Conceptual framework for tinnitus: a cognitive model in practice

Tinnitus is a conscious attended awareness perception of sourceless sound. Widespread theoretical and evidence-based neurofunctional and psychological models have tried to explain tinnitus-related distress considering the influence of psychological and cognitive factors. However, tinnitus models seem to be less focused on causality, thereby easily misleading interpretations. Also, they may be incapable of individualization. This study proposes a Conceptual Cognitive Framework (CCF) providing insight into cognitive mechanisms involved in the predisposition, precipitation, and perpetuation of tinnitus and consequent cognitive-emotional disturbances. The current CCF for tinnitus relies on evaluative conditional learning and appraisal, generating negative valence (emotional value) and arousal (cognitive value) to annoyance, distress, and distorted perception. The suggested methodology is well-defined, reproducible, and accessible, which can help foster future high-quality clinical databases. Perceived tinnitus through the perpetual-learning process can always lead to annoyance, but only in the clinical stage directly cause annoyance. In the clinical stage, tinnitus perception can lead indirectly to distress only with experiencing annoyance either with (“ \({\underset{{\mathcal {C}}}{{{\varvec{Ind-1}}}}}\) $\underset{\mathcal{C}}{\mathit{I}\mathit{n}\mathit{d}\mathbf{-}\mathbf{1}}$ ” = 1.87; 95% CI 1.18–2.72)[“1st indirect path in the Clinical stage model”: Tinnitus Loudness \(\rightarrow\) $\to$ Attention Bias \(\rightarrow\) $\to$ Cognitive-Emotional Value \(\rightarrow\) $\to$ Annoyance \(\rightarrow\) $\to$ Clinical Distress]or without (“ \({\underset{{\mathcal {C}}}{{{\varvec{Ind-2}}}}}\) $\underset{\mathcal{C}}{\mathit{I}\mathit{n}\mathit{d}\mathbf{-}\mathbf{2}}$ ”= 2.03; 95% CI 1.02–3.32)[ “2nd indirect path in the Clinical stage model”: Tinnitus Loudness \(\rightarrow\) $\to$ Annoyance \(\rightarrow\) $\to$ Clinical Distress] the perpetual-learning process. Further real-life testing of the CCF is expected to express a meticulous, decision-supporting platform for cognitive rehabilitation and clinical interventions. Furthermore, the suggested methodology offers a reliable platform for CCF development in other cognitive impairments and supports the causal clinical data models. It may also enhance our knowledge of psychological disorders and complicated comorbidities by supporting the design of different rehabilitation interventions and comprehensive frameworks in line with the “preventive medicine” policy.