Misophonia, a condition consisting of a strong emotional and physical response to certain sounds, can leave people feeling perplexed, helpless and stuck. We work with children, teenagers and adults with misophonia as clinical psychologists within audiology services. Although we have not found that one approach helps everyone we have found a common set of ideas to help people with misophonia and their families.

Stop thinking about the person with misophonia as the problem and start thinking about the misophonia as the problem.

This way of viewing it can create space to work together as a couple or family to find ways to manage it. One way of understanding misophonia is that a short-circuit gets set up in the brain between:

Hearing a sound ---> feeling strong emotion + a physical response (fight or flight system)

Misophonia is no one’s fault. No one wants to have misophonia. Neither does anyone want to be triggering misophonia and be on the receiving end of an angry outburst. Recognising misophonia as a problem that everyone in the family can work on together, helps reduce the urge to blame someone and this in itself can help.

Start talking about misophonia in new ways.

The intense emotions associated with misophonia, particularly anger, can drive a wedge between people. The problem is often only talked about when a misophonic reaction is triggered and everyone is already feeling upset and resentful. At these times it is more likely that hurtful comments are thrown about. For example between sisters:

Daisy: (angry, disgusted, hurt that Megan eats like this despite knowing the effect) "Shut your mouth! You’re disgusting!"

Megan: (upset, embarrassed, fed up with this all the time) "You’re such a freak, just get over it!"

The person with misophonia may feel let down and unloved by others who persist in making distressing noises despite having been told many times to stop. A partner can feel criticised and hurt by comments about personal habits such as how they eat, drink, breathe or talk. The person with misophonia concludes (usually incorrectly) that their partner does not love them, as otherwise they wouldn’t keep making these awful noises. They may come to believe that the sounds are being made deliberately to taunt or upset them. More often than not, making such sounds (e.g. how we talk, eat and drink) is automatic, unintentional and habitual.

It is helpful to talk with each other about how misophonia is affecting everyone in the family. Practicing listening and respecting each other’s perspectives, and being calm whilst doing so, can help to dispel unhelpful assumptions. Some families find that setting aside a time to talk about misophonia can be helpful, for example for an hour every Saturday morning. This could mean that the rest of the week can be free of discussion about misophonia. Being kind and compassionate to ourselves and to our family members (out loud and in our heads) is a useful skill to develop. For example, "I’m trying hard to cope with this and I know my dad is too." Again, this takes practice!

Agree on how best to raise concerns.

Examples of concerns could be how to ask or remind a partner about a triggering noise, or how to convey to a brother that you are doing the best you can. It seems that much less anger and distress is experienced by everyone when it is believed that sincere efforts are being made to minimise the noises as much as reasonably possible.

Consider non-verbal communication.

Our body language can be as important as what we say. Touch can help to convey love and concern in the midst of unavoidable sounds. A hug can be a powerful counter to the distancing effects of anger and hurt. Such closeness can be soothing, loving and healing and may help to reassure both that each are trying their best to cope with this difficult problem.

Boost happiness and well-being generally.

This may include managing stress, low mood, anxiety and other difficulties. As a general rule, tolerance to sounds is improved when we are in a better mood.

Increase the amount of time spent having fun and enjoying each other’s company.

Don't let issues around misophonia become the sole focus of interaction with someone important.

Find ways to manage and tolerate difficult feelings of anger, disgust and anxiety.

Calming the body and lowering the physical response allows one to think more clearly, to talk and act more helpfully. Relaxation, breathing and meditation techniques can be used. Hot, angry thoughts fuel anger and so it is important to increase awareness of these and replace them with calmer, coping thoughts, for example:

"His breathing is disgusting," "I hate him," "I want to hit him"

versus

"It’s just a breathing noise," "I’m learning to cope with this," "Keep calm"

Practice listening to the disliked sounds whilst feeling more neutral or positive.

This is likely to be easier when feeling confident in coping with difficult emotions. Using relaxation, distraction strategies and calming thoughts can help. Some people have found coping with eating sounds easier with relaxing background music on, after doing exercise, or by deliberately selecting engaging and fun conversations for this time.

Ask for help.

Some people can feel very stuck with these difficulties and may want professional support. We recommend discussing concerns with their GP in the first instance.