Burnout is a concept that is most commonly referred to in autism, ADHD, and AuDHD circles and research. Since misophonia is most likely a neurophysiological condition and neurodivergent (Brout et al, 2018), with a sensory-motor and brain basis (Kumar, 2021), it is not surprising that persons with misophonia also experience burnout. Burnout refers to a sensory state that is beyond shutdown (the point where persons with neurodivergent conditions are no longer able to function properly), and is caused by persistent exposure to triggers, masking (refers to the process of acting ‘normal’ or hiding misophonia), and an overall lack of capacity to regulate the nervous system. Since persons with misophonia are in fight-flight-freeze whenever they are triggered by the misophonic response, it stands to reason that burnout is the end result of not being able to regulate one’s nervous system.
Burnout is not just an emotional or psychological state; it is a physiological state where the nervous system is taxed beyond its capacity. Common symptoms of burnout are exhaustion, limited function, a ‘low battery,’ social withdrawal, and an increased need for sensory-soothing or calming activities. It is important to consider burnout as a serious part of misophonia, especially as those with autism have shown an increased risk of suicidal ideation from burnout (Reid, 2024). Suicidal ideation has also been shown in literature on misophonia (Simner, 2023).
The response to misophonia burnout should be twofold: first, persons with misophonia should not be forced to endure exposure therapy, which is counterintuitive to sensory information being cumulative (Tremblay, 2010) and the onset of burnout; and persons with misophonia should be provided tools to regulate their nervous system, including accommodations and the ability to use sensory-based tools and assistive devices such as headphones and earplugs.
Coping with misophonia requires a bottom-up process, which means that we cannot put the psychological and cognitive emotions first. This does not work because misophonia itself is not a cognitive response, but rather a physiological response to sensory stimuli. While burnout sounds like an extreme presentation of misophonia, it is likely more common than not. It is especially likely considering that persons with misophonia and autism often share similar traits (Rinaldi, 2023).
A neuro-affirming approach to misophonia and sensory-based coping skills is imperative for clinicians, parents, and persons with misophonia. In some cases, burnout may be inevitable due to life circumstances that don’t allow for appropriate coping measures—especially in situations where environments cannot be changed, such as living in a loud and triggering location, or a job or school that is not accommodating.
The following worksheet comes from my book Cognitive Behavioral Therapy (CBT) for Misophonia. CBT for misophonia has no exposure therapy and surrounds the misophonic moment rather than trying to change the physiological reality of the condition. While there are many parts of misophonia that individuals cannot control, such as when and where they are triggered, it is nonetheless the case that planning to use accommodations, physiological coping tools, and assistive devices can make a world of difference.
Depending on life circumstances and specific triggers, these plans can look different for each person with misophonia. Planning coping skills is one of the most powerful tools that persons with misophonia have at their disposal. While misophonia itself cannot be controlled, the ability to accommodate, use sensory skills, or have assistive devices are invaluable ways to improve the quality of life of individuals with misophonia.
Planning around misophonia can be as simple as ensuring that tools like earbuds, earphones, and stress balls are always carried by the individual with misophonia or as complex as a sensory diet planned with an occupational therapist or clinician. Sensory diets are planned activities that help the sensory system integrate and have traditionally been used in occupational therapy.
Worksheet: Scheduling Your Coping Skills
Instructions: Plan and schedule specific times throughout your week to practice your coping skills.