Misophonia: what the heck is it and what’s a trigger?

Misophonia is a condition in which a person has an automatic, unpleasant internal reaction to specific sounds.  This reaction can vary from frustration to panic and even rage, and can be quite an intense experience for the sufferer.  Sounds that lead to this reaction are typically sounds from everyday life, such as others’ chewing food/gum, sniffling, or heavy breathing.  People with misophonia will often refer to “triggers”; a trigger, for someone with misophonia, refers to any sounds that produces the intense internal reaction.

Many people who have misophonia experience a lot of shame before they come to understand that this is a condition experienced by many others and that they are not alone in their struggles.  They can experience a lot of shame about both the intensity of the internal reaction and their response to those who have made a sound that is triggering.  I was one of those folks.

How I learned about my misophonia:

I learned about misophonia about 5 years ago.  I was talking with a colleague about my internal responses to certain noises and she noted that one of her clients had very similar experiences and told her that it was called misophonia.  I remember the first time I googled misophonia and found a video on YouTube, in which a man with misophonia was talking about his internal experiences of it.  After getting over the oddity of hearing this man talk about things I had never heard anyone else talk about, I began to feel so much more understood, by both myself and this larger community.  As I met others with misophonia, I discovered a community who could provide the sort of support that was difficult to garner from those who did not have misophonia.

Discovery and recovery:

Since discovering that I have misophonia, I have engaged with the misophonia community on a few different levels.  Given that I am a psychotherapist, I became interested in helping myself, and others with misophonia, learn to live with the condition and have relationships with others that thrive. I currently specialize in working with people with misophonia and am actively working on developing treatments that can help them to learn better ways to cope with the condition. I feel like being involved in the misophonia community and learning about the experiences of others has given me a lot of insight into the condition that I can share with others who are struggling. I feel grateful to have found this community and am thankful I get to pass on what I have learned to others.

Misophonia Treatment at Portland Psychotherapy

It’s Not Your Fault: How the Mind Copes with Abuse by Someone Close to you

If you have been hurt by someone close to you, it’s likely you are bothered by feelings of shame. Maybe you find that it is hard to stop beating yourself up over small mistakes you make. Maybe you can’t stop thinking about the way you look to other people. Maybe you feel bad about yourself and you are not even sure why. Just because you feel shame doesn’t necessarily mean that you have done anything wrong or that there is anything wrong with you.

Research on Betrayal Trauma has found that if you have been abused by someone you are close to or depend on, you may be affected in particular ways. One way you might be affected is that you may feel a lot of shame . When you feel shame, you may focus on beliefs that you are bad or flawed, rather than noticing that someone is hurting you. In addition to feeling shame, people who are hurt by someone close to them are also more likely to forget that the abuse happened or “dissociate” or feel spacey. Forgetting, spacing out, and feeling shame may all be different ways in which your mind tries to protect you from knowing about abuse, or at least knowing how bad it is or was.

Why would your mind keep you from knowing?

People who are in danger will sometimes try to get away from the thing that is causing them danger, or maybe try to fight it. However, if you really need the person who is hurting you, for example if they are helping to raise your children or they are paying your bills, you are in a bind. If you fight or flee, you might lose those resources. In addition, if the person is violent, then fighting or fleeing might result in more violence and harm. As a result, sometimes your mind can simply block you from even knowing about the abuse to protect you from further harm. Or you might know that something feels bad, but make sense of it by telling yourself there is something wrong with you instead of recognizing that it is the other person who is doing something harmful.

You may also feel shame because of ways the abuser acts toward you. Dr. Jennifer Freyd, an expert on betrayal trauma, came up with an acronym called DARVO, which stands for “”Deny, Attack, and Reverse Victim and Offender.” What that means is that the person who is hurting you may make you believe that you are the one doing the hurting and they are the one being hurt. They may ​deny that the abuse ever happened or even say something like​, “You are the one who is hurting me by saying that I hurt you.” This response makes things even more confusing and causes more shame and not knowing.

If you have experienced abuse and had periods of shame and not knowing, your mind may have been trying to protect you from further harm. At the same time, shame and not knowing may cause problems in other parts of your life and may keep you from finding resources that could help you be safer. With the support of resources like domestic violence centers, hotlines, safe friends and family, and/or a trusted therapist, you can learn to recognize when you are feeling shame even though you’ve done nothing wrong. You can notice, “Oh, this is shame I’m feeling. It’s telling me I’m no good but I don’t have to listen to it.” Then, with the help of your support system, you will have ​more​ power to decide what works for you.

I know it can be hard to reach out for help, but reaching out can be a very powerful step in the process of healing from trauma and shame. If you are in the Portland area and ready for some support, feel free to contact me at Portland Psychotherapy, or take a look at some of these resources:

Local Oregon resources for adult survivors of child abuse and for survivors of domestic violence:

 

 

 

National/International resources:

“I Already ate Half a Box of Cookies, I Might As Well Eat Them All”

If you’ve ever tried to change your diet, you’ve probably experienced a situation like the following:   You’re committed to pursuing a healthy lifestyle and as part of that commitment you’ve decided to reduce the amount of processed sugar you eat. It’s been tough, but over several weeks you’ve steadily decreased it. Then, you’re invited to a friend’s birthday party. At this party there are delicious, decadent cupcakes. Everyone’s enjoying themselves eating those lovely cupcakes. Your friend asks you if you want one and you say…”Yes.” You think, “One won’t hurt! It’s a celebration.” So, you eat a cupcake. If you stopped right there, after this initial slip, it wouldn’t be a big deal. You could just go back to your plan for eating healthy. But you don’t. Before you know it, you eat a second cupcake, drink 2 cups of sparkling orange juice, and eat a bunch of candy.

You are not alone in having this experience. Time and again I hear friends and associates talk about how they ate a whole loaf of bread (those who were on the Atkins diet), ate a whole box of cookies (those on just about any diet), or ordered the Grande size nachos when they were out at a happy hour (I, myself have been guilty of ordering a mountain of nachos even though I highly value a healthy lifestyle). An interesting phenomenon can occur after this initial slip into old habits (eating or other habits we’re trying to change). This occurs so frequently that researchers have studied it and clinicians have come up with strategies to combat it. The phenomenon I’m describing is called the Abstinence Violation Effect.

Abstinence what?

The Abstinence Violation Effect (abbreviated AVE) occurs when a person lapses, or slips, into an old pattern of behavior and then continues this pattern of behavior beyond the initial slip. Let’s come back to our cupcake example to more closely examine AVE. You experienced a lapse when you ate the first cupcake (you violated your commitment to a reduced sugar diet). You then ate a whole bunch of things loaded with sugar following your initial lapse. What just happened? When we violate a commitment we’ve made to change our behavior, an interesting combination of thoughts and feelings occurs. You might have thoughts like, “well, I already had one, might as well have another!” or “I just blew my diet so it’s ruined and it doesn’t matter what I eat now, because I already blew it.” We may also feel guilt, shame, or anxiety during or after our initial slip. This pattern of negative feelings, thoughts related to our initial slip (e.g., “I blew it, might as well forego the rest of my diet today”), and actions (e.g., eating another cupcake, drinking 2 cups of juice, and eating a bunch of candy) make up the Abstinence Violation Effect.

The Abstinence Violation Effect relates to any kind of habit change

This effect applies to anyone who is trying to break a habit. That habit could relate to patterns of eating, as in the example above, or it can relate to trying to exercise more, to stop biting your finger nails, or reducing drug or alcohol use. For people who are trying to stop or cut back on drug or alcohol use,  the abstinence violation effect can turn an initial slip (e.g., one drink after a period of sobriety), into a full-blown relapse (i.e., going back to old patterns of drinking or using). The consequences of AVE can be especially high for individuals with addictions and can lead to a cycle of multiple relapses or accidental overdose.

What can I do when I experience a slip? Practical tips for combating the AVE.

Being aware that the Abstinence Violation Effect (AVE) occurs is your first step in combating it. Armed with this knowledge you can develop strategies to help you avoid or reduce the impact of AVE. Some helpful strategies for AVE include :

  • Prepare yourself for high-risk situations (e.g., places where an initial slip may occur, such as birthday parties when you are on a diet) by making a plan to reduce or avoid triggers for your old behavior. For example, you can eat before you go to the party so you are too full to eat a cupcake. You can also reduce the amount of sugar you eat during the day of the party so you can have part or all of a cupcake without going over your allotted amount of daily sugar. You can speak with your partner or friend and enlist them to help you cope with temptation when at the party. Another idea is to tell your friend at the party about your commitment and how she can help support you (e.g., not offer you cake) before the cake comes out.
  • Remind yourself of your values related to why you are changing your behavior. For example, you might remind yourself of your values (why you are making the change in your life) on a daily basis by writing them down and placing them in strategic places (the fridge, your wallet, your pocket). You can set a reminder on your phone that helps you remember your values (e.g., a picture of your kids to remind you that you are committed to a healthy lifestyle so you can be around longer).
  • Encourage yourself if you do slip. Remind yourself that many people slip when making lifestyle changes; in fact, slipping is the norm! Congratulate yourself on the changes that you have made so far and tell yourself that one slip (or even many slips) does not mean that all the time and efforts you’ve made are worthless. Remind yourself that you can recover from a slip and that you are capable of recovering from it. Beating yourself up about slipping up is not.
  • Come up with a plan for how you will recover from your slip-up. Think of concrete steps you can take to get back on track following a lapse and write these down on a piece of paper. Put this paper in a place where you can easily access it.

A slip does not need to be the end of your pursuit of positive life changes, whether it is changing your diet or cutting back or stopping use of drugs or alcohol. By being aware of the Abstinence Violation Effect and developing strategies to combat it, you can remain on or quickly return to your path of valued living.