Take Action: Behaviour and Cognition Change

The "ABC" of CBT in CBT4T 2025/26

A: Taking ACTION

"Doing the same thing over and over again, and expecting a different result" is - as the saying goes - the definition of insanity! This course walks you through the Action you can take to change

B: BEHAVIOUR 

Behaviour is 'what you do'. Many of our behaviours have become HABIT. By introducing a simple alternative ROUTINE of Behaviour in to our day creates and builds new habits that help rather than hinder

C: COGNITIONS

Cognitions are our interpretations of our experiences. These too become HABIT. Just as with our behaviours, we have an extraordinary ability to change our interpretation of experiences, creating new habit cognitions that help rather than hinder

CHANGE

C is also for Change - living well, rather than being trapped by learned BEHAVIOURS and COGNITIONS that are HABITS we are all too often too lazy to do anything about, or argue we "don't have time" or "it won't work for me". Our Behaviours and Cognitions bring about and maintain suffering when with willingness to give ourselves a chance, we are the ones best placed to live well without suffering. Instead of spending time suffering, spend a fraction of that time using the plasticity the brain has in abundance. There is nothing difficult about it provided you have the will to Change

Cognitive Behaviour Therapy (CBT)

CBT is acknowledged to be the only clinical intervention with a strong evidence-base for reducing tinnitus distress. When you are seeking CBT to help you, be aware that CBT has evolved over the years, especially so in recent years. There is a family of CBT psychotherapies - not just "CBT":

The CBT Used in CBT4T

• CBT4T (previously known as the CBT for Tinnitus E-Programme) uses a Neuroscience & CBT Process specifically developed for severe and very severe distress experienced because of tinnitus

• CBT4T uses a defined process, to be used in the order it is presented

• There is a reason for everything used in the course being not only what it is, but where it is in the process

• You are asked to work through the process AT YOUR OWN PACE: no individual can be expected to fit a process - a process has to fit the individual

• Neuroscience is a massive subject of study. Two aspects in particular inform the Neuroscience & CBT Process in CBT4T: polyvagal theory and neuroplasticity

• CBT4T is provided by Debbie Featherstone, PGDip Psychotherapy (2005) and MSc Psychotherapy (2012), so qualified in psychotherapy (since 2005) and Hearing Therapist (since 1994)

• CBT itself has evolved. Traditional 2nd wave CBT uses restructuring of thoughts to change feelings. It was the CBT used in my clinics from 2005-2018, some of which was included in the original Tinnitus E-Programme until 2018. It is 2nd wave CBT that is still found in most "CBT for Tinnitus" including 1-1 a) if you can find a qualified psychologist/psychotherapist that can do it - Audiologists are not qualified as psychologists/psychotherapists - and b) you are prepared to pay £1,500-£3,000. There is now an increasing number of Apps purporting to use CBT, of which only ONE has a very well qualified psychologist on their team - the rest do not. There are also some self-help UK publications that also use the old 2nd wave version of CBT, primarily by Audiologists

• Since 2018, it is PSYCHOLOGICAL FLEXIBILITY (3rd wave CBT) that is incorporated in to the CBT for Tinnitus E-Programme and subsequently CBT4T, along with additional 3rd wave CBT practices, including those from Acceptance & Commitment Therapy (ACT). There are widely accepted correlations between distressing tinnitus and distressing pain, and McCracken & Vowles' research paper is referenced below. 3rd wave CBT practices are particularly helpful when learning how to live a normal life alongside tinnitus, and for my patients and those using CBT4T, have proven to be more intuitive and user-friendly than the old 2nd wave form of CBT. It is how the CBT in CBT4T brings about change in PERSPECTIVE via NEUROPLASTICITY through ADAPTIVE PLASTICITY - leading to development of a recovery-oriented perspective rather than the user being stuck in a problem-oriented mindset. There is additional information in the blog post: ACT, CBT and Neuroscience

• In CBT4T, there is no "ban" on using sound enrichment i.e. the playing of music or other everyday background sound in the environment free field or using bone conduction headphones as decreed - wrongly in my opinion and my experience - by some. For the Users of CBT4T, such use spontaneously diminishes, without any need to ban its use

• This course IS NOT LIMITED TO CBT; rather, it draws on the latest, up to date relevant research and expertise from other fields including TRAUMA, NEUROSCIENCE (predominantly neuroplasticity), and CONSCIOUSNESS STUDIES

• The course uses bespoke "CBT tools" developed by Debbie Featherstone, specifically for the CBT for Tinnitus E-Programme and now, for CBT4T

• The expectation is that everyone who completes the CBT4T process as it is set out reaches at least TFI category 2 (18-31% - tinnitus is a small problem), even those starting with a TFI category 5 (73-100% - tinnitus is a very big problem) See Outcomes

• These are the same excellent Outcomes achieved through individual working with Debbie Featherstone but the cost is 90% less

• Approximately 40% of enrolments start with Category 5 TFI (very big problem), 40% start with Category 4 TFI (big problem), and the remaining 20% start with Category 3 (moderate problem)

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REFERENCE: McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol. 2014 Feb-Mar;69(2):178-87. doi: 10.1037/a0035623. PMID: 24547803

McCracken & Vowles' is a fine example of evidence for using third wave CBT over traditional 2nd wave CBT