buylotrogold

Disclaimer: I'm not a medical professional. This is an amateur perspective. ........................................................................ COGNITIVE THERAPY The main problem with *new* tinnitus (it was for me, at any rate) is the tendancy to focus on it too much - to give  it more attention than it deserves. In some cases, this can have such a powerful effect that it blocks your natural ability to habituate to it. (Most people find that it gradually becomes less significant over the first two years.) Cognitive therapy is a simple, (imo) neatly structured, one-to-one therapy that is designed to enable you to get things into a true perspective (eg tinnitus is merely a background noise. It is not a threat to health or sanity ) It is, I think, useful for many cases of new tinnitus and some cases of established tinnitus where a person is having difficulty. Cognitive therapy has the same aims as directive counseling, and is in some ways similar I like it because the claims made for it and expectations projected upon the patient are valid, realistic and down to earth. There are no cures for tinnitus. CT promises what is achievable. I did it for 10 weeks when my t first started. Gradually over a few months, and continuing over the next two years, I found myself thinking about T less and less. The first few months with tinnitus are often the worst, and it was really helpful having someone to 'dump' all my problems and woes on every Wednesday afternoon. It was almost like *they* could do the worrying for me. (there is more to CT than that, though, but for me that was a part of it.)  Cognitive Therapy made that time a lot easier. Here is an article from a text book. (Psychology by Robert Baron) It explains CT rather well, but is written from a different perspective, and  you will have to use some insight to see how it would be applied to tinnitus. Cognitive therapy is, I understand, widely available. If interested, ask your doctor or health care provider. .......................................... Cognitive Therapies: ........................................... FIGURE 14-7 According to Ellis  individuals often experience frustrations and disappointments These may activate irrational beliefs. Such beliefs produce negative feelings and behaviors  which then sustain or intensify the beliefs. The result: people are trapped in an especially damaging type of vicious circle. .......................................... A major theme in modern psychology is as follows: cognitive processes exert powerful effects both on emotions and on behavior. In other words, what we think strongly affects how we feel and what we do. This basic fact forms the foundations of a third major approach to psychotherapy: cognitive therapy. The basic idea behind it is simple: many psychological disorders stem from faulty or distorted modes of thought. Change these, it is reasoned, and the disorders, too, can be alleviated. We have already considered such an approach in our discussion of depression (see Chapter 13). As you may recall, this serious problem has been related to faulty negative views held by individuals about themselves and the external world (e.g., Beck, 1976) or to the maladaptive tendency to  focus attention inward after failure, while avoiding self-focused attention after success (Pyszczynski & Greenberg, 1987). (See Figure 14-6.) The cognitive approach has been applied to many other psychological problems as well. Perhaps its most popular form is rational-emotive therapy (RET), a technique Llevised by Albert Ellis (1977, 1987a).         Rational-Emotive Therapy: Eliminating Irrational Beliefs. Vccording to Ellis ( l 987b), many psychological disorders have a common root: they spring from powerful irrational beliefs held by most human beings. Ellis suggests that these in turn, can be understood as part of what he terms the ABC model. The model begins with the fact that most people have strong desires for success, love, and a safe, comfortabe existence. Life, however, often fails to gratify such desires; some activating event (A) occurs which blocks progress toward these goals. At that point, two categories of beliefs can be initiated. Many of these are rational. For example, following a failure at work, an indvidual may conclude, I don't like failing, but it's not the end of the world, and I can sill reach many of my other goals. Unfortunately, though, people seem to have strong blilt-in tendencies toward irrational beliefs as well (part B of the model).         Such beliefs take many different forms, but most seem to involve escalating reasonable desires into musts and what Ellis describes as awfulizing or catastrophizing An example of the must tendency is provided by the following idea: Because I strongly desire to succeed, I must perform well at all times. An example of awfulizing as contained in this statement: I absolutely cannot stand it if my lover rejects me. Once such beliefs develop, Ellis argues, individuals essentially cause their oven disturbances they worry about their inability to reach impossible goals, convince themselves that they Cannot tolerate the normal frustrations and disappointments of life, and experience many other negative cognitive, behavioral, and emotional consequences (part b of the model). To add insult to injury, once negative feelings and behaviors develop these tend to perpetuate the irrational beliefs which caused them in the first place. As Ellis notes (l987bX p. 367), this is the ''Catch-22 of human neurosis unrealisic ideas create disruptive feelings and behaviors which tend to sustain and even intensify such crazy beliefs! (Please refer to Figure 14-7 on page 444 for a summary of the ABC model.)         How can this self-defeating cycle be broken? Ellis suggests thatthe answer inVolves forcing disturbed individuals to recognize the irrationality of their vows Thus, the therapists task is to identify such beliefs and then to induce the person to recognize them for what they are: distorted views of reality. Unfortunately, this task is more difficult than it seems. Many irrational beliefs are not as obvious as the ones described above (Ellis, 1987b). For example. consider the lolhlv ing ideas: Becausc I really try hard at various tasks, I deserve to do well on deem. Because I have failed so manv times in the past I absolutely must succeed now Because I only want a little approval from others, I absolutelv must have it. Because I havent had much love and approval for a period of time, I absolutely must have it now.         Such beliefs are illogical, but it may be difficult for many persons to recognise this fact. As Ellis puts it (1987b, p 365), humans have a strong tendency to needlessly and Severely disturb themselves . . and they are powerfully predisposed to prolong mental dysfunction and to fight like hell against giving it up. It is the job of the therapist to combat such tendencies and induce patients even ones who are strongly resisting to recognize that their problems are largely self-inflicted. In a sense, then. therapists using RET often act in an opposite manner from those employing the person centered approach. Rather than expressing warm understanding and acceptance of a client's  thoughts, they strongly and mercilessly reject these. Only by doing so, Ellis sue gests, can the irrational beliefs be overcome and unnecessary psychological pain he eliminated.  ................................. TonyJeffs Liverpool UK

Cognitive therapy has the same aims as directive counseling This comment is simply incorrect, and while the article is a nice discussion of cognitive therapy, the above statement reflects Tony's (well-documented) lack of understanding of TRT and the neurophysiological model of tinnitus, about which he waxes so ineloquent quite frequently. To quote Jastreboff (Margaret Jastreboff, that is):  Directive counseling and sound therapy, the two elements of TRT, ...are actively inducing process which are leading to habituation of the reaction and then the habituation of the perception [of tinnitus], whereas cognitive therapies focus on reduction of the distress caused by tinnitus.  To paraphrase in the context of Tony's misguided statement, while cognitive therapies focus on lessening the annoyance of tinnitus, they are not suited the lessening the perception of tinnitus. I feel that cognitive behavioral therapy is an excellent modality for tinnitus management (I have learned the technique and use it in my clinic); this technique, however, is neither equivalent to nor has the same aim as directive counseling. NB:  Tony's post will I hope be the start of a productive thread about cognitive therapy.  My observation above should be viewed only as an aside to correct the one glaring error, not as an attempt to shift the discussion to TRT.  Had Tony himself not originally mentioned directive counseling (one of the two crucial elements of TRT) in his comments about cognitive therapy, my response would have only been complimentary.   smn Stephen M. Nagler, MD, FACS Director Southeastern Comprehensive Tinnitus Clinic Atlanta, Georgia (404) 531-3979 www.tinn.com

....a very nice review of cognitive therapy, most of which was a direct quote from another source, but very helpful and very much appreciated nonetheless.  I have only one comment to add. Tony says: Cognitive therapy has the same aims as directive counseling This comment is simply incorrect, and while the article is a nice discussion of cognitive therapy, the above statement reflects Tony's (well-documented) lack of understanding of TRT and the neurophysiological model of tinnitus, about which he waxes so ineloquent quite frequently. To quote Jastreboff (Margaret Jastreboff, that is):  Directive counseling and sound therapy, the two elements of TRT, ...are actively inducing process which are leading to habituation of the reaction and then the habituation of the perception [of tinnitus], whereas cognitive therapies focus on reduction of the distress caused by tinnitus.  To paraphrase in the context of Tony's misguided statement, while cognitive therapies focus on lessening the annoyance of tinnitus, they are not suited the lessening the perception of tinnitus. I feel that cognitive behavioral therapy is an excellent modality for tinnitus management (I have learned the technique and use it in my clinic); this technique, however, is neither equivalent to nor has the same aim as directive counseling. NB:  Tony's post will I hope be the start of a productive thread about cognitive therapy.  My observation above should be viewed only as an aside to correct the one glaring error, not as an attempt to shift the discussion to TRT.  Had Tony himself not originally mentioned directive counseling (one of the two crucial elements of TRT) in his comments about cognitive therapy, my response would have only been complimentary.   smn Stephen M. Nagler, MD, FACS Director Southeastern Comprehensive Tinnitus Clinic Atlanta, Georgia (404) 531-3979 www.tinn.com TonyJeffs Liverpool UK

If my definition of Directive Counselling is incorect, could you please post a correct definition. ........................................ Here are definitions of Directive Counseling and Cognitive Therapy: Directive Counseling is an element in Tinnitus Retraining Therapy, proposed and developed by Jastebroff.  It is a series of intense interactive individualized educational episodes designed to demystify the tinnitus experience and to emphasize the role of non-masking neutral sound in accomplishing habituation of tinnitus, an otherwise loud and meaningful stimulus.  Auditory habituation is a passive process. Cognitive therapy is a very active, not passive, approach to tinnitus management.  It is _base_d on the concept that in many ways our fellings come from our thoughts (not the other way around) and in the stressed or depressed state, those thoughts are often distorted and non-productive or counter-productive.  In Cognitive Therapy, through a series of active exercises, those cognitive distortions (the non-productive or counter-productive thoughts) are altered with the goal that the feelings resulting from those thoughts are improved. Cognitive Therapy, proposed by Ellis, further developed by Beck, and popularized by Burns, is useful in the management of some forms of depression.  Many consider it to be a treatment of choice in panic attack disorder.  With the exception of the fact that can be helpful in the treatment of tinnitus sufferers, it has little in common with Directive Counseling.  Tony, once again, you and I appear to disagree. Now, Tony.  Chinnis has raised an interesting question.  You continue to write in an authoritative manner about various issues.  You state that you are a student taking a neurology course, yet you write with the tone of a full professor.  I appreciate your enthusiasm.  Chinnis, and now I, would simply like to know just a bit about your educational background.  We know you disagree with Gutnick (PhD in Audiology), Chinnis (PhD in Neuropsychology), and me (lowly MD).  Tell us a bit more about your education, please, and about your ambition. smn Stephen M. Nagler, MD, FACS Director Southeastern Comprehensive Tinnitus Clinic Atlanta, Georgia http://www.tinn.com (404) 531-3979

Here are definitions of Directive Counseling and Cognitive Therapy: Directive Counseling is an element in Tinnitus Retraining Therapy, proposed and developed by Jastebroff.  It is a series of intense interactive individualized educational episodes designed to demystify the tinnitus experience and to emphasize the role of non-masking neutral sound in accomplishing habituation of tinnitus, an otherwise loud and meaningful stimulus.  Auditory habituation is a passive process. Cognitive therapy is a very active, not passive, approach to tinnitus management.  It is _base_d on the concept that in many ways our fellings come from our thoughts (not the other way around) and in the stressed or depressed state, those thoughts are often distorted and non-productive or counter-productive.  In Cognitive Therapy, through a series of active exercises, those cognitive distortions (the non-productive or counter-productive thoughts) are altered with the goal that the feelings resulting from those thoughts are improved. The above definitions do not appear to be inconsistant with my own. I dont see the point in arguing about this. Tony TonyJeffs Liverpool UK