Pascal, France
Enrolled with 6 appointments included
Stage 6: Tinnitus Functional Index (TFI): Initial 56.8% > Stage 4 15.2% > Stage 6 > 15.6% (category 4 big problem > category 1 not a problem)
Pascal's feedback at the end of Stage 6
Q: Do you recommend others to use the CBT for Tinnitus E-Programme?
A: "I would definitely recommend it. At first, when one is very distressed by tinnitus, it can be challenging to believe that CBT will be effective, especially when people learn that it may take several months before seeing a real benefit. But it is a proven evidence-based therapy that works."
Q: What benefit have you experienced using the relaxation element of the course so far?
A: "Prior to starting the course, I had some experience of breathing relaxation going back 30+ years ago when I learned yoga fundamentals. It took me some time to master the nose breathing exercise, but its benefits are undeniable. My routine is about 3 nose breathing per day. I usually breathe in and make a short pause (about 2 seconds) before breathing out. And the same before breathing in again. Trying to keep the mind not distracted by parasite thoughts during the breathing exercise is always a challenge but something that improves with practice. I usually do 1 or 2 physiological relaxation a day. I found the first 2 guided relaxation exercises a bit long, but I really enjoy the last one. I found myself close to falling asleep at the end. All in all, this routine has helped a lot especially during the first 3 months."
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: "It has helped a lot. With my scientific background, it allowed me to understand my reactions, feelings and thoughts as I was struggling to make sense of what was happening. The part on brain plasticity is crucial as it explains how we keep adjusting to our environment and the tinnitus habituation process. The reading material is very well sequenced and full of information. I found myself going back and re-read on several occasions. Which is quite normal and I will continue to do so."
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 combination of cognition tools (two arrows, costs & benefits, cognitive distortions, meaning adjuster) is quite powerful. Somehow I intuitively used some of them before the course, but it has allowed me to structure my own thinking and develop more positive outlooks which I apply to tinnitus as well as to other adverse events in my life. To put a rating to it, I would say that I have improved from 1/10 when I started the course to probably around 7/10 today."
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 have had three 1-1 appointments so far. I have enjoyed them as it allows me to share my experience with the course and get in-depth feedback from Debbie."
Q: What is your own impression of your progress to date?
A: "So far so good. I am definitely not as anxious as I was in the early days. Tinnitus distress has not entirely gone away but I feel that I am better equipped to manage my emotions and feelings when it is a bit more intrusive than usual. The combination of the course, the antidepressant (low dose) and the hearing aids is, I think, a combination that is working for me."
Q: The weekly SITREP was introduced in August 2023. Have you found it useful to report in weekly and if so, why?
A: "It is a good practice. My initial SITREPs were more elaborate and long than my current ones. But it allows me to take a weekly pause and reflect. So, all in all, I found it quite useful."
Pascal's feedback after Stage 4
8 weeks post-enrolment: Stage 4 - Tinnitus Functional Index reduced from 56.8% > 15.2% (category 4 big problem > category 1 not a problem)
Following these repeat measures and a first appointment, Pascal's feedback is:
Q: The progress I have achieved indicated in my stage 4 repeat Tinnitus Functional Index (TFI):
A: "My progress was more than I was expecting when I enrolled on CBT4T"
Q: The progress I have achieved indicated in my stage 4 repeat Anxiety/stress Symptoms (ASQ):
A: "My progress more than I was expecting when I enrolled on CBT4T"
Q: What do you believe to have been the most impactful aspect(s) up to Stage 4 for you? Choose as many as you like:
A:
1. Breathing exercises
2. Physiological exercises (9 minutes)
4. Learning about the Amygdala
5. Understanding more about the Change Process
6. Recognising how many 2nd, 3rd, 4th etc “Arrows” cause you emotional distress
7. Recognising how much Cognitive Distortions cause you emotional distress
8. There is a difference between having a Problem-oriented perspective and a Recovery-oriented perspective
Q: Of the above impactful aspects you have chosen, pick your top three (or more) in order of importance for you
A:
1. Breathing and physiological relaxation exercises
2. Learning about the amygdala and the autonomic response
3. Understanding more about the change process
4. Recognizing how much cognitive distortions cause emotional distress
5. Difference between a problem-oriented perspective and a recovery-oriented perspective
Q: Are there any further aspects that you would like to add?
A: "As a medical practitioner, I have been impressed by the breadth and depth of science underpinning the CBT4T programme. In particular it was very interesting learning more about the neuroscience behind CBT in general and CBT4T in particular, as well as recovery-oriented strategies using brain's neuroplasticity. Another aspect is the standardized tests that allow measurement of progress. In my case, I feel that the progress I have made up to this point is the result of several factors: 1) understanding the science behind tinnitus, the emotional response and CBT4T, 2) breathing/relaxation exercises, 3) antidepressants (to reduce anxiety and obsessive monitoring of tinnitus), 4) hearing aids (I realized that I had moderate hearing loss at higher frequencies), and last but not least the resumption of physical activities. Finally, the relaxation logs and SITREP are important elements of individual commitment and accountability."
Q: Please write about your experiences so far (up to Stage 4/starting Stage 5)
A: "My experience so far is positive. As I said, I feel that somehow the tinnitus experience is also an opportunity to apply CBT principles to my life more generally and how I deal with stressors and negative thoughts. I am sure more will come in the next stages."
Q: Would you recommend CBT4T to others looking for help, based on your experience of the course so far, and why?
A: "Yes, I would definitely recommend the course to people who suffer from tinnitus."