Dr. Hashir Aazh(Tinnitus and Hyperacusis Team-lead at the Royal Surrey County Hospital)
Professor Brian C.J. Moore(Department of Psychology, University of Cambridge)
Dr Fiona Seaman-Thornton(Clinical Psychologist at the Royal Surrey County Hospital)
Full Name(This is only needed if you would like to be issued a certificate after completing this module. If you do not need a certificate of completion then leave this blank)
This is the audio recording of Dr Hashir Aazh reading out loud the text of this module and offering some further explanations. You may listen to this audio recording before, during, or after completing this model. This is a supplementary feature that is aimed to improving your learning experience.
This therapy programme is designed for those who experience bothersome tinnitus and wish to learn how to manage the distress caused by their tinnitus using the techniques of cognitive behavioural therapy (CBT).
By the end of this session, you will be able to:
Tinnitus is the perception of sounds in the absence of actual acoustic stimulation. Common descriptions of tinnitus are: buzzing noise, high-pitched noise, hissing, whistle, waterfall, grinding wheel, ringing, white noise, wind noise, bubbles, clicks, beeps, static noise and humming. About 20% of patients are unable to describe what their tinnitus sounds like. Most people who experience tinnitus also have some degree of hearing loss, but not all people with hearing loss have tinnitus.
In the majority of patients, tinnitus is not related to any known disease. In some patients, tinnitus may be related to disorders of the auditory system. In this CBT programme the aim is not to review theories about tinnitus and its causes but to focus on how to manage tinnitus distress using CBT.
People often benefit from various forms of therapy that help them to learn alternative ways of reacting to tinnitus so as to modify the emotional disturbance caused by their tinnitus. This makes it possible for the tinnitus to lose its significance and fade away into the background instead of being at the centre of attention.
The main factor that contributes to tinnitus severity is the annoyance it causes rather than its loudness. CBT can help you to explore and modify the process that produces tinnitus-related annoyance.
The ABC model is based on cognitive behavioural theory and aims to explain the relationship between our environment, what we think, how we feel, and what we do.
A represents Activating events or situations
B represents Beliefs or underlying thoughts
C represents the Consequences or reactions, which may be emotional, behavioural or physiological. Figure 1 illustrates the ABC model.
"Nothing is either good or bad, but thinking makes it so" – William Shakespeare
Based on the ABC model, our reactions to life events are the result of our interpretations of and thoughts about those events.
In our day-to-day experience, we often notice events and their corresponding impact on how we feel and what we do. However, we do not necessarily recognise the underlying thought processes that link the events and our reactions.
The ABC model highlights the role of our thoughts in influencing the effect that an event can have on us.
In order to learn CBT, it is important to be able to distinguish between Activating events, Beliefs or thoughts, and Consequences such as our emotions and behaviours.
Please complete this quiz.
Distinguish between activating events, beliefs/thoughts and consequences (such as emotions or behaviours) by choosing the correct option from the drop down menu.
Match each activating event with a belief/thought and a corresponding consequence (emotion/behaviour).
Diagram for reference:
In this example, the Activating event (A) is the fact that a doctor is stuck in traffic. If he thinks that he will be blamed (B) then he will feel anxious (C). Can you change his thought to help him feel less anxious in the exact same scenario? In other words, just change B with no change in A and see what will happen to C.
Click on the arrow to see the example that we could think of.
In this example, the Activating event (A) is the fact that a man sees a bird of prey. If he thinks that it brings good luck (B) then he will feel excited (C). Can you change his thought to make him feel frightened in the exact same scenario? In other words, just change B with no change in A and see what will happen to C.
In this example, the Activating event (A) is hearing a noise at night. See what will happen to Emotions (C) when the Thoughts change (B).
In this example, the Activating event (A) is hearing tinnitus. See what will happen to Emotions (C) when the Thoughts change (B).
The ABC model suggests that the reason for reactions such as annoyance or anxiety is not the tinnitus itself but is instead the negative thoughts we have about it.
Consequently, the emotional reaction we can have to tinnitus makes it difficult for our brains to put it into the background, as it usually does with many different internal bodily noises and environmental sounds.
CBT can help you to identify your negative thoughts about tinnitus and modify them. Once the tinnitus-induced annoyance or anxiety is minimised with the use of CBT techniques, tinnitus can lose its significance, and fade away into the background.
CBT can also help you notice what you tend to do when tinnitus is bothering you, consider whether these actions are helpful to manage tinnitus, and test out new ways of responding that may be more helpful for you in the long-term.
The CBT model here shows us that the physical sensations that we experience due to tinnitus can affect our thoughts, feelings and behaviours. These reactions can, in turn, affect how we continue to experience and react to tinnitus in the future.
The model begins with the physical sensations related to the experience of tinnitus. These sensations can trigger negative automatic thoughts, which can lead to us feeling difficult and distressing emotions.
These sensations, thoughts and feelings can lead us to change our behaviour (the things we do every day). Often we try to change our behaviour in ways that we think might protect us from having these unwanted experiences again.
All of these different areas can interact and affect each-other. For example, when we try to control tinnitus and do things to make it go away, we can develop a belief that this is the only way to cope and that we will not be able to manage if we do not always do this.
Unfortunately, we know that some of our experiences and reactions can create ‘vicious cycles’ where tinnitus continues to have a significant effect on how we feel and what we do, which can lead to exacerbation of tinnitus symptoms.
For example, if we experience very loud tinnitus one day and have the belief that loud tinnitus will make it impossible for us to work, this may lead us to feel upset and fearful, and we may choose not to go to work that day. However, if we often repeat this pattern, this in turn may mean that we become more alert to the sensations of tinnitus in the future and may notice it even more. We may then have thoughts that “this is hopeless. I will never be able to work again” which may lead us to feel depressed, fearful or angry. Our low mood may then lead us to stop doing other activities, such as socialising or hobbies, which may lead to our lives feeling smaller, and tinnitus feeling like an even bigger part of our life.
This is the final page of the introduction to CBT for tinnitus. Use this template model to describe your tinnitus distress. Type your own thoughts, emotions, physical sensations, and behaviours in the spaces provided in the template model. Once you are done, then click on the print button to have a hard copy of the model. Please study and reflect on this before proceeding to the next module.
Print Your Model and Move on to the Resources Page
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