Interview: Tom Dozier, Misophonia Institute

Tom Dozier (MS, BCBA, BAMC:BCCBT) is. President of Misophonia Institute and Author of Understanding and Overcoming Misophonia, 2nd Edition.

Q: You've dedicated your career to understanding Misophonia, a condition many teenagers struggle with silently. What first drew you to this field, and was there a particular moment that convinced you to establish the Misophonia Institute?

A: My first career was as an engineer and engineering manager. After retiring, I transitioned into the field of behavioral science and became a behavioral parenting coach. One day, a mother approached me for help with her 12-year-old daughter, who had been diagnosed with an incurable hearing disorder called misophonia—something she feared would ruin her child’s life. But the girl didn’t just react to sounds; she also had visual and olfactory triggers.

That couldn’t be a hearing defect. It had to be some reflexive reaction beyond the hearing neurology. I thought, Surely we have research on reflexes—let’s see what can be applied here. I also realized that misophonia existed within my own family. So I began trying to understand what misophonia really was, and how we might reduce the response to these various triggers.

At the time, there were only three journal articles published on the subject. Since then, we've made meaningful discoveries. I felt compelled to share this knowledge. Initially, I published information on my personal website, but I soon realized the need for something more formal. That’s why I founded Misophonia Institute—to create a platform for conducting serious research and spreading the insights we were uncovering.

And we’ve been doing just that. In fact, in September 2025, we’ll launch a new misophonia research study in collaboration with Dr. Sam Spencer at the University of North Texas. This pilot treatment study will be funded by donations to the Misophonia Institute and will apply many of the principles I describe below.

We’ve come a long way in understanding misophonia, but there’s still much more to learn and do.

Q: For teenagers who might be experiencing misophonia but haven't been diagnosed, what are the key signs that distinguish normal irritation from this condition, and at what point should they and their parents seek help?

A: What distinguishes misophonia from normal irritation? If a sound is common—like chewing, breathing, or tapping—and most people don't react strongly to it, but you experience a severe, distressing emotional response that's hard to tolerate, that’s likely misophonia. It’s not about loudness. If the sound is simply too loud and that's what bothers you, that’s not misophonia.

The sooner you learn about this condition, the better. You can train yourself to relax, redirect your focus, and allow your reaction to subside. This is important because misophonia typically gets worse over time through normal experience. Each time you're exposed to a trigger and have a strong reaction, your misophonia response becomes slightly stronger.

If you're repeatedly exposed to triggers—especially in situations where you can’t escape them—your sensitivity can intensify, and you may develop new triggers. That’s why it’s important to get help early. If you have access to a treatment option, take it. Learning how to bring down your reactions is key to preventing the condition from worsening.

There are videos and resources at misophonia.org that can help you get started.

Q: Your background includes behavioral psychology work. How has this informed your approach to misophonia treatment, and what techniques have you found most effective specifically for adolescents?

When you're triggered, the emotional response is intense and distressing. You can't stand the sound, but the emotional turmoil is actually driven by an initial physical bump in your body. This physical reflex can manifest anywhere—your neck or shoulders may tense, you might stop breathing, or, like my granddaughter, your toes might flare. For my wife, her breathing stops when triggered.  As we reduce this physical bump, the emotions and urge to run also reduce.

Tip #1: You all know that headphones and music reduce the severity of triggers.  Noise can be much more effective.  Try the free app White Noise Lite (red icon) and make a mix of several sounds that have the same components as the trigger.  For example, for a crunchy trigger, make a mix with some clicking and harshness.  For typical life situations, you want to set the volume where you can interact with others and occasionally hear weak triggers, but if you are trying to concentrate, it is good to block out triggers completely.

Tip #2: Try to relax your muscles.  Having your muscles relaxed makes the trigger/anger less severe. If a trigger changes your breathing, practice slow, steady breathing when there are triggers.

Tip #3: Focus you attention on other stimuli.  Name objects you can see.  Look at details on a picture. Notice how your feet feel on the floor. Focusing on other stimuli reduces the severity of small to moderate triggers, and can slowly reduce your misophonia.

Tip #4: Reduce/eliminate the self-monologue after a trigger.  Thinking about the trigger extends your misophonia response.

Tip #5: If at all possible, after a trigger, carry on with what you were doing.

Doing these 5 things when there are weak triggers will allow your Lizard Brain (ANS) to let go of these sounds, and your misophonia can slowly decay.

Q: Your research has focused on the "Neural Conditioned Reflex Model" of misophonia. Could you explain this model in terms teenagers could understand, and how it differs from other theories about what causes misophonia?

The model of misophonia we developed—supported by research and work with sufferers—defines it as a conditioned neurological reflex disorder. It stems from Pavlovian conditioning: a person hears a sound, has a thought with a physical action, and after a few times, that action becomes a reflex automatically triggered by the sound.  For example, suppose you were told, Eat quietly.  You accept and internalized the rule as, Eat silently. When you hear your father eating, you think, He’s breaking the rule. That’s not fair. And you clench your fists a bit. If you do that five times, your Lizard Brain sees the pattern and then when you hear your father eating your fists instantly clinch.  That is a Pavlovian conditioned reflex.  Your Lizard Brain literally zaps your forearms making your fists clench – and then your emotions explode.

You are probably thinking, But I don’t have a physical reflex, I instantly feel rage. The physical reflex does happen, but you immediately feel rage, so you don’t notice the physical response.  If you want to test yourself for this physical reflex, get the free Misophonia Reflex Finder app and play a microscopic trigger.  What you feel is what I call your Initial Physical Reflex (IPR).

What we've found is that when we reduce this physical reflex (IPR), the emotional intensity and distress also diminish. That overwhelming I can't stand this reaction lessens significantly. This is a key characteristic of misophonia we've observed. I didn’t discover this because I’m particularly clever—people with misophonia I worked with simply showed it to me.

Your emotional reaction is usually so overwhelming that you don’t even notice the physical reflex that sets it off. But when that reflex fades, the emotional storm eases and can even go away. And that can make all the difference.

Most treatment providers work with you to improve your ability to stay calm and carry on when you hear a trigger and have the miso-emotions and distress.  My work with people focuses on reducing the fundamental reflex (the IPR) that drives your miso-emotions, so you don’t experience the miso-emotions and distress.

Here is a sad note – Only the people at the University of North Texas understand the IPR and how important it is to the misophonic response.  All the other researchers are studying why these common soft sounds directly trigger the miso-emotions and distress.

Q: Social situations like school cafeterias or family dinners can be particularly challenging for teens with misophonia. What practical coping strategies would you recommend for these high-stress environments?

For challenging situations, use the five tips described above.  It is important to note that if your distress is increasing, you are probably increasing your misophonia severity slightly.  It is okay to go to the bathroom or take a break as needed.

Q: You've developed specific behavioral techniques like the "Neural Repatterning Technique" (NRT) for treating misophonia. Could you walk us through how this works and what makes it particularly effective for adolescents compared to other treatments?

 I developed a method originally called the neural repatterning technique. Today, we refer to it as counterconditioning. The core idea is this: when you deliberately do something physically opposite to your misophonia physical reflex—something calm instead of reactive—it allows the automatic physical/emotional response weaken and fade. This targets what I call the Lizard Brain, or your autonomic nervous system.

The Lizard Brain is always watching. It learns from patterns it sees you doing. If every time you hear a certain sound, if you tense your shoulders—even slightly—your Lizard Brain starts to take over. Do it four or five times, and it says, Got it, I’ll handle this for you. Then the next time that sound plays, in 200 milliseconds, it reacts automatically by tightening your shoulders.

The Lizard Brain is neurotic and insecure. After it triggers a response, it watches for about two seconds to see how you react. If you flinch, groan, or feel distressed—natural reactions when you're being triggered—it sees that as confirmation: Great, I nailed it. Next time, I’ll do it a little harder.

But here's the good news: the opposite is also true. If you can intentionally relax before and through the trigger instead of tensing, the Lizard Brain notices. At first, it will still trigger the response, but as you keep relaxing before and through trigger, it starts to realize it made a mistake. It begins backing off. In as little as 30 minutes of consistent counterconditioning, you will notice the trigger becomes less severe.

That’s what counterconditioning is—teaching your body (Lizard Brain) a new, calmer response when a trigger happens.

For example, my wife has a mild case of misophonia. She developed a trigger response to the sound of her pet chickens squawking. She was worried the noise would annoy the neighbors. Every time they squawked, she held her breath—just a little. Soon, her Lizard Brain took over: squawk → breath-holding.

She came to me frustrated, saying, Tom, you’ve got to do something about the chickens—they’re driving me crazy. I asked what they were doing. She said, They’re squawking. I replied, Pam, they’re chickens. That’s what they do. But to her, it wasn’t just noise—it was a trigger.

So we tested her reaction and confirmed it: her breathing was stopping when she heard the squawking. The counterconditioning approach was simple. Every time the chickens started squawking, she consciously did the opposite of what her body was trying to do. She breathed in slowly... then out slowly... over and over. With consistent practice, the trigger soon faded. Today, it’s completely gone.

Why? Because the Lizard Brain is a follower, not a leader. When it saw her breathing through the squawks, it stopped trying to stop her breathing. It backed off. That’s the power of counterconditioning—a key part of what I now offer through Relaxation and Counterconditioning Therapy for Misophonia.

Q: What was the reception and feedback from your book “Understanding and Overcoming Misophonia”, and has much changed in the 8 years since its release?

I published Understanding and Overcoming Misophonia: A Conditioned Aversive Reflex Disorder in 2015. The second edition was released two years later. Now, it’s time for a third edition.

The book was very well received because, for many readers, it finally made sense of their experience. Instead of framing misophonia as some mysterious neurological disorder—where people inexplicably hear certain sounds and then explode—I described it as a conditioned reflex. That is, a specific sound triggers a physical jolt in the body, and that jolt drives intense negative emotions.

If you can remove or reduce that physical reflex, the emotional reaction will diminish along with it.

The response to the book has been overwhelmingly positive. I’ve received a lot of praise and gratitude from readers. It was even translated into German and is now sold in Europe, which has been a rewarding milestone.

While the core ideas remain valid, I believe the book could benefit from restructuring and the addition of new strategies and insights—things I’ve learned since the last edition—that could make it even more helpful for readers.

I think the primary change since releasing the second edition of the book is our understanding of a more comprehensive, progressive treatment process for misophonia. Previously, much of the focus was on individual tools—like the Trigger Tamer app—used in isolation. But now we’re seeing that the real value lies in combining these elements into an integrated treatment methodology.

It’s not just about using an app. It's about creating conditions where you can remain relaxed—modifying the environment, using sound masking to reduce the impact of triggers, shifting your focus, engaging in physical activity, look away, move away—all as part of a coordinated strategy. In the current edition, these methods are discussed separately. In the next edition, I’d like to bring them together into a unified, more holistic treatment approach.

There are also important new insights that weren’t included in the earlier editions. For example, Dr. Nate Mitchell has identified a secondary reflex—what we might call a memory reflex or trauma reflex. You might recall being in a car with your family during a triggering ride, and just the memory of that moment can produce a physical reaction. This is a learned reflex and needs to be addressed in treatment as well. That concept isn’t covered in the current book, but it’s essential to include in the next edition.

Another key component is how you talk to yourself after a trigger. That internal monologue—This is so unfair. They know this bothers me and they’re doing it anyway. No one cares. Engaging in this self-talk can dramatically extend the emotional pain and physical distress from a trigger. The more you dwell on the injustice or discomfort, the longer the reaction lasts. Reducing this kind of negative self-talk is a crucial piece of treatment, and it’s another area Dr. Mitchell has emphasized.

So, in short, the third edition will bring together these newer understandings: a combined treatment methodology, recognition of memory-based reflexes, and the role of post-trigger self-talk—all of which are essential to more effective and lasting relief.

Q: Your behavioral research with the Misophonia Institute has explored connections between anxiety disorders and misophonia. What have you discovered about this relationship, and how does this inform the treatment approaches you recommend for teenagers?

The Misophonia Institute has conducted research on the connection between misophonia and other conditions. Anxiety is one of the most common co-occurring issues. Another frequent trait among people with misophonia is perfectionism. When you view everything as right or wrong, when someone does something wrong per your rule, you tense a bit, and start to develop a trigger. When you’re anxious or overly tense, your reactions to misophonia triggers tend to be more intense. So, if you can take steps to calm your anxiety, you’re likely to handle triggering situations better.

Knowing you have tools at your disposal—like keeping AirPods in your pocket, having a sound generator app ready on your phone, or simply knowing it’s okay to leave a situation if triggers become overwhelming—can make a huge difference. When you know you can take action, even if you don't need to, your anxiety about entering potentially triggering environments decreases.

On the other hand, if you feel stuck—like you’re not allowed to leave or you have to tough it out—you’ll likely hit a breaking point where the reaction becomes unbearable. That kind of stress is not just miserable in the moment; it also worsens misophonia over time.

Having a solid plan for how to handle triggers is crucial. It reduces anxiety, which in turn weakens the intensity of the reflexive response. But it’s not just about managing triggers—it’s also about building a life that misophonia doesn’t dominate. Focusing on the positive, creating joy, engaging in activities that release endorphins—these all help buffer the impact of misophonia. The more fulfilling and enjoyable your life is, the less room misophonia has to take over.

Still, life comes with stress, and anxiety isn’t going away completely. The challenge is that as anxiety increases, so does misophonia sensitivity. But the good news is this: there are tools to reduce both the anxiety and the misophonia reaction itself. Once you realize that you can lower your misophonic response—or that you can remove yourself from a situation if needed—it gives you a greater sense of control. And that sense of control can significantly lower your overall anxiety, helping break the cycle.

Q: There seems to be increasing awareness of misophonia in popular culture and media. From your perspective, what misconceptions about the condition still persist, and how can accurate information be better communicated to the public?

Misophonia is a real condition—an invisible disability. Public awareness of misophonia is growing, which is a great step forward. It’s a world apart from where things stood 12 years ago when I first got involved. Today, many therapists at least recognize the term. They may not know what to do with it, but they’ve heard of it—and that’s progress.

The biggest challenge, though, is that misophonia doesn’t look real to others. Because it’s invisible, people often dismiss it. How can a tiny little sound make you that angry? Just control yourself.

Misophonia is not about being easily annoyed or overreacting—it’s a reflex. The anger, disgust, or panic you feel is not a conscious choice. It’s automatic, like sweating when you step out into the heat. You can’t just decide not to sweat. Your Lizard Brain kicks in, and the body reacts. Same with misophonia: you hear a trigger, and the emotional reaction is immediate and involuntary.

That’s what people need to understand: misophonia is not a choice. You're not choosing to be irritated or angry at someone. You’re experiencing a conditioned reflex that your body learned, and now it fires off without your consent. In a normal environment, you can’t just will it away. It’s real—and the sooner society accepts that, the better it will be for those living with it.

Q: Many teenagers with misophonia worry about how it might affect their future education, career, and relationships. What message of hope would you share with young people who fear their condition might limit their options in life?

To teens with misophonia, my message is, There is hope. Misophonia is a brutal condition. The anxiety, the anger, the awkwardness, the daily struggle—it’s real. But here’s the good news:

We’ve learned so much in the last 12 years. Real research. We're providing real treatment for misophonia, but the number of therapists is limited, so hang in there, hope on. I feel confident it'll get better for you.

Also, Universities have an accommodation office, often called Student Accessibility Services. You can get accommodations.  You can also get accommodations for grades K-12. I can help you get them.

The awareness and attention on misophonia are growing. So don’t give up. You’re not alone. And it can get better, much, much better.  I wish you well!

Q: How can people reach you if they would like to schedule an assessment or consultation?

To reach me for an assessment or consultation, you can email me at any address associated with Tom Dozier, such as tom@misophoniatreatment.com. You’re also welcome to call me directly. If you email me, I’ll send you an information packet that explains the treatment I offer.

To schedule an appointment after you contact me, simply visit calendly.com/tomdozier. Pick a time that works for you, and it’ll show up directly on my calendar. I’m always happy to meet with people, explain what misophonia is, show how it may be affecting them personally, and help develop a plan to improve their daily life.

If you simply want accommodations for school, I can help you get them.

Let me share a quick story. I met a few times with a 12-year-old girl and her parents.  About a year later the father set up an appointment because the girl’s misophonia was much worse and disrupting family life.  We met, and dad explained the severe disruption at home. When we first met, her misophonia severity was the same as at home and at school.  I asked the girl, How is your misophonia at school?  She replied, It’s not a problem at school.  I asked, What did you do at school – relax?  She replied, What else could I do.  She fought her triggers at home, and they became worse.  She used the techniques I taught her at school, and those triggers went away.

If you are on this website, your misophonia may be much worse than hers.  You may have many triggers, extreme emotions, and you can’t just relax when triggers occur. It will take more time and careful planning for severe misophonia. But the principles are the same for mild or severe misophonia. With the right experience, misophonia triggers will decline.