What’s New in Decreased Sound Tolerance Research? Key Updates from September 2025
Exposure and Stress Management Therapy for Misophonia
Researchers tested a 12-session telehealth program combining exposure therapy (gradual, controlled exposure to trigger sounds) and stress management techniques.
Key findings:
- Participants showed large reductions in misophonia symptoms after treatment.
- Improvements lasted for at least six months.
- Depression and anxiety didn’t change much—likely because participants weren’t highly distressed to begin with.
What this means:
Exposure therapy, when adapted for misophonia, can help people tolerate trigger sounds better. Adding stress management skills makes the process more acceptable and sustainable.
Implications for you:
If you struggle with misophonia, therapies that combine exposure and coping strategies may offer relief. Ask providers about approaches that emphasize gradual exposure and skills for managing emotional reactions.
Psychoacoustic Testing: Listening Tasks for Misophonia
Adults with misophonia and those without were asked to rate how unpleasant recorded trigger sounds felt. Researchers compared these ratings to scores on a misophonia questionnaire.
Key findings:
- People with misophonia rated trigger sounds as far more unpleasant than controls.
- Ratings strongly correlated with questionnaire scores.
- Correctly identifying the sound mattered; misidentified sounds caused little reaction.
What this means:
Listening tests could become a useful tool for diagnosing misophonia, alongside questionnaires. They help confirm how strongly someone reacts to common triggers.
Implications for you:
If you suspect misophonia, future assessments may include sound-based tests in addition to questionnaires. This could lead to more accurate diagnosis and tailored treatment.
Misophonia, Cognitive Rigidity, and Rumination
This research explored whether misophonia is linked to difficulties in mental flexibility and repetitive negative thinking (rumination).
Key findings:
- People with severe misophonia had trouble switching attention in emotional tasks.
- They also reported greater cognitive inflexibility and higher rumination.
- Rumination explained about 40% of the link between mental rigidity and misophonia severity.
What this means:
Misophonia isn’t just about sound sensitivity, it may involve broader challenges with emotional regulation and thinking flexibility.
Implications for you:
Treatments that target cognitive flexibility and reduce rumination, such as certain CBT techniques or mindfulness, could complement sound-based therapies.
Loudness Discomfort Levels at Extended High Frequencies
Researchers measured loudness discomfort levels (LDLs), the point where sound becomes intolerable, at very high frequencies (9–16 kHz) in young adults. They compared people with and without hyperacusis.
Key findings:
- People without hyperacusis tolerated high-frequency sounds at about 74 dB HL, but some found even 10 dB HL uncomfortable at 16 kHz.
- Those with hyperacusis had much lower LDLs (around 61 dB HL) and smaller dynamic ranges, meaning their “comfort zone” for sound was narrower.
- Hyperacusis participants also showed worse hearing thresholds at high frequencies, even when standard hearing tests looked normal.
What this means:
Testing at extended high frequencies could reveal hyperacusis earlier and more accurately than traditional tests. It might also uncover hidden hearing damage linked to hyperacusis.
Implications for you:
If you experience sound sensitivity, ask your audiologist about extended high-frequency testing. It could help confirm hyperacusis and guide treatment, especially for hearing aid fitting or sound therapy.
Auditory Discomfort and Visual Sensitivity
What the study did:
This research explored whether people who are visually sensitive (e.g., bothered by flickering patterns) also react strongly to sound. It included a large survey and a small brain-imaging study.
Key findings:
- People who saw more visual illusions in a “pattern glare” test also scored higher on hyperacusis questionnaires.
- The link between visual and auditory sensitivity was stronger for hyperacusis than for misophonia.
- Brain imaging showed that uncomfortable sounds triggered larger and slower responses in the auditory cortex, suggesting a hyperactive brain response.
What this means:
Hyperacusis may share a common mechanism with other sensory sensitivities, like visual discomfort, possibly involving cortical hyperexcitability.
Implications for you:
If you’re sensitive to both light and sound, these may be connected. Treatments that calm sensory overload, such as stress management or environmental adjustments, could help across multiple senses.
Smees, R., Simner, J., Hoare, D. J., & Ward, J. (2025). Dissociable effects of hyperacusis and misophonia severity imply different mechanisms of decreased sound tolerance. International journal of audiology, 64(9), 964–971. https://doi.org/10.1080/14992027.2024.2419558
Haigh, S. M., Haggerty, J. A., & Delgado, A. (2025). Auditory discomfort and visual sensitivity. Vision research, 234, 108655. https://doi.org/10.1016/j.visres.2025.108655
Black, V. K., Allen, K. J. D., Aazh, H., Johnson, S. L., & Erfanian, M. (2025). Misophonia symptom severity is linked to impaired flexibility and heightened rumination. British journal of psychology (London, England : 1953), 10.1111/bjop.70025. Advance online publication. https://doi.org/10.1111/bjop.70025
Bigras, C., Duda, V., & Hébert, S. (2025). Loudness discomfort levels at extended high frequencies in young adults: A potential marker of hyperacusis. Hearing research, 467, 109425. Advance online publication. https://doi.org/10.1016/j.heares.2025.109425
Suraj Urs, B. R., Nisha, K. V., Mohamad, A., & Prabhu, P. (2025). Distortion-product otoacoustic emission input-output characteristics of misophonic ears with normal hearing. Hearing research, 467, 109435. Advance online publication. https://doi.org/10.1016/j.heares.2025.109435
Dwyer, P., Williams, Z. J., Lawson, W., & Rivera, S. M. (2025). A Trans-Diagnostic Investigation of Attention and Diverse Phenotypes of “Auditory Hyperreactivity” in Autism, ADHD, and the General Population. Journal of attention disorders, 10870547251361226. Advance online publication. https://doi.org/10.1177/10870547251361226
Spencer, S. D., McKay, D., Mangen, K. H., & Rabasco, A. (2025). A Pilot Clinical Trial Examining Exposure and Stress Management Therapy for Adults With Misophonia. Journal of psychiatric practice, 31(5), 251–259. https://doi.org/10.1097/PRA.0000000000000874
Black, V. K., Allen, K. J. D., Aazh, H., Johnson, S. L., & Erfanian, M. (2025). Misophonia symptom severity is linked to impaired flexibility and heightened rumination. British journal of psychology (London, England : 1953), 10.1111/bjop.70025. Advance online publication. https://doi.org/10.1111/bjop.70025
Kirby, B. J., Cunningham, A., & Zant, O. M. (2025). Psychoacoustic assessment of misophonia. JASA express letters, 5(9), 094401. https://doi.org/10.1121/10.0039238
Dr. Jon Douglas specializes in tinnitus, hyperacusis & misophonia management, hearing aid technology, and vestibular evaluations. With over 19 years of academic and clinical experience, Dr. Douglas is deeply committed to providing evidence-based audiological care that improves the lives of patients affected by hearing, balance, and sound sensitivity disorders.