University of South Florida Misophonia Clinic
Certain sounds shouldn’t control your life
MISO CALM (Cognitive Auditory Learning & Management) is a comprehensive, audiologist-provided program designed by Dr. Douglas specifically for misophonia management. Our approach combines:
- Psychoeducation
- Customized sound therapy protocol
- Cognitive behavioral interventions
- Biofeedback training
- Proven relaxation techniques (progressive muscle relaxation, mindfulness, self-regulation)
Led by an experienced audiologist and doctoral students who specialize in sound sensitivity disorders, MISO CALM helps you build tolerance, reduce emotional distress, and reclaim the activities and relationships that matter most.
Call us at 813-974-8804, email us at hearingclinic@usf.edu, or complete this form and we will reach out to you.
Candidates for our misophonia management program are 12 or older, at least average intellectual ability, and are willing to utilize sound therapy. Our facility is a teaching clinic and your management plan will be done by doctoral graduate students in Audiology under the supervision of a licensed Audiologist. By using our services, you agree to permit professionals and pre-professionals to observe assessment and management sessions.
During your appointment, we will conduct a survey of the impact of misophonia and evaluate your hearing. If you go ahead with the MISO CALM program, we will guide you through our comprehensive MISO CALM Toolbox to provide practical steps for managing your response to triggers. In most cases we will recommend the use of ear level sound generators.
Primer on Misophonia
Understanding, Managing, and Finding Help
If you experience intense emotional reactions, anger, disgust, or anxiety, when you hear certain sounds like chewing, breathing, or sniffling, you’re not imagining it. You may have misophonia, a condition that affects millions of people worldwide. This guide will help you understand what misophonia is, how it differs from other sound sensitivity conditions, and what options exist for managing it.
What is Misophonia?
Misophonia is a condition characterized by strong negative emotional reactions to specific sounds. Unlike general noise sensitivity, people with misophonia don’t react to all sounds. They react intensely to particular trigger sounds that are typically produced by other people.
In 2022, an international expert committee published the first consensus definition of misophonia after a rigorous Delphi study involving leading researchers and clinicians from around the world (Swedo et al., 2022). According to this definition, misophonia involves a heightened sensitivity to specific, pattern-based sounds, usually produced by other humans, that triggers intense emotional reactions such as anger, disgust, or anxiety. These reactions are accompanied by increased physiological arousal (your body’s fight-or-flight response) and can significantly impair daily life.
The condition was first described in 2001 by audiologists Pawel and Margaret Jastreboff, who noticed that some of their patients didn’t fit the typical profile for hyperacusis (general sound sensitivity) but instead had strong reactions to very specific sounds. Since then, research has exploded, with over 300 peer-reviewed articles now published on the topic.
Diagnostic Criteria
Although misophonia is not yet included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11), proposed diagnostic criteria have been developed by researchers. The most widely referenced criteria were published by Schröder and colleagues in 2013 and 2020 and refined by the 2022 consensus committee.
Key Features of Misophonia
Evokes Strong Negative Emotional, Physiological, and Behavioral Responses: The emotional response might be rage, disgust, or panic. Physiologically, we see increased heart rate, muscle tension, even sweating. Behaviorally, people may lash out, flee the room, or shut down. These responses are not exaggerated, they’re automatic. The autonomic nervous system is engaged, and the fight-or-flight response is often triggered.
Specific Pattern or Meaning to an Individual: The trigger isn’t just the sound itself. It’s the pattern, the context, and the meaning that the brain assigns to it.
May experience suffering, distress, and/or impairment in social, occupational, or academic functioning: The reactions to trigger sounds can be so intense that they interfere with daily life. Patients may avoid restaurants, meetings, or even family gatherings. Some may wear headphones constantly or isolate themselves to avoid triggers. In the workplace, misophonia can lead to reduced productivity, conflict with coworkers, or even job loss. In school, it can impair concentration and participation.
Recognition that the response is excessive: Most people with misophonia understand that their reactions are disproportionate to the trigger, though this awareness doesn’t diminish the intensity of the response. This disproportion is part of what makes misophonia so misunderstood. Friends, family, and even clinicians may dismiss it as overreacting or being dramatic.
Misophonia vs. Hyperacusis vs. Phonophobia: What’s the Difference?
Understanding the differences between these conditions is crucial for getting the right help. They are related but distinct conditions, and they require different management approaches. A 2022 tutorial published in the American Journal of Audiology (Henry et al., 2022) provides clear definitions that I use in my clinical practice.
Hyperacusis
Hyperacusis is physical discomfort or pain when sounds reach a certain level of loudness that would be tolerable for most people. The key feature is that the reaction is based on the volume of the sound, not its specific type or pattern. Someone with hyperacusis might find moderately loud traffic, dishes clanging, or even normal conversation painfully loud. The response is primarily physical discomfort rather than emotional distress.
Misophonia
Misophonia involves intense emotional reactions (anger, disgust, anxiety) to specific trigger sounds that are not influenced by loudness. A soft chewing sound can be just as triggering as a loud one. The reaction is tied to the specific sound pattern and often to who is making the sound. People with misophonia don’t typically experience physical pain from loud sounds unless they also have hyperacusis.
Phonophobia
Phonophobia is the fear of sound, specifically, anticipatory anxiety and avoidance behaviors driven by fear that a sound might occur that will worsen another condition (like tinnitus) or cause discomfort. Phonophobia is often seen alongside tinnitus or hyperacusis. The emotional response is primarily anxiety and fear rather than anger or disgust.
What Causes Misophonia?
The exact cause of misophonia is not fully understood, but research over the past 15 years have uncovered important clues about what’s happening in the brain. The evidence points to misophonia being a neurophysiological condition. This means it involves differences in how the brain processes certain sounds and generates emotional responses, rather than it being a psychological disorder.
Brain Differences in Misophonia
In a study by Kumar et al. (2017), they used functional MRI to examine brain activity in people with misophonia. The researchers found that when people with misophonia heard their trigger sounds, there was abnormal activation in a brain region called the anterior insular cortex (AIC). The AIC is a key hub of the brain’s “salience network” that determines which stimuli are important and generates emotional responses.
The study also showed unusual connectivity between the AIC and regions involved in emotion processing and regulation, including the amygdala (the brain’s alarm center), the ventromedial prefrontal cortex, and the hippocampus. This suggests that in misophonia, the brain is assigning excessive emotional significance to specific sounds.
The Motor Theory of Misophonia
In 2021, the same research group published an important follow-up study proposing what they call the “motor basis” for misophonia. Since most trigger sounds are produced by human orofacial movements (chewing, breathing, sniffling), they hypothesized that the brain’s mirror neuron system might be involved.
Their findings supported this theory: people with misophonia showed stronger connectivity between auditory regions and the part of the motor cortex responsible for orofacial movements. When they heard trigger sounds, there was stronger activation in this motor area. The researchers propose that misophonia may involve “hyper-mirroring,” an excessive mirroring of the actions of others, with sounds serving as the trigger for this exaggerated response.
Structural Brain Differences
Additional neuroimaging research has identified structural differences in the brains of people with misophonia, including larger amygdala volume and differences in white matter connections between brain regions involved in emotion processing and attention. These findings suggest that misophonia involves fundamental differences in brain organization, not just temporary emotional responses.
When Does Misophonia Start?
Research consistently shows that misophonia typically begins in childhood or early adolescence. Studies report that more than 80% of cases begin before age 18, with the average age of onset around 12 years old. The condition often starts with one or a few trigger sounds and may gradually expand to include additional triggers over time. A family history of misophonia appears to be a risk factor, suggesting a possible genetic component.
How Common is Misophonia?
Prevalence estimates for misophonia vary widely depending on how the condition is defined and measured. Studies using self-report questionnaires in general population samples have reported rates ranging from about 5% to 20%. A 2022 epidemiological survey in Germany found that approximately 5% of the adult population met criteria for clinically significant misophonia symptoms. A Turkish population-based study reported a prevalence of 12.8%.
It’s important to note that many people experience some degree of sound sensitivity without it rising to the level of a clinical condition. The key distinction is whether the symptoms cause significant distress or impairment in daily functioning. Using stricter diagnostic criteria, clinically significant misophonia likely affects somewhere between 5-10% of the population.
Common Trigger Sounds
While trigger sounds are highly individual, research has identified common categories. The most frequently reported triggers are human-produced oral and nasal sounds, though environmental sounds can also be triggers for some people.
Oral/Eating Sounds
- Chewing or smacking lips
- Slurping or sipping
- Swallowing
- Crunching
- Gum chewing
Nasal/Respiratory Sounds
- Sniffling or sniffing
- Heavy or loud breathing
- Sighing
- Yawning
- Throat clearing or coughing
Other Common Triggers
- Pen clicking
- Keyboard typing
- Foot tapping
- Clock ticking
- Bass through walls
How Misophonia Affects You: Common Responses
The experience of misophonia goes far beyond simple annoyance. The responses are complex, involving emotional, physical, cognitive, and behavioral components.
Emotional Responses
- Anger or rage: Often described as instant, intense anger that feels disproportionate to the trigger
- Disgust: A visceral sense of revulsion
- Anxiety: Anticipatory dread about encountering triggers
- Irritation and annoyance: Feeling on edge, easily frustrated
- Helplessness: Feeling out of control of one’s reactions
Physical Responses
- Increased heart rate
- Muscle tension, especially in shoulders, jaw, and hands
- Sweating
- Feeling of pressure building up
- “Fight or flight” sensation
Cognitive Responses
- Difficulty concentrating or thinking clearly
- Intrusive negative thoughts about the person making the sound
- Hyper-awareness of trigger sounds (seeming to hear them everywhere)
- Rumination after trigger exposure
Behavioral Responses
- Leaving the room or situation
- Using earphones or earplugs
- Avoiding meals with others
- Creating white noise or background sounds
- Verbal outbursts or arguments
- Social withdrawal and isolation
The Challenge of Being Understood
One of the most painful aspects of misophonia is the lack of understanding from family members, friends, and employers. Because the emotional response can seem so disproportionate to the trigger, people with misophonia are often told to “just ignore it,” “stop being so sensitive,” or “get over it.” This invalidation can be as distressing as the triggers themselves.
Why It’s Hard for Others to Understand
The sounds that trigger misophonia are typically ordinary, everyday sounds that most people barely notice. Family members eating breakfast, coworkers typing, friends sniffling. These are things everyone does without thinking. It can be genuinely difficult for someone without misophonia to comprehend why such mundane sounds could cause such intense distress.
Additionally, because misophonia is not yet widely recognized in mainstream medicine, many healthcare providers, teachers, and employers have never heard of the condition. This can lead to skepticism, dismissal, or misdiagnosis.
Impact on Relationships and Work
Research shows that misophonia can significantly impact relationships and professional life. People with misophonia may avoid family meals, struggle with open-office environments, or limit social activities. The condition can strain marriages and family relationships, particularly when the person making the trigger sounds doesn’t understand why their normal behaviors cause such distress.
Practical Coping Strategies
While professional treatment is important for significant misophonia, there are also practical strategies that can help you manage symptoms day-to-day.
Sound Management
- Background noise: Using white noise, nature sounds, or music can reduce the prominence of trigger sounds without blocking all hearing
- Noise-canceling headphones or earbuds: These can be helpful in specific situations, though should be used strategically rather than constantly
- Environmental modifications: Moving to a different seat, choosing quieter restaurants, or using a fan for background noise
Emotional Regulation
- Deep breathing: Slow, diaphragmatic breathing can help calm the physiological fight-or-flight response
- Grounding techniques: Focusing on physical sensations (feet on floor, hands on chair) can help when feeling overwhelmed
- Mindfulness: Observing reactions without judgment can reduce the secondary distress about having reactions
- Self-compassion: Reminding yourself that your reactions are involuntary and not your fault
Communication and Planning
- Educating others: Sharing information about misophonia with family, friends, and coworkers
- Having an exit plan: Knowing you can leave a situation if needed can reduce anticipatory anxiety
- Strategic seating: Positioning yourself away from likely trigger sources when possible
- Support groups: Connecting with others who have misophonia can reduce isolation and provide practical tips
Lifestyle Factors
- Sleep: Poor sleep can increase reactivity to triggers; prioritizing rest is important
- Stress management: General stress tends to worsen misophonia; managing overall stress helps
- Exercise: Regular physical activity can help regulate the nervous system and reduce reactivity
What Does NOT Help
Understanding what doesn’t work is just as important as knowing what does. Some commonly suggested approaches can actually make misophonia worse or provide false hope.
Exposure Therapy (Traditional Format)
Traditional exposure therapy, where you’re repeatedly exposed to trigger sounds with the expectation that you’ll “get used to them,” is not recommended for misophonia. Misophonia is not a phobia. In phobias, the fear is irrational and exposure helps the brain learn that the feared stimulus is actually safe. But in misophonia, the brain isn’t making an error about safety. It’s generating an involuntary emotional response based on abnormal sound processing.
Forced or premature exposure to trigger sounds can worsen misophonia by increasing sensitization and anticipatory anxiety. Some patients who attempted exposure-based approaches report that their triggers expanded or intensified.
If a provider recommends simply “exposing yourself” to trigger sounds, this is a red flag that they may not understand misophonia. While some therapeutic protocols incorporate carefully designed and supported exposure components (such as in CBT for misophonia), this is very different from traditional exposure therapy and should never involve forcing yourself to endure triggers.
Other Approaches That Don’t Help
- “Just ignoring it”: The response is involuntary; willpower alone cannot override neurological processes
- Telling yourself you’re overreacting: Self-criticism increases distress without reducing reactions
- Expecting others to completely eliminate triggers: While accommodation is helpful, expecting a trigger-free environment is unrealistic and can increase anxiety
- Constant use of earplugs or noise-canceling headphones: Overuse can increase sensitivity and prevent the brain from adapting; use strategically, not constantly
- Complete avoidance: While temporary avoidance can be helpful, extensive life restriction tends to worsen the condition over time
- Medications as a standalone treatment: No medications are specifically approved for misophonia; while some may help manage co-occurring anxiety or OCD, medication alone is unlikely to resolve misophonia
When to Seek Professional Help
Many people with mild misophonia can manage symptoms with self-help strategies. However, professional evaluation and treatment is recommended if:
- Misophonia is significantly interfering with work, school, or daily activities
- Relationships are being damaged due to your reactions or avoidance behaviors
- You find yourself increasingly isolated or avoiding social situations
- You’re experiencing depression, significant anxiety, or thoughts of self-harm
- Your trigger sounds are multiplying or reactions are intensifying
- Self-help strategies aren’t providing sufficient relief
- You want an accurate diagnosis to rule out other conditions
- You need documentation for workplace accommodations
- You need documentation for a 504 plan
Who Can Help
Because misophonia sits at the intersection of audiology, psychology, and psychiatry, several types of professionals may be helpful. The ideal provider has specific knowledge and experience with misophonia. Unfortunately, not all professionals in these fields are familiar with the condition.
Audiologists
Audiologists are hearing healthcare professionals who can conduct comprehensive evaluations to assess sound tolerance conditions. They can differentiate misophonia from hyperacusis and phonophobia, evaluate hearing sensitivity, and in some cases provide sound-based interventions or counseling based on TRT and CBI principles. Look for an audiologist with experience in decreased sound tolerance or tinnitus/hyperacusis management.
Psychologists and Licensed Therapists
Mental health professionals trained in CBT, ACT, or other evidence-based approaches can provide therapy to help manage the emotional and behavioral aspects of misophonia. The most important factor is finding a therapist who understands misophonia, or is willing to learn, rather than one who dismisses it or applies inappropriate treatments.
Psychiatrists
Psychiatrists may be helpful if there are co-occurring conditions like anxiety, depression, or OCD that might benefit from medication management. While no medications are specifically approved for misophonia, treating co-occurring conditions can sometimes reduce overall symptom burden.
Specialized Misophonia Clinics
Several academic medical centers have established specialized programs for misophonia, including Duke University, Amsterdam UMC, and Newcastle University. These centers offer comprehensive evaluation and cutting-edge treatment approaches.
What to Look For in a Provider
- Knowledge of misophonia as a distinct condition (not just “anxiety” or “anger issues”)
- Understanding of the difference between misophonia, hyperacusis, and phonophobia
- Experience with evidence-based approaches like CBT or ACT
- Willingness to collaborate with other specialists if needed
- An approach that validates your experience rather than dismissing it
Looking Forward
Misophonia research has advanced tremendously over the past decade. We now understand that misophonia is a real neurological condition with identifiable brain differences. Not a personality flaw, not an overreaction, and not something you can simply “get over.” While there’s still no cure, effective management strategies exist, and more treatments are being developed and tested.
If you have misophonia, know that you’re not alone. Millions of people share your experience. With proper understanding, support, and treatment, it’s possible to reduce the impact of misophonia on your life and relationships. The first step is education and by reading this guide, you’ve already taken it.
Common Questions
Insurance typically covers the initial misophonia evaluation under your audiology benefits. The MISO CALM management program is offered as an out-of-network service. We provide itemized receipts (superbills) that patients can submit to their insurance for potential out-of-network reimbursement. Coverage varies by plan, and we recommend checking your out-of-network benefits.
No, we cannot cure misophonia. There is ongoing research across multiple universities and institutions including the University of South Florida, but we are not there yet. There are no medications, supplements, or homeopathy that consistently and specifically work for misophonia.
A 504 plan can provide accommodations and support for a student with misophonia in a school setting. We can write a letter of support to schools to help implement a 504 plan. Accommodations can help create a more supportive and effective learning environment for a student with misophonia, enabling them to better focus on their education and participate fully in school activities.
References
Cavanna, A. E., & Seri, S. (2015). Misophonia: Current perspectives. Neuropsychiatric Disease and Treatment, 11, 2117-2123.
Eijsker, N., et al. (2021). Structural and functional brain abnormalities in misophonia. European Neuropsychopharmacology, 52, 62-71.
Henry, J. A., et al. (2022). Sound tolerance conditions (hyperacusis, misophonia, noise sensitivity, and phonophobia): Definitions and clinical management. American Journal of Audiology, 31(3), 513-527.
Jakubovski, E., et al. (2022). Prevalence and clinical correlates of misophonia symptoms in the general population of Germany. Frontiers in Psychiatry, 13, 1012424.
Kılıç, C., et al. (2021). The prevalence and characteristics of misophonia in Ankara, Turkey: Population-based study. BJPsych Open, 7(5), e144.
Kumar, S., et al. (2017). The brain basis for misophonia. Current Biology, 27(4), 527-533.
Kumar, S., et al. (2021). The motor basis for misophonia. Journal of Neuroscience, 41(26), 5762-5770.
Potgieter, I., et al. (2019). Misophonia: A scoping review of research. Journal of Clinical Psychology, 75(7), 1203-1218.
Schröder, A., et al. (2019). Misophonia is associated with altered brain activity in the auditory cortex and salience network. Scientific Reports, 9, 7542.
Siepsiak, M., & Dragan, W. (2019). Misophonia—A review of research results and theoretical concepts. Psychiatria Polska, 53(2), 447-458.
Swedo, S. E., et al. (2022). Consensus definition of misophonia: A Delphi study. Frontiers in Neuroscience, 16, 841816.
Twohig, M. P., et al. (2025). Acceptance and commitment therapy versus progressive relaxation training for misophonia: A randomized controlled trial. Journal of Affective Disorders, 393(Pt B), 120366.