Living with misophonia might feel hopeless, especially given the relatively small amount of research that has been done to explore this issue. But as more mental health professionals develop an awareness of misophonia, people have a better chance of discovering treatment methods that work for them and minimize their symptoms. If you experience mild to severe aggravation in response to specific noises, consider talking to a psychotherapist about misophonia. The more people who come forward to talk about misophonia, the better the chances of treatment evolving to meet the needs of people with misophonia.
- Misophonia Test and Diagnosis
- Finding a Misophonia Cure
- How to Deal with Misophonia
- Therapy and Treatment for Misophonia
- Case Examples of Therapy for Misophonia
Misophonia Test and Diagnosis
There is no one protocol for identifying or diagnosing misophonia. To determine whether someone has misophonia, a therapist will likely require a detailed case history including when the person began experiencing symptoms, what their triggers are, their reactions, and any co-occurring mental health conditions. Beyond this detailed intake, the therapist might also have a person complete one of several available questionnaires about misophonia.
Questionnaires are a method of self-reporting that evaluate misophonia-related symptoms, as well as the person’s emotional reactions to triggers. Through questionnaires and/or interviews, the therapist will assess the time a person spends focusing on misophonia; the degree to which it interferes with social functions; the person’s level of anger; their impulse control and control over thoughts and anger; and the time the person spends avoiding situations contributing to misophonia. Some therapists or psychologists might also perform hearing tests or test the person’s loudness discomfort levels.
Finding a Misophonia Cure
There is currently no cure or pharmaceutical treatment for misophonia. Some people might be prescribed an antidepressant or anti-anxiety medication to help reduce symptoms or address co-occurring mental health issues. There are also various therapeutic approaches to help manage symptoms.
In some cases, especially for people with tinnitus who also experience misophonia, ear training therapies can substantially alleviate misophonia. Tinnitus retraining therapy (TRT) alters subconscious conditioned reflexes, dulling or eliminating the connection between the auditory system and the limbic and autonomic nervous system. Similar to eye movement desensitization and reprocessing (EMDR), TRT aims to rewrite or rewire negative emotional connections to a sensation and reinforce positive emotional connections with pleasing sounds. Though these approaches have been effective in some cases, they are not guaranteed to work for all people with misophonia and are not clinically proven.
How to Deal with Misophonia
People who live with misophonia can help make the experience easier in some cases by wearing headphones or earplugs, counteracting triggering noises with sounds they find calming, and talking to people they are in continuous proximity to about the issue. Educating others about misophonia may help them be more mindful of actions that may be triggering to the person with misophonia. These actions likely will not address the underlying triggers of misophonia, but they can help someone live more comfortably.
Some people with misophonia turn to alcohol or other drugs to cope with their sound sensitivity and reactivity. Mind-altering substances can have a short-term effect of making symptoms more manageable, but their longer-term impact can heighten sensitivity and emotional overwhelm. People with misophonia are encouraged not to use substances for self-medication.
Therapy and Treatment for Misophonia
Therapy might focus on helping a person manage the fight/flight/freeze response initiated by a trigger, control the anger that arises, and develop positive ways of talking to family, friends, and coworkers about monitoring triggers they are responsible for. A therapist may encourage the person with misophonia to experiment with calming imagery, soothing noises, and meditation—especially when confronted with a triggering sound. In a process called counterconditioning, the therapist leads a person through a cycle of exposure to triggers and positive reinforcement, eventually diminishing the negative trigger response.
Though there are not yet therapeutic approaches specific to misophonia, established modalities such as cognitive behavioral therapy seem to have a positive impact in reducing symptom severity in people with misophonia. Mindfulness-based therapies and treatments for anger management also seem to work for alleviating emotional overwhelm related to misophonia. Researchers theorize that introducing these therapies to adolescents who are exhibiting anger issues may help reduce misophonia severity or a person’s likelihood of developing misophonia later in life.
Because research on misophonia is lacking and it is not yet included in the Diagnostic and Statistical Manual (DSM-5), public reaction isn’t always accepting of the condition or those who live with it. But the more people discuss misophonia, the more the field of psychotherapy and individual therapists may acknowledge and respect the process of helping people achieve more peace with the condition and live more fully.
Case Examples of Therapy for Misophonia
- Misophonia since adolescence: Sufi, 32, experienced feelings of rage related to certain audio triggers since her early teenage years. At first her reactions were isolated to her father, who tended to slurp his coffee relentlessly and whistle while doing chores. Her family convinced her that these issues were typical signs of a teenage temper, but as she grew up, the triggers didn’t go away. If anything, they got worse. It takes a couple tries to find a therapist who acknowledges the condition as misophonia rather than a byproduct of anxiety, but finally Sufi finds relief through talk therapy, guided meditation, self-care, and some anger management workbooks that her therapist recommends.
- Co-occurring misophonia and obsessive-compulsive issues: Robin, 44, has noticed that the OCD he’s lived with since it was diagnosed in his 20s has gotten worse since his divorce. He’s been meaning to return to therapy to address the new obsessions and compulsions he has noticed, but in the past two years he has found a more pressing issue: persistent anxiety and agitation related to sounds around him. His coworkers’ gum chewing and pen clicking are the worst of several triggers, and he can neither find relief in his office nor understand why these issues have been so grating lately. Robin finally revisits therapy with a counselor who is aware and understanding of misophonia, and helps him identify triggers and coping mechanisms, as well as address the prevailing OCD symptoms Robin experiences.
- Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. S. (2013). Misophonia: physiological investigations and case descriptions. Frontiers in Human Neuroscience, 7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691507/
- Palumbo, D. B., Alsalman, O., De Ridder, D., Song, J. J., & Vanneste, S. (2018). Misophonia and potential underlying mechanisms: A perspective. Frontiers in Psychology, 9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034066/
- Schneider, R. L., & Arch, J. J. (2017). Case study: a novel application of mindfulness-and acceptance-based components to treat misophonia. Journal of Contextual Behavioral Science, 6(2), 221-225. Retrieved from https://www.sciencedirect.com/science/article/pii/S2212144717300285
- Schröder, A. E., Vulink, N. C., & Denys, D. (2013). Misophonia: diagnostic criteria for a new psychiatric disorder. PLoS One, 8(1), e54706. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054706
- Schröder, A. E., Vulink, N. C., van Loon, A. J., & Denys, D. A. (2017). Cognitive behavioral therapy is effective in misophonia: an open trial. Journal of Affective Disorders, 217, 289-294. Retrieved from https://www.sciencedirect.com/science/article/pii/S0165032716321681