Models of tinnitus suffering and treatment compared and contrasted

Abstract

This paper discusses the two main approaches to tinnitus management: the ‘psychological’ approach that seeks to understand and treat tinnitus within a cognitive behavioural model, and the ‘neurophysiological’ approach that suggests that tinnitus distress can be understood within a classical conditioning paradigm. Both models, and their corresponding approaches to therapy, have strong followings, and this has given rise to debate about their relative merits. However, there is some confusion among practitioners over points of similarity and differences between the two approaches. The psychological model proposes that autonomic nervous system (ANS) arousal is involved, but highlights the importance of cognitive processes in the tinnitus experience. The neurophysiological model also contends that ANS and brain processes play a fundamental role in the perception of tinnitus; it suggests that tinnitus becomes problematic because it becomes associated with something negative. This model stresses the importance of unconscious conditioning over conscious cognitive processes. Both models represent a major departure from an earlier focus on cochlear mechanisms. Both propose that habituation is a key process in attenuating tinnitus distress. There is an overlap in the evidence cited in support of each model but they differ in the emphasis they give to the role of cognition and classical conditioning within the process of tinnitus perception, suffering and treatment. This difference indicates that they derive from different philosophical traditions. The similarities and differences between the models and the theories underpinning them are discussed. Questions concerning the models are raised. The need for more evidence in support of the habituation hypothesis is discussed. The relevance of the classical conditioning paradigm, and therefore the neurophysiological model, to the human experience of tinnitus is questioned. In questioning the psychological approach, the need for a more elaborate cognitive model is highlighted. The models need stronger experimental support than they currently enjoy, but either of them provides a more clinically relevant account of tinnitus than the older cochlear models. They have both led to practitioners offering at least some help to people for whom tinnitus is problematic. However, neither gives a complete picture, and a more comprehensive model of tinnitus that seeks to elucidate the mind‐body interaction is still needed.

• tinnitus
• psychology
• neurophysiological
• classical conditioning
• congnitive behaviour therapy