Misophonia is a condition characterized by a decreased tolerance to specific sounds, known as “triggers,” which are often repetitive and primarily involve human-generated noises like chewing, slurping, or pen-clicking. The reaction to these sounds is disproportionately intense, involving strong negative emotional and physiological responses such as anger, anxiety, or a strong fight-or-flight feeling. Effective management requires a multi-faceted approach that addresses the neurological, emotional, and behavioral components of the disorder. Treatment focuses on managing these intense reactions and improving the person’s quality of life rather than eliminating the sounds themselves.
Clinical Psychological Interventions
Specialized psychological therapy is the most supported treatment approach, designed to change the internal response to trigger sounds. Adapted Cognitive Behavioral Therapy (CBT) for misophonia is a primary intervention, focusing on restructuring the negative thought patterns and emotional reactions that follow a trigger. This approach recognizes that while the initial reaction is likely automatic and neurological, subsequent distress and avoidance behaviors are maintained by cognitive factors.
CBT aims to challenge dysfunctional automatic thoughts, such as the belief that the person making the sound is intentionally trying to cause distress. By changing these interpretations, the therapy works to interrupt the maladaptive cycle of emotional escalation and avoidance. Psychoeducation is a key component that helps individuals understand the neurophysiological basis of misophonia, reducing self-blame.
Dialectical Behavior Therapy (DBT), a form of CBT, is helpful for individuals with strong emotional dysregulation. DBT teaches emotional regulation and distress tolerance techniques. These interventions focus on helping the individual remain calm and manage the high arousal response when exposed to a trigger, thereby reducing the severity of the fight, flight, or freeze reaction.
The goal of these interventions is to empower the patient to cope with triggers without severe emotional upheaval, though the sounds may still be perceived as unpleasant. Specialized CBT has demonstrated significant clinical improvement in misophonia symptoms that was maintained one year later in a randomized clinical trial. This therapy often includes behavioral components to practice helpful coping strategies and reduce avoidant behaviors.
Acoustic and Sound-Based Therapies
Acoustic therapies focus on changing the perception of sound using external methods, often inspired by treatments for tinnitus. The core concept is “sound enrichment,” which involves providing a continuous, non-stimulating background sound. This decreases the contrast between the environment and the highly aversive trigger sound. Silence is often detrimental to misophonia management, as it heightens the auditory system’s sensitivity and can lead to a warning response.
Specialized wearable devices, such as sound generators, deliver a neutral or pleasant sound directly into the ear. These devices play sounds like white noise, pink noise, or nature sounds at a low level. This partially masks the trigger sound and promotes sound habituation, helping the brain gradually filter out the constant background noise. This process makes the trigger less prominent and less likely to elicit a strong reaction.
Adaptations of Tinnitus Retraining Therapy (TRT) combine sound enrichment with directive counseling to create a positive association with sounds. This involves initially mixing the trigger sound with a positively associated sound, like favorite music, at a volume that partially obscures the offensive noise. The volume of the positive sound is then slowly decreased, aiming to retrain the brain to associate the context of the trigger with a less negative emotional status.
Managing Associated Symptoms with Medication
There is currently no medication specifically approved by the FDA to treat misophonia directly. Pharmacological intervention is primarily used as a supportive measure to manage co-occurring mental health conditions that often accompany the disorder. The emotional distress and functional impairment caused by misophonia frequently lead to or exacerbate symptoms of anxiety, depression, or obsessive-compulsive disorder (OCD).
A healthcare provider may prescribe selective serotonin reuptake inhibitors (SSRIs) or anti-anxiety medications in these cases. By treating secondary mood and anxiety symptoms, these medications can sometimes indirectly reduce the intensity and frequency of the misophonic reaction. Case reports suggest that SSRIs like fluoxetine or sertraline may lead to a reduction in misophonia symptoms, but this evidence is limited and requires further research.
Other medications, such as certain beta-blockers or low-dose antipsychotics, have been explored for their potential to modulate the autonomic nervous system’s heightened response. It is important to understand that medication serves as a tool for symptom management and emotional stabilization, supporting the patient’s engagement in psychological and acoustic therapies, but it is not considered a standalone cure.
Environmental and Lifestyle Adjustments
Individuals can significantly improve daily functioning through practical, self-directed strategies focused on environmental control and stress reduction.
Environmental Control
A highly effective proactive measure is the use of non-clinical sound-blocking tools, such as noise-canceling headphones or earplugs. These are useful in environments where triggers are likely to occur, such as public transport or shared living spaces. These tools create a barrier against the immediate auditory impact of the trigger, providing a necessary respite.
Creating “sound-safe” zones, whether at home or in the workplace, allows a person to retreat and reset their nervous system when feeling overwhelmed. This may involve using sound-absorbing materials like thick carpets or curtains to dampen ambient noise. Incorporating background noise sources like a fan or white noise machine can also help mask potential trigger sounds and maintain a lower overall level of auditory sensitivity.
Lifestyle Management
Lifestyle factors play a significant role in lowering the overall physiological arousal level, which in turn can reduce the severity of misophonic reactions. Effective communication is also a powerful coping strategy, as openly discussing the condition with family, friends, and colleagues can foster understanding and lead to manageable environmental accommodations. Key adjustments include regular exercise, maintaining good sleep hygiene, and practicing stress-management techniques like mindfulness or meditation.