The main measure used is the Tinnitus Functional Index (TFI). Before a CBT4T User starts the process at Stage 1, they complete a TFI along with a THI (Tinnitus Handicap Inventory), a GAD-7 for anxiety, PSS (Perceived Stress Score) and ASQ (Anxiety/stress Symptoms Q). The TFI and ASQ are repeated before leaving Stage 4, then all five measures are repeated at the end of Stage 6 and again at the end of the process.

It is the TFI subscales that offer the most insight to how much progress has been made by Stage 6 - in the main this is progress through having built in a consistent routine of using a very short but extremely effective breathing exercise throughout their day (6 x daily), a physiological relaxation exercise 2-3 x daily alongside 2-3 of the breathing exercises, and used additional recorded relaxation exercises if not every day, then 4-5 times each week. Building a new breath work and relaxation routine in to their day is the largest behavioural component of the process, followed by activities the User identifies in Stage 5b in the Goal Setting section.

On average, by the end of Stage 6, the TFI has reduced by AT LEAST one category - often by two (or more) categories. By Stage 6, the main TFI subscales that reduce the most are Interference with Relaxation, Emotional Distress and Sleep Disturbance. The remaining 5 subscales are reduced, but it is the cognitive elements of "CBT" that go on to reduce elevated levels of Intrusiveness, Sense of Control, and Concentration. The main cognitive tools used are:

  • Two Arrows (Stage 4)

  • Costs & Benefits Transaction (Stage 4)

  • Cognitive Distortions Practical (Stage 4)

The Reaction Analysis tool at Stage 5 merges the previous three tools from Stage 4, then the Meaning Adjuster - a reframing tool introduced across Stages 5 and 6 continues to be used regularly and consistently through the remaining stages, until the tool has done its job and the User is "automatically reframing" without needing to use the tool.

By the time the User completes the full process, they will have used the Core Belief tools (Stage 7), comprising identification of any remaining negative core beliefs, and started work on a new core belief. It is once the User has completed the final stage (Stage 8) they repeat for a final time the full set of clinical measures. 

An audit of TFI Outcomes (Stage 12) completed in May 2022 is as follows:

*Average change by TFI value: 

  • Category 5 pre-course: 84.9% > 29.9% (Category 2 post-course)

  • Category 4 pre-course: 64.8% > 20.8% (Category 2 post-course)

  • Category 3 pre-course: 45.6% > 19.0% (Category 2 post-course)

*Figures published 22 May 2022