Treatment plans for Misophonia need to be personalized. Some may include psychotherapy, and some may not. Some may include audiological interventions, and some may not. Our goal is to help create a careful and custom care pathway that prioritizes (a) multi-disciplinary approaches and (b) evidence-based interventions. For those people who are seeking and could benefit from a psychological treatment for Misophonia, we develop a customized coping and management treatment plan that uses evidence-based processes of change likely to help the person.
This could include, for example, brief and evidence-based interventions for:
- Attentional hypervigilance
- Attentional flexibility
- Regulation of emotional arousal
- Cognitive biases
- Interpersonal skills
What about exposure therapy? We often get asked by patients, loved ones, and clinicians whether exposure therapy should be used for Misophonia. On the one hand, exposure therapies are well-supported by scientific evidence in the treatment of many psychiatric disorders (e.g., PTSD, OCD, panic disorder). When considering the question transdiagnostically (i.e., by not thinking about it from a medical model with distinct diagnoses), exposure-based procedures are evidence-based processes of change for a range of problems, including those related to the avoidance and intolerance of emotional distress. And, Misophonia appears to be associated with avoidance and escape from aversive triggers and related distress. For these reasons, we understand the logic driving many to consider trying exposure therapy for Misophonia. On the other hand, Misophonia has not been scientifically characterized yet in a way that suggests traditional exposure therapy is indicated as a specific treatment. Additionally, traditional exposure therapy involves repeatedly using habituation procedures designed to change the conditioned responses to triggering cues. It is unknown whether or why this conventional approach may be beneficial for Misophonia. Beyond theory and data, consider this... For a treatment to work, it must be acceptable and feasible to patients and their loved ones. It is not clear whether exposure therapies are acceptable and feasible to use for those with Misophonia. Only through rigorous science will it become more clear whether exposure therapies should be considered a primary treatment option for Misophonia. At this point, until there are more scientific data about this question we do not recommend using conventional (i.e., habituation-based) exposure therapy as a first-line behavioral approach to treatment of individuals with Misophonia. That said, we encourage more research, delineation of theoretical models, and well-coordinated communication to the scientific community from patients and loved ones about this issue. In addition, when treating Misophonia using psychological interventions, we believe that given the early work done by Jastreboff* and the Amsterdam Medical Center** it is reasonable to consider a range of counterconditioning approaches, including the use of inhibitory learning adaptations of traditional exposure therapy.
In short, when receiving psychological services as part of a care plan for Misophonia, we suggest not beginning with or over-simplifying treatment with exposure therapy, but instead developing a contemporary process-based cognitive and behavioral treatment plan that is tailored to the individual and done, ideally, within the context of a multi-disciplinary approach.