Managing your tinnitus changing your thoughts and feelings session 2 of 3
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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

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

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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 Agenda

  • Review and discuss the Changing Thoughts and Feelings Worksheet

  • Review homework

    • Two relaxation exercises: Deep Breathing and Imagery

    • Adding pleasant activities

  • New topic: Becoming aware of your thoughts

    • 12 most common negative thoughts

    • Practice at home: identifying thoughts


  • 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

Take a moment to…

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

Discussion:Changing Thoughts and Feelings Worksheet

  • Was it difficult to identify a problem for #1?


  • 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


Discussion: #2 on the Worksheet

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

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

Discussion: #2 on the Worksheet

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

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 Thoughts

Paying Attention to Thoughts

Review: #2 on the Worksheet

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

New skill you will begin to learn today

New Skill: Introduction to Changing Thoughts

The CBT Cycle

& 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

What are “Thought Errors”?

  • “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


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 Homework

Thought 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 section


  • Relief Scale for Relaxation Exercises:

    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 for your next session with the audiologist

Next session

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

WAITuntil the next session to complete the Changing Thoughts section on the Worksheet

WAIT: do not complete yet

Other agenda items?


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