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Psychological mechanisms and treatment
The typical course of tinnitus involves habituation over time; however, research shows that those seeking treatment tend to display reduced habituation function compared to controls.

Recent psychological research on tinnitus focuses on the Tinnitus Distress Reaction (TDR) to account for differences in tinnitus severity

Studies have demonstrated that tinnitus annoyance is more strongly associated to psychological symptoms than acoustic characteristics. Several robust psychological findings have demonstrated comorbidity of psychological complaints of depression, anxiety, sleep disturbances, concentration difficulties with increased tinnitus severity Several personality characteristics, such as neuroticism, anxiety sensitivity, and catastrophic thinking predispose increased TDR and maladaptive coping skills   Further, evidence from biochemical studies of patients with distressing tinnitus and psychological disturbances demonstrated some evidence of altered serotonin function that is consistent with studies that linked non-habituation processes with increased negative perceptions and tinnitus annoyance ; Simpson and Davies, 2000).  These findings suggest that at the initial perception of tinnitus, conditioning links tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time.  This enhances activity in the limbic system and autonomic nervous system, thus increasing tinnitus awareness and annoyance Misinterpretation of symptoms as threatening and debilitating triggers avoidance and safety behaviours, including sound and social avoidance, which maintain symptoms. This self-perpetuating pattern impairs daily functioning, leading to greater isolation, increased symptom awareness, impedes concentration, and prevents engagement in activities that challenge maladaptive beliefs, resulting in a vicious cycle that further decreases cognitive ability to manage symptoms.

Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress (i.e. nature and extent of tinnitus-related problems), measured subjectively by validated self-report tinnitus questionnaires. However, wide variability, inconsistencies and lack of consensus regarding assessment methodology is evidenced in the literature, limiting comparison of treatment effectiveness

Developed to guide diagnosis or classify severity, most tinnitus questionnaires have also been shown to be treatment-sensitive outcome measures. The recently developed Tinnitus Functional Index (TFI) is the only measure specifically developed to detect treatment-induced changes.

In the treatment of tinnitus-related distress, studies have focused on the efficacy of Cognitive-Behavioural Therapy (CBT), Relaxation Training, and Mindfulness-based interventions. Two systematic reviews, using stringent inclusion criteria, and meta-analyses have been conducted on studies undertaken between 1995-2010

Only Cognitive-Behavioural studies are numerous enough to perform meta-analysis. Face-to-face therapist-delivered treatments with individual or group formats demonstrate greatest main effects in improving tinnitus-related distress, anxiety, and depression. Internet-based CBT interventions provide mixed results with some studies showing no improvements to anxiety and depression as well as higher attrition rates and smaller main effects compared to face-to-face treatments

Subsequent randomised controlled trials provide burgeoning support for mindfulness-based interventions. Single session psychoeducation reduces tinnitus-related negative emotions and ruminations, and effects are maintained with Mindfulness, but not relaxation training No significant differences in treatment effectiveness were found when eight-week, manualised, internet-based CBT and Acceptance and Commitment Therapy (ACT) were compared. Both treatments yielded significant improvements in tinnitus-related stress and impact, as well as anxiety and depression Importantly, evidence suggests that CBT may not improve some wider impacts of tinnitus (e.g. social impacts), when these are in fact assessed. Manualised treatments, without individual attention to client problems, likely limit the foci and impact of intervention. This underscores the importance of comprehensive individualised biopsychosocial assessments, a multi-disciplinarian approach and responsive treatment plans A number of tinnitus specific CBT treatments have been developed  with varying degrees of focus on cognitive and behavioural elements. However, the specific change mechanisms are not yet fully understood. These treatments use a wide range of psychological strategies. Components common to most of them include: psycho-education, cognitive restructuring, management of avoidance, relaxation training, use of positive or calming imager, sleep hygiene, sound enrichment and coping strategies.