Tinnitus Retraining Therapy
Tinnitus Retraining Therapy (TRT) is a specific well-defined protocol based upon the Neurophysiological Model of Tinnitus developed by Dr. Pawel Jastreboff. The ultimate goal of TRT is a significant decrease in the amount of time one is consciously aware of tinnitus and a significant decrease in the amount of distress caused by the tinnitus when one does happen to be consciously aware of it. Dr. Jastreboff refers to these phenomena as habituation of perception and habituation of reaction, and they occur regardless the acoustical characteristics (loudness, pitch, timbre, etc.) of the tinnitus itself. Thus, no matter how severe the tinnitus might be, TRT can effectively serve as a vehicle for its habituation.
The fundamental principle of the Neurophysiological Model is that clinically relevant bothersome tinnitus, the tinnitus that brought you to this website, involves activation of systems other than the auditory system, systems that come to occupy a dominant role in tinnitus awareness and tinnitus-related distress. The most prominent of these systems are the limbic system (emotion) and the autonomic nervous system ("fight-or-flight").
In TRT the functional connections among the respective systems are addressed through the use of sound therapy and a series of bi-directional educational sessions known as "TRT counseling." Most commonly the sound therapy is provided by a pair of small inconspicuous wearable devices generating a soft soothing "shhhh" sound that does not interfere with hearing, concentration, or activity. Shortly after putting them on, the wearer becomes unaware of the presence of the devices as well as the sound they make unless he or she purposely listens for it. With modern technology TRT devices are all but undetectable in business or social settings, and at the conclusion of the treatment period they are no longer needed. TRT counseling generally requires three sessions spread out over a year. For patients living at a distance, all follow-up TRT counseling can be accomplished by telephone or video conferencing; only the initial TRT counseling session must be completed in person.
Tinnitus Retraining Therapy is highly clinician-dependent, but in knowledgeable and experienced hands it is the absolute gold standard among treatment protocols that seek to significantly decrease tinnitus awareness and tinnitus-related distress.