DEALING WITH MISOPHONIA: THERAPIES AND COPING STRATEGIES
NB: MISOPHONIA UK DOES NOT GIVE MEDICAL ADVICE. We list these therapies and coping strategies as an informational aid only and make no representation whatsoever as to their efficacy. In all cases, if you believe you have misophonia/selective sound sensitivity syndrome, you should see your family doctor or ask them to refer you to a consultant with expertise in the condition. You should ask to see an audiological physician (ideal but hard to find!) or ENT (ear, nose and throat) surgeon. Last content review: 12 September 2011.
NB: MISOPHONIA UK DOES NOT GIVE MEDICAL ADVICE. We list these therapies and coping strategies as an informational aid only and make no representation whatsoever as to their efficacy. In all cases, if you believe you have misophonia/selective sound sensitivity syndrome, you should see your family doctor or ask them to refer you to a consultant with expertise in the condition. You should ask to see an audiological physician (ideal but hard to find!) or ENT (ear, nose and throat) surgeon. Last content review: 12 September 2011.
THERAPIES
There is currently no cure for misophonia/selective sound sensitivity syndrome (SSSS). The following therapies are said to have helped certain patients with their symptoms:
There is currently no cure for misophonia/selective sound sensitivity syndrome (SSSS). The following therapies are said to have helped certain patients with their symptoms:
Tinnitus Retraining Therapy (TRT)
Tinnitus Retraining Therapy uses a combination of sound therapy and teaching/demystification/learning about mechanisms, with directions about how to return to normal life without provoking symptoms. It is based on the work of Professor Pawel Jastreboff who coined the term misophonia. TRT is aimed primarily at those with tinnitus and hyperacusis but Prof Jastreboff has claimed success with people suffering from misophonia. It should be mentioned that Dr Marsha Johnson believes that Prof Jastreboff may have had success with people with misophonia who dislike all sound but not those with selective sound sensitivity syndrome. For further information, click here.
Tinnitus Retraining Therapy uses a combination of sound therapy and teaching/demystification/learning about mechanisms, with directions about how to return to normal life without provoking symptoms. It is based on the work of Professor Pawel Jastreboff who coined the term misophonia. TRT is aimed primarily at those with tinnitus and hyperacusis but Prof Jastreboff has claimed success with people suffering from misophonia. It should be mentioned that Dr Marsha Johnson believes that Prof Jastreboff may have had success with people with misophonia who dislike all sound but not those with selective sound sensitivity syndrome. For further information, click here.
Habituation Therapy [THIS ENTRY IS PROVISIONAL ONLY - PLEASE AWAIT UPDATE]
Dr Marsha Johnson advocates habituation therapy as developed by Dr Pawel Jastreboff in the 1980s. She claims as many as three-quarters of her patients have shown significant improvement during therapy, and that the use of broadband sound generators, combined with supportive family and patient follow-up, has provided both short term and long term relief. The units engage the auditory system and lessen the amount of auditory contrast between a quiet background noise floor and the offending trigger sounds. While the use of these devices does not appear to result in long-term recovery or diminution of the 4S symptoms, it eases the severity of the reactions and allows the wearer to enjoy more of daily life. Click here.
Dr Marsha Johnson advocates habituation therapy as developed by Dr Pawel Jastreboff in the 1980s. She claims as many as three-quarters of her patients have shown significant improvement during therapy, and that the use of broadband sound generators, combined with supportive family and patient follow-up, has provided both short term and long term relief. The units engage the auditory system and lessen the amount of auditory contrast between a quiet background noise floor and the offending trigger sounds. While the use of these devices does not appear to result in long-term recovery or diminution of the 4S symptoms, it eases the severity of the reactions and allows the wearer to enjoy more of daily life. Click here.
Cognitive Behavioural Therapy (CBT)
The Royal College of Psychiatrists defines cognitive behavioural therapy as a way of talking about:
If you are not sure you want to commit to a long course of sessions with a clinical psychologist, there are various resources on the Internet which will provide an introduction to CBT or even a course of computer-aided CBT sessions:
The Royal College of Psychiatrists defines cognitive behavioural therapy as a way of talking about:
- How you think about yourself, the world and other people
- How what you do affects your thoughts and feelings.
If you are not sure you want to commit to a long course of sessions with a clinical psychologist, there are various resources on the Internet which will provide an introduction to CBT or even a course of computer-aided CBT sessions:
- Developed by the Australian National University, MoodGYM is a fun, free interactive web program that teaches the principles of CBT using flashed diagrams and online exercises. It demonstrates the relationship between thoughts and emotions, and works through dealing with stress and relationship break-ups, as well as teaching relaxation and meditation techniques. It consists of five modules (why you feel the way you do, changing the way you think, changing ‘warped’ thoughts, knowing what makes you upset, assertiveness and interpersonal skills training), an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment. Scientific trials have shown that using two or more modules is linked to significant reductions in depression and anxiety symptoms. These benefits last after 12 months. MoodGYM has won several IT and health awards, and has over 200,000 users worldwide. Click here.
- Living Life to the Full is a free online life skills course for people feeling distressed. It aims to provide easy access to CBT skills in a way that cuts through jargon. It helps you understand why you feel as you do, and to learn new ways of improving how you feel, by making changes in your thinking, activities, sleep and relationships. The course is based on the idea of helping you to help yourself. It is supported by a series of CBT self-help workbooks that can be used between the e-learning sessions. These encourage you to put what you are learning into practice, and to stop, think and reflect on what you are learning. Click here.
- FearFighter delivers CBT over the internet, useful for those who may be concerned about the stigma associated with seeing a therapist. Taking only three months to complete, with minimal telephone support, FearFighter helps you improve even if you have virtually no computer skills.
You are encouraged to use FearFighter as often as you wish but for at least once a week. It helps you identify specific problems, work on realistic treatment goals, and monitor achievement of those goals by repeated self-exposure. You get scheduled brief helpline support to a total of one hour over 10 weeks.
FearFighter helps you to work out exactly what brings on your fear, so you can learn how to face it until it subsides. This is called exposure therapy.
It consists of nine steps that need to be worked through one by one to obtain the greatest benefits. Like a therapist, FearFighter asks you to return every week to report on how you’ve been doing. You can ask it to print out questionnaires and graphs of your progress. It guides you through CBT as much as a therapist does.
Step 1: Welcome to FearFighter
Introduces the system, asks you to rate your problem on the Fear Questionnaire (FQ) and Work & Social Adjustment Scale (WSA), and asks about suicidal feelings and alcohol misuse.
Step 2: How to Beat Fear
Explains the principles of CBT, with case examples. You are asked to keep a daily record of your triggers.
Step 3: Problem Sorting
Helps you identify your triggers, shows you scenarios relevant to your problem, and helps you personalise your triggers and rate them on a 0-8 scale.
Step 4: How to Get a Helper
Explains the value of recruiting a CBT co-therapist and gives hints on how to find one.
Step 5: Setting Goals
Guides you through the process of setting good goals and tests them. You record and rate these on the system and can print personalised homework diaries.
Step 6: Managing anxiety
Offers a menu of coping strategies for use during CBT homework.
Step 7: Rehearsing Goals
Guides you on how to practise personal coping strategies during both imagined and live CBT homework.
Step 8: Carrying On
Reviews progress with the help of graphs, allows new goals to be devised, and offers feedback and advice.
Step 9: Troubleshooting
Offers a menu of tips on overcoming common sticking points in treatment.
You may have found that when you avoid things that make you panic or feel uncomfortable, the situation tends to get worse and worse. FearFighter can teach you how to face your fear until you adapt and no longer want to run away from it. It helps you learn to face the things that make you panic, such that, with time, you’ll find that, one by one, they’ll get easier.
Self-exposure therapy guided by computer is as effective as clinician-guided therapy and both are superior to relaxation to improve phobia/panic. FearFighter has been tested in four clinical trials and is as effective as the best CBT therapists.
Approved by the National Institute of Clinical Excellence (NICE), free access can only be prescribed by your doctor in England and Wales. Click here.
Hypnosis
Some people have found that psychotherapeutic hypnotherapy has helped them to become calmer and more relaxed and thus better able to deal with their misophonia indirectly.
Here is a useful article entitled "5 misophonia-beating tips you can apply today" by Mark Tyrell at Uncommon Knowledge. Also, listen to Mark's 3-minute self-hypnosis track designed to alleviate misophonia. If you like that, you may want to try their half-hour long, paid-for, version. Or try their misophonia script. There is a testimonial from a real person here. Mark is a successful therapist, trainer and former psychiatric nurse.
Some people have found that psychotherapeutic hypnotherapy has helped them to become calmer and more relaxed and thus better able to deal with their misophonia indirectly.
Here is a useful article entitled "5 misophonia-beating tips you can apply today" by Mark Tyrell at Uncommon Knowledge. Also, listen to Mark's 3-minute self-hypnosis track designed to alleviate misophonia. If you like that, you may want to try their half-hour long, paid-for, version. Or try their misophonia script. There is a testimonial from a real person here. Mark is a successful therapist, trainer and former psychiatric nurse.
Colour noise
Colour noise can be used to mask offending sounds, usually by playback through earphones or headphones. A noise's "colour" simply refers to the bias it has towards a certain range of frequencies. Although there are a wide range of colours, the ones generally used by people with misophonia to mask trigger sounds are white noise and pink noise. These are available commercially, and by downloading free files from the Internet. It is worth experimenting to see which, if any, work for you. Brown noise is another possibility. NB1 Always satisfy yourself that an Internet file comes from a reputable source before downloading it to your computer. NB2 Some practitioners claim that overuse of colour noise will aggravate misophonia. Misophonia UK is not aware of any research to back up those claims but caution is advised.
Click here to go to the Misophonia UK Emporium where various commercial noise products are on sale.
Nature's Tapestry sell Sleepeze in-ear white noise generators and nature sound machines.
Enhanced Listening sell SnoreMasker Pro In Ear White Noise Machines and Tinnitus Management Devices. For further information on SnoreMasker, go here: http://snoremasker.com/index.htm.
Puretone offer a wide range of in-ear white noise generators (both off the shelf and custom made).
PureWhiteNoise offer a large selection of white noise CDs and MP3 downloads. They cite the following reasons why their products might be superior to a white noise machine. Most white noise generators use small "loops" that play the same sound over and over. These short bursts of sound can become quite annoying over time, perhaps creating more anxiety rather than relaxation! Pure White Noise CDs and MP3s offer real 60 to 74 minute digital recordings in broadcast-quality stereo. The tiny mono speaker on a white noise machine cannot reproduce the full spectrum of frequencies that make up pure white noise. Most white noise generators do not offer bass and treble controls to add both low-end bass and high-end treble when you need it. Pure White Noise also offer multiple versions of the same genre of sounds, with different tempos, pitch and tones, to help you find what works for you.
Pure White Noise are kindly offering visitors to this website 10% off. Simply quote coupon code MIS10 when you order at PureWhiteNoise.com.
NB With all noise-cancelling products, ensure that you are still able to hear fire/smoke/heat/carbon-monoxide alarms and other security devices.
Colour noise can be used to mask offending sounds, usually by playback through earphones or headphones. A noise's "colour" simply refers to the bias it has towards a certain range of frequencies. Although there are a wide range of colours, the ones generally used by people with misophonia to mask trigger sounds are white noise and pink noise. These are available commercially, and by downloading free files from the Internet. It is worth experimenting to see which, if any, work for you. Brown noise is another possibility. NB1 Always satisfy yourself that an Internet file comes from a reputable source before downloading it to your computer. NB2 Some practitioners claim that overuse of colour noise will aggravate misophonia. Misophonia UK is not aware of any research to back up those claims but caution is advised.
Click here to go to the Misophonia UK Emporium where various commercial noise products are on sale.
Nature's Tapestry sell Sleepeze in-ear white noise generators and nature sound machines.
Enhanced Listening sell SnoreMasker Pro In Ear White Noise Machines and Tinnitus Management Devices. For further information on SnoreMasker, go here: http://snoremasker.com/index.htm.
Puretone offer a wide range of in-ear white noise generators (both off the shelf and custom made).
PureWhiteNoise offer a large selection of white noise CDs and MP3 downloads. They cite the following reasons why their products might be superior to a white noise machine. Most white noise generators use small "loops" that play the same sound over and over. These short bursts of sound can become quite annoying over time, perhaps creating more anxiety rather than relaxation! Pure White Noise CDs and MP3s offer real 60 to 74 minute digital recordings in broadcast-quality stereo. The tiny mono speaker on a white noise machine cannot reproduce the full spectrum of frequencies that make up pure white noise. Most white noise generators do not offer bass and treble controls to add both low-end bass and high-end treble when you need it. Pure White Noise also offer multiple versions of the same genre of sounds, with different tempos, pitch and tones, to help you find what works for you.
Pure White Noise are kindly offering visitors to this website 10% off. Simply quote coupon code MIS10 when you order at PureWhiteNoise.com.
NB With all noise-cancelling products, ensure that you are still able to hear fire/smoke/heat/carbon-monoxide alarms and other security devices.
Abdominal breathing
Abdominal breathing, also known as diaphragmatic or Hara breathing, is a tried and tested technique for ameliorating panic reactions. Practised for only ten minutes a day, it has associated health benefits, such as increased energy! Breathing from the diaphragm (the muscle between the chest and the stomach) allows more oxygen to enter the body. Be careful not to overdo it (ie too quickly or for too long) as you might end up feeling a little light-headed. There is a lot of information about abdominal breathing on the Internet. For two easy "how-to" guides, go here and here.
Abdominal breathing, also known as diaphragmatic or Hara breathing, is a tried and tested technique for ameliorating panic reactions. Practised for only ten minutes a day, it has associated health benefits, such as increased energy! Breathing from the diaphragm (the muscle between the chest and the stomach) allows more oxygen to enter the body. Be careful not to overdo it (ie too quickly or for too long) as you might end up feeling a little light-headed. There is a lot of information about abdominal breathing on the Internet. For two easy "how-to" guides, go here and here.
COPING STRATEGIES
Many of these coping strategies will be well familiar to those with misophonia. They are listed as much for the benefit of sufferers' families, friends and practitioners:
Many of these coping strategies will be well familiar to those with misophonia. They are listed as much for the benefit of sufferers' families, friends and practitioners:
Diagnosis
Do not underestimate the benefits of seeking a medical diagnosis. Official confirmation that you have a recognised illness can be a powerful psychological boost. It may also help when you talk to people who trigger you to show that you are not just "making it up". Also bear in mind that the more people who are diagnosed with the condition, the more likely there is to be scientific interest in developing more effective therapies and, the Holy Grail, a potential cure.
Do not underestimate the benefits of seeking a medical diagnosis. Official confirmation that you have a recognised illness can be a powerful psychological boost. It may also help when you talk to people who trigger you to show that you are not just "making it up". Also bear in mind that the more people who are diagnosed with the condition, the more likely there is to be scientific interest in developing more effective therapies and, the Holy Grail, a potential cure.
Keep a diary
Keep a misophonia diary. Record who your triggers are, what they do that triggers you, the times of day it happens, what you felt before, during and after the incident, what made things worse, what made things better. Take charge of your misophonia. Remember, you are not your condition! Download our free misophonia record sheet. Coming soon.
Keep a misophonia diary. Record who your triggers are, what they do that triggers you, the times of day it happens, what you felt before, during and after the incident, what made things worse, what made things better. Take charge of your misophonia. Remember, you are not your condition! Download our free misophonia record sheet. Coming soon.
Avoidance
Planned avoidance of known trigger situations is clearly sensible, where practicable. Eating meals separately from the rest of the family is an obvious one. Clearly a delicate issue and negotiations with the family are to be approached with sensitivity. Just because you have a serious illness doesn't mean you can assume that everyone will know exactly what it entails. An acceptable half-way house might be to wear earplugs or listen to headphones while at the table, although not if the sight of a trigger person eating is sufficient to provoke an attack.
Planned avoidance of known trigger situations is clearly sensible, where practicable. Eating meals separately from the rest of the family is an obvious one. Clearly a delicate issue and negotiations with the family are to be approached with sensitivity. Just because you have a serious illness doesn't mean you can assume that everyone will know exactly what it entails. An acceptable half-way house might be to wear earplugs or listen to headphones while at the table, although not if the sight of a trigger person eating is sufficient to provoke an attack.
Talking it over
Plucking up the courage to discuss your illness with your worst trigger people is likely to pay enormous dividends. Most people are going to want to help minimise your discomfort, even if, from time to time, they forget, or don't realise what they are doing. There is a possibility that they will not take you seriously and be insensitive about it ("we all have sounds we don't like, grow up and deal with it!") or worse still, deliberately make the offending sound in your presence as loudly and as often as possible. Hopefully these people are in a tiny minority.
Plucking up the courage to discuss your illness with your worst trigger people is likely to pay enormous dividends. Most people are going to want to help minimise your discomfort, even if, from time to time, they forget, or don't realise what they are doing. There is a possibility that they will not take you seriously and be insensitive about it ("we all have sounds we don't like, grow up and deal with it!") or worse still, deliberately make the offending sound in your presence as loudly and as often as possible. Hopefully these people are in a tiny minority.
Joining a support group
Being able to read about other people's experiences, and to interact with fellow sufferers on the Internet or in person, is another powerful way of coming to terms with your condition, and hopefully, picking up some tips on how to deal with it better! Join the UK Misophonia Support Group here.
Being able to read about other people's experiences, and to interact with fellow sufferers on the Internet or in person, is another powerful way of coming to terms with your condition, and hopefully, picking up some tips on how to deal with it better! Join the UK Misophonia Support Group here.
Masking the noise
Masking the noise 1: use of ambient noise
Having some music, the radio or television on may help to mask the trigger sounds.
Masking the noise 2: mimicking
Mimicking the trigger noise brings some misophonic sufferers psychological release during the worst moments of the panic reaction. Clearly, there is a danger that the trigger person will think they are being insulted, so it is to be used with caution (if indeed it works for you). This is one area where talking it over with the trigger person involved really is a must.
Masking the noise 3: synchronisation
If eating sounds are the problem, you may help to mask them with your own eating, by synchronising your biting with that of your trigger person. This may sound like an act of desperation, but if it is the only option, it may help prevent a misophonic attack, or at least bring some relief. Again, be sensitive to those who may misunderstand your behaviour if they notice what is happening.
Masking the noise 1: use of ambient noise
Having some music, the radio or television on may help to mask the trigger sounds.
Masking the noise 2: mimicking
Mimicking the trigger noise brings some misophonic sufferers psychological release during the worst moments of the panic reaction. Clearly, there is a danger that the trigger person will think they are being insulted, so it is to be used with caution (if indeed it works for you). This is one area where talking it over with the trigger person involved really is a must.
Masking the noise 3: synchronisation
If eating sounds are the problem, you may help to mask them with your own eating, by synchronising your biting with that of your trigger person. This may sound like an act of desperation, but if it is the only option, it may help prevent a misophonic attack, or at least bring some relief. Again, be sensitive to those who may misunderstand your behaviour if they notice what is happening.
Awareness of bodily reactions
Awareness of bodily reactions 1: unwanted sexual arousal
Some people with misophonia experience a feeling of unwanted sexual arousal on hearing one or more of their trigger sounds. This is certainly not uncommon and may be caused by nothing more sinister than over-activation of the hormonal circuits during the rage/panic stage. Adrenaline (epinephrine in American English) and noradrenaline (norepinephrine in American English) are both involved in fight-or-flight and sexual response.
Awareness of bodily reactions 2: potentiation
When a person with misophonia is exposed to their trigger sounds by a known trigger, this can lead to potentiation, so that the sufferer is then triggered more easily by someone who would not normally do so, such as another family member or a complete stranger. It is helpful to realise that the misophonic reaction is not necessarily getting permenantly worse in these circumstances.
Awareness of bodily reactions 3: tiredness
It is common for people with misophonia to be significantly more sensitive to trigger sounds when they are tired. Common sense dictates that this is a good time to avoid your trigger people (and possibly non-trigger people who might make the trigger sound), if at all possible,. Again, awareness that your misophonia is not necessarily getting permanently worse in these circumstances can be helpful.
Awareness of bodily reactions 4: super-charged memory
People with misophonia have an ability to recall trigger incidents years after the event (and not necessarily the argument with their trigger person that follows it!). This is a marker of the emotional impact of the sound on the sufferer's psyche.
Awareness of bodily reactions 1: unwanted sexual arousal
Some people with misophonia experience a feeling of unwanted sexual arousal on hearing one or more of their trigger sounds. This is certainly not uncommon and may be caused by nothing more sinister than over-activation of the hormonal circuits during the rage/panic stage. Adrenaline (epinephrine in American English) and noradrenaline (norepinephrine in American English) are both involved in fight-or-flight and sexual response.
Awareness of bodily reactions 2: potentiation
When a person with misophonia is exposed to their trigger sounds by a known trigger, this can lead to potentiation, so that the sufferer is then triggered more easily by someone who would not normally do so, such as another family member or a complete stranger. It is helpful to realise that the misophonic reaction is not necessarily getting permenantly worse in these circumstances.
Awareness of bodily reactions 3: tiredness
It is common for people with misophonia to be significantly more sensitive to trigger sounds when they are tired. Common sense dictates that this is a good time to avoid your trigger people (and possibly non-trigger people who might make the trigger sound), if at all possible,. Again, awareness that your misophonia is not necessarily getting permanently worse in these circumstances can be helpful.
Awareness of bodily reactions 4: super-charged memory
People with misophonia have an ability to recall trigger incidents years after the event (and not necessarily the argument with their trigger person that follows it!). This is a marker of the emotional impact of the sound on the sufferer's psyche.
A word to family and friends
One of the hardest things for the friends and family of a person with misophonia to accept is when they see their loved one go into full "panic mode" when they (the friend or family member) do something which is, objectively speaking, perfectly normal behaviour, but then see the person with misophonia bat not an eyelid when someone else makes the same noise, or bears the same expression. Please try and be understanding - the "double standard" inherent in the two reactions is one of the standard symptoms of misophonia. Many people with misophonia, in the absence of hard science, believe that the disease is rooted in faulty neurology. But there is a clear emotional component to the reaction - which is not to say that it is under the sufferer's control. This is clearly evidenced when a known trigger person is assumed to have made a trigger noise, but the misophonia sufferer realises it was actually made by someone who is not a trigger for them. The rage/panic reaction can dissipate to almost nothing in a fraction of a second. This is all very hard for a non-sufferer to comprehend. But people with misophonia have a hard enough time trying to work it out themselves! Please see here.
One of the hardest things for the friends and family of a person with misophonia to accept is when they see their loved one go into full "panic mode" when they (the friend or family member) do something which is, objectively speaking, perfectly normal behaviour, but then see the person with misophonia bat not an eyelid when someone else makes the same noise, or bears the same expression. Please try and be understanding - the "double standard" inherent in the two reactions is one of the standard symptoms of misophonia. Many people with misophonia, in the absence of hard science, believe that the disease is rooted in faulty neurology. But there is a clear emotional component to the reaction - which is not to say that it is under the sufferer's control. This is clearly evidenced when a known trigger person is assumed to have made a trigger noise, but the misophonia sufferer realises it was actually made by someone who is not a trigger for them. The rage/panic reaction can dissipate to almost nothing in a fraction of a second. This is all very hard for a non-sufferer to comprehend. But people with misophonia have a hard enough time trying to work it out themselves! Please see here.
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