Lovely, thank you very much for coming back to this session… and uh… what were your reflexions on this
session that did last on over the things that you found useful, over the things that (your parents?) didn’t
like?
Umm you really did get me thinking um I realized that some of my thoughts and feelings were maybe a little
bit irrational, that maybe they were not substantiated by the truth um and that maybe I was making them
into something bigger than what they really were. And you helped me understand that.
And uhhh, let me just uhh… excellent and were there thing that you perhaps didn’t like from the last
session?
Well obviously I felt like I was put almost into a corner where I was pressured to admit that what I’m
thinking is maybe a little bit exaggerated or a little bit unsubstantiated, and that made me feel a little bit
anxious. You know, my anxiety was definitely peaking in our last session, and maybe that’s something I
don’t really want to face or deal with, but I got to if I want to get better.
So even thinking of these thoughts can make you feel anxious?
Yes, definitely.
And uhh but… I also think that you were really open and honest during our last session, and that is why we
could actually come up with this little behavioural experiment… and uhh… we can now go and review your
experiment if that’s okay, and see what we can take (it?) from there. So I’m going to share my screen with
you. So, there are some of the thoughts that you had, which came true and they were right, and then some
of them what were not true. So, let’s explore them a little bit further and see what exactly happened. So the
“I feel very stressed” to the 8/10 level. You stated “no” there, so like how much stress did you think you
experienced?
I think I was more of a 6/10.
6/10, okay. And uh so this thought which says “I feel stressed” to this level, so basically it was not very
accurate, and what advantages or disadvantages do you see for thinking this way?
I think if I pre-inputed(?) my stress levels being high I’ll probably cause them to be higher than they need to
be.
Can you see any advantages for thinking in that way?
Um, if I think I’m going to feel very stressed it’s not going to help me in any way.
So, the thought was not accurate based on your experiment, and also you can’t think of any advantage for
thinking in that way and the disadvantage is that you’re pre-inputing yourself to feel stressed. So, do you
want to keep this thought, or do you want to change it?
I’d prefer to change it, but honestly I do feel stressed at night so it’s hard to change.
Exactly, and let me see if I can move this… uhh… alright I just wanted to move this far right so I can see the
comments… oh I can’t see the comments that’s why. Okay so, if you were not to think this way, what would
be the alternative then?
Well I’d say… um… I would still be able to fall asleep even though I’m stressed.
Yeah but this is only about the… you know… feeling of stress… so and uhh what you’re going to do now is to
create alternative thoughts if you like, and these are called “counter-statements”. And the counter-staement
needs to be relevant and contradictory to the negative thought, so you must say something that is relevant
to you feeling stressed, not necessarily this lead(?) part was not really included in this particular thought
If I say I will feel relaxed.
But did you feel relaxed?
No.
So, the counter-statements need to have certain criteria for them to be good counter-statements. I’ll just
type these here for you, and then we have to follow these. So the counter-stat—
So, “I will feel a little bit stressed”.
Little bit, that’s good… let me just type the uhh… don’t forget that, because I think it was a good counterstatement. So, the counter-statement needs to be relevant and contradictory to the negative thought. They
need to be believable to you; and, for example, if you said something about “okay I’m stressed but I can
sleep” it is not necessarily relevant or contradictory to this [the negative statement], so you have to
concentrate on this stress and uhh… sleep will come. There is another thought about not being able to fall
asleep, so you can use that. And then if you say “I feel relaxed”, then it is not really believable to you
because you were not relaxed. And then there are two other criteria: you should not have any negative
words; for example you can’t say “I will not be stressed” because you have a “not” there; and [fourth
criterium] they have to be in your own words. So, what was it that you suggested that I said maybe a good
one?
“I will feel a little bit stressed”.
*types it down* but was it really true? Did you feel a little [stress]? Because you said your stress level was
5… did you say 5/10?
I said 6/10.
6/10, so that doesn’t really count as “little”, it’s a bit more than “little”, so I think that it may not be
believable to you entirely.
But perhaps if I said “I will feel stressed” rather than “I will feel very stressed”?
*corrects the written statement like so* And so… that’s good. And was the eh... the stress... the level of…
because if it was 8/10, if it was a very high level of stress, and the level that it was 6/10… was it a level that
you could take it if you liked?
Um, it was more manageable that I thought it would be, but it was still a little bit high.
*corrects the written statement by adding: “Although the stress can be high but I feel that I can manage it”*
Is this something believable to you?
Yes.
And uhh… so you can change these and make them more believable to you than ever needed, but this is
something we came up with at this moment. It does sound like a good counter-statement to me, as
opposed to “feeling very stressed”. And the next one you had a “no” is “it will take me 4 hours to fall
asleep”. So what happened then?
It only took me about one hour to fall asleep.
So, the thought that says “it will take me 4 hours to fall asleep”, what’s the advantage or the disadvantage
of it?
The disadvantage is that it was inaccurate, and so it makes me… fear I’m going to bed because think I’ll take
very long to fall asleep.
Exactly, like if you feel… if you go to bed and even before 4 hours, even at [minute?] 10 if the thought comes
to your mind that “it will take me 4 hours to fall asleep”, this thought… it makes you feel anxious, and that
anxiety will prevent you from falling asleep, basically leading to this thought actually coming true. And then
when the thought comes true, if you take that as a proof for your negative thought, it becomes like a selffulfilling prophecy, because at minute 1 or minute 10 when you’re in bed you wouldn’t know how long it
will take you to fall asleep, so a negative prediction like that can have that negative impact. So what would
you use instead of that, what would be your counter-statement to this?
Um, it’s difficult because I don’t know how long it will take every night, you know maybe one night will be
one hour and another night will be two hours. So I think I shouldn’t be giving it a time frame.
Yeah, I really like your thinking, because the problem with that thought is that it was a future prediction and
you don’t know whether you’ll be falling asleep in ten minutes or not at all. So, whatever you’ll say, even a
positive one, is going to have the same sort of irrational component to it. So why don’t you stay with the
things you’re sure about?
I think I would replace it with something quite different. I would say: “I will try not to worry about how long
it takes me to fall asleep. Eventually I will fall asleep”.
How do you know that eventually you’ll fall asleep?
Because I always fall asleep eventually.
So this part of it, you have quite robust evidence for it, that you will eventually fall asleep, and “I will try not
to worry—” you’ve got a “not” there.
Pardon?
You’ve got a “not” there.
Oh yes, I do have a “not” there hahaha.
And then also, apart from the “not”, the counter-statement should not really imply an action, so it should
not want you to do something. So, when you say “I will try not to worry—” basically you’re putting pressure
on yourself that “I will not worry”, or “I shouldn’t worry”. So, the counter-statement should just be an
absolute statement, without basically implying that you should do something or not do something, so that
bit of it should not be in the counter-statement. So, we can’t really use umm this *cancels the first sentence
from the written statement*. So “Eventually I will fall asleep”, this is good, but uhmm… what else can you
come up with?
*both talk over each other*
Sorry?
“I will go to bed knowing that I’ll fall asleep”.
*writes it down* Very good, but you’re not asleep in that very moment, that you lie down there and hear
this tinnitus(?) screaming in your ears and… so… what can you say about that moment because this is…
again it’s… you know it’s also reassuring thoughts that you know “I will eventually fall asleep”, but deep
down there was at least one of your thoughts you didn’t think it was very likely but it has happened in the
past, that is why we have it on this uhh diagram uhh which was “I will not get any sleep at all”… so… let me
see where was it yes! *finds said statement in the diagram*. So this was a possible scenario, a worst case
scenario that can happen, so this thought can… be there really, and not giving a huge amount of impact to
your counter-statement while this still exists. So I think this is a good thing to add to our counter-statement,
but I don’t thinks you can actually use this as your proper counter-statement for “It will take me 4 hours to
fall asleep”. So you have to come up with something which is not a prediction of future, doesn’t involve any
negative words, it is relevant and contradictory to the original negative thought, and is believable to you. So
no pressure.
I’m not pressured at all hahaha.
This is actually the most difficult task of Cognitive Behavioural Therapy, to come up with counter-statements
which meet all of the criteria for good counter-statements.
Mh mh. “I will go to bed…
You will go to bed, let’s not give any guarantee about the sleep…
Mh mh.
… and what is it that, when you are in bed, you’re sure that is happening. Well, the best-case scenario
would be that you’ve err… asleep. And uhh that you will get refreshed and that you will get fully rested. So
best case is: sleep *writes that down*. So, in order to rest… so… sleep is the best-case scenario. What’s the
second best?
Rest.
Yeah. To rest. To rest is the second-best, so how do you… if resting… if the best-case scenario for resting is
asleep, what would be the second-best scenario or the third best scenario for resting. Like, for example, if
you’ve been working hard in a building site and you want to uhh rest, so the best-case scenario, fully rested,
would be getting a nap, and what’s the second. If it’s not possible for you to have a nap, what’s the secondbest for you to rest?
To… relax.
Relax. Like lie down and relax.
Yeah.
So the second-best would be to lie down and the third best – like if it’s not possible to lie down, what would
be the third-best?
To sit down.
To sit down and rest. And if it was not possible to sit down, what would be the next best, to rest.
Stand up.
Stand up and rest. All of them are still resting isn’t it? You take a break from your work and you rest. If it is
possible for you to take a nap, you take a nap, that would be the best. The second-best is you just lie down,
third-best to sit down and the fourth-best to stand up and rest. But while you’re in bed we know that you’re
not asleep, so what is it that you’re getting?
I’m getting some rest, I’m relaxing.
So, “I’m lying down and resting” *writes the counter-statement down* and this is the second best. Because
we said that the first-best is you fall asleep, second-best if you lie down, third-best if you sit down, and the
fourth-best would be to stand up. And so you’re actually having the second-best, when you lie down and
you’re not obviously asleep because you’re hearing the tinnitus at that point in time. So you’re having the
second-best: “I’m lying down and relaxing, this is the second best”. Is it something believable to you?
Yeah.
And uhh so if you lie down, you’re not really doing anything isn’t it? So your muscles are not particularly
working, so your muscles are resting. You’re not lifting anything, you’re not doing anything, so as long as
your muscles are concerned, your body is concerned, you are resting.
Mmh.
And your mind… yes, you’re not unconscious or fully switched off, but you’re not really solving a
mathematical problem or a project or anything, so your mind is resting as well. So you could add things like
that to… [referring to the counter-statement]. “My body is resting. My mind is resting” *adds that to the
written counter-statement*. And uhh… potentially uhh you could add this bit: “I eventually will fall asleep”.
This bit of a prediction of future is not too much main component of your counter statement. The main
component of your counter-statement are the reflexions of the reality: that you’re resting and your body is
resting, your mind is resting. And uh this is the second-best after sleep if you like. And uhh so is this thought
believable to you?
Yes, it is.
So which one is more rational? “It will take me 4 hours to fall asleep” or “I’m lying down and relaxing, this is
the second best…”?
Yeah, that’s more rational [referring to the counter-statement].
More rational. It’s not entirely positive, because if the positive would be “Yeah I will sleep, and I will be
asleep in 5 minutes, I can do this” and stuff like that, that would be a positive thought. But this is a more
rational thought as opposed to a positive thinking. And uhh the next one, tightness in the chest, difficulty
breathing, so you did not experience these, but you experienced feeling trapped and itchy. So what was this
“feeling trapped” that you uhh experienced?
Umm I think it was because the trapped feeling made me feel a bit panicky like uhh I had to sleep, it was
time to sleep, it made me feel like I was under a little pressure and time constraints to fall asleep.
Mmh.
And I find that I always feel like that. And I’ve got this tinnitus going and I can’t switch it off, so I can’t just
put my head down like my husband and just sleep. And that makes me feel trapped.
Like uhh… hopeless scenario.
Yeah, yeah.
And uhh, you did feel trapped and itchy, but you didn’t feel tight chest and difficulty breathing. And uhh so…
so what would you say as a counter-statement for these two [referring to tight chest and diff. breathing].
You could perhaps come up with one counter-statement…
“I will breathe normally. I will be able to breathe.”
Okay. So “Even if I feel trapped, I will still be able to breathe normally” *writes it down*. So let’s uhhh… so
be incorrect, and uhh… I’ll just do this for you as an example, if you like, for you to learn how to do the
counter-statements. You need to basically do the counter-statements in your own time at home between
now and the next session. So we’re doing a few examples for you to get the hang of it, for how to actually
do counter-statements. Does that make sense?
*nods head*
Excellent. So let’s do some counter-statement for some other ones, like for example “I will wake my
husband”. You didn’t wake your husband, so what would be the counter-statement for this one?
“Despite me feeling fidgety, my husband will not wake up”. No, “…my husband will remain asleep”.
So, you did not feel out of control to actually wake him up yourself?
“Despite feeling out of control, I managed to deal with my tinnitus without waking my husband up”.
“…without needing to wake my husband up”.
So… and you didn’t feel out of control either, so this one was a no.
True.
“Despite feeling panicky…” so we can start from there. “Despite feeling panicky…” then what? *writes the
counter-statement down*. So, “Despite feeling panicky…” then what’s the end of the sentence?
Hahahaha yeah, so “Despite feeling panicky I did not…” “I-I was able to feel in control enough not to have to
wake up my husband”.
And the counter-statements, we try to put them in present tense or uhh… so you can basically use them
ehhh in the moments that you need to. So, “Despite feeling panicky I am able to…” to “take control” did you
say?
“… to have enough control not to feel in need”.
We have a “not” there.
Oh yes. “…to allow my husband to carry on sleeping”.
*writes it down* What does this tell you about you? Despite feeling very panicky and having very loud
tinnitus, you can have good control of yourself not to wake him up. What does that tell you about you?
It tells me that I’m not as reliant on other people to fix this as much as I thought, that I am able, I’m strong
enough.
“This means that I’m strong enough…” *writes it down*. You’re strong enough to what?
I’m strong enough to deal with the tinnitus…
*writes it down*
…at the time.
And this was the worst time because at night the tinnitus was loud.
Mh mh.
*adds “at the time” to the counter-statement*. So, do you have any questions about how to create counterstatements?
*lightly shakes head* ……. Yes(?)
So basically I uhh I… if that’s okay, I’ll just give you a bit of explanation of how eventually you will be using
these counter-statements. And that can help you to … your mind full of how is it that you’re gonna use
these counter-statements. It can help to create counter-statements which can be more useful. And
eventually what will happen is that once you have counter-statements for all of these negative thoughts and
then, say, you go to bed another night and the tinnitus is loud and bothering you, you have to think “okay,
what is it that I’m thinking right now?” and if, for example, this thought comes to your mind -- you have to
identify what is the thought in that very moment that comes to your mind. You consider that thought as a
dark cloud and you try to *blows* blow away the dark cloud and let the sunshine in with your positive,
rational counter-statement, which is relevant to that negative thought, and then carry on doing… whatever
you were doing before you’d be lying down and trying to fall asleep. And uhh what you do: you identify the
negative thought and replace that with the corresponding counter-statement, and then move on. And then
if you identify different negative thoughts then you will be using a relevant counter-statement for them. So
there is no one counter-statement for every single negative thought. Each negative thought – or group of
negative thoughts – will have their own corresponding counter-statements.
So are you saying that when I’m sleeping at night I should… and I have these thoughts coming to my head
and these feelings, should I stop and think what these negative thoughts are or should I be doing it later or
the next day?
No you… at this moment… because you have… as you can see, we are spending a lot of time in creating
good counter-statements, and it’s quite a challenging uhh task, especially at the beginning that [when] you
try to learn how to create counter-statements. So you… it can be very hard for you to… on the spot, create
counter-statements for the negative thoughts you identify in the middle of the night. But, the process is:
you do your homework for this basically. So you create counter-- in this process of these CBT sessions that
we have, you create a lot of counter-statements for your negative thoughts, and then you memorize these
counter-statements. And then, once you have counter-statements for a big bulk of negative thoughts, then
you can actually more freely use these counter-statements. Does that make sense?
*nobody answers*
Are you still with me?
*still no answers*
Is my patient gone?
She’s gone *smiles*.
Terrible behavioural experiment.
*another woman enters the call*
Excellent. So, do you have any questions about the counter-statements?
What do I do if the counter-statement doesn’t work?
Well that’s adifferent question. I think it’s uhh too much ahead of you, if you like, at this moment. Because,
at this moment, the task is to ehhh to learn how to create the counter-statements. If the counter-statement
doesn’t work, then it could be a bad counter-statement. And so uhh… I can’t hear your voice.
Oh, sorry. Can you hear me now?
I can hear you now.
Yeah.
And uhh… So, there are a lot of things that can uhhh can influence on whether the counter-statement could
work or not. At this moment, you should not focus on whether it works or not. Your focus needs to be…
how to do the task ehmm properly.
Okay, okay.
And uhh for example, if I… I think this is an important thing, that you’re doing CBT. And so it is important
uhm to think of it this way: where your focus needs to be. For example, if your leg gets broken, and you go
to a doctor and you want them to fix your leg uhh… fix the bones, would you want the doctor to think of
how much pain you’re experiencing and to think whether after he fixes your leg: “Will you be able to run?”
“Will you be able to go to a match or something?”. Or you want him to focus on putting these two bones
exactly where they need to be and make sure there’s no infection introduced and basically just do their job
properly?
*nods head* Yeah. I would prefer him to do their job properly first. Definitely.
Exactly. And if he’s thinking about how you’re feeling, the pain that you’re experiencing and whether you’ll
be able to run after this operation, then this is going to distract him from doing the job properly. And that is
why try to not treat their own family members and not to do an operation on them: because these thoughts
are inevitable, they’ll come to their mind and will distract them from delivering what their task is to deliver.
And uhh when you do CBT, you need to think of it this way. You need to tell yourself that “I am the doctor,
so my job is to put these two bones next to each other, make sure that it is straight and no infection is
introduced; and not to think whether I can run or dance or whatever, those are just a distraction”. So, to …
CBT, “I am the doctor, all I need to do is to think what is the counterstatement that I need to create, and to
think that counterstatement, to do this process of the CBT properly not thinking whether it’s gonna work or
not or what will happen in the future”. So you have to give yourself much more focus then you try to do
that, in a way that you would expect from a doctor to do when they are operating umm on you. So let me
share my screen again to just make sure that you got the message from this. So your task at the moment is
to create counter-statements for all of these negative thoughts that are listed here, specifically the ones
which proved to be wrong. And uhh you could have a go at the ones that proved to be correct as well, but
those are more difficult as you have the evidence that they can happen. The ones with the “no” it’s much
easier to tackle them and create counter-statements for them. The next day that you come to the session,
we are going to review your counter-statements. Is that ok?
Yeah.
I do not know why I do not have your voice.
Sorry, I just think it’s my laptop and you’re not hearing me because of that. Can you hear me a bit clearer
now?
Yeah, I can hear you very well when you come closer, but when you…
Okay, I’ll stay close.
It has apparently a very sensitive microphone that doesn’t pick up sounds that are further away and uhh…
excellent. So this is one task and ehhh… I have a small presentation uhh that I’d like to share with you if
that’s okay and uhh that is about common errors of judgement in our thoughts… and that can also help you
with your next task of challenging some of your own thoughts if you can identify any of those distortions or
errors of judgement within them. Is it okay if we go through that?
Yeah, that’s okay.
Excellent. So I’m gonna share my screen with you… after you first… open the presentation…… Excellent. I’m
going to share my screen now. So, there are… the thoughts that we discussed in your diaries and
behavioural experiment, they are called “automatic thoughts” that come to our mind without us necessarily
being aware of them. And we tend to believe them, they’re very believable and they seem to be out of our
control. So this is the nature of automatic thoughts: for us not to be aware of them, to believe them and to
not be able to control them. So, what we usually feel and experience is the result of these thoughts. They
should be like our emotional reactions, like when we feel angry, annoyed or frustrated when we hear
tinnitus. We are not necessarily aware of the negative thoughts that go through our mind. In the process of
CBT, we wat to go against the nature of these automatic thoughts. First, we want to become aware of them.
Second, you want not to just believe them, you want to question them: if they are true and rational yes, we
believe them, but if they are irrational we want to question them. And uhhh they seem to be out of control
but we want to get control over them and modify them if they are irrational thoughts. So we are going to
ehh… during this CBT session you’re learning something that doesn’t necessarily, naturally come to us. A
natural process is not to be aware of these, believing them and let them control themselves. The unnatural
process is to become aware of them and question them and modifying them. Hence it takes time for you to
master this skill. So, according to our own bag/Aaron Beg(??) there are a number of common cognitive
distortions that all of us have in our minds, and these distortions or errors of judgement are on this page
and uhh: All or nothing thinking, Mental filter, Over generalisation, Discounting the positive, Jumping to
conclusions, Magnification, Emotional reasoning, Should statements, Labelling, Personalisation and blame.
And umm so everybody has these. I have these, you have these, our parents had these, our children will
have these and uhh so this is part of the experience of being a human being, having these errors of
judgements in our mind, these thought distortions. And uh the aim of the cognitive therapy is not to get rid
of them, and it’s almost impossible, unless you become a robot. And uh our aim is to get some sort of
recognition about these and understand them and if they become a barrier for us to live our life or do the
things that we need to do, then why a little modifying them, then we can have a better, satisfying life as
opposed to letting these become a barrier for us, to do the things that we need to do. And uh on this page
that you’re looking uhm any one of these… which one of these you’re familiar with?
All or nothing thinking ehmm…
Can you give me an example?
Uhm…… My tinnitus…
Doesn’t have to be tinnitus related.
No, I suppose it doesn’t. Uhm… “If I don’t get this done in time… if I don’t get this project done for work in
time I could be fired”. That would be all or nothing thinking.
Sure, and what else do you recognise on this list?
Uhm… Discounting the positive.
What do you think that is?
Well I think it’s completely focusing on the negative and not seeing what support and love and kindness
that you have in your life.
Exactly, and what else do you recognise here?
Magnification…?
And… what is it?
I- well, my understanding of Magnification would be blowing up issues to a huge extent when actually
they’re not that big.
Exactly. Thank you very much for uhh… for uhh going though this and answering the questions and uhhh…
my plan is actually to go through these one by one and give you examples of these. By the explanations you
gave me… most of these you already know… but uhh we’ll just review these to get some sort of a
consistency in how we conceptualise these so you can use these for the tasks in hand. So is it okay if I go
ahead with this?
Yeah, that’s okay. Thank you!
You’re welcome. So, All or nothing thinking, if a situation falls short of perfect you see it as a total failure.
When a young woman on a diet ate a spoonful of ice cream, she told herself “I have blown my diet
completely”. Do you agree with her?
No.
So, what do you think she should think instead of this?
Um… I think “It’s okay to eat a spoonful of ice cream even if you’re on a diet”. Even a bowl of ice cream
would be okay on a diet as long as you’re not having two or three every day.
Exactly. So, what is wrong? What would be the negative consequence of the thought she already has? This
All or nothing thinking, which says “I have blown my diet completely”, what would be the consequence of
thinking that way?
I think she could uhh be stopping herself from eating foods that she actually needs for her nutrition and to
be healthy. So it could have even more negative consequences, not just on her mind, but on her physical
body.
Exactly. Or could it make her completely disappointed and abandon the diet because she thinks she has
already blown the diet so what’s the point.
*brief inaudible talking*
So, the next one is Overgeneralisation, which is drawing broad and general conclusions from a limited
amount of information. You see a single negative event as a never-ending pattern of defeat by using words
such as “always” or “never” when you think about it. A depressed person becomes terribly upset when
noticing bird droppings on the windscreen of his car. “Just my luck! Just my luck, birds ‘always’ crapping on
my car”. So, whenever, in your own thoughts, you notice you are using words like “always” or “never”, then
you can highlight this, in your diaries, that this is an overgeneralisation. By the way, I will be sending you the
handouts for this presentation for your reference, because you need to- for the next task that you have for
the next session, there is a diary you need to complete and identify your thoughts in different scenarios and
then you need to challenge your own thoughts and find out if they had any of these distortions that we are
discussing. So I’ll send you the handout for this to refer back to it, so you know that if you forgot any of
these you can refresh your memory. Mental filter, this is a very difficult distortion to overcome. We tend to
confirm our pre-existing assumptions. Whatever information doesn’t fit with our belief is screened or
filtered out, ignored or explained away as insignificant. You pick out a single negative detail and focus on it
exclusively so that your vision of all reality becomes darkened. So, this Mental filter is, basically, if you have
a pre-assumption about something, like for example “Jack doesn’t like me”, this creates a filter, and every
time that Jack does something that proves he doesn’t like me, I take that information as proof for my
assumption. Millions of times that Jack does something that shows that he has no dislike for me, those will
be not noticed, they will be filtered out. So I could- because of a mental filter, I could have a wrong idea and,
throughout life, all of my life experiences which disapprove with this idea, I will not learn from them
because they are simply filtered out. And as for the few examples that prove this idea of mine, those will be
taken as the evidence, as the proof for that assumption and… so the assumption can get stronger
throughout life despite a lot of contrary evidence to it, and that is because of the Mental filter. Discounting
the positive, as you said it nicely, you reject the positive experience by insisting they “don’t count”. If you do
a good job, you may tell yourself that it wasn’t good enough or anyone could do it. Discounting the positive
takes the joy out of life and makes you feel inadequate and unrewarded. Jumping to conclusions. Jumping
to conclusions is a pattern of making negative conclusions based on incomplete or ambiguous information,
and it has two sides to it. One is Mind reading, the other is Fortune telling or Future telling. Mind reading is
“My husband will think such and such” or “My friend will think such and such”, “My colleagues will think I’m
stupid or incompetent”. Whatever thought in your mind about what other people think is Mind reading,
because you don’t know what they think. And Future telling is your thoughts about the future: “I will not be
able to do such and such”, these will all be considered as Future telling. You do not know what is going to
happen in the future, the negative predictions of the future are Future telling. Magnification ehmm… are
you okay that I’m carrying on quite fast on these presentations? Please feel free to stop me.
That was good, thank you.
Excellent. And so… Magnification is reacting to worst-case scenarios as if they were actually happening. You
exaggerate the importance of your problems and shortcomings, or you minimize the importance of your
desirable qualities. Emotional reasoning, this happens a lot with tinnitus, hyperacusis and misophonia. It is
thinking based on emotions, taking what your emotions seem to be telling you as a literal fact. For example
– these are not tinnitus related, general examples – “I feel terrified of going on airplanes. It must be very
dangerous to fly.” or “I feel angry. This proves that I’m being treated unfairly.”, “I feel so inferior. This means
I’m a second-rate person.” and uhh “I feel scared. This means tinnitus is going to ruin my life.”, “I feel
disgusted. This means that the noises my parents are making are inappropriate.”. And uhh so Emotional
reasoning bubbles up a lot in the conditions we are dealing with. Should statements: you tell yourself that
things should be the way that you hoped or expected them to be. “I shouldn’t have made so many
mistakes”. Should statement that are directed against yourself lead to guilt and frustration, and Should
statements which are directed against others lead to anger or frustration like “He shouldn’t be so stubborn
and argumentative” or “He shouldn’t be making so much noises” or “I should be able to control my
emotions for tinnitus”, “I shouldn’t make this many mistakes when I hear my tinnitus”. So, Should
statements are a thought distortion. Labelling: complex human beings are taken out of context and reduced
to an over-generalised characteristic. Labelling is an extreme form of All or nothing thinking. Instead of
saying “I made a mistake” you attach a negative label to yourself: “I am a loser” or “I am a failure”.
Personalisation and blame. Causes of negative events are attributed to ourselves rather than to context and
situations. When a woman received a note that her child was having difficulties at school, she told herself
“this shows what a bad mother I am” instead of trying to pinpoint the cause of the problem so that she
could be helpful to her child. So, what are your reflexions on this pr- I know that I had to go through it so
fast for various reasons… so what do you think?
It makes a lot of sense. Umm and it also would challenge a lot of the thoughts that I would have myself…
and probably the core beliefs(?). I’m sure there’s a lot of core beliefs(?) there that I’m not aware of, that are
driving a lot of the thoughts around tinnitus for me.
And those core beliefs can also have these distortions in themselves. And… for the task for the next week
you already have the behavioural experiment, which you need to go through it and do the counterstatements for them. The next task: I’m going to give you a diary so you can keep track of your thoughts and
the distortions within them. And uhh so let me just share my screen with you to see what is this. So, this is
the diary that I’d like to give to you to complete between now and the next session. So, under the event
column you need to- every time that your tinnitus is bothering you need to- not every time that you hear
tinnitus, you may be haring tinnitus all the time, but it is about the time it interferes with the activity that
you’re doing, all the times that it impacts your mood (this is when we say that you’re bothered by your
tinnitus). Those are the times that effectively you need to do CBT, but you have not learned CBT yet, so you
do the exercises in those times. So uhh you need to take not of what’s happening, for example, “On Tuesday
5 pm I was watching TV and my tinnitus was interfering” this would be the vent. In that very moment, you
need to ask yourself: “What is it that I’m thinking about my tinnitus right now”. So you need to capture that
negative thought. This is a skill that you need to build, we don’t naturally do this, so, by practicing, you
gradually will be able to do that, and one practice is filling this diary. So, these two columns you need to do
them exactly at the time that tinnitus is bothering you. And once you do five events during the next seven
days- you’ll have plenty of time to put at least five events, five times that tinnitus is bothering you, and the
very moment you need to think what is your thought, write it down. Then later on you can go back to this
and look at your thought and try to identify the error of judgement and the distortions within that thought,
like the example I have here. I elaborated a little bit on this and explained why did I think that my thought
had Magnification for example. You don’t need to elaborate on this, you can just say “Magnification”,
“Future telling”, “All or nothing”, and then, when you come back, we discuss these, together, and I ask you
about your reasons to thinks that way. And the final thing that I’d like you to have a go is, knowing the
distortions in your negative thought, try to create counter-statements for them. So, the first two columns
will be done in the moment, the second two columns will be done later on. And when you come back, we’ll
review these as well as reviewing your counter-statements for the behavioural experiment task. And do you
have any questions for me?
No, that’s really clear. I understand what I have to do, thank you.
Excellent, thank you very much and uhh… mee(?)