Stepped-Care CBT Treatment from the University of Maastricht

Discussion in 'Treatments' started by jacob21, Feb 23, 2019.

    1. gorzakus

      gorzakus Member Benefactor

      Tinnitus Since:
      02/2018
      Cause of Tinnitus:
      Hearing loss ?
      I really don't understand why this was all over the news here in Belgium as a new cure for tinnitus sufferers, where did this come from?

      I'm sure these people had some connections with the media.
       
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    2. Markku
      Inspired

      Markku Founder Staff Benefactor Hall of Fame Advocate

      Tinnitus Since:
      04/2010
      Cause of Tinnitus:
      Syringing
      I want to believe they are open to discussing. It's also something that interests me on a personal level; e.g., how was the severe spectrum of tinnitus sufferers considered when these guidelines were being written. It is, after all, the severe sufferers that need these type of guidelines the most.

      We know Rilana (the main author of the guidelines) - a couple of years ago we promoted her research survey on here (it wasn't related to these guidelines), and @Steve has met her at some of the tinnitus conferences.

      @Hazel will also have the opportunity of meeting Rilana at the next ESIT meeting in Milan later this month.

      We haven't yet arranged anything with her, but if schedules permit, Hazel could interview her.

      Feel free to send some questions over just in case.
       
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    3. Codaz

      Codaz Member

      The thing about this therapy is to be less anxious about fluctuating tinnitus, by doing exposure exercises. Part two of this treatment is focus. Learning to shift your focus is difficult. I'm now doing almost the exact same techniques for my chronic pain and yes it can help to relax a bit. But no, I'm still freaking out on loud tinnitus awareness so I doubt the effectiveness.
       
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    4. DaveFromChicago

      DaveFromChicago Member

      Tinnitus Since:
      01/2014
      Cause of Tinnitus:
      Headcold/Flu
      Thanks very much Autumnly, for including that attachment.
      I don't know how much Orwellian Doublethink , Chinese Red Guard "Re-Education", Jim Joneses' Cultist Psychological Bludgeoning, or North Korean "Removal of Ideological Divergence Training" I would have to undergo to comprehensively believe that a tinnitus spike could be construed as "an acceptance of tinnitus as a benign signal."
       
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    5. Gman

      Gman Member Benefactor

      Tinnitus Since:
      07/2016
      Cause of Tinnitus:
      Ototoxic earwax drops
      Let’s just stop all medical research and just have this to treat every illness and condition. It’s easy, just get used to it. Just get used to AIDS, MS, diabetes, Parkinson’s, Cancer, ALS, Ebola, etc. It’s just mind over matter. The human brain is a powerful thing. We can do it.

      Tell neuromod, frequency therapeutics et al to shut up shop. Not needed thanks. NIOSH and OSHA...we don’t need that stuff anymore. It’s cool, we got it all sorted now with CBT.
      These geniuses deserve a Nobel prize for this.

      If you just keep doing anything you want and keep going anywhere, it will get worse... much much worse. So, do you then have to keep repeating the treatment to get used to the ever increasing sound as your hearing deteriorates?
       
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    6. Manny
      Sad

      Manny Member Benefactor Hall of Fame

      Location:
      United States
      Tinnitus Since:
      1/2018
      Cause of Tinnitus:
      central gain << NIHL
      Perfect post.
       
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    7. DaveFromChicago

      DaveFromChicago Member

      Tinnitus Since:
      01/2014
      Cause of Tinnitus:
      Headcold/Flu
      I frequently ask myself to what degree I would have to transform myself into a stupefied, completely outer-directed , opinion-lacking, cool aid-drinking, unconditionally psychologically subservient character to actually embrace these CBT recommendations. The most insulting feature of this CBT "methodology" is that I would be expected to debase myself to this level.
       
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    8. Autumnly
      Wishful

      Autumnly Member Benefactor Hall of Fame

      Tinnitus Since:
      July/August 2013
      Cause of Tinnitus:
      Noise induced
      The Fear of Tinnitus Questionnaire
      Toward a Reliable and Valid Means of Assessing Fear in Adults with Tinnitus

      Objectives: The purpose of this study was to assess the factor structure, reliability, and validity of the Fear of Tinnitus Questionnaire (FTQ); a brief self-report measure of people’s fears about potential cognitive, emotional, behavioral, and social consequences of living with tinnitus.

      Design: 588 Dutch-speaking adults with tinnitus completed an online battery of questionnaires measuring tinnitus-related distress, fear, catastrophizing, and quality of life. The sample was randomly split into two to perform exploratory and Bayesian confirmatory factor analyses. A subsample of participants (n = 144) completed the battery of questionnaires a second time after a 2-week interval to calculate test-retest reliability and conduct a Bland-Altman analysis. Convergent and concurrent validity of the FTQ was assessed with the complete data set and measures of tinnitus-related distress as the outcome.

      Results: Exploratory factor analyses indicated that single- and three-factor FTQ models were both valid solutions. Posterior predictive p values for the Bayesian confirmatory factor analyses ranged between 0.51 and 0.53 indicating that the respective models were an excellent fit for the data. The FTQ showed excellent test-retest reliability (average value intraclass correlation coefficient (ICC) = 0.92; 95% confidence interval, 0.89–0.95) and in the Bland-Altman analysis, satisfactory agreement between participants’ scores after a 2-week interval. Furthermore, the FTQ demonstrated good internal reliability (α = 0.83, 95% confidence interval, 0.81–0.85) and added statistically significant amounts of variance to models predicting tinnitus-related distress and interference in daily life.

      Conclusions: The FTQ has good psychometric properties and can be used to assess people’s fear of tinnitus in research or clinical settings. Further work to establish the reliability and validity should be conducted and include an examination of a version of the FTQ that uses Likert-type response scales which might offer improved sensitivity.
       
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    9. Autumnly
      Wishful

      Autumnly Member Benefactor Hall of Fame

      Tinnitus Since:
      July/August 2013
      Cause of Tinnitus:
      Noise induced
      "The Fear Avoidance (FA) Model as applied to tinnitus (Cima, 2013) proposes that in people with bothersome tinnitus, fear of tinnitus is a product of catastrophic misinterpretations of the tinnitus sound and that it subsequently leads to safety behaviours that are not functional in the long term, and contribute to avoidance, disability and emotional distress. The Fear of Tinnitus Questionnaire (FTQ) is a 17 item self-report measure assessing fear of tinnitus, using a binary scale with use of a series of statements (e.g. I am afraid that tinnitus will become worse) which people respond to. This poster presents of the initial analysis of the psychometric properties of the FTQ."- source

      Bildschirmfoto 2019-04-24 um 11.31.27.png
      A similar image can be found in the European guideline.

      They also mention the phrase "I am afraid that tinnitus will get worse" in their paper. Which makes sense because in the European guideline they said tinnitus usually doesn't get worse, thus being worried of it can easily be seen as irrational. I also thought some of the questions mentioned applied more to people who recently developed tinnitus.
       
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    10. GamesB2
      Predatory

      GamesB2 Member

      Location:
      Huddersfield, UK
      Tinnitus Since:
      2010
      Cause of Tinnitus:
      Dumb brain
      Wish they could remind my tinnitus it's not meant to get worse as it seems to have missed that memo.

      Serious note, I'm gonna try CBT once I get a chance, I'm hoping it can alleviate some of the mental impact.
       
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    11. Helheim
      Stressed

      Helheim Member

      Tinnitus Since:
      01/2017
      Cause of Tinnitus:
      Infection
      I love how they ignore the fact that tinnitus does get worse for a lot of people. How dare they base a "treatment" plan on that smh.
       
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    12. Codaz

      Codaz Member

      They translate that into your perception of tinnitus is more intense. You experience it louder but it is not. And I became angry and said for sure it is louder. For someone as a therapist without tinnitus you cannot understand it.
       
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    13. Helheim
      Stressed

      Helheim Member

      Tinnitus Since:
      01/2017
      Cause of Tinnitus:
      Infection
      Lol how easy it is to counter that with "but it is louder, I used to only hear it at night in a quiet room and now I hear it everywhere" though? Bless these CBT types.
       
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    14. Luman
      Tired

      Luman Member Benefactor

      Location:
      Brooklyn
      Tinnitus Since:
      07/2017
      Cause of Tinnitus:
      Intermittent Tinnitus probably noise induced
      I was lucky enough to find a therapist who has severe tinnitus and hyperacusis, who helped me quite a bit.
       
    15. Codaz

      Codaz Member

      She then probably will deny this and say because your focus is more on it or something. I tried every possible thing to counter such answers, to the point that they thought I was not cooperating enough to let the therapy succeed. It is louder but they say it isn't... They don't have your head, your ears, your anxiety but they do have an opinion about it...
       
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    16. Helheim
      Stressed

      Helheim Member

      Tinnitus Since:
      01/2017
      Cause of Tinnitus:
      Infection
      Yeah that's my main issue with this approach as well. I can tell the difference between when I'm focusing on it and it sounds louder vs. when it's actually louder - does the sound of the fridge cover it up? Cool, I'm having a quiet morning. It doesn't? Great, I'm having a loud morning and it's only getting louder from there. Sometimes I feel like therapists can't actually understand until they've actually been there...
       
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