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. 2018 May;66(5):369-374.
doi: 10.1007/s00106-018-0502-9.

Bothersome tinnitus : Cognitive behavioral perspectives

R F F Cima  1
Affiliations

Bothersome tinnitus : Cognitive behavioral perspectives

R F F Cima. HNO. 2018 May.

Abstract
in English, German

Tinnitus is not traceable to a single disease or pathology, but merely a symptom, which is distressing to some but not all individuals able to perceive it. The experience of tinnitus does not equate to tinnitus distress. Tinnitus suffering might be understood as a function of tinnitus-related distress in that bothersome tinnitus is an illness rather than a disease. In bothersome (distressing) tinnitus, the perception of the characteristic sound is a very disturbing and bothersome experience because of maladaptive psychological responses. Several cognitive and behavioral theoretical frameworks attempting to explain the nature and cause of tinnitus suffering have been introduced in and will be summarized here. Current treatment approaches are generally based on models that aim to: alleviate the perceptional experience by focusing on the tinnitus perception for habituation or even soothing purposes; decrease awareness of the sound by attentional training and cognitive interventions; decrease the maladaptive responses and the resulting distress by behavioral methods (i. e., exposure). The cognitive behavioral fear-avoidance model may offer an integrative cognitive behavioral approach that can lead to a new set of paradigms for studying the underlying mechanisms explaining chronic tinnitus suffering as well for developing innovative strategies to treat bothersome tinnitus.

Tinnitus ist nicht auf eine einzelne Krankheit oder pathologische Veränderung zurückzuführen, sondern nur ein Symptom, das für einige, aber nicht für alle Betroffenen belastend ist. Das Erleben von Tinnitus ist nicht gleichzusetzen mit tinnitusbedingtem Stress. Das Leiden am Tinnitus könnte insofern in Abhängigkeit von tinnitusbedingtem Stress verstanden werden, dass störender Tinnitus eher einen Zustand des Sich-krank-Fühlens als eine Krankheit darstellt. Bei störendem (stressverursachendem) Tinnitus wird die Wahrnehmung des typischen Geräusches – bedingt durch maladaptive psychische Reaktionen – als sehr störend und lästig empfunden. Verschiedene kognitive und verhaltensbezogene theoretische Konzepte, mit denen die Art und Ursache des Leidens am Tinnitus zu erklären versucht wird, sind etabliert und werden hier zusammengefasst. Aktuelle Therapieansätze basieren i. Allg. auf Modellen, deren Ziel es ist, die erlebte Wahrnehmung durch Fokussieren auf die Tinnituswahrnehmung zum Zweck der Habituierung oder gar Linderung zu erleichtern, das Bewusstsein für das Geräusch durch Aufmerksamkeitstraining und kognitive Interventionen zu senken oder die maladaptiven Reaktionen und den daraus resultierenden Stress durch verhaltensbezogene Methoden (d. h. Exposition) zu vermindern. Das kognitiv-behaviorale Angst-Vermeidungs-Modell („fear-avoidance model“) bietet möglicherweise einen integrativen kognitiv-behavioralen Ansatz, der zu neuen Paradigmen für die Untersuchung der zugrunde liegenden Mechanismen, durch die sich das Leiden am chronischen Tinnitus erklärt, sowie zur Entwicklung innovativer Strategien für die Behandlung des störenden Tinnitus führen kann.

Keywords: Auditory perception; Cognitive behavioral therapy; Hearing disorders; Psychological distress; Tinnitus.

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Conflict of interest statement

R.F.F. Cima declares that she has no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
The neurophysiological model. (Adapted from Jastreboff [41])
Fig. 2
Fig. 2
The cognitive behavioral model. (Adapted from McKenna et al. [49])
Fig. 3
Fig. 3
The fear-avoidance model of chronic tinnitus (based on the fear-avoidance model of chronic pain [57])
See this image and copyright information in PMC

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