S6 E23 - 2/2/2023

S6E23 - Dr. Ezra Cowan

Dr. Cowan is pretty well-known in the Misophonia community as a researcher and therapist focusing on misophonia, as well as OCD and other conditions. We talked about how he got interested in misophonia, especially since he doesn’t have it himself. He explains extensively his model for what misophonia is and then he describes how he developed his therapy, known as Experiential Acceptance and Stimulus Engagement (EASE). You can learn more at his website:  https://ocdmiso.com 


Disclaimer: These are machine-generated transcripts and so are not completely accurate. However they will be manually updated over time until they are.

[00:00:00] Adeel: Dr. Ezra Cowan. Very good to finally get to talk to you. Welcome to the program.

[00:00:05] Ezra: Thank you for having me. It's a pleasure being here.

[00:00:07] Adeel: Yeah, just to kick it off, you should just to ask people where you located, what you do, and I will have, introed you before this, but would love to hear it in your own words.

[00:00:14] Ezra: Sure. I live in north Jersey close to Manhattan the big city.

And I'm a clinical psychologist, so my focus, my background training is mainly in the world of psychology. Understanding how the mind works, how emotions and behavior all kind of coincide and how people we try to understand how people, what makes people tick in that world. And that, that's my whole, ever since I was a young kid, I've always just tried to understand why, just this question, like why do people do what they do?

And that question leads me till this very day. I constantly ask this question, and I also ask that question with misophonia. And I think some interesting answers. Or potential answers or ideas emerge so that we could talk about that. I'm sure we'll get to those.

Yeah. We'll talk about Misson . Cool. And and oh yeah, speaking of Ms. Funny, so you don't have misson yourself, but you treat a lot of people who have Miss Ionia.

Correct. I I fell, I would say almost fell almost by by chance. Nothing's chance, but it, I stumbled on it and I slowly got to learn about the world of misophonia and really appreciate the amount of pain and suffering that is, that someone with misophonia has.

I'm sure I don't have to tell you and many of your listeners, and I actually to be honest I l I did a lot of research on it. I really got to get a sense of the amount of pain. And suffering and the loneliness from listening to your show deal. I would say that's where just hearing the personal accounts the, just the everyday life it's there's the academic side, there's the numbers, there's the, what people are reporting on self-report measures and all that stuff.

But then there's this, the individual stories that really gave me a much a richer picture.

[00:02:07] Adeel: Yeah. I started cuz I wanted to get past the ogle beyond the rans that you just see on Facebook and get it that richer view. So I'm glad you let you that. And yeah, so yeah. I'm curious how, in your practice, how did you did you notice people were coming in with, missed plenty of symptoms?

Cuz you were you probably were doing other, you were treating other other conditions before I think O C D. Right? I'm curious how that kind of started for you.

[00:02:29] Ezra: Yeah, it's a great question. So yeah, my, my background is in the world of OOC d treatment.

So I guess a short description of the evolution of my, my training and then how I entered into the world of misophonia in particular. I started to specialize in O C D or obsessive compulsive disorder in early on in my graduate school. So I've a doctorate in psychology and we have to do a lot of what we call externships.

It's like a, essentially an internship. And so my internships basically were all focused to some degree on O C D there. And so I was also at the same time doing my dissertation on O C D. And I was like totally immersed in this world called Obsessive compulsive Disorder and trying to understand it on a very, really breaking it down tits pieces and basic elements as it were, and to comprehend it.

And as I mentioned before, we try to make sense, try to understand it, and that's usually how we could then arrive at a treatment. Once you understand what's going on, then the therapy naturally flows in that. So I, there's already a therapy for e r P. It's when you have a deeper understanding, then the therapy itself also could become a little bit more effective because all the nuances also make sense and you could respond to the nuances in a more meaningful all the corner cases and Yeah.

And and so that was what drove me there to just get to that world and then. , I, it started to, then I realized that everyone, almost every single person with O C D had something, what we would term some perfectionistic tendencies. So I started to ask myself what is this thing called perfectionism?

And I tried to then understand the notes the bolts and pieces of that. And I started to de go de just what is this? Why do people have all or nothing thinking why do we engage in this type of, why are people holding themself back from becoming their awesome self when, fear of failure, et cetera where's all this coming from?

And so I started to really question the bring these types of questions to my mind and do a lot of research. And I wouldn't rest until I, each question I had some type of compelling answer. And so I was, my, my dissertation was really understanding the relationship between O C D and perfectionism.

That's, that was the, that qu connection. and one day at home, my my wife says, ha, have you ever heard of something called Misophonia? And I said I said, actually, I might have heard of it. I, it once came up in a supervision, like we were in a group supervision and someone mentioned something about it.

It sounded a little familiar, but I never, you see a lot of things and you don't pay attention to it and . So I said, I think and she said, there's this article, someone wrote an article about their experience with misophonia. And so I read it and it was, it opened my eyes.

And to be honest, I was I didn't understand it. I didn't like it was just confusing to me. And I wa and I just left it at that. But I had this feel af walking away from that. I just had this feeling of, there seemed to be. , some type of psychological part. And that psychological part tasted, and it's hard for me to use the word beyond tasted, but almost tasted like some of the patterns I've seen in perfectionism.

, that, that's all my mo my brain told me. I, and so one day I just, I, that was I put that, filed that in, in the back of my mind, and one day I decided to just do a little research and Sure. I opened this article by an individual named Schroeder Dr. Schroeder from I believe Amsterdam.

And he has a big misophonia research team out there. And he published a paper in 2013, which I believe was, if not the first, one of the first psychiatric psychological oriented papers on misophonia. And he looked at, among the many things that he looked at were some of the. Variables like the psychological personality variables.

And he found that he, it was a small group of people. It was 42 people in the study. Half of them reported that they reported that they have what's called obsessive compulsive personality tendencies. Some of them, even what we would call like a disorder, meaning those tendencies would get in their life, which is essentially, if we wanna know what that is, it's the psychiatric fancy way of saying perfectionistic and inflexible, having a hard time with things being outside the way someone understands the world.

, that, that was all that was mentioned there. And so I found that kind of pick picked my interest in the sense that there was someone who looked at this and found that there was a potential relationship between misophonia. Whether what came first, did the misophonia come first? Did the perfection?

These are all kind of questions that were Yeah. Up in the air. And when that that, that really, that study was the one that gave me a little bit of a sense of grounding to start looking into it further. That I, that maybe there is something for me to look into here from a psychological perspective.

And that led to I had a break at one point, like a winter break and I had two weeks off. And I literally just plunged myself into the world of literature on misophonia into just trying to read and on everything, both sort of formal academic studies and just anything that's online. And that's when I found you you were starting, I think you were pretty early at that point, and.

and I was I was driving to I would be driving, doing my commute and I'd be listening to a deal and his friends just yeah, getting, and so it was part of my research experience. And so that, that's how it started.

[00:08:23] Adeel: Cool. Okay. Yeah, no, thanks for giving that background.

And yeah I know looking at your website again and the you cited a a statistic where, like you, you said and there was a study where 97% of people with MS had like clinical perfectionism. And I thought that seems like a lot. I don't know. I'd never heard of that before, but I looked it up and it's, yeah it's very true.

And it wasn't a small study, it was a major study, so I thought that was interesting. I, that was used to me. I felt embarrassed not knowing that. But so since then, Misson is now a major part of, I guess your your practice. Do you want to talk about. We should also, at some point, I'm sure we'll talk about ease.

Do you wanna talk about after you did your research how long did it take for you to maybe develop some compelling treatments and we'll get into what some of

[00:09:02] Ezra: those might be? . Yeah. So it's interesting. It's like still a journey. It's still an, I'm always like, I, it's always refining, always trying to make things better.

And so in terms of when I felt like I had something that made sense, that made I would say the whole, it took probably two years till it was like the first year and a half. It was just trying to develop a conceptualization. And understanding that made sense that you could, if you told the story to someone you, they would say, oh, okay. , I could hear that. That probably took a year and a half. And then once once we, once I had, and we could talk about what that sort of, the model, the psychological model of misophonia, once there was an understanding, then the therapy tends to flow rather quickly, relative quicker to the understanding.

At the same time, it turned out to be more complex than I anticipated. And then it's you have the concept and then there's implementing the concept and that requires a lot of refining and rethinking and broadening and broadening the conceptualization itself. So that's usually how , that, that's pretty typical in the world of psychology.

And I would say even beyond that you have a concept and you try to implement it, and then get the feedback of the world that says, Hey, this works, this doesn't. Do you wanna start?

[00:10:27] Adeel: Yeah, go ahead. I'm sorry. Thanks for laying out the roadmap for that B Do you know, do you wanna maybe talk about the, your concept for misophonia and how you

[00:10:34] Ezra: explain it?

Sure. Yeah. So it's a great question and I feel humbled to share it on, on, on this on this platform. So the way I would begin, like what, how do I understand misophonia? I'm gonna, I'll try to skip a lot of the, like the academic psycho babble and the jargon.

I'll just, I'll try to share it the way. I share with anyone I work with really we all have stories about the world. That's the way our mind works. We are born into a certain family and our family shares with us their views. And tho some of those views we take in, some of them we develop from outside and we develop an idea, a story about the world.

A good person is supposed to be responsible, make a living and do their thing. Just be a good person, smile and that's being good. Another person would say being good involves going far places and helping people. That's what it means.

That's the story of what being a good person is. It, we all share I stories about the world and so with misophonia there's also a, what I call the misophonia story, and it goes something like this when people will. , stop making certain sounds that really bother me, that are really painful to me, then I will be better.

Now I'm curious what do you think of that story? A deal? As I said that Oh

[00:11:58] Adeel: if people will stop making noises, I'll feel better. That's

[00:12:01] Ezra: story. Yeah. Would you agree with it? Would that, does that feel accurate

[00:12:04] Adeel: to you? Ye yes. For that. For when I'm in a moment.

In the moment, exactly. Yeah. When I'm in the moment. I, and I'll get to this later, I'm very curious where those stories come from, because I feel like there's a there's treating things in the moment and then there's maybe treating the root. Oh, very good. Yeah. But yeah. But yeah,

[00:12:21] Ezra: for that sentence, that's a question.

Yeah. , I like that. Yeah. Is that, yeah. Where did that story come from? That's a great, that's a great question. So I think what we're looking at it right now. There's this I think what, when someone come, comes into therapy or when someone's getting triggered, we find someone, it's, it makes sense.

I, I, when this trigger goes away, I will be comfortable. I would be able to not worry about getting clobbered by these type. I don't have to worry. I don't, I could be comfortable. And that, that there's nothing intrinsically wrong with that idea up until there's, it there's another phenomenon like the, let's just call it the phenomenon that triggers, let's say whatever the trigger.

I'm not going to, I'm not gonna give examples here. You know your triggers. Yeah. Th those triggers aren't, have historically, have not have been around. And so that suggests that they're probably going to continue , in other words. , I had a professor that said Dr. Brandwein he always said the best predictor a future behavior is past behavior.

In other words, if we wanna make a conservative assumption of what things are going to be look like in the future, it's probably the way things work. In other words it's we could all hold ideas and hopes about how we hope things are going to be. And because also we really don't wanna be hurt at the same time that I what that hope or that the idea that triggers can go away is something that clashes with what's likely going to unfold.

And , this is what one beginning point of understanding, there's a lot of, there's a clash between how I'm expecting things to flow and how things tend to be going and how things are going to unfold. And so what I it brings up a lot of, a lot, an intense amount of frustration, an intense amount of pain and it's very disappointing when the triggers continue to happen.

Now, we could say logically, I know that they're gonna go away, but for some reason, logic lo, the logic doesn't tend to have a, an input in this situation. We can't, I can't, if I were to say this right now to everyone and say, look, the triggers are gonna go away, are not gonna go away.

That doesn't have any impact on how triggering it is. It's, I might know that intellectually, but it doesn't have an impact emotionally. And so that relates to what we would call a sense of we don't wanna be hurt. So inherently, with the desire to not be hurt, we, that comes with the hope, which kind of hope and expectation are really in the world of psychology, are the same.

That the triggers will go away. So we don't wanna be hurt, in other words what kind of if we were to, if we were to put a different angle at this, we could say a different story and the story could go like this. There are people around me that do things that I really don't like.

However, it's especially people that are close to me that I have the highest expectation that they won't hurt me. , they are, unfortunately, they're not going to, this behavior is not going anywhere. That's just, and I hate I, I don't like saying this in a, in a, in just a matter of fact way, but it that just from a phenomenological place, that's what seems to be happening.

And what would you be left with if we can't change? If we were to see this as something that's never gonna go away, then that would be very sad. That would be very, feel very hopeless. And I tell people, this sense of this feeling of hopelessness, this sadness, it's actually usually we don't think of hopelessness as like a good thing.

But sometimes in order for us to move on from something very painful, it involves going through the a dark tunnel and the dark tunnel. Could lead to something brighter. At the same time, it is very painful when people around us are doing something that is so painful to me and I can't get it to change.

And so if we could establish that and again, how that's done we'll talk about with the, how that's done. If we could establish that they're not changing and then that means that, now if I'm the one being hurt, if I'm the one being triggered, I'm stuck with getting hurt. And so then I could begin to focus on what I could do, which is focusing on the pain that's inside of me, because now I'm not looking to change what's out there.

And so the, there's really, in this sense, this kind of leads to the therapy itself, which is really, there's two steps to the. And before I talk about the therapy, I wanna clarify cuz I think sometimes this seems to it doesn't explain certain aspects of misophonia, especially like the intensity and the overwhelming aspect of like, why is my brain so latched onto the sound and why does it like, hijack my entire nervous system?

And so I, I often explain that when we hear a sound that makes us uncomfortable, the tendency would be to not wanna notice it. So if I hear a sound, I don't want to hear, it's I would want to ignore it, I would wanna move away. If it really bothers me, I definitely want to not notice it. So the problem is that there's something called the White bear phenomenon.

Have you ever heard of the White Bear phenomenon? I've read it on your website yet. Okay, excellent. So if you I'll share with the with the audience. If I, if if I were to ask everyone listening don't think of a white bear. I'm guessing most of you thought of the white thing one in my head.

Yeah that's just the way we end up thinking about, we don't wanna think about, now this is true for sounds also, if I try not to notice a sound, it's just it's like a not fear part of the brain. Like why does the brain have to do that? It's just a it's, this is the way everyone seems to be wired and it makes sense in a sense that we notice the things we don't want to notice.

We, and let me clarify that. In order to not notice something, you have to think about that thing that you don't want to notice. So you, we just, it just keeps on bringing it back in a loop to your awareness. And so it, if I'm trying to not notice the sound, then I'll be more aware of the sound and I'll be, it'll be with, it will be stuck with me now.

There's another effect that when I'm trying to, when I'm trying to there, that's one piece. Unfortunately, there's like another piece called the zoom in effect. The zoom in effect, which means that if, in the same way that if I were to be studying for a final, let's say for a test, and I really wanna be fully focused, I'm giving my full attention.

It's almost like I'm losing track of everything around me besides for the material and of, and that I'm trying to focus on. The same is true with sounds that I'm trying to not notice. The brain doesn't distinguish between the things that you do wanna notice and don't wanna notice. It just says notice, and then it says notice even more.

And then it says notice even more more. And it keeps, and it becomes like a the brain just attends it. It thinks that it's doing what it's supposed to be doing, which is just to attend what. The mind is being told to attend to, even though we're telling it not to attend to that. So it becomes, it's almost like taking headphones, putting on, on, on really high quality headphones and putting the volume all the way to the max and taking a microphone and putting it to the trigger that we don't wanna notice or the site, if in the case of a site, miso, esia and it becomes just becomes the only thing that the brain is attending to in a certain sense. And so that from, to me, could at least partially explain why it's so the, some of the overwhelming factor because it's we're to, it's like to the exclusion of everything else, all that's being focused on is this one trigger.

So that, to me, a lot of the very, very difficult parts of misophonia, I believe are secondary effects. There's secondary effects to the initial, I don't, of trying to not be present with a sound that's uncomfortable to, to the, so why exactly are people bothered by sounds in the first place?

I think what I've found is that there are many, there, there are many reasons meaning there are different types of contributors. I don't think each person has like the same exact conditions. For example I, there is one piece with the perfectionism that we saw, which basically means that when people have perfectionism, when they are, when there's some type of pain points, in other words, like we the symptoms of perfectionism are more well known.

The need to have things a certain way, the all or nothing thinking. If it's not like this, then I'm not okay with it at all. Fear of failure different. There are different, we could list different symptoms in terms of what at the core of it. , at least how it could be understood.

One perspective is that when we don't feel comfortable, we don't, we become more extreme. So we become a little bit more inflexible. Hey, do you mind if I'm like taking a knife and poking you with it yeah, I do mind about that. That bothers me. Could I do it a little bit? No, not at all.

Like we don't become like flexible when we're being hurt, so , when something, when, if for some reason the sound is be it touches someone's pain point to a degree. Now that's something that could happen and I'll explain how, but if it does, then the, then we become more inflexible about the sound.

So like the sound could become more bothersome and less acceptable in like where, whereas one person might say, okay, it's not a big deal. Like whatever, it's annoying sound, but there's nothing I could do about it. , someone who it's already, it's touching a pain point, then it's no, I can't have this.

And what would be an example of a pain? I, there, there could be many things, and I don't want there no one on this planet is free of any of pain. Everyone has their package as they say. I'll just give an example. Let's say someone has like a helicopter mom or dad. It's not just moms that are helicopter that could be helicoptering.

. But it's it, there's a, and there's a feeling of I don't have space. And so then in that environment where I already feel like I don't have space, if I'm noticing a sound and that sound makes me, it brings up that same feeling to some degree. I'm gonna try to move away from that sound because it also brings up a feeling that I'm already having in my life.

That's already a pain point. That's just one example. I think the perfectionistic part that we're seeing in the research, this is just like explaining what, when we talk about perfectionism, all perfectionism means is that there's something in a person's life that they're, they don't wanna feel and they're responding to the world in a way that they're protecting themselves from that.

So they wanna do well on a test because not doing all tests, not doing well on a test will make them feel vulnerable to some type of pain that they've already had, for example at least Okay,

[00:23:30] Adeel: go some kind of pain point that they already have. Yeah, I guess my, I think people might be curious like where that come from and is it worth addressing that as well as, how to accept a sound?

Is that part is addressing the, is addressing that the roots pain point, part of the

[00:23:43] Ezra: therapy? Great question. So the answer is ultimately yes. I'm glad. That's such a good question. Ultimately, yes. And I'll, we'll, when we I'll get to the therapy in a second, and I think that you, and I'll show you how I mean by that.

So the the, so the pain point it that, that's one way that, that kind of is connected to the broad perfectionism and so how, but there are other factors that could relate to contributing the rise for, in the first place of developing misophonia, meaning if someone has perfectionism, doesn't mean that they'll develop misophonia.

, however, like certain risk factors, let's call it, that could contribute, I believe is, let's say someone someone lives in a house where someone does. have manners that are deviate from the norm. And, it's not, as I say, it's not just in the mind. I think that could create a risk if someone is an incredibly loud breather, for example.

I apologize for using a certain but this is, I think that does have an impact. Again, it's not the whole story, but it, I think it's a, what we would call it a risk factor. If someone and just for example, if someone goes through a recent change where someone used to not make a certain sound and then they started, then they can become aware of sounds.

And even if that sound goes away, that like sudden new sound came I'll just give an example. I think if there was someone who, who told me that they a sibling got , braces. Or some type of orthodontic procedure. And the way that, that the sibling was eating changed and that change was very uncomfortable because it was just a new type of sound that wasn't there before.

And then even though that went away, eventually, once the mind becomes aware of it, it's hard to become unaware of it. And so then it starts to generalize. So that's another example. So is

[00:25:33] Adeel: this maybe related to maybe that example related to rigidity, if somebody is predisposed to being extra, have rigidity, whatever that definition is when they see something that deviates from that, is that part of your model in terms of like where, how Ms.

Bu could develop something outside of their expectation?

[00:25:51] Ezra: Exactly. Exactly. It's there there's a sense of I think that. Things should, this is the way someone should eat. And it's not being done. So I'm expecting that to change that's part of it.

At the same time, I think it's important to realize that, that on a, perhaps on a deeper level, the perfectionism emerges from, already emerges from general sense of I'm already, I already have something that, that hurts inside to some degree. Cuz everyone has something. And that sound is rubbing against that.

So I don't like the way you eat. Maybe it's because of a, it seems like a rule, a steadfast rule about how I expect things to be. But often that rule why things I, why I expect it to be that way and it's hard for me to be flexible about it is because of how I already, how I feel inside. And And yeah.

So that would definitely play a role. And yeah.

[00:26:41] Adeel: And you said something earlier, maybe related to that is, was that mi mione yeah, we feel like you, when you ask me like you wish something, I wish something, oh, a noise would stop when I'm in the moment. But you also said that we hope that in the future triggers won't happen, but I, but I don't know.

Have you talked to anyone who's told you that they actually realistically expect sounds to stop in the future? Because I don't know that I certainly don't expect sounds to stop in the future. I'm looking for ways to heal my misophonia, but I'm curious where that observation came from.

[00:27:13] Ezra: Yeah, it's a great, it's a great question. So it's, I think on the, we're looking at the at the gap called the from of. What we believe on a kind of, just like our typical kind of this is I believe logically, and then there's the emotional part of the, what I would call the hope that almost like the hope that this would stop and that you really find more in the moment.

Like when there's a trigger can't and you could find this with the types of thoughts that someone has. Can't you just eat a little quieter, for example? Like just there. It's just instinctual. And in other words what I find is that there's and I guess we could talk about this is gonna start bleeding into the therapy itself.

It's not uncommon for us to have almost like conflicting beliefs in the same moment. In other words, I could know that this is not gonna go away and at the same time have a certain hope that it would go away. And that's not a, and that's not a contradiction in terms of the rea, the existence of those two exi in, in the minds.

It's entirely possible for someone to have those two. And I think it's coming. It's not coming. It, I think we're I find that individuals misophonia tend to be on the brighter side. It's not coming from a logical conclusion per se. It's coming from the desire to not be hurt.

So everyone has a deep desire to not feel hurt anymore. So naturally there's it, the mind sees the way out or hopes the way out is the mind hopes that there's a way out. And then naturally the mind says if people were to stop chewing, that would be a way out of this. Out of the situation if people would stop doing the triggers that bother me.

And it's I call it like a little bit of a twilight zone in the sense that a person knows and doesn't know is aware, has this one belief that I know that it's not going to go away. And then it's like emotionally there's a sense of hope that, and I u I call that hope toxic hope because it's a hope that really holds us back from healing.

And I'll, let me talk about what healing could look like. So the way the mind, the, it's really a two step there's two steps. And I'll start with describing what a therapy looks like for not misophonia. And I think it will be useful as a launching pad to go into how it looks like.

So for, let's say someone is dealing with a lot of anxiety, anxious distress, and they work to go to a therapist. There's many there. The, there's different ways people treat it. One of the, the cut the frontline ways today that a lot of people are treating anxiety difficult emotions.

It's, it is using what's called an acceptance based approach, which is basically taking the follow the following. This is what the conversation looks like. Look you're experiencing a lot of anxiety and I'm hearing that you're in a very difficult state and that it's painful for me to see that.

And the hard part is that some of these emotions they're like part of they're a part of us. We have positive things, we also have painful parts and we can't. Really get rid of these emotions or not something that we could get around. So let's learn how to feel them. Let's learn how to experience in other words, it's not about feeling good.

It's about being good at feeling. And so we could do exercises together in, we could practice and how to learn to deal with those difficult feelings. And we can learn how to experience those. In other words, how to make peace with difficult feelings. And this actually, and the research, there's tons of research on this is incredibly effective in learning how to just move on from difficult emotions in other words I might feel pain, but I'm okay with my pain.

I've made, in a sense, in other words, in other way of putting it is I'm at peace with my pain. And so I'm not thinking about it. Oh, I feel sad. Okay, I feel sad today. It's okay. I don't need to get, this is a, this is where I'm at. Trying to move out of this, trying to fight that is only gonna create suffering.

It's only gonna make me even more depressed and feel like more like I have less control over my life and more desperate. So the another way is just to take, pull back and be, okay, this is where I'm at right now, and that's okay. And there's a lot of nuances with that, and there's, but that's the big picture.

So with misophonia there's a step before that needs to be taken, and that's related to the idea that the solution for this really painful problem called misophonia is outside of me. If I believe on any level whatsoever that the solution is outside of me, then I'm gonna continue to wait for that solution to emerge.

before I even start thinking about dealing my own, dealing with painful emotions. In other words, we're not willing to deal with a difficult situation unless we really have to. And so painful feelings is we just don't like to feel bad a deal. I don't know about you a ideal, but I don't like feeling negative emotions.

I'm, it's not, and I'm sure many of the listeners could would agree. It's not fun to feel uncomfortable. There's many industries all based on just pain relief. Make me feel

[00:32:27] Adeel: bad. Yeah. Or

[00:32:28] Ezra: pain relief too. , I think the term out there, even in the business world for marketing different products is like what's, solving a pain points.

In other words, like every, everything is there to. some, someone has a problem, like a discomfort of sorts. And this is going to alleviate that, that right at the core, we just don't like being uncomfortable and, but we can learn how to deal with that if we feel there's nothing else that we could do with, unless we bel, unless we think that there's something that could be done to solve the problem.

If we think there's something that could be done to solve the problem, then we'll take that step first. We're not gonna start saying, all right, let me just sit kumbaya with my feelings over here. And and while there's, there seems to be this button I could press and everything will go away. And so w with misophonia, there's it's what we wanna do is to recognize all the ways that my mind entertains as possible ways to n to feel like this.

this could change. Like the sound could change or this, the sound could go away. And this involves, in order to create this type of conditions of that, the situation's not going to change. We need to look at all the different variables that give that, that contribute and give rise to the sense that I could get away from these sounds.

And so that involves thinking about how the other ho, how the trigger, the source of the trigger could go away. That involves thinking about how I could get away and that and all the different ways that are, that go with that. And that also involves, and this is an interesting one, and yet I think this is another kind of, I would call it risk factor that I find in misophonia where peop where we have this certain expectation of our own body, of how we're supposed to feel.

I find that there there's, there are different types of , ways that it perfectionism emerges that ways that it how it affects people, is it could be so many different ways. One way is how a person feels like I shouldn't be feeling this emotion. The very interesting thing that we do, like I have an emotion, and I could look at it and be like, this should not be happening.

This emotion is not supposed to exist inside of me, which is an interesting way phenomenon that we do this, and yet we do this all the time. And so if I feel like I'm already getting, I'm already uncomfortable and now I'm telling myself I shouldn't be triggered by this town, that's creating a whole new level of distress on myself, pressure that like somehow I'm violating the norms of humanity that I'm feeling the way I'm feeling, and so the, and it creates a lot of distress.

And so the third piece is also recognizing that the way I'm responding right now is not changing in the moment right now. This is how I'm reacting right now. So it's not expecting it's recognizing the person's not changing, recognizing that I'm not leaving now, I'm not doing anything to escape the situation.

And that the way that I respond right now is just, is the way it responds. So everything is put in its place. Nothing is moving, nothing is changing. That's the concept. Now. The therapy is packaged in a way that is it's to con, it's to build up that belief system, emotional belief system, let's call it, in a consistent way.

And it takes quite a while because the brain, the way I see it, is there's been one conversation going in the mind for the most part, which is how the mind has been thinking until now regarding the misophonia. if we're introducing a new way of thinking about it. It's like you have, you're, you have a ver like the dominant voice is the old way.

And if a new voice is being introduced, it's still like a small little voice being overshadowed by you imagine you have a thousand people at a protest and then there's one person on the other side protesting something else. It's hard to hear what the, that one person is saying.

It's overwhelmed by. And so the idea is to bring one is to reinforce the idea time and time again to bring, put ourselves into situations in a very, slow but consistent buildup to challenge ourselves to start thinking in this type of way and acting in this way.

And that's something that's in our realm of choices. We have that ability. That's something that, that's accessible to us. It's not easy. And and that's why I usually. Start this using more imaginable techniques. I say, Lee, let's just try to imagine the trigger and see what's happening in your mind and body.

And we'll take it from there. And then we start to introduce the different way we're we create a new dialogue in the mind. This I can't take this. I see you can't take this and yet this is not gonna go away. Like it has to go away. I understand a lot of validation. We validate ourselves.

We, we validate the heck out of ourselves because we're in so much pain. We need that feeling of it's okay to feel overwhelmed, but we always need to end the with an and it's not going to change. Now that sounds painful and yet, like we were saying before, it's actually it's that it's like a bitter medicine in a sense.

We, we need that. We need to be told that. the one one. I use a little bit of an extreme example to bring out this point, cuz sometimes we can understand like a more nuanced point when it's in, in the extreme aspect. Imagine someone loses let's say, let's call someone John loses hi his dog Parker and John is devastated.

Parker was everything to John and John has a friend named Jack and Jack comes over to John and says, you know what, John, I see you really sad. I don't like seeing you sad. Parker's gonna come back one day, Parker. It'll be okay. And so we would tell that friend, that's not helpful. That's probably not going to happen.

And we, it's okay for John to mourn, to feel sad over. over Parker, because that's just, that's what is it's there's a finality to it. And that creates a pathway for healing from moving on. In a certain sense, we're putting ourselves in a path to begin thinking in that way.

This is the way it, the mind is gonna be put. No, it can't be. It can't be. We're going back and being like, I know. It's so painful and this is just the way this, the they're, even though it looks like they might change, they're probably not going to change. And regarding like the, I use a metaphor sometimes to bring out the idea of how people tend to change.

Because sometimes we see oh I sometimes ex let's say my sister triggers me. So my sister Maggie is one time I saw that she could change and so she could change. And so we could, I, I always liken people to a guitar. You take a guitar string and you pluck it, it makes a little sound and might move a little bit, but then it goes back to where it was before.

And people are like that. I know this might sound like a little bit a pessimistic view, a cynical of humanity, but for the most part, we people for, if we think about people in their lifespan, like for the grand majority of people's personality and tendencies, they, for the most part kind of stick to overall where they are.

And then when they do, the change is slow and gradual. In fact, when we see someone change very quickly, very fast, usually we start to like wonder like, how long is this going to last and, or is this healthy? So that's usually the types of questions that we ask when someone has a radical change. So it's We wanna always go, we have to be creative about this in terms of how to speak back to our mind regarding all these counterpoints that it says, it's gonna say a lot of counterpoints. And we're gonna constantly bring back us back to this is just the way it is. And we also, we need to, and for when we start doing the therapy and beginning to do live exercises, I call them, it involves a commitment for a certain amount of time.

That right now I am choosing to act in a way as if leaving is not an option at all. So I'm starting to get a taste of what it's like to be stuck. And I, and they're not changing, I'm not leaving. The way I respond is the way I respond. That's just, I'm starting to learn how to, what's called accept the situation for what it is.

That's step one. So I'm and that involves a lot of building up ano. Another metaphor that I use is, imagine you were tasked to fill up a tub of water. , a big tub you live in, you're in the basement, the tub's on the third floor, and you were given a mouthwash cup, right? It's two ounces and says, go, I want you to fill up the tub on the third floor with the sink in the basement.

So fill up water, run upstairs, put it in the tub, go back downstairs again, right after a hundred times, if I look in the tub, it's gonna be pretty disappointing, right? It's like I'm panting and yet still it's like it, and it's like that, like we're it's a very slow process with a little, but then once we put ourselves on this track, after sometime we start to begin to think differently, we begin to respond differently.

The conversation becomes different in the mind. So that's step one. Step two is now that I'm beginning to let go of what's going on out there, I don't see any hope for change there. And it's also important to realize that it's like we wanna learn to sit with those, to mourn that loss. That's part of it, is yes, this does feel sad.

It feels like a sense of helplessness. Like I, I thought that it, that something could change and that's a loss, and that's okay. We could process that together. That is painful. And then we do what's called the U-turn, which I spell w y o u-turn. We turn to U and we focus on the individual.

Because now that we've let go of out there, we're gonna focus inward. And that step I specifically created a step for that because it's a conscious effort. It requires like a decision okay, I am letting go of out there and I'm moving inward into my body. Have you ever had that experience where something was a problem and all of a sudden you're like, oh wait I'm contributing to the, to what's going on here?

Like that aha moment of it. I'm involved. I'm also part of this. I was looking out there now it's also inward, that type of experience. It requires a conscious effort. And so that's, it's like a decision. And then the last step is called the experiential acceptance, which is learning how to experience difficult emotions.

And only once we've gone through the first step could we then show up to the learning to deal with painful emotions. And that's something that is very hard. And yet we're very capable. I actually find that the first step is in a sense, more difficult than the second step. It is hard for people to deal with painful emotions.

It's harder for people to let go of the idea that there's no solution for the change out, out the outside of me. Once a person realizes nothing to do, it's it, there is a certain ease of learning how to deal with painful emotions if taught how. Once a person's taught how to deal with painful emotions without resisting the emotions, and there are a lot of nuanced ways that we do try to resist our own emotions.

We can learn how to let go and let go of control of our own emotions and to experience the emotions as they are. We become free people because I'm not fighting anything. I'm not fighting out there, and I'm not fighting my own internal world. Does that mean that I'm not bothered by sounds? Does that mean that I'm, that sounds don't bother me?

Not necessarily. However, I'm not spending time thinking about it, and I'm not spending time getting stuck on it. So my mind is I'm not worrying about it. And when I do feel uncomfortable, I'm able to move on from it and forget about it. And so that that's how that. How that process works. , so that's the therapy in, in a, I wouldn't say nutshell.

I gave

[00:44:25] Adeel: a little Yeah, no, that was good. Thanks. Yeah, no, thanks for going through that and the rationale and the background behind it. And that, that first step the, that you mentioned dialogue at a couple points. Is there like a a script or playbook or decision tree that, that you give the person to think through?

Or do you give 'em some general is there a character that they, I'm just curious, what they think about when they're

[00:44:42] Ezra: Yeah. Go through that. So there are some like useful tools that I try to use to help with that. For example, I'll say let's try to imagine the person, the whoever the trigger or is, let's try to imagine that person in a year from now doing the same exact thing.

And then I'll say, okay, think about that for a minute now let's think about that. They'll be doing the same exact thing in two years. And then I just like slowly try to like, build it up to, just to help impress, to make it a little less abstract. That's just one type of tool that we could use.

And that kind of helps with the dialogue in the mind. There is no, there's no one structured way because people have different way, like what their mind is telling them is different, but for the most part, I it's like a teaching them how to respond. So for example, in a therapy session, I would have the client share what their mind is saying, what is going through your mind?

And let's respond to that. And then, so it it's more like choosing teaching how to respond to each like line that the brain re says in the moment when we're doing an exercise engaging in the. And the trigger and responding to the thought in a way that's consistent with the philosophy that we're trying to, IM I impress on the mind.

And and then I have them practice that every day in between sessions. So it's becoming it it's just like that example of running up and down with the cup. It's just it's a it's just a lot of repetition. A lot of repetition and also upping the difficulty as it as we go through it.

[00:46:22] Adeel: Gotcha. Yeah. And then, but, and going back, that's interesting. The asking them if in a year, if they're gonna still hear the sound or two years bec going back to my original one of, one of my points earlier, I think and you said that, it's, we have often two conflicting thoughts in our hands at the same time.

A lot of us know that. Some of these sounds are not gonna go away. We know that. Going back to that another analogy that passed the past as a predictor of the future, we know that logically if somebody's looking, what do you say to people who are thinking that and say I already know that, so how are you gonna help me?

Kind of thing.

[00:46:52] Ezra: So it's like in the moment when they're saying like, ah, it could be just like, I can't handle this. So it could be like logically the in between, living in between. It's the, it's not necessarily only knowing that that whether or not we know if the person's gonna change or not.

Like we might know that the person's not gonna change. But we also haven't made like the next step, which is and. Th this is not something that I could get away from. In other words, there's nothing that it's almost like the brain could hold the idea that they're not gonna change.

And also I somehow would be able to get away from this and that. But that idea that I could somehow get away from this is not a logical idea. It's coming from, I just don't wanna be hurt. So it's becomes a default, like the default doctrine in the mind is I can't take this.

And we, and the, when we examine like, why okay, you can't take this, and, but what could we do about it? And that doesn't seem like there's what, like we could escape from it temporarily. That's true. And that reinforces the sense that this is something that we could escape.

So it's not necessarily like the belief. The a sort of a clear this is the story I have and this is how I think things will change. It's it's more on a, on an emotional sense of I need to get, I need to get away from this. And we're saying like, but how are we going to get away from this?

Then we think about there is no I guess the only way is to just be, find a comfort zone, which where I just wanna feel normal and not triggered, which is, which makes total sense. And when we take away that as well, then that also takes away from the sense of there's no, there's nothing could change the situation.

So then we're forced in a, we're forcing ourselves if we're if we're willing to then deal with the feelings themselves. Because I've I've developed a sense that nothing, there's nothing out there that I could I can't get away from this at all. So you're right.

I think to your point it's not a , it's usually not like a clear, sometimes it is, sometimes it's just there is what we would call like, just like a straightforward belief system that this is something that could be changed. I actually find that to be pretty com pretty often that individuals there's certain expectations that it's, especially when someone is, does again I don't think there's objective measures, but when someone does deviate somewhat from the norm of how someone, how people sounds or whatever, that's, I don't wanna use examples here, but there, there's the, and that's the hard part. That's how do we learn to live with difficult people, right?

. way to think about on one hand, we do this on our relationships also. Someone is always late. Why can't you come on time? Like it's Just try to think about the, the hour plan accordingly, and then, and yet the person comes late again.

So it, it looks like the person, like there's this characteristic in the person. It looks like it's a low hanging fruit that we could get it to change, and yet it's still cut. Keeps them alluding us. And so it is realizing that's not really a low hanging fruit. It's actually built in a very deep way to how the person, it's a manifestation of how the person thinks it feels.

[00:49:56] Adeel: And maybe related to having conflicting thoughts at the same time, but also your, I think part of your the dialogue in your therapy made me think of like parts work in ifs internal family systems. And I'm wondering if any of that informs this is that voice that's the illogical voice that's afraid of something, is that maybe.

a part that comes from the past? Or is it a part of you that's not necessarily broken, but is trying to warn you something that is not a danger anymore? Or is that not in the scope of what you're trying to do

[00:50:27] Ezra: here? No. Adeel you're, I've been reading some stuff.

You're educated. I'm loving these questions. This is great. Answer, the short answer is yes. I think IFS is a wonderful contribution to the world of psychology, the world of mental health. The idea of thinking about a person having different parts to them and realizing that they're all kind of part of one's makeup and to learn how to live with all parts of us is just to that's in a short, what I.

Ifs is a very broad area, but for the most part, like people have painful parts. We have good parts and we have parts that we don't like so much. And so this actually goes back to your question before about do we deal with that, the pain point? And the answer is yes. When we are doing the final step, the experiential acceptance or the second step of the therapy, what we often find is there, that's where we're going.

Whatever feelings are there, they're gonna, I present themselves. They're they're there. A big part of that step is teaching people to learn like these. Number one, these reactions and the different types of feelings that are showing up inside. It's not just, it's not just frustration, it's not just anger.

It's often, there's often anxiety and there's often pain beneath. And that, that's learning how to realize that, that's part of you and that's okay. And so when we learn to make peace with all parts of us whatever parts are being activated, that's what we're learning to learn to live with.

And so in that regard, it's very much I would say ifs that def I definitely draw. I don't have a strong background in ifs I, it, it's like a lot of the therapies when it gets deeper, when you get deeper into the therapies, you find there's a lot of overlap between the two.

And I find IFS does a great job languaging the parts aspect. Like realizing like this is just a part of you and it's okay to learn how to experience it we'll only and specifically in the context of misophonia. We're only gonna really learn to be okay with that part of us if we re realize that that there's not.

There's no solution for it outside of us. And which includes any form of avoidance trying to move away from the sound. Cuz then we're gonna, we're we, it it impresses upon the mind that I could get away from this part of me.

[00:52:38] Adeel: Gotcha. And then when let's say you someone done gone through this therapy and treatment with you like a year or two later.

Are there like, ongoing work that they do? Is there different ways that they, when they're sitting in a, at dinner or whatever is there like a a way to think about sounds that's more permanent? Or is this, is your therap, do you find after, when somebody's completed your work with you that they can go out in the world and they're not noticing sounds and they don't have to think about it anymore?

[00:53:04] Ezra: That's a great question. What I find is that after. I would say a typical course of this therapy is between six, six months and a year. And after be, by the time we're getting like, towards the end of the therapy, one of the positive indicators that I find is that the, that way of thinking is much more instinctual.

So it's oh, I don't like that. But there's nothing like moving through those steps in a more of a rapid, instinctual way. And being able to again, it's like how do we, we working with an unpleasant coworker who has an like a little bit of a intense, unpleasant, let's just say like a personality that's hard to get along with.

We can make peace with that. It's still not necessarily pleasant being around that individual, but we're not we just realize this is just what it is. The same. The same is true here. It's okay, I don't like this, and this is just the situation. And it's not getting stuck on it.

It's just and so the mind is not thinking about it. The mind is. And so sometimes what I do find, and this is what I when I finish working, when I conclude working with someone they know that when someone's very stressed out, they're gonna be more triggered. That's just and it's not just like we are more, we get more easily frustrated from things that wouldn't bother us on a regular day, when we're more stressed out from something, we're probably going to be more sensitive to the sound.

And therefore it might require more of an ef conscious effort to work through the sound. So that's when, usually, that's when the work would be a little bit more conscious. And it will require more of like working through the steps. , as but, and, but that's not, that's just for life.

It, it's once the brain learns about something, it's hard. The brain doesn't unlearn it. So the things that stress us out, usually they, we could learn how to deal with them, but when we're very stressed out, they're still gonna bother us that's, and that's true for almost all forms of anxiety.

[00:54:58] Adeel: Gotcha. Okay, cool. I know we're running over hour here. This has been a really interesting discussion. Yeah. And just maybe just a couple other questions that we can, I would love to get your kind of final thoughts and stuff, but for someone who are there certain types of obviously Miss Funny is pretty wide in terms of like types of triggers or types of people.

Anything that, I guess if somebody's thinking about approaching is there a type of misophonia or type of person that, that responds better to, to your to your

[00:55:22] Ezra: therapies? . So I would say I find that I think that there is first of all, what if someone's going through a lot of different things in their life?

Like they're already their plate is like really full, is like brimming with just stress from different parts of their life. I don't think that's the best time because we are putting ourselves out of the comfort zone. That's what's happening. And so it's important for someone to be in a place where they feel settled.

They feel like they have, for the most part their life in order. And this is just, this is something that's important for them. It's also I would say all a person needs to succeed, and this is, this has been the recipe for success, is that they wanna go into the therapy. In other words, like if someone is dragging into therapy.

They are not going to succeed because they're inherent. You can't force willingness. And a lot of this is willingness to experience, to change how we think and feel about things. And that's hard. So if someone's being you could physically drag someone to therapy room, but you can't physically force someone to be willing in their mind at how to deal with their own their own world.

And so I would say that, that's all it requires is overall, I would say being in a reasonably stable place in terms of just like life and for each person that's different. So you have to know yourself and just a willingness, the, a commitment to being like, look I'm, I wanna I wanna take this.

I want, and I'll go with the, and I would say another piece it's a good, now that you brought it up. It's that example of like with the bathtub and filling up the bathtub. If we're looking to fill up the bathtub, if we wanna see that bathtub filled already, so to speak, we're gonna be, it's just gonna be a very disappointing process.

It's it's a commitment to the process itself, to the just doing it time and time again. It's like training, it's like we're , we're not gonna see the, that six pack right away . It's just and if every time we look we're gonna be disappointed cuz it, it takes time.

So it's like a it's a commitment to the process itself. Gotcha.

[00:57:30] Adeel: Okay. Yeah. Interesting. Yeah. Ezra. Yeah, it's been great to have any kind of final I'll have obviously links and everything to your website and all that stuff. Anything you want to, anything else you want to share?

Any new research that you've got coming out or findings or yeah, closing thoughts for our listeners.

[00:57:46] Ezra: I think that we're living in my, I just wanna sh this is my sense from what I see Yeah. In my kind of like little world that and it's been, it's really humbling experience to be an ally to the world of individual suffering from misophonia or as you call Misa phones.

[00:58:03] Adeel: Yeah. Just, no, just no, I think accepted word,

[00:58:05] Ezra: but I say mis. Yeah. Yeah. And it, it's like I five years ago you would've mentioned the word misophonia. I would say Misa who here we are. And it's it's an absolute it's really humbling.

And I think that I just wanna share with all the listeners that I really believe that I know it's hard. People have been hurt by having hope and for getting better. Because there's just been so many disappointments in this. And we are at a very, in my opinion, there's, so we're seeing there's an explosion of interest in the world.

It could always be more. And I have seen in my own eyes that there is hope and people could move on from misophonia. And I believe we're at the at the beginning of of of the heal the healing era. For misophonia and I think, I believe it's only gonna get better from here.

So I just went into that note. Thank

[00:58:57] Adeel: you Dr. Cowan again. That was a long one, but it was great to really go deep into his thinking behind misophonia and his therapies. If you liked this episode, don't forget to leave a quick review or just hit the five stars wherever you listen to this podcast. You can hit me up by email@hellomissonpodcast.com or go to the website misson podcast.com.

It's even easier to just send a message on Instagram. At Miss Podcast, follow there or Facebook can Miss Podcast Twitter. Where Miss Show Support the show by visiting the patreon patreon.com/miss podcast, the music by Moby. And until next week, wish a new peace and.