1 of 3)

Managing Your Tinnitus: Changing Your Thoughts and Feelings(Session 1 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

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

IntroductionsIntroductions

Please share the following with the group: What is tinnitus like for you? Do you also have hearing loss? How we should communicate as a group? How do you deal or “cope” with your tinnitus?

Please share the following with the group: What is tinnitus like for you? Do you also have hearing loss? How we should communicate as a group? How do you deal or “cope” with your tinnitus?

Remember: Tinnitus cannot be curedRemember: Tinnitus cannot be cured

“Cure” = eliminate or reduce the tinnitus No cure yet – research underway It can’t be cured, but you can learn to manage your

reactions to it

[Note: “managing tinnitus” really means “managing reactions to tinnitus” – you can’t change the sound of the tinnitus, but you can change how you react to the sound]

“Cure” = eliminate or reduce the tinnitus No cure yet – research underway It can’t be cured, but you can learn to manage your

reactions to it

[Note: “managing tinnitus” really means “managing reactions to tinnitus” – you can’t change the sound of the tinnitus, but you can change how you react to the sound]

Remember: Goals of Tinnitus Management (All Methods)

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

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!

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

Understand what “CBT” means Learn about stress and tinnitus Learn two relaxation exercises:

1. Deep Breathing

2. Imagery Learn about “distraction” (by keeping your mind off of

your tinnitus using pleasant activities) Start using the Changing Thoughts and Feelings

Worksheet

Understand what “CBT” means Learn about stress and tinnitus Learn two relaxation exercises:

1. Deep Breathing

2. Imagery Learn about “distraction” (by keeping your mind off of

your tinnitus using pleasant activities) Start using the Changing Thoughts and Feelings

Worksheet

Goals of Today’s WorkshopGoals of Today’s Workshop

■ Tinnitus is not a mental health disorder■ CBT is used to change thoughts, behaviors, or

emotions■ CBT helps you think more positively about your

tinnitus■ CBT also helps people who have pain and other

health problems

■ Tinnitus is not a mental health disorder■ CBT is used to change thoughts, behaviors, or

emotions■ CBT helps you think more positively about your

tinnitus■ CBT also helps people who have pain and other

health problems

Introduction to Cognitive Behavioral Therapy (CBT)Introduction to Cognitive Behavioral Therapy (CBT)

The CBT Cycle The CBT Cycle

Beliefs

Emotion

Behavior& Thoughts

The CBT CycleThe CBT Cycle

Behavior, emotions, and thoughts/beliefs are related If you change one of these then you can change all of

these Behavior or thoughts can lead to negative feelings

about tinnitus TODAY: You will work on behaviors that can help you

think more positively and help you feel better

Behavior, emotions, and thoughts/beliefs are related If you change one of these then you can change all of

these Behavior or thoughts can lead to negative feelings

about tinnitus TODAY: You will work on behaviors that can help you

think more positively and help you feel better

Ground Rules…Ground Rules…

Time is limited, so we will follow the agenda We will stay focused on learning ways to manage

reactions to tinnitus

Time is limited, so we will follow the agenda We will stay focused on learning ways to manage

reactions to tinnitus

Today’s AgendaToday’s Agenda

1. Changing Thoughts & Feelings Worksheet

2. Discuss stress and tinnitus

3. Learn and practice two relaxation exercises: Deep Breathing and Imagery

4. Learn to plan pleasant activities





Tear out a blank Changing Thoughts and Feelings Worksheet:Tear out a blank Changing Thoughts and Feelings Worksheet:

Take a moment to…Take a moment to…

Learning How to Use theChanging Thoughts & Feelings WorksheetLearning How to Use theChanging Thoughts & Feelings Worksheet

Use this Worksheet to take notes while you learn skills to manage your reactions to tinnitus

Use a new Worksheet for each bothersome tinnitus situation

This Worksheet help guide you as you practice the new skills

What you put on the Worksheet will change as you figure out what works best for you

Use this Worksheet to take notes while you learn skills to manage your reactions to tinnitus

Use a new Worksheet for each bothersome tinnitus situation

This Worksheet help guide you as you practice the new skills

What you put on the Worksheet will change as you figure out what works best for you

How do I fill out #1 on the Changing Thoughts

& Feelings Worksheet?

How do I fill out #1 on the Changing Thoughts

& Feelings Worksheet?

#1 on the Changing Thoughts & Feelings Worksheet#1 on the Changing Thoughts & Feelings Worksheet The first step in completing a Changing Thoughts and

Feelings Worksheet is to write down a bothersome tinnitus situation

You already identified a bothersome tinnitus situation last week when you met with the audiologist using the Tinnitus Problem Checklist on page 29

Does everyone have a bothersome tinnitus situation to write for #1?

The first step in completing a Changing Thoughts and Feelings Worksheet is to write down a bothersome tinnitus situation

You already identified a bothersome tinnitus situation last week when you met with the audiologist using the Tinnitus Problem Checklist on page 29

Does everyone have a bothersome tinnitus situation to write for #1?

Remember from first Workshop with audiologist the Sound Plan Worksheet: 1. One bothersome tinnitus situation

Remember from first Workshop with audiologist the Sound Plan Worksheet: 1. One bothersome tinnitus situation

How do I fill out #2 on the Changing Thoughts & Feelings Worksheet?

How do I fill out #2 on the Changing Thoughts & Feelings Worksheet?

During the workshops with the mental health provider, you will learn the CBT skills shown on #2 of the Worksheet

During the workshops with the mental health provider, you will learn the CBT skills shown on #2 of the Worksheet

Today you will learn these two CBT skills to manage your tinnitus:Today you will learn these two CBT skills to manage your tinnitus:

Write down details about the skill you will use to manage your reactions to tinnitus

Write down details about the skill you will use to manage your reactions to tinnitus

#3 on the Worksheet#3 on the Worksheet

After you try the skill, write down how helpful that skill was in helping you feel better

After you try the skill, write down how helpful that skill was in helping you feel better


Write down a comment describing how you feel after trying this skill

Write down a comment describing how you feel after trying this skill







5. Other topics suggested by the group






Stress and TinnitusStress and Tinnitus

Many people say stress makes their tinnitus worse Many people say stress makes their tinnitus worse

Reducing stress can help your tinnitus Think of stress as a “challenge” instead of a “threat” Healthy living will help you manage stress Things you can do to reduce stress:

Plan ahead for stressful events Exercise and eat right Get enough sleep Meditate or learn yoga Do relaxation exercises – there are many kinds

Reducing stress can help your tinnitus Think of stress as a “challenge” instead of a “threat” Healthy living will help you manage stress Things you can do to reduce stress:

Plan ahead for stressful events Exercise and eat right Get enough sleep Meditate or learn yoga Do relaxation exercises – there are many kinds












Why learn relaxation exercises?Why learn relaxation exercises?

Relaxation Exercises: Why do they help?Relaxation Exercises: Why do they help?

They help you take a break from stress They slow down your breath and heart rate They distract you from your tinnitus

They help you take a break from stress They slow down your breath and heart rate They distract you from your tinnitus

Relaxation Exercises: How do they help?Relaxation Exercises: How do they help?

By slowing down your body By helping you get your mind off of your tinnitus By helping you feel relaxed and calm so you:

Feel a sense of relief from tension and stress caused by your tinnitus

Think more clearly Feel better over

By slowing down your body By helping you get your mind off of your tinnitus By helping you feel relaxed and calm so you:

Feel a sense of relief from tension and stress caused by your tinnitus

Think more clearly Feel better over

Relaxation Exercises:When should I use them?Relaxation Exercises:When should I use them?

Any time you feel stressed or tensePractice everyday between group

sessionsShare with the group next session

Any time you feel stressed or tensePractice everyday between group

sessionsShare with the group next session

How to prepare before a Relaxation Exercise

How to prepare before a Relaxation Exercise ■ Find a place where you won’t be disturbed

■ Tell others you need privacy■ Loosen tight clothing or change clothes■ Sit with feet flat on the floor or propped up■ Place your hands in your lap or on chair arms■ Turn on soothing sound or soft music ■ Avoid silence when practicing relaxation

exercises

■ Find a place where you won’t be disturbed■ Tell others you need privacy■ Loosen tight clothing or change clothes■ Sit with feet flat on the floor or propped up■ Place your hands in your lap or on chair arms■ Turn on soothing sound or soft music ■ Avoid silence when practicing relaxation

exercises

Relaxation Exercise #1:Deep Breathing - A Step-by-Step Guide

Relaxation Exercise #1:Deep Breathing - A Step-by-Step Guide

Step 1: Prepare using the information above.Step 2: Put one hand on your stomach and one on your

chest. Notice which hand moves. Move your stomach hand more for a deeper breath.

Step 3: Close your eyes or focus on a thing in the room.Step 4: Breath through your nose for 3 seconds – count in

your head “one-two-three.”Step 5: Hold that breath for 2 seconds (count “one-two”) &

release the breath for 3 seconds (count “one-two-three”).Step 6: Repeat Steps 4 and 5 for five to ten minutes.Step 7: When you are done, think about where you are,

wiggle your hands and feet, and open your eyes.

Step 1: Prepare using the information above.Step 2: Put one hand on your stomach and one on your

chest. Notice which hand moves. Move your stomach hand more for a deeper breath.

Step 3: Close your eyes or focus on a thing in the room.Step 4: Breath through your nose for 3 seconds – count in

your head “one-two-three.”Step 5: Hold that breath for 2 seconds (count “one-two”) &

release the breath for 3 seconds (count “one-two-three”).Step 6: Repeat Steps 4 and 5 for five to ten minutes.Step 7: When you are done, think about where you are,

wiggle your hands and feet, and open your eyes.

When you are done, choose the amount of relief you feel

Choose either 0, 1, 2, 3, 4, or 5 Be ready to share your rating with the group



Deep BreathingDeep Breathing

Let’s try it!

The Relief Scale: The Relief Scale:

Raise your hand if you felt no relief from the stress or tension caused by your tinnitus


Raise your hand if you felt slight relief from the stress or tension caused by your tinnitus


Raise your hand if you felt mild relief from the stress or tension caused by your tinnitus


Raise your hand if you felt moderate relief from the stress or tension caused by your tinnitus


Raise your hand if you felt nearly complete relief from the stress or tension caused by your tinnitus


Raise your hand if you felt complete relief from the stress or tension caused by your tinnitus


Deep Breathing Track your progress on this chart Deep Breathing Track your progress on this chart

What is Imagery?What is Imagery?

Imagery is imagining you are some place calming and peaceful

Some people call this their “happy” place Choose a place that feels safe to you Think about each of your 5 senses to get a good

picture of the place: Sight Smell Sound Touch Taste

Imagery is imagining you are some place calming and peaceful

Some people call this their “happy” place Choose a place that feels safe to you Think about each of your 5 senses to get a good

picture of the place: Sight Smell Sound Touch Taste

Imagine…Imagine…

Picture a safe, calming, and peaceful place

Picture a safe, calming, and peaceful place

Relaxation Exercise #2:Imagery - A Step-by-Step Guide

Relaxation Exercise #2:Imagery - A Step-by-Step Guide

Step 1: Prepare as you would for any relaxation exercise.Step 2: Take several deep breaths.Step 3: Choose a calming and peaceful place to imagine. Imagine the place as you close your eyes or focus on a thing in the room. Do this for five to ten minutes.Step 4: When you are done, think about where you are, wiggle your hands and feet, and open your eyes.

Step 1: Prepare as you would for any relaxation exercise.Step 2: Take several deep breaths.Step 3: Choose a calming and peaceful place to imagine. Imagine the place as you close your eyes or focus on a thing in the room. Do this for five to ten minutes.Step 4: When you are done, think about where you are, wiggle your hands and feet, and open your eyes.





ImageryImagery

Let’s try it!













Practice the Imagery exercise at home: Track your progress page 43Practice the Imagery exercise at home: Track your progress page 43

Tell me in your own words:Tell me in your own words:Why might Relaxation Exercises help

you feel better?Why might Relaxation Exercises help

you feel better?

Explain the concept rather than giving an example

HINT:

Record your progress and try the DVD in the back of the Workbook:Record your progress and try the DVD in the back of the Workbook:

Today’s Agenda Today’s Agenda











Planning Pleasant Activities: Distraction Planning Pleasant Activities: Distraction

Planning Pleasant ActivitiesPlanning 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

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

Step 1: Track Your ActivitiesStep 1: Track Your Activities

Use the Activity Planning worksheet to see how many pleasant activities you have in your daily routine

If you don’t have “2’s” (pleasant activities) everyday you may need to add them

Sometimes we forget to make time for ourselves Pleasant activities can keep your mind off your tinnitus Pleasant activities also can keep you feeling positive about

life

Use the Activity Planning worksheet to see how many pleasant activities you have in your daily routine

If you don’t have “2’s” (pleasant activities) everyday you may need to add them

Sometimes we forget to make time for ourselves Pleasant activities can keep your mind off your tinnitus Pleasant activities also can keep you feeling positive about

life

Planning Pleasant ActivitiesStep 1: Track Your ActivitiesPlanning Pleasant ActivitiesStep 1: Track Your Activities

Planning Pleasant Activities Step 2: List of Activities

Planning Pleasant Activities Step 2: List of Activities

Plan at least one pleasant activity each day Ask yourself (keep a journal):

Did I do all of my scheduled pleasant activities each day?

What prevented me from doing my pleasant activities?

Might more activities help?

Planning Pleasant Activities Step 3: Schedule Pleasant Activities Planning Pleasant Activities Step 3: Schedule Pleasant Activities

Record your progress:Record your progress:

Tell me in your own words:Tell me in your own words:Why might planning more pleasant activities

help me manage my reactions to tinnitus?Why might planning more pleasant activities

help me manage my reactions to tinnitus?

Describe the concept rather than giving an example

Summary of Today’s HomeworkSummary of Today’s Homework Changing Thoughts and Feelings Worksheet

(See the back of your Workbook) Relaxation exercises Planning pleasant activities Wait to complete the Changing Thoughts section

Relaxation Practice: Deep Breathing and Imagery Record your progress: Deep Breathing and Imagery

Planning Pleasant Activities Step 1: Track Your Activities Step 2: Make a List of Pleasant Activities Step 3: Schedule Pleasant Activities

Changing Thoughts and Feelings Worksheet (See the back of your Workbook)

Relaxation exercises Planning pleasant activities Wait to complete the Changing Thoughts section

Relaxation Practice: Deep Breathing and Imagery Record your progress: Deep Breathing and Imagery

Planning 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 Worksheet for your next session with the Audiologist

Remember:

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

Other agenda items?Other agenda items?

Questions?Questions?

Documents

Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 1 of 3) Version date: June 5, 2012