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Self-Help Cognitive Behavioural Therapy (CBT) for Tinnitus

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Self-Help Cognitive Behavioural Therapy (CBT) for Tinnitus Self-help Cognitive Behavioural Therapy (CBT) for Tinnitus What is Tinnitus? Tinnitus is the perception of noises without an external source. They can he heard in either or both ears, or in the head. Tinnitus can sound like ringing, buzzing, hissing, whistling or other noises. The sensation can be constant or intermittent and it can vary in volume. Some people experience musical tinnitus, which often sound like a familiar tune or song. Other people experience pulsatile tinnitus which beats in time with their heartbeat. Tinnitus is very common. It is estimated that 30% of people will experience tinnitus at some point during their life. However, it is thought that tinnitus is persistent in 13% of people (BTA, 2020: https://www.tinnitus.org.uk/all-about- tinnitus). What causes Tinnitus? The exact cause of tinnitus is currently unknown. We know that tinnitus is often present following change, for example, change to hearing, as well as physical and mental changes such as illness or stress. You can have adequate hearing and still experience tinnitus. Sometimes, it can link to a glitch in your hearing system with no known cause. Image from: https://hearingexcellence.ca/wp- content/uploads/2018/04/tinnitus.jpg What can I do about it? There are lots of strategies you can use to help manage your tinnitus. The following information will discuss cognitive behavioural therapy (CBT). Talking therapies such as CBT can help to manage how you respond to the tinnitus, and can help you to learn how you think and act towards the tinnitus and how much attention you give it. Talking therapies can also help reduce the distress caused by tinnitus. CBT is often performed with a therapist. However, many of the exercises and techniques used in Patient Self-help Cognitive Behavioural Therapy Information (CBT) for Tinnitus CBT can be done at home by yourself. It is a good idea to try the exercises one at a time, rather than all at once, and work at a pace you’re comfortable with. What is CBT? Cognitive behavioural therapy (CBT) is a treatment approach commonly used in the treatment or management of mental and physical health problems such as depression and anxiety, as well as tinnitus management and balance rehabilitation. CBT is based on the theory that our thoughts, feelings, actions and emotions are all connected. If we change one of these elements, it can affect the others. CBT combines cognitive therapy – examining the things that you think, and behavioural therapy – examining the things that you do. CBT focuses on setting goals, the present day, and what is affecting you in your life now. The theory is that the way we think about situations can affect the way that we feel and behave. For example, if you interpret a situation negatively then you might experience negative emotions as a result, and those bad feelings might then lead you to behave in a certain way, such as avoidance. If your negative interpretation of situations goes unchallenged, then these patterns in your thoughts, feelings and behaviour can become part of a continuous cycle. CBT aims to teach you to challenge these negative thoughts and therefore lead to a change in behaviours and emotions. Hot Cross Bun Model CBT has a particular way of looking at how we make sense of the world. It has four core components: Thoughts: what we think about the situation, automatic negative thoughts. Behaviours: how we react to the situation, for example, avoidance. Feelings: our emotional response to the situation. Bodily sensations: our physical reaction such as increased heart rate, sweaty palms. Each of these components link together. If you change one of these components, it will change all of the others. This is known as The Hot Cross Bun Model. A diagram is given on the next page. CBT focuses on changing thoughts and behaviours as these are more easily influenced and controlled. This can be used to think about your tinnitus and how you react when you notice it. Self-help Cognitive Behavioural Therapy (CBT) for Tinnitus Patient Information Patient Self-help Cognitive Behavioural Therapy (CBT) Information for Tinnitus Positive statements or affirmations Positive statements encourage us and help us cope through situations we find distressing. It can be a useful exercise to write positive statements to counteract negative thoughts. Try to think of times and situations where you think negatively. Write a positive statement to counteract each negative thought. You can repeat the positive statements to yourself when you feel a negative thought creeping in, or when you are facing a challenging situation. In time, you’ll create new associations, replacing the negative thoughts with positive ones. Examples of positive statements are: Stop and breathe. I can do this. This will pass. I can be anxious/angry/sad and still deal with this. I have done this before, and I can do it again. These are just feelings, they will go away. I can cope with this. It’s okay to feel this way, it’s a normal reaction. My mind is not always my friend. Thoughts are just thoughts – they’re not necessarily true or factual. This is difficult and uncomfortable, but it’s only temporary. I can use my coping skills and get through this. I can learn from this and it will be easier next time. Use the table below to write down a positive thought for each distressing situation. It is useful to review and refresh the positive statements from time to time. Situation Positive Statement Patient Self-help Cognitive Behavioural Therapy (CBT) Information for Tinnitus CBT thought records – to help change the way that you feel As previously mentioned, the theory of CBT is that what we think can affect our emotions and the way that we feel. If we have negative thoughts about ourselves or a situation, it can result in negative feelings. Sometimes we have thoughts which are unhelpful. These unhelpful thoughts are often automatic, and therefore known as ‘negative automatic thoughts’. Negative automatic thoughts are based on assumptions and are often inaccurate. We can have negative automatic thoughts without realising we are. By recording our thoughts, we can use a thought record to challenge them, and think in a more balanced way. This can help us to learn to think differently. How to use a thought record To begin to record your thoughts, you will need to start to pay attention to what you are thinking. Ask yourself ‘what was going through my mind just then’? When you have a thought, try to record it as soon as possible. It can be helpful to see the thought written down. It can be useful to record a thought when you notice a change in how you are feeling. Try to record the thought quickly as it is more likely that you will be able to recall everything. Situation - Note down some information about the situation in which you noticed the change in emotion. This can help you gain more understanding of what triggered the change. Think about when it happened, what you were doing, where you were and who you were with. Emotion - Note the thoughts you were having. Think about just before you noticed the change in how you were feeling. What was going through your mind? What did you think to yourself? How to challenge thoughts CBT helps you to think accurately, as sometimes our thinking can become biased. We are able to change our way of thinking. Identifying our thoughts is the first step. You can then consider the evidence for and against the thought. 1. Identify when you are having a negative automatic thought. 2. Rate how much you believe the thought. You could score it as a percentage. 3. List why the thought might be true. Think about what evidence there is to support the thought. 4. List why the thought might not be true. What would you say to a friend who was having this thought? 5. Read the original thought and the evidence for and against it. It can help to do this aloud. 6. Think about whether there is a more helpful way of thinking. Have you been harsh on yourself? 7. Write your new thought. 8. Rate how strongly you believe the new thought. You can use the thought record sheet given on the next page Patient Self-help Cognitive Behavioural Therapy (CBT) Information for Tinnitus Patient Self-help Cognitive Behavioural Therapy (CBT) Information for Tinnitus Relaxation Tinnitus is often linked to increased stress levels. Relaxation techniques such as relaxed breathing and progressive muscle relaxation can help to reduce stress and anxiety levels, and therefore how you respond to the tinnitus. Relaxed breathing (from Http://psychology.tools) When we feel anxious, we experience the fight or flight response to prepare our body for danger. This can happen when we experience tinnitus (this is the ‘bodily sensations’ part of the Hot Cross Bun model). Due to this response, our breathing tends to speed up. Performing relaxed breathing tells the body that it is safe to relax. Relaxed breathing tends to be slower and deeper than regular breathing, and is from the belly rather than the chest. Image from: http://psychology.tools Try to sit down comfortably. You might like to lie down. Close your eyes if you like. Try to breathe through your nose rather than your mouth. Take slow, steady breaths Count to four as you breathe in, pause, then count to four as you breathe out. Pause before starting to breathe in again. Tips Try for a few minutes at a time to begin with. Try to build up to five to ten minutes of relaxed breathing per session.
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