Another technique included in the workbook and class is cognitive behavioral treatment (CBT) exercises that target the negative reactions ringing in the ears can trigger. "A lot of people with tinnitus develop mental reactions to ringing in the ears," said Dr. Caroline Schmidt, PTM author and Licensed Research Psychologist at the VA Connecticut Healthcare System. "Those could possibly be lack of sleep, feeling anxious, frustration; some people relate the audio to an especially traumatic function that happened." If the Veteran is already in touch with a mental health specialist or not, the PTM course introduces them to a number of CBT exercises that have proven effective in assisting many tinnitus patients. Leisure methods, distraction by planning pleasurable exercises and changing how clients think about tinnitus will be the three main techniques taught in the course.