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Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 3 of 3)
Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 3 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
Materials Needed for This Meeting Materials Needed for This Meeting Changing Thoughts & Feelings Worksheet
(from last meeting) Your Workbook
Changing Thoughts & Feelings Worksheet (from last meeting)
Your Workbook
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
Today’s Agenda Today’s Agenda
1. Review and discuss the Changing Thoughts and Feelings Worksheet
2. Review: Relaxation Exercises Adding Pleasant Activities 12 common Thought Errors
3. New topic: Changing Thoughts Step-by-Step
1. Review and discuss the Changing Thoughts and Feelings Worksheet
2. Review: Relaxation Exercises Adding Pleasant Activities 12 common Thought Errors
3. New topic: Changing Thoughts Step-by-Step
Review Review
The Changing Thoughts & Feelings Worksheet Stress Management and Relaxation Exercises
Deep Breathing Imagery
Planning Pleasant Activities 12 common Thought Errors
The Changing Thoughts & Feelings Worksheet Stress Management and Relaxation Exercises
Deep Breathing Imagery
Planning Pleasant Activities 12 common Thought Errors
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
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
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…Take a moment to…
Discussion: Relaxation ExercisesDiscussion: Relaxation Exercises
Discussion: Planning Pleasant ActivitiesDiscussion: Planning Pleasant Activities
Take a moment to discuss: Did the Relaxation Exercises or Planning Pleasant Activities help you feel better?
Take a moment to discuss: Did the Relaxation Exercises or Planning Pleasant Activities help you feel better?
#4 and #5 on the Worksheet#4 and #5 on the Worksheet
Things to RememberThings 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
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
Discuss: Introduction to Changing ThoughtsDiscuss: Introduction to Changing Thoughts
ReviewReview
What is “Changing Thoughts”? First you identify thoughts you had just before
feeling bad Then you work on changing that thought to
something more helpful How can “Changing Thoughts” help?
Changing your thoughts about your tinnitus can help you change the way you feel about it
When can I use “Changing Thoughts”? Any time you feel tension or stress when you think
about your tinnitus
What is “Changing Thoughts”? First you identify thoughts you had just before
feeling bad Then you work on changing that thought to
something more helpful How can “Changing Thoughts” help?
Changing your thoughts about your tinnitus can help you change the way you feel about it
When can I use “Changing Thoughts”? Any time you feel tension or stress when you think
about your tinnitus
Thoughts Affect Feelings 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
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
The CBT Cycle The CBT Cycle
Beliefs
Emotion
Behavior& Thoughts
Review: Feelings Affect HealthReview: 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
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 Feelings Affect Health
Review:Thought Errors
Paying Attention to Thoughts
“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
“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
Review: What are “Thought Errors”?Review: What are “Thought Errors”?
Review of Practice at home: Review of Practice at home:
In your Workbook (pages 50-53) you wrote down your own examples of each of the 12 Thought Errors
Take a moment to discuss
(see next 2 slides for definitions)
Twelve Common Thought Errors:Twelve Common Thought Errors:1. All-or-nothing thinking: When you see things in only
two categories
2. Over-simplifying: When you see one bad event as a never-changing pattern
3. Focusing on wrong details: When you pick out a single detail and focus on it
4. Jumping to conclusions: When you make assumptions that things will turn out badly even though you don’t have facts to support them
5. Over-estimating: When you think things are more important than they really are
6. Under-estimating: When you think things are less important than they really are
1. All-or-nothing thinking: When you see things in only two categories
2. Over-simplifying: When you see one bad event as a never-changing pattern
3. Focusing on wrong details: When you pick out a single detail and focus on it
4. Jumping to conclusions: When you make assumptions that things will turn out badly even though you don’t have facts to support them
5. Over-estimating: When you think things are more important than they really are
6. Under-estimating: When you think things are less important than they really are
Twelve Common Thought ErrorsTwelve Common Thought Errors7. Assuming the worst: When you think something is
much worse than it really is8. Emotional thoughts: When you think that your
emotions show the way things really are9. “Should” statements: When you say “should” or
“shouldn’t” to try to get yourself to do hard task10. Labeling: Attaching a bad label to yourself or others11. Making things personal: You see yourself as the
cause of some negative event when you aren’t responsible
12. Blaming: You blame others for your problems or blame yourself for other people’s problems
7. Assuming the worst: When you think something is much worse than it really is
8. Emotional thoughts: When you think that your emotions show the way things really are
9. “Should” statements: When you say “should” or “shouldn’t” to try to get yourself to do hard task
10. Labeling: Attaching a bad label to yourself or others11. Making things personal: You see yourself as the
cause of some negative event when you aren’t responsible
12. Blaming: You blame others for your problems or blame yourself for other people’s problems
Today’s new skill on the Changing Thoughts and Feelings WorksheetToday’s new skill on the Changing Thoughts and Feelings Worksheet
New skill you
will begin to
learn today
New Skill: Use this guide to help youChange Thoughts – Step-by-StepNew Skill: Use this guide to help youChange Thoughts – Step-by-Step
Step 1: Event (A)
Identify what was going on when you started feeling bad
What happened?
Note: Sometimes it is hard to remember the event that was happening that made you feel bad until later. If this is the case for you, go to the second step and come back to this step later.
Step 1: Event (A)
Identify what was going on when you started feeling bad
What happened?
Note: Sometimes it is hard to remember the event that was happening that made you feel bad until later. If this is the case for you, go to the second step and come back to this step later.
Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Step 1: Event. Identify what was going on when you started feeling bad What happened? – “My tinnitus isn’t getting any better”
Step 1: Event. Identify what was going on when you started feeling bad What happened? – “My tinnitus isn’t getting any better”
Example: Changing Thoughts Example: Changing Thoughts
Take a moment to:Complete Step 1Take a moment to:Complete Step 1
Step 2: Thoughts (B)
Now try to write down a thought you had just before you started feeling bad or upset
What was the first thought that came into your mind?
Note: You may have had many thoughts just before you started feeling bad. If you had more than one thought, pick the one that made you feel the worst.
Step 2: Thoughts (B)
Now try to write down a thought you had just before you started feeling bad or upset
What was the first thought that came into your mind?
Note: You may have had many thoughts just before you started feeling bad. If you had more than one thought, pick the one that made you feel the worst.
Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Step 2: Thoughts What was the first thought that came into your mind?
“Why can’t anyone help me?”
Step 2: Thoughts What was the first thought that came into your mind?
“Why can’t anyone help me?”
Example: Changing Thoughts Example: Changing Thoughts
Take a moment to:Complete Step 2Take a moment to:Complete Step 2
Step 3: Feelings (C)
Write down any bad or upsetting feelings you are/were having.
For example, sad, angry, jealous, or disappointed
Step 3: Feelings (C)
Write down any bad or upsetting feelings you are/were having.
For example, sad, angry, jealous, or disappointed
Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Step 3: Feelings
Write down any bad or upsetting feelings you had
Step 3: Feelings
Write down any bad or upsetting feelings you had
Example: Changing Thoughts Example: Changing Thoughts
Take a moment to:Complete Step 3Take a moment to:Complete Step 3
Step 4: Evidence for
Examine the thought you described in Step 2.
Write down evidence that this statement is true where it says “Evidence For” on the Changing Thoughts Exercise.
Note: Our thoughts often have some truth to them, but some have many more errors. Write down what is true about the thought in the “Evidence For” box.
Step 4: Evidence for
Examine the thought you described in Step 2.
Write down evidence that this statement is true where it says “Evidence For” on the Changing Thoughts Exercise.
Note: Our thoughts often have some truth to them, but some have many more errors. Write down what is true about the thought in the “Evidence For” box.
Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Step 4: Evidence for
Write down evidence your thought in Step 2 is true
Step 4: Evidence for
Write down evidence your thought in Step 2 is true
Example: Changing Thoughts Example: Changing Thoughts
Take a moment to:Complete Step 4Take a moment to:Complete Step 4
Step 5: Evidence Against
Again, examine the thought you described in Step 2
Identify evidence that this statement is not true. In the next box where it says “Evidence Against” write down the reasons the thought may not be true.
Note: You may be able to identify this thought using the 12 Thought Errors from the list. You can have more than one error in a single thought.
Step 5: Evidence Against
Again, examine the thought you described in Step 2
Identify evidence that this statement is not true. In the next box where it says “Evidence Against” write down the reasons the thought may not be true.
Note: You may be able to identify this thought using the 12 Thought Errors from the list. You can have more than one error in a single thought.
Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Step 5: Evidence against
Write down a new more helpful thought about the event
Step 5: Evidence against
Write down a new more helpful thought about the event
Example: Changing Thoughts Example: Changing Thoughts
Take a moment to:Complete Step 5Take a moment to:Complete Step 5
Step 6: New Positive Thought
Write down a new more helpful thought about the event
This step requires a lot of practice to feel more natural
Note: Sometimes it helps to say statements that apply to many things. Some people call these “mantras.”
New thoughts should be (1) brief, (2) easy to remember, (3) true to you, (4) apply to your life, and (5) helpful
Step 6: New Positive Thought
Write down a new more helpful thought about the event
This step requires a lot of practice to feel more natural
Note: Sometimes it helps to say statements that apply to many things. Some people call these “mantras.”
New thoughts should be (1) brief, (2) easy to remember, (3) true to you, (4) apply to your life, and (5) helpful
Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Step 6: New Positive Thought
Write down a new more helpful thought about the event
Step 6: New Positive Thought
Write down a new more helpful thought about the event
Example: Changing Thoughts Example: Changing Thoughts
Take a moment to:Complete Step 6Take a moment to:Complete Step 6
Step 7: Feelings (C) when you think the new thought
As you practice, pay attention to how you feel when you have positive thoughts instead of negative thoughts
Step 7: Feelings (C) when you think the new thought
As you practice, pay attention to how you feel when you have positive thoughts instead of negative thoughts
Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Step 7: Feelings when you think the new thought
Pay attention to how you feel when you have positive thoughts instead of negative thoughts
Step 7: Feelings when you think the new thought
Pay attention to how you feel when you have positive thoughts instead of negative thoughts
Example: Changing Thoughts Example: Changing Thoughts
Take a moment to:Complete Step 7Take a moment to:Complete Step 7
Step 8: Picture yourself in the future
Look at the negative thought from Step 1 again
Think of a time in the future when you might have that thought again
Picture yourself thinking the positive thought from Step 6 instead
Step 8: Picture yourself in the future
Look at the negative thought from Step 1 again
Think of a time in the future when you might have that thought again
Picture yourself thinking the positive thought from Step 6 instead
Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Step 8: Picture yourself in the futureLook at the negative thought from Step 1 Think about the positive thought from Step 6 instead
Step 8: Picture yourself in the futureLook at the negative thought from Step 1 Think about the positive thought from Step 6 instead
Example: Changing Thoughts Example: Changing Thoughts
Take a moment to:Complete Step 8Take a moment to:Complete Step 8
How to use every day:How to use every day:Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step
Do the Changing Thoughts Exercise on page 56
Write down these steps on a small piece of paper so you can do use the steps anytime
When you feel bad or when something bad happens, use the Changing Thoughts Exercise to feel better
Sometimes you can feel better about your tinnitus if you just change the way you think about it
Do the Changing Thoughts Exercise on page 56
Write down these steps on a small piece of paper so you can do use the steps anytime
When you feel bad or when something bad happens, use the Changing Thoughts Exercise to feel better
Sometimes you can feel better about your tinnitus if you just change the way you think about it
Practice using the Changing Thoughts Exercise Continue to use the Changing Thoughts and Feelings
Worksheet:
1. Relaxation Exercises
2. Planning Pleasant Activities
3. Changing Thoughts Use the skills that work for you to manage your
tinnitus!
Practice using the Changing Thoughts Exercise Continue to use the Changing Thoughts and Feelings
Worksheet:
1. Relaxation Exercises
2. Planning Pleasant Activities
3. Changing Thoughts Use the skills that work for you to manage your
tinnitus!
Practice at homePractice at home
Other agenda items?Other agenda items?
Questions?Questions?