Explore how changes in brain processing lead to tinnitus, and how cognitive-behavioral approaches can help manage distress associated with this condition.
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
An editable Microsoft PowerPoint version of the resource.
Tinnitus is the perception of sound without an external source, arising when the brain’s normal filtering mechanisms fail to suppress internal auditory signals. This loss of filtering means that sounds which would typically go unnoticed enter conscious awareness. While the perception of tinnitus itself is the result of this altered processing, the associated distress stems from how the sound is interpreted. When tinnitus is appraised as threatening, uncontrollable, or harmful, it draws focused attention, triggers emotional responses such as anxiety or frustration, and becomes increasingly intrusive. This information handout describes these processes using client-friendly terminology.
This resource is designed to support mental health professionals working with clients experiencing tinnitus or hyperacusis.
Clients who are distressed by the perception of internal sound, struggling with attention, emotional reactions, or unhelpful beliefs about the noise they hear.
Clients who experience heightened sensitivity to everyday sounds, often accompanied by fear, avoidance, or distress related to certain auditory environments.
Use the handout to clearly describe the psychological approach to tinnitus.
Encourage clients to identify and explore negative apparaisals tied to tinnitus.
Facilitate discussions about the emotional reactions linked to tinnitus perception.
Foster client reflection on how their thoughts may impact the persistence of tinnitus.
The cognitive-behavioral model of tinnitus builds on earlier work such as Jastreboff’s neurophysiological model (1990), which proposed that tinnitus becomes distressing not because of the sound itself, but due to how it is interpreted and appraised. While tinnitus often begins with changes in the auditory system — such as hearing loss — distress arises when the brain fails to filter out the sound and instead assigns it threatening meaning.
In individuals who do not find tinnitus distressing, the brain habituates to the sound, treating it as neutral background noise. In contrast, when tinnitus is appraised as dangerous, uncontrollable, or a sign of ongoing damage, it becomes emotionally salient. This increases autonomic arousal, draws attention to the sound, and reinforces the belief that the tinnitus is harmful or unbearable. Over time, a self-perpetuating feedback loop develops: attention and distress heighten perception, and the perception confirms threat appraisals (McKenna et al., 2014).
Cognitive behavioral therapy (CBT) aims to break this cycle by helping clients reappraise the meaning of tinnitus, reduce avoidance, and manage emotional responses. Acceptance and commitment therapy (ACT) has also been applied to tinnitus with promising results. ACT shifts the focus from symptom reduction to building psychological flexibility — helping clients relate differently to tinnitus through acceptance, mindfulness, and values-guided action. Rather than trying to control or eliminate the sound, ACT encourages individuals to allow tinnitus to be present without struggle, and to engage in meaningful activities despite it (Westin et al., 2011; Beukes et al., 2018).
