Since misophonia first manifests as an auditory problem, it only makes sense that the best solution for it would be auditory in nature. No?
There are a few professionals at the forefront of sound sensitivity training. Audiologist Marsha Johnson is one. A longtime sound therapy advocate, Dr. Johnson said via email that she saw her first case of misophonia in her Portland, Oregon, clinic in 1997, and soon after named the unclaimed fledgling condition Selective Sound Sensitivity Syndrome or 4s. (There has been some professional contretemps over the identification and “ownership” of this disorder.)
Dr. Johnson’s approach--the Misophonia Management Protocol--is now offered by a small network of providers throughout the country. The first component of the program utilizes in-ear sound generators developed by Dr. Johnson that are designed to diminish the contrast between trigger sounds and neutral sounds, making the former more tolerable.
The second component of the MMP includes a course of cognitive behavioral therapy, which, Dr. Johnson said, is supposed to teach misophonics “how to live with a chronic medical condition.”
The trial period for the entire MMP program is 6 months, said Dr. Johnson, but the sound generators are worn permanently.
Dr. Johnson sells the sound generators for between $1,800 and $2,400 with a 30-day free trial period. She said she does not offer a cognitive behavioral therapy program, but audiologist Melanie Herzfeld, a Woodbury, New York, MMP provider said via email that she refers to outside therapists, and that the cost of the treatment is determined independently by them. She said the CBT portion of the program is designed to help misophonics be less reactive to trigger sounds.
Dr. Pawel Jastreboff, the neurophysiologist who coined the name “misophonia,” is another treatment leader. Dr. Jastreboff maintains that the disorder is a subconscious reflex and that misophonics, much like Pavlov’s dogs, can be reconditioned to find trigger sounds actually pleasing, or at least neutral.
In one protocol used by Jastreboff, a trigger sound is mixed with a sound that evokes a positive reaction (e.g. music). Over time, the pleasing sound is decreased, at which point the misophonic is conditioned to have a positive association with the trigger sound.
“Any conditioned reflex can be reconditioned if you know how to do it,” Dr. Jastreboff said via email. He is currently training audiologists and E.N.T. doctors in his methods, but is not involved in treatment pricing decisions.
Then there is Hamden, Connecticut-based audiologist, Natan Bauman, who borrows from both camps. Like Dr. Jastreboff, Dr. Bauman believes that misophonia is a learned conditioned response, and like the providers in Dr. Johnson’s network, Dr. Bauman’s program-- Cognitive Habituation Tinnitus Therapy (CHaTT)--utilizes sound generators and cognitive behavioral therapy designed to “extinguish the learned response.”
According to Dr. Bauman, the CHaTT program can last from 12 to 24 months and costs between $3,000 and $4,000. It is not covered by insurance, he said.
Dr. Bauman, as well as the other professionals behind each of these sound therapy treatment options, claim high success rates, yet to date there have been no independent, peer reviewed studies of the efficacy of any of them.
And there are skeptics.
“I am quite sure that misophonia is not a conditioned reflex, but there are signs and indications that it is caused by incorrect wiring somewhere (high) in the brain,” says Dr. Aage Moller, a neuroscientist at the University of Texas at Dallas who specializes in the auditory system. “I cannot predict what may be an effective treatment. Some kind of reversal of the way the brain changes after experience (neuroplasticity) may be a possibility.”
As for me, I have not tried any of the sound therapy treatments, so I cannot speak from personal experience. But based on the totality of available research, I feel misophonia is not about the way our ears hear or our eyes see, but the way our brains process these sounds and sights.
Therefore, though I believe that sound therapy is one of the best treatment alternatives available today, my gut tells me that it is only one chapter in a long book that has yet to be written.
What has been your experience with sound therapy? I’d like to hear from you.