Misophonia – more than just dislike of sounds and how OTs can help

Most people can relate to the experience of certain noises or sensations as being really unpleasant. For example, the thought of nails scratching down a blackboard can make the hairs on your arms to stand up, your teeth feel ‘on edge’ and the strong impulse to quickly cover your ears to stop the noise!  

The term “misophonia” (hatred of sound) was first used in the early 2000’s to characterise the experience of an extreme emotional and physical response to certain ordinary, often repetitive, day to day sensory input. It is reported to occur in up to 20% of the population and equally in men and women. The input that evokes the most intense responses tends to be human created orofacial noises like breathing, swallowing, chewing, sniffing, throat clearing and lip smacking. Noises such as tapping and pen clicking have also been reported to be problematic. For people with misophonia, these experiences can evoke intense responses that may not seem in keeping with the circumstance such as disgust, irritation, anxiety, distress, anger and an overwhelming desire to remove themselves or remove the input from their environment.

Rather than misophonia being a hearing problem, it is now proposed to stem from attentional or emotional processing issues later in the brain’s auditory system. In examining brain activity while listening to a variety of sounds (including neutral, unpleasant and known misophonia triggers) Kumar et al (2017) found the following:

·         the misophonia group rated the trigger sounds as more distressing than the other sounds.

·         the research control group rated trigger and unpleasant sounds as similarly annoying.

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Blogs Index

Using alternatives to torch light monitoring in Mental Health Unit Design

This blog will outline some of the challenges involved in using torch light to observe clients in mental health units at night and also provide some alternative options. Part of routine mental health care on mental health units is regular observations of people while they are sleeping/lying in bed. These routine observations are undertaken due to their perceived benefit in ensuring safety and wellbeing and to reduce the risk of suicide or severe harm. Nursing staff may need to complete observations up to 4 times per hour overnight and torch light is frequently used.

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Sensory Modulation to reduce restrictive practice Part 2: Policy Context

Currently, NDIS providers are struggling to reduce the use of restrictive practices in service delivery. A report by the NDIS Quality and Safeguards Commission showed that there were more than a one million incidents of unauthorised restraints in 2020 – 2021, a 240% increase from the previous 12 months. The restraints included use of sedation, strapping down a person or depriving them of their personal belongings. (Henriques-Gomes, 2021 report of NDIS quality and safeguards commission)

As described in Part 1 of this blog series, Sensory Modulation is an intervention shown to be effective for reducing restrictive practice. Sensory Modulation can be defined as “using your senses to change the way you feel” (O’ Sullivan, Fitzgibbon 2017). Sensory Modulation interventions involve:

  • identifying problematic, or overwhelming sensory stimuli and developing strategies to reduce the input or promote self-regulation, with the goal of supporting the individual to continue to be able to engage in occupations.

  • Identifying calming and soothing sensory strategies to prevent the use of and/or be an alternatives to restrictive practices.

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Acute Care Team Legend Rachel Woolcock using cooling down sensory modulation options.

Recently I met with one of the most experienced and skilled Mental Health Clinical Nurses in Queensland – Rachel Woolcock. Rachel has over 20 years’ experience with Mental Health including acute care and homeless health. Rachel has undertaken Sensory Modulation Brisbane training and applies Sensory Modulation strategies regularly when working with very distressed or agitated clients. Rachel identifies that one of the most beneficial techniques for this client group has been cooling down with the dive reflex response. In her experience, Rachel has found that it is important to acknowledge that the technique sounds 'unusual' or 'a bit funny' but continues to encourage people to try it, with positive outcomes!

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Factors Influencing Occupational Performance

Occupational Therapists have a lead role working with individuals in the area of occupational performance. Occupational performance refers to how a person engages in meaningful and valued activities in their life and can include self care, daily living skills, community living skills, work, leisure and many more.

An Occupational Therapist who is assisting a person with their occupational performance will identify strengths, barriers, supports, problems and solutions to participating in occupational performance. This process often involves an observation of the person undertaking a or a select number of tasks, as well as completion of checklists and standardised assessments. From here, the OT will then identify possible interventions, with regard to the person (P), the environment (E) and the task/occupation (O), aimed to improve or assist their ability to actively engage in the activity, thus enhancing their occupational performance.

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