Bridging the Gap Between Tinnitus Science and Human Experience
- Art of Hearing | Dyon Scheijen
- Jul 14
- 17 min read
“Scientific progress is often associated with discovering new mechanisms. Equally important, however, is discovering new ways to connect existing knowledge.
Inspired by the theme of the Tinnitus Research Initiative Conference 2026 - Jump the wall – discover and uncover gaps - this perspective explores one such gap: the space between scientific understanding and human experience.”
The Hearing Triptych and the Glass Metaphor as an Integrative Clinical Perspective
A perspective inspired by the theme of the Tinnitus Research Initiative Conference 2026:
Jump the wall – discover and uncover gaps
Dyon Scheijen
Clinical Physicist-Audiologist | ACT Practitioner | Artist
Founder of Art of Hearing
Abstract
Over the past decades, scientific and clinical understanding of tinnitus-related distress has developed considerably. Neurophysiological, cognitive-behavioural and acceptance-based perspectives have demonstrated that the impact of tinnitus cannot be explained by the auditory percept alone. Attention, emotional meaning, threat appraisal, learning, avoidance behaviour, psychological flexibility and the wider context of a person’s life all influence how tinnitus is experienced.
Contemporary tinnitus rehabilitation therefore increasingly adopts a person-centred and biopsychosocial approach. However, a gap may remain between scientific explanation, clinical recommendations and the lived experience of people with tinnitus. Patients do not only ask why tinnitus has become intrusive or which mechanisms maintain their distress. They also ask how they can continue living when the sound remains.
This perspective introduces The Hearing Triptych and The Glass Metaphor as complementary clinical concepts intended to support the translation of existing scientific knowledge into an accessible and coherent narrative. The Hearing Triptych organises tinnitus-related experience within three continuously interacting dimensions: Sound, Brain and Human Experience. The Glass Metaphor subsequently illustrates how rehabilitation may focus not only on reducing the burden associated with tinnitus, but also on increasing a person’s capacity to carry what cannot always be removed.
Neither concept is presented as a new explanatory or scientifically validated model of tinnitus. Instead, they offer an integrative clinical perspective that connects established theoretical frameworks, multidisciplinary rehabilitation and the everyday realities of people living with tinnitus. In doing so, this article explores a possible translation gap between what science can explain and what people need in order to move forward with their lives.
Keywords: tinnitus, tinnitus-related distress, neurophysiological model, fear avoidance, cognitive behavioural therapy, Acceptance and Commitment Therapy, psychological flexibility, multidisciplinary rehabilitation, Hearing Triptych, Glass Metaphor.
1. Introduction
Tinnitus is one of the most common auditory symptoms encountered in clinical practice. Although often described as the perception of sound in the absence of an external acoustic source, this definition captures only part of the condition. While it accurately describes the auditory percept, it does not explain why tinnitus has little impact on some individuals while profoundly affecting the lives of others.
Over the past three decades, considerable scientific progress has been made in understanding tinnitus-related distress. Research has increasingly demonstrated that the burden associated with tinnitus cannot be explained by the auditory signal alone. Instead, it emerges from a complex interaction between auditory processing, attention, emotional appraisal, learning, behaviour and the broader context of an individual’s life.
These insights have fundamentally changed tinnitus rehabilitation. Contemporary international clinical guidelines now advocate a multidisciplinary, biopsychosocial approach in which patient education, hearing rehabilitation, psychological interventions and shared decision-making play central roles. The emphasis has gradually shifted from attempting to eliminate tinnitus towards improving quality of life and supporting long-term adaptation.
Despite these advances, an important challenge remains.
Patients rarely ask only how tinnitus works.
Instead, they ask questions such as:
“Why does this sound control my life?”
“Will I ever be able to enjoy silence again?”
“How do I continue living if the tinnitus never disappears?”
These questions reveal a distinction between understanding tinnitus and living with tinnitus. Scientific models successfully explain many of the mechanisms involved in tinnitus-related distress. However, translating these mechanisms into a meaningful and understandable narrative for patients - and into a shared language for multidisciplinary rehabilitation - a challenge.
The theme of the Tinnitus Research Initiative (TRI) Conference 2026, Jump the wall – discover and uncover gaps, provides an opportunity to reflect on this challenge. While important scientific gaps continue to be explored, there may also be a translation gap: the space between scientific understanding, clinical practice and the lived experience of people with tinnitus.
This perspective does not propose a new explanatory model of tinnitus. Rather, it explores whether existing scientific knowledge can be integrated into a broader clinical perspective that supports communication, multidisciplinary collaboration and patient understanding.
Building upon established theoretical frameworks, this article introduces The Hearing Triptych as an integrative clinical framework and The Glass Metaphor as a communication tool that together seek to bridge the gap between tinnitus science and human experience.
2. From Hearing a Sound to Living with Tinnitus
The history of tinnitus rehabilitation reflects a gradual expansion in our understanding of human suffering. Over the past four decades, scientific progress has moved beyond explaining the auditory perception of tinnitus towards understanding why some individuals adapt successfully while others experience persistent distress. Rather than replacing one another, successive theoretical frameworks have progressively deepened our understanding of tinnitus and its rehabilitation.
2.1 Understanding the Auditory Percept
A major turning point occurred with the introduction of the Neurophysiological Model by Jastreboff (1990). Before this model, tinnitus was largely regarded as an auditory disorder, with clinical attention focused primarily on the peripheral hearing system and the search for abnormalities capable of explaining the tinnitus percept.
Jastreboff proposed a fundamentally different perspective. The perception of tinnitus itself was considered insufficient to explain tinnitus-related suffering. Instead, the degree of distress depends on interactions between the auditory pathways, the limbic system and the autonomic nervous system. Through learning and conditioning, an initially neutral auditory signal may acquire emotional significance, resulting in increased attention, physiological arousal and persistent awareness (Jastreboff, 1990).
These theoretical principles formed the foundation for Tinnitus Retraining Therapy (TRT). Together with Jonathan Hazell, and through the early clinical implementation by colleagues including Jacqui Sheldrake, the neurophysiological model was translated into one of the first structured rehabilitation programmes for tinnitus (Jastreboff & Hazell, 2004). TRT combined directive counselling with sound therapy, aiming not to eliminate tinnitus, but to facilitate habituation by changing the significance attributed to the tinnitus percept.
This work established an important principle that continues to influence tinnitus rehabilitation today: successful treatment is not necessarily achieved by changing the sound itself, but by changing the brain's relationship with that sound.
2.2 Understanding Behaviour
While the neurophysiological model explained why tinnitus may become emotionally relevant, another question remained unanswered.
Why do some individuals become increasingly disabled by tinnitus, while others gradually resume normal daily life?
Important insights came from behavioural science. The Fear-Avoidance Model, originally developed by Vlaeyen and Linton (2000) to explain chronic musculoskeletal pain, proposed that disability is not determined solely by symptoms themselves, but also by the interpretation of those symptoms. Catastrophic beliefs lead to fear, fear increases vigilance, vigilance promotes avoidance behaviour, and avoidance prevents corrective learning, thereby maintaining long-term disability.
Although originally developed within pain research, these behavioural principles proved highly relevant to tinnitus rehabilitation. Building upon this theoretical framework, Cima and colleagues translated these concepts into specialised multidisciplinary tinnitus care, integrating cognitive behavioural principles with audiological rehabilitation.
This work culminated in the landmark randomised controlled trial published in The Lancet (Cima et al., 2012), demonstrating that specialised multidisciplinary treatment based on cognitive behavioural principles resulted in significantly greater improvements in tinnitus-related quality of life than usual care.
Importantly, this approach did not primarily aim to reduce tinnitus loudness. Instead, treatment focused on reducing maladaptive beliefs, diminishing avoidance behaviour, restoring participation and improving quality of life.
This represented another important shift in tinnitus rehabilitation: success was increasingly defined not by the absence of tinnitus, but by the restoration of meaningful functioning.
2.3 Understanding Psychological Flexibility
Acceptance and Commitment Therapy (ACT), originally developed by Hayes and colleagues during the 1980s and further elaborated in later publications (Hayes, Strosahl, & Wilson, 1999; Hayes et al., 2012), broadened rehabilitation beyond symptom reduction.
Rather than attempting to eliminate unpleasant internal experiences, ACT aims to strengthen psychological flexibility - the capacity to remain engaged in personally meaningful activities while making room for difficult thoughts, emotions and bodily sensations.
Within tinnitus rehabilitation, this represented another important conceptual development. The therapeutic question gradually shifted from:
"How can tinnitus be controlled?"
towards:
"How can life continue to be lived despite tinnitus?"
Participation, values, resilience and quality of life increasingly became central therapeutic outcomes.
2.4 Towards Contemporary Tinnitus Rehabilitation
Together, these developments fundamentally transformed tinnitus rehabilitation. The neurophysiological model explained how tinnitus acquires emotional significance (Jastreboff, 1990). Behavioural science explained how fear, attention and avoidance may maintain tinnitus-related distress (Vlaeyen & Linton, 2000). Specialised multidisciplinary rehabilitation demonstrated that these maintaining mechanisms could be successfully addressed in clinical practice (Cima et al., 2012). ACT subsequently broadened rehabilitation by emphasising psychological flexibility and valued living (Hayes et al., 2012).
Contemporary international clinical guidelines increasingly integrate these complementary perspectives within a biopsychosocial approach to tinnitus care. They consistently recommend patient education, hearing rehabilitation where appropriate, cognitive behavioural interventions and multidisciplinary collaboration as central components of evidence-based tinnitus management.
Yet an important challenge remains.
Patients do not experience tinnitus as separate neurophysiological, behavioural or psychological processes.
They experience tinnitus as part of a human life.
Scientific understanding has advanced remarkably. The remaining challenge may therefore no longer be explaining tinnitus itself, but integrating these complementary scientific perspectives into a framework that is both clinically meaningful and immediately understandable for patients.
The following chapter introduces The Hearing Triptych as one possible response to that challenge.
3. Bridging the Gap: The Hearing Triptych
The theoretical developments described in the previous chapter have profoundly changed the field of tinnitus rehabilitation. Together, they have shifted our understanding from tinnitus as a purely auditory phenomenon towards a multidimensional condition in which auditory processing, neural mechanisms, cognition, behaviour and psychological flexibility all contribute to the way tinnitus is experienced (Jastreboff, 1990; Vlaeyen & Linton, 2000; Cima et al., 2012; Hayes et al., 2012).
Yet despite these advances, an important challenge remains.
Scientific knowledge is organised into disciplines. Audiologists describe hearing. Neuroscientists investigate perception and neural networks. Psychologists study cognition, behaviour and emotion. Rehabilitation specialists focus on participation and quality of life.
Patients do not experience tinnitus in separate scientific disciplines.
They experience one life.
The sound, hearing loss, concentration, fatigue, sleep, work, relationships, identity and future are experienced simultaneously, continuously influencing one another. During clinical consultations, this difference between scientific organisation and lived experience repeatedly becomes apparent. While science explains tinnitus through increasingly specialised models, patients seek an understanding that reflects the way they actually experience their condition.
This observation raised a simple question:
How can contemporary scientific knowledge be organised into a framework that reflects the lived experience of tinnitus without losing its scientific foundation?
Interestingly, the inspiration for this question did not originate from science.
It originated from art.
For centuries, artists have used the triptych to portray different perspectives of a single reality. Each panel contributes its own perspective, yet none can be fully understood in isolation. Meaning emerges through the relationship between all three panels.
While working both as a clinical physicist-audiologist and as an artist, I gradually recognised that this artistic principle closely resembles modern tinnitus rehabilitation. Different scientific disciplines illuminate different aspects of tinnitus, yet none fully captures the experience of the person living with it.
This insight became the starting point for The Hearing Triptych.
The Hearing Triptych is not proposed as a new explanatory model of tinnitus. Rather, it is presented as an integrative clinical framework that organises existing scientific knowledge into three continuously interacting dimensions: Sound, Brain and Human Experience.
The first dimension, Sound, represents the physical reality of hearing. It includes the auditory signal, hearing loss, cochlear function, speech perception, environmental acoustics and the measurable aspects of auditory function that form the basis of audiological assessment.
The second dimension, Brain, represents the processes through which sound acquires meaning. Attention, salience, prediction, learning, memory, emotional processing and behavioural adaptation continuously interact within this domain. Existing theoretical frameworks, including the Neurophysiological Model (Jastreboff, 1990), behavioural principles derived from the Fear-Avoidance Model (Vlaeyen & Linton, 2000), and cognitive behavioural approaches to tinnitus rehabilitation (Cima et al., 2012), primarily contribute to understanding this dimension.
The third dimension, Human Experience, represents the personal reality in which tinnitus is lived. It encompasses relationships, identity, values, participation, work, culture, resilience, purpose and psychological flexibility. Within this dimension, the principles of Acceptance and Commitment Therapy (Hayes et al., 2012) provide an important perspective by emphasising that a meaningful life is not dependent upon the complete absence of unpleasant internal experiences.
Importantly, these three dimensions should not be interpreted as independent domains. They continuously interact.
Changes in hearing influence neural processing. Neural processing influences attention and emotional significance. Emotional responses affect participation, relationships and identity. Conversely, changes in social participation, personal values or psychological flexibility may alter attention, emotional salience and ultimately the experience of tinnitus itself.
The Hearing Triptych therefore does not seek to replace existing scientific theories. Instead, it provides a conceptual structure within which these complementary perspectives can be understood as components of one integrated clinical reality.
It also reflects the multidisciplinary nature of contemporary tinnitus rehabilitation. Audiologists, psychologists, physicians, hearing therapists, occupational therapists and social workers naturally enter the framework from different perspectives. Yet all contribute to understanding the same individual.
In this sense, The Hearing Triptych represents more than a visual framework.
It represents a different way of listening.
Listening not only to the sound that is heard.
Listening not only to the brain that interprets it.
But also listening to the human experience in which that sound has become part of a person's life.
This perspective also reflects the philosophy of Art of Hearing.
Not because art replaces science.
But because art has the unique capacity to integrate complexity into images that invite understanding, dialogue and reflection.
In that sense, The Hearing Triptych emerged where art meets science. Science provides the evidence. Clinical practice provides the experience. Art provides the language that brings these perspectives together.
Figure 1 illustrates The Hearing Triptych as an integrative clinical framework connecting contemporary tinnitus science with the lived experience of people living with tinnitus.
4. The Glass Metaphor: Expanding the Capacity to Live
The Hearing Triptych provides an integrative framework for understanding tinnitus through the continuous interaction between Sound, Brain and Human Experience. Yet during clinical consultations another observation repeatedly emerged. Patients rarely ask how the auditory pathways function, how the limbic system contributes to tinnitus-related distress or whether psychological flexibility has increased. Instead, they ask something much more fundamental:
“How do I live with this?”
Scientific explanations are essential. They provide understanding, reduce uncertainty and form the foundation of evidence-based rehabilitation. Yet understanding alone is often insufficient. Patients are not only looking for an explanation of tinnitus; they are searching for a way to continue living despite tinnitus. The Glass Metaphor emerged as an attempt to translate contemporary scientific knowledge into a shared language that patients, families and healthcare professionals can immediately understand.
Most people are familiar with the question: Is the glass half full or half empty? Within tinnitus rehabilitation, however, this may not be the most relevant question. For some people, the glass already feels as though it is overflowing. Others may experience relatively little tinnitus-related distress despite perceiving tinnitus continuously. The difference often lies not only in the amount of water, but also in the size of the glass.
Within this metaphor, the water represents the total burden carried by an individual. Tinnitus may contribute to that burden, but it rarely exists in isolation. Hearing loss, hyperacusis, sleep disturbance, chronic pain, stress, relationship difficulties, occupational demands, financial concerns, grief and other life events may all add water to the glass. This perspective closely reflects contemporary rehabilitation. Every person arrives with a unique life history, different resources and different challenges. Consequently, two individuals with comparable tinnitus characteristics may experience profoundly different levels of distress.
Healthcare understandably focuses on reducing the amount of water. Whenever possible, this remains an essential objective. Hearing rehabilitation may improve communication. Medical treatment may reduce associated symptoms. Cognitive behavioural interventions may diminish catastrophic interpretations and avoidance behaviour. Education may reduce uncertainty and increase self-efficacy. These interventions remain fundamental.
Yet rehabilitation also reveals another possibility. Sometimes the water cannot be removed completely. The tinnitus remains. The hearing loss remains. Life itself continues to place demands upon the individual. At that point, another therapeutic question emerges:
Can the glass become larger?
Within the context of Acceptance and Commitment Therapy, this process closely resembles the development of psychological flexibility (Hayes et al., 2012). More broadly, however, the size of the glass reflects the interaction between resilience, participation, social connectedness, personal values, purpose, self-efficacy and the capacity to adapt to circumstances that cannot always be changed.
The Glass Metaphor therefore complements The Hearing Triptych. Where The Hearing Triptych helps us understand the interacting dimensions of tinnitus, the Glass Metaphor helps us understand the aim of rehabilitation. Rehabilitation is not only about reducing tinnitus-related burden; it is also about increasing the person’s capacity to carry that burden.
Importantly, enlarging the glass is rarely the responsibility of one healthcare professional. The audiologist contributes by improving hearing and communication. The psychologist addresses fear, beliefs and behavioural responses. The hearing therapist strengthens communication strategies. The occupational therapist facilitates participation in meaningful activities. The physician excludes treatable pathology and provides medical guidance. The social worker supports the social environment. Family members, friends and employers may all contribute as well. Each enlarges the glass in a different way.
This perspective also changes the way multidisciplinary rehabilitation can be understood. Rather than viewing different professionals as providing separate interventions, the Glass Metaphor suggests that they work together towards a shared objective: not simply reducing tinnitus, but enlarging the person’s capacity to continue living.
Perhaps this is where the metaphor finds its greatest value. It does not explain tinnitus. Science has already provided increasingly sophisticated explanations. Instead, it translates those explanations into a shared language through which professionals and patients can explore rehabilitation together.
The question therefore changes from “How can we remove every drop of water?” to “How can we help enlarge the glass?”
5. Clinical Implications: From Treating Tinnitus to Supporting People
Contemporary international tinnitus guidelines consistently advocate a multidisciplinary, person-centred approach to rehabilitation. Patient education, hearing rehabilitation where appropriate, cognitive behavioural interventions and shared decision-making are increasingly recognised as essential components of evidence-based tinnitus care. Together, these recommendations reflect an important shift in clinical practice: the goal is no longer solely to reduce tinnitus-related symptoms, but to improve functioning, participation and quality of life.
The Hearing Triptych and the Glass Metaphor do not replace these recommendations. Rather, they offer a conceptual framework that may facilitate their implementation in everyday clinical practice.
The Hearing Triptych encourages clinicians to consider tinnitus from three continuously interacting perspectives. Sound reminds us to understand the auditory system through careful audiological assessment and appropriate hearing rehabilitation. Brain emphasises the importance of attention, learning, emotional processing and behavioural adaptation. Human Experience recognises that tinnitus is ultimately lived within relationships, work, identity, personal values and participation in society.
The Glass Metaphor complements this framework by providing a shared language for discussing rehabilitation goals. Instead of focusing exclusively on reducing tinnitus-related burden, clinicians and patients may also explore ways of strengthening the individual's capacity to manage ongoing challenges. This shift encourages a broader conversation about resilience, social support, communication, psychological flexibility, participation and quality of life.
Importantly, this perspective reinforces the value of multidisciplinary rehabilitation. Every professional contributes from a different perspective. Audiologists optimise hearing and communication. Psychologists help patients understand and modify behavioural and emotional responses. Hearing therapists improve listening and communication strategies. Occupational therapists facilitate participation in meaningful daily activities. Social workers strengthen the social context, while physicians contribute medical expertise and exclude treatable pathology.
Although their interventions differ, they share a common purpose.
Not every professional removes water from the glass.
Some help make the glass larger.
This distinction may appear subtle, yet it fundamentally changes the therapeutic conversation. Success is no longer measured exclusively by changes in tinnitus loudness or distress scores. It may equally be reflected in returning to work, rebuilding relationships, sleeping better, participating in social activities, rediscovering valued life goals or simply regaining confidence in the future.
Future research should explore whether integrative conceptual frameworks such as The Hearing Triptych and communication tools such as the Glass Metaphor improve patient understanding, therapeutic alliance, interdisciplinary collaboration and the implementation of evidence-based tinnitus rehabilitation. Their value may ultimately lie not in introducing new scientific mechanisms, but in helping existing scientific knowledge become more meaningful within everyday clinical practice.
6. Conclusion
Over the past four decades, tinnitus rehabilitation has evolved from a predominantly biomedical approach towards a multidisciplinary, person-centred model of care. Successive scientific developments have each contributed important pieces to this transformation.
The Neurophysiological Model explained why tinnitus acquires emotional significance (Jastreboff, 1990). Behavioural science demonstrated how fear, attention and avoidance may contribute to the persistence of tinnitus-related distress (Vlaeyen & Linton, 2000; Cima et al., 2012). Acceptance and Commitment Therapy further broadened rehabilitation by emphasising psychological flexibility and engagement in a meaningful life despite ongoing symptoms (Hayes et al., 2012).
Rather than replacing these perspectives, The Hearing Triptych seeks to integrate them within a single clinical framework. By considering tinnitus through the continuously interacting dimensions of Sound, Brain and Human Experience, it offers a way of organising existing scientific knowledge that reflects the complexity of everyday clinical practice.
The Glass Metaphor complements this framework by translating these scientific insights into a language that is accessible to patients, families and healthcare professionals alike. Instead of focusing exclusively on reducing the burden associated with tinnitus, it encourages an equally important therapeutic question: How can we increase a person's capacity to live well despite persistent tinnitus?
This perspective does not suggest that symptom reduction is unimportant. On the contrary, reducing distress whenever possible remains a fundamental goal of rehabilitation. However, when tinnitus cannot be completely eliminated, rehabilitation may also involve helping individuals strengthen the psychological, social and personal resources that enable them to continue living meaningful lives.
In this sense, The Hearing Triptych provides a framework for understanding tinnitus, while the Glass Metaphor provides a shared language for communicating that understanding.
Perhaps this also reflects the broader challenge described by the theme of the Tinnitus Research Initiative Conference 2026: "Jump the Wall – Discover and Uncover Gaps."
Scientific progress is not only achieved by discovering new mechanisms.
Sometimes it is achieved by connecting existing knowledge in ways that help clinicians work together, help patients understand their experiences and, ultimately, help people live better lives.
Personal Reflection
As a clinical physicist-audiologist, I have spent much of my professional life trying to understand hearing through measurements, physiology and scientific evidence. As an ACT practitioner, I have learned that understanding alone does not necessarily change a person's life. And as an artist, I have discovered that a single image can sometimes communicate what pages of scientific explanation cannot.
The inspiration for The Hearing Triptych therefore did not arise from science alone. It emerged from the intersection of two worlds. The artistic tradition of the triptych provided a way of seeing complexity as a coherent whole, while science provided the knowledge needed to understand each individual part.
For me, this is the essence of Where Art Meets Science.
Art does not replace science.
Science does not replace human experience.
Together, they create a language through which understanding can become connection.
When patients ask whether their glass is half full or half empty, I rarely answer the question directly.
Instead, I ask another:
How can we make the glass bigger?
Perhaps that question is not only relevant for people living with tinnitus.
Perhaps it is equally relevant for those of us who seek to understand, to treat and, above all, to listen.
Because ultimately, hearing has never been only about sound.
It has always been about people.
References
Cima, R. F. F., Andersson, G., Schmidt, C. J., & Henry, J. A. (2014). Cognitive behavioral treatments for tinnitus: A review of the literature. Journal of the American Academy of Audiology, 25(1), 29–61.
Cima, R. F. F., Maes, I. H. L., Joore, M. A., Scheijen, D. J. W. M., El Refaie, A., Baguley, D. M., Anteunis, L. J. C., van Breukelen, G. J. P., & Vlaeyen, J. W. S. (2012). Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: A randomised controlled trial. The Lancet, 379(9830), 1951–1959.
Cima, R. F. F., Mazurek, B., Haider, H., Kikidis, D., Lapira, A., Noreña, A., & Hoare, D. J. (2019). A multidisciplinary European guideline for tinnitus: Diagnostics, assessment, and treatment. HNO, 67(Suppl. 1), 10–42.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford Press.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd ed.). Guilford Press.
Jastreboff, P. J. (1990). Phantom auditory perception (tinnitus): Mechanisms of generation and perception.Neuroscience Research, 8, 221–254.
Jastreboff, P. J., & Hazell, J. W. P. (2004). Tinnitus Retraining Therapy: Implementing the Neurophysiological Model.Cambridge University Press.
Leeuw, M., Goossens, M. E. J. B., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. S. (2007). The Fear-Avoidance Model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30(1), 77–94.
McKenna, L., Handscomb, L., Hoare, D. J., & Hall, D. A. (2014). A scientific cognitive behavioral model of tinnitus.International Journal of Audiology, 53(7), 402–412.
Trevis, K. J., McLachlan, N. M., & Wilson, S. J. (2018). Cognitive mechanisms in chronic tinnitus: Psychological and neural contributions to tinnitus distress. Neuroscience & Biobehavioral Reviews, 83, 188–207.
Tunkel, D. E., Bauer, C. A., Sun, G. H., et al. (2014). Clinical Practice Guideline: Tinnitus. Otolaryngology–Head and Neck Surgery, 151(2 Suppl.), S1–S40.
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332.
Further Reading
For readers interested in the development of the concepts presented in this perspective, the following essays provide additional background and reflections:
Scheijen, D. (2026). The Hearing Triptych: Sound, Brain and Human Experience. Art of Hearing.
Scheijen, D. (2026). The Glass Metaphor. Art of Hearing.
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