TRT — Tinnitus Retraining Therapy — was developed by Pawel Jastreboff in the 1990s and has been one of the most influential frameworks in tinnitus care since. It is not a fancy white noise machine, though sound is part of it. It is a structured programme of two things: directive counselling and long-term sound enrichment.
The model says tinnitus only causes suffering when the limbic system has wrongly tagged it as a threatening signal. The counselling part explicitly walks you through how the auditory and limbic systems work, the neurophysiology of habituation, and why the sound is not dangerous. The sound part is broadband, low-level, all-day sound enrichment delivered through hearing aids, ear-level generators or simply environmental sound, kept just below the tinnitus rather than masking it.
The pairing matters. Counselling without sound is half the protocol; sound machines without the framing are the other half. The Cochrane review of TRT is mixed because trials vary in fidelity, but high-fidelity TRT outperforms most comparators.
It is slow — months — and requires a clinician trained in the model.