TABLE 1.

Six-Session VET CBT-T Curriculum

Components	Strategies and Class Activities	Homework Activities
Session 1 Introduction/psycho-education	Provider established rapport and discussed ground rules Patients learned the rationale for CBT Patients learned about self-managing tinnitus and goal setting Patients received an outline of the coping skills and objectives for sessions Patients received information about tinnitus physiology and known interventions Patients received handouts and discussed homework (all sessions)	Patients made a list of things that make their tinnitus more or less noticeable Patients wrote 3 overall goals related to their tinnitus Patients read any parts of the handouts not covered in class
Session 2 Stress Management/Relaxation	Patients learned about the connection between tinnitus and stress Patients learned ways to reduce stress Patients learned and practiced deep breathing and imagery relaxation exercises	Patients practiced deep breathing and imagery relaxation exercises Patients charted their practice on a worksheet
Session 3 Distraction/Activity Planning	Patients learned about the concept of distraction for tinnitus Patients learned to track and plan pleasant activities to cope with tinnitus and to improve quality of life	Patients tracked their pleasant activities Patients made a list of pleasant activities using topics and examples Patients scheduled an additional pleasant activity each day and identified barriers
Session 4 Mindfulness Training	Patients learned how to pay attention to thoughts and patterns Patients learned the concept of mindfulness Patients learned about the 12 common negative thoughts with tinnitus examples	Patients wrote examples of each of the 12 negative thoughts about their tinnitus to identify patterns in their thoughts
Session 5 Cognitive Restructuring	Patients learned more about goal setting and practiced writing goals Patients learned how to modify negative thought patterns Patients practiced the process of changing negative thoughts	Patients identified 3 negative thoughts Patients followed the steps for generating a new thought Patients worked toward accomplishing weekly goals
Session 6 Flare-up Prevention/Sleep Hygiene	Patients reviewed coping skills and learned how to continue self-managing their tinnitus as new problems arise Patients learned about sleep hygiene Patients learned when to ask for help	Patients continued to practice all the coping skills Patients were encouraged to review and repeat the homework often

Abbreviations: CBT, cognitive behavioral therapy; VET CBT-T, veteran-specific cognitive behavioral therapy for tinnitus protocol.