Welcome to our collection of insights into the psychodynamic process and contemporary mental health. These reflections explore the unconscious dynamics of the inner life, and the complex emotional currents within our relationships.
Below, you’ll find our latest articles. Many come with a companion clinical worksheet — a focused, interactive exercise you’re welcome to request at the end of the relevant post, to support the reflective journey in your own time.
Tinnitus: Changing Your Relationship With the Sound – Interactive Worksheet
Tinnitus: Changing Your Relationship With the Sound
A CBT-informed interactive worksheet for understanding attention, distress and habituation
A clinical worksheet from Online Therapy Clinic — Dr Ruxandra Ion, Consultant Psychiatrist | CBT
Dr Ruxandra Ion, Consultant Psychiatrist | CBT · enquiries@online-therapy-clinic.com
Dr Ruxandra Ion offers CBT-informed work and brings a psychiatric perspective, without providing psychiatric diagnosis or prescribing medication within this worksheet. Ari Sotiriou provides Individual and Couples therapy from a psychodynamic perspective, via secure Live Video. UK practice · 50-minute sessions, on the hour.
Tinnitus is a real auditory experience. This worksheet does not suggest that the sound is imaginary, or that tinnitus is caused simply by anxiety.
For some people, however, attention, fear, monitoring and physiological arousal can make tinnitus increasingly intrusive. This worksheet helps you observe that relationship, and experiment with ways of responding differently.
You do not need to complete the worksheet in one sitting. You may pause, return later, or work only with the section that feels most useful to you.
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Medical assessment reminder
This worksheet supports reflection on tinnitus-related distress. It is not a diagnostic tool and does not replace medical or audiological assessment. If your tinnitus is new, changing, persistent in one ear, or synchronised with your heartbeat, please seek medical assessment. Tinnitus accompanied by sudden hearing loss, new facial weakness, significant neurological symptoms, severe vertigo, or occurring after a head injury requires urgent medical attention.
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Your privacy is fully protected
This worksheet runs entirely within your browser. Nothing you write is transmitted, stored on a server, or accessible to anyone else. All responses are saved locally and are cleared only when you choose to reset. Online Therapy Clinic has no access to your answers.
Your progress will be saved automatically as you write.
Complete the worksheet, then save or print your responses
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Companion Article
This worksheet accompanies our clinical article exploring how attention, threat, monitoring and emotional arousal can influence the experience of tinnitus-related distress.
Read the article →
Part OneMap Your Tinnitus Cycle
When tinnitus becomes distressing, the sound itself may be only one part of what happens. A thought, an emotional reaction, a bodily response and an urge to monitor or control the sound can follow very quickly. Mapping the sequence can help you see where the cycle becomes self-reinforcing.
Looking at the whole cycle
Part TwoWhat Does the Sound Mean to Me?
Tinnitus can become particularly distressing when the sound becomes linked with frightening predictions about health, sleep, control or the future. The aim here is not to tell yourself that everything is fine. It is to notice what your mind is predicting, and to examine how certain that prediction really is. You do not need to explore every thought below — work with whichever feel relevant to you.
“This will never stop.”
Not yet set
“Something serious must be wrong.”
Not yet set
“I won’t be able to sleep.”
Not yet set
“I am losing control.”
Not yet set
“I won’t be able to cope.”
Not yet set
“My life will always be like this.”
Not yet set
“Something else.”
Not yet set
Part ThreeWhere Is My Attention Going?
Once the brain begins treating a sensation as important, attention can repeatedly return to it. Monitoring is understandable — we tend to watch things that worry us. But repeated checking can also keep tinnitus in the foreground.
Not yet set
0 = Barely any attention10 = Almost all my attention
Part FourFrom Monitoring to Re-engaging
The aim is not to force yourself to ignore tinnitus. It is to practise noticing it without automatically making it the next problem you must solve.
“There’s the tinnitus again. I don’t need to solve it right now.”
Before
Not yet set
Not yet set
After
Not yet set
Not yet set
Part FiveMy Habituation Experiment
Habituation does not necessarily mean that tinnitus disappears. It describes a gradual reduction in the importance the brain gives the sound. One way of supporting this process is to begin reclaiming activities without making the disappearance of tinnitus a condition for doing them.
My Experiment
My experiment is not to make tinnitus disappear. It is to discover what may become possible when I allow myself to live alongside the sound, rather than waiting for it to disappear first.
Part SixClosing Reflection
You may have discovered patterns rather than solutions. That is enough. The purpose of the worksheet is to help make visible processes that can otherwise happen almost automatically.
Bring This Into a Session
Tinnitus-related distress can become difficult to navigate alone. Dr Ruxandra Ion offers CBT-informed consultations for tinnitus-related distress, via secure video — and if a connection is ever unreliable, a phone call works just as well.
This is a private, browser-based reflective tool intended to support your care. It is not a diagnostic instrument and does not replace professional medical or audiological assessment.
If you are in crisis or at risk of harm, please contact emergency services or a crisis helpline in your country without delay.
If you are working with Dr Ion, bring this completed worksheet to your next session. The sections that were hardest to answer are often the most useful place to start. To book a session or make an enquiry, contact: enquiries@online-therapy-clinic.com
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The sound may remain, even as your relationship with it begins to change.
Dr Ruxandra Ion offers CBT-informed work and brings a psychiatric perspective; she does not provide psychiatric diagnosis or prescribe medication within this worksheet.
Ari Sotiriou provides Individual and Couples therapy from a psychodynamic perspective, via secure Live Video.
