The Cognitive Model
A conceptual cognitive model proposed by McKenna et al. (2014), incorporates a cognitive model of distress to explain tinnitus-associated insomnia (Harvey 2002). McKenna et al. argue that the tinnitus-signal distress and bodily arousal are provoked mainly through negative cognitive misinterpretations, leading to inaccurate evaluations of sensory activity and distorted perceptions (see Fig. 8.2). It is
Fig. 8.2 Cognitive model—reproduced from (McKenna et al. 2014) proposed that the resulting stress and hypervigilance contribute to a feedback cycle that exacerbates the distress associated with flawed sensory processing, of which tinnitus may be a major component. The model attributes a fundamental role to the negative evaluation of tinnitus. The negative evaluation of the tinnitus percept can be viewed as comprised of primary and secondary appraisals. For example, a person might initially appraise the tinnitus as being threatening to their health and then make a secondary appraisal of their (in)ability to cope with it.
The cognitive model attributes a fundamental role to the negative evaluation of tinnitus.
Clinical trials in which this model is applied to treatment, by which the clinical relevance of the model can be tested, have not taken place yet. However, evidence exists that cognitive processes, such as interpretation, attention, and memory, are indeed involved in chronic tinnitus suffering (Andersson et al. 2013; Conrad et al. 2011; Rossiter et al. 2006; Stevens et al. 2007), though these studies were not specifically aimed at validating the model.