What happens when you finish CBT for Misophonia
Are you cured? Does it go away? Do you need therapy forever?
I’m Rebecca, and misophonia has been a part of my life for over two decades. Having finished a programme of CBT with the Hashir Institute in 2022, I found the impact on my life extremely positive. So positive in fact, that since then I have become a patient support officer who offers support sessions with those going through the programme themselves. These sessions are informal, peer support conversations, where we discuss how patients are finding the therapy, what challenges they may be facing, and generally have a good heart-to-heart between two misophonia sufferers who really understand how each other can feel.
Something that I often get asked, is about the lasting impact of CBT. Patients are keen to know if it still ‘works’ once you stop having video sessions with your therapist, and how you continue to feel the changes that CBT can create. Obviously, it is a little more complicated than being able to say ‘yes! it lasts forever!’ so I hope to answer in more detail for you today, so you can understand how to carry CBT with you, through the ups and downs of being someone with misophonia.
Before CBT, my misophonia was woven into my daily routine. I would wake up having worn earplugs for sleep, and immediately start a podcast on my phone for background noise. I wasn’t enjoying the podcast, but the sounds of voices helped to muffle any environmental sounds that could be a trigger for me. Then, working from home I would wear noise-cancelling headphones and constantly feel anxious about what noises I would hear throughout the day. Public transport was a minefield of possible sniffs, coughs or chewing, and many activities like the cinema were completely off-limits to me. You can read more about my decision to start CBT and my experience completing it here.
To add some context, an important part of CBT consists of examining the thoughts and beliefs that surround the trigger sounds which affect us. We often develop negative and exaggerated interpretations of these sounds, which fuel our emotional reactions. CBT helps us to challenge and replace these thoughts with more realistic and balanced ones. By doing so, the goal is to reframe our perception of the sounds, reducing the emotional impact they have. I felt like this process had been a turning point for me during my therapy. Through identifying those thoughts with my therapist, I had learnt to recognise my perceptions as and when they happened. A thought would pop into my head and instead of my emotions reacting, I would realise what the thought was and be able to pause. Yes the thought made me angry, but it was the thought doing that, not actually the sound. And crucially – it was the thought that I could learn to control. I carried this through CBT with me: I was learning to be in control of my thoughts, not to be in control of every sound I heard.
At the end of the CBT programme, your sessions gradually get further and further apart. Because of this, as we neared my final session I had been testing my ability to put CBT skills into practice and felt well-equipped to take on the noisy world. I had experienced many occasions where a noise would happen, and if I noticed it, then my awareness of my thoughts came first. This may sound minor, but it was a revelation to me. I noticed that I felt an understanding instead of instant rage. I was determined to continue this and signed off from my CBT programme feeling confident and prepared.
My daily routine had become totally different. Throughout the programme, I had been gradually reducing the routine of behaviour that I had built to avoid sound. Now, they were completely gone. I no longer used earplugs to sleep and I didn’t have the impulse to turn on the radio or a podcast out of habit. I would listen to music and podcasts with the intention of enjoyment, they were fuelled by a happy impulse instead of an anxious one. I was sure to recognise this positive feeling, and acknowledge it each time, feeling proud of my progress.
The CBT had given me a new set of skills and awareness to use, but like anything else – an athletic talent or musical instrument – I needed to practice and train those skills. They needed maintenance and attention to stay strong. I dedicated myself to recognising my reactions to sounds, and I found that writing everything down worked for me. I had always been a big list maker and loved to keep diaries. I treated this in the same way and would write out my CBT steps, my thoughts, counter statements and reactions on paper. I kept my notebook with me wherever I was, and if I felt the need to write something down when I was out and about, the notes app on my phone became full of lists and descriptions of thoughts. In complete honesty, some days I felt like I couldn’t be bothered with the effort of writing things down, but I always felt dramatically better when I did. For me, it was a little like exercise – I couldn’t imagine how it would help me before doing it, but once I did I was reminded of its positive power.
Each occasion that I felt triggered and noticed that negative thoughts were rolling in, I would do a process called KKISS through writing in my journal. I realised as the weeks went by, that this was happening less often. A few months after finishing the CBT, I was needing to write in my journal only a few times a month, sometimes only twice. The same noises which once affected me were still happening, but I was experiencing them in the same way that others without misophonia did. I heard them, but I didn’t feel an instant surge of anger and furious thoughts. I also noticed that the occasions where I did feel triggered, coincided with other struggles in my daily life. Perhaps I wasn’t feeling very well, or I had lots on at work, or I had slept badly. When my reserves of general health and wellness were down, I was much more likely to hate the sound of a neighbour in their garden. Realising this was always a reminder that I needed to look after myself, or slow down.
I am overjoyed to say that now, years on this feeling has continued. I am both proud of myself and amazed at the effectiveness that CBT had with my misophonia. It took dedication and practice, and I know that the misophonic part of my brain will be there forever – but I also know that I am the one in control.