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