CBT for Misophonia

Misophonia is a strong and often overwhelming reaction to particular everyday sounds. Dr Dan White offers specialist cognitive behavioural therapy (CBT) for misophonia, online across the UK and in person in Oxfordshire. He treats misophonia in the NHS as part of a specialist misophonia clinic which has contributed to the development of the CBT approach used to treat it. 

What is misophonia? 

Misophonia is an extreme or intense reaction to specific sounds, usually sounds made by other people. Chewing, sniffing, breathing, throat-clearing, tapping, pen-clicking and keyboard noises are among the most common triggers.

What separates misophonia from ordinary irritation is the size and the speed of the response. It is not a mild annoyance that builds. It often arrives rapidly and at full strength, and it is frequently experienced as rage, panic, overwhelm, disgust or a combination of these emtions. People often describe it as feeling trapped, or as though something is being done to them.

It is also worth saying plainly what misophonia is not. It is not being fussy. It is not a failure of tolerance or manners. It is not something you should be able to  "just" talk yourself out of, and the fact that you cannot is not evidence of a character flaw.

What misophonia actually costs people 

The impact is routinely underestimated, including by the people who have it, because the trigger sounds are so ordinary that the reaction seems out of proportion. In practice misophonia can mean: 

• Eating separately from your own family, or dreading mealtimes

• Wearing headphones or earplugs for much of the day

• Avoiding open-plan offices, restaurants, cinemas, public transport and classrooms

• Snapping at people you love, then feeling guilty or ashamed of it

• Relationships being placed under real strain, with partners and family members walking on eggshells

• Constant scanning for the next sound, which is exhausting in itself

Because misophonia is not widely understood, many people have been told to ignore it, get over it, or stop being difficult or over-sensitive, sometimes by health professionals. Being taken seriously is often the first useful thing that happens in therapy.

How CBT helps with misophonia?

There is now good preliminary evidence that CBT can reduce the impact of misophonia, and a specific cognitive behavioural understanding of the condition has been developed in UK specialist services over the past several years.

The starting point is an important one. Therapy does not aim to stop you hearing the sound, and it does not try to convince you the sound is fine. The underlying sensitivity is probably not something therapy changes directly. What therapy works on is everything built on top of it, and that turns out to be where a lot of the suffering lives.

Meaning

Sounds do not arrive neutrally. A sound that means "they are doing this deliberately" or "they do not care about me" or "I am going to lose control" produces a very different reaction from a seemingly identical sound that means nothing in particular. We look at what your trigger sounds have come to mean, and test whether those meanings hold up. 

Behaviour 

Almost everyone with misophonia has developed ways of coping: avoiding, masking, monitoring, mimicking, leaving the room, keeping headphones in. Every one of these makes sense in the moment. The paradox is that many of them keep attention locked on the sound and prevent anything from ever changing the felt sense of threat, therefore, despite understandable best efforts these strategies may have unintended consequences, including keeping the problem going. We look carefully at what your coping strategies are doing for you and to you. 

Attention

Misophonia trains a highly efficient sound-detection system. Learning to shift and hold attention deliberately, rather than having it captured, is one way of gaining back a degree of control. 

Self-criticism and shame 

Many people are as distressed by their own reaction as by the sound itself, particularly where it has spilled over onto family. Working on that layer often produces relief quickly, and where it runs deep I can draw on Internal Family Systems alongside CBT. 

What treatment involves 

We begin with a thorough assessment, including a structured measure of how misophonia is affecting you, so that we have a baseline and can track change rather than guess at it.

From there we build a shared picture of what is keeping the problem going in your particular case. Misophonia varies a great deal between individuals, and the treatment follows the formulation rather than a fixed script.

The work itself is active and collaborative. It involves experiments and interventions, designed to test the beliefs and the coping strategies we have identified rather than simply to expose you to sounds. Nothing happens without your agreement, and being ambushed with a trigger is not part of the method.

Length varies. Some people make significant progress in a focused block of sessions; where misophonia sits alongside other difficulties, or has been present since childhood, the work usually takes longer. I will give you a realistic estimate after assessment.

Why work with me? 

Very few therapists in the UK have specialist experience of misophonia, and it is not covered in standard CBT training.

• I treat misophonia in the NHS at the Oxford Health Specialist Psychological Intervention Centre, as part of the specialist misophonia clinic led by Dr Jane Gregory. 

• I am named in the acknowledgements of Dr Gregory's book on misophonia, Sounds Like Misophonia.

• I have contributed to the development of clinical and training materials for therapists on the CBT treatment of misophonia.

• I am accredited by the BABCP and hold an MSc and DPhil from the University of Oxford, with over twenty years of clinical experience.

• Alongside CBT I am trained in EMDR and in Internal Family Systems, which matters when misophonia sits alongside trauma, anxiety or long-standing self-criticism.

Working online

I offer CBT for misophonia online throughout the UK, and in person in South Oxfordshire. Most of my misophonia work is online, and it suits the condition well: sessions happen in the environment where your triggers actually occur, which is often more useful than a consulting room. 

Common questions about misophonia

Is misophonia a recognised condition?

It does not currently appear as a diagnosis in the main classification systems, but it is increasingly well described in the research literature, and a UK population study has established how common it is and how it is distributed. Lack of a formal diagnostic code does not mean it is not real or not treatable.

Will therapy make the sounds stop bothering me?

Realistically, the aim is not to make trigger sounds pleasant. It is to reduce their power over your life: fewer situations avoided, less time spent monitoring, a smaller and shorter reaction, and less fallout afterwards. Most people find that when the reaction shrinks, so does the fear of the reaction, and a good deal opens up from there. Therapy aims to reduce the effects of misophonia so it stops being an "everyday/all day" problem.

Will you make me listen to my trigger sounds?

Probably, BUT not without your agreement, and not as a test of endurance or as a means of "exposure" or "desensitisation", these interventions do not work for this condition and therapists describing such an approach are probably best avoided. Where we do work with sounds, it is planned together, starts at a level you can manage, and has a clear purpose/function that you understand in advance.

I am not sure it is bad enough to warrant therapy.

This is one of the most common things people say, and it is usually said by someone who has quietly rearranged their life around the problem. If it is affecting your relationships, your work, or where you are willing to go, it is worth an initial conversation.

Do you work with children and teenagers?

Currently, I only work with adults (18 years and older).

Getting in touch

If misophonia is affecting your life and you would like to talk about whether therapy could help, do get in touch. I will usually reply within two working days, and there is no obligation to book.

Email: dan@sinodunhillCBT.com