Research — Interactive Session Expansion (experiment, reframe, sentenceCompletion, valuesSort, chipExercise)¶
Net-new sessions for the five interactive session types, grounded in the session-content evidence base, the CBT/ACT protocols, and the building-blocks programme inventory. Each proposed session honours its format standard in
docs/authoring/standards/session-<type>.md. The rows produced from this doc are appended tosessions/sessions-backlog.csv.Origin tag for all rows here:
research:interactive-sessions(+ anybuilding-blocks:<ID>it operationalises).No citation is fabricated. Every
source_refsvalue below is either a PMC/PubMed ID already indocs/session-content-evidence-base.md, a building block fromcoach-conversations/building-blocks.csv, or a source verified by web research during this pass (links at the foot of each section).
Why these five types, and what was thin¶
The five interactive types had only 2–5 rows each. The evidence base (§2 the 25 CBT components; §3 new techniques; §4 refinements; §5 sequencing) names several validated components that had no interactive session yet — graded exposure beyond a single ladder, behavioural activation, ACT committed action and willingness, gratitude/positive-psychology, self-as-context defusion variants, and CBT-I stimulus control as a self-assessment. Each gap below maps to a building block already scoped in the programme inventory but not yet authored as an interactive session.
The tier follows the locked rule: chipExercise and light
sentenceCompletion are free; experiment, valuesSort, and multi-step
reframe are premium. The sequencing (program_week) follows §5:
psychoeducation → sleep → relaxation → cognitive work (Wk 5–7) → ACT acceptance
and committed action (Wk 8–12).
experiment (+3) — CBT behavioural experiments / graded exposure¶
Format standard: avoided activity → written prediction → real-world test →
return-to-record (the session stays open via the alert field). Mechanism is
prediction testing, rated 9/10 by patients (PMC12109689). All premium,
all audio_first=no. Existing slugs avoided: test-a-prediction,
an-evening-without-earplugs, a-stretch-of-quiet, build-your-noise-ladder.
| slug | what it tests | grounding | week | tier |
|---|---|---|---|---|
back-to-the-thing-you-stopped |
a pleasant/meaningful activity dropped since tinnitus (behavioural activation as an experiment: predict "I won't enjoy it / it'll be too much", then do it once and record) | Behavioural activation is a core CBT-for-tinnitus component aimed at overruling the learned avoidance→distress link (PMC6478149; building-blocks EXR-15/EXR-16). Framed as a behavioural experiment so it fits this format's predict→test→record mechanism. | 5-7 | premium |
a-call-you-have-been-putting-off |
a social/phone interaction avoided because "I won't be able to follow the conversation over the ringing" | Graded exposure + behavioural experiment on the social-listening prediction; the 25-component review lists graded exposure (Behavioural) and behavioural experiments as distinct-but-linked (evidence-base §3a, §3i; building-blocks EXR-27 Social Event Preparation). | 5-7 | premium |
one-quiet-task-without-masking |
doing a single focused task (reading, falling asleep) without turning on masking sound, testing "I can't cope in quiet without it" | Targets safety-behaviour / masking over-reliance (the "cobra effect" of sound overuse, evidence-base §4c, vault #591; building-blocks EXR-28 Masking Reduction Protocol). Prediction-test frame keeps it an experiment, not a cold-turkey instruction. | 8-10 | premium |
Web grounding: behavioural activation in CBT-for-tinnitus (PMC6478149); 2025 Tonndorf lecture rating behavioural experiments 9/10 (PMC12109689).
reframe (+3) — CBT cognitive restructuring (two-field) / ACT defusion¶
Format standard: two text prompts — current unhelpful thought → a more
balanced (not positive) alternative. Spike variants validate distress first.
Multi-step reframe is premium; a single-pass spike reframe can be free.
Existing slugs avoided: the-story-and-the-evidence, what-a-spike-tells-you,
notice-the-thought.
| slug | the thought it targets | grounding | week | tier |
|---|---|---|---|---|
it-means-something-is-wrong |
the catastrophic-meaning belief: "the ringing means my hearing/brain is damaged and getting worse" | Cognitive restructuring of the threat-appraisal that fear mediates (vault #542; Cochrane CBT PMC3936550). Corrects the meaning distortion, not the sensation. | 5-7 | premium |
i-cant-do-anything-until-it-stops |
the conditional-life belief: "I can't get back to normal life until the tinnitus is gone" | This is the exact belief ACT values/committed-action work dismantles, but here in CBT-reframe form — restructure "until it stops" → "alongside it" (evidence-base §2 Cognitive; building-blocks EXR-07 Thought Challenging). Bridges to the valuesSort/experiment work. | 8-10 | premium |
everyone-can-tell |
the social-spotlight belief during conversations/social events: "people can tell I'm distracted / I'm being rude" | Targets the social-evaluative cognition that drives social avoidance (links to graded-exposure experiments; building-blocks EXR-27). Single comparison of belief vs. evidence; lighter, fits free. |
5-7 | free |
Web grounding: Cochrane / systematic-review evidence for CBT reducing tinnitus distress, cognitive restructuring the most consistently present component (PMC6478149; S027273581000200X).
sentenceCompletion (+3) — single-prompt ACT reflection¶
Format standard: one open sentence stem, qualitative output, quiet intro.
Light reflective stems are free; a multi-part / progress-acknowledgement stem
positioned late can be premium. Existing slugs avoided: catch-the-thought,
what-still-matters, more-than-the-sound, one-thing-i-handled, reading-the-pattern.
| slug | stem function | grounding | week | tier |
|---|---|---|---|---|
i-notice-im-having-the-thought |
defusion stem: completing "When the sound is loud, I notice I'm having the thought that…" — the canonical ACT defusion frame | ACT cognitive defusion, hexaflex (ACT protocol; Zetterqvist thesis via session-audio-protocols-ip-guide; building-blocks EXR-11). Written form of the defusion move. | 8-10 | free |
the-sound-is-here-and-so-am-i |
self-as-context stem: "The sound is here, and I am also…" — separating the observing self from the experience | Self-as-context hexaflex process; counters tinnitus-as-identity consolidation (ACT protocol; building-blocks EXR-18 Mindful Acceptance). | 8-10 | free |
one-small-step-toward-what-matters |
committed-action stem: "One small thing I can do this week toward what matters, even with the sound, is…" | ACT committed action — concrete values-aligned step (Westin/Hesser RCT, S000579671100163X; building-blocks EXR-13 Committed Action Planning). Positioned after values work; premium as it sits in the committed-action arc and pairs with a coach follow-up. | 10-12 | premium |
Web grounding: ACT values + committed action as hexaflex processes, Westin RCT effective for tinnitus (S000579671100163X; Zetterqvist thesis, liu.diva-portal.org).
valuesSort (+2) — ACT values card-sort (drag-to-rank)¶
Format standard: 6–8 plain-language value labels spanning life domains;
re-ordering is the therapeutic act. Output must be used downstream. All
premium, all audio_first=no. Existing slugs avoided: what-matters-most-now,
where-youre-starting-from.
| slug | sort framing | grounding | week | tier |
|---|---|---|---|---|
what-youd-do-with-a-free-day |
a day-shaped sort: rank what you'd give your time to on a free day with no tinnitus constraint — surfaces values as lived time, not abstractions | ACT "what would you do today if tinnitus wasn't a factor?" made concrete (ACT protocol; building-blocks EXR-12 Values Card Sort). Feeds committed-action sessions. | 8-10 | premium |
who-you-want-to-show-up-as |
a relational/character sort: rank the kinds of person/relationship you want to keep being (e.g. Patient, Present, Honest, Generous) — character-values, distinct from activity-values | Values clarification across the relational domain; the standard requires values span life domains beyond tinnitus-adjacent ones (building-blocks EXR-06 Values Alignment Check / EXR-12). Used as the motivational anchor before committed action. | 10-12 | premium |
Web grounding: values clarification as the upstream driver of tinnitus acceptance, mediator of 18-month ACT superiority (Westin RCT, S000579671100163X).
chipExercise (+3) — chip-guided CBT self-assessment (one dimension each)¶
Format standard: one assessment dimension, 4–8 experiential plain-language
chips, stable snake_case values, no implied-correct answer, intro states the
purpose. All free per the locked rule; all audio_first=no. Existing slugs
avoided: what-makes-it-louder, what-have-you-stopped-doing, three-good-things,
what-youve-handled-well, how-was-it-today.
| slug | the one dimension it maps | grounding | week | tier |
|---|---|---|---|---|
where-the-thoughts-go |
thought monitoring — which type of automatic thought shows up most (e.g. "It'll never stop", "Something's damaged", "I can't cope", "Everyone notices") | Thought monitoring is a distinct component rated 9/10 (PMC12109689; building-blocks EXR-08). Distinct from thought-challenging; produces the classification a reframe session then acts on. | 5-7 | free |
what-the-bed-has-become |
CBT-I stimulus control self-assessment — what the user actually does in bed besides sleep (scroll phone, watch the clock, lie awake worrying about the ringing, turn masking on/off) | Stimulus control strengthens the bed↔sleep association; CBT-I superior to audiology care for tinnitus insomnia, >80% clinically meaningful improvement (PMID 35762946; building-blocks REF-10 Sleep Diary / EXR-23 Stimulus Control). One assessment dimension: bed-behaviours. | 3-4 | free |
what-helped-even-a-little |
self-efficacy / positive-psychology — which coping moves have actually helped at all this week (a soundscape, a walk, talking to someone, a breathing minute) | Self-efficacy building (Kalmeda L5, evidence-base §3g; building-blocks EXR-25 Strengths / EXR-24 Gratitude). Three-good-things-style positive reflection, well-established in positive psychology. Surfaces what to reinforce. | 8-10 | free |
Web grounding: thought monitoring 9/10 (PMC12109689); CBT-I stimulus control for tinnitus insomnia, >80% clinically meaningful improvement (PMID 35762946); Three Good Things positive-psychology evidence (Seligman; Greater Good in Action, ggia.berkeley.edu).
Tier / sequencing summary¶
| type | +rows | tier | weeks used |
|---|---|---|---|
| experiment | 3 | all premium | 5-7, 8-10 |
| reframe | 3 | 2 premium, 1 free | 5-7, 8-10 |
| sentenceCompletion | 3 | 2 free, 1 premium | 8-10, 10-12 |
| valuesSort | 2 | all premium | 8-10, 10-12 |
| chipExercise | 3 | all free | 3-4, 5-7, 8-10 |
| total | 14 |
Status convention¶
status=plannedwhere the session is fully sourced to evidence/protocol/building-block.status=ideawhere the concrete chip concept is net-new (no pre-existing building block of that exact shape) — flagged inneeds_confirm=concept.needs_confirm=categoryflagged where the best-fit category is defensible but a second category (e.g. sleep vs understanding) is plausible.