Nathaniel, UK
Review written at intermediate Stage 6
Tinnitus Functional Index (TFI) 97.6% > 20.8% (category 5: very big problem > category 2: small problem)
Q: Do you recommend others to use the CBT for Tinnitus E-Programme?
A: "Yes absolutely, tinnitus therapy as set out in the course is the only effective treatment for tinnitus and in my case it has certainly worked. It is vital if a path to recovery is to be created that a patient is clear about the causes of tinnitus and the connection between tinnitus and tinnitus distress - having tinnitus and being distressed by tinnitus are not the same. I have used the course in the best way for me - at my own pace - which is what Debbie recommends."
Q: What benefit have you experienced using the relaxation element of the course so far?
A: "I had always struggled with relaxation exercises. I now have a tentative diagnosis of attention deficit disorder which will be further investigated in 2025 and I hope very soon to have a formal diagnosis and begin treatment. Before finding the CBT4T programme, in December '23 my hearing therapist raised the possibility that I might have ADHD after I reported that trying to use the guided relaxation exercises she was giving me seemed to be making my tinnitus anxiety worse. I really struggled too when I started Debbie's course, but with her support I persisted and - as ADHD practitioners also recommend - I worked around my earlier limitations, and have to a significant extent benefited from the relaxation elements of this CBT4T course despite the obstacles I have faced. I have modified my practice to reduce the connection my brain seemed to be making between tinnitus and efforts to relax. I did this by various means including breathing exercises and relaxation while walking, while outdoors, while exercising and in bed. Overall I have significantly increased my level of relaxation and my tinnitus distress is far below the levels it reached this time last year."
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 science is clear to me and I understand how and why brain plasticity can help in managing tinnitus distress. I have taken very much on board the approach that runs through the course at every level and have done the course according to my capabilities and person circumstances. I have done it at my own pace and drawn back from exercises which generate anxiety and I have had to accept that in my case, particularly in the 2nd half of 2023 before I found this CBT for Tinnitus E-Programme, my forceful efforts to do guided relaxation created strong links in my brain between breathing/relaxation exercises and tinnitus distress. I have worked hard to tailor the course and the practice to my personal circumstances. I have in addition to going at my own pace only produced coursework and written reports as and when my anxiety allows. This is very much something which is affected by ADHD. As well as following this course I have been under the care of my local audiology team and am having 6 monthly review appointments. They are fully supportive of my following the course and are sure that it will help me - indeed it already has. My softly softly approach is allowing brain plasticity to work in my favour."
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: "I have not always been able to use Costs & Benefits Transaction tool as frequently as I would like, but I have used it - and the other tools in the course - enough to be able to apply the underlying principles to my daily experience of tinnitus. This has been very positive and I am now very much experiencing a Recovery oriented perspective and I never allow myself to lose sight of the fact that I am managing my tinnitus and not letting it have a debilitating impact on my life. Hand in hand with this I am trying to develop an 'acceptance' perspective which will allow me to accept that I have tinnitus and that while tinnitus itself does not go away, it does not have to generate strong distress or disrupt my day to day activities."
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: "My first 1 2 1 was such a useful element in the course. I found that talking to someone who understood the experiences I was having and understood the journey I was on towards recovery was hugely beneficial. It is difficult for those who have never experienced tinnitus to understand just how distressing and debilitating it can be to constantly hear a deafening noise which is not caused by anything outside of the body. At the 1 2 1 I was able to ask questions and to receive guidance on how to take my progress further. Talking with Debbie made me feel supported and allowed me to move away from the awful feeling that I had often had that nobody understood the situation I was in and that I would never be able to live a normal life again."
Q: What is your own impression of your progress to date?
A: "I have had to follow the course at my own pace and possibly more slowly than many others, but I feel I have massively benefited from the course to date. From the outset one of the key elements in the therapeutic treatment for tinnitus is 'information' or 'understanding'. That is to be clear about what tinnitus is, how it arises, how it generates distress and hopelessness but also to know that recovery is possible and that even someone with severe intrusive tinnitus can live a normal life. This understanding has allowed me to reduce periods of severe distress to a minimum and the course has also given me the tools to quickly reduce distress when it does occur. At my worst (this time last year) the tinnitus was so overwhelmingly distressing that I could not get through a day without having masking sounds on or walking around outdoors or listening to loud music all the time. I still sometimes wake to hear very loud tinnitus which momentarily upsets me, but I never need to resort to playing music or using masking sounds. I tend to use the lack of need for masking sounds as a measure of how well I am managing my tinnitus."