When the Sound Isn’t the Problem: What My Recovery Taught Me About Tinnitus Distress and the Brain

Author: Scott Muenzler, ICF Certified Coach (PCC)

Behavioral coaching for chronic tinnitus and pain, adjunctive to medical and psychological care

Contact for clinicians: Physicians@c3coaching.co

When my tinnitus began, I thought the problem was the sound itself. Over time I realized that what kept me stuck wasn’t the sound, but how my brain treated it as an unwelcome, persistent intruder. This article outlines what helped me retrain that reaction, how later research clarified why it worked, and how the same principles can help patients recover alongside standard medical care. It offers an inside look at that experience and how practical, well-established methods can help reverse it.

I’m not a physician or researcher, but as someone who has lived through severe tinnitus and now helps others navigate it, I wanted to understand why the approach that gave me back my life worked. Comparing my experience with the research revealed a coherent story that aligns with mechanisms already familiar to medicine: central sensitization, predictive processing, and the influence of attention and emotion on perception.

A version of this story was first published on Reddit in May 2025, where it reached more than 137,000 readers. That post was written for people struggling with tinnitus; this version is for clinicians, to show, from the inside, what their patients are actually experiencing, and how distress can lessen, or even disappear, while the sound remains.

What It Was Like in the Beginning

In those first weeks, I didn’t just hear a sound; I reacted to it. Within hours, it filled my awareness as something intrusive I couldn’t shut out. Nights blurred together as sleep vanished, concentration fractured, and every quiet moment became a search for the noise I was desperate to escape. For a time, I used alcohol to blunt the anxiety.

Looking back, it’s clearer what was happening. The sound itself was harmless, but my brain treated it as an intrusion that needed constant monitoring. Each spike of fear made the sound feel louder and more inescapable. Attention locked onto it, and the loop sustained itself.

In predictive-processing terms, the sound was assigned excessive importance, which only strengthened its hold. That’s a dynamic consistent with Karl Friston’s work on the brain’s drive to minimize prediction error.

This kind of loop is likely familiar to anyone who works with chronic pain or anxiety: a benign internal signal becomes over-monitored and emotionally charged until it feels intolerable, even when harmless. The focus itself becomes reinforcement. Every act of checking or worrying strengthens the brain’s expectation that the signal matters, which is why it stays intrusive. Research shows that tinnitus distress is driven by learned attention and appraisal processes rather than by hearing thresholds, which is why distress so often exceeds the audiogram.^1-3

At the time, none of this was obvious to me. I only knew that my life was shrinking around a sound I couldn’t escape. What initially seemed like an auditory problem was, in retrospect, a neurobehavioral fear–attention feedback loop. This pattern is consistent with descriptions of conditioned threat responses that can persist after danger has passed.

Not everyone’s tinnitus starts the way mine did. For many (like veterans, musicians, and others exposed to acoustic trauma), the sound begins with genuine damage in the auditory system. In those cases, the signal may arise from a structural change, but the suffering that follows still depends on how the brain interprets and reacts to it. Even when injury plays a role, the same fear and attention circuits can keep the sound intrusive long after the damage has healed or stabilized. That’s why behavioral and perceptual retraining can still make a meaningful difference, even when the sound itself can’t be silenced. What’s being retrained isn’t the ear but the brain’s response to what it hears. 

Exhaustion and fear eventually pushed me to seek medical answers, hoping someone could tell me what was happening and how to stop it. That search, driven more by fear than by sound, became the turning point. Here’s how that process unfolded and what eventually helped me retrain my response.

A Timeline of Cognitive, Attentional, and Behavioral Change 

What follows is not a treatment plan, but a chronological account of the cognitive, attentional, and behavioral changes I made over the course of my recovery.

1. Medical reassurance and early stabilization

Early stabilization mattered because fear and sleep disruption were amplifying distress. At this stage, the focus was on reassurance, limiting catastrophic interpretations, and restoring basic sleep. Two ENT visits confirmed normal findings and ruled out anything serious. Hearing that there was no structural damage eased some of the anxiety, but uncertainty lingered. Maybe I just hadn’t seen the right doctor or done the right test. What if something was missed? Even if I could be certain there was no pathological cause, what if it never went away? What if it got worse?

In behavioral terms, that reassurance reduced some of my uncertainty, and it was that uncertainty that had kept my alarm system running. When a symptom is experienced as potentially dangerous or unexplained, attention naturally stays locked onto it, amplifying distress.^1,3,4 The sound itself did not change, but as it felt less threatening, my overall sense of alarm began to settle. With less uncertainty driving vigilance and worry, facing tinnitus and addressing it felt a bit more manageable.

2. Improving Sleep and Settling Heightened Vigilance 

Because sleep problems and concentration difficulties often appear together in tinnitus, addressing sleep can reduce stress, and sleep-related conditions are associated with heightened vigilance and reactivity.^1,5 Once I was able to start cutting out the alcohol, I began using melatonin and focused on calming music rather than the tinnitus. Over time, this refocusing became the key to shutting out the noise, which helped wind down that cycle of exhaustion and anxiety.

3. Breaking the Panic Loop: Cognitive and Perceptual Relearning 

Once sleep and acute vigilance were stabilized, deeper questions emerged about why fear and attention had taken such a powerful hold, and whether similar mechanisms might be involved across symptoms. This is where neuroscience and lived experience begin to overlap, and where mechanisms implicated in pain and tinnitus point in the same direction.

Years earlier, after encountering the work of Dr. John Sarno (The Mindbody Prescription, 1998; The Divided Mind, 2007) and his writings on what he termed Tension Myositis Syndrome (TMS), I had overcome chronic pain without drugs or surgery. His work offered a clinically grounded way of understanding how fear, attention, and meaning can shape physical symptoms, which was an insight that proved transformative for my recovery. That experience did not immediately translate to tinnitus, but it gave me a framework for considering what might be happening beneath the surface.

Neuroscience now shows that tinnitus and chronic pain share many of the same brain mechanisms, where attention and emotion influence how strongly sensations are perceived.^6,7 In this account, I draw on concepts of attention, learning, and expectation when considering how sensory experiences can persist. Clinicians and researchers such as Lorimer Moseley have described persistent pain as a protective response shaped by learning, attention, fear, and appraisal, rather than a direct readout of nociceptive input or tissue damage.^8,9

Around this time, I revisited Sarno’s books and worked through a TMS (commonly referred to now as PPD – psychophysiologic disorder) workbook. It didn’t make the sound disappear, but it helped me reinterpret what was happening: the distress wasn’t proof of damage, but learned reactivity. For physicians interested in how these principles align with predictive-processing and behavioral medicine, see Persistent Physical Symptoms in Clinical Practice: A Descriptive Framework for Psychophysiologic Disorders (PPD).

The most important thing early on was to recognize and start breaking the panic loop I was in. Anxiety made my tinnitus louder, which in turn made me more anxious. Breaking that cycle was essential, and it was also the hardest thing to do. It didn’t happen all at once, and I failed many times. But with practice, and alongside other things I was doing, I got better at it. Research indicates that tinnitus-related distress commonly involves catastrophic interpretations and heightened perception of the sound; anxiety is an associated feature of this distress profile.^10,11 Higher levels of tinnitus catastrophizing are also associated with greater subjective tinnitus loudness and more frequent health care utilization, even when objective auditory measures do not fully account for differences in reported severity.¹¹

I also had to stop what I call tinnitus doomscrolling. The more I read, the more catastrophic stories I found, and the worse I felt. Thoughts such as “What if that happens to me?” could spike the anxiety instantly. Studies show that catastrophic interpretations of tinnitus are strongly associated with greater distress, with selective attention toward the sound identified as an important factor in tinnitus-related distress.^11,12 For me, this meant recognizing that repeatedly searching for information and reassurance about tinnitus was keeping my attention locked on the symptom, reinforcing the very distress I was trying to escape.

Changing my mindset was equally important. Reading Martin Seligman’s Learned Optimism helped me move from “I’m stuck like this forever” to “This is something I can live with and retrain my brain around.” Optimism research suggests a robust association between hopeful outlooks and better health outcomes.¹³

This combination of cognitive reframing, behavioral restraint, and gradual emotional retraining mirrored what the PPD framework describes: reducing fear, restoring safety, and allowing the brain to unlearn its overprotection response.

4. Coaching as a Framework for Translating Insight into Change 

The value here was not technique, but accountability, pacing, and help translating insight into behavior.

When my self-directed efforts hit a wall, I started working with a coach who specialized in chronic-pain and mindbody patterns. She didn’t have specific tinnitus experience, but she understood fear, attention, and conditioning, and that helped me start piecing things together. Having someone who understood mindbody principles and didn’t treat me like a medical anomaly made a meaningful difference. It was the first time I felt genuinely heard. Meta-analytic evidence indicates that the quality of the therapeutic alliance is robustly associated with positive treatment outcomes across adult psychotherapies, with particular emphasis on the collaborative bond between patient and therapist.¹⁴ Most of the changes that follow grew out of conversations with my coach, her questions, and a lot of trial and error on my part. 

Early on in working with my coach, she encouraged me to start making gratitude lists. I was skeptical, but I tried it. At first it felt forced; then it started to shift my mood in subtle ways. Over time, it rewired where my attention went. Evidence shows that gratitude practices enhance positive affect and optimism.¹⁵ Each of these steps targeted something different (attention, fear, avoidance, and mindset) but the real progress came from the cumulative effect: a slow retraining of meaning and safety.

A couple of months into coaching, I started wondering if I could actually train my attention. I didn’t yet know about CBT or attention retraining, but I began experimenting on my own, starting with sounds, then with simple tasks and conversations. Eventually, I realized that anything capable of drawing my focus away from listening for the noise helped. Some days I managed a few seconds; on others, a few minutes. It wasn’t consistent, but the more I practiced, the less I feared the sound, and the less space it took up in my mind. Research indicates that difficulties with attention control and attention-switching are associated with the persistence and impact of tinnitus, with impaired ability to disengage attention from the tinnitus sound linked to greater distress.^5,10 In tinnitus-specific intervention contexts, directed-attention approaches have been described in which patients practice shifting attention away from the tinnitus sound toward external stimuli, with these approaches framed as targeting tinnitus awareness and distress in clinical practice.⁵

I’d spent months avoiding everyday sound out of fear of spikes. My coach encouraged me to get curious about those fears instead of automatically protecting against them. That’s when I began to see that avoidance was keeping the fear alive. I started wearing earplugs only in genuinely loud environments. The first few times were uncomfortable, but nothing bad happened, and that’s when the fear began to lose its hold. Studies of sound intolerance describe avoidance and safety behaviors as maintaining hypersensitivity, while gradual increases in sound exposure and tolerance are associated with improvement in hyperacusis following behavioral treatment.¹⁶ In tinnitus, remission case reports include retrospective narrative descriptions of changes in daily functioning, although these patterns are described retrospectively rather than analyzed as mechanisms.¹⁷

During the first two years, I experienced several setbacks and took them hard at times. The book Changing for Good (2007), which grew out of Prochaska’s stages-of-change research, helped me understand relapse as part of the process rather than a failure. Bad days weren’t proof I was back at square one; they were part of the learning curve. Research indicates that reductions in tinnitus-related distress can occur over time, and that higher levels of acceptance are associated with better adjustment and reduced interference, even when the tinnitus sound itself persists.¹⁸ 

5. Social Re-engagement and the Quieting of Symptom Monitoring 

Around fifteen months in, isolation and fatigue pushed me to start reconnecting with people again. Being around others helped shift my focus outward and quiet the constant internal monitoring. Getting out and being more social turned out to be one of the simplest but most powerful things I did. It gave my mind something healthier to track. Evidence indicates that social connection and perceived social support are associated with better psychosocial functioning and more adaptive emotional functioning.^19,20

As time went on, I noticed that the less I talked about tinnitus, the faster I improved. I even asked friends and family not to bring it up. The less space it occupied in conversation, the less space it occupied in my awareness (a form of attention retraining in disguise). Research suggests that repeated monitoring and cognitive elaboration of bodily symptoms, including verbal focus, are associated with increased symptom salience and distress, consistent with models in which persistent symptoms repeatedly interrupt and capture attention.^4,21

By the end of the second year, the tinnitus remained but no longer mattered. The shift from alarm to indifference marked full habituation. The sound was still there, but it had lost its emotional charge.

The Outcome: Habituation Without Silence 

Taken together, these changes were not dramatic in any single moment, but they marked a clear shift in how tinnitus was experienced day to day. Over time, several practical changes became apparent:

Where I once needed to drown the noise in beer every night, I now sleep through the night without even hearing it most of the time.

Instead of plugging my ears every time I hear crinkling plastic bags, I’m back to seeing live metal bands as I did for decades before tinnitus.

I even made it through one of the world’s strictest COVID lockdowns without any tinnitus issues.

My life today feels fuller than it did before tinnitus, and I appreciate it more. 

The tinnitus is still there, but it’s irrelevant. I can hear it as I type this; I just don’t care. And in a few minutes, I’ll forget it’s even there

In lived experience, this meant that changes in distress tracked shifts in appraisal, attention, and emotional response far more closely than any change in the perceived intensity or character of the sound itself. I’ve since learned that what happened to me isn’t unusual, but reflects a pattern described in the tinnitus literature. Research indicates that reductions in tinnitus-related distress can occur even when the tinnitus sound itself persists, and are closely linked to changes in appraisal, attention, and emotional response rather than to changes in sound intensity.²² Attention-based tinnitus interventions describe the use of directed-attention strategies aimed at shifting attention away from the tinnitus sound and reducing its salience and emotional reactivity within clinical practice.⁵

In the end, what changed wasn’t the sound, but how I related to it; with that change, peace stopped depending on silence. 

From Lived Experience to Clinical Insight 

Taken together, the sequence described above illustrates a broader pattern that may be clinically relevant. It wasn’t any single technique that made the difference, but a gradual change in how I related to the sound itself. Each behavioral step, from restoring sleep to reconnecting socially, taught my mind and body to stop overreacting to it. Over time, that change in meaning became the recovery.

Implications for Clinical Communication and Care 

It is important to recognize how the words “You’ll just have to learn to live with it” can sound to someone who is already overwhelmed. While often intended as reassurance, they may be experienced as dismissive or abandoning. When an anxious patient leaves without a clear explanatory frame, what often follows is not acceptance but increased panic, despair, and continued searching for someone they feel will truly listen. Prior research suggests that when patients leave without a clear explanation of what their symptoms mean, uncertainty tends to increase and distress often follows. In qualitative studies, patients describe continuing to search for explanations and elaborating their symptom narratives in an effort to make sense of the problem.^23,24

The same mechanisms described above take on a different significance in clinical conversations, where explanation, reassurance, and framing can meaningfully shape patient expectations and attentional focus. In this section, communication is framed around clear, validating explanations and compassionate engagement rather than cure-focused messaging. Studies show that individuals with tinnitus can adapt and experience improvements in quality of life despite persistent symptoms.^1,18,25 Here, tinnitus-related distress is framed in terms of cognitive and emotional processes alongside auditory factors. Communication research indicates that explanatory clarity and relational quality can meaningfully influence patients’ emotional response, expectations, and engagement with care.^26-28 Those few ideas, communicated with clarity and compassion, can profoundly influence the direction patients take in their recovery. This way of understanding tinnitus distress can be especially useful when you’re seeing patients who continue to seek reassurance despite normal evaluations, and fear of the sound itself becomes the main driver of suffering.

When time allows, moving beyond reassurance to offer concrete orientation can be helpful. Clinical models of tinnitus describe how sleep, attention, stress, and emotional patterns influence how intrusive tinnitus is experienced. Encouraging patients to focus on one manageable, stabilizing change (such as targeting sleep regulation, fear-driven behaviors, or social withdrawal) can help patients regain a sense of agency. Randomized controlled trials and meta-analytic reviews indicate that psychological and behavioral interventions, particularly cognitive-behavioral approaches, are associated with significant reductions in tinnitus-related distress and handicap.^1,22 These interventions are understood to work by targeting cognitive appraisal, attentional focus, emotional regulation, and behavioral responses rather than the auditory signal itself. From a clinical perspective, this highlights the value of approaches that help patients reinterpret symptoms, regulate attention, and rebuild confidence. These mechanisms can also be addressed through structured education and coaching. 

When clinic time is tight, a behavioral coach can help with the non-medical work that often determines whether reassurance sticks: pacing, sleep stabilization, attention retraining practice, and reducing safety behaviors. If you ever want a quick fit check on whether coaching is a reasonable adjunct for a particular patient, I am happy to talk it through briefly, no referral expected.

What anxious tinnitus patients often need from medicine is clarity, compassion, and a credible “how”: an explanatory roadmap that helps them understand why the sound feels so intrusive, why that does not necessarily indicate damage, and what specific steps can help them move toward recovery. Clinicians who communicate belief, calm confidence, and a clear next step can help reduce fear and confusion, not by minimizing symptoms, but by helping patients make sense of what they are experiencing and see a workable path forward.

In Practice: Helpful Ways to Frame the Conversation 

• “Your experience is real, and many others who’ve felt the same fear and confusion have gone on to live full, happy, and productive lives.” 

• “Help exists, and professionals can help guide you through the recovery process.” 

• “Sleep, attention, stress, and emotional patterns all influence how intrusive tinnitus feels.” 

• “Start with one small, stabilizing step, like restoring sleep, reducing panic behaviors, or reconnecting socially. Like physical therapy, progress takes time, but with persistence, it comes.”

These kinds of messages combine validation, clarity, and hope. Research on clinician–patient communication shows that empathy, emotional support, and relational quality are associated with improved patient outcomes across healthcare settings.²⁸

From Recovery to Clinical Takeaways 

The more I learn, the clearer it becomes that for many people, recovery from tinnitus is less about the sound itself and more about the meaning attached to it, and the brain can learn to attach a different meaning over time. There are no quick fixes here; this process isn’t about fixing, but about gradual retraining. That process gave me back a full life, and it’s what I now help others work toward in collaboration with their medical care. 

For clinicians skimming, the bullets below simply recap the mechanism labels already illustrated in the narrative and communication sections above. They function as a quick reference to the conceptual framing developed in the paper. 

Clinical Synthesis: Mechanisms That Matter 

• Distress often reflects expectation and over-monitoring rather than sound intensity. 

• Retraining targets meaning and salience rather than sound intensity. 

• Fear and persistent attentional focus can sustain tinnitus distress. 

• Clinically, it is useful to frame recovery as non-linear and context-dependent.  

Disclaimer: This article is provided for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. 

About the author: Scott Muenzler is an ICF-certified professional coach who helps clients apply research-informed behavioral and perceptual retraining strategies for tinnitus and chronic pain. His work complements – but does not replace – medical care.

For clinicians interested to see how coaching integrates with medical care, there’s an article about that as well.

For clinicians: A PDF version of this article will be available shortly.

References

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29. Pryce H, Moutela T, Bunker C, Shaw R. Tinnitus groups: A model of social support and social connectedness from peer interaction. Br J Health Psychol. 2019;24(4):913-930. doi:10.1111/bjhp.12386