Why is Habituation-based Exposure Therapy not Recommended for Treating Misophonia?

Why is habituation-based exposure therapy not recommended for treating misophonia?

When misophonia first gained clinical attention, it was often treated similarly to obsessive-compulsive disorder, using habituation-based or graded exposure therapy, since repeated exposure to a feared stimulus is a standard approach for OCD. However, this approach has proven counterproductive for misophonia. Rather than habituating to trigger sounds through repeated exposure, individuals with misophonia tend to become more sensitized, meaning their reactions intensify rather than diminish over time.

This outcome makes intuitive sense once misophonia is understood as an autonomic, threat-based response rather than an anxiety-based avoidance pattern. Deliberately exposing someone to a sound their nervous system interprets as toxic or harmful is highly distressing and does not create the extinction of response seen in habituation-appropriate conditions. As a result, clinicians are encouraged to explore alternative frameworks, such as inhibitory learning models or process-based approaches, rather than relying on traditional exposure techniques.