Sound Sensitivity and Misophonia w/Dr Jane Gregory (Ep 033)

SPEAKER_00 0:01

With the misophonia reaction, there was a little bit of a feeling like I might snap and say something I regret.

SPEAKER_03 0:08

It's so overwhelming that it's unbearable. What will I do in an unbearable situation?

SPEAKER_00 0:12

Either crying or snapping at someone with the two main things that I feared.

SPEAKER_03 0:16

Just in this particular context, the trigger would be sound.

SPEAKER_00 0:19

Generally, they're good at regulating their emotions. Generally, they're good at paying attention and focusing on things. But when it comes to these specific sounds, it's like all those skills go out the window. And it's almost like the contrast between normal you and misophonia you is so vast that it feels unexplainable and out of control. Most people can't understand with misophonia is that it can get to that point because you can't filter out the sound. And it stays there at the same, if not worse, intensity over time.

SPEAKER_03 0:52

Welcome to Disordered. This is episode 33, the podcast entitled Sound Sensitivity and Misophonia. Uh today we have a special guest, Dr. Jane Gregory. Um, it is just me today. I'm Drew Linsolata, a graduate student in clinical mental health counseling therapist and training here in New York in the US of A. Uh, my esteemed co-host is not here today, Josh Fletcher, but he's here in Spear. And uh today we're gonna talk about sound sensitivity and something called misophonia. And uh sitting next to me on video, if you ever get to watch this video, is Dr. Jane Gregory. Dr. Jane is coming all the way from you're in the London area, right? In the UK? What part of the Oxford. Oxford, okay. So there you go. But uh yeah, so Dr. Jane is a misophonia expert. I think her your content is really so interesting to me because no one else talks about this. I've never seen anybody else talk about this. And she just wrote a book called Sounds like Misophonia. Yeah, look, I'll put it up on the screen, or maybe I will. We'll see. Um anyway. Welcome, Dr. Jane. Thanks for coming.

SPEAKER_00 1:50

Thanks for having me. And Josh, I forgive you for not being here, even though you have asked me many times to talk to you, and I'm so sorry. Just to explain, we have been trying to organize this for two years. Drew and Josh separately trying to organize this. And I kept saying, Yes, I'd love to. I'll get back to you, and then not replying. So I am so excited to finally be here and not be the terrible person that I felt like I was.

SPEAKER_03 2:18

Oh, hardly. You know, and you were writing a book at the time, which listen, I get it. There's a lot going on, and you're doing research. And uh, yeah, it's funny because when he messaged me yesterday, he's like, Oh, I gotta skip out on tomorrow after all this time. Because we were each trying to have you on our individual podcast, and then finally I'm like, No, no, you come on this one. This is the one you need to be on.

SPEAKER_00 2:34

So um I like to think that you joined forces and created this podcast just to get me because you were like, It's never gonna work. We're never gonna get her on both podcasts.

SPEAKER_03 2:42

So pretty much it. You nailed it. Yeah, we were literally like, Oh, she's gonna love this. And then we'll wait 32 episodes before we invite her on.

SPEAKER_00 2:51

Yeah, well, I like efficiency, but I also like things to be sort of run in before I take part. So yeah, exactly.

SPEAKER_03 2:57

We want them to break it in so it doesn't have that new podcast smell anymore, you know, that whole thing. So, um anyway, let's talk about sound sensitivity. You know, our our the community that surrounds this podcast are people who are dealing with chronic and disordered states of anxiety. They're they're working the recovery process, panic disorder, agoraphobia, OCD, health anxiety, all that stuff. Um, and I the sensitivity to sound is a thing that I'm sure that you understand. Uh, Dr. Jane is a clinical psychologist, she's more than familiar with these things and uh also well versed in CBT, clearly. And uh given your email address, this is CBT, which really coming. But uh, folks in our community uh often talk about being overwhelmed by by sensory stimulus, right? When they're in an anxious state. Sound is one of them. So give us the reader's digest version about who you are and where you came from, and let's talk about this.

SPEAKER_00 3:47

Okay, well, uh, so I'm a clinical psychologist by background, and yes, CBT is very much my jam. Um, the reason I got into misophonia is basically trying to work out why I wanted to murder my husband when he breathed too close to my ear or ate across the table from me. How dare he! And for my whole life, I had this like feeling of rage and extreme irritation anytime I heard these kinds of sounds like chewing and breathing and even clocks ticking, the sound of pigeons making that weird noise that pigeons make. Yeah, for my whole life I've been bothered by these sounds. I had no idea why, I had no idea that anyone else felt this way until I discovered the word misophonia that exactly perfectly encapsulated what I'd experienced my whole life. And so started thinking at that point, like what can we do to help? Well, selfishly, firstly, what can I do to help myself? I started there, started just experimenting a little bit. And my main area of work before this was OCD, and particularly like long-term OCD for people who still had really severe OCD, even though they'd been through lots of courses of treatment and tried different medications. That was kind of the main area I worked in. And so I started to just borrow some of the strategies that were used from that and tried them out on myself. Um, my children got to eat a lot of Doritos in my ear as I tested these things out. My poor husband was the subject of many, many experiments, and started to realize that some of the stuff that we use for other conditions, other disorders, other phenomena helped a bit and not completely, like it's definitely not gone. I still uh occasionally sneak a little glare across the table at my poor husband. But the really intense reaction, the like state of sort of feeling really panicked or really angry started to melt away, and now it's more like I can't concentrate if I can hear those sounds, I can't relax if I can hear those sounds, but I don't get this intense reaction anymore. And so once I was started working on that for myself, I started to think, well, this is obviously something we should be putting out into the world. And so we started seeing patients at our clinic, um, which is an NHS clinic in the UK, which means that these are people who don't pay for the care as they receive it, it's it's provided free under public health. And did a what we call a case series, which is when you sort of take a number of people in a row and offer them similar treatment and then evaluate the outcomes and had some really uh promising results for using these techniques with our patients in that clinic. But it's you know a really small little project and it doesn't show much that anyone will listen to. So we decided to try and embark on doing research on top of my clinical work as well, which is how I ended up at University of Oxford, which is where I'm doing my research now.

SPEAKER_03 6:58

And you spent three years doing that at least, yes. I mean, I was looking at some of your info.

SPEAKER_00 7:04

Yeah, it's been so I'm I'm I've just finished three years at Oxford and it was two years before that working on it in the NHS as well. So it's been five, five and a half years now since I first started little experiments on myself.

SPEAKER_03 7:19

Yeah, I kind of dig that you were like your own like experimental subject. I'll be the guinea pig for this.

SPEAKER_00 7:24

Um absolutely, and that's what that's what I do with therapy anyway. Like if I'm expecting anyone that I'm working with to do something, I think I should be willing to do it myself. So I often test stuff out and and see what it feels like to um be exposed to these sorts of things that are usually inherently unpleasant to be exposed to. So that was already something that was part of my normal self-practice for for CBT.

SPEAKER_03 7:50

Yeah, yeah, I love it. I love it. So you like, okay, I'm gonna do it, I'm gonna hack my own brain here. So that's it. We're officially a biohacking podcast now. Exactly.

SPEAKER_00 7:59

Now the big bucks come in.

SPEAKER_03 8:00

Now the big bucks come in. That's exactly right. This is only a branded merch on the way.

SPEAKER_00 8:04

So I just need the word bio or neuro, and suddenly that's it. You're in.

SPEAKER_03 8:10

Yeah, we need to be somehow a neurohacking AI powered. Boom, we got all the buzzwords right there. You're our people. I could clearly see you're our people. We need to have you on.

SPEAKER_00 8:20

Oh, there's a reason why I was attracted to your um accounts on Instagram because yeah, I really like the way that you put stuff out in the world. And that was one of the things that I realized when I started this was that there was hardly any information out there. And when it was out there, it wasn't necessarily communicated in a very effective or compassionate way. And so the first year of working on this, I was also um doing training in science communication. I was doing comedy classes, I started doing some of what we call nerd comedy, yeah, where I would sort of get up on stage and talk about my experiences with how I got to be doing research in Misophonia, and that has helped me to at least feel moderately comfortable talking about it in public.

SPEAKER_03 9:07

Um doing fine so far here. So very good. Um, I'm not not surprised now. You're doing comedy classes and stand-up. And that's a piece of puzzle.

SPEAKER_00 9:17

That isn't a little side hustle.

SPEAKER_03 9:20

Very good. So here's what I find interesting. You were you use the word like panicked or like you know, kind of uh describing like, well, when I would be triggered by these sounds, I'd get into a bit of a meltdown mode or a spiral. A lot of people like to say they spiral. So you would really exit you would you uh experience that like level of almost panic, level anxiety and arousal when you'd be triggered by these sounds?

SPEAKER_00 9:44

I think that spiral is probably of those words that you used for my experience, spiral is probably the best one. It could just kind of escalated and I felt trapped in the situation. I felt helpless, I felt like I couldn't get away, or that I I'm really worried about offending people. So that was part of the problem, is that I thought that if I left the situation or put earplugs in, that I would offend people. Fortunately, I've gotten a little bit better at not caring if somebody gets offended by me putting in earplugs. But I've had panic attacks before and it definitely wasn't the same as a panic attack. I didn't have for me, it didn't have that same feeling. When I had panic attacks in the past, I was sort of afraid that I would like lose control, lose my mind, um, that I was going crazy or that something disastrous was going to happen. With the misophonia reaction, it there was a little bit of a feeling like I might snap and say something I regret. Or when I was a kid, I'd like us to grab food out of my brother's hand if he was eating too loudly. So there it was based in experience. But um, I think that that was part of it was that the childhood experience of doing that had stuck with me. So it felt like that was still possible, even though I had a lot more self-control and a lot better emotion regulation skills than I did when I was a kid. But that feeling like that could happen was still there. And I think that's something that is really close to panic, is that even when you rationally know that you're safe, it feels like you're in danger or that you're at risk of doing something hard.

SPEAKER_03 11:18

I'm guessing in a way, it's almost like uh the experience of it's just becoming unbearable. It's so overwhelming that it's un unbearable. What will I do in an unbearable situation?

SPEAKER_00 11:27

Yeah. And and for me, I get I cry really easily. And that's just a general trait of mine that's not specific to misophonia. My sisters, my mom, we're all big criers, and we all get like really rednecks. And um, so one of the things for me is like it's gonna be really visible how upset I am. And again, some past experience, like I remember being really upset and overwhelmed in an exam and getting tearful and getting all red and being vigilators are sort of walking up and down looking at me, not quite sure what to do with me, because there was nothing technically wrong. I mean, there was inside, but they couldn't see what was going on. So, yeah, that feeling of being overwhelmed and that that would come out in some way. And for me, that would be either crying or snapping at someone were the two main things that I feared.

SPEAKER_03 12:12

Yeah, just in this particular context, the trigger would be sound.

SPEAKER_00 12:15

Yes, exactly. And I didn't experience that kind of fear in any other part of my life. It was really, really specific to sound.

SPEAKER_03 12:24

I get it.

SPEAKER_00 12:24

And a lot of a lot of people miss when you say the same thing, like that actually generally they're good at regulating their emotions, generally they're good at paying attention and focusing on things unless they've got some kind of co-occurring um ADHD or something like that. But when it comes to these specific sounds, it's like all those skills go out the window. And it's almost like that um the contrast between normal you and misophonia you is so vast that it feels unexplainable and out of control.

SPEAKER_03 12:54

Yeah, but I would think that understandable though. So if you go up to the, you know, the god of the palace, right? And they're supposed to be stoic, but you just poke that person, punk, pock, poke, you would drive them to a breaking point too. And it sounds like why wouldn't you have a hard time regulating in those moments?

SPEAKER_00 13:08

Yeah, exactly. And I think that's a really good point that, like, if you keep doing something to somebody that they don't like, they will be driven to some at some point, some kind of breaking point.

SPEAKER_03 13:21

Yeah.

SPEAKER_00 13:21

Yes, exactly. And I think that thing that most people can't understand with misophonia is that it can get to that point because you can't filter out the sound. So it keeps coming at you like you're hearing it for the first time. So it's like, oh, it's still there, oh, it's still there, oh, it's still there. Whereas most people, even if they don't like those sounds, and most people find the sound of loud chewing annoying or disgusting, but people with misophonia can't filter it out, so it just stays there and it stays there at the same, if not worse, intensity over time. And so the reaction builds and builds and builds.

SPEAKER_03 13:54

Yeah, yeah, that makes sense. Uh, you know, that the part that you just said where it doesn't go away. It's not like the sound's gonna go away. I mean, I guess at the end of the meal, presumably you go away, but is it in a similar situation? A person who's in a very highly anxious state who's trying not to panic feels like a minute and a half is 10 years. I'm guessing that you know the meal will be over and the chewing will stop in seven or eight minutes, but that might as well be a month.

SPEAKER_00 14:18

Yeah, like a packet of chips can last far longer than you think it is going to. Like you can see, it's like, how is that bag not empty? And especially in an enclosed environment, like on a plane or a train or something where you can't get away from the sound, yeah. It that that time sort of stretches out. But that's also um one of the reasons why chewing gum is such a problem because you don't know when it's gonna finish. Sometimes if you can see how long it's gonna last, you can manage it. Because it's like, oh, well, I know how long I have to cope with this for, and I know I can cope for the time it takes to eat a bag of crisps. But with chewing gum, it could just keep going forever.

SPEAKER_03 14:55

That's a oh, I would have never thought of that. You're right. You do not know when I'm gonna stop chewing that gum.

SPEAKER_00 15:00

Yeah, and so if someone was having a panic attack and they knew that that those sensations could just keep going on forever, are they going to stay in that heightened state?

SPEAKER_03 15:09

You know, it's funny because Josh suffers from misophonia, and I think that's one of the reasons he was he was so interested in your work. And you know, when I said, Yeah, well, we Dr. Jane is booked in, so would it be wrong? And you know, us at this point, would it be wrong if I just like crunch chips into the microphone the whole time the three of us are talking? And he said, It wouldn't be wrong, but I would kill you.

SPEAKER_00 15:28

Yeah, and you just wouldn't get anything out of me. Like if I have to listen to that, I can't concentrate. And so when I was um when I was a manager in an NHS workplace, I'd have times where people would have to come and like bring really important questions to me. And if they were eating or chewing gum or something, I'd have to say, I'm really sorry, but I cannot concentrate if I can hear the sound of chewing. So if if you want to have this conversation and you want all of me, all of my attention, we're gonna have to do it when you're finished eating, or you're gonna have to temporarily spit out your chewing gum or something because I just can't focus. And that, even though I've done loads of work on this, that is still true for me. That if I'm if I'm conscious of the sound, that's it, my attention's gone.

SPEAKER_03 16:19

But even though that situation is not your fault, it's not anybody, it's not your fault that you're sensitive to sound. Do you still find yourself almost being apologetic when you have to say that? Like, listen, it's not your fault that you're eating lunch right now, you're allowed to eat lunch, just this is my thing. It's a me, it's a me problem.

SPEAKER_00 16:35

Yeah, yeah. I I mean I I probably tend to be, I'm working on it. I tend to be over-apologetic anyway. But for Misophonia, a lot of people grew up being told it was their fault, it was them, there was something wrong with them. They're too sensitive, they're controlling or manipulative, or they're trying to like control the family. And so if you've been told that by your family, or if you've experienced that as true, even if no one said it, then of course that's what what you're going to feel. And for me, now it's more again. I said I'm not really don't really like offending people, and it's really hard to tell somebody that they are disgusting without offending them, because it's inherently an awful thing to say. Yeah, I get that.

SPEAKER_03 17:19

And you know, from the other side, it's like, well, I have to eat. I can't not, you know, I'm not doing something disgusting. So I get that. It must be a terribly isolating experience from a social connection.

unknown 17:29

Yeah.

SPEAKER_00 17:29

And I think that there's sort of there's two parts of it. One is when someone is just doing something that they have every right to do, and another is when someone is doing something that most people would consider to be bad manners, but you don't know what their situation is, you don't know what's going on. Like one of my kids literally cannot eat with their mouth closed, and it kills me. Like I've worked so hard and tried to be so gentle with like teaching them to eat nicely. And one of them was just like, it I just can't, it's really uncomfortable. And every time you mention it, it makes me really self-conscious, and then I don't enjoy my food. And so we had to agree as a family that it was far more important for people not to be self-conscious around food than it was to be able to eat with your mouth closed, even though it might cause problems in in the future if they're around other people with misophia. But I would rather it be a bit uncomfortable for me, or we need to put some music on, or I take a little break, than make my kids feel self-conscious about something that they literally can't control. And that helped me to be more sympathetic towards other people who may or may not be able to control it, but I like to pretend in my own heart that they can they can't control it, and therefore I can forgive them for being so repulsive at the table.

SPEAKER_03 18:43

Yeah, I I I'm really finding this this is a great I I love that you're sharing. Thank you so much because I think the this is an example of you know, you can't fix it. And I noticed, you know, you were right even in some of your writing, like I'm not trying to find a cure because it I don't think I don't know if there is one or will be one, but we are trying to find ways to adapt, you know, and be a little less, you know, uh uh impacted by it. And that's what you're describing perfectly. Which yeah, you know, I appreciate that.

SPEAKER_00 19:10

Yeah, and I think there are there are like layers to it. So part of what the book is trying to do is help people to remove some of the layers because in the middle you've got this, oh, I can't concentrate when I can hear these sounds. And most people, if that was the only problem, that would for most people that would be manageable. If it was someone constantly thumping above you in your apartment, you know, maybe that would be really hard work, or if you worked in an environment where there was those sorts of sounds all the time. But most of us can manage. If that's the only problem, is I can't really concentrate when I can hear these sounds. That would be manageable for most people, but we get these layers attached to it, like feeling bad about yourself, like worrying what's your reaction will be. Yeah, we also think that there's part of your brain is kind of attached, these sounds to some sort of sense of threat or violation or a fear of being overwhelmed, which then intensifies the reaction. Yeah, so those are all the layers that we're trying to remove.

SPEAKER_03 20:10

If you're listening, does this all sound familiar, even if you don't have misophonia? This is, I mean, this is really the analog is so there. It's um so it I'm I'm so interested in what you're saying here because of that. It's applicable outside even just this particular presentation, right?

SPEAKER_00 20:25

Absolutely, yeah. And it was the same when I was working with a lot of people with OCD, especially people who have lived with it their whole lives and haven't necessarily gotten better with previous treatment. There's a lot of shame attached to that. And so that's one of the layers. And it's like, well, we can't do the other work if you're feeling ashamed about this problem. We actually need to help resolve that first so that you have access to change, because we we can't, our brains don't learn and change and grow in a state of shame.

SPEAKER_03 20:55

Yeah.

SPEAKER_00 20:55

So we need to resolve some things before other things are possible.

SPEAKER_03 20:59

Yeah, because otherwise that exposure would be hey, as your helper, clinician therapist, I'm asking you not only to do a scary thing, but a shameful thing. I'm asking you to go directly into the mouth of the lion every time.

SPEAKER_00 21:11

Yeah.

SPEAKER_03 21:11

Yeah, that's a problem.

unknown 21:12

Yeah.

SPEAKER_00 21:12

That makes sense.

SPEAKER_03 21:13

And I can imagine for somebody with misophonia, especially if it's and I hear this common thread, eating sounds. We attach so much significance to food and communal eating and gathering to eat and going out to eat and eat and that that must be so incredibly impactful from a social standpoint because you can't extra you can, but it'd be very impactful to extract yourself from those social rituals, if you will.

SPEAKER_00 21:38

Yeah. Absolutely. And I I live in England, I'm actually Australian by um uh by background, by birth, grew up in Australia. My background live in England now where there is a very heavy tea culture, and a lot of people like to just take a sip from their tea as soon as it's poured out of the kettle, which means that they slurp it because it's so hot. And again, it's a real Important cultural social bonding experience to have a cup of tea together. And if that sound of someone drinking a cup of tea disconnects you from them, it has the opposite function of what a cup of tea together is meant to have. And same with food together and um that sort of shared family experience.

SPEAKER_03 22:19

Yeah. When you were working on the S5, I'm looking at the paper up next to me. It was a big sample of eight over 800 individuals in your study. Cross-cultural, what about the cultures where slurping is encouraged? It's actually a compliment, if you will. If you did not slurp my soup, I would be insulted by you.

SPEAKER_00 22:35

Yeah, and that we're we're really, really interested to find that out. So that sample was um a UK sample, and our previous one had been people with misophonia for, and it was mostly it was an English-speaking sample, but we've since sampled it in a Mandarin-speaking Chinese population, in um uh Iranian population, in a German population, in a Polish population. So we're looking at all these different cultural groups, and what we're finding is there's a the the fundamental sort of factors, we call it in in this type of measuring, um, is the same across all the cultures. So there's these five key elements that we think are really important. So one is this feeling of kind of being um distressed or helpless or out of control when you hear the sounds. One is feeling like there's something wrong with you when you're reacting this way, one is feeling like there's something wrong with the other person for making you feel this way, one is feeling like you're you might miss out on things or you do miss out on things because of the reactions, and one is um fearing that you'll have some kind of outburst or so occasionally actually having outbursts. So those five factors that came out of that big study have shown up in all those different cultures, which, according to my statistician collaborator, is really rare that you get such a robust consistency across cultures. So to start with that, that's just amazing to see that it has a really consistent pattern.

SPEAKER_03 24:02

That is amazing, not to get too nerdy, but especially with a new instrument. I mean, it's only a few years off. You've already got that validation across so many.

SPEAKER_00 24:09

Yeah, absolutely. Yeah. And that that's that's the great thing about working with a statistician. She her specialism, so that's Celia Vicharatu, my collaborator, she started that project and we found each other because we both have misophonia, and she was working at it from a statistics perspective, and I was looking at it from a clinical perspective. So we're able to bring those skills together. And I was able to say, like, what you've got already is is great in measurement terms, but here are all the things that I'm seeing people uh saying change for them over therapy. And so we need to bring some of those things in so that we can use this to tell whether therapy is helping this person or not. And so it's not just about does this sound make you angry or not? It's does it make you feel bad about yourself? Does it make you feel afraid of what's going to happen next? That kind of thing. But back to your original question, which was about cultures where slurping is considered a sign of appreciation. And it's very, very early data still for that. But what we're finding is that that that sound is still a problem for people with misophonia in those cultures. So even though it has a cultural positive connotation to that sound, something about that sound is still causing a reaction to people with misophonia. And I'd say it probably causes a more jarring reaction because it's so different from what other people in their culture would consider to be.

SPEAKER_03 25:30

And I'm guessing in that context, that missing out dimension is going to be amplified as now.

SPEAKER_00 25:35

Like Yes, yeah, real disconnection. Absolutely.

SPEAKER_03 25:38

Yeah, for sure. This is fascinating. Um, you can hang a little longer, longer than 30 minutes.

SPEAKER_00 25:43

Absolutely. Yeah. Literally, I I I love having the opportunity to just talk about this with no restrictions. All my friends and family are bored of hearing about it. So if you want to think about it, I will talk about it.

SPEAKER_03 25:54

Well, let's talk about like, okay, so you start experimenting on yourself, and it's it's fascinating when you think about it. I understand that you don't hear the term a lot, so it's not something that's widely known, I think. But it's amazing that you had to actually think, well, let me just experiment on myself with these CBT techniques or exposure-based techniques or regulation techniques. Like no one had done that before. But what did you start to find out? What so whether somebody is listening and they say, Hey, I probably have misophonia, or they're just triggered by sound as part of their anxious state, what did you learn on yourself and what are you working on that you would do with a client now based on this research?

SPEAKER_00 26:29

So uh first, I'm just gonna close my curtain a little bit because the sun is uncharacteristically right for Oxford, England.

SPEAKER_03 26:37

Yeah, sure.

SPEAKER_00 26:37

I'm just gonna pull that over a little bit. Ah, that's better. Now I will not look quite so red-faced for you. Um, so firstly, I'll say that it turns out that there were other people who were also working on this. It just hadn't been much published at the time. So over the last few years, and especially in the last two years, there's been more misophonia research in the last two years than there ever was before in total. And that's partly because there's this um fund called the Misophonia Research Fund, which is specifically to fund misophonia research. So a lot of stuff we have learned in the last two years that just wasn't there before.

SPEAKER_02 27:13

Okay.

SPEAKER_00 27:14

Um but so yeah, your question was about what I have learned. So there's a lot of the stuff that I work on with patients is stuff that I would do with any person that I was working with with CBT and just figure out how to adapt it for misophonia. So things like if you're feeling bad about yourself because of your reactions, then there are certain techniques that we might do around sort of self-compassion or um sort of understanding I'm particularly interested in sort of how childhood experiences shape what feels true in the moment, especially when there's that mismatch between what feels true and what you rationally know to be true. So if you feel like I'm a terrible person who could snap at any minute, that you know rationally I'm a pretty kind and gentle person, and I've never attacked anyone, there's that mismatch. And so often that stems from some kind of experience, often in childhood. And so what we one of the techniques that we do is what we call emotion bridging, where you bring a current example to the surface and bring back some of those emotions that you're feeling at the time, and then you use those emotions to bridge back into early memories where you first remembered feeling that way. And so you're actually traveling there through the emotions, and so it takes you to emotionally relevant memories, and then we work through some of those memories and think about what was missing at the time that you needed that wasn't available for you, which has made that memory stay kind of frozen in time and is influencing your reactions now. And so if we can meet those needs first for that inner child of yours, and then for you in the present, then that can help to sort of remove one of those layers that sort of help calm calm the system a little bit and also just give you a little bit of validation. Well, no wonder you feel that way, because that experience is still stored in there as if that is still happening for you today.

SPEAKER_03 29:18

So that might be an irrational belief, but he here's why it doesn't seem so irrational in the moment.

SPEAKER_00 29:24

Yeah, so it's not irrational at all because it's it's shaped through your actual experiences. And sometimes it's literally what happened in the moment, and sometimes it's your perception of what happened in the moment because you didn't have any other information. So if you had known at the time that this thing called misophonia existed, then you would know, oh, I'm not crazy, I'm not oversensitive, I just happen to have a different way of processing sounds from other people. You wouldn't have interpreted it that way at the time. And so again, it's it's about sort of introducing the information that wasn't available at the time and updating that memory with what you now know. And it's it's the same process that we use for processing trauma in in post-traumatic stress disorder. Yeah. But for things that seem small, the memory itself doesn't seem necessarily very dramatic, but for some reason it's stayed stuck, yeah, in time, frozen in time in your body and and is influencing your current reactions.

SPEAKER_02 30:21

Yeah, makes perfect sense.

SPEAKER_00 30:22

So that's one thing that and that's I I really love doing that with people because it's really a validating experience. It helps them to understand that it's it's not this irrational, wild process. It's it's formed from your past experiences and and that there were things that you needed that weren't available, and we can now meet those needs, and therefore we can start to heal that process a little bit.

SPEAKER_03 30:48

And I would think that in the moment, that triggered moment too, there's the trigger, there's the response, which is almost automatic. And then that dimension, I'm a horrible person for feeling this way, is now going to amplify the automatic. Now that's a problem on top of a problem.

SPEAKER_00 31:01

Yeah, and and and it escalates the fears. So people will see that I'm a terrible person and I will be judged for that. And therefore, there might be consequences to that. So that's the other area that my research is in is feared consequences. What are the things you are afraid will happen because of the way you react to sounds? And that kind of groups together into like personal consequences, which look similar to some of um the anxiety disorders that we know and love. So one is a fear of losing control, which is really similar to panic disorder. One is a fear that you will act on your thoughts, which is really similar to OCD. One is a fear that yeah, then there's more social ones, which again it sort of looks a little bit like social anxiety. So a fear that you will offend somebody or that you'll be judged negatively, or that there'll be really big consequences to people's perceptions of you. And sometimes those feared consequences are completely accurate, that actually it for that person in their life, people will judge them, people will be offended if they say something. And so it's not like those um very traditional CBT where you kind of know where they're likely to be, yeah, um, misinterpreting something, and we can sort of update their understanding of the situation because with misophonia, sometimes it's true, and so we need to check that and and work out whether is this um a circumstance that you need to figure out how to deal with? So learn how to deal with the fact that people in your life are judging you and aren't very compassionate and setting boundaries and problem solving, or is this a an old interpretation of a current problem? And therefore, we do some more classic CBT ideas of like, well, let's just find out what happens if you do share that information. Will that do they actually judge you? And that's then more about experimenting and finding out.

SPEAKER_03 32:57

Yeah, navigating through learning how to deal with it or navigate it as opposed to like trying to I'm saying invalidate or dispute the belief through those logical worksheets and the old school CBT stuff. So yeah.

SPEAKER_00 33:07

Yeah, and I'm not a huge fan of worksheets and thought disputation anyway.

SPEAKER_03 33:12

Well, it's 2023.

SPEAKER_00 33:13

It's not yeah, we've come a long way, thankfully. Although some people are still a little bit stuck in in worksheets, which I'm sure I know that worksheets can sometimes be harmful. I don't want to mean to diss the way other people practice, but one of the things I I think is really important is the influence of our experiences and anything that feels true in the moment that your body is telling you is true, even if it doesn't make rational sense, that comes from your experiences, and that can be early experiences or it could be recent experiences or it could be influenced by your behavior. So if you glare at some your partner every time they eat loudly, then that will feed into the belief that um you will offend them, that you will be judged for reacting this way, that you're a bad person because you're acting as if you are an unkind person, or um, that you can't tolerate other people's differences or something like that. And so the the things that we do can also influence what feels true in the moment. So then that's another part of the therapy is like, is there anything that you would like to experiment with changing to see whether that helps you to feel different? Or most of the time, that's not necessarily in the moment, it might be the stuff that you do in between when there are no sounds or the way you process things afterwards and beat me to it, reclaiming that time in between.

SPEAKER_03 34:35

Yeah, because I think it would be contextual. You know, if you are you are in a triggered state, it's not your fault. You are literally experiencing distress and discomfort in that moment. The glare might be more understandable if you are able to connect it to that context.

SPEAKER_00 34:47

Exactly. And when you're in a state of distress, when your body is overwhelmed, you don't actually have access to any alternative strategies. You can't make a decision in that moment because you've already moved into that part of your brain that acts entirely on reflex.

SPEAKER_02 35:01

Yeah.

SPEAKER_00 35:01

So there's not much value in trying to change something in that moment. But what we can do is create smaller versions of that moment and experiment a little bit and practice different things and then see whether we can carry that into the real situation.

SPEAKER_03 35:20

This is sounding also very familiar if you guys are listening. Yeah. You might not be dealing with misophonia, but see where this applies. I here's what I love when I asked, what did you learn? You didn't lead with like, oh, I have these techniques that I use when I'm triggered to calm myself down. You didn't lead with that. You led with the emotional response. I'm a bad person for feeling this way, which tells me a little something, maybe. Is that more important? The mechanical, like, yeah, my heart races.

SPEAKER_00 35:49

Yeah. Well, I for some people, my heart races will be the most important thing. And if if that's the thing that somebody tells me, I'm really scared what's going to happen with my heart, then that's what we work on. But um, yeah, for me, it was the emotional experience. So that's kind of where I started for me. And for other people, it might be the same. But what we'll try and do is just sort of map it out a little bit first and think first of all, like what's the most important thing to change? And secondly, what's most what feels easiest, or what do you feel like you can face first? And so it might be the most important thing, or it might be something that feels a bit easier to change, or it might be something that is a barrier to something else changing. Like I was talking before about shame. Like if you're experiencing shame in the moment, all the other changes are going to be near impossible because we just don't change or learn from within that state.

SPEAKER_03 36:39

I mean, not that I want to co-opt your work and drag it into other areas, but you know, it's a thing, and you understand you're in this, you're in this business, if you will, but you know, people who there are people who present in uh panic disorder or agoraphobia as like, no, I'm primarily concerned with the physical symptoms. And there are other people who are primarily concerned with the social outcomes or the emotional outcomes. I feel shame or I'm gonna make a scene or like I'm ruining everybody's day. So for people who often will come to people like Josh and I and ask questions, and if you go to disorder.fm, you can do that, but uh, and they'll say, but but what if what if the fear is not a heart attack? What if the fear is that I'm causing a scene while listening to what Dr. Jacob myself, yeah. Yeah, yeah. And working on that too is a valid way to approach this for sure.

SPEAKER_00 37:19

Absolutely. Yeah. Yeah. And anything that gives you an opportunity to be curious about your reactions, curious about what's going on for you inside, I think is a really healthy thing because you're not approaching it from a place of judging yourself or being judged by others. You're not approaching it from a place of fear. You're saying, I'd like to understand this a little bit better. So I want to just kind of slow down the process and figure out what's going on for me, where that might have come from, and then experiment a little bit with trying things differently.

SPEAKER_03 37:48

Yeah, sounds good. I can ask you questions about this for a very long time. Where do you want to go from here?

SPEAKER_00 37:54

Um well, the I I think the the probably the next big thing in terms of what actually helps people is the like the actual reaction to sounds. And this is the bit which is a little bit different. I mean, you'll see some similarities with what what works for other conditions, but this is the part where because of having misophonia, your brain has developed an association between these sounds and some kind of danger, whether that's like a threat or a violation or a fear of being overwhelmed. And so then the the part that we usually save till the end of treatment, once we've removed the other layers, is actually trying to create new associations with those sounds so that it doesn't feel anymore like this sound is a violation or overwhelming. It still might be disgusting, it still might be annoying or hard to concentrate, but it doesn't have that association with it's a violation or it's um for some people it might be it feels like the other person doesn't care about me if they're making that sound, even when they know rationally that they do. And so the way that we do that is, and this is based on what we call inhibitory learning principles, which is you basically try to um get rid of the old associations by creating new associations in the brain. So you inhibit the old learning and create new learning, and so the the our brain learns much faster if things are surprising, if we if we don't expect the outcome, if things are a bit funny, it can also help us to learn where in a much more receptive state, hence partly doing the comedy stuff. Um that yeah, so if things are novel and unexpected and sometimes funny, then our brain can learn a little bit faster. So we try and embed all of those principles into these strategies of playing around with sounds, and so for me, um, some of the things that I practiced for myself was um I practiced listening to the sound of someone yawning really loudly, and then my um kids got me a Chewbacca toy, and so I would imagine that the yawn was coming from Chewbacca, and he was really trying desperately to communicate something with me, and I just couldn't understand it because I don't speak Wookiee. Yeah, and the the sound of yawning stopped having that intense, like just that feeling of anger and irritation and feeling like this person's doing it theatrically, deliberately to get attention. And I started just feeling like, oh, that's just Chewbacca, he's trying to talk and no one understands him. And this poor guy in this meeting just wants to be understood. And by doing that outside of the moment, so practicing it on my own, listening to the sounds and pairing it with something new. Then when I was in the moment, I was able to bring all of that learning with me and discover that actually now that I've practiced that, that sound doesn't have that same association with offense and violation that it had before.

SPEAKER_03 41:03

Yeah. Uh so I can either respond the old way or I can respond the new way that I practiced.

SPEAKER_00 41:11

Yeah. And sometimes it feels like that's the choice, like you're there and I'm gonna, I'm gonna make a choice. And for a lot of people that we work with, they just say, actually, it just feels different now. I don't have that old reaction, so I'm not choosing between two parts anymore. This is just the new path. And it's not that I like the sound now, but I no longer have that old reaction.

SPEAKER_03 41:32

It's not that I want to panic, but I just don't see it the way I used to.

SPEAKER_00 41:37

Yes. And that's yeah, so it's they've sort of some people have said it's just like a mindset change.

SPEAKER_03 41:42

Yeah, just that you had to work at that with a Wookiee doll. Like you couldn't just decide to see it differently.

SPEAKER_00 41:49

Yeah. You can't just decide to see things differently because it's not coming from a conscious decision-making place, it's coming from a felt experience place. So you need to create new experiences if you want to override those old ones.

SPEAKER_03 42:01

This is great. Uh I am so appreciative of this. I I think people are gonna dig this. I I'm pretty sure they're gonna dig this because misophonia or beyond what you're talking about is gonna resonate with a lot of people. So if somebody is dealing with this, what would you suggest they do? It's gonna be hard to find a clinician that probably is experienced in this problem, am I correct?

SPEAKER_00 42:20

Yes, that is correct. And I have we we have a clinic now in Oxford, so we take referrals from around the country. So a small number of you in England will be able to access our service. But actually, one of the reasons I wrote the book is because I kept getting people contacting me saying, I can't get access to a clinician, I don't know what to do. And I knew that for most people with misophonia, it's not so extreme and severe that they need a therapist, they just need the right information. So, step number one, obviously buy my book because that's what it's there for. Um, and the other thing that I'm finding is people are writing to me saying that their clinicians are using the book with them. So they're working through it together. So they've got that added support from a clinician who can help them to understand things, to structure the plan, to review the plan and to put things into place in between, but using some of these techniques.

SPEAKER_02 43:14

Yeah, it makes perfect sense.

SPEAKER_00 43:15

And there are loads of techniques in the book, like that that example of the Wookiee and yawning, that's not even in there. Like there's that didn't that it's not that it didn't make the cut. I came up with that one after I'd already sent it to my editor and she was like, please stop sending me new information.

SPEAKER_03 43:28

That's great. Um, I mean, if we ever do publish the video, I I put the book up on the screen over my shoulder here. It's called Sounds like Misophonia. And actually, if you want to find that book, it's on Amazon, right? I noticed I that's where I grabbed the cover, to be honest with you. So um it's on Amazon and you can you have a website, it's sounds like misophonia.com, correct?

SPEAKER_00 43:47

That's right. Yes. And my original plan for that website was to be uh writing about research that's happening in a way that it is easier to understand than most research papers. I wrote the book instead, so the website just kind of Stalled for a little while, but I am back updating the website. So I will now also be talking about misophonia research as we learn more. Because the book is like this timestamp of what I understood at the time I submitted it, which was actually nearly a year ago. And since then, there's been a whole lot more research. And fortunately, a lot of it fits with what I'd already written. So thankfully, there's nothing I have to like retract. But there's new stuff coming out every not every day, but every month there's new papers coming out. So the website will sort of provide up-to-date information about the research.

SPEAKER_02 44:34

Very good.

SPEAKER_00 44:34

And um, I also like to encourage people to buy the book from local bookshops if they can, because I love bookshops and I want them to survive. So if you are able to go and visit your local bookshop, please do.

SPEAKER_03 44:45

Yes, yes, that's very good. I appreciate I really appreciate that because I would I am a fan of that. So that's really great. If you are the book, the book is called Sounds Like Misophonia, and you can go to soundslikemisophonia.com. But if you go to disordered.fm slash 3333, I will make sure that the links and everything to all Dr. Jane's stuff is there, including the book. So make it easy to find. This is the part where like we would be doing did it anyways and and you know answering questions, but we've already done 45 minutes, so I think this was great. We'll we'll be back next week. But um, thanks for coming by. I really appreciate it.

SPEAKER_00 45:20

Thanks for having me. Yeah, and I'm so glad we finally managed to do it. And actually, I'm in a much stronger position to be talking to you now than I was two years ago when we first talked about this because I have learned so much in the last two years. So I think we actually timed it perfectly.

SPEAKER_03 45:35

Good things come to those that way.

SPEAKER_00 45:37

And I've now had media training, so I can actually talk a little bit more coherently than I would have done two years ago.

SPEAKER_03 45:43

You would you did really well. It's I feel like you must do this every day, or maybe you don't, I don't know. But either way, you're really good at this. So I appreciate it. Um before we go, also people on uh social media links.

SPEAKER_00 45:53

I I know you on Instagram, so yes, I'm on Instagram and I'm trying to get better at it, learning from the masters such as yourself. I'm at SoundsLike Miso for misophonia research and sort of updates in the misophonia world, and at Dr. Jane Gregory for me as a person and my sort of journey through as being a researcher and being an author and all that sort of stuff. So I'm in on Instagram and Twitter on both of those handles.

SPEAKER_03 46:19

I will put all the links there. Disorder.fm slash three three will get you to this show. We're gonna that's something new that we've never done, but I'll do it for this one. And um, what else? If you have questions or comments, if you want to ask a question, I can relay it to Dr. Jane for sure. So just go to disorder.fm and use the email function or leave us a voicemail. Josh and I listen to all of them. We can't answer all of them, but we do send us a did it anyway. And uh, of course, as we always say, if you're listening to the podcast on you know some platform that lets you give a thumbs up or a five-star rating or leave a review, please do that for us because it really helps us out, especially in the UK. I will pitch for the UK today because even though, because you guys are smaller than us, so we need UK reviews, so go get them anyway. Thanks, Dr. Jane. I appreciate it.

SPEAKER_00 47:01

Thanks for having me.

SPEAKER_03 47:02

All right, we'll see you next week.