What is the treatment for misophonia, a condition where a person is sensitive to chewing noises?

Treatment for Misophonia (Sensitivity to Chewing Noises)

Cognitive Behavioral Therapy (CBT) is the most effective first-line treatment for misophonia, with evidence showing it can significantly reduce symptoms in approximately half of patients. 1

Understanding Misophonia

Misophonia is a condition characterized by:

• Intense negative emotional responses (anger, irritability, disgust, anxiety) to specific sounds
• Common triggers include chewing, breathing, or coughing sounds
• Physiological autonomic responses (fight-or-flight reaction)
• Significant distress and social avoidance
• Often develops during adolescence

Treatment Algorithm

First-Line Treatment: Cognitive Behavioral Therapy

1. Group CBT sessions

   • 8 bi-weekly sessions focusing on:
   • Education about misophonia
   • Identifying and challenging unhelpful thoughts
   • Addressing cognitive features related to hypervigilance
   • Developing coping strategies 2, 1

2. Specific CBT techniques

   • Help patients notice and challenge unhelpful thoughts
   • Address catastrophizing (e.g., "I can't handle this sound")
   • Challenge all-or-nothing thinking
   • Plan behavioral experiments to address fear and avoidance
   • Gradually increase exposure to trigger sounds 2

3. Transdiagnostic CBT approach for youth

   • Family-based treatment for ages 8-16
   • Unified Protocol for Transdiagnostic Treatment of Emotional Disorders
   • Involves parents in the therapeutic process 3

Second-Line Treatments

Pharmacological Options

• Beta-blockers (propranolol)

  • Dosage: 60mg daily
  • Targets the physiological fight-or-flight response
  • Can significantly reduce both emotional and physical symptoms
  • May be particularly effective for patients with prominent sympathetic overactivity 4

• Antidepressants

  • SSRIs or low-dose amitriptyline
  • May help manage emotional responses and associated anxiety 2

Sound Desensitization Approaches

• Gradual and systematic exposure to trigger sounds
• Redirection of attentional focus during exposure
• Use of background noise to mask triggers

Psychological Strategies

1. Education about anxiety physiology

   • Explain the anxiety arousal curve
   • Discuss importance of avoiding avoidance behaviors 2

2. Attention redirection techniques

   • Teach patients to shift focus away from trigger sounds
   • Introduce distraction methods during exposure 2

3. Mindfulness training

   • Develop awareness without judgment
   • Practice maintaining focus on other sensations 2

Addressing Comorbid Conditions

• Treat any comorbid psychiatric disorders (anxiety, depression, OCD)
• Address associated conditions that may worsen misophonia:
  • Acid reflux
  • Post-nasal drip
  • Stress and anxiety disorders 2

Relapse Prevention

• Prepare strategies for dealing with setbacks
• Develop self-management techniques for symptom recurrence
• Establish clear criteria for when to seek additional treatment 2

Prognostic Factors

Positive predictors of treatment response include:

• Higher initial severity of misophonia
• Presence of disgust as a primary emotion 1

Clinical Pearls and Pitfalls

• Important distinction: Misophonia differs from hyperacusis (pain from loud sounds) as it's specifically about emotional reactions to certain sounds regardless of volume 5
• Common pitfall: Focusing only on avoidance rather than gradual exposure
• Key insight: Treatment should address both emotional and physiological responses
• Warning sign: Severe social isolation requires more intensive intervention

By following this evidence-based approach, many patients with misophonia can experience significant improvement in their symptoms and quality of life.