Resources that may be of particular interest to people experiencing Misophonia, their families and health professionals.
What is Misophonia?
Misophonia is an extreme emotional reaction to certain everyday sounds that most people would find relatively easy to ignore. The three main types of sounds that disturb individuals with misophonia are eating, nose and throat sounds and repetitive environmental sounds like keyboard tapping and rustling paper.
Whilst many people find these noises annoying, individuals with misophonia describe an intense feeling of disgust, anger, distress or panic that escalates while the sound is still present. This can happen even when the sound is at a very low volume. They report physical sensations similar to a “flight or fight” response, including racing heart, short of breath, tension, feeling hot, and sometimes an unwanted groinal response. They often describe a sense of feeling trapped, helpless and out of control when they can’t get away from these sounds.
"I am filled with an all-consuming and overwhelming rage and hatred for the person sitting there near me sniffing constantly... to the level where you want to rip your own ears off rather than hear the sound anymore.”
An individual can be considered to have clinically significant misophonia when it causes frequent distress and has an impact on daily living, work, study and/or relationships. This might include anxious anticipation of sounds before they happen, replaying sounds after the event, feeling guilty or embarrassed about one's own reactions, thinking a lot about the person making the sound, verbal outbursts and avoidance of things one would otherwise like to do (for fear of encountering sounds). They might report low mood, anxiety, sleep problems, family tensions, inability to relax in the home and trouble focusing.
At the more severe level, individuals may be unable to work or attend school, have trouble maintaining relationships, feel near constant distress, and may contemplate ending their life. Because misophonia is not well known, people often feel isolated and struggle to get support from family, friends and health professionals.
“There is no escape from the triggers; even home is not a safe place. I have often been suicidal myself. Misophonia has the potential to be life threatening.”
There are many individual differences in the experience of misophonia, demonstrating the complexity of the condition. Some people tell us they react more strongly to sounds made by those close to them, others are more impacted by the sounds made by strangers. Some have been bothered by these sounds for as long as they can remember, others recall a particular time where their reactions to sounds got a lot worse and some can pinpoint a particular event when their sound sensitivity suddenly developed. While one person might react to a wide range of sounds, another might only be affected by one specific sound. Some may react in certain circumstances, but the same noise may not bother them at other times. Many individuals with misophonia also report that they also react to repetitive movement (misokinesia), such as leg shaking, fidgeting or blinking lights.
“Misophonia is the most debilitating, lonely place to be in.”
Severity of misophonia is measured based on the level of distress it causes and the impact it has on an individual’s life.
This description of misophonia was written in consultation with a misophonia support group on social media.
Can treatment help?
There is some evidence that cognitive behavioural therapy (CBT) can be helpful for people with misophonia. It is likely to be especially helpful for those with more severe misophonia that significantly disrupts daily living or causes distress on most days.
We think at the core of misophonia is a variation in sensory processing, which includes heightened attention to certain sounds that could be a sign of potential contamination (e.g. illness from breathing through a blocked nose, spreading illness through spit when eating with mouth open) or a potential “predator” (e.g. footsteps, tapping and rustling sounds). This is the part that might not be able to change with therapy.
However, therapy may be helpful for with more severe misophonia, for example those whose reaction feels like a "flight or fight” type feeling, or if they feel trapped, panicked or helpless around sounds. In particular, therapy can help if the impact of the sound exists even when the sound is not present (e.g. taking a long time to “wind down” from a reaction, worrying about sounds in advance or having lasting impacts on work or relationships).
Therapy may also be helpful for those with co-existing conditions that cause misophonia to be worse (or is made worse by misophonia).
Aims of treatment
The main aims of CBT for misophonia are to reduce the intensity of the reactions to sounds and to minimise the impact that sounds have on the person’s life. Because misophonia is influenced by the individual’s past experiences, current circumstances, beliefs and personality, there is not one set protocol for therapy.
We will aim to:
• Develop a shared understanding of the problem, including the beliefs that “feel true” in the moment and what you do in response to those beliefs
• Use the S-Five, a questionnaire for misophonia, to understand the complexities of misophonia and to monitor your progress across sessions
• Set some goals together about what the person would like to change
• Design experiments and test out ideas
• Exercises to shift those felt-sense beliefs that you suspect may not reflect reality
• Strategies to better identify and understand your emotions
• Identifying possible links between your current feelings and past experiences, and processing any relevant memories
• Using imagery (and humour) to reducing the intensity of the reaction to sounds
• Reclaiming your time when there are no sounds present
• Processing and letting go of anger
• Developing tools for communicating with important people in your life to support you with your sound sensitivities
• Identifying and problem solving any other issues that might be exacerbating your reactions to sounds
• Working out suitable accommodations to minimise the impact of sounds on living a fulfilling and contended life.
OHPSIC will liaise with local teams to ensure that the work on overcoming misophonia can successfully continue, including offering joint work and supervision, as necessary. Home visits or out of office sessions will be included and encouraged as part of joint work with local teams.