title: A scientific cognitive-behavioral model of tinnitus: novel conceptualizations of tinnitus distress.
abstract: The importance of psychological factors in tinnitus distress has been formally recognized for almost three decades. The psychological understanding of why tinnitus can be a distressing condition posits that it becomes problematic when it acquires an emotive significance through cognitive processes. Principle therapeutic efforts are directed at reducing or removing the cognitive (and behavioral) obstacles to habituation. Here, the evidence relevant to a new psychological model of tinnitus is critically reviewed. The model posits that patients' interpretations of tinnitus and the changes in behavior that result are given a central role in creating and maintaining distress. The importance of selective attention and the possibility that this leads to distorted perception of tinnitus is highlighted. From this body of evidence, we propose a coherent cognitive-behavioral model of tinnitus distress that is more in keeping with contemporary psychological theories of clinical problems (particularly that of insomnia) and which postulates a number of behavioral processes that are seen as cognitively mediated. This new model provides testable hypotheses to guide future research to unravel the complex mechanisms underpinning tinnitus distress. It is also well suited to define individual symptomatology and to provide a framework for the delivery of cognitive-behavioral therapy.
authors.affiliation: Royal National Throat Nose and Ear Hospital, University College Hospitals , London , UK.
authors.forename: Laurence
authors.initials: L
authors.lastname: McKenna
authors.affiliation: Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR), University of Nottingham , Nottingham , UK ; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham , Nottingham , UK ; UCL Ear Institute, University College London , London , UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Handscomb
authors.affiliation: Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR), University of Nottingham , Nottingham , UK ; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham , Nottingham , UK.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hoare
authors.affiliation: Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR), University of Nottingham , Nottingham , UK ; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham , Nottingham , UK.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Hall
keywords: belief; distorted perception; negative thoughts; safety behavior; selective attention; tinnitus