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Editorial Standard — reframe session (CBT thought reframing)

Purpose

A reframe session presents two text-entry prompts in sequence: the user's current (unhelpful) thought about their tinnitus, then a more balanced alternative. It implements cognitive restructuring -- the CBT technique of identifying automatic negative thoughts and generating evidence-based alternatives. This is not positive thinking or denial; the reframed thought must be genuinely more accurate, not just more comfortable.

Reframe sessions are positioned primarily in Weeks 5-7 (Cognitive Work phase), where the Beukes iCBT programme concentrates cognitive restructuring modules. They also appear as spike/setback interventions: when the tinnitus spikes or a setback hits, automatic catastrophic thoughts emerge ("this is permanent", "I will never sleep again") and the reframe session provides a structured container for challenging them.

Voice register

Default register for programme-scheduled sessions: early habituation -- companion-forward, warm. The intro paragraph must acknowledge that the thought being challenged is real and understandable before inviting the reframe. The knowledgeable guide does not tell the user their thoughts are wrong; it invites them to examine whether the thought is fully accurate.

For spike/setback variants: warm-authoritative. Validate the distress without minimising it, then direct the user to the task. "A spike is real. The thought that follows is a story -- let's look at it." Brief, concrete, no softening before the acknowledgement.

The closing paragraph (optional field) should be brief and grounding, not celebratory. It acknowledges that reframing is a skill that takes practice; it does not declare success.

Evidence / IP

Grounded in docs/protocols/CBT for Tinnitus.md. Key sources:

  • Cognitive restructuring: core component of the Beukes iCBT programme (Weeks 5-6, Modules 11-15). Beukes et al. JAMA noninferiority trial (PMC8642102) established iCBT as equivalent to face-to-face CBT. Cognitive restructuring is the primary active ingredient in tinnitus distress reduction in the CBT framework.
  • Thought challenging + reframing: from the 25-component CBT review (vault note #586, Cognitive category): two distinct but sequential components -- "thought challenging" (evaluate evidence for/against the thought) and "balanced reappraisal" (generate an alternative). The reframe session implements both in a single interaction.
  • Cochrane CBT review: PMC3936550 confirms moderate-certainty evidence for CBT reducing tinnitus distress vs. waitlist/usual care. Cognitive restructuring is the most consistently present component across all reviewed programmes.
  • Fear mediation: vault note #542 -- fear mediates CBT benefit. The reframe session directly targets the fear-sustaining cognition ("this will never stop") and replaces it with a fear-reducing alternative based on evidence.

IP: CBT cognitive restructuring techniques are academic and unprotectable. Reframe session format is Naluma-authored. Hint text examples should be realistic and tinnitus-specific, not reproduced from any protected programme materials.

Length / reading level

  • Intro paragraph: 2-4 sentences. Frames the exercise as evidence-testing, not positive thinking. Should acknowledge that the starting thought is real and understandable. Invites the user to examine it, not replace it.
  • Prompt labels: 4-10 words. Clear and specific. "My unhelpful thought" + "A more balanced thought" -- or variants that are slightly more tinnitus-specific ("What I believe about this spike" + "What I know is also true").
  • Hint text (per prompt): 6-15 words. A tinnitus-specific example for each prompt. First hint: an example catastrophic thought ("e.g. I will never be able to concentrate again"). Second hint: an example balanced alternative ("e.g. Concentration is harder right now, but I can still focus with practice").
  • Closing paragraph: 1-2 sentences maximum, if included. Grounding, not celebratory. Optional -- not every reframe session needs one.
  • Reading level: Grade 8 or below throughout.

Editorial-required elements

  1. Intro must validate before inviting. "Notice a thought that's been bothering you" validates that the thought exists and matters before asking the user to examine it. "Identify your negative thinking patterns" implies the thought is wrong before the user has written it. The former is CBT-consistent; the latter is not.

  2. Balanced, not positive. The second prompt must guide the user toward an accurate alternative, not a positive one. "A more balanced thought" or "What I know is also true" is the right frame. "A more positive thought" or "The silver lining" is not -- it teaches toxic positivity, not cognitive accuracy.

  3. Hint text must model the mechanism. The second prompt's hint must demonstrate how a balanced alternative works -- it acknowledges the difficulty while correcting the distortion. "e.g. I have handled hard days before and I will handle this one" is balanced. "e.g. Everything will be fine" is toxic positivity and incorrect.

  4. Spike variants need a validation sentence first. The intro for spike/setback reframe sessions must validate the distress before directing the user to the exercise. "A spike is real and it is hard" before "let's look at the thought it brought with it." Skipping this validation in a moment of distress risks the user feeling dismissed.

  5. Closing must avoid success framing. If a closing paragraph is used, it cannot imply the user has fixed their thinking. "Reframing takes practice -- one session does not rewrite a long-held pattern, and that is expected." Not "Great work -- you've taken an important step."

  6. Obeys ai-patterns-en.md. All copy must obey ai-patterns-en.md. The closing paragraph is the field most at risk for toxic positivity ("you've got this", "stay strong") -- those are banned in all endorsed copy.

Examples

Good -- spike reframe session intro:

A spike can bring with it thoughts that feel absolutely certain. They are not facts -- they are the nervous system's threat response running the same pattern it always does. Write the thought down, then write what you know is also true.

Why this works: validates the spike and the associated thought (real, certain-feeling), corrects its epistemic status (not facts, nervous system response), and gives the user a concrete frame for the second prompt ("what you know is also true"). No toxic positivity, no dismissal of distress.

Bad -- thought reframing intro:

❌ Tinnitus can sometimes lead to negative thoughts that aren't helpful. This is a great opportunity to challenge those thoughts and find your peace by replacing them with more positive ones. Stay positive and remember: you've got this!

Why it fails: "find your peace" and "you've got this" are banned under ai-patterns-en.md (Naluma-voice additions). "Stay positive" imports toxic positivity. "Negative thoughts that aren't helpful" is clinical-abstract rather than experiential. "Replace them with more positive ones" is the wrong frame -- the goal is balanced/accurate, not positive. A user who follows this framing will write a cheerful lie in the second prompt, which has no therapeutic value.