Does exposure therapy help misophonia?

Exposure therapy using traditional habituation-based exposure to sounds is not recommended as a therapy for misophonia.

Traditional ‘exposure therapy,’ as this term is most commonly used, is habituation based. This means the person is exposed to a feared, but unharmful, stimuli and asked to do nothing other than experience the experience passively, repeatedly. Over time and across contexts (imaginary and in vivo usually using a graded hierarchy) until their distress habituates; until they become acclimated to the triggering stimulus.

This is an evidence-based treatment strategy for certain anxiety disorders, phobias, and OCD.

However, it may be helpful to learn how to approach and respond differently to triggers and associated cues as part of a broader set of treatment approaches.

Some approaches—such as “inhibitory learning”—are used to describe what happens when people repeatedly encounter and actively change the stimulus or context around the stimulus in order to change the outcomes of encountering the cue/trigger, when they happen in life. This means the person controls the context and way in which they encounter the feared stimulus in order to widen the expectations they have about what could happen if they don’t avoid/escape.

This approach is not a kind of direct habituation/acclimation exposure therapy. Rather, it helps people learn different ways to respond when triggers do happen, to not assume one can expect negative outcomes in all situations that could possibly be triggering, to use their resources to manage life in a world that will, at times, include triggers outside of one’s control. The results are not “suffering in silence,” and could help some people reduce the impact misophonia has on their lives.

This approach might be one of many that can be used in a personalized plan for living with misophonia.

[Thanks to Drs. Zachary Rosenthal and Jennifer Brout for their help on this answer.]