Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 3 of 3) Version date: June 5,...

Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 3 of 3)

Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 3 of 3)

Version date: June 5, 2012

This workshop was developed by researchers at: The VA RR&D National Center for Rehabilitative

Auditory Research (NCRAR), located at the Portland, Oregon VA Medical Center

The VA Connecticut Healthcare System in West Haven, Connecticut

This workshop was developed by researchers at: The VA RR&D National Center for Rehabilitative

Auditory Research (NCRAR), located at the Portland, Oregon VA Medical Center

The VA Connecticut Healthcare System in West Haven, Connecticut

Materials Needed for This Meeting Materials Needed for This Meeting Changing Thoughts & Feelings Worksheet

(from last meeting) Your Workbook

Changing Thoughts & Feelings Worksheet (from last meeting)

Your Workbook

Remember: Goals of Tinnitus Management (All Methods)

Remember: Goals of Tinnitus Management (All Methods)

Negative emotional reactions are reduced Stress is reduced Little, if any, attention is given to tinnitus Tinnitus does not negatively affect any life activities in

a major way Further help for tinnitus management is not needed

or wanted

Negative emotional reactions are reduced Stress is reduced Little, if any, attention is given to tinnitus Tinnitus does not negatively affect any life activities in

a major way Further help for tinnitus management is not needed

or wanted

Today’s Agenda Today’s Agenda

1. Review and discuss the Changing Thoughts and Feelings Worksheet

2. Review: Relaxation Exercises Adding Pleasant Activities 12 common Thought Errors

3. New topic: Changing Thoughts Step-by-Step

1. Review and discuss the Changing Thoughts and Feelings Worksheet

2. Review: Relaxation Exercises Adding Pleasant Activities 12 common Thought Errors

3. New topic: Changing Thoughts Step-by-Step

Review Review

The Changing Thoughts & Feelings Worksheet Stress Management and Relaxation Exercises

Deep Breathing Imagery

Planning Pleasant Activities 12 common Thought Errors

The Changing Thoughts & Feelings Worksheet Stress Management and Relaxation Exercises

Deep Breathing Imagery

Planning Pleasant Activities 12 common Thought Errors

Look at your Changing Thoughts and Feelings Worksheet that you started to fill out at the last meeting

If you don’t have it, get out a clean Worksheet

Look at your Changing Thoughts and Feelings Worksheet that you started to fill out at the last meeting

If you don’t have it, get out a clean Worksheet

Find your Worksheet from last week or tear out a copy of the Changing Thoughts and Feelings Worksheet from the back of your Workbook

Find your Worksheet from last week or tear out a copy of the Changing Thoughts and Feelings Worksheet from the back of your Workbook

Take a moment to…Take a moment to…

Discussion: Relaxation ExercisesDiscussion: Relaxation Exercises

Discussion: Planning Pleasant ActivitiesDiscussion: Planning Pleasant Activities

Take a moment to discuss: Did the Relaxation Exercises or Planning Pleasant Activities help you feel better?

Take a moment to discuss: Did the Relaxation Exercises or Planning Pleasant Activities help you feel better?

#4 and #5 on the Worksheet#4 and #5 on the Worksheet

Things to RememberThings to Remember

Tinnitus is less likely to get your attention when you manage your stress and stay busy

Use sound when practicing relaxation exercises You might not notice relaxation exercises helping

you right away—that doesn’t mean they’re not helping you. Keep practicing!

Increasing pleasant activities over weeks or months can help you get better at ignoring tinnitus

Tinnitus is less likely to get your attention when you manage your stress and stay busy

Use sound when practicing relaxation exercises You might not notice relaxation exercises helping

you right away—that doesn’t mean they’re not helping you. Keep practicing!

Increasing pleasant activities over weeks or months can help you get better at ignoring tinnitus

Discuss: Introduction to Changing ThoughtsDiscuss: Introduction to Changing Thoughts

ReviewReview

What is “Changing Thoughts”? First you identify thoughts you had just before

feeling bad Then you work on changing that thought to

something more helpful How can “Changing Thoughts” help?

Changing your thoughts about your tinnitus can help you change the way you feel about it

When can I use “Changing Thoughts”? Any time you feel tension or stress when you think

about your tinnitus

What is “Changing Thoughts”? First you identify thoughts you had just before

feeling bad Then you work on changing that thought to

something more helpful How can “Changing Thoughts” help?

Changing your thoughts about your tinnitus can help you change the way you feel about it

When can I use “Changing Thoughts”? Any time you feel tension or stress when you think

about your tinnitus

Thoughts Affect Feelings Thoughts Affect Feelings

What you think affects how you feel

Example: Imagine your dinner guests are late

Sometimes the way you feel is caused by the thoughts about the event, not the event itself

What you think affects how you feel

Example: Imagine your dinner guests are late

Sometimes the way you feel is caused by the thoughts about the event, not the event itself

The CBT Cycle The CBT Cycle

Beliefs

Emotion

Behavior& Thoughts

Review: Feelings Affect HealthReview: Feelings Affect Health

Your feelings affect your health

Stress and negative emotions can lead to health problems During stress, hormones are released Too much of these hormones is bad for health

It is important to learn to change your thoughts that cause negative feelings

Your feelings affect your health

Stress and negative emotions can lead to health problems During stress, hormones are released Too much of these hormones is bad for health

It is important to learn to change your thoughts that cause negative feelings

Feelings Affect Health Feelings Affect Health

Review:Thought Errors

Paying Attention to Thoughts

“Thought Errors” are negative thoughts They are not helpful or are unhealthy Sometimes people get in the habit of having thoughts

that make them feel bad All people make Thought Errors from time to time Thought Errors make people feel sad or upset

A different thought might make them feel better You can control your thoughts If you are aware of your Thought Errors, you can

catch yourself and correct your thinking BEFORE YOU CAN CHANGE YOUR THOUGHTS

YOU NEED TO KNOW WHAT YOU ARE THINKING

“Thought Errors” are negative thoughts They are not helpful or are unhealthy Sometimes people get in the habit of having thoughts

that make them feel bad All people make Thought Errors from time to time Thought Errors make people feel sad or upset

A different thought might make them feel better You can control your thoughts If you are aware of your Thought Errors, you can

catch yourself and correct your thinking BEFORE YOU CAN CHANGE YOUR THOUGHTS

YOU NEED TO KNOW WHAT YOU ARE THINKING

Review: What are “Thought Errors”?Review: What are “Thought Errors”?

Review of Practice at home: Review of Practice at home:

In your Workbook (pages 50-53) you wrote down your own examples of each of the 12 Thought Errors

Take a moment to discuss

(see next 2 slides for definitions)

Twelve Common Thought Errors:Twelve Common Thought Errors:1. All-or-nothing thinking: When you see things in only

two categories

2. Over-simplifying: When you see one bad event as a never-changing pattern

3. Focusing on wrong details: When you pick out a single detail and focus on it

4. Jumping to conclusions: When you make assumptions that things will turn out badly even though you don’t have facts to support them

5. Over-estimating: When you think things are more important than they really are

6. Under-estimating: When you think things are less important than they really are

1. All-or-nothing thinking: When you see things in only two categories

2. Over-simplifying: When you see one bad event as a never-changing pattern

3. Focusing on wrong details: When you pick out a single detail and focus on it

4. Jumping to conclusions: When you make assumptions that things will turn out badly even though you don’t have facts to support them

5. Over-estimating: When you think things are more important than they really are

6. Under-estimating: When you think things are less important than they really are

Twelve Common Thought ErrorsTwelve Common Thought Errors7. Assuming the worst: When you think something is

much worse than it really is8. Emotional thoughts: When you think that your

emotions show the way things really are9. “Should” statements: When you say “should” or

“shouldn’t” to try to get yourself to do hard task10. Labeling: Attaching a bad label to yourself or others11. Making things personal: You see yourself as the

cause of some negative event when you aren’t responsible

12. Blaming: You blame others for your problems or blame yourself for other people’s problems

7. Assuming the worst: When you think something is much worse than it really is

8. Emotional thoughts: When you think that your emotions show the way things really are

9. “Should” statements: When you say “should” or “shouldn’t” to try to get yourself to do hard task

10. Labeling: Attaching a bad label to yourself or others11. Making things personal: You see yourself as the

cause of some negative event when you aren’t responsible

12. Blaming: You blame others for your problems or blame yourself for other people’s problems

Today’s new skill on the Changing Thoughts and Feelings WorksheetToday’s new skill on the Changing Thoughts and Feelings Worksheet

New skill you

will begin to

learn today

New Skill: Use this guide to help youChange Thoughts – Step-by-StepNew Skill: Use this guide to help youChange Thoughts – Step-by-Step

Step 1: Event (A)

Identify what was going on when you started feeling bad

What happened?

Note: Sometimes it is hard to remember the event that was happening that made you feel bad until later. If this is the case for you, go to the second step and come back to this step later.

Step 1: Event (A)

Identify what was going on when you started feeling bad

What happened?

Note: Sometimes it is hard to remember the event that was happening that made you feel bad until later. If this is the case for you, go to the second step and come back to this step later.

Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step

Step 1: Event. Identify what was going on when you started feeling bad What happened? – “My tinnitus isn’t getting any better”

Step 1: Event. Identify what was going on when you started feeling bad What happened? – “My tinnitus isn’t getting any better”

Example: Changing Thoughts Example: Changing Thoughts

Take a moment to:Complete Step 1Take a moment to:Complete Step 1

Step 2: Thoughts (B)

Now try to write down a thought you had just before you started feeling bad or upset

What was the first thought that came into your mind?

Note: You may have had many thoughts just before you started feeling bad. If you had more than one thought, pick the one that made you feel the worst.

Step 2: Thoughts (B)

Now try to write down a thought you had just before you started feeling bad or upset

What was the first thought that came into your mind?

Note: You may have had many thoughts just before you started feeling bad. If you had more than one thought, pick the one that made you feel the worst.


Step 2: Thoughts What was the first thought that came into your mind?

“Why can’t anyone help me?”

Step 2: Thoughts What was the first thought that came into your mind?

“Why can’t anyone help me?”


Step 3: Feelings (C)

Write down any bad or upsetting feelings you are/were having.

For example, sad, angry, jealous, or disappointed

Step 3: Feelings (C)

Write down any bad or upsetting feelings you are/were having.

For example, sad, angry, jealous, or disappointed


Step 3: Feelings

Write down any bad or upsetting feelings you had

Step 3: Feelings

Write down any bad or upsetting feelings you had


Step 4: Evidence for

Examine the thought you described in Step 2.

Write down evidence that this statement is true where it says “Evidence For” on the Changing Thoughts Exercise.

Note: Our thoughts often have some truth to them, but some have many more errors. Write down what is true about the thought in the “Evidence For” box.


Examine the thought you described in Step 2.

Write down evidence that this statement is true where it says “Evidence For” on the Changing Thoughts Exercise.

Note: Our thoughts often have some truth to them, but some have many more errors. Write down what is true about the thought in the “Evidence For” box.



Write down evidence your thought in Step 2 is true


Write down evidence your thought in Step 2 is true


Step 5: Evidence Against

Again, examine the thought you described in Step 2

Identify evidence that this statement is not true. In the next box where it says “Evidence Against” write down the reasons the thought may not be true.

Note: You may be able to identify this thought using the 12 Thought Errors from the list. You can have more than one error in a single thought.

Step 5: Evidence Against

Again, examine the thought you described in Step 2

Identify evidence that this statement is not true. In the next box where it says “Evidence Against” write down the reasons the thought may not be true.

Note: You may be able to identify this thought using the 12 Thought Errors from the list. You can have more than one error in a single thought.


Step 5: Evidence against

Write down a new more helpful thought about the event

Step 5: Evidence against



Step 6: New Positive Thought


This step requires a lot of practice to feel more natural

Note: Sometimes it helps to say statements that apply to many things. Some people call these “mantras.”

New thoughts should be (1) brief, (2) easy to remember, (3) true to you, (4) apply to your life, and (5) helpful



This step requires a lot of practice to feel more natural

Note: Sometimes it helps to say statements that apply to many things. Some people call these “mantras.”

New thoughts should be (1) brief, (2) easy to remember, (3) true to you, (4) apply to your life, and (5) helpful


Step 7: Feelings (C) when you think the new thought

As you practice, pay attention to how you feel when you have positive thoughts instead of negative thoughts

Step 7: Feelings (C) when you think the new thought

As you practice, pay attention to how you feel when you have positive thoughts instead of negative thoughts


Step 7: Feelings when you think the new thought

Pay attention to how you feel when you have positive thoughts instead of negative thoughts

Step 7: Feelings when you think the new thought

Pay attention to how you feel when you have positive thoughts instead of negative thoughts


Step 8: Picture yourself in the future

Look at the negative thought from Step 1 again

Think of a time in the future when you might have that thought again

Picture yourself thinking the positive thought from Step 6 instead

Step 8: Picture yourself in the future

Look at the negative thought from Step 1 again

Think of a time in the future when you might have that thought again

Picture yourself thinking the positive thought from Step 6 instead


Step 8: Picture yourself in the futureLook at the negative thought from Step 1 Think about the positive thought from Step 6 instead

Step 8: Picture yourself in the futureLook at the negative thought from Step 1 Think about the positive thought from Step 6 instead


How to use every day:How to use every day:Changing Thoughts – Step-by-StepChanging Thoughts – Step-by-Step

Do the Changing Thoughts Exercise on page 56

Write down these steps on a small piece of paper so you can do use the steps anytime

When you feel bad or when something bad happens, use the Changing Thoughts Exercise to feel better

Sometimes you can feel better about your tinnitus if you just change the way you think about it

Do the Changing Thoughts Exercise on page 56

Write down these steps on a small piece of paper so you can do use the steps anytime

When you feel bad or when something bad happens, use the Changing Thoughts Exercise to feel better

Sometimes you can feel better about your tinnitus if you just change the way you think about it

Practice using the Changing Thoughts Exercise Continue to use the Changing Thoughts and Feelings

Worksheet:

1. Relaxation Exercises

2. Planning Pleasant Activities

3. Changing Thoughts Use the skills that work for you to manage your

tinnitus!

Practice using the Changing Thoughts Exercise Continue to use the Changing Thoughts and Feelings

Worksheet:

1. Relaxation Exercises

2. Planning Pleasant Activities

3. Changing Thoughts Use the skills that work for you to manage your

tinnitus!

Practice at homePractice at home

Other agenda items?Other agenda items?

Questions?Questions?

Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 3 of 3) Version date: June 5,...

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Transcript of Managing Your Tinnitus: Changing Your Thoughts and Feelings (Session 3 of 3) Version date: June 5,...