Intro
Welcome to CBT4T+ !
Enrolment in CBT4T+ programme offers Enhanced Support with six 1-1 monthly appointments.
Enrolment is for 12 months from the date you enrol.
About the programme
Everyone coming to the CBT for Tinnitus E-Programme (CBT4T) comes with their own story and background, and as we all know, we are all different! We have different strengths, different abilities, different characteristics and different expectations!
What each of us have in common though, is a marvellous functioning brain that steers us through all our experiences in life. We each shape how our brain functions through our behaviours and cognitions, and the "plasticity" of the brain enables us to keep on repeating what is helpful and good for us. However, if we allow it to happen - and we all do at times - plasticity enables us to keep on repeating what isn't helpful and good for us! Thankfully, plasticity also enables us to CHANGE unhelpful behaviours and cognitions.
The process in this programme did not come about as a "happy accident".
The first six months of 2020 was spent analysing my process and data from work I had carried out with patients individually over many years, all of whom had started out with either a Tinnitus Functional Index (TFI) category 4 (54-72%) or 5 (73-100%). These patients also had anxiety either at moderate or severe levels. From the analysis, I was able to translate the process in to what became the 12 Stage Cognitive Behaviour Therapy for Tinnitus E-Programme in 2020, then CBT4T in 2024.
From October 2023, enrolment was simplified further so that everyone enrolling could do so with ONE 1-1 appointment, with the option to add 1-1 appointments ad-hoc as they progress through the CBT4T process.
From October 2024, the CBT4T+ is being made available for those who feel they need regular monthly 1-1 clinical support during their initial 6 months in the programme. This amounts to up to NINE HOURS (6 x 90 minutes) of meeting one-on-one on a regular monthly basis.
The "ABC" of the CBT for Tinnitus E-Programme
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 for Tinnitus E-Programme
The CBT for Tinnitus E-Programme is a Neuroscience & CBT Protocol specifically developed for severe and very severe distress experienced because of tinnitus
It is therefore 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
Users are asked to work through the process at their 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 Protocol in the CBT for Tinnitus E-Programme: polyvagal theory and neuroplasticity
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 the form still found in most "CBT for Tinnitus" online and self-help publications to date, particularly by those without a psychology or psychotherapy background, training and experience, but also it is still used by many psychologists and psychotherapists
Since 2018, it is psychological flexibility that is incorporated in to the CBT for Tinnitus E-Programme, along with additional 3rd wave CBT practices, including those from Acceptance & Commitment Therapy (ACT) that are particularly helpful when learning how to live a normal life alongside tinnitus. These are found to be more intuitive and user-friendly than the old 2nd wave form of CBT by patients. The CBT in this course brings about a change in perspective through adaptive plasticity - this means a recovery-oriented perspective is developed rather than the user being stuck in a problem-oriented mindset. There is additional information in the blog post: ACT, CBT and Neuroscience
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. For those using the CBT for Tinnitus E-Programme, such use spontaneously diminishes, without a need to ban its use
This course is not limited to CBT; it draws on the latest, up to date relevant research and expertise from other fields including trauma, neuroscience, and consciousness studies
The course uses predominantly bespoke "CBT tools" developed by Debbie Featherstone, specifically for the CBT for Tinnitus E-Programme
The expectation is that everyone who completes this 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 CBT but the cost is 90% less
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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 is a fine example of evidence for using third wave CBT over traditional 2nd wave CBT
Complete your Tinnitus Functional Index (TFI)
The first thing to do is to complete your initial TFI (Tinnitus Functional Index):
Tinnitus Functional Index
If you found the TEP via the main Tinnitus E-Programme website www.tinnituseprogram.org, or the TEP courses courses.tinnituseprogram.org site you may have already completed a TFI and sent it in. That's great! No need to do another!
I ask you to complete your TFI for two reasons:
Completing it gives you your starting point. It reflects how you have been coping with tinnitus over the past week to two weeks. It gives you a measure that is used to "measure" how much you progress and improve through using the course. You'll complete them again mid-term (Stage 6) and at the end of the course, and your score will have reduced - most commonly by at least 2 of the TFI categories
The second reason is that when you press SEND at the end of the TFI, you receive a copy of your answers, and they also come through to me. I will be working with you after you enrol, so it gives me an idea of how well you are currently coping in terms of tinnitus distress.
Once you have enrolled, in addition to your TFI, I also ask that you complete and send in a THI (Tinnitus Handicap Inventory), your GAD-7 that gives a measure of anxiety (you will be asked to complete a second anxiety measure (Anxiety Symptoms Q) should your GAD-7 or PSS indicate being higher than at a mild level), your Perceived Stress Scale (PSS) and also a brief history of what has happened in terms of your tinnitus to date - it is called your Mini-history.
Pre-Stage 1 Sections
As soon as you enrol, you have access to the content up to the end of Stage 1 including the all-important pre-Stage 1 "Amygdala" section and an optional section about Sleep. The reading is not onerous; however, it is sensible to read the content one page - or part of a page - at a time.
From February 2024, there is a Q&A section comprising questions I've received from people on the course and my replies. You may well find you have similar questions so they are worth referring to.
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The CBT for Tinnitus E-Programme is not a "book about tinnitus". If you want a good, informative book about tinnitus, one of the best ones around is "Living with Tinnitus and Hyperacusis" by Laurence McKenna, David Baguley and Don McFerran.
The CBT for Tinnitus E-Programme is a hands on, practical, module-based course of treatment for tinnitus distress.
IMPORTANT! Treat this course as a "PROCESS" that you are following stage by stage. Each stage consists of a module that you should aim to take a MINIMUM of one whole week to complete. To help remind you that you are in a process, each module is called a "stage".
One of the elements of CBT is "education", and this too is woven in to the Tinnitus E-Programme process.
Stage 1 starts you on that process, and includes not only the basics of the mechanism of tinnitus, but even more importantly, why and how to begin making the necessary physiological changes. The practical element of the CBT for Tinnitus E-Programme is THE most significant aspect of changing the experience of tinnitus from being distressing - with all that 'distress' entails - to reducing distress.
As well as the very easy practical exercise(s) throughout the course, I have included some of the neuroscience behind them. Neuroscience is basically the "brain science" behind what's going on in terms of neurochemistry (chemical changes in the brain), neurobiological systems (the nervous systems in the body) and the "firing and wiring together" of neural pathways (brain plasticity).
A Brief Background
Historically, from 2009 until mid-2018, the Tinnitus E-Programme provided an online self-directed course of Tinnitus Management. Materials used were the same as those I use in my NHS clinics. It included CBT worksheets from 2nd wave CBT.
8 years on, following analysis of its use during 2017 and 2018, since the completion of an independent evaluation by NHBRC (Nottingham Hearing Biomedical Research Centre) and the introduction of mandatory submission of initial THI (Tinnitus Handicap Inventory) mid-2017, it became clear that being entirely self-directed (no therapist input) was NOT the best way for those with severe tinnitus distress - THI category 4 (58-76%) and 5 (78-100%) - to benefit. The majority of users (52% of all those registered) had THI scores in excess of 58% THI score tinnitus distress. These findings are similar to those in other self-help health fields.
After running pilot projects with Tinnitus E-Programme (TEP) users from October 2017 to July 2018 incorporating therapist input (from me) during the 6 Module Tinnitus E-Programme, everyone - without exception - who engaged, completed the course successfully. In addition, with therapist input of CBT (Cognitive Behaviour Therapy) training for those needing this additional element of Tinnitus Management, the evidence clearly pointed to the need for therapist input in addition to the course materials themselves.
Clinical Outcomes for both sets of TEP users were as good as the outcomes achieved by patients attending my clinic. This too matches findings in recent published research.