Psychological Models of Tinnitus

This chapter presents three psychological models with the purpose to comprehend patients’ struggle with tinnitus and how their tolerance to tinnitus can be improved. The intention is to give clinicians landmarks to rely on when meeting patients in need for guidance and hope. First, the neural networks involved in the salience of tinnitus are discussed in the light of current neuropsychological research. Second, the cognitive and behavioural reactions to the tinnitus signal are addressed in a model of tinnitus-related distress. Third, the fluctuation of tinnitus intrusiveness is enlightened in relation to patients’ frustration, goal fulfilment and search for meaning throughout their journey towards tolerance. With distinct emphases, these models share the following assumptions: (1) The alleviation of intrusiveness requires patients’ commitment to change their attitude towards their suffering, (2) the worsening of tinnitus-induced suffering results from self-perpetuating mechanisms that can be softened through the therapeutic alliance and (3) long-term tolerance of tinnitus is mediated by the strengthening of non-auditory factors such as attention, working memory and the fulfilment of valuable goals. Understanding the interaction between the perception of tinnitus and the patients’ attitude towards it can help them to resume with a sense of responsibility in the alleviation of distress, although tinnitus, initially, was perceived as being out of control. Psychological research suggests that situations that fuel self-focused thinking would increase the level of frustration in suffering patients and, at the same time, the salience of tinnitus. A goal-directed focus on valued aims and improved control of attention may promote new pathways to nurture patients’ ability to reduce their attention to tinnitus.