Understanding Misophonia and How Treatment Can Help

I try to help my clients better understand that Misophonia is better to be undesrstood as a manageable condition.  Misophonia is a condition in which specific sounds or movements trigger an emotional reaction. These sounds are often everyday noises such as chewing, breathing, sniffing, slurping, coughing, or gum chewing. Some people who have this condition are also triggered by visual movements such as someone touching their face, playing with their hair, or repetitive gestures.

People with misophonia typically experience an emotional reaction when these triggers occur. The most common include irritation, anger, disgust, or even intense rage. Many people also experience a strong physiological response, such as muscle tension or a fight-or-flight reaction, which at times can be described as overwhelming.

For some individuals, the emotional reaction can feel so intense that they may experience intrusive thoughts about wanting the sound to stop immediately. These thoughts are typically distressing and unwanted, and people often feel ashamed of them.

Most of the time, people who have Misophonia describe the condition as a problem that generally interferes with their daily life.

How Misophonia Often Develops

Many people report that misophonia begins gradually during childhood or early adolescence. The average reported age of onset is around 13 years old, although some people who have the condition have reported noticing symptoms earlier. Women appear to report higher rates of misophonia than men, and symptoms often become more intense over time.

Triggers often begin with a single specific sound and gradually expand. For example, someone may describe feeling irritated by chewing sounds and later begin reacting to breathing, sniffing, or other repetitive noises.

Another important pattern is that triggers are frequently linked to specific people in the sufferer's life. Many people report that family members are the strongest triggers. What I find of most interest is that the same sound made by another person may not provoke the same level of reaction.

Because these triggers often occur in everyday environments such as family meals, shared living spaces, workplaces, or classrooms, misophonia can create stress in relationships and daily routines.

How Misophonia Affects Daily Life

Over time, people with misophonia often begin organizing their lives around the trigger sounds. They may avoid eating meals with family, withdraw from shared spaces, or rely heavily on headphones or earplugs to block out noise.

While these strategies can provide some relief, avoidance can unintentionally reinforce the problem. The brain becomes increasingly focused on monitoring for the trigger sound, and the emotional reaction may become stronger when the sound eventually occurs.

Many sufferers also spend a significant amount of time worrying about future triggers. Anticipating when the next trigger might occur can consume a lot of mental energy and create ongoing stress.

Misophonia can also create tension within families. From one perspective, the sounds being made, such as chewing, are ordinary everyday behaviours. From the perspective of the person with misophonia, those same sounds can feel unbearable. This difference in experience can make it difficult for families to understand one another and often at times can create tension. I often work with my patients by having their family brought in so they, too can better understand the experience.

Research and Theories About Misophonia

Misophonia is a relatively new area of research. The term itself was first introduced in the year 2000 by audiologist Pawel Jastreboff, who proposed that misophonia may involve an unusually strong connection between the auditory system, emotional centers of the brain, and the body’s autonomic nervous system.

According to this model, certain sounds may trigger an intense emotional and physiological response because of the way these systems interact.

Another explanation involves classical conditioning. Humans naturally have reflexive reactions to certain sounds, for example many people experience discomfort when hearing nails on a chalkboard. Researchers have suggested that misophonia may develop when everyday sounds become associated with strong emotional reactions over time. Recent research has also explored the role of mirror neurons. Studies using functional brain imaging have found evidence that individuals with misophonia may have heightened activity in systems, and seeing or hearing someone chew may trigger a strong internal simulation of that action, which may contribute to the discomfort or distress.

Psychological research has also found associations between misophonia and certain personality traits. Higher levels of rigidity, perfectionism, and obsessive-compulsive personality traits appear to occur more frequently in individuals experiencing misophonia symptoms.

I try to help each of my patients better understand an important psychological factor involved with those that struggle with misophonia called  the white bear effect, or ironic process theory. When people try not to think about something, their minds often become even more focused on it. For example, if someone is instructed not to think about a white bear, the image of a white bear tends to appear in their mind more frequently. A similar process can occur with misophonia. When someone tries very hard not to hear or notice a trigger sound, their attention may become even more locked onto that sound.

A Psychological Model of Misophonia

One way I explain misophonia to clients is by looking at how attention, emotional reactions, and avoidance interact over time.

Imagine a child who feels frustrated with a parent. During a meal, the child hears the parent chewing loudly. At first the sound may feel mildly irritating. However, if the child is already feeling tense or upset, the sound may quickly be interpreted as unacceptable or overwhelming.

The child may then try to ignore the sound or push it out of awareness. However, the attempt not to notice the sound may increase attention toward it. The sound becomes more noticeable, which increases irritation.

As attention becomes more focused on the sound, the emotional reaction intensifies. The individual may become increasingly rigid in the belief that the sound should not be happening. This leads to even more attempts to avoid noticing the sound, which in turn increases awareness of it.

Over time, the brain may also begin associating the sound with frustration, anger, or distress (via classical conditioning- for my students reading this). Avoidance of situations where the sound occurs reinforces the idea that the sound is something that must be escaped (operant conditioning).

How I Treat Misophonia

In my work with individuals experiencing misophonia, my goal is to help people become less stuck on trigger sounds and reduce the emotional reaction those sounds produce.

The approach I use focuses on helping individuals change their relationship with the sound rather than attempting to eliminate the sound itself.

When someone is in a room with many sounds, their attention can become completely absorbed by a single unpleasant noise. When this happens, it can feel as though that sound dominates the entire environment.

Part of my work involves helping clients loosen that attentional lock so the sound no longer controls their awareness.

Learning to Engage With the Sound

A central part of treatment involves helping individuals stop fighting the sound.

When people try to block out or suppress a trigger sound, they often become even more aware of it. Instead of trying to eliminate the sound, I help clients gradually learn how to allow the sound to exist without becoming overwhelmed by it.

This process helps reduce both the emotional reaction and the level of attention given to the trigger.

Addressing the Factors That Maintain Misophonia

In treatment, I also help clients identify patterns that may maintain the cycle of misophonia. These often include:

• avoidance of situations where triggers occur
• constant monitoring for trigger sounds
• rigid expectations about how others should behave
• strong emotional reactions such as anger or disgust

By working through these patterns, individuals can begin to develop greater flexibility in how they respond to trigger sounds.

Goals of Treatment

The goal of treatment is not to eliminate every trigger sound. Instead, the goal is to reduce the intensity of the reaction and help individuals feel less controlled by these experiences.

Over time, many people notice:

• reduced emotional reactions to trigger sounds
• less fixation on specific noises
• greater ability to remain present in shared environments
• improved relationships with family members and others
• less need to avoid everyday situations