1. Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 2 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 Your Workbook Changing Thoughts & Feelings Worksheet 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

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

6. Today’s Agenda 1.Review and discuss the Changing Thoughts and Feelings Worksheet 2.Review homework  Two relaxation exercises: Deep Breathing and Imagery  Adding pleasant activities 3.New topic: Becoming aware of your thoughts  12 most common negative thoughts  Practice at home: identifying thoughts 1.Review and discuss the Changing Thoughts and Feelings Worksheet 2.Review homework  Two relaxation exercises: Deep Breathing and Imagery  Adding pleasant activities 3.New topic: Becoming aware of your thoughts  12 most common negative thoughts  Practice at home: identifying thoughts

7. Review The Changing Thoughts & Feelings Worksheet Stress Management and Relaxation Exercises Deep Breathing Imagery Planning Pleasant Activities The Changing Thoughts & Feelings Worksheet Stress Management and Relaxation Exercises Deep Breathing Imagery Planning Pleasant Activities

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. Was it difficult to identify a problem for #1? Discussion: Changing Thoughts and Feelings Worksheet

12. Remember: 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 Remember: 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

13. Did the Relaxation Exercises help you notice your tinnitus less? (Also review p. 43 – Relief Scale) Discussion: #2 on the Worksheet

14. 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 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

15. Relief Scale for Relaxation Exercises

16. Review of practice at home: Take a moment to discuss Deep Breathing page 43

17. Review of practice at home: Take a moment to discuss Imagery page 43

18. Planning Pleasant Activities: Distraction

19. Did you plan any new pleasant activities? (Also review pages 46 and 47 – Tracking and Listing activities) Discussion: #2 on the Worksheet

20. Skill Review: Planning Pleasant Activities

21. 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 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

22. Practice at home: Take a moment to discuss Tracking Activities page 46

23. Planning Pleasant Activities Step 1: Track Your Activities

24. Planning Pleasant Activities Step 2: List of Activities

25. 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

26. Changing Thoughts Paying Attention to Thoughts

27. Skill you have not yet learned to manage your reactions to tinnitus Review: #2 on the Worksheet New skill you will begin to learn today

28. New Skill: Introduction to Changing Thoughts

30. The CBT Cycle Beliefs Emotion Behavior & Thoughts

31. 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 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

32. How can “Changing Thoughts” help? Changing your thoughts about your tinnitus (A) can help you change the way you feel about it (C)

33. When can I use “Changing Thoughts?” Any time you feel tension or stress when you think about your tinnitus

34. 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

35. 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

36. Feelings Affect Health

37. “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 What are “Thought Errors”?

38. Twelve Common Thought Errors: #1 – All-or-nothing thinking

39. Twelve Common Thought Errors #2 – Over-simplifying

40. Twelve Common Thought Errors #3 – Focusing on wrong details

41. Twelve Common Thought Errors #4 – Jumping to conclusions

42. Twelve Common Thought Errors #5 – Over-estimating

43. Twelve Common Thought Errors #6 – Under-estimating

44. Twelve Common Thought Errors #7 – Assuming the worst

45. Twelve Common Thought Errors #8 – Emotional thoughts

46. Twelve Common Thought Errors #9 – “Should” statements

47. Twelve Common Thought Errors #10 – Labeling

48. Twelve Common Thought Errors #11 – Making things personal

49. Twelve Common Thought Errors #12 – Blaming

50. 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

51. Tell me in your own words: What must you do BEFORE you can change your thoughts? Describe the concept rather than giving an example

52. Practice at home - Continue to record your progress for the first two skills: Relaxation Exercises and Planning Pleasant Activities

53. 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 Relaxation  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 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 Relaxation  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

54. Remember: Continue to work on your Sound Plan for your next session with the audiologist

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

56. WAIT until the next session to complete the Changing Thoughts section on the Worksheet WAIT: do not complete yet

57. Other agenda items?

58. Questions?