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The cognitive model of tinnitus distress (McKenna, Handscomb et al. 2014) is a theoretical model which describes the interaction between thoughts, emotions, behaviour and attention that may cause tinnitus to become, and be maintained as, a distressing problem. It consists of a series of testable hypotheses and this project set out to investigate these systematically in order to test the model's accuracy. A survey was compiled from existing questionnaires which provided measures of each separate component of the model. This was made available online and on paper. Members of the public with tinnitus were recruited from a volunteer database and from tinnitus organisations. The survey was completed by 342 adults who reported varying degrees of overall tinnitus distress. Factor analysis of all the questionnaires was carried out and 12 different versions of the cognitive model were created based on questionnaire results, existing literature and theory. These were then tested using path analysis. A satisfactory factor structure was found for all questionnaires and the resulting 15 factor scores were used to test the full model. All 12 models tested were at least an acceptable fit to the data (RMSEA <0.080). The two best fitting models had comparable fit indices (model 1: RMSEA=0.071, CFI=0.982, TLI=0.966; model 2: RMSEA= 0.066, CFI=0.991, TLI=0.975). They differed primarily in the placement of tinnitus magnitude, which was a product of attention in model 1, but an exogenous variable in model 2. Additionally, model 1 included tinnitus control beliefs while model 2 did not. These findings add to existing evidence which indicates that emotional distress, negative thinking and avoidance behaviour contribute to a worse experience of tinnitus. They also shed new light on the role of attention and monitoring in tinnitus distress and increase understanding of how emotional, cognitive and behavioural responses to tinnitus interact. Questions remain as to the role of beliefs in tinnitus distress and as to whether and to what degree perceived magnitude is influenced by psychological processes. The predictions made by the cognitive model of tinnitus distress appear to be largely accurate and it is to be recommended as a solid foundation for psychological therapy for tinnitus. The need for further research in the areas of beliefs and perceived magnitude is highlighted. [ABSTRACT FROM AUTHOR]

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.