To be used:
- After 5-6 weeks of using the breath work consistently 4-6 times on a daily basis and
- The physiological relaxation 2-3 times alongside 2-3 of the breathing exercises
- After identifying your main cognitive distortions that enable you to identify "alternative balanced thoughts" in the Thought record
Thought records are generic to 2nd wave cognitive behaviour therapy (CBT) for cognitive restructuring. Manual thought records are included in the downloadable CBT for Tinnitus Basic Workbook when you are using the process self-directed. Although there is an opportunity to use Thought Records at Stage 9 of the therapist-supported CBT for Tinnitus E-Programme, the later 3rd wave of cognitive behaviour therapies lend themselves more suitably to greater than mild-moderate distress.
Used consistently, after balancing top-down and bottom-up brain action over at least 4-6 weeks of consistent and regular breath work and relaxation practice, these 2nd wave CBT thought records enable the restructuring of negative thoughts. They can still establish, grow and strengthen new neural pathways in the brain (through brain plasticity) to reset perspective, bringing about more objective habit-thinking rather than subjective distorted habit-thinking that causes distress.
The therapist-supported CBT for Tinnitus E-Programme uses a bespoke electronic reframing tool called the Meaning Adjuster along with a Costs & Benefits Transaction tool more aligned to 3rd wave CBT; these have removed the necessity to learn to identify "automatic" and "hot" thoughts required by 2nd wave CBT. The Meaning Adjuster is introduced at Stage 5 (of 12). By Stage 6 (of 12) the Tinnitus Functional Index (TFI) is repeated and compared to the result prior to starting the process at Stage 1.
After using 2nd wave CBT from 2005-2018 when working individually with patients in my clinics, and some being included from 2009-2018 in the early version of "The Tinnitus E-Programme", the length of time it was taking for patients to reap genuine benefit was somewhat inconsistent. The section CBT and Thoughts goes some way to explain why.
Since 2018, it is psychological flexibility from Acceptance & Commitment Therapy (ACT) third wave CBT that is incorporated in to the current therapist supported CBT for Tinnitus E-Programme. Patients with a Tinnitus Functional Index (TFI) score in the upper categories (categories 4 and 5; 54-100%) for whom the CBT for Tinnitus E-Programme was developed, find the ACT practices more intuitive and user-friendly than 2nd wave CBT and the majority of people do progress more quickly than they used to with the earlier thought-based (2nd wave) CBT. There is no "ban" on using sound enrichment i.e. the playing of music or other everyday background sound in the environment free field or using bone conduction headphones. For those using the CBT for Tinnitus E-Programme, such use spontaneously diminishes, without a need to ban its use.
Understanding the difference between objective and subjective thinking is included in the main 12 stage CBT for Tinnitus E-Programme in Stage 5 (of 12), as is Goal Setting in Stage 6 (of 12) that channels "perspective-resets" in to identifying activities in your individual everyday life that you want to renew, change or create through Values Based Action, another major aspect of ACT the CBT for Tinnitus E-Programme benefits from.
To date, online and self-help 'CBT for tinnitus' publications by those without psychology or psychotherapy background, training, and experience still use 2nd wave CBT, much along the lines of these free sections in the website that are suitable for those with a TFI up to mid category 3 (category 3 = 32-53%), although those I have seen to date have no breath work and/or relaxation content. All my psychotherapy work whether it is tinnitus distress, or anxiety-related, depression or a combination, ALL begin with little and often, regular and consistent breath work and relaxation for the reasons described in the relevant section(s).