The other day I got an email from a follower, and here's what it said: "I have been in and out of
therapy for many, many years, mostly trying to find someone to help me with anxiety and
depression related to environmental noise, which usually came from neighbors living in
surrounding apartments, but no one has been able to give me any skills to get some relief from all
this anxiety. And yes, my whole body does want to just avoid the sound because it feels horrible,
more horrible than anything. So after decades of that apartment, living in turmoil, I finally
moved to a house in a state park. The house was quiet for a year except for the leaf blowers,
mostly in the autumn, but the last two months the airport must have redirected their flights to go
right over my house every 15 minutes or so. So finally, living in my own house and in nature has
become stressful, and even taking hikes in the woods have become very stressful for me to the
point where I don't take care of myself anymore except for the basics. I don't know what to do.
Do you have any suggestions? Okay. So first, I've got to say I usually don't have time to
reply to all the emails and questions I get, and it's unethical for me to diagnose or recommend
treatment to anyone over email. So here's what I told him. The first thing I recommended to him
was that he worked with some informed provider to get a really good diagnosis of what's going
on because it doesn't sound as much like an anxiety disorder to me as a sensory sensitivity
or a hearing disorder. But then I got really curious because I don't know that much about sound
sensitivities. So me being me, I spent the last month researching it and talking with experts,
and here's what I've learned. There are at least three different types of sound sensitivities. And
this matters because sound sensitivities sometimes co-occur with other mental health conditions
like OCD, autism, anxiety, trauma, and sensory processing disorders. So let's talk about what
the three conditions are, and then you'll learn a little bit about what the treatment options are.
So there are three different types of sound sensitivities that we'll talk about today.
If you get really angry about certain noises, that's misophonia. If you get really anxious or
scared around certain sounds, that's phonophobia. And if everyday normal sounds are painfully loud,
that's hyperacusis. So let's start with hyperacusis. Hyperacusis is when you perceive
sounds as being louder than they objectively are. Everyday sounds seem louder than they should. Now,
this can be caused by physical damage to the ears from loud noises or head injuries
or acoustic trauma, but it's also associated with a ton of other physical conditions. 47%
of people with hyperacusis also have anxiety. And while it does have overlap with the other forms
of noise sensitivity, hyperacusis can sometimes be diagnosed as physically occurring within the ears.
But because of the interplay of the brain's auditory processing system and how the brain
interprets noise, hyperacuity can also be more of an issue with the nervous system hyperarousal. So
it's essentially the brain perceiving loud noises to be a threat. Now, auditory sensitivity can
occur on a spectrum where hyperacuity can be more on the more severe end of the spectrum and, like,
a dislike of loud noises can be more on the less severe side of the spectrum. Auditory sensitivity
can also be associated with sensory differences like um that often occur with autism, and it
can stand alone. It can be that you just have really sensitive ears. Okay. Now let's talk about
misophonia. Misophonia is when specific sounds trigger an, an intense reaction, usually anger,
but it can also be irritation, rage, anxiety, and disgust. The most common triggers are repetitive
sounds, like chewing, breathing, lip smacking, or tapping. Essentially, these sounds are triggering
the nervous system reaction of fight in the fight/flight/freeze response, and this can lead to
people to react with hostility or avoidance. Now, like hyperacusis, misophonia is not a recognized
disorder in the DSM-5, and research is just beginning to understand the causes and treatment.
There are some early studies indicating that there are brain differences in people with misophonia
and that there's heightened response to sounds in the brain. Misophonia commonly occurs with other
disorders, including anxiety, obsessive-compulsive personality disorder, autism spectrum disorder,
and sensory processing disorder. There's also a higher incidence in people with tinnitus and
hyperacusis. The co-occurrences may be better explained by symptom overlap. So for example,
"Oh, that sound makes me anxious, but when I'm anxious that sound bothers me more." But
the fact that the sound bothers you is not just anxiety. Okay. Now, let's talk about phonophobia.
Phonophobia is an intense fear reaction to certain sounds. So like other phobias,
it can be connected to anxiety disorders or a history of trauma, but it can also stand alone.
One case study I read about was a girl who was 12, and after Chinese New Year, where she heard
a lot of loud fireworks go off, she developed an acute electrifying intensified noise sensation in
both ears when hearing sudden loud noises. And since then she began experiencing abnormally
intensified sounds followed by unpleasant buzzing noises every time she was exposed
to normal intensity sounds. So for example, the sound of a balloon popping or the rustle of a
plastic bag were almost unbearable to her, to the point where she developed palpitations, shivering,
excessive sweating, and crying. Her condition gradually worsened until she only wanted to spend
time in a quiet room and was no longer attending social functions in school. So her parents took
her to a doctor, and the ENT assessed her ears and her hearing and they found nothing wrong,
nothing different about her hearing. They did an MRI and they found nothing wrong there,
and then she got a thorough psychiatric evaluation and she was diagnosed with phonophobia. Now,
phonophobia is generally considered an anxiety disorder, not a disorder in hearing. It's an
intense fear of loud sounds. So for someone with a phonophobia, watching someone blow up a balloon
until it bursts could possibly trigger a panic attack. Now, for the average person, loud sounds
might be uncomfortable or anxiety-inducing, but with phonophobia it's extremely anxiety producing.
Okay. So now let's talk about treatment. Right? With all three of these types of disorders,
there are two main approaches to treating these noise sensitivities. So first I'm going to
encourage you all to work with an audiologist to get a good diagnosis. An audiologist will
rule out other conditions, and an audiologist who specializes in sound sensitivities can
provide acoustic therapy. Okay. The second part of treatment is psychological. So counseling can help
people decrease their anxiety response to sounds. You can learn to regulate your nervous-system
response through grounding skills. But first, before we even go into that, we need to talk
about how avoidance can make these conditions worse. Now, I want you to notice how, both with
this girl from the case study and with the man who emailed me, they both had a drive to avoid noises,
but as they did their symptoms worsened. So this this man who emailed me, he moves all the way out
to a state park where it's really quiet. And for a year things were okay, but then gradually noises,
even the quietest noises, like an airplane overhead, would bother him more and more. And and
that's because sounds aren't just processed in the ears; they're processed in the brain. Our brain
and our nervous systems are plastic. So that means that they adapt to the situations we experience.
So when we experience a trigger like leaf blowers or a plastic bag rattling and then we avoid that
trigger and we don't die, our brain thinks, "Whoo, I survived! Let's make my human avoid those things
again because they must be dangerous." So your brain actually increases your anxiety response
to those sounds. It's going to increase your sensitivity to those sounds. Avoiding triggers
makes you more anxious. It's like if you're in a very dark room and you turn on a flashlight,
it might feel uncomfortably bright. But if you're outdoors during the daytime and you turn
on the exact same flashlight, it doesn't seem that bright. Your eyes adjusted so that situation isn't
so uncomfortable. So with sound sensitivities your natural tendency is going to be to avoid or escape
those sounds or to wear earplugs or headphones to block them out, but this will make things worse.
So so now a regular sound is like a flashlight in a dark room; it hurts even more. We we can't
completely eliminate sound. All we can do is develop greater courage in the face of these
triggers. Right? So the first thing to remember is don't avoid or overprotect against sound,
and then second is learn to change how you think about the sounds and the reactions you're having
to them. So you've got to work on catastrophizing and blaming and labeling these triggers as bad.
Um you gotta learn to accept sounds and refocus your attention and, you know, let go of self-pity
and trying to change everyone else. So these are, you know, essential skills that, you know,
in acceptance and commitment therapy, we we use the skills of willingness, acceptance, defusion,
and understanding that the trigger, these noises are actually neutral, but our interpretations
of it and our emotional response is what we can change, Now, let me put in a quick caveat because
some therapists are going to teach coping skills and avoiding skills in response to these sounds,
and that's actually going to make it worse. So that's why it's really important to find an
informed provider. That's one of the reasons why I spent the last month researching this, and I still
don't consider myself an expert in this in any way. I would definitely send someone with these
disorders to a specialist. Okay. Then after you've started learning how to face these sounds and how
to think differently about them, and perhaps you've done some acoustic therapy, we're gonna
talk about how to soothe your nervous system. So if you can learn skills to calm yourself down,
this will retrain your nervous system to not react to these triggering sounds in
the same way. So some of these nervous system skills include deep breathing,
the yawn, and progressive muscle relaxation. Now, I teach about 15 of these in my Grounding
Skills for Anxiety course. It's free. So you can check that out. The link is in the description.
But there's a lot of other ways to learn these grounding skills, and I've got also a bunch of
these videos on the um on my YouTube channel, so check out my grounding skills playlist too.
Okay. So after you have stopped avoiding these sounds, you um have worked on how
you think about these sounds a little bit, and you've learned some grounding skills,
now the next step is usually super-duper gentle, systematic exposure. This means that you're going
to super gently face uncomfortable sounds. This literally rewires your brain to realize that these
sounds aren't a threat. It's really important to know that you don't just expose yourself or
a child to an uncomfortable sound just to get the child used to it. Right? This can actually
make sound sensitivities much worse. Now, let's listen to Dr. Lindsey Tubaugh, who is a specialist
in sound sensitivities, describe how she would use um acoustic therapy to treat one of these
sound sensitivities. Sound therapy for any of the types of hyperacusis should really include a form
of passive sound therapy, which is enriching your environment with soft, pleasant sound for
as much of the day and night as possible. We don't want it loud. We don't want to hurt your
ears. And if you need to take a listening break, that's great. But that's passive sound therapy.
The idea is that it's a sound that your brain learns to tune out. Okay. And then active sound
therapy. Active sound therapy is using that window of tolerance for 20 minutes a day. This is really
for misophonia. This is what active sound therapy looks like. A lot of times we start with the the
triggering sound. I'll either create it for them myself or I'll have a loved one create it for
them. So you're doing, you're doing something fun for 20 minutes. Every five minutes you
turn it on, turn it off. And typically that's not long enough for people to trigger. You can start
with a three -econd exposure and then get back to another five minutes of doing what you love. So
basically we're exposing that person to that sound without having that trigger response. Okay. Next,
you know, just in general when you're treating these things you want to decrease your overall
stress and increase, increase your overall health, and that's going to improve your resilience. And
then of course, as always, like I said, you want to get professional support - an audiologist,
an ENT, and a trained mental health professional who can help with these co-occurring conditions.
Okay. So let's go back to this 12-year-old girl. She and her parents, this is how treatment went
for them. They had two therapy sessions where they learned all about phonophobia and its treatment.
Right? Just psycho-education. And then the therapist taught the girl how to calm her nervous
system using deep breathing and progressive muscle relaxation. Then after she mastered those skills,
they started in with gradual exposure. So they start with the least provoking stimulus at first,
like drawing a smiling balloon and then drawing a bursting balloon. Right? So I, just to be super
clear, they're not just taking this girl and popping balloons around her all the time. Right?
Super gradual. Just drawing pictures of balloons. Okay. After the child was comfortable with this,
the stimulus was then increased to bursting inflated balloons in the clinic and at home
with parents. The parents acted as a co-therapist in the situation. And each successful session was
rewarded accordingly. The child showed tremendous improvement in her symptoms after three months
of therapy. And then gradually the child was brought to public places, like a restaurant,
and finally it was brought again, we watch a fireworks show with no resulting complications
after six months of therapy. Okay. So going back to the man who emailed me. Again, I recommended
that he visit an audiologist and a mental health professional who specialize in these conditions to
get a good diagnosis and treatment. And you can too. With the right support and education you
really can learn the skills to manage and decrease sound sensitivities like hyperacusis, misophonia,
and phonophobia. Okay. I hope you found this video helpful. Thank you for watching, and take care.
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