Counterconditioning Treatment for Misophonia

Misophonia is a recently identified discrete and independent condition that cannot be classified using DSM-V criteria. With misophonia, a trigger stimulus elicits a reaction starting with irritation or disgust that immediately escalates. The trigger stimulus can be any typically occurring sound. The reaction is both extreme and irrational, and can include feelings of hate, anger, rage, and disgust. This response is perceived as involuntary, and individuals report feeling a loss of self-control. Misophonia can be conceptualized as a conditioned response to the trigger stimulus. This article describes a counterconditioning treatment of a middle-aged woman for misophonia that involved pairing a positive stimulus with a reduced trigger stimulus. Under these conditions, the misophonic response to the stimulus progressively weakened. Four distinct trigger stimuli were addressed in a multiple baseline treatment format. The overall severity of misophonia and the strength of the misophonic responses to triggers reduced over the course of the treatment, based on client self-assessments. These indicated large reductions in severity of misophonia and response to individual triggers, both at the end of treatment and at 10 months posttreatment. During treatment, responses to low intensity trigger stimuli were purely physical and independent of any emotional response. This demonstrated that, in this case, misophonia included a conditioned physical reflex to the trigger stimulus. It is proposed that misophonia consists of an aversive physical reflex elicited by the trigger stimulus and an emotional response elicited by the aversive physical reflex.