What is misophonia? Symptoms, causes, and treatment
Misophonia: sounds triggering intense emotional reactions such as anger, irritation, or anxiety.
Misophonia is a condition in which specific everyday sounds trigger intense emotional reactions such as anger, irritation, or anxiety. These sounds, often called trigger sounds, commonly include chewing, breathing, or repetitive noises such as pen clicking.
Common misophonia triggers include sounds such as chewing, breathing, sniffing, pen clicking, or typing on a keyboard. These sounds are usually harmless background noises for most people, but for someone with misophonia they can trigger powerful reactions such as irritation, anger, anxiety, or disgust.
Research shows that these trigger sounds can activate a strong emotional and physiological response in the brain, sometimes described as a “fight-or-flight” reaction. As a result, people with misophonia may feel an urgent need to escape the situation, avoid certain environments, or react verbally when confronted with the sound. In some cases, frustration may also be directed towards objects (for example slamming a door or throwing something) [1].
Misophonia treatment generally focuses on reducing the conditioned emotional response to trigger sounds and helping individuals regain control over their reactions. Because misophonia has only recently begun to receive significant scientific attention, there is currently no single evidence-based misophonia treatment that works for everyone.
However, several therapeutic approaches show promising results, including cognitive behavioural therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Tinnitus Retraining Therapy (TRT). Ongoing research continues to investigate which treatment methods are most effective for reducing misophonia symptoms.
Last update: March 2026.
Struggling with misophonia?
If certain sounds trigger strong irritation, anger, or anxiety, you are not alone.
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Clinical observations from Barends Psychology Practice
Barends Psychology Practice conducted a small exploratory evaluation of
Barends Desensitization© in individuals experiencing misophonia symptoms.
These observations are based on a small clinical sample (n = 10) with varying
levels of symptom severity, ranging from early-stage misophonia to more severe cases.
Because of the small sample size, the findings below should be interpreted as
preliminary clinical observations rather than definitive scientific conclusions.
Patterns observed during these sessions include:
- Many participants reported experiencing stronger misophonia reactions when trigger sounds were produced by people from their inner circle, such as parents, romantic partners, or siblings. Reactions were often reported to be less severe when the same sounds were produced by strangers or acquaintances, although individual differences were observed.
- In several cases, participants reported that one specific person tended to trigger the most intense misophonia reactions, while similar sounds produced by others resulted in milder reactions.
- Some participants described stressful or emotionally overwhelming experiences earlier in life, often involving feelings of helplessness or lack of control. In some cases, the onset of misophonia symptoms appeared to follow these experiences, although this relationship cannot be considered causal based on the current observations.
- In this small sample, Barends Desensitization© was associated with reductions in misophonia symptoms in several participants, particularly among those with mild to moderate symptoms. In cases with more severe misophonia, symptom reductions were observed but appeared to require continued practice to maintain progress.
Further research with larger samples and controlled study designs is needed to evaluate the effectiveness of this treatment approach more rigorously.
What are the diagnostic criteria of misophonia?
Misophonia is still an emerging field of research and there is currently no official diagnostic category for misophonia in major diagnostic manuals such as the DSM-5. However, researchers have proposed several definitions and diagnostic criteria to better understand the condition.
An early and influential study by Schröder et al. (2013) proposed diagnostic criteria for misophonia based on observations of patients seeking treatment [1]. These proposed criteria include:
- (A) Strong feelings of irritation, anger, or disgust triggered by specific sounds
- (B) Occasional difficulty controlling reactions to these trigger sounds
- (C) Awareness by the individual that their reaction may be excessive or disproportionate
- (D) Avoidance of situations in which trigger sounds are likely to occur
- (E) Significant distress or interference in social, occupational, or daily functioning
- (F) Symptoms that cannot be better explained by another disorder
These criteria were based on a relatively small clinical sample (n = 42) and should therefore be interpreted with caution. In this study, the average reported age of onset was approximately 13 years old, although symptoms ranged from early childhood to adulthood [1].
In this sample, trigger sounds were most commonly produced by other people. The most frequently reported triggers were:
- Eating-related sounds (81%)
- Breathing or nose sounds (61.3%)
- Repetitive sounds such as pen clicking or keyboard typing (59.5%)
More recent research suggests that misophonia triggers are not limited to human-generated sounds. Some individuals also report reactions to sounds produced by animals, machines, or environmental sources such as distant trains or aircraft [3].
A recent international consensus definition describes misophonia as a condition characterized by a decreased tolerance to specific sounds or associated stimuli, which trigger strong emotional, physiological, and behavioral responses such as anger, anxiety, or disgust. These reactions can lead to avoidance behavior and significant impairment in daily functioning.
Because research on misophonia is still developing, scientists continue to study its causes, mechanisms, and diagnostic criteria.
Common misophonia symptoms
People with misophonia often experience intense emotional and physical reactions when exposed to trigger sounds.
Common misophonia symptoms include:
- Strong irritation or anger when hearing specific sounds
- An urge to escape the situation
- Difficulty concentrating when trigger sounds occur
- Avoiding situations where certain sounds may occur
- Strained relationships with family members or partners
Misophonia treatment
If left untreated, misophonia can negatively affect many areas of life, including school performance, work, family relationships, and social functioning. Many people begin to avoid situations where trigger sounds may occur, which can further limit social activities and daily functioning [3].
Although research on misophonia treatment is increasing, there is currently no universally established evidence-based treatment. Several therapeutic approaches show promising results, but more large-scale studies are needed to determine which treatments are most effective.
Barends Desensitization© is an online treatment approach offered by Barends Psychology Practice. The method consists of two stages.
During the first stage, Eye Movement Desensitization and Reprocessing (EMDR) may be used to address earlier distressing experiences that may contribute to emotional sensitivity to trigger sounds.
During the second stage, an adjusted form of EMDR combined with elements of cognitive behavioural therapy (CBT) is used while the client is exposed to trigger sounds produced by the person who typically evokes the strongest misophonia reactions. The aim is to gradually reduce the emotional response to these sounds.
Sessions are guided online by the therapist so the treatment can take place in the client’s own environment. This allows exposure to trigger sounds in a setting that more closely resembles real-life situations.
Some individuals with misophonia report that exposure to recorded eating sounds used in certain treatment settings does not trigger the same level of reaction as real-life sounds. Conducting the treatment in the client’s natural environment may help address this limitation.
As with other treatment approaches described below, the effectiveness of Barends Desensitization© still requires further scientific research with larger and controlled studies.
Cognitive behavioural therapy (CBT) is currently the most studied psychological treatment for misophonia. A randomized clinical trial found that group-based CBT significantly reduced misophonia symptoms in a portion of patients, although not everyone improved and further research is still needed.
Tinnitus retraining therapy (TRT), originally developed for tinnitus, has also been proposed as a treatment for misophonia. Some clinical reports suggest improvement in symptoms, but most studies have small sample sizes and lack controlled designs.
Eye Movement Desensitization and Reprocessing (EMDR) has shown preliminary benefits in small pilot studies. Some participants experienced reductions in misophonia symptoms after several EMDR sessions, although larger controlled studies are needed to confirm these findings.
Overall, research into misophonia treatment is still developing, and scientists continue to investigate which therapeutic approaches may be most effective. This page will be updated as new scientific findings become available.
The outline below describes how Barends Psychology Practice currently delivers The client answers briefly and the treatment then continues. This sequence is repeated throughout the treatment phase.
During treatment the therapist may also periodically ask the client to rate the intensity of the emotion on a 0–10 scale (often called a Subjective Units of Distress scale).
This description reflects current clinical practice and is provided for informational purposes. Treatment is always tailored to the individual client.
About the author
This article was written and reviewed by psychologist Niels Barends, MSc.
Niels Barends, MSc is a psychologist and founder of
His work focuses on practical, evidence-informed psychological interventions that help people reduce emotional reactivity and regain control over distressing symptoms.
At Barends Psychology Practice he also developed Barends Desensitization©, an exploratory treatment approach aimed at reducing misophonia symptoms.
If you would like to schedule a first, free-of-charge session to discuss misophonia treatment, please make sure you have access to a laptop with a camera and that the person who most strongly triggers your symptoms is willing to participate in the sessions. Sessions are typically scheduled during lunch or dinner times, when trigger sounds are most likely to occur.
Other proposed treatments
Clinical method transparency: how treatment is delivered
Barends Desensitization© for misophonia in clinical practice.
This description is provided to offer transparency about the treatment process.
The exact structure may be adjusted depending on symptom severity, individual circumstances, and practical considerations.
The process starts with a 30-minute session in which the client and therapist discuss the client’s misophonia symptoms, possible onset, relevant history, and whether earlier distressing or overwhelming experiences may be related. During this session the therapist also explains the treatment procedure.
If the client wishes to continue, consent forms and treatment paperwork are completed. The client also receives preparation assignments, such as:
The first treatment session lasts approximately 45 minutes and usually includes about 15 minutes of introduction and preparation, followed by approximately 30 minutes of treatment.
During treatment, the client sits at a dining table in front of a normal-sized laptop. A person who commonly triggers the strongest misophonia reactions sits beside the client at approximately a 90-degree angle. This person prepares foods, drinks, or objects that typically trigger the client.
The client starts the visual bilateral stimulation video on the laptop at the agreed speed while the therapist guides the session via Zoom. The therapist can observe the client during the session, but during the active treatment phase the client focuses primarily on the stimulus on the screen.
The trigger person begins to eat, drink, or use the relevant object as naturally as possible. The client simultaneously follows the moving stimulus on the screen from left to right and back again, while being exposed to the trigger sounds produced by the trigger person.
At regular intervals the bilateral stimulation is paused. During these pauses the therapist may briefly ask the client questions such as:
If emotions become very intense or the client feels stuck, the therapist may suggest neutral associations or distractions to help the client continue the process. If needed, a short break can be taken, after which the treatment resumes.
The trigger person is asked to behave as naturally as possible. If they switch to a different food, drink, or object during the session, they briefly mention this beforehand so the client knows what is changing.
From the second session onward, treatment sessions usually last around 45 minutes. The number of sessions depends on the severity and persistence of the symptoms.
Between sessions, clients are encouraged to practice gradual exposure in daily life. For example, they may remain in the room while the trigger person is eating and stay for as long as tolerable before stepping away. The goal is to gradually increase tolerance to trigger sounds.
the 20-80 Method.
He has been working with international clients and expats for more than a decade and has a particular interest in the treatment of misophonia, anxiety disorders, and stress-related problems.
Literature used for this article:
Schröder, A., Vulink, N., & Denys, D. (2013). Misophonia: diagnostic criteria for a new psychiatric disorder. PLoS ONE, 8(1), e54706.
Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. (2013). Misophonia: physiological investigations and case descriptions. Frontiers in Human Neuroscience, 7, 296.
Cavanna, A. E., & Seri, S. (2015). Misophonia: current perspectives.Neuropsychiatric Disease and Treatment, 11, 2117–2123.
Jager, I., Vulink, N., van Loon, A. J., Buitelaar, J. K., & Denys, D. (2020). Cognitive behavioral therapy for misophonia: A randomized clinical trial. Depression and Anxiety, 37(7), 708–718.
Swedo, S. E., Baguley, D. M., Denys, D., et al. (2022). A consensus definition of misophonia: Using a Delphi process to reach expert agreement. Frontiers in Neuroscience, 16.
Rosenthal, M. Z., Anand, D., Cassiello-Robbins, C., et al. (2023). A systematic review of treatments for misophonia. Neuroscience and Biobehavioral Reviews.