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Assessment and 4C

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    Watch this video before starting the module

    Module ID iCBT for Tinnitus self-help, Module number 1
    Title Assessment and 4C
    Author

    Dr. Hashir Aazh
    (Tinnitus and Hyperacusis Team-lead at the Royal Surrey County Hospital)
    Collaborators

    Professor Brian C.J. Moore
    (Department of Psychology, University of Cambridge)

    Dr Fiona Seaman-Thornton
    (Clinical Psychologist at the Royal Surrey County Hospital)
    Duration 17 pages

    Terms and conditions: By accessing this module you consent to (1) adhere to Copyright regulations (i.e., not to reproduce or copy any parts of this programme without written permission from the author), (2) you understand that we do not keep any identifiable information but anonymised data will be used for service improvement and research, (3) the email address you provide will be used for forwarding you the assessment reports, CBT information and worksheets relevant to your iCBT treatment and future communications in order to inform you about research updates, new services, future events, and tinnitus-related news (4) Like most websites we use cookies to deliver a personalised service, (5) For full information about our policies click on the relevant links here: Terms and conditions, Copyright, Privacy policy, Cookies policy, Medical information disclaimer.

    Welcome

    Welcome to this tinnitus assessment module. It is necessary to complete this assessment section prior to enrolling in the internet CBT (iCBT) for tinnitus. Please answer the questions to the best of your knowledge. Based on the answers you provide a report will be developed automatically and will be sent to your email address. The report will include recommendations for further medical evaluations and/or psychological support (if indicated). This report will remain confidential but you may share it with your doctor, audiologist, or other relevant healthcare providers. Keep a copy of this report as you will need some of its details for your final assessment module.

    None of your responses would exclude you from benefitting from this iCBT programme. However, you are strongly encouraged to consider the recommendations given in the report as some responses may indicate other factors that may be affecting your experience of tinnitus and benefit from further investigation.

    4C Tinnitus Assessment and Management

    In addition to routine questions about tinnitus and your medical and mental health, this module includes a unique method of therapeutic assessment in which it sets out the direction for the therapy, building on the progress you have already made in coping with your tinnitus and identifying room for improvements. I have developed this method by reflecting on my clinical experience of supporting thousands of tinnitus patients over the last 10 years. This method is entitled 4C as it explores 4 aspects of your Confidence in managing your tinnitus.

    What if I don’t answer these questions?

    Some people choose to not to fully adhere to the preparatory tasks given in this module. This is very understandable, as they may be feeling overwhelmed by their tinnitus, lack of sleep and perhaps the distress it causes. They may like to get to the technical aspects of iCBT as fast as possible. There are also many people who choose to think and reflect on the questions presented. They feel that these foundational and introductory stages are crucial in preparing you for successful therapy.

    My experience shows that people who spend time comprehending these foundational stages improve far more than those who do not.

    What if I don’t answer these questions?

    Would you like to improve the management of your tinnitus and enjoy a satisfying life despite having tinnitus? If your answer is yes, then I need you to answer the questions given to you in this preparatory module.

    "In all things success depends on previous preparation, and without such previous preparation there is sure to be failure."

    Confucius (Chinese philosopher 551 BC–479 BC)

    Tinnitus questions

    Please answer these questions to the best of your knowledge.

    Do you think that any of the following are possible causes for your tinnitus? Tick all that apply.
    What does your tinnitus sound like? Tick all that apply.
    Where your tinnitus is perceived? Tick all that apply.

    Ear and hearing questions

    Do you suffer from ear pain?
    Do you have any ear discharge?
    Do you have any balance problems?
    Do you feel that you have any hearing difficulties?
    Do you have any medical conditions that might be relevant to your tinnitus?
    Do you have hyperacusis?
    Hyperacusis is intolerance of certain everyday sounds. The sounds may be perceived as uncomfortably loud, painful, frightening or annoying.
    Do you have misophonia?
    Misophonia is a strong emotional reaction to certain sounds, such as sounds created by chewing food, swallowing, tapping, breathing, lip smacking, nose sniffing, and other man made noises.

    Screening for symptoms of anxiety and depression

    Please answer these questions with regard to your mood in general. These do not have to be related to tinnitus. Over the last 2 weeks (14 days), how often have you been bothered by any of the following problems?

    Feeling nervous, anxious or on edge
    Not being able to stop or control worrying
    Little interest or pleasure in doing things
    Feeling down, depressed or hopeless

    4C (Assessing and enhancing your confidence in tinnitus management)

    I have developed the 4C Tinnitus Assessment and Management method based on reflecting on the feedback and comments that I have received from my patients about some of the commonly used tinnitus questionnaires. According to the patients who were undergoing the therapy in my clinic, the tinnitus questionnaires were too focused on assessing the disability caused by tinnitus instead of evaluating the individuals’ coping strengths and ability to lead their life despite having tinnitus. They suggested that as there is no known cure to stop tinnitus, the focus of the tinnitus questionnaires should be on the coping ability of the person and how to improve it, as opposed to the disability caused by their tinnitus. Consistent with this suggestion from my patients, 4C focuses on how to manage tinnitus as opposed to simply checking which aspects of the person’s life are affected by tinnitus.

    4C (Assessing and enhancing your confidence in tinnitus management)

    The 4C sets out to evaluate and simultaneously enhance your confidence in managing your tinnitus by encouraging you to think about 4 different aspects of tinnitus management as listed below:

    • How confident are you that you are able to carry out your day-to-day tasks even with tinnitus?
    • How confident are you that you are able to rest and relax even with tinnitus?
    • How confident are you that you can enjoy your life fully even with tinnitus?
    • How confident are you that you can do all the above without using any distraction or avoidance (e.g., background music or tinnitus maskers)?

    4C (Assessing and enhancing your confidence in tinnitus management)

    The 4C questions are carefully designed to psychologically engage you in thinking about your own coping methods and resources and how these can be improved. It also encourages the use of strategies that do not involve avoidance or distraction as these have been found to be less helpful long-term strategies to manage tinnitus.

    Unlike other questionnaires, 4C uses the language of confidence, acceptance and practicality as opposed to simply checking which aspects of the person’s life is affected by tinnitus and producing a score for tinnitus disability. There is surely a place for questionnaires assessing tinnitus disability, but in the context of iCBT, our aim is focused on building on your abilities rather than quantifying any disability.

    From my clinical experience, patients feel much more engaged in the therapy after going through the 4C process compared to completing endless tinnitus disability questionnaires.

    4C TINNITUS MANAGEMENT QUESTIONNAIRE

    For each question please select one number based on how you are feeling now.

    1. How confident are you that you are able to carry out your day-to-day tasks even with tinnitus?
    2. How confident are you that you are able to rest and relax even with tinnitus?
    3. How confident are you that you can enjoy your life fully even with tinnitus?
    4. How confident are you that you can do all the above without using any distraction or avoidance (e.g., background music or tinnitus maskers)?

    4C Results

    Based on your responses to the 4C questionnaire, your total score for tinnitus management is %.

    In the other words, there is about % scope for further positive changes to your current tinnitus management skills.

    Well done for managing your tinnitus very well.

    In the next few pages we will focus on:

    1. Exploring the ways that you currently manage your tinnitus
    2. Identifying your strengths and weaknesses in coping with tinnitus
    3. Planning for a way forward

    4C: At the times that you are aware of your tinnitus, how confident you are that you can still complete your day-to-day tasks?

    4C: At the times that you are aware of your tinnitus, loud and clear, how confident are you that you can still rest and relax?

    4C: How confident are you that you can enjoy your life fully even with tinnitus?

    4C: How confident are you that you can do your day to day tasks, rest and relax, and enjoy your life without using any distraction or avoidance (e.g., background music or tinnitus maskers)?

    4C summary

    Here is a summary of your ideas on how to improve your tinnitus management:

    4C aspects
    Your ideas on how to improve
    Improving your confidence that you can complete your day to day tasks despite tinnitus
    Improving your confidence that you can still rest and relax
    Improving your confidence that you can enjoy a satisfying life despite your tinnitus
    Improving your confidence that you can do all of the above without using any distraction or avoidance (e.g., background music or tinnitus maskers)

    By pressing the submit button, the Initial Assessment Report will be emailed to you within few minutes. Please feel free to share your report with any relevant healthcare providers.

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