What is misophonia and how can therapy help?

Imagine someone tells you they’re sensitive to certain sounds. You nod sympathetically – that seems understandable. But then they add, “I can’t stand the sound of people breathing. It makes me feel furious.” Or, “I can’t eat dinner with my family because the chewing noises overwhelm me.”

At first, this might sound confusing or even exaggerated. But for someone living with misophonia, these reactions are very real.

What is misophonia?

Misophonia is a condition involving strong emotional reactions to specific sounds. People who suffer from misophonia are sensitive to man-made noises such as chewing, breathing, pen clicking, lip smacking, etc. And when I say they are sensitive, I really mean it: those trigger sounds may spark intense emotional reactions, such as rage and disgust. The reaction is explosive and often overwhelming – extremely hard to contain and control. 

What's even more unusual, is that many people with misophonia react more intensively if the trigger noise is made by a person to whom they are connected. For example, a family member, a partner, siblings etc. No wonder psychiatrists find this so fascinating! However, as you can imagine, misophonia doesn't only affect the person who has it, but their family and friends, too.

Why do certain sounds trigger such strong reactions?

Thanks to contemporary science and brain imaging, we know that misophonia is not just bad manners or rudeness. Research suggests it may be linked to differences in how certain areas of the brain process sound and emotion.. 

In our brain, the anterior insular cortex is responsible for the subjective sense of the inner body, emotional processing and is part of the salience network. The function of the salience network is to single out significant stimuli and focus our attention so we are able to react to them appropriately. 

With misophonia, the anterior insular cortex is hyperactive. This means the activity in the salience network is increased, and through functional connectivity with other regions in the brain, it is this interaction that is responsible for the intense emotional and behavioural reactions.

To put it simply: everyday sounds are singled out as highly significant (possibly threatening) sounds, so they trigger intense responses.

The emotional impact of misophonia

Understandably, when something like that happens – when the clicking of a pen result in a meltdown or the sound of someone breathing causes an angry outburst – it leaves both the person with misophonia and the people around them feeling rattled.

Friends and family might try and accommodate, which can mean they feel as if they are walking on eggshells, while the misophonia sufferer is battling with guilt, and perhaps a sense of shame, as if they are somehow faulty, odd, and bad-tempered. This is often followed by attempts to avoid future incidents by isolating themselves. 

On the longer term, this can lead to increased anxiety due to being afraid of what might happen, and the separation from others can be the onset of other mental health concerns, such as loneliness and depression.

Research in misophonia is ongoing, and there is currently no widely agreed medical treatment. This lack of support can further add a sense of hopelessness.

Can therapy help with misophonia?

The good news is that there are ways to live with misophonia and not let it take over your life. We might not be able to control our immediate feelings in the moment, but we can choose how we think and how we act those feelings out. In therapy, we do not try to "fix" misophonia, but use the brain’s remarkable ability to learn and adapt. 

The learning that needs to happen is two-fold: firstly, through exposure and behavioural experiments, we can recognise that those sounds do not actually harm us and we can manage the difficult feelings they trigger. Secondly, we can change how we think of ourselves: we can stop the vicious cycle of negative thoughts bringing up negative feelings by encountering the negative thoughts with positive statements.

It is important to remember the mechanics of misophonia: your nervous system focuses the attention on certain sounds (triggers) and connects them to negative emotions which leads to negative reactions (for example: an angry outburst).

Specialised cognitive behavioural therapy (CBT) aims to retrain your nervous system by getting you comfortable with hearing the trigger sound. Your nervous system must relearn that those sounds are not a threat, so it can decrease the emotional intensity of the reaction. If the fear lessens, the trigger becomes less important and you can create a positive feedback loop.

Living with misophonia

Then it's on to your thinking: if you have lived with misophonia for a while, it might have affected how you view yourself. Low self-esteem, anxiety and depression can often follow when we feel bad about ourselves. 

Because of your misophonia, you might have started to doubt yourself, questioning whether you are a good person, whether you are a burden to friends when reacting in such a way to everyday sounds. These doubts can lead to low self-esteem and high anxiety. However, working with a therapist can help you to restore your faith in yourself, see yourself in a more realistic light and change how you think of your misophonia.

Change is never easy and people who have misophonia must battle with their own nervous system. If you know or suspect you are experiencing misophonia, or you live with someone who does, just remember that a little acceptance and kindness to ourselves and each other can go a long way.

Working with a therapist can offer personalised support to help you manage triggers and rebuild confidence. If you’re considering therapy, you can explore options on Counselling Directory.