Stage 4 is where you start to get in to the "Cognitive Behaviour Therapy" training. It begins with Cognitive Fusion, clarifying how it is our "subjectivity" that causes us suffering, Part 2 of the Costs & Benefits Transaction, followed by an overview of Negative Thoughts and some common examples of thoughts people have about their tinnitus.

You also learn about "Cognitive Distortions" in Stage 4, and now you have the opportunity to see what yours have been doing and how they have been making you feel. You'll see how you have a tendency to use the same 3 or 4 cognitive distortions over and over again. We all do - until we realise it, and then, we have the opportunity to change all that.

In Stage 5, you have the opportunity to put the three tools you practiced using during Stage 4 together, using the Reaction Analysis tool. This eases you in to using the Meaning Adjuster - the main reframing tool used in the course. Although it is a reframing tool, the purpose is to reframe a usually unhelpful view (problem-perspective) of an experience to a more helpful, beneficial recovery-perspective. Thoughts themselves aren't the issue - it's the meaning behind them, usually based on internalised assumptions and beliefs that keeps us stuck in an unhelpful mindset (problem-perspective).

Beck Thought Records (a cognitive restructuring tool for reframing but from 2nd wave CBT) are also included in the CBT for Tinnitus E-Programme, and should you want to use them you can start using them in Stage 9 should you so wish. 

All "tools" used in the course, including the Costs & Benefits Transaction, Cognitive Distortions Practical, Meaning Adjuster and Thought Records, are electronic - you complete a record in the website, press SEND, a copy comes through to your email address and through to me.

Stage 6 onwards

You begin using the Meaning Adjuster in Stage 5, and following the previous weeks' use of regular and consistent relaxation exercises, you are ready to build on those relaxation skills. A six-week course in Autogenic Relaxation Training starts in Stage 6. Autogenics is an additional powerful relaxation method and very effective indeed.

It is also at the end of Stage 6 (of 12 stages) that you complete your mid-term measures. You'll repeat the TFI, THI, GAD, PSS and ASQ. By Stage 6, you can see the progress you have made so far. Most commonly, where individuals begin with a TFI Category 5 score, it will have dropped to Category 4; where they begin with a Category 4 score, it will have dropped to Category 3. 

"Taming Tinnitus" in Stage 7 is a paper written by Laurence McKenna (if you haven't heard of him, he is a well published Clinical Psychologist who specialises in tinnitus) and colleagues. I include this short paper because it's a useful "check-list" for lots of "Do's and Don'ts" about tinnitus. However, there is a particularly effective Attention-Switching exercise from this paper that you start using in Stage 7. 

You also have the third and fourth guided relaxation recording in Stages 6 and 8 (there is a different one every 2 weeks starting in Stage 2) and each of them lasts around 30 minutes.

Reframing using the Costs & Benefits Transaction and/or Meaning Adjuster is used throughout the modules from Stage 5 onwards.

AFTER STAGE 7

Once you have completed Stage 7, the remaining modules are opened up. You use the content in Modules 8-12 as you need to. There are opportunities to repeat your measures (TFI etc) at modules 9, 10 and 12 .

Module 11 covers work on Core Beliefs (not required by everyone, but useful for those that need it), and Module 12 is about consolidation. It's the time to allow everything to sink in and begin enjoying how differently you feel.

We will have continued to keep in touch throughout the course, primarily via your weekly SITREP, as well as the Progress Check at the end of each of the first 5 stages and one at the start of Module 9.

How long you take to complete the process varies from individual to individual, and depends heavily on where you started from. Starting out with category 5 TFI, people are completed after between 18-28 weeks. It is slightly shorter for those starting out with a category 4 TFI - between 16-26 weeks.

Once you are completed, I ask you to complete an online review/evaluation of the CBT for Tinnitus E-Programme.

Finally

When you have enrolled, take each Stage AT YOUR OWN PACE. Never feel compelled to move on to a next Stage until you are ready - it will still be there when you are ready for it. There is a wide range of time taken by people using this course, although you continue to have access for up to a year. 

I look forward to working with you!

Debbie Featherstone MSc
Hearing Therapist & Psychotherapist
Founder of the CBT for Tinnitus E-Programme