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

2. 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

3. Materials Needed for This Meeting Changing Thoughts & Feelings Worksheet (from last meeting) Your Workbook Changing Thoughts & Feelings Worksheet (from last meeting) Your Workbook

4. 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

6. 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

7. 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

8. 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

9. 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…

11. Discussion: Relaxation Exercises

12. Discussion: Planning Pleasant Activities

13. Take a moment to discuss: Did the Relaxation Exercises or Planning Pleasant Activities help you feel better? #4 and #5 on the Worksheet

14. 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 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

15. Discuss: Introduction to Changing Thoughts

16. Review 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

17. 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

19. The CBT Cycle Beliefs Emotion Behavior & Thoughts

20. Review: 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

21. Feelings Affect Health

22. Review: Thought Errors Paying Attention to Thoughts

23. “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”?

24. 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)

25. 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

26. Twelve Common Thought Errors 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 others 11.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 others 11.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

27. Today’s new skill on the Changing Thoughts and Feelings Worksheet New skill you will begin to learn today

28. New Skill: Use this guide to help you Change Thoughts – Step-by-Step

29. 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-Step

30. 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

31. Take a moment to: Complete Step 1 Take a moment to: Complete Step 1

32. 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-Step

33. 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

34. Take a moment to: Complete Step 2 Take a moment to: Complete Step 2

35. 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-Step

36. 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

37. Take a moment to: Complete Step 3 Take a moment to: Complete Step 3

38. 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-Step

39. 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

40. Take a moment to: Complete Step 4 Take a moment to: Complete Step 4

41. 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-Step

42. 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

43. Take a moment to: Complete Step 5 Take a moment to: Complete Step 5

44. 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-Step

45. 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

46. Take a moment to: Complete Step 6 Take a moment to: Complete Step 6

47. 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-Step

48. 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

49. Take a moment to: Complete Step 7 Take a moment to: Complete Step 7

50. 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-Step

51. Step 8: Picture yourself in the future Look at the negative thought from Step 1 Think about the positive thought from Step 6 instead Step 8: Picture yourself in the future Look at the negative thought from Step 1 Think about the positive thought from Step 6 instead Example: Changing Thoughts

52. Take a moment to: Complete Step 8 Take a moment to: Complete Step 8

53. How to use every day: Changing 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

54. 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 home

56. Other agenda items?

57. Questions?