Case study of Relaxation and Counterconditioning Therapy for Misophonia: A Conditioned Aversive Reflex Disorder

Misophonia is an under-studied condition in which a person has intense emotional and physiological reactions to subtle stimuli (e.g., chewing sounds or hair twirling) which cannot be classified using DSM-5 criteria. This case illustrates the conceptualization of misophonia as a conditioned aversive reflex disorder consisting of a physical (e.g., muscle) reflex elicited by the misophonic trigger stimulus and subsequent emotional, physiological, and behavioral responses. This case describes a successful behavioral treatment of a middle-aged woman who was disabled by severe misophonia. The treatment included identifying the initial physical reflex, progressive muscle relaxation, and counterconditioning the initial physical reflex. Counterconditioning was accomplished by relaxing the initial physical reflex muscle during exposure to in vivo trigger stimuli, while using ambient sound as needed to reduce the severity of the misophonic response. The overall severity of misophonia reduced over the course of the 13-week treatment, based on client self-report. Data were analyzed using recovery percentage formula. The recovery percentage average of 3 scales was 82.1% at end of treatment and 93.1% at 1-year follow-up. In this case, when the initial physical reflex’s muscle was held relaxed by the patient when exposed to trigger stimuli, the initial physical reflex and the emotional reflex diminished and extinguished. This theory of misophonia, as a conditioned physical reflex to subtle stimuli, should be an essential consideration for research of the etiology, expansion, maintenance, and treatment of misophonia.