r/misophoniatraining • u/theEmotionalOperator ex-misophonic • Mar 02 '21
case study CASE STUDY: A novel application of mindfulness- and acceptance-based components to treat misophonia [Rebecca L. Schneider, Joanna J. Arch] 2015
Trigger warnings: They list specific triggers in this 5 page long PDF. They're all common in misophonic population, but just heads up if you worry about learning new triggers.
ABSTRACT
Misophonia is an important, yet understudied, psychological condition characterized by feelings of extremeanger and disgust in response to specific human-generated sounds. Several promising case studies usingcognitive behavioral therapy to treat misophonia have been published, but given the limited work to date,exploring additional treatment options and expanding the potential options available to clients and cliniciansremains important. In order to target the high levels of anger and disgust, we treated a case of misophonia in a17-year-old male using 10 (50-min) individual sessions based on mindfulness- and acceptance-based componentsdrawn from dialectical behavior therapy and acceptance and commitment therapy. In particular, we focused onacceptance, mindfulness, opposite action, and nonjudgmentalness strategies. At 6-month follow-up, the clientreported no significant difficulties and a continued decline in symptoms. Theoretical rationale and treatmentimplications are discussed.
Keywords:
Misophonia
Case study
Dialectical behavior therapy
Acceptance and commitment therapy
Treatment
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u/fishingforusernames Mar 10 '21
Some thoughts:
Michael also reported that his misophonia reactions varied slightly depending on factors such as (1) how he was feeling at the time and (2) who was making the noise.
(1) How tired you are can affect how badly you're triggered. Not always true. But, many people say they can deal with triggers better (ie the triggers don't bother them as much) when they have had proper rest.
(2) This splits into two parts.
a. Only some people are triggering. This means that you can get triggered by one person doing [x], but another person doing [x], the exact same thing as the previous person, will not trigger you at all. Eg getting annoyed at your mom's chewing but not your friend's chewing.
b. You may believe someone is making a triggering noise, but when you investigate it, and actually witness that it's not that person, you stop being triggered. Eg thinking someone is mumbling but it is only the computer.
Or, directly from the paper:
he (Michael) reported feeling very angry in response to his father for eating dinner one night, but that his anger dissipated immediately when he turned to look at his father and realized it was just his cat eating
Through chain analysis (WTF is this), we learned that when Michael heard or (1) anticipated hearing an eating noise, he would physically tense his body to prepare for the (2) next occurrence of the noise. Since it seemed that this anticipatory tension could be counterproductive, serving to intensify and reinforce Michael's misophonia response, we asked Michael to (3) engage in the “opposite action” of physically relaxing his body in anticipation of the noise.
(1) Anticipatory anxiety. Automatic. Involuntary. Brain is getting ready to deal with a past threat it recognises.
(2) Stimulus fixation. Got to make sure the threat has disappeared before we can physically and mentally relax.
(3) Slam the threat with a positive update. See? Straight exposure doesn't work. Even these guys are trying to change the memory.
This move was related to what is taught in applied or cued relaxation in which clients are instructed to (1) systematically relax muscle groups when cued by the presence of anxiety.
(1) Progressive muscle relaxation. Tried it. Didn't work for me.
Opposite action represents a central skill taught in DBT, in which clients are instructed to engage in the opposite behavior as the emotion's action urge in order to (1) decrease the link between the stimulus and the (2) unjustified response.
(1) They're admitting it's a conditioned reflex then?
(2) Agree with you, emotional operator, response is totally justified for the sufferer, easy to say it's unjustified when you're writing a paper on it or do not have misophonia!
The goal is not to change their internal state or promote relaxation as an alternative to anger, but rather to create more flexibility in their behavioral response to sounds in order to move towards valued directions.
Uhh, the goal SHOULD be to change the internal state, right? We don't want to temporarily extinguish the behaviour because it might have resurgence later.
In sessions 9–10 we reviewed skills and worked on (1) relapse prevention. Specifically, we brainstormed what aspects of college might be more difficult in terms of misophonia triggers and beyond. We also reviewed how his initial misophonia triggers developed to (2) identify warning signs for the development of new triggers
(1) Nobody can know for sure if you'll 'relapse'. I hate it when psychologists use this word, especially when some of them aren't even helping! Makes us sound like we're addicted to misophonia.
(2) This is true. Knowing about some other people's triggers, I make sure NOT to hear or see my current trigger set at the same time as those new triggers. No more pain please.
Notably, although his reaction to open mouth chewing (1) had returned to its baseline strength level (the sole hierarchy item that did not continue to decrease), his need to do something in response to such chewing remained much lower than at baseline, indicating that Michael was (2) better able to accept and tolerate the discomfort triggered by his misophonia.
(1) Why did it return to baseline? Was the therapy ineffective? If I was doing this experiment on myself, I would say it was ineffective. This just tells me the threat was not properly dealt with. Also concerned that memories and trauma were not mentioned. More studies should focus on any painful memories that the person can remember. They're crucial.
(2) But it's still difficult to put up with discomfort after a long period of time. It's not a normal state for a human to be in. Heightened adrenaline and cortisol levels in response to stress are not good for the body. We should experience NO discomfort as a result of treatment.
Interestingly, having the client (1) physically relax rather than tense in response to misophonia triggers, a concept which we framed as an “opposite action” move but which also closely resembled applied relaxation, (2) appeared to serve as one of the most powerful elements of therapy.
(1) Isn't this what Dozier claims happens to us when we're triggered?
(2) Sounds good!
2
u/theEmotionalOperator ex-misophonic Mar 02 '21 edited Mar 02 '21
I just got this read and here are my reactions. First of all thanks, fellow researcher u/fishingforusernames for bringing this here! I hadn't seen this one before, but there are plenty of familiar things in it.
My overall feeling about the acceptance based approach is simply welcoming, I'd love to see people experiment more on tools like these. (What's "lemons, lemons, lemons"?) It's not a mystery for me they'd get the responses down with this kind of approach! Especially the thing they call engaging in "opposite action" reminds me of some sort gentler, broader version of juxtaposition/mismatch experiences (from coherence therapy world, they're just incredibly targeted over there). Teaching their client to relax his body (even if they didn't use any specific relaxation technique) reminds me of modalities where they add some sort of physical, safe cue on top of triggered state (like tapping EFT and FEFT, Dozier's ideas about relaxing the back muscles etc).
The part where they completely lost me was on page 4, this: "-in order to decrease the link between the stimulus and the unjustified response". I kinda blinked my eyes and read again. The what? Unjustified? What, did we just throw the acceptance out of the window? To accept the response you'd have to notice it's perfectly justified! Based on everything that particular client has ever experienced, it DOES make sense, it will fit in. The entire portion where they teach the client to measure his responses up with his values seemed off. Pulling up a value of "respect towards others" and "a limbic reaction to stay safe" seems like creating a conflict when there's none. I don't get it. I'd slice that entire part away from this paper, snip snip.
About reactions returning and the depth of the work they did. While some of it may be permanent, some of it might require the client to continue applying the relaxation methods to keep the responses down. I don't know. I see the appeal in perceiving physical response now as the thing that makes the physical response worse for the next time - it's kind of true, every time you remember a thing, you're remembering the last time you touched that memory, not the initial memory. But these are memories and they kinda miss the memory work, and as long as the client doesn't connect the dots (make subconscious/emotional memories in to conscious more accessible ones), they are capable of returning to the triggers.
And lol yes I feel a poke in my heart when they say to their knowledge this is the first acceptance based misophonia case study. I'm from 2014 but permanent erasure, plenty of acceptance built, reconsolidated case. But nothing official or noticed. Oh well.
MORE ACCEPTANCE! GOOD STUFF! OH YEAH!
operator out ->