When specific sounds fill up all of your hearing, and when they hurt (and it happens all the time for those with misophonia), you just want the sounds to stop.
Trigger sounds are distracting, obnoxious, and painful to those with misophonia. Whether it’s someone eating popcorn, breathing heavily, or chewing gum, listening to the sound is sheer torture. The person with misophonia can become extremely angry and/or anxious at the sound. The solution, it would seem, would be to wear earplugs or headphones to protect against the trigger sounds.
It would be nice if that were the case. Unfortunately, it doesn’t seem to work that way. Blocking out sound actually makes the misophonia worse. The trigger sounds become much more intrusive — perhaps even more trigger sounds develop — and earplugs are worn more frequently.
Recent research has shown that we have central auditory gain. This means that the brain centers that deal with hearing increase the intensity of sound (the loudness) within the brain to make up for perceived hearing loss. So, if the brain can’t hear the sound well (because of hearing loss or earplugs), it will try to intensify the sound in the brain. And it does this at several levels in the brain, starting at the brainstem (low-level areas) up to the cortex (the higher-thinking brain.). This may lead to increased sensitivity to trigger sounds. The misophonia becomes worse and even more unbearable.
On the bright side, exposure to sound — even relatively soft sound — can decrease central auditory gain and increase tolerance levels. This is true for those who have hearing loss and those with decreased tolerance to loud sounds. We also use this principle in treating misophonia.
Our treatment for misophonia begins with the introduction of low-level noise to the ear — like white noise or ocean sounds — to reduce central auditory gain. This noise does not interfere with conversation or hearing desired sounds such as a teacher or music. It’s not that loud, but it supplies a continuous low-level sound that also allows for normal daily communication. It doesn’t cover up or mask the trigger sounds; it cushions the trigger sounds by raising the floor of the sound environment.
It is also important to realize that listening to this sound must happen with unblocked ear canals. Wearing earbuds, headphones, or anything that blocks sound from entering the ear canal works like an earplug, and central auditory gain ensues. The sensitivity to trigger sounds becomes worse. In treating misophonia, we use special devices that transmit various specific sounds while leaving the ear canal open. The devices are usually paired to smartphones, which provide an unlimited variety of sounds to use. An added benefit: they are the coolest Bluetooth® devices out there!
Sound generation provides numerous benefits in the treatment of misophonia. The reduction of central gain is a particularly important benefit for getting misophonia under control.