Misophonia in a CBT Framework
CBT is meant to take less time than traditional psychotherapy and talk therapy. With that in mind, most CBT programs aim to initiate change in the individual within a set number of sessions. These sessions can be week to week, bi-weekly, or in any structure that is both psychologically and financially feasible for the individual receiving CBT. In the CBT-MISO program in this book, I discuss an approach that is meant to be done in 10 sessions that are each one hour. Some individuals may require more sessions in different areas, and that is for the clinician or individual to decide.
In Cognitive Behavioral Therapy in 7 Weeks Gilligan (2016) lays out a 7-week plan for CBT which includes the following weekly goals for CBT: 1. Setting goals, 2. Values, 3. Identifying thought patterns, 4. Breaking negative thought patterns, 5. Time and task management, 6. Facing fears, and 7. Putting it all together.
Based on principles from Cognitive Behavioral Therapy and Acceptance and Commitment Therapy, the following table outlines how core beliefs, intermediate beliefs, thought patterns, and values interact in conditions like misophonia. This model is based on the foundational cognitive hierarchy developed by Judith Beck (2011), which outlines how deep beliefs influence automatic thoughts and emotional responses. For the purposes of this book, I have expanded the model to include values, which guide purposeful action, and thought patterns (also known as cognitive distortions), based on the work of Gillihan (2016) which help identify recurring styles of unhelpful thinking. I have also removed “behaviors and reactions” from this model to better align with a physiological approach to misophonia and have instead listed “misophonia coping skills” in its place.
Find on your favourite retailer.
Identifying Goals for Coping with Misophonia
Whether you are a clinician working with a client with misophonia, a person with misophonia, or a parent looking for coping skills for your child, it is important to identify goals for coping with misophonia. These goals should not be chosen and led by a clinician or parent but rather should be identified by the client as their personal goals for coping with misophonia. If your client or child is resistant, it can be helpful to make suggestions based on observed behavior, but do not impose these goals. It is also important that goals for coping with misophonia reflect on the core beliefs and values of the individual—not the other parties involved. If you have strong views one way or another about how one should cope it may be necessary to allow the client or child to reflect on these goals on their own in a private journal before sharing. The following are example goals for coping with misophonia. I have only shared three examples as it is best to keep goals manageable in the beginning. Later on, in sessions more goals may arise as coping skills are developed.
Goals for Coping with Misophonia
It is important for clinicians and persons with misophonia to understand that misophonia is not a psychological phenomenon, but rather has a neurological brain basis (Kumar, 2017), whereby the physiological part of the equation must be considered paramount when developing goals for misophonia. Goals should be realistic and highlight ways in which thoughts and perceptions of misophonia can change rather than engaging in wishful thinking. It is not reasonable at this time to have goals such as “Have misophonia go away completely” or “Never be bothered by sounds”. Goal setting should not revolve around exposure therapy or desensitizing persons with misophonia as this increases distress levels and can lead to worse cognitive distortions (e.g. I will never feel better, this is terrible; I cannot be fixed, I am broken, etc.).
Like any physical ailment or condition—persons with misophonia can learn to cope in the moments surrounding the misophonic trigger but cannot change the reality of the fight-flight-freeze response to stimuli. For example, it would be inappropriate to tell a person permanently in a wheelchair that they can have the goal to “walk again completely” unless that is medically possible. At this time, there is no indication of a treatment that can permanently alleviate symptoms of misophonia (Brout, 2018; Swedo, 2022).
Worksheet: Goals for Coping with Misophonia
Instructions: List three personal goals for managing your misophonia.
1. _________________________________________
2. _________________________________________
3. _________________________________________
Find on your favourite retailer.
