Cognitive Behavioral Therapy (CBT) for misophonia involves surrounding the moment of misophonia—not the trigger itself, and learning how to adapt to and live with the complex emotions that come from a fight-flight-freeze response to auditory (or visual) stimuli.
“CBT for misophonia should in my opinion not include exposure therapy, as this has been noted by persons with misophonia to be highly uncomfortable, and sensory information is likely cumulative. This is not to say that CBT cannot be helpful for misophonia, but that a phobia or OCD-based treatment plan for misophonia is not appropriate for those suffering with misophonia. Instead, CBT for misophonia should revolve around what the person with misophonia can control and not alleviating the trigger entirely.”
— Shaylynn Hayes-Raymond
CBT-MISO, by Shaylynn Hayes-Raymond is specifically adapted to use the parts of CBT that can help an individual deal with the emotional and behavioral impact of misophonia outside of the precipitatory moment of fight-flight-freeze, while omiting parts such as exposure therapy and behaviour experiments.
While evidence for any treatment method for misophonia is still in its infancy, a 2021 randomized clinical trial was conducted which determined that, “the CBT group had an observed clinical improvement in 37% compared to 0% in the waiting list group” (Jager, et al. 2021). Jager went on to note that these changes were still maintained at 1-year follow up appointments. This provides peer-reviewed evidence that CBT has some benefit for misophonia and is more beneficial than the control group which received no intervention and maintained the same level of impairment on the scale used for the study.
The cognitive model introduced by Shaylynn Hayes-Raymond is meant to adapt common CBT principles with coping with misophonia, and thus I have labeled the approach CBT-MISO. The above diagram shows misophonia as the central issue, with each cognitive and behavioral stage presented in a circular pattern. Misophonia is central rather than the main situation/reaction to highlight the neurophysiological nature of misophonia which is external to psychological cognition and behavior.
Since cognitive behavioral therapy is a type of therapy modality, and not only one specific therapy, there are variabilities that can be used to cope. Some people may prefer one exercise, where others will be drawn to a different one. The key to coping with a disorder like misophonia is not to try and fit a square peg in a round hole, but to discover what is appropriate for each person’s needs.
If you are looking for misophonia coping skills, you can go here to see coaching (worldwide) and here to see therapy (Canada) options with Shaylynn Hayes-Raymond. Shaylynn also offers both live and on-demand webinars for misophonia.