For clarity, please note, this page discusses a treatment in development, rather than an established treatment.
What is it?
Misophonia can be described as a severe sensitivity to certain trigger sounds or images, which is not dependent upon the intensity of the trigger, (so very quiet sounds may trigger the same response as much louder sounds). The trigger typically causes an intense emotional response such as rage, anger, anxiety or resentment. This is often accompanied by thoughts that the person is deliberately causing the sound (or whatever the trigger is). Triggers usually have the characteristics of being repetitive, and are most commonly related to sounds from the mouth, such as chewing, crunching, slurping, or breathing.
The reaction to a trigger may vary according to the individual’s state at the time; for example, tiredness may make the reaction more intense, or more difficult to manage. Triggers may also be specific to particular people, so someone might have a severe reaction to the sound of a partner’s breathing at night, but never experience anything more than mild annoyance with such sounds from other people and situations. Also, some people may be triggered by the sound of chewing, but also find the sight of someone eating triggers them, even when they’re out of earshot. It is quite common for triggers to be quite specific in the beginning, but over time become more wide-ranging.
It seems that this is not simply a reaction to ‘a sound’, as the origin and context of the sound often appear to be part of the trigger.
Misophonia is a relatively recent term, and as such there are no established diagnostic criteria, and equally, no established, evidence-based treatments (as of 2019). However, the condition is being researched, and a number of different methods have been applied to treat it, with varying degrees of success. It is also important to differentiate misophonia from other sound-related conditions such as hyperacusis (which is not sound-specific, and does not necessarily involve a strong emotional response), and phonophobia (a fear of a specific sound), although fear and anxiety may be experienced as a symptom of misophonia.
People experiencing misophonia often find the symptoms have a negative impact on their quality of life, as they seek to avoid triggering situations, and this can directly limit their socialisation, having an impact on relationships, work, travel, group activities, etc.
My recent experience of working with misophonia:
In 2018 a past client* decided to return to therapy to work on a particular issue, not directly related to misophonia. However, they mentioned having experienced misophonia symptoms since adolescence. These were triggered by eating sounds (particularly crunching and chewing), the sight of someone chewing (even when inaudible), and also at times visual triggers such as restless legs. The triggered emotion was mostly rage. As we began working on their initial therapy goal, I also researched misophonia, only to discover that there was very little published in terms of potential approaches to treatment.
We were working with a mindfulness-based therapy approach (ACT), and I recalled how certain mindfulness practices had seemed to have a significant impact on how I was experiencing specific annoying sounds. I also connected this with some of the neuroscience research into mindfulness, particularly regarding the way sensory inputs are subjected to top-down as well as bottom-up processing, and the way these processes are closely coupled. Most of this research has been into difficult sensory inputs such as the sensation of pain in the body, but it has shown that these processes become less closely coupled after mindfulness practice, making a change in the overall experience possible. In addition, I was aware of potential early life triggers for this client, so I suggested we could take a dual approach to the misophonia symptoms if they wished: Starting by shifting focus to specific mindfulness practices (although not to the exclusion of others), and then using EMDR therapy to reprocess those early memories, in case they were significant in the triggering of an emotional response to current sounds.
We completed four full sessions of EMDR therapy, with part of two more sessions being dedicated to that work. The client had also been actively working with a variety of mindfulness practices (not just meditations) for 10 weeks. At the conclusion of therapy the client was free of all misophonia symptoms, and was able to watch a video showing close-up footage of people eating noisy foods and chewing with their mouths open; they said that prior to the therapy work they wouldn’t have been able to watch more than a few seconds before being flooded with rage. They were also free from being triggered by people eating noisy foods in close proximity, such as a colleague eating an apple. Their personal impression was that the mindfulness practices had played a major part in this transformation of their experience.
*This client kindly gave permission for these details of their treatment to be shared to help in any development of this protocol.
Obviously, a successful outcome from a single case cannot be generalised to establish a new treatment for everyone. However, I have been working on developing a protocol based on this case, and using mindfulness practice as a core element. I am interested in finding several more clients to work with, to help me to determine what elements of this approach might be most helpful to people experiencing the symptoms of misophonia, and also if it is possible to reduce the amount of time in therapy sessions.
Initially, I am seeking clients with misophonia, who meet the following criteria:
- Are experiencing triggers from sounds (but may also have visual triggers)
- Are willing and able to commit to 30 minutes a day of mindfulness practices during the therapy, this is very, very important!
- Are prepared to commit to eight sessions of therapy, over approximately ten weeks.
- Are able to attend weekday afternoon sessions or on Saturday mornings.
Unfortunately, I do not currently have any research funding, but I am offering a reduced rate of £40 per session, to reflect the developmental nature of this treatment. As a result, I also have very limited places available, but if you’re interested in taking part, please either e-mail me or call me on 07831 693684.