Misophonia treatment is not one-size-fits-all. Effective approaches depend on the nature of the individual’s misophonic response, particularly the initial physical reflex that occurs when a trigger is encountered.

The Misophonia Institute approaches treatment by focusing on the conditioned reflexes that underlie misophonia, rather than viewing misophonia solely as an emotional, cognitive, or auditory disorder. From this perspective, treatment is aimed at reducing or altering the reflexive physical response that drives distress, anger, and avoidance.

This page provides an overview of how misophonia is treated within the Misophonia Institute framework and how the different treatment approaches relate to one another. Some sections offer links to related materials beyond this Treatment menu.

Understanding Treatment vs. Management

It is important to distinguish between misophonia management and misophonia treatment.

Management approaches focus on reducing distress in the moment or improving day-to-day functioning. These strategies can be very helpful, but generally do not change the underlying reflex.

Treatment approaches aim to reduce the intensity of the misophonic response over time by modifying the conditioned physical reflex elicited by a trigger.

Both management and treatment may be used together, depending on individual needs.

The Role of the Initial Physical Reflex

A central concept in the Misophonia Institute’s treatment model is the initial physical misophonic reflex.

When a trigger is encountered, many individuals experience an immediate, involuntary physical response, such as:

  • Muscle tightening or jerking
  • Jaw clenching
  • Shoulder elevation
  • Other rapid skeletal muscle contractions

This physical reflex typically precedes conscious emotional responses such as anger or panic. Over time, this reflex becomes strongly conditioned and automatic.

Identifying the nature of the initial physical reflex is an important step in determining which treatment approaches are most appropriate.

Core Treatment Approaches

The Misophonia Institute emphasizes treatment methods that directly address conditioned physical reflexes.

Progressive Muscle Relaxation (PMR)

Progressive Muscle Relaxation is a foundational treatment tool for individuals whose initial physical reflex involves skeletal muscles. PMR is a structured daily practice that develops the ability to voluntarily relax muscles. When applied consistently, this skill can reduce emotional reactivity and, in some cases, weaken the physical reflex itself.

PMR also serves as a prerequisite skill for other treatment approaches. Several additional pages on the website are devoted to this topic, including the following:

Misophonia Treatment With Progressive Muscle Relaxation (video)

Relaxation Techniques (webpage under Coping & Accommodations menu)

Applied Relaxation

Applied Relaxation refers to using muscle relaxation skills in real-world situations, including:

  • Immediately after a trigger
  • Before anticipated triggers
  • During prolonged trigger exposure

Applied Relaxation builds on PMR practice and plays a key role in reflex repatterning. Read more through the links referenced above.

Neural Repatterning Technique (NRT)

The Neural Repatterning Technique is a counterconditioning approach designed to weaken the conditioned physical reflex associated with misophonia. NRT uses reduced-intensity triggers and controlled exposure to facilitate reflex change.

NRT is often more effective when individuals have already developed muscle relaxation skills through PMR.

Neural Repatterning Technique and the Trigger Tamer (video)

Adjunct and Supportive Approaches

In addition to reflex-based treatments, some individuals benefit from supportive or adjunctive approaches.

These may include:

  • Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT) for emotional regulation and coping
  • Medication for comorbid anxiety or depression
  • Neurofeedback
  • Tinnitus Retraining Therapy (TRT) in select cases

While these approaches may improve overall functioning or reduce distress, they are not generally considered curative treatments for misophonia itself.

Treatment for Children and Adolescents

Treatment considerations for children and adolescents may differ from those for adults. Developmental factors, family dynamics, and the ability to practice specific techniques all play a role.

The Misophonia Institute provides guidance on age-appropriate strategies and adaptations for younger individuals.

How Children Develop Misophonia (webpage)

Choosing an Appropriate Approach

No single treatment approach is appropriate for everyone. Factors that influence treatment selection include:

  • The type of initial physical reflex
  • Age and developmental considerations
  • Ability to engage in daily practice
  • Severity and frequency of triggers
  • Presence of comorbid conditions

In many cases, treatment involves a combination of approaches used over time.

Moving Forward

Misophonia treatment is a process rather than a single intervention. Skill development, consistency, and gradual change are central to effective outcomes.