Exposure Therapy for Misophonia: Concepts and Procedures

J Cogn Psychother. 2021 Aug 1;35(3):156-166. doi: 10.1891/JCPSY-D-20-00042.


Misophonia, a condition marked by extreme intolerance to certain classes of sounds (e.g., respiratory or gustatory noises), has recently attracted increased research attention. As yet there are no evidence-based treatments, although some promising options are under empirical consideration. This paper presents a stress management and exposure therapy-based treatment protocol for adults with misophonia. The protocol details considerations specific to exposure therapy for misophonia, including unique considerations for developing hierarchies and example misophonia exposure exercises and exposure homework. Stress management approaches employed to facilitate engagement with exposure are also described. Two case examples are included, which illustrate the application of the misophonia treatment protocol. The first case describes treatment for a client whose misophonia symptoms are the primary focus and the second case describes treatment for a client whose misophonia symptoms are secondary to relationship difficulties. This protocol can be used to stimulate further treatment research for misophonia and guide treatment for individuals with misophonia.

Keywords: exposure; misophonia; stress management; treatment.

MeSH terms

  • Adult
  • Attention
  • Humans
  • Hyperacusis
  • Implosive Therapy*
  • Noise
  • Sound