Episode Transcript
[00:00:00] Speaker A: This show is not a substitute for professional counseling and no relationship is created between the show hosts or guests and any listener. If you feel you are in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling Center at 348-3863. If you are not a UA student, please contact your respective county's cris service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.
[00:00:42] Speaker B: Again for Brain Matters, the official radio show of the UA counseling center. We are broadcasting from the campus of the University of Alabama. Good evening. My name is Dr. B. J. Gunther, and I'm the host of the show, along with my colleague and producer, Catherine Howell. And in case you don't know, the show is about mental and physical health issues that affect college students and in particular UA students. So you can listen to us each Tuesday night at 06:00 p.m. On 90.7 FM or online at wvuafm ua.edu, or you can also download the Mytuner Radio app and just type in Wvuafm 90.7. Also, if you have any ideas for upcoming show topics, please email those to me. We've got about four or five shows left in this semester, and then we've got all spring semester. We usually do twelve to 13 shows per semester. So I'm always asking for interesting topics, maybe some topics that we've done in the past and we need to redo those again and kind of talk about trends with college mental health. But if you have any ideas, email those to Brainmattersradio at wvuafm ua.edu and I'll consider using your idea. And I'll try to remember to give out this email address periodically throughout the show tonight. Tonight's topic is an interesting topic to me because I really don't know if I've ever had a student or anyone at my private practice have this. I guess it's a disorder or a syndrome. We're going to talk about what it actually is, but it's called misophonia, and I'm going to have a problem pronouncing this the whole night. So sorry, but some people have a strong negative reaction to certain sounds, and these sounds can cause intense feelings and people may experience the physical symptoms also. And the name of this disorder, when I was doing my research, I came across the Greek word hatred of sound is what it is. And my guest tonight I guess you specialize in this, since you're the director of the center at Duke University. Dr. Zach Rosenthal is a clinical psychologist, associate professor with a joint appointment in the Department of Psychiatry and Behavioral Sciences and Department of Psychology and Neuroscience at Duke University. And he's the director, as I mentioned, of the center for Mesophonia and Emotion Regulation, where he leads a team conducting research, providing education and developing clinical care pathways for mesophonia. That's a mouthful. Thanks for being on the show.
[00:03:11] Speaker C: My pleasure. Thanks for having me.
[00:03:12] Speaker B: I know you've done this a lot, and I don't know when you've been a guest on shows before, a podcast. I don't know how educated people really are about this. Is it a syndrome? Is it a disorder? First of all, tell us a little bit about yourself, more than I already introduced you and your credentials and why you're interested in this topic.
[00:03:37] Speaker C: Sure. Well, again, thanks for having me. I'm happy to be here, and hopefully this will inspire some people to know what they're struggling with or know what their friends or family members are struggling with and maybe even help inspire people to get some help for this. So let's see what we can do together here. My name is Zach Rosenthal. I'm a psychologist at Duke University, and I've been studying misophonia for a little while now. It's interesting.
First of all, we're going to call it misophonia misophonia because we're going to eat miso soup, or maybe we're going to drink miso soup, whatever you call it, but we're going to consume miso soup. We're going to call this term misophonia instead of misophonia. But if you want to call it misophonia, I won't hold it against you. That's okay. You can do that.
[00:04:23] Speaker B: Good. Because I'm the show host.
[00:04:25] Speaker C: You can do that. This is good.
All right, good. Well, you call whatever you want as the show host, you call it anything.
So misophonia is something I've been interested in for a while. It's a term that came about in the early two thousand s, and it probably is something people have struggled with for a long time well, before then, but the name itself was coined in the early two thousand s, and as it turns out, I have it in my house. And we didn't even know it until years after the term was coined. And I have permission to say this. I'm not outing anybody for the first time, but I have it in my house. It's in my family. I don't personally have it, but I lived with misophonia for many, many years. My wife has it. She's very open about it. She's very supportive, in fact, of me sharing her story to talk about it, because we didn't know what it was until the name came about and we thought, oh my gosh, this is definitely the name for what we experience and what she experiences day to day. So that people sometimes criticize me. Search. They'll call me search where you study the thing, you know, I don't criticize it. I just think that's what a lot of people do because it's what we know. Writers write about what they know, and people who are clinicians maybe help people who have problems with what they know and so on. So anyway, misophonia is something that is near and dear to me. It's in my family. It's in my house. I live with it every day. And I've learned a lot from that perspective now, professionally and scientifically, I've been doing research and leading the Duke Center for Misophonia and Emotion Regulation for the past five years. Prior to launching the center, we were doing misophonia research, really on kind of a shoestring budget, know, a small study here and a small study there for many years beforehand. But in earnest, really. Just about five years ago, we started we were fortunate to get some funding, philanthropically from a family that had misophonia, has misophonia in their family. And they said, hey, we want to rapidly accelerate research on misophonia. We want somebody who can do this. Would you like to do it? And of course, that's the greatest gift for a scientist is to have funding to do the thing you're passionate about studying. So that's really me in a nutshell.
[00:06:50] Speaker B: Well, and I'm looking back, I mentioned, I don't know, maybe I have had some students, clients who have had this, and I didn't know enough about it to even recognize what it was.
Maybe some of the research I was reading prior to the show, because I try to research a little bit before we start talking. But in one article, I seem to remember the researcher talking about people almost being embarrassed to mention it because they're embarrassed to mention it even to their healthcare professionals.
Maybe they didn't know they had it. They didn't know this existed. Have you encountered people who finally got to you guys but didn't know that what they were having had a name?
[00:07:40] Speaker C: Absolutely, yeah. I think you're spot on in your thoughts there. There are people who have this condition but don't necessarily know the name of it. And they go online, and they might look to try to understand what it is that they're experiencing, and lo and behold, they find there's a name for it. And actually, we get a lot of people at Duke who will do this, and they reach out to us because we're Duke and we have a center, and there's not a lot of places like that in the country. And so we will do that. And they'll say, wow, I didn't even know this existed.
And they think, wow, this is really a real thing now. I didn't realize it. It's very validating to see this is a real thing with a real name.
[00:08:24] Speaker B: So in the introduction, I read a little bit about what it is, but give us more details. Give us some specific examples so that if people are listening, they can kind of pinpoint what falls under the umbrella of misophonia.
[00:08:41] Speaker C: Sure. So misophonia is essentially a strong negative response to common everyday sounds where the negative response is intense.
It's multimodal, meaning it might happen emotionally or cognitively or behaviorally or attentionally or socially. In other words, it's not just one narrow way you'reacting but in a lot of different ways. You might be reacting negatively in a way that causes impairment in your day to day functioning. Impairment means the reactions you're having to these sounds, they might get in the way of how well you're doing in the classroom if you're a student, or maybe how well you're doing in your relationships or how well you're doing at work. So what happens is with people with misophonia, they will have really strong reactions to very particular sounds that over time have happened many, many times to them to elicit this strong pattern of responses. Anger, anxiety, distress, shame, sadness, disgust, you name it. And then physical reactions of heart racing, skin sweating, body feeling tense or rigid, behavioral reactions of wanting to escape or avoid the situation that they're in, to try to just get out of dodge, just to get away from whatever situation there. They just want to get away. And it's such a strong fight, flight like reaction that it overwhelms the person and they really feel like there's nothing else they can focus on. I'll give you a quick example. One of the patients I first was working with, she said, Zach, don't you understand?
This is like a grizzly bear suddenly walking into your office and you're just standing there and it's just right next to you. How do you think your body would react to this? So it's this really intense, strong, automatic, bottom up, as we say, reaction. That's really intense.
[00:10:41] Speaker B: Yeah, I think one of the articles I read listed it. I'm trying to find it as a perpetual state of anxiety.
[00:10:52] Speaker C: Yeah, it is a lot like a perpetual state of anxiety for some people here's. One of the interesting things about this is that misophonia is not the same for everybody. So what is the same for everybody is a strong negative reaction to particular sounds. These sounds are typically oral, like eating, chewing, crunching, sniffing, snorting, or facial. So mouth noises or throat noises, coughing, heavy breathing, things like that, smacking of lips. They're typically oral or facial kinds of noises made by other people. That's almost always what we see and what the research says so far. But that isn't the only set of sounds. There can be any number of environmental sounds, construction sounds, beeping sounds, cars making noises, you name it. There can be unpleasant sounds that are a part of this whole package of misophonia for people. But misophonia is not the same thing as just being annoyed by sounds. Everybody gets annoyed by sounds. Yes, we all do. This is normal, right? And then some people have what we would call noise sensitivity. So they're particularly sensitive to a lot of sounds. These are the people that kind of they might jerk or twitch or kind of startle a little bit easily to sounds in crowds. That's not misophonia. Typically there are other people who have what's called hyperacous, which is a really intense, super strong reaction to sounds because the sound is experienced as louder than it really is. Than it really is. Yeah. And it's just the loudness, right?
[00:12:33] Speaker B: Yeah, I wrote that down because I don't think the article that you're quoted in a lot often is a New York Times article. I think that's correct. But in another article yes, they mentioned how do you say that? Hyper.
[00:12:51] Speaker C: Hyperacusis, yes, hyperacusis.
[00:12:54] Speaker B: And I was trying to differentiate the difference between that and misophonia. And it's the loudness, isn't it?
[00:13:02] Speaker C: That's it. That's it. With hyperacous, sounds are louder. Full stop. With misophonia, it's not about the sound loudness. It's about the pattern or the meaning and the repetition of the sound. In context. In context, it's the context of the sound.
You take someone with misophonia and they may have a reaction to chewing or crunching sounds to their partner, but you put them in front of somebody they don't know, and they may or may not have the same reaction. It's context dependent.
[00:13:33] Speaker B: Wow. So they don't even know when they're going to have that reaction.
[00:13:38] Speaker C: Correct. They know when they're going to because they know their particular triggers and triggering context. But if they're in new context, new situations, they may or may not know. And you can see where the anxiety comes in.
You're traveling. You're traveling. You're getting on an airplane. Yeah.
[00:13:56] Speaker B: Let's take our first break, and when we come back, I want to ask you what causes this? Do you know what causes this? In all the research you've done and read about and people you've met, patients that you've had. So stay with us. You're listening to Brain Matters on 90 point Capstone.
[00:14:24] Speaker C: Tuscaloosa.
[00:14:25] Speaker A: This show is not a substitute for professional counseling, and no relationship is created between the show hosts or guests and any listener. If you feel you are in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling Center at 348-3863. If you are not a UA student, please contact your respective county's cris service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.
[00:15:05] Speaker B: Matters on 90.7 the capstone. I'm Dr. B j gunther. We're talking tonight about what I think, and I don't know if it's unique or if it's common, how common it is, but it's called misophonia. And Dr. Zach Rosenthal from Duke University is here talking to us about what it is. And when we left off, I kind of teased you about what causes this. First of all, give us tell for the people who are just tuning in, what is misophonia, again, really quickly and what causes it.
[00:15:36] Speaker C: Sure. So misophonia is abnormally strong reaction to everyday sounds, typically oral or facial. So chewing and crunching or sneezing or snorting or tapping or other things made by the fingers or hands or feet can also sometimes be sounds. They're usually sounds produced by other people, though they're not usually just sounds of nature or anything like that.
[00:16:00] Speaker B: So their chewing doesn't bother them. That's not the thing.
[00:16:04] Speaker C: Not typically. Not typically. Very rarely.
A good question is whether that in fact is misophonia or not. That's a different question. But most typically what we see is sounds that other people make that are chewing, eating, drinking, or maybe sleeping or breathing noises, snoring or walking or other kinds of noises produced by the person's body.
And they're typically repetitive and they're typically people that they know.
So usually when this starts, it starts in childhood or adolescence, typically.
And it typically starts with people who have triggering sources that are the people around them. Family friends are the two most common that we hear.
[00:16:55] Speaker B: So parents would notice this first, maybe, or teachers who are with parents a lot. And to me, I would think it would seem unbearable for the child.
[00:17:10] Speaker C: Yeah, parents will notice this. And unless they would know what it is up front, which they probably wouldn't.
[00:17:18] Speaker B: No, I don't think.
[00:17:19] Speaker C: Who would?
[00:17:19] Speaker B: Who would?
[00:17:20] Speaker C: Unless you're listening to this radio show or you're just really well educated, you wouldn't necessarily know what misophonia is. It's a new term, actually, a new study came out this last year. 11% of Americans are aware of the term, so not very many people even know about it. Including physicians. Including doctors and clinicians may not know much about it. So we can't expect parents to necessarily know what it is and assess it or know what to do about it when they first see it.
Kids report. The kids will report. They experience it and they feel overwhelmed by it. And then what will often happen is that there will be more and more and more kinds of situations over time where they have the same thing happen again and again and again where they're in a situation that they can't quite get out of, they can't control it, and it's highly unpleasant. There's sounds being made that are really annoying or irritating and they can't get out of the situation because they're a kid or they're a teenager and they're stuck in a car. They're not driving, they can't get out of the car and somebody's making these eating sounds or chewing sounds. And the context is often a context that they report as really unpleasant. So uncontrollable and unpleasant contexts that are repetitive where the sound is happening over and over and over again.
If you think about this logically, when something unpleasant happens to any of us repetitively, our brain starts to pay attention to it. Yeah, that's what brains do.
That's what they're supposed to do, in fact. So our brains start paying more attention to the things that are more unpleasant, more aversive, because our brains are designed to help keep us alive and keep us safe and keep us going.
[00:19:15] Speaker B: Right.
Can you say what is the occurrence of this? That's being first I don't know how to ask this that is being first diagnosed in college age students since our show is geared for college age people, college mental health. Do you have very many individuals who are first diagnosed with this in college and they've lived a long time with it, but didn't know what it was.
[00:19:48] Speaker C: We do see college students in college realize this is a problem that starts to emerge, but more typically, we see people who come to college already knowing this is a problem from childhood or adolescence, and it's getting worse and worse and worse. And what happens to them is now they're in college and they're in a setting where there's new people triggering them and there's new triggers or new situations that are difficult for them and causing problems in the classroom. And it's interesting, too, because one of the first studies that was done on misophonia was with college students, some of the very first studies and found that roughly right around 20% of college students have moderate or higher misophonia symptoms. 20%. You heard that right. It's a lot.
So this is something that's probably much more common on a spectrum of severity, right? Not necessarily. Everybody is the worst. There's no way everybody is the worst, right? But on a spectrum, some people don't have any of this. Some people have a little touch. Some people have a mild version, and they're not really impaired. Some people have a more moderate version, and they are kind of impaired. Some people are more severe. They're definitely very impaired. Very impaired, that whole spectrum. And we think about in college students, the data suggests that, again, somewhere around 20% of college students across the country, there's studies in other countries that have found a very similar number. There's even one study in the UK that found with medical students, 50%. 50% of medical students reported this, some degree of symptoms. And a different study in the UK.
No, a different study in the UK, a prevalent study just showed that 18% of the UK as a whole reports this. Now, again, how many people is probably a function of how strict you define it. So if we define it by very severe impaired, it's probably not that high of a number. It's probably more like 1% to 5% of people.
But if we define it as very bothered and somewhat impaired by these kinds of sounds, it is probably closer to 20%. It's a lot of people.
[00:22:07] Speaker B: Is it a syndrome? Is it a disorder? Is it a DSM diagnosis?
[00:22:12] Speaker C: I love that question. It is not a DSM diagnosis. It is considered to be a disorder by those of us who have kind of what you might say, experts in the field, we consider it a disorder, but it's not technically a disorder that is under the purview of any particular clinical discipline. Like, it's not owned by mental health, it's not owned by neurology, it's not owned by audiology. Kind of sort of sits in my opinion, it sits at the intersection.
It's like right in the middle of a five way or four way intersection.
[00:22:52] Speaker B: Because there's a lot of stuff going on.
[00:22:54] Speaker C: Yeah, exactly.
[00:22:55] Speaker B: Neurologically, physically, with the ears, audiology, I could totally see that. And then psychologically yeah, exactly right. Definitely. What about the causes? I've been meaning to get to this since we came back from that break, but have you found what causes this?
[00:23:14] Speaker C: Well, we don't know what the cause is. The short answer is we don't know until we have much more research done, which of course, takes a lot of time and costs a lot of money. And that's just the nature of research. But that's the reality is people have just started to really study misophonia. The very first study, in fact, the very first scientific study, was only ten years ago. Wow, 2013. So we're just now beginning and in the last few years really just starting to accelerate research on misophonia. My group and a number of other groups around the world are starting to do this work. We don't know the causes, but like a lot of things like this, you can imagine that there is probably many different contributing factors to causes and not just one simple cause. And maybe even the different people have different sets of causes. So not one cause and not one cause or multiple causes that are the same for everyone. So you might have this and I might have this, but it might be we come at it from different angles.
[00:24:14] Speaker B: In the research that's been done that you mentioned in just the short period that it's been done, what has the research found with regards to brain activity or brain function? I don't know how to ask that, but you know what I mean.
[00:24:27] Speaker C: No, you got it. You got it. That's a great question. There have been a few studies that have looked inside the brains of people with misophonia, and lo and behold, they found that these folks are and they're not making stuff up.
[00:24:38] Speaker B: No, it's real.
[00:24:39] Speaker C: They're not just talking about it. It's happening in the brain. You can see in different systems in the brain when people get triggered. You can see their brains react differently than when they respond to other kinds of just typically unpleasant sounds that anybody else would find unpleasant.
They respond differently. So we're starting to see that brain activity is showing that there is a different kind of response in misophonia. We're also seeing in brain activity that there are parts of the brain that are kind of all over the brain that are responding. It's not like just one part of the brain reacts. It's more like a distributed network of systems that react. So it's kind of complicated. So, like, parts of the brain that deal with attention. We see in studies that the parts of the brain that are part of how we pay attention to stuff, those parts of the brain get activated. And people with misophonia, their attention gets kind of messed up when they're being triggered or when they're about to be triggered? Well, kind of can't focus. They get really focused, almost like a PTSD patient would. They kind of get hyper vigilant and focus on the trigger.
[00:25:52] Speaker B: Well, and I was going to read you the email question, one of the email questions we got. What comorbidities do you tend to regularly find with misophonia, such as ADHD? What other comorbidities are there?
[00:26:09] Speaker C: It's a great question. I love this question. In fact, we published this last year, one of the largest and most rigorous studies to answer this question.
So I could talk a lot about it. Here's the short version. The short version is, there's a lot of different mental health problems that are correlated with misophonia.
And if you ask people just to tell you, hey, what are your mental health problems?
They might come up with certain things. They just say, but if you do a really careful, rigorous, scientific way of doing this, and you thoroughly, methodically diagnose across all mental health problems end up finding that there's actually a lot of different ones. There's a lot of different ones. But the ones that are the most associated in our study and in a couple of other studies are anxiety disorders. I could see that, like, not OCD. Generalized no, generalized anxiety disorder and social anxiety disorder are the two top. OCD is in there with a mix of other ones that are in there, but not as high as you might think. It's not quite as related. In fact, there's other studies that show that OCD is not related to misophonia, and then there's some studies that say it is related to misophonia.
[00:27:29] Speaker B: Yeah, I think in one of the articles I read, that's where I got that from is they mentioned OCD. Yes, OCD could be related somehow.
[00:27:38] Speaker C: Yeah, I think it's more complicated. It's sort of like some people with misophonia have OCD, but most people with misophonia don't.
[00:27:47] Speaker B: Yeah, sometimes misophonia is confused with OCD.
[00:27:51] Speaker C: Yes, that's really true.
[00:27:55] Speaker B: And also with sensory processing disorder.
[00:27:59] Speaker C: Bingo. That gets confused too. So because dysphonia is a reactivity to sensory input and the reactivity is a lot of strong emotional and physiological and behavioral reactions, it easily gets confused with a whole bunch of other stuff.
Just all sorts of other stuff. So people who have I'll just anecdotally tell you, like if I have a patient who comes in and they have OCD and misophonia, they will tell me, I think it must be the same thing. And then they leave, and then the next patient comes in and they don't have OCD, they have Add. They'll say it has to be correlated with Add. And then the next patient will come in and they'll say, well, my brother has autism, so it must be correlated with autism. Right.
[00:28:48] Speaker B: It's interesting you said that, because that was one of my questions I wrote down. I don't think I sent that to you.
Is it correlated with autism.
[00:28:56] Speaker C: So there's correlations with autism symptoms and there's correlations with ADHD symptoms. There's correlations with anxiety, there's correlations with mood, there's correlations correlations. Correlations, right.
[00:29:09] Speaker B: There's a lot of correlations down a rabbit hole.
[00:29:11] Speaker C: Yeah.
There's just lots of different studies that are depending on the methods they're using, they tell you it's correlated. It's not correlated. I think the way I look at that as a scientist and as a clinician and honestly, as just a layperson at home with someone who struggles with this is that there's just a lot of variability across people and we don't know yet.
[00:29:35] Speaker B: No. And I want to get to treatment, definitely. But in my experience, if you really don't know the cause, sometimes it's very hard to treat. And so I want to talk about that in a minute. But I want to ask you for personal experience with the patients you've treated or the people you've studied. What's the most common sound that triggers misophonia?
[00:29:58] Speaker C: Chewing, crunching eating not pin clicking in meetings.
No, but that bothers a lot of people.
[00:30:08] Speaker B: Well, I think in one of the articles I said you correct me if I'm wrong, but the most prevalent emotion is anger.
[00:30:22] Speaker C: Well anger anger.
Let's open it up for a minute. Let's just look at that. So it depends probably on the person and it depends on the context and it depends on what slice of time are we talking about before they're triggered, when they're anticipating it and they're preoccupied with it? Because in those contexts it might be more like anxiety.
Are we talking about while they're triggered and it's happening? Well, now we might be talking anger or irritation.
[00:30:53] Speaker B: Yes. And it was in the context of treating misophonia like if you don't know where to start first, maybe start with treating anger symptoms.
[00:31:05] Speaker C: Yeah, I wouldn't look at it that simplistically if you don't know where to start. I would say assess assess typical patterns. What are the typical patterns that happen for the person before they're triggered, while they're triggered and then after the offset of a typical trigger and patterns you could kind of break down into different areas of functioning. What are they thinking typically before, during, and after they're triggered? What kinds of thoughts? How are they thinking? What kinds of behaviors? What typical things are happening before and during and after?
Are they fleeing? Are they getting hostile? Are they being passive aggressive? Are confrontational? Are they avoiding? Are they being submissive? Are they being shameful? What's the pattern of behavior we can look at socially? What do they typically do with people before, during, and after? Do they tend to be silent? Do they tend to be over communicative? Do they tend to be et cetera. We can look attentionally at what do they do before, during and after? Do they focus excessively in a hyper vigilant way and can't get their focus off it off where the potential trigger could be before. It's even happened?
Or do they kind of look away and won't focus at all because they just don't even want to deal with it? These are patterns. So if we're not sure what to do with it, what we would recommend is get to somebody, get to a mental health professional as a starting point, who can carefully, methodically assess patterns before and during and after across these different.
[00:32:39] Speaker B: Areas of how many people across the country, how many professionals really know how to treat misophonia?
[00:32:46] Speaker C: That is a great question.
[00:32:47] Speaker B: I mean, come on.
[00:32:48] Speaker C: That is a great question. I'll tell you my answer.
More people know how to treat it than they even realize, probably.
[00:32:57] Speaker B: Well, here's the next email question that kind of plays into this. We've already talked a little bit about how prevalent misophonia is and how often it's diagnosed.
And also the next question for this person is what's the age of onset? You've already mentioned that. But let's get to the treatments. Let's get to the therapies what are available? You said if you go to a therapist and let's say I don't specialize in misophonia, so how do I treat this?
[00:33:30] Speaker C: What we recommend, first of all, is a multidisciplinary approach. So multidisciplinary approach. We're going to start with treatment recommendations and evaluations. And let's just stop there for a moment and do that. First step, mental health evaluation, audiologist evaluation, and perhaps an OT evaluation. We get recommendations, a team approach. We want to start there, and then from there, we can see what all these different experts have to say about everything for each person, because each person's different.
Then after that, now we can decide where to intervene. And if it's mental health, well, let's have a conversation about in detail what we can do there.
[00:34:13] Speaker B: There's so much I read in the articles I read that were very negative with regards to there's no cure. And I know people probably when they are diagnosed with this.
Our last show actually last week was on cyber Chondria. Googling your symptoms, googling your ailment, googling your disorder. And I know people do that and when they see that there's not a cure for it, how do you deal with that? How do you teach people how to cope with something that's not curable, I guess?
[00:34:51] Speaker C: Well, one of the things we do is we help validate and educate, and then we find evidence based approaches that can help with treatment, even if they're not cures.
We don't have cures for almost anything. If we stop and think about it.
[00:35:07] Speaker B: It'S just treatment, perpetual treatment.
[00:35:10] Speaker C: Yeah, look, I have type one diabetes.
There's no cure for that.
[00:35:16] Speaker B: There's no cure for that. It's treatment maintenance.
[00:35:20] Speaker C: You got it.
[00:35:21] Speaker B: One thing I read what do you think about this? One thing I read, and it's just a form of treatment, I guess an audiologist would do sound therapy. Have you seen success with something like that?
[00:35:31] Speaker C: I have some patients really like sound therapy approach?
Well, there's different ways to do it. There's different ways to do it. One of the ways they do it is kind of fancy sound generators that can help people mask sounds in their environment and block them out or kind of just almost like fancy AirPods. That's one way people do it. So they can turn up or turn down the sound that's coming into their ears in any given moment. So they can sit at the dinner table with their loved one. Oh, yeah, tolerate, because they're just not hearing it as loud. And quite honestly, some people find that to be really helpful and some people don't. It really is at an individual level.
[00:36:11] Speaker B: It's kind of hit or miss.
Let's take our next break, and when we come back, we'll just have a few minutes. I want you to talk about resources for listeners, so if you're listening, stay tuned. We'll be right back. You're listening to Brain Matters on 19.7 the Capstone.
[00:36:39] Speaker C: Tuscaloosa.
[00:36:41] Speaker A: This show is not a substitute for professional counseling, and no relationship is created between the show hosts or guests and any listener. If you feel you are in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling Center at 348-3863. If you are not a UA student, please contact your respective county's crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.
[00:37:18] Speaker B: Hey, you're back? Listening to Brain Matters on 90.7 the Capstone. I want to remind everyone, if you have ideas for upcoming show topics, email those to me at brainmattersradio at wbuafm ua.edu. Of course, I'll consider your topics tonight. We're talking about misophonia.
I think it's a fascinating disorder that maybe more people have than we realize.
And hopefully, if you're listening to this, you may think you might have it and you could get to a therapist or a professional. It doesn't necessarily have to be a counselor, a healthcare professional that might be able to assess what's going on. But Dr. Zach Rosenthal is joining us tonight from Duke University, and I'm really kind of shocked. I'm still stuck on how new this is and how there's really not that much research in this field across different fields psychiatry, audiology, medical psychology.
It's fascinating, but when we left off, I ask you to talk about some resources for our listeners. Books, websites, sources, other podcasts.
[00:38:36] Speaker C: Yeah, you bet. Well, one of the main things people ask me all the time as the director of the Duke Center for Misophonia and Emotion Regulation is, what do I do about this? In fact, right before I got on your show, I was meeting with someone. They want to know, what do I do to treat this? So this is really the main thing people want for resources is help. How do I get help? So let me talk for just a moment about what we recommend. I mentioned earlier we recommend a multidisciplinary treatment approach to be able to first establish a set of kind of evaluations to assess what in the world's going on for this person. Everybody's different when it comes to the mental health portion of this. One of the things we recommend is finding somebody who can help from a mental health perspective using evidence based and I'm putting up air quotes transdiagnostic interventions. Now, evidence based transdiagnostic interventions is mouthful, but basically what it means is treatments that have been shown scientifically to work for a lot of people across lots of different diagnoses. And the reason we recommend that is A, we don't have a gold standard treatment for misophonia yet there is not one kind of brand specific recommendation. And number two, there's so much variability within and across people with misophonia with regard to what their co occurring mental health problems are. So if we can take a transdiagnostic approach, what we can do is we can help treat the whole person, not their misophonia. We're treating the whole person, their depression, their anxiety, their OCD, their PTSD, their Add, their whatever, and their misophonia all in one fell swoop. And there are really good interventions that can help with that.
Particularly what we recommend on that front is we use one of two approaches and they're both pretty structured, but one is much more structured than the other. And they're both from the family, largely of cognitive behavioral, therapies CBTS. CBTS is a family of therapies it's not one thing, it's a whole hundreds of kinds of treatments are in the family of CBTS. So what we do is one of them we recommend is called the Unified Protocol, the up. The Unified Protocol is a transdiagnostic 16 week treatment. It works from a kind of scientific perspective. It works well for people with a lot of different kinds of problems related to emotion and emotional reactivity. Yes, and so we've been using that and testing it and we've got a paper that will soon hopefully be published showing kind of our first attempts to try this with people and most people really did well and benefited from it. It is not scientifically proven, but it is something that's beginning to show some promise. So that's one option. The second option is something that's called Process Based therapy. Process based therapy is an acronym for a framework that is new, but the interventions that are used are not new. So earlier in the show I said I think a lot of clinicians can treat this and they don't even know it. And this is what I meant. If you're a clinician and you know how to use evidence based interventions to help people in a very personally tailored way, like you can stitch together a treatment for anybody that walks in your door, you can probably treat misophonia too. What we recommend and we have on our website and we started to write about is kind of a framework that says, number one, what is this patient's main patterns related to misophonia? What are their patterns? So we first figure out the patterns, patterns behaviorally and cognitively and physiologically and emotionally and so on, before, during, and after they're triggered what typically happens. So we first discover patterns. The second thing we do is we look inside those patterns and we figure out what are the biological or psychological or social or cognitive processes. What are the processes that are behind those patterns? Is it hyper vigilance? Is it rumination? Is it shame? Is it hopelessness? What is it that's driving the problem here? And then what we do is we ask the patient to prioritize among all of these different patterns and processes, which ones do they want to start working on first?
So we let them be empowered to say, I want to work on this one first, and we help them figure out how to answer that question.
Once we have priorities, we then move to different types of therapeutic interventions, and we give them options. We say, for this particular process that you're prioritizing, here's a couple of different evidence based interventions that might work. I can do either one. Either one will help you. The best one is the one you do. Which one are you willing to do?
[00:43:39] Speaker B: Yeah.
[00:43:40] Speaker C: And they choose and then away we go.
[00:43:42] Speaker B: And it motivates them, too, when they have the choice to do it. It keeps them engaged in therapy, I think, when you give them a choice like that. But just listening to you provides so much hope. In the articles I were reading, like I mentioned before, there's no hope. There's no cure. There's no cure. There's no cure. And just to talk with you, to be able to consult with you and your center gives so much hope that there's going to be more treatment available.
[00:44:09] Speaker C: That's the idea.
[00:44:11] Speaker B: They do have control over this at some level. And there is help out there.
[00:44:16] Speaker C: Yes, there is help out there. There is help out there. And they do have some control over it. And talking to somebody who can help them create a really thoughtful personalized plan that builds off of evidence based tools, that's a great place to start. And look, I'm happy as the center director to talk to anybody in the world about misphonia. In fact, I do every week from all over.
[00:44:39] Speaker B: I'm doing it right now.
[00:44:40] Speaker C: I'm doing it right now. Thanks to you all.
[00:44:43] Speaker B: Yes. Thank you so much for being on the show. I'm honored that you took time. I know you're busy.
[00:44:49] Speaker C: My pleasure, my pleasure. I recommend resource wise, I would recommend people they can check out our website. It's misophonia, duke.edu.
Misophonia duke.edu or a really great advocacy resource is called Soquiet.org Nice, soquiet.org awesome. I'm involved with them, but, man, they are awesome. They just do a great job at providing advocacy and resources. If somebody wants a disability letter, they've got templates for it online. They can go, they can download them, they can use them, they can bring them to their doc. They can bring them to someone and say, Here helpful. Yes, it's amazing.
[00:45:32] Speaker B: Like you said, it validates what's going on. Thanks again so much. I know it's an hour later up there. I mentioned it to you, and I appreciate it so much.
[00:45:40] Speaker C: It's my pleasure.
[00:45:41] Speaker B: Dark there by now.
[00:45:43] Speaker C: It's getting dark. But you know what? I keep going all night about this, and I appreciate y'all having me on the show. Thank you so much.
[00:45:50] Speaker B: It was great. It was great. Don't forget our shows are recorded and podcasted on Apple. Podcasts, audioboom.com and voices. ua.edu you can just type in Brain Matters and you'll find some of our past shows. There's also a link to Voices ua.edu on our Counseling Center's website. That's counseling ua.edu. I'd like to thank the people who've made our show possible, dr. Greg Vanderwal, who's executive director here at the Counseling Center, my producer and colleague, Catherine Howell, my colleagues here at the Counseling Center, the WVUA staff who edit our show every week, and my guest tonight, Dr. Zach Rosenthal. Don't forget, we're on next week. Our show is going to be another interesting show that I think is pertinent right now, and it's setting boundaries with social media. So tune in next week. Again, thanks for listening and good night.
[00:46:47] Speaker A: This show is not intended as a substitute for professional counseling. Further, the views, opinions and conclusions expressed by the show hosts or their guests are their own and not necessarily those of the University of Alabama, its officers or trustees. Any views, opinions, or conclusions shared on the show do not create a relationship between the host or any guest and any listener, and such a relationship should never be inferred. If you feel you are in need of professional mental health and are a UA student, please contact the UA Counseling Center at 348-3863. If you are not a UA student, please contact your respective county's cris service hotline or their local mental health agency or insurance company. If.
