that treatment failures in general--no matter the medical issue-- quite often result in a "blame the patient" conclusion. Whether or not this is fair, accurate, or even relevant in the treatment of tinnitus, I'm not prepared to say, but that was my first impression after a quick perusal of the article.

I do not know how this is helpful to patients. If true, it seems to suggest the need for a psychological referral for the majority of these patients---just as we all too often do for chronic or neurologic pain (especially among those practitioners who really do not understand the full spectrum of pain and their origins/different pathogenesis).

Maybe this approach will be validated, but this leaves me a bit disquieted and thinking oh, no, not again...

Seems to me, also, that it’s BS, since common sense indicates that tinnitus patients who do not improve after so much treatment might experience increased distress, anxiety, etc., leading to the data which show they score lower on the Big 5, while those who improve will naturally be happy, more agreeable, etc.

So the clinical results are the cause.

Also, an ENT recently told me that amitriptyline, a personality sledgehammer is, still, the frontline drug used to treat it.

Is that what I read?
Personally, and what doctors have told me, I believe it has more to do with stress than anything else. When I am more stressed, it gets worse.