Tinnitus Functional Index (TFI) Outcome: 82.4% very big problem > 26.8% small problem

Q: In your own words, please leave your review of the CBT4T programme – thank you

A: "A worthwhile course that has helped me improve my approach and response to tinnitus. It covers many aspects and provides information on them that is useful to help you understand and deal with the problem that you've been struggling to get past."

Q: What have you found helpful in the CBT4T programme?

A: "The neuroscience to provide understanding, breath work to aid relaxation. Information on hyperacusis. Cognitive reframing. Having the ability to discuss things with Debbie, both in our meetings and via email."

Q: What difference has CBT4T made to you overall, especially in terms of how you live your life now compared to prior to enrolling on the CBT4T programme?

A: "When I think back to January when I started it's significant. This speaks to the incremental nature of the change and the 'little and often' aspect. You don't notice your hair growing until you look in the mirror and realise it needs cutting."

Q: Do you recommend others to use CBT4T and if so, based on your own experience, please explain to them why

A: "I certainly do. Tinnitus can be hard to deal with, some people don't have an emotional response to it but for others, like me, I found it debilitating. There was a cascade effect where, in addition to the noise, there was the impact on my relationships and my ability to do my job. This caused stress and anxiety and made the tinnitus worse. At this point you need to reach out to people who can help you change things. Educating yourself on tinnitus; what it is and isn't, challenging yourself with your negative self-messaging, relaxing, understanding the need for good sleep and a reduction in stress. You learn about all this in this course, plus you have several meetings with Debbie which help very much too."

Tinnitus Functional Index (TFI) 17 weeks post-enrolment: 82.4% very big problem category 5 (73-100%) > 28.4% small problem category 2 (18-31%)

Ian's full feedback at Stage 6:

Q: Would you recommend others with severe tinnitus distress to use the course, and if so, what would you say to them?

A: "I would certainly recommend this course. I started with anxiety and distress around my tinnitus and had tried another course prior to this one which was actually one-to-one but was not working for me. This course has covered many things that have been useful and have helped me make steps to regaining my life. Tinnitus has been one of the hardest things I've had to deal with, this course has certainly helped me to do so."

Q: What benefit have you experienced using the relaxation element of the course so far?

A: "I hadn't intentionally used relaxation techniques before. That said, I was aware that slow, relatively deep, controlled breathing felt good and had a calming effect. I used them, when I remembered to. It has been good to formalise this knowledge and build on it and I have continued to try and use it much more. I used it more at the beginning of the course, and a little less recently and I think this is evidence of my more relaxed, less anxious state. Life throws problems at us and I'm sure there will be an uptick in its use as the next problem arises."

Q: How has the neuroscience-based learning about the amygdala, autonomic ladder and brain plasticity helped you to relate to your experience of tinnitus, anxiety and stress?

A: "The neuroscience aspects have been very welcome. I think as we navigate life we come across things that cause us distress and, for me, learning about the things that are causing this distress help demystify them. I'm never going to become a neuroscientist but I don't need to be, I just need enough knowledge to help me comprehend and explain what is going on. Then, like a problem shared, the weight of the experience begins to lift. This helped turn down the associated anxiety and move into a mindset of getting past the problem."

Q: What have you learned from the costs & benefits transaction work (used from stage 3)? Estimate how much you have already adjusted from having a problem-oriented perspective towards a recovery-oriented perspective (e.g. 2/10 > 7/10 indicates an improvement of 5 so far)

A: "The costs-benefits work helped to set the scene for changing my mindset. I found this, in conjunction with the explanations of cognitive distortions and the meaning adjuster really useful. I think I've moved from 2/10 to 6/10. I'm still working on this, challenging my negative self-dialogue."

Q: You are likely to have had your first 1-1 by now. Did you benefit from your 1-1 and if so, how?

A: "I've had two 1:1s now. They have been very useful. I can understand why, for a 'typical' attendee you say to wait for the first meeting. I'm also glad, that with my perhaps more atypical presentation, tinnitus with a side helping of potential Meniere's/AIED/ETD, I was able to see you sooner."

Q: What is your own impression of your progress to date?

A: "Progress is not linear and that is fine. For me, most progress was made at the beginning of the course. This is perhaps to be expected."