Why Exposure Therapy Doesn’t Work for Misophonia

by | Jan 4, 2019 | Articles | 24 comments

Misophonia Exposure Therapy

In this article we’re going to look at a popular so-called ‘cure’ for misophonia.

Exposure therapy.

First we’ll consider the theory behind the treatment, then we’ll look at how this treatment should in no way be applied to misophonia whatsoever.

So what is exposure therapy?

The idea behind exposure therapy is that you subject the patient to the very small doses of the thing that’s causing them distress or discomfort. It could be a fear of spiders, heights, open spaces – any phobia or irrational fear.

You steadily increase the frequency and intensity of this exposure over time until the patient is able to cope on their own. Start small and slowly build up a tolerance.

You are effectively reconditioning the brain to no longer associate the trigger sight or sound as being a threat.

You were afraid of house spiders, now you’re not.

The theory makes sense. Irrational fears fester and snowball over time and create a whole ecosystem of anxiety that feeds off itself. The humble house spider, who offers no threat to humans, becomes a giant, flesh-eating psychopath through a process of internal Chinese whispers.

By repeatedly showing, in controlled and safe environments, that spiders won’t bite, poison or eat you, the brain can be reconditioned to accept a new set of truths. Spiders are safe. They’re not going to hurt you.

So far so good?

To any layman, misophonia would seem like the PERFECT candidate for exposure therapy.

After all, misophonia IS irrational. Patients are triggered by normal, everyday day sounds which pose no threat to threat to us whatsoever.

So why not use exposure therapy?

Misophonia is not learned or conditioned

Who did you ‘learn’ your misophonia from? Did a parent or sibling teach it to you? Most people won’t have come across anyone with this disorder growing up.

And if it’s not a learnt behaviour where did the conditioning come from?

As a child were you subjected to violence every time someone ate an apple?

We you told scary stories of murderous soup slurpers living under the bed?

Were you slapped every time someone nearby whistled?

But what about people who did experience abusive childhoods? (and tragically there are some).

Could there be a connection here with acts of cruelty or abuse taking place during mealtimes and the subsequent development of misophonia? Could those of us who recall growing up in a safe and loving environment be repressing memories?

There are two counterpoints to this theory.

1. For it to have any validity it would mean every misophone would have had to have suffered abuse or trauma as a child (typically misophonia develops around the age of 11 – 13) and for this to have had a clear association with eating or certain repetitive sounds before, during or after

2. Each victim would have to develop the exact same aversion to very specific stimuli: chewing, gulping, sniffing, rustling, crunching, tapping, clicking.

The problem is there are thousands of misophones on this website alone. All from different family setups, economic backgrounds and cultures.

The chances of us being ‘conditioned’ with the exact same triggers – while being in total isolation from one another – are infinitesimally small.

But there’s more…

We all eat at least 3 times a day, how come we haven’t ‘cured’ our misophonia with our own daily exposure therapy?

This is something that Dr Jennifer Jo-Brout brought up when I was discussing exposure therapy with her some time ago.

As misophones (and as human beings) we are already constantly ‘exposed’ to trigger sounds.

– We eat a meal 3 times a day. On top of that we’re often around people who eat and drink at slightly different times to us. Family, friends, coworkers

– Exposure is not just limited to ‘intense’ or ‘prolonged’ triggers each time either. Consider snacks… passersby… people sitting across the room

– It’s not just eating! Misophones are often surrounded by people who make other trigger noises (whistling, rustling, tapping and so on) at work, when we socialise, when we commute

You would expect this daily, repeated exposure to trigger sounds to re-condition the brain to accept that chewing or rustling sounds are non-threatening stimuli… but it doesn’t.

None of these encounters appear to result in a normalisation of the sounds or our neurological and physiological response to them.

Most of us can easily avoid spiders but we can’t avoid eating or spending time around other people.

Misophonia is a neurological disorder, not a behavioural disorder

Herein lies the core issue. The latest research suggests that misophonia is a neurological disorder.

You can read more here:

The Brain Basis for Misophonia

and here:

Investigating Misophonia

The success of exposure therapy rests of the premise that the fear, anxiety and discomfort that the patient suffers from has been conditioned.

This is not the case with misophonia.

You can’t cure dyslexia with exposure therapy and the same thing applies to misophonia.

The problem is many of us are so desperate for a respite from this disorder that we’re vulnerable to practitioners who offer unproven cures.

Many of these people have testimonials from happy, ‘cured’ patients. As humans we are drawn to social proof. Just look at the way we use Amazon. Most of us ignore the content of the listing and scroll straight down to the reviews. If all these people say it’s wonderful, surely it works, right?

Ask yourself the following questions:

1. Have you personally met or spoken to the ‘cured’ patients? Is their testimony credible? What type of exposure therapy did they have and under what conditions? How did they feel before and after? Was the testimonial solicited? How long have the effects lasted?

2. Has the practitioner submitted their treatment to independent, controlled studies?  ANYONE can do a misophonia study, you or I can set one up tomorrow with a piece of paper, a pencil and a Mickey Mouse eraser. A credible study has to take place in controlled setting with findings that are independently scrutinised. Typically you would need to have a group which is undertaking exposure therapy and a group which isn’t (in most studies you would have a placebo group as well, where possible), followed by a detailed measuring of brain response. No independent, controlled studies for misophonia treatment using exposure therapy have taken place to date

3. Does the practitioner have a vested financial interest in telling you their treatment works? In other words are they charging money for their unproven treatments? If the effectiveness of the treatment hasn’t been independently verified how can you trust that it is put forward in your best interests and not in the interests of financial gain?

4. What do the experts say? Not self-proclaimed experts but neuroscientists conducting studies involving EEGs and fMRI scans in strict, regulated environments… psychologists with decades of experience dealing with the disorder

Exposure therapy is an unproven treatment for misophonia. It may do more harm than good, not to mention the vast expenses involved in some of these treatments.

With all this said I don’t necessarily think that every practitioner who offers exposure therapy as a misophonia treatment is necessarily a ‘bad’ person intending to scam us or do us harm.

I think some of them genuinely believe that they are in the right. They truly believe that these unproven treatments can be effective, despite evidence to the contrary and despite the possible harm it could cause.

Please be careful.

You have a beautiful brain. It might not feel like it sometimes with the misophonia raging away but you do.

You are not mad, you are not wrong or bad. Wonderful minds are working on understanding our disorder and they’re making progress all the time. We will find ways to cope with this and I’m right behind you.



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24 Comments

  1. Amanda Drage

    exposing myself to triggers makes misophonia worse for me, my temper boils.

    Reply
    • Anon

      I very much agree with the above comment. I find that I am much less affected (and can more easily control) triggers initially – most of the time – e.g. the odd family meal, a very transitory bit of roadwork (banging / drilling), people walking around on creaking floorboards in a friend’s flat when I am just making a quick visit… but the more regularly I am exposed to the specific instance of a trigger – e.g. daily meals with family, the worse it becomes. A sort of ‘kindling’ process 🙁

      Reply
    • Maggie Sproxton

      I agree wholeheartedly!

      Reply
  2. Julie M

    Another wonderful article, and so insightful. Thanks for being there for us!

    Reply
    • Roma

      I respectfully disagree. I’m trying to do a therapy with me by preparing myself for the danger. I ask my husband and son to warn me before they eat something. They announce and that way my brain is prepared to not get in fight and flight mode – rather it prepares itself to be accept it. It helps me to stay calm- and I’m feeling I’m not getting that angry.

      Reply
  3. Marcie

    Wondetful, educational piece.
    Thank you

    Reply
  4. Tammy

    Thank you so much for your information and time you spend working on this website.

    Reply
  5. Lucy Costick

    I agree with this. I tried exposure therapy and it didn’t work, it only made it worse.
    The good thing that came of it was that I got in ear noise generators which are making life a lot easier.

    Reply
  6. Pamela Cooper

    When I was a child my father had the irritating habit of drumming his fingers. Later, my husband had the habit of sniffing instead of blowing into a tissue (literally grounds for divorce). Looking back on my life, I notice a trend of distancing myself from perfectly nice people simply because they had a high pitched
    voice. I didn’t know until recently when a hearing aid technician told me I have noise intolerance. It answers a lot of questions such as why I detest being around loud giggly people, and often prefer my own company.

    Reply
  7. Sam

    Hi I am a Mum of a daughter aged 11 who suffers with this awful miso. She has outbursts at home but manages to keep it in most places. Which I think means she lets it all out at home. She can be violent with them and screams abuse at myself and her brother aged 4 which upsets him. I can tolerate and be as patient as I can with her but as soon as she upsets her brother I get so frustrated and angry with her. When she has calmed down she is throughly remorseful and is upset with herself. She beats herself up every time which is making her have self hate issues which I fear might lead to other self harm or self control issues. Do I explain this miso to her will that make things easier for her to deal with as this definitely sounds like my daughter or do I get a specialist to speak to her what do I say or not say as I don’t want to make things worse for her. Thank you

    Reply
    • Allergic to Sound

      Hi Sam, I’m so sorry to hear what you’ve been going through.

      Everyone will be different but for me personally, knowing and learning about misophonia has really helped. It’s also the first step to finding more effective coping mechanisms.

      In terms of finding a specialist, you could also do that. If you do, please make you find someone reputable who knows of and understands misophonia. It’s not a big list but you can find a few suggestions here.

      https://allergictosound.com/articles/how-to-get-help-treatment-for-misophonia/

      Reply
    • LL

      I have looked at Sequent repattering therapy recently and I am thinking of giving it a go, do your own research and see what you think. My advice would be to tell her all about it, it will stop her thinking she is crazy so should help somewhat.

      Reply
  8. Darren

    I’ve just come across this site, great work!

    I’ve discovered so much from my brief visits to this site. I haven’t been diagnosed with either, however from reading the descriptions and comments, I am certain that I suffer from Misokenisia and have in the past suffered from Misophonia.

    My story (long one short). When I was 19 at a ‘friends’ house on xmas eve getting my hair cut by his cousin.

    Like a sheep I accepted and participated in smoking a bong (weed) that was going around.

    A cousin of said friend (my past childhood enemy) joins the party and his friend shows off a butterfly knife.

    (I didn’t know that marijuana had the effect of making people paranoid – seeing the knife didn’t help later on).

    After getting my hair cut I was invited to show the guys in the kitchen the hair cut. I thought this was a little strange but why not!

    In the kitchen they encircled me and deliberately spoke in broken sentences. “you hair looks…” one said “hey Daron wha….”. There was around 10 of them cousins and close friends all taking part in the ‘fun’. I was the outsider.

    Seconds later I stopped finding it funny and realised that I was on the other side of the joke. My heart raced and I grabbed my stuff and proceeded to get out of the place.

    A few of the guys followed trying to explain that it was just a bit of a joke… I was on the phone with my folks who didn’t know the area I was in. They said to me to get a lift from one of the guys.

    Guess who was ever so happy to give me a lift?! Yes previous high-school-bully-cousin!!

    His mate came along for the ride! I mentioned that it was new years eve. The roads were quiet. They drove in snaking left-right-left all the way home whilst they continued talking fast and loud in broken sentences.

    This was back in the day, the friend changed radio station constantly creating the varying whirring high pitched sounds. I couldn’t think, my heart raced until it hurt I contemplated jumping out but they were going too fast.

    I asked to come out at the next corner. I could hardly speak. The guys enjoying themselves were keen to drop me closer to my home as I couldn’t possibly live where I was asking to be let out.

    Lucky they let me go. I staggered home and begun having panic attacks for the next 10 yrs of my life.

    There wasn’t much information on the internet about drugs and psychological info. This was 1997ish. I believed it could be flashbacks…

    I noticed that sounds would trigger my panic attacks especially harsh sounding consonants. They would send my heart racing. I had to leave the room many times. I couldn’t bare being in a crowd and dreaded any moment that the teachers left the classes unattended as the room would fill with these sounds.

    Luckily for me my mum wouldn’t let me stay at home. I would go to college each day believing that I would have a fatal heart attack that day and then onto uni.

    If this is/was Misophonia, then I want to say that you can get rid of it. It requires you to sit down and rationalise the sounds that put you on edge and for you to choose to hear or ignore them at will. Try hearing other sounds exclusively.

    I went to uni with panic attacks. After “going out to die” so many times you lose the fear. The panic attacks came less frequently.

    I would ask questions to people that I saw smoking. I was looking for answers for years about the ‘flashbacks’ I was experiencing.

    I realised that I must be fixating on the sounds and somehow focusing on the hissing sounds that would make my heart race. I could never reproduce a panic attack by hissing myself or getting others to do so. Just in crowds when I felt ‘on edge’.

    I made a conscious effort to hear past them. To accept them as a normal part of speech. I almost saw it as the speakers problem/impediment. I don’t have it at all now. It doesn’t take long to get rid of maybe a couple months once you accept the sound and get past it. Its the fact that you’ve attached significance to it that makes it a trigger.

    To get past panic attacks I heard an audio downloaded from Napster (file sharing client). It was from a chat show. The advise they gave was that panic attacks are likely to only make you sweaty and weak and that it was rare that you would faint or have a heart-attack.

    They said to become aware as the feeling crept up on you and to imagine the sensations like waves of a pool. You were to breath through them and ‘float’ until the panic attack went. They explained that the less you allowed your internal dialog to be fear driven, the faster the feelings would subside. Worked for me, eventually.

    Years later I suffered with them again during a stressful period of my life. “Floating” got me through them again.

    More recently I’ve been working away a nasty embarrassing OCD trait. I was making quite a lot of progress by myself however this book has helped me soo much: The Mind Illuminated: A Complete Meditation Guide Integrating Buddhist Wisdom and Brain Science for Greater Mindfulness

    You’ll learn so much about your mind. These problems (panic attacks, OCD, Misophonia, Misokenesia) share similar elements:
    – hyper fixation on some stimulus
    – inappropriate or hyper reaction to stimulus

    Seems some people are more susceptible to issues along these lines. The meditation helps by making you focus on one thing. You realise the internal conflict thats working in the background.

    I noticed a couple years ago that my smell and hearing seem to share wiring. I’m unable to identify smells when I have headphones on. I’ll be aware that there is a smell but until I remove the headphones, I’m unable to say what the smell is. I read somewhere on this site today that this is common among sufferers.

    I came to this site because people are annoying me by passing by my monitor whilst I work.

    They zig-zag and pull my attention away from my work. Sometimes I could swear that they do it on purpose (just like the hissing consonants). I doubt that this is really the case.

    Instead I feel that I am paying too much attention to movements that I should be ignoring.

    I’m going to try to get rid of it the same way I did the Mesophonia.

    Reply
    • Allergic to Sound

      Hi Darren, thanks for your comment. So sorry to hear what you went through, that sounds really traumatic. I’m not a doctor but what you’ve described (with regards to noises) sounds like it could be PTSD. The latest research suggests that misophonia is a neurological disorder and is a hypersensitivity either in the input of certain sounds or how they’re processed by the brain. As such – as far as we’re aware – it can’t be removed (in the same way you can’t remove something like synaesthesia). That book certainly sounds interesting though.

      Reply
    • LL

      I am so sorry for what you have been through.

      I would ask that you consider blanket statements like ‘ It requires you to sit down and rationalize the sounds that put you on edge and for you to choose to hear or ignore them at will’ as this is not the case due to the neurological component. Its just the same as not saying to a dyslexic you can get over it by just concentrating a bit harder. That could lead to people asking why they are not able to do this and feeling even worse.

      Reply
  9. Olivia

    I understand everything about misophonia, but the problem is my family members will never understand how it feels to have misophonia. And the thing is, I can’t tell my parents to stop making those noises, because I think they might not understand my point. Everyone will just laugh at me. Every day, this is getting worse and I have started to be rude to others, but I just can’t help it.

    Reply
  10. Diana

    I am a perfect example of how Exposure Therapy does not work. My trigger sounds are the usual chewing, coughing, slurping, blowing nose, etc. But the Coughing is what I really can not tolerate.

    Myself and my family lives with my mother-in-law that has COPD. Her coughing makes me want to leave the house or the room immediately.

    I am around it whenever I am home. The longer I am at home the angrier and more agitated I get. I don’t ever get used to it. I can’t drown it out. I only hear it more. I have actually used headphones and go to my room and close the door.

    I am glad that I have found your site because I know that I am not alone or a bad person for getting mad when people cough.

    Reply
    • Allergic to Sound

      Hi Diana,

      Thanks so much for sharing your experience and I’m very sorry to hear what you’ve been going through.

      You are absolutely not a bad person for getting mad when people cough (we’ve just got some quirky brain wiring is all!)

      Reply
  11. Rebecca

    I have been doing intensive treatment like this for years now. I can’t tell you how close I am to just being done. It had drained me, to the point of just being done. I was told last Christmas I would never have a family or kids so now that’s all I think about. I only have one friend. That’s it. Nobody understands it. My family can be very verbally abusive but I know they don’t understand. I’m just I just need someone to talk to cause I’m just like. Done. Sorry thanks for letting me rant

    Reply
    • Allergic to Sound

      Hi Rebecca, I’m so sorry to hear that, that’s really awful.

      Exposure therapy has not undergone ANY proper, independent trialling to date and has zero proof of efficacy. In fact it may be harmful. Also what you’ve been told re: never having kids due to misophonia is total hogswash, so please treat it with the contempt it deserves. Misophones often make wonderful, empathetic parents who are extremely attentive to their child’s needs.

      You are not alone Rebecca. We are all here for you!

      Reply
  12. Anna Marie

    I still cry sometimes from when I was forced to listen to my mom eat a bag of chips years ago in an attempt at “exposure therapy.” It felt cruel- I can’t possibly imagine how any sort of exposure therapy could work. I appreciate this website so much– Every article I read from here validates me when I need it the most.

    Reply

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