How Triggers Spread
Triggers can spread like an infectious disease. If I kiss my grandkids that have a cold and then I kiss my wife, my wife ends up with a cold. The grandkids had contact with me, and then I had contact with my wife. So if I have a trigger sound and it comes in contact with some other sound, I can go away with two trigger sounds. This doesn’t mean that you can pass a trigger on to another person. It means that anytime you are being triggered, and there is a repeating non-trigger sound or sight, you can develop a new trigger.
Here are some examples. Suppose you have a trigger to crunching, and while you are sitting at the dinner table being triggered you start noticing that the people are making sounds with their forks on the plates – the clicking. That clicking can become a trigger sound. You may trigger to the crunching at first, but you are also noticing that the person’s sniffling at dinner table. Now you go away with crunching and sniffling triggers. You trigger to the crunching of one person but then you start noticing the eating sounds of other people at the table. You might then trigger to eating sounds from all of them, and then you start triggering to everyone in the world.
When a non-trigger sound occurs at the same time as a trigger sound, or while you are still upset from a trigger sound, the non-trigger sound can become a new trigger. The same thing is true with the visual triggers. Misophonia almost always starts with an auditory trigger, but any repeating visual image that occurs while you’re being triggered can become a visual trigger. For example, consider gum chewing. You trigger to the popping sound of the gum, and then you see the person’s jaw moving. Seeing the person’s jaw movement becomes a new trigger. When this happens, the jaw movement becomes an independent trigger. Even if you do not hear the sound of gum popping because you are wearing headphones or earplugs, seeing the jaw movement will still trigger you. In fact, a person with misophonia may notice a person in another car chewing gum. There is no sound, but they may trigger to the visual of their jaw movement.
Brent, a middle-aged man, had several visual triggers. He reported that his physical response to triggers was a constriction of his intestines. In the early days of working with the Visual Trigger Tamer app, we attempted treatment of a visual trigger. Because he was using music for the positive stimulus, a chime was included prior to the trigger so he would know when to view the trigger video. When he heard the chime, he would look at his cell phone, and one-half second after the chime, he would see a very short clip of his visual trigger. He was cautioned to keep the trigger stimulus short so his misophonic response would be weak and brief. Obtaining a brief response was particularly difficult because the intestinal constriction would persist if the trigger was too strong. We hoped this would minimize the risk of the chime becoming a trigger. Brent reported that in an effort to speed the treatment’s effect, he increased the trigger strength. When he did this, the chime began to elicit intestine constriction, so the treatment was halted.
We have since modified the Visual Trigger Tamer so that it uses ten different chimes (a variety of sound clips) to alert the user to view the phone, and we increased the delay from one-half second to four seconds. However, in this case, we accidentally demonstrated that we could create a new trigger by pairing a neutral sound (chime) with the trigger stimulus (video clip). This demonstrated developing a new trigger stimulus through Pavlovian conditioning.
You want to avoid triggers. If you stay in a triggering situation, you are setting yourself up to get a new trigger. If you can’t avoid the trigger, sometimes you can minimize your response. These techniques will be covered in more detail in the treatment section, but at this point, I will briefly mention them. One way you can minimize your response is to reduce the trigger reflex response by using background noise – a box fan, noise machines, headphones, and behind-the-ear sound generators are all great for reducing the misophonia reflex response. If you can reduce the response, then you’re far less likely to pick up another sound as a trigger, because you won’t be so emotionally distressed and distraught from being triggered.
You can also reduce your emotional response by viewing the trigger as a physical reflex. Say, “Oh that’s my little lizard brain nipping at me. It’s not the other person attacking me.” There was a case study with cognitive behavior therapy where the person was able to deal with triggers in a calm way and carry on with her life. She didn’t like the sounds, but she overcame the emotional upheaval from triggers. If you do that, then you might not pick up new triggers.
Muscle relaxation can also help. If you relax your muscles instantly after being triggered, you can greatly reduce the anger and rage that comes from the misophonia trigger.
What do you do when there’s a trigger? As your first option, if you hear a trigger, then you need to be free to leave. For example, parents of kids with misophonia should remember that your child needs to be free to get up and move away from the dinner table without you saying, “Oh, again!” If you grumble or complain, your child is not really free to leave. Your child needs to be free to move away from the trigger.
You need to avoid and escape the triggers because tolerating the triggers will only make your misophonia worse. If you have misophonia, it’s up to you to protect yourself. A person doesn’t have to be screaming or yelling or complaining to be sitting there getting triggered. You know when you are being triggered, so move away from it. A great tool is the Bose noise cancelling headphones (QC20/20i or QC25). They are wonderful at blocking out trigger sounds. With these headphones, you can be in a trigger situation but not be triggered at all, especially if you play some white noise (or any kind of noise). Playing white noise through these headphones can completely eliminate your audio triggers. These headphones are unique in their ability to block out single occurrence sounds.
You should also do the things that will improve your overall wellness, such as getting sufficient sleep, eating properly, diet, exercise, and muscle relaxation practice. These things help your mood and well-being, and the better you are feeling the less your misophonia is going to impact you. The less it impacts you, the less likely you are to pick up new triggers.
There’s a second way that you can get a new trigger, and it’s the way you got your first trigger: by pairing the response of the distress situation with a repeating sound. This is for non-triggers. To reduce the distress when hearing that irritating sound, just think of the world around you as a noisy place. It’s not a personal attack on you. It’s just environmental noise. It is life going on around you. Those noises are positive to someone or something, so try to put a positive spin on it. Try to relax about it. A good example of this was my wife reacting to my electric toothbrush. Luckily she didn’t develop misophonia from this, but she could have. I have used an Interplak electric toothbrush ever since my mother gave me one twenty years ago. My wife would beat me to bed and start relaxing and chilling out. She was trying to read and relax, and I was in the bathroom with that noisy toothbrush. She said to herself, “That’s so annoying. I wish he’d stop. Why does he have to use that stupid toothbrush?” She was emotionally upset, and there was a physiological action occurring also. That’s just the type of situation where a person acquires a misophonic trigger, but luckily she didn’t. One day she thought, “It’s just an electric toothbrush. Lots of people use an electric toothbrush, so if Tom wants to use one, he has every right to.” After that it never bothered her again.
There’s something about putting a positive spin on sounds that helps you let them go. As I mentioned before, there’s something positive about a lot of these sounds, even if it is only positive to someone else. For example, the sound of someone eating a chip might upset you, but it might be their comfort food that somehow makes their world feel better. Think about it from their shoes, for their sake. Distract yourself. Sing a song, say a poem, squeeze an object, focus on wiggling your toes or something, but get your mind off the sound by doing something else. Relax your muscles, and if you can’t relax or ignore it then you have to just escape – get away from it because distress plus a repeating sound is a way that you develop another misophonic trigger.
I have worked with a few people that have two misophonia reflexes. For example, their jaw would clench in response to sounds of eating, and their shoulders clench in response to sounds of typing. That means that they developed misophonia twice. Most people don’t. Most people only develop it once, and then they pick up new triggers by pairing a new sound with a trigger sound. So try to lighten up when it comes to mildly irritating, non-trigger sounds.
My conclusion is this: Take good care of yourself. Take charge of your trigger sounds. Don’t let them take charge of you, and don’t feel that you have to stay and tolerate a trigger sound. If you stay and tolerate it then you are liable to go away with a new trigger sound, and you don’t want to do that.