Initial appointment at 4-6 weeks

Initial 1-1 appointment

There are very good reasons why a first 1-1 appointment is optimally used 4-6 weeks after starting the process in the CBT for Tinnitus E-Programme. It is not an arbitrary period of time pulled out of thin air.

When anyone starts this programme, they are in a significantly distressed state
Seeing the therapist early on uses up 50% or 33% of the 1-1 appointment time when enrolment is with 2 or with 3 appointments, respectively
Having a 1-1 appointment too early is time spent reinforcing and retriggering fear based emotions
The person invariably and understandably wants to talk about how bad everything is for them
These expressed thoughts reinforce and retrigger the fear based emotions (amygdala in the limbic brain)
The hippocampus (memory formation and retention) is also part of the limbic system, so the ability to remember anything useful is extremely limited and ability to recall information is near zero
The pre-frontal cortex has at best reduced capacity to take in information in the first place
The limbic activity blocks their ability to process any new or different information

The above points cover what is happening for a person during the initial 4-6 weeks of the course. Either Progress Check 3 (completed at the start of Stage 4) or Progress Check 4 (at the start of Stage 5) triggers booking your 1-1 appointment. The appointment you are offered aims to be for the following week, on the preferred day chosen via your appointment preference form

Compare the above to what happens after working through each of the first 3-4 stages:

The person builds a new routine of physiological relaxation, breathing exercises etc
They begin to understand how their perspective is 100% problem-oriented rather than coming around to building a recovery-oriented outlook
They can also see how their autonomic nervous system has them “at the bottom of the ladder”, in terms of the autonomic ladder discussed in stage 2
They have learned that it is the breath work and relaxation that is enabling them to move “up the ladder” – that it has come about through using the exercises regularly and consistently
The 50% or 33% of 1-1 appointment time is of good use to them
Their distress is already reduced considerably and are experiencing a sense of having some control over themselves
The questions they ask are practical as opposed to being 100% emotional and desperate
They are able to take in the information discussed, process it more beneficially and even remember much of it!

What to expect at your initial 1-1 appointment

Your initial 1-1 appointment is intended as an opportunity:

For you to ask questions and clarify understanding where needed
For discussion on your progress to date
To give you an overview of what follows in subsequent stages