Misophonia and Sound Sensitivity: A Polyvagal Informed Approach to Treatment
Do you have extreme negative reactions to specific sounds like chewing or paper crinkling?
Do you get overwhelmed by noises that won’t stop, like traffic or the humming of a fridge?
Do you find yourself upset easily by sudden, loud noises?
These symptoms may indicate a sound sensitivity disorder that is common in people struggling with mental health challenges such as anxiety, depression and trauma. Somatic and polyvagal informed therapies offer some promising treatments for regulating the distress associated with sound sensitivity.
If you suffer from sound sensitivity, you may be experiencing misophonia, hyperacusis, or both. Here’s how to understand the differences and what you can do to treat them.
Misophonia
This is a problem that is often undiagnosed but common amongst those who experience anxiety and mental health problems. Many people think that there is something wrong with them until they identify with the symptoms of misophonia. Misophonia literally means “hatred or dislike of sound.” It is a neurological condition in which a specific region of the brain responds to “trigger” stimuli in a way that involves a profound negative emotional reaction. The triggers can be precise like the following:
Food packaging noises (chip bags rustling)
Eating noises (chewing, slurping)
Bodily functions (burping, sniffling, persistent coughing, throat clearing)
Environmental noises (faucets dripping, household appliance noises)
Repetitive behaviours (pen clicking, whistling, knuckle cracking, breathing noises)
Emotional responses to triggers can include:
Anger and rage at the person making the sound
Anxiety and even anticipatory fear of hearing the sound
Profound disgust
Guilt for having such a strong emotional reaction to the sound, especially when others don’t experience the same
HyperacusisHyperacusis is a condition where regular, everyday sounds can feel too loud or distorted. Sudden and loud sounds like fireworks, ambulances, and telephones can feel uncomfortable and sometimes even painful. This can be a problem when going out in public places, riding public transportation, or even managing sounds in the home with family. Children and adolescents with sound sensitivity have difficulty learning in school and may need special headphones to block out ambient noises.
Sound Sensitivity and Polyvagal Theory
The polyvagal theory was developed by Dr. Stephen Porges and informed somatic therapies to mental health problems. Trauma and anxiety disorders are understood as being rooted in dysregulation of the autonomic nervous system, which is mediated by the vagus nerve. The vagus nerve is a complex, wandering nerve extending from the neck to the face and visceral organs. The tone of the vagus nerve determines our ability to feel safe and regulated. Porges coined the term “neuroception” to describe the body’s ability to determine if a person or situation is safe or not.
Perception is an automatic response below conscious awareness. Each person has a different set point for their perception of safety, and this can be severely compromised in people who suffer from sound sensitivity. When a person has an extremely negative response to specific sounds, their nervous system responds to this potential threat by shifting into a protective, defensive state. Even though the sound may be benign, the body interprets the presence of danger by going into a fight, flight or freeze response. One of the most effective ways to treat sound sensitivity is with somatic therapies that work from the “bottom-up.” “Top-down” approaches like CBT and psychoeducation can help reframe and understand the problem but won’t necessarily change the physical reactivity. By changing the tone of the vagus nerve, we can train the body to respond rather than react to unpleasant sounds. Here are some therapies that work on the principles of the polyvagal theory.
Mindfulness
The first step to treatment for sound sensitivity should be the practice of mindfulness meditation. This can be learned through coaching with a mindfulness therapist and eventually integrated as a regular, daily practice for maintaining one’s mental health. Mindfulness meditation can be thought of as an exercise to regulate attention and learn to be with unpleasant sensations and emotions in the body. Over time meditation will widen your window of tolerance and help your nervous system to feel more resilient and be less reactive to triggers.
Safe and Sound Protocol
The Safe and Sound Protocol is a 5-hour listening therapy that was developed by Stephen Porges and is now offered as a remote therapy for people suffering from a range of mental health conditions. SSP is a therapeutic treatment that involves regular listening and self-care practices with the support of a certified clinician. Click here to learn more about SSP.
EEG Neurofeedback
EEG neurofeedback is another somatic therapy that has excellent results for misophonia and sound sensitivity. Neurofeedback trains the brain to feel calmer and less reactive to triggering stimuli by rewiring the neural networks. There are many types of neurofeedback. Infra Low-Frequency neurofeedback is one of the most effective treatments, which uses an individualized protocol for each person’s unique symptoms. It is not unusual for sound sensitivities to improve within a few sessions, but a complete treatment is a minimum of 20 sessions. Here are some resources to learn more about misophonia:
https://www.goodtherapy.org/learn-about-therapy/issues/misophonia
https://misophoniainstitute.org/