This workshop was developed by researchers at: This workshop was developed by researchers at

This workshop was developed by researchers at:

• 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

Please share the following with the group:

• Please share the following with the group:

• What is tinnitus like for you?
• Do you also have hearing loss?
• How we should communicate as a group?
• How do you deal or “cope” with your tinnitus?

“Cure” = eliminate or reduce the tinnitus

• “Cure” = eliminate or reduce the tinnitus

• No cure yet – research underway

• It can’t be cured, but you can learn to manage your reactions to it

• [Note: “managing tinnitus” really means “managing reactions to tinnitus” – you can’t change the sound of the tinnitus, but you can change how you react to the sound]

Negative emotional reactions are reduced

• 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

Understand what “CBT” means

• Understand what “CBT” means

• Learn about stress and tinnitus

• Learn two relaxation exercises:

• Deep Breathing
• Imagery

• Learn about “distraction” (by keeping your mind off of your tinnitus using pleasant activities)

• Start using the Changing Thoughts and Feelings Worksheet

Tinnitus is not a mental health disorder

• Tinnitus is not a mental health disorder

• CBT is used to change thoughts, behaviors, or emotions

• CBT helps you think more positively about your tinnitus

• CBT also helps people who have pain and other health problems

Behavior, emotions, and thoughts/beliefs are related

• Behavior, emotions, and thoughts/beliefs are related

• If you change one of these then you can change all of these

• Behavior or thoughts can lead to negative feelings about tinnitus

• TODAY: You will work on behaviors that can help you think more positively and help you feel better

Time is limited, so we will follow the agenda

• Time is limited, so we will follow the agenda

• We will stay focused on learning ways to manage reactions to tinnitus

Changing Thoughts & Feelings Worksheet

• Changing Thoughts & Feelings Worksheet

• Discuss stress and tinnitus

• Learn and practice two relaxation exercises: Deep Breathing and Imagery

• Learn to plan pleasant activities

Tear out a blank Changing Thoughts and Feelings Worksheet:

• Tear out a blank Changing Thoughts and Feelings Worksheet:

Use this Worksheet to take notes while you learn skills to manage your reactions to tinnitus

• Use this Worksheet to take notes while you learn skills to manage your reactions to tinnitus

• Use a new Worksheet for each bothersome tinnitus situation

• This Worksheet help guide you as you practice the new skills

• What you put on the Worksheet will change as you figure out what works best for you

How do I fill out #1 on the Changing Thoughts & Feelings Worksheet?

• How do I fill out #1 on the Changing Thoughts & Feelings Worksheet?

The first step in completing a Changing Thoughts and Feelings Worksheet is to write down a bothersome tinnitus situation

• The first step in completing a Changing Thoughts and Feelings Worksheet is to write down a bothersome tinnitus situation

• You already identified a bothersome tinnitus situation last week when you met with the audiologist using the Tinnitus Problem Checklist on page 29

• Does everyone have a bothersome tinnitus situation to write for #1?

Write down details about the skill you will use to manage your reactions to tinnitus

• Write down details about the skill you will use to manage your reactions to tinnitus

After you try the skill, write down how helpful that skill was in helping you feel better

• After you try the skill, write down how helpful that skill was in helping you feel better

Write down a comment describing how you feel after trying this skill

• Write down a comment describing how you feel after trying this skill

Changing Thoughts & Feelings Worksheet

• Changing Thoughts & Feelings Worksheet

• Discuss stress and tinnitus

• Learn and practice two relaxation exercises: Deep Breathing and Imagery

• Learn to plan pleasant activities

• Other topics suggested by the group

Reducing stress can help your tinnitus

• Reducing stress can help your tinnitus

• Think of stress as a “challenge” instead of a “threat”

• Healthy living will help you manage stress

• Things you can do to reduce stress:

• Plan ahead for stressful events
• Exercise and eat right
• Get enough sleep
• Meditate or learn yoga
• Do relaxation exercises – there are many kinds

Changing Thoughts & Feelings Worksheet

• Changing Thoughts & Feelings Worksheet

• Discuss stress and tinnitus

• Learn and practice two relaxation exercises: Deep Breathing and Imagery

• Learn to plan pleasant activities

• Other topics suggested by the group

• They help you take a break from stress
• They slow down your breath and heart rate
• They distract you from your tinnitus

• By slowing down your body
• By helping you get your mind off of your tinnitus
• By helping you feel relaxed and calm so you:
• Feel a sense of relief from tension and stress caused by your tinnitus
• Think more clearly
• Feel better over

• Any time you feel stressed or tense
• Practice everyday between group sessions
• Share with the group next session

Find a place where you won’t be disturbed

• Find a place where you won’t be disturbed

• Tell others you need privacy

• Loosen tight clothing or change clothes

• Sit with feet flat on the floor or propped up

• Place your hands in your lap or on chair arms

• Turn on soothing sound or soft music

• Avoid silence when practicing relaxation exercises

Step 1: Prepare using the information above.

• Step 1: Prepare using the information above.

• Step 2: Put one hand on your stomach and one on your chest. Notice which hand moves. Move your stomach hand more for a deeper breath.

• Step 3: Close your eyes or focus on a thing in the room.

• Step 4: Breath through your nose for 3 seconds – count in your head “one-two-three.”

• Step 5: Hold that breath for 2 seconds (count “one-two”) & release the breath for 3 seconds (count “one-two-three”).

• Step 6: Repeat Steps 4 and 5 for five to ten minutes.

• Step 7: When you are done, think about where you are, wiggle your hands and feet, and open your eyes.

When you are done, choose the amount of relief you feel

• When you are done, choose the amount of relief you feel

• Choose either 0, 1, 2, 3, 4, or 5

• Be ready to share your rating with the group

• The Relief Scale:

Raise your hand if you felt no relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt no relief from the stress or tension caused by your tinnitus

Raise your hand if you felt slight relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt slight relief from the stress or tension caused by your tinnitus

Raise your hand if you felt mild relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt mild relief from the stress or tension caused by your tinnitus

Raise your hand if you felt moderate relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt moderate relief from the stress or tension caused by your tinnitus

Raise your hand if you felt nearly complete relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt nearly complete relief from the stress or tension caused by your tinnitus

Raise your hand if you felt complete relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt complete relief from the stress or tension caused by your tinnitus

Imagery is imagining you are some place calming and peaceful

• Imagery is imagining you are some place calming and peaceful

• Some people call this their “happy” place

• Choose a place that feels safe to you

• Think about each of your 5 senses to get a good picture of the place:

• Sight
• Smell
• Sound
• Touch
• Taste

Picture a safe, calming, and peaceful place

• Picture a safe, calming, and peaceful place

• Step 1: Prepare as you would for any relaxation exercise.

• Step 2: Take several deep breaths.

• Step 3: Choose a calming and peaceful place to imagine. Imagine the place as you close your eyes or focus on a thing in the room. Do this for five to ten minutes.

• Step 4: When you are done, think about where you are, wiggle your hands and feet, and open your eyes.

When you are done, choose the amount of relief you feel

• When you are done, choose the amount of relief you feel

• Choose either 0, 1, 2, 3, 4, or 5

• Be ready to share your rating with the group

Raise your hand if you felt no relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt no relief from the stress or tension caused by your tinnitus

Raise your hand if you felt slight relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt slight relief from the stress or tension caused by your tinnitus

Raise your hand if you felt mild relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt mild relief from the stress or tension caused by your tinnitus

Raise your hand if you felt moderate relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt moderate relief from the stress or tension caused by your tinnitus

Raise your hand if you felt nearly complete relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt nearly complete relief from the stress or tension caused by your tinnitus

Raise your hand if you felt complete relief from the stress or tension caused by your tinnitus

• Raise your hand if you felt complete relief from the stress or tension caused by your tinnitus

Why might Relaxation Exercises help you feel better?

• Why might Relaxation Exercises help you feel better?

Changing Thoughts & Feelings Worksheet

• Changing Thoughts & Feelings Worksheet

• Discuss stress and tinnitus

• Learn and practice two relaxation exercises: Deep Breathing and Imagery

• Learn to plan pleasant activities

• Other topics suggested by the group

What are 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

• Use the Activity Planning worksheet to see how many pleasant activities you have in your daily routine

• If you don’t have “2’s” (pleasant activities) everyday you may need to add them

• Sometimes we forget to make time for ourselves

• Pleasant activities can keep your mind off your tinnitus

• Pleasant activities also can keep you feeling positive about life

Why might planning more pleasant activities help me manage my reactions to tinnitus?

• Why might planning more pleasant activities help me manage my reactions to tinnitus?

Changing Thoughts and Feelings Worksheet

• Changing Thoughts and Feelings Worksheet

• (See the back of your Workbook)

• Relaxation exercises
• Planning pleasant activities
• Wait to complete the Changing Thoughts section

• Relaxation

• Practice: Deep Breathing and Imagery
• Record your progress: 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