Misophonia Treatment: Misophonia (also known as selective sound sensitivity syndrome) is a condition characterised by negative reactions to specific auditory stimuli. The negative reactions predominantly relate to anger.
The sounds can be common everyday sounds that most people would normally dismiss or barely remember hearing as the sounds don’t have to be particularly loud.
Misophonia usually starts as a negative reaction to soft sounds but can also become a negative reaction to visual stimuli that accompany those sounds. Misokinesia is the hatred of seeing specific movements.
The prevalence of misophonia is not fully understood, but some symptoms have been reported as early as mid-childhood. Research completed on a group of medical students found nearly half of the sample to have some level of sound sensitivity. A third of the sample was found to have mild symptoms and less than one percent had severe misophonia symptoms.
The term misophonia literally translates as a “hatred of sound”.
Misophonia Treatment: What causes misophonia?
The exact causes of misophonia are not fully understood, but a number of issues can contribute the condition. They can include an over-activation of certain parts of the brain (limbic and autonomic nervous system) responsible for processing emotions and the connections to the auditory cortex. In other words, it’s related to how sound affects your brain and automates the responses in your body. Whilst these tests have been done on subjects who already have misophonia, it may not verify whether the parts of the brain have developed as a result of individual learned or conditioned responses see below).
Causes can also be attributed to neurological disorders like Tourette syndrome, OCD and other anxiety-related disorders. Misophonia may also run in families, indicating a genetic link that can increase your risk of developing the condition.
Misophonia is particularly common with those who suffer with tinnitus.
Misophonia Treatment: How is misophonia learned?
For the sufferer of misophonia, common sounds which others may take for granted can be compared to hearing “nails on a chalkboard” on a regular basis. There is a constant, intense agitation when hearing those misophonic sounds that can take someone to the level of rage.
Misophonia usually starts during late childhood and early adolescence, affecting more females than males, and affecting those with higher IQ’s.
Sounds that cause the negative reaction can be learned by association from a variety of situations. Those sounds then become connected to the negative emotion and when those sounds are heard again, the negative emotion is re-experienced. Situations in which you associate those sounds can include:
- When you are trying to concentrate on something importantg. having a conversation, doing an assignment or work project etc.
- When you are trying to relaxg. when reading, watching television, falling asleep etc.
- When you are experiencing anxiety or stressg. social anxiety whilst eating and hearing cutlery sounds, when dogs barking or traffic sounds are heard after you have woken early, repetitive sounds like clocks ticking heard during periods of abuse, hearing neighbours playing music late at night when you have to wake early for work.
- When you have a medical condition or are experiencing medical changes that are affecting your tolerance to those sounds.
- When you have communicated your condition to others and they have mocked or teased you (rather than help you), by imitating the sounds that cause your distress. This may inhibit you from being open about the condition in the future in case it is met with ridicule again.
- When you have high expectations and you need the world around you to meet those expectations. Anger can be experienced when expectations are not being met. This can make your negative reaction harder to manage when compared to someone else who is able to moderate their expectations and lower their anger reaction.
Misophonic triggers can associate first in situations with one’s parents or primary caregivers. They can then be learned in situations with immediate family like siblings, friends or work colleagues where a significant amount of time is spent with them. Tolerance is usually given to those people with whom you have a close relationship, but the reaction can still be present regardless of the company.
Misophonia can intensify over time, rapidly and uncontrollably trapping more triggers or stronger reactions for the individual - in the same way that an infectious disease might spread. Or for some sufferers, misophonic learning can hit a peak and then can subside where there is a significant lifestyle change.
Infrequent situations with strangers in adulthood can set up new misophonic triggers, but they usually act as reinforcing events that exacerbate the situation created earlier during childhood.
With chronic misophonia, some people may abuse substances like alcohol or drugs to cope with the severity of the condition. Whilst these substances give some immediate relief to the negative reaction, in the long term they can increase your sensitivity to your misophonic triggers. There are other health risks associated with substance misuse.
Long-term sufferers with misophonia experience a diminished quality of life, trying to avoid sounds that can be heard in so many situations of everyday life. Constant panic and paranoia can develop when chronic misophonia is untreated.
Other sound-sensitive conditions related to misophonia
Misophonia differs from other sound sensitivity-related conditions, but can exist alongside these other conditions. Hyperacusis is a condition in which you are sensitive to sound and feel discomfort at a certain frequency or volume, whereas with misophonia, the negative reactions can be triggered at any volume of sound, including low volume sounds.
Phonophobia is a type of phobia dominated by a fear of certain sounds that are usually loud and unexpected e.g. from a popping balloon or from a firework. When hearing those loud sounds it typically causes a panic attack. As mentioned earlier, the dominant emotion with misophonia is usually anger.
Common with all of these conditions is a degree of anticipation and hyper-vigilance in which the autonomic nervous system prepares you for danger when hearing these specific sounds. Your negative over-reactions can become conditioned by the various sound-related triggers, intensifying and automating your reaction.
Misokinesia is the negative reaction to seeing specific movements that may originally be associated with the “misophonic” sounds. For example, a negative reaction of anger to the sound of nail biting can rapidly become a negative reaction to seeing someone who has the habit of biting their nails, regardless of whether you can hear them bite their nails or not. It is thought that the parts of the brain responsible for filtering these misophonic sounds can then provoke other neural processing problems.
Misophonia Treatment: Sounds that can trigger misophonia
The majority of the sounds that trigger a misophonic response are created by the human body, but some can originate from inanimate objects. Ironically, misophonia sufferers do not experience the same level of irritation when they produce the same sounds themselves.
Below is a list of common misophonic sounds. The sounds that trigger your negative reaction can be specific to your situation.
Vocal sounds – breathing, snoring, snorting, throat-clearing, sneezing, sniffing, sniffling, hiccups, burping, whistling, humming, singing, yawning, screaming, specific voice sounds, specific types of crying, general “din” from group conversation or children in playgrounds, several people talking simultaneously, words pronounced incorrectly, etc.
Non-vocal sounds – nail-biting, finger tapping, knuckle-clicking, fidgeting, passing wind, kissing etc.
Meal time sounds -, chewing, chomping, crunching, swallowing, drinking, sucking, slurping, lips-smacking, culinary sounds, clinking of glasses, utensil/plate sounds, saying “ah” after a drink, talking whilst eating etc.
Sounds from inanimate objects – food packaging noises, ballpoint pen clicking, rustling papers, writing sounds, flossing, nail clipping, keyboard typing, mouse clicking sounds, board writing, cleaning sounds, windscreen wipers, general traffic, ticking or chiming clocks, drills, ringing phones and other phone sounds, ringing bells, buzzing sounds, lawn mowers, air conditioning noises, refrigerators, car doors slamming, electric toothbrushes or razors, taps dripping, other household appliances etc.
Musical sounds – specific genres of music, percussive rhythm, sounds from specific instruments etc.
Animal/insect sounds - Dogs barking or whining, claws scratching, pets licking their fur, birds chirping, insects buzzing, crickets chirping,
Environmental sounds – Various weather sounds e.g. rain, wind etc.
Some sounds can become visual annoyances (misokinesia) – repetitive motion, foot wagging, nose rubbing, hair twirling, nail biting, yawning, thumb sucking, lip movements, nose, ear or skin picking, inner cheek biting, removing food in-between teeth etc.
What affects the severity of your reaction?
As a sufferer of misophonia, the sensitivity of your reaction can be variable depending on:
- Your emotional state in that situation.
- The frequency, repetition and loudness of the noise.
- Your previous evaluations of that sound.
- The conditions in which those sounds were experienced.
- How your medical conditions are affecting your experience.
- You may be able to tolerate the sounds more when you have a close relationship with the person making the sound.
Your reactions typically become more intense when you are unable to change the situation from which the sounds are being made or alter your reactions.
Signs, symptoms and diagnosis of misophonia
The signs and symptoms of misophonia include:
- Anger or rage.
- Guilt or shame from your expression of anger.
- Panic attacks.
- Feeling of claustrophobia or need to escape the situation quickly which can be connected with agoraphobia.
- Self isolation and loneliness.
- Crying related to your intense irritation or agitation.
- Teeth grinding (bruxism) as a symptom of suppressed anger.
- Inability to communicate or move.
- Violent or impulsive thoughts towards others or towards the source of the noise.
- Frustration resulting in mimicking or mocking those sounds.
With regards to a diagnosis of misophonia, your GP who may refer you to an ENT specialist or audiologist who can help you manage the condition.
Common misophonia treatments
There are few evidence-based misophonia treatments. Current misophonia treatments can include cognitive behavioural therapy in which you challenge your negative thoughts. Medication can also be prescribed from your GP to treat the anxiety and depression associated with misophonia.
Another type of misophonia treatment is Tinnitus Retraining Therapy (TRT) which can also benefit those with misophonia. With this treatment, devices are worn to help you ignore or divert your attention away from your misophonic noises. It can also include learning relaxation techniques to lower your stress response.
Other self-help coping strategies can include using earplugs or headphones when you feel overwhelmed by your misophonic noises. You may also benefit by using other background noises like music, the television or “white noise” to drown out your misophonic noise.
Other self-help strategies can include learning new ways to manage stress, changing your proximity to those sounds in a situation and establishing a moderated exit from the situation where it is reasonably possible.
Being open about your condition and assertively communicating your needs to others may help them to assist you by empathising with you or by moderating their habits where possible. Learning ways to reinterpret your perception of those sounds and your reactions is fundamental to misophonia treatment.
Misophonia treatment using hypnotherapy
Hypnotherapy can treat your misophonia in a controlled environment
Your alertness and sensitivity to the sounds that irritate you is maintaining this sound-reaction loop. Hypnotherapy can help you to detach your emotional reaction in a controlled environment, learning to stay relaxed as you are progressively reintroduced to those sounds. In hypnosis, you can accept positive suggestions or affirmations to target your misophonia reactions. This approach is similar to “Sequent Re-patterning” techniques, and “Exposure Response Prevention” techniques used in the treatment of OCD.
Control your anger and stress response
When you suffer with misophonia, your anger and stress response has become automated and is now overwhelming you. The intensity of your anger and stress is magnifying your perception of those irritating sounds. Being mindful of your anger in hypnosis will enable you to observe how it is affecting you at the sensory, cognitive, emotional and behavioural levels. Relearning how to control your anger will further assist the dissociation of your response to those sounds.
Treat anticipatory anxiety
The demands you need to cope with the noises in the situation can be exaggerated by your anxious anticipation. You will build up your negative emotional response before you actually hear those sounds, waiting for the sounds to be triggered. You may even imagine those sounds to be audible in the situation, even in their absence. Managing your anticipatory anxiety will enable you to separate and disconnect this anxious build-up so that you can apply positive techniques when it’s needed.
Assist your desensitisation (controlled exposure)
Desensitisation (also known as controlled exposure) is an effective dissociation process. It is commonly used in the treatment of phobias. By itself, the method can be cumbersome however. When combined with hypnotic techniques, the desensitisation process can be accelerated. In hypnosis, you can mentally rehearse confronting those irritating sounds with a calmer response, acting as if you have already completed the desensitisation practice with a positive emotion.
Treat the causes of your misophonia
Regression to release the emotion from the significant past sensitising events can be an effective tool in a treatment programme. This does not mean arduously tracing through every year of your life as is often considered by solution focused hypnotherapy. Instead, only the most relevant experiences are reappraised, enabling you to appreciate your beliefs and conflicts that may have exacerbated your condition in its early development. With effective regression, you can then freely move forwards with the achievement of your goals.
Visualisation of your desired positive response
Visualisation can act as rehearsals for how you want to cope with those irritating noises. In hypnosis, you can enhance your visualisation abilities, engaging more of your imagination, your thinking, your emotions and beliefs into the experience. This can accelerate your learning potential to positively change your negative misophonic reactions when you are not in the “live” noisy situations that are currently distressing you.
Hypnotherapy can help you communicate your needs
Being assertive (rather than being aggressive), communicating your needs, being prepared to handle conflict and believing that you have “rights” can prevent you from suffering in silence (or should that be – in noise!?) for extended periods and then overreacting. Hypnotherapy can explore your approach and identify where you can communicate effectively.
For more information on misophonia treatment using hypnotherapy, contact Richard J D’Souza Hypnotherapy Cardiff