Misophonia from a Social Worker’s Perspective

social worker misophonia

Misophonia is a disorder in which certain sounds trigger emotional and or physical responses that others may consider irrational. It is mainly self-diagnosed because finding a health care practitioner that will diagnose or treat, is a huge challenge. Finding a mental health care practitioner to diagnose and treat is impossible. Why is that? Misophonia is not determined a psychiatric disorder so a diagnosis of Misophonia would not be able to be provided by a behavioral or mental health practitioner. There is a manual called the DSM-V, The Diagnostic Statistical Manual of Mental Disorders published by the American Psychiatric Association which lists all classifications of mental disorders. The DSM-V guides behavioral and mental health practitioners in diagnosing those mental health disorders. Misophonia cannot be found in the DSM-V.

There isn’t any medication or universal established treatment at this time, yet there is hope, ongoing research, support and coping mechanisms you can learn about and utilize. Psychotherapists provide treatment for behavioral and mental health issues. They can be a great resource for support and coping skills to the stress response that you experience after a trigger. The stress response is fight or flight, a natural response and healthy when we need it when we are faced with an actual threat of harm. The stress response helps us fight our way through a dangerous situation or run from it. A therapist can range from Psychologists, Licensed Clinical Social Workers, Licensed Professional Counselors, Licensed Marriage and Family Therapists and more.

Since misophonia is not in the DSM-V, finding a therapist that understands can be puzzling. It is a great opportunity for you to broaden awareness and education to a therapist about your challenges living with misophonia. As a Licensed Clinical Social Worker working in a behavioral health setting, I learn from my patients every day. I believe in learning from them and working collaboratively on their goals in therapy makes me a better therapist and overall a better person. So turning to a therapist can be beneficial and one should not shy away. I have been asked by others that questioned if a health care or behavioral health care provider does not live with an issue would they understand. Everyone can learn about a specific topic or issue. Would you not go to a cancer doctor if they never had cancer? We can teach each other about Misophonia and many therapists are open to learning and understanding. However, there are therapists out there that have an understanding of misophonia. I am one of them.

I have had misophonia ever since I was a young girl. I did not know what it was until just recently working with my audiologist for new hearing aids for both ears. I had just replaced the ones I have had for the last 10 years. I have always been hearing impaired. I began talking about experiences that were puzzling and my audiologist asked more detailed questions leading us to misophonia. I cope very well in many environments. Having misophonia, I believe, helps me truly understand the confusion and distress that it brings. There are many noises I truly enjoy and some that I do not. There are just a few that trigger my stress response and that can be hard to tolerate at times.

I have worked on some behavior experiments of various ways of coping and recovery response time to the stress response has been positive. There are times that ultimately I have been through my coping skills box (figuratively) and I have to take a break and remove myself when I can. I have noticed some trigger noises throughout my experiences with patients and have been able to cope well. I can cope well because, in that timeframe of our sessions, they come first. A lot of times we often put others before ourselves and that tends to happen more so when someone works in a helping profession. In between sessions, when I am not focusing on someone else, I practice many small things that bring me joy and peace to distress. When I am triggered by the noises during those times, it does take some extra care on my part to get through them.

What kind of coping is there that a therapist can help with?

Keeping a journal or diary can be a good place to start. This can show patterns and triggers more closely. The diary can include the time of day and what was happening around you or what you were doing at the time. How did you feel? Sad, angry, joyful, shameful, fearful? What was your body feeling? Did you shake, tense up, and have trouble breathing? What did you do to cope and did it help (can be where behavior experiments take place)? Were there others involved? Were they helpful or contributing to the stress? If the people around you are stressed, you will likely feel that energy and the situation could worsen.

Promoting and educating on healthy self-care. Care of your physical health, nutrition, exercise, healthy sleep practices and activities daily that brings you a sense of accomplishment and joy. These practices are especially important if you are struggling with depression and anxiety. Many people develop depression from isolating and avoiding the situations that can cause a trigger. Or social anxiety having persistent worries about managing misophonia around others, even your family or any other social setting.

Cognitive Behavioral Therapy (CBT) is a therapy model that many therapists use which is an evidence-based treatment for depression and anxiety and many other mental health challenges. CBT helps you become more aware of inaccurate or unhealthy thoughts (the cognitive) so you can see challenging situations more clearly and respond (behavioral) to them in a more constructive way. Thoughts can be very random and people often will panic from thoughts worrying constantly that they are going to act out on them. Thoughts and feelings are different and we chose whether to act on them or not. Some thoughts are not healthy. You may notice some negative appraisals when your stress response is activated from a trigger. These can be inaccurate due to our perceptions of the situation. Just a few types of unhealthy thought patterns are catastrophizing, mental filter, overgeneralizing. Catastrophizing is where people think of numerous worst- case scenarios in a situation and then treat it is if those scenarios were inevitably going to happen. Mental filter is where a person is only thinking of the negatives surrounding something and will not think of the positives. Overgeneralizing is a thinking pattern of taking a past or present situation that is usually negative as all occurring for future situations “everyone” you never, I always” are common in overgeneralizing thoughts. These thoughts and many other unhealthy styles of thought influence how we feel and behave. Therapy can help someone be more aware and challenge these thoughts. Investigate the facts and look at other ways to see the situation.

Stress reduction and self-regulation techniques. Stress regulation and calming methods to help people prepare themselves ahead of time to manage the stress response and minimize the intensity. Calming methods like deep regulated breathing and scanning your body for tension and relaxing the muscles. Progressive muscle relaxation where you tense the muscles purposely and relax them.

There are many behavior experiments or planned activities for coping that you and a therapist can plan to use. Technology such as smartphone apps helps with anxiety, stress, depression, etc. Earphones and white noise machines. Take breaks, be self-compassionate and forgiving. Hold yourself accountable to change a behavior if it is destructive. Remove yourself and take a walk, watch nature, play your favorite music, take a bubble bath, lean on your support system, hug yourself, make a gratitude list of things that you are grateful for, make a list and keep it with you that includes reminders to practice body scans, progressive muscle relaxation, supportive and soothing self-talk statements and affirmations, deep breathing, and acronyms to remind you to calm down such as STRIP (stop, take a breath, relax all your muscles, imagine consequences if you were to act negatively and proceed). Learn about your misophonia or other health-related issues. Ultimately accept and love yourself.

You can find Stacy on the Misophonia Provider Network.

Looking for more information on misophonia? Consider attending our workshops at Misophoniaeducation.com

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kayla August 26, 2019 - 5:19 pm

I can see that it has good information. Can it be part of anxiety issue? I have been dealing with anxiety/depression since 2011 and recent years certain sounds that kept repeatedly or see people doing certain things repeatedly would literally drives me nuts that would cause anxiety big time. The tricky part is, is being in college when Im next to a student or near a student who makes certain sounds or certain movements where it just drives me nuts that causes anxiety. Students who moves sideways on a movable chair next to me or near me would drive me nuts and causes anxiety big time. With this situation I try to work it out by turning to other side without seeing it while for this semester I cannot since the powerpoint screen is on my right while the instructor is on my left due to my hearing while the student is on my right. I have to be in the front which surprisedly is where its happening. Usually thought it would happen in the back. To get exercise and sleep can be a little tricky. Exercise for me here in AR is tricky since theres no sidewalks and don’t like to walk around the subdivision where houses are everywhere. I rather be out in the scene that is clear. I also try not to drive much due to traffic and how people drive nowadays specially after what had happened at my last car accident.

stacy Irene buonomo August 27, 2019 - 10:48 am

Hi Kayla
I do think that anxiety can result from it. Anxiety essentially has the same physical symptoms like rapid heartbeat, shortness of breath, tension, etc as Misophonia where the sympathetic nervous system (SNS) is dominant. The SNS is the system we want to be in if we are faced with a real danger so we can fight our way out of it or run to safety. Yet with chronic stress and anxiety, we often can perceive something dangerous that is not. I have tended to anticipate a feeling of dread and worry for situations that I MAY face with certain trigger noises. MAY is the keyword and I am able to talk it through to myself that I have proof that not EVERY situation I dread or worry about actually happens. There have been successful times I coped with a trigger noise. When I notice thoughts about trying to tell the future and dreading, worrying and anticipating anxiety, I ask what is my biggest worry? Is it likely or unlikely to happen? If it is unlikely I imagine picking it up and putting it on a shelf; however, most instances the worry can be likely. if it is likely…what is my plan to cope with it? Who can I lean on for support? This is a focus for me working in psychotherapy with people dealing with anxiety (noticing unhealthy types of thoughts such as catastrophizing about the future) and teaching calming strategies. I also notice for myself that when I am stressed out (already SNS dominant) the harder it is sometimes so having an ample list of healthy coping strategies is very important. I hope to help break the stigma surrounding mental health and seeking treatment. Everyone can use a little outside help sometimes especially when trying to cope with a medical or neurological condition on top of anxiety and/ or depression.

Kayla August 27, 2019 - 2:05 pm

Thanks! I kind of figured that can be part of anxiety/depression. It is harder when being back in college in 2017 and as a transfer student to different state last year where now we have those movable chairs that we all love to swivel back and both including myself which I try not to when students are around being respectful to others in case if they are trying to learn too but at least I do it at home. Chairs are the biggest trigger for me while certain sounds will too. I almost nearly lost it the other day when a student next to me swivel back and forth where I literally couldnt focus on the PowerPoint and listen when trying to learn and had to sit where I was for a reason. It was tricky trying to avoid seeing it unless have a tri-fold up to o block it. Sadly the student will be moving to another seat so hopefully it doesnt happen again. Other times in previous classes I was able to work it out just by moving totally to one side does help. (If I’m looking on the left, then I move my whole body to the left to block the scene on the right) Thankfully I do take prescription med which normally is for tension headache due to anxiety that actually does calm me down just enough to get me through the class. I actually almost literally in tears due to anxiety/depression when I went to class right after this one. Thankfully only lasted for little bit and had to take 2 the most for the day (1 for every 4 hrs if needed to but most times I take 2 the most in 1 day and not everyday but bc I’m back in class usually take it when taking classes) knowing I will be good for sure if the med works. At least my 2nd class was more enjoyable where I usually looking forward to it for now.

Anonymous August 27, 2019 - 3:39 pm

thanks for sharing your story Kayla
I can only imagine how frustrating that would be
there are a lot of great things nowadays from free calming apps to youtube videos
you can look into progressive muscle relaxation and some deep breathing exercises to help calm yourself

Kayla August 27, 2019 - 3:52 pm

I have looked into calming videos which I havent really used in longer period of time just yet. But seem like white noise actually does help a little but again havent used it in longer period just yet. Seem like white noise is little harder to find. It’s not just any sounds, it’s a certain sound that plays but does call it white noise. At least able to bookmark the website that I found white noise but trying to find a site that can download it without going to the internet.

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