Treatment and support

A frame worth starting with

Two things need to be stated together at the start.

First: misophonia is not currently curable in the sense that a bacterial infection is curable. Nothing in the current evidence base warrants that language, and articles that use it should be treated with caution.

Second: misophonia is genuinely workable. Multiple published studies show that the impact of the condition — the intensity of trigger responses, the functional impairment, the associated distress — can be meaningfully reduced with structured intervention. Many people move from “unable to eat with family” to “manageable most of the time”. That is a real and worthwhile outcome, even if it is not the outcome misophonia is sometimes marketed as producing.

The honest goal is reduced impact and increased regulation, not eradication.

Cognitive-behavioural approaches

Established Adapted CBT protocols show benefit

The largest single evidence base for a misophonia intervention comes from work by Damiaan Denys’s group at the University of Amsterdam. Their open trial (Schröder et al., 2017) reported clinically meaningful improvements in around 48% of participants completing an eight-session group CBT protocol adapted for misophonia.¹

A subsequent randomised controlled trial (Jager et al., 2020) confirmed statistically significant improvement compared with a wait-list control, with effects broadly maintained at follow-up.²

Key features of the adapted protocol — worth understanding, because misophonia does not respond to standard OCD-style exposure:

• Attention manipulation. Practices that shift the way attention is deployed around triggers, rather than eliminating triggers.
• Counter-conditioning. Pairing trigger sounds with incompatible positive stimuli — not direct exposure alone.
• Relaxation techniques. Reducing baseline autonomic activation.
• Stimulus manipulation. Learning to modify the sound experience itself (through headphones, music, altered attention) rather than avoid.

These findings are meaningful but should not be over-sold. The RCT sample was modest; not all participants improved; and generalisation to different populations and delivery formats is still being established.

Nervous-system regulation approaches

Emerging Autonomic regulation reduces impact

Because misophonia is a defensive nervous-system response, approaches that reduce baseline autonomic activation and improve regulation capacity have plausible mechanistic grounds. Clinical experience across multiple practitioners consistently supports their inclusion, and published studies of specific regulation-focused protocols (including Havening Techniques and similar somatosensory approaches) are beginning to appear.

The current evidence base for nervous-system regulation as a standalone misophonia treatment is smaller than the CBT evidence base. However, regulation approaches are frequently combined with cognitive elements in practice, and the combination has strong clinical support.

Practices that reliably reduce baseline load — and therefore tend to widen the trigger-tolerance window:

• Adequate, protected sleep. The single most modifiable factor for many people.
• Breathwork and paced-breathing protocols.
• Somatosensory techniques (grounding, gentle bilateral touch, orienting).
• Regular movement and reduction of sedentary autonomic activation.
• Stress-management practices that reduce cumulative allostatic load.

Audiological approaches

Emerging Sound therapy has a role — usually alongside psychological approaches

Approaches adapted from tinnitus and hyperacusis management — including desensitisation protocols and sound-therapy programmes — have some published support for misophonia, particularly where hyperacusis is co-occurring. The strongest audiological work in this area comes from teams with specific misophonia expertise (see Aazh and colleagues).³

Standalone audiology is unlikely to resolve misophonia in most cases, because misophonia is not fundamentally an auditory processing disorder. Audiology combined with psychological approaches has better support.

Environmental and practical adjustment

The evidence base here is largely observational and clinical rather than randomised — but the effect sizes reported in daily life are substantial. Practical adjustments do not treat the underlying sensitivity; they reduce cumulative load and prevent the escalation of secondary distress.

1. Discreet noise-cancelling equipment. Not eliminating triggers, but reducing incidental exposure.
2. Household adjustments. Music at meals, structural changes to shared spaces, permission-to-move-away agreements.
3. Workplace adjustments. Quieter locations, permission to use headphones during focused work, occasional remote-working arrangements.
4. School adjustments. Reasonable adjustments under whatever framework applies in your country — see misophonia at school.

A note on medication

No medication is currently licensed for misophonia in any of the five markets this article addresses (UK, USA, Canada, Australia, New Zealand). Where medication has been used in clinical practice, it has typically been directed at co-occurring conditions — particularly anxiety, depression or OCD — rather than at misophonia itself.

The evidence base for pharmacological treatment of misophonia specifically remains thin. This article does not recommend, discourage, or discuss specific medications — decisions about medication belong with a prescribing clinician who knows your full history.

What to look for in a professional

Because misophonia is a specialist area within a specialist area, the professional you consult matters more than the professional title.

Useful questions to ask when considering support:

• How much of the clinician’s current practice involves misophonia specifically?
• Are they familiar with the 2022 Delphi consensus definition and the current research base?
• What is their working model — auditory, psychological, integrated?
• What do they consider a realistic outcome — reduced impact, or something more?

Professionals who claim to “cure misophonia” in a defined number of sessions, without acknowledging the limits of the current evidence, are worth approaching with caution.

Further reading

Related articles in the Misophonia Hub:

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