When starting out with CBT4T, the vast majority of people are feeling overwhelmed, stressed moment by moment, anxious about the future and experiencing a sense of loss in some way that can be quite difficult to define in words – maybe loss of confidence, loss of self-belief, loss of normality (particularly when tinnitus onset is new/recent), loss of a sense of independence, loss of a future to look forward to. These feelings of loss are just some of the more common ones that are talked about in the Impact Statements when people begin the course.

A common result of such feelings is also a loss of a framework to daily living. Healthy routines that were once part of life have been replaced by hopelessness for some, by anger and frustration for others; certainly, fear of what might/could happen is at the top of the answers to Impact Statement 3 question: “What are the thoughts you have about the future and how do they make you feel?”

It is routine that gives us an existential sense of safety. Therefore, when we are going through difficult times in life, rather than allowing the chaos to take us over, establishing one or two new routines in to each day becomes a genuine bolt-hole. Routines that work effectively need to be simple, and of short duration. Anything complex or that takes too long cannot be coped with, due to restricted capacity of the neocortex (top brain) caused by dysregulation in our nervous system.

Two simple and short duration routines are introduced at Stage 1:

Wherever possible, a routine should have more than one benefit, and this is the case for both the routines you begin at Stage 1.

The short-duration breath work exercise used in CBT4T has the following benefits:

Sending in a daily Relaxation Log has the following benefits:

In addition to the above regarding the importance of ROUTINE, the 9 minute physiological relaxation is extremely beneficial for most people, particularly when it is used alongside 1, 2 or even 3 of the 6 x daily breathing exercises time allowing. And in Stage 2 is the first of four 30 minute guided relaxation recordings – ideally used daily, but because they are building on your breathwork practice, aiming for 4-5 times a week is fine.

 

Once I receive your Progress Check 3 (as you begin Stage 4), we will be arranging your face-to-face appointment using Zoom. This is a good opportunity for you to ask any questions, and also, I can discuss with you your progress to date, and give you an overview of what is still to come.

There is some preparatory content in Stage 3 introducing the differences between a perspective (mindset) that is problem-oriented and one that is recovery-oriented. Whenever difficulties arise in life, if they turn in to something we can’t immediately resolve or make “go away”, it is very easy to become trapped in a problem-oriented mindset, along with all the trappings such a mindset brings. The trappings include:

The practices during the earlier stages (1-3) were in preparation for Stage 4 onwards.

Stage 4 introduces tools that, used consistently over 2-4 weeks, DISRUPT the neural pathways that perpetuate the unhelpful fear-perpetuating automatic thinking, and begin forming NEW pathways. Just as the unhelpful automatic thinking is enabled through brain plasticity, so too is the growing and strengthening of different NEW neural pathways, by using the CBT4T tools:

By Stage 5, the ground has been prepared for two more CBT4T tools:

Stage 5 is also where you begin to identify and set yourself some goals. For goals to be valuable, they need to be “values-based” i.e. based on YOUR values – what is important to you. It’s useful to identify some goals that are short-term, some medium and some long-term. By Stage 6, there is more helpful content to help you further with the Meaning Adjuster now you’ve practiced using it for a couple of weeks during Stage 5. You’ll be using the Meaning Adjuster “until you don’t need it anymore”. In fact, the need to use it reduces after a time – the time varies from one person to another – but because it is a training tool, there comes a time when it’s no longer needed because it has done its job.

Breath work and relaxation practice continues during Stages 4-6, including a second 30 minute guided relaxation in Stage 4, and a third in Stage 6. Also in Stage 6, the first of a 6-part Autogenic Relaxation practice begins, that is extremely popular and used by many long after they have finished CBT4T!

Stage 6 is when you come to repeat the clinical measures you used when you started CBT4T: TFI, THI, GAD-7, PSS and ASQ. You’ll receive an email from me with your results, how they compare to your initial results and feedback. What to expect from these repeat measures forms part of the discussion we had at your face-to-face back during Stage 4/5.

By Stage 7, the vast majority of people using CBT4T know precisely what works best for them, what they need to do and what they don’t need to do. You have had my feedback from the results of your repeat clinical measures, and that includes recommendations for how to proceed.

After Stage 7, the remaining modules 8-12 are all open. Use the content in these modules that you find helpful. There is a real mix of what people use and spend time on in the final modules. There are also three opportunities to “test” your continued progress (Modules 9, 10 and 12) by repeating the clinical measures. The recommendation is to always ensure there is AT LEAST 4 weeks between completing them.

I will be advising when it’s time to stop sending in your weekly SITREP. There comes a time when they are counter-productive. And once you are happy you no longer need the course content and you’ve sent in your final clinical measures (and received my reply), a final review of your experience using CBT4T is very much appreciated! However, you continue to have access to the course until the 12 month enrolment is up.   

Finally, a brief note about the Core Belief work in Module 11. In more than 90% of cases, the Meaning Adjuster has cleared and changed strong core beliefs. However, CBT4T is a full and comprehensive intervention and for those that need to address really stuck Core Beliefs, the opportunity to address them needs to be there. Core Belief work is NOT about tinnitus; rather, core beliefs are deep rooted beliefs a person has about themselves, about others and/or about the world. They are best addressed with a qualified therapist, so those that do use the Core Belief work book a face-to-face appointment with me.  

I hope this CBT4T Supplement to the course content is of some additional value.