Tom Dozier - Hope and Treatment Insights from a Misophonia Expert

Adeel [0:01]: Welcome to the Misophonia podcast. This is episode 22 of season 3, the season finale. My name is Adeel Ahmad, and I have Misophonia. This week, to end season 3, I'm happy to bring you a name that's very well known in the Misophonia world, and that is Tom Dozier. He's come up on a number of podcasts previously. And as he's someone that guests have gone to seeking help for their miso, he's a behaviorist and founder of the Misophonia Institute. You can Google his name or I'll have some links in the show notes. He's got all kinds of videos and articles online, but this is one of the only times you'll find a one-on-one conversation that covers his background, why he got interested in misophonia in the first place, his thoughts and approach to dealing with misophonia, and insight into his methods. Now, it's important for me to state that, as always, I make no recommendations or judgment on anything. There are certainly some folks who are critical of anyone who's even insinuating a permanent treatment for misophonia, but I'm more than happy that Tom offered to come on, because whether you like it or not, he's a major figure in the misophonia community, and I was fascinated to get a chance to dive into his story. As I've said, this is the last episode of Season 3, but fear not. There is a very full and exciting new season starting next week. I have a full schedule of interviews being recorded this month with new stories, maybe some new tips, insights, and advice from fellow sufferers. There'll be a few surprise announcements, too, coming over the course of this season. If you don't have a chance to find a time slot, actually, for interviews, the next batch of interviews will be announced towards the end of the summer. In the meantime, you can always reach out to me by sending a message through the website, misophoniapodcast.com, or emailing directly at hello at misophoniapodcast.com. Or hit me up on Instagram or Facebook at Misophonia Podcast. All right, now here's my conversation with Tom Dozier. Tom, great to have you on the podcast. Thanks for reaching out.

Dozier [2:08]: Adeel, it's great to be here.

Adeel [2:09]: Yeah, so, you know, I'm sure a lot of people in listening probably have heard of you. I mean, you're a big part of the Misophonia conversation, have been for years. But for those who maybe don't, you kind of want to say, you know, yeah, who is Tom and why are you so involved in the community? Because you don't actually have Misophonia, right?

Dozier [2:31]: I do not have Misophonia. So what happened is I spent my first career as an engineer and engineering manager. and went into a second career as a behavioral parenting coach, a behaviorist, a behavior specialist, a behavior analyst, it's called. And about eight years ago, I had a mom with a 12-year-old who had this hearing disorder that was gonna ruin her life. She had this condition called misophonia that we didn't know anything about. There was no cure for it. And this hearing disorder in this girl, she had auditory, visual, and olfactory odor triggers. And I go, that cannot be a hearing neurological defect, right? That has to be a reflex behavior. And so I said, well, let me look at this. And by the way, I recognized it in my daughter, who was then 35, that as a As a teenager, she had hated the sound of my chewing and didn't want to sit near her dad because he chewed too loud and his jaw popped. And I had the time to basically try to apply the science of human behavior to this unknown disorder. And at that time, I went on, I'm on Google Scholar, and there were three articles on Google Scholar, none of which were research studies. So I thought, hey, let's see what we can find out. And I really went in with a blank slate. And so for the last eight years, I've been working on this, trying to understand what it is, how we can make people's lives better with it. And so that's just kind of sucked me in.

Adeel [4:22]: Gotcha. Yes. You're a fellow engineer, but you had retired, it sounds like.

Dozier [4:28]: Right. I had retired.

Adeel [4:30]: Yeah. And decided that this is a great thing to jump into. It was kind of affecting your daughter. And so you didn't go into behavioral science because of me. It's when this kind of like was one of the first things you noticed and you got kind of sucked in that way.

Dozier [4:46]: Well, I made this change about 18 years ago. So I'd been doing the behavior science for 10 years as a parenting coach. It's really a very practical application in families. It's almost like a behavioral engineering from a parenting coach standpoint. So it really fit me well. And I just saw this as something that was a challenge. I love challenges. I'm a helper guy, a fix-it guy. And I thought, oh my goodness, we don't understand this. Surely I can go find a way to fix this problem. Naively, he says. And so I just jumped in and started reading what I could about it, reading all of the information on respondent behavior and classical conditioning and conditioned emotional responses and just started talking with people with misophonia and just you know, went to the first Misophonia Conference ever, which was by the Tinnitus Practitioners Association and went to the first Misophonia Association Conference ever up in Portland, Oregon, and just started, you know, getting involved and listening to people talk, you know, meeting with people. One woman I met with for six months, once a week, just because I could learn and maybe we could figure out a way of helping her. So I just, kind of went in and started looking at this, what I thought at the time was a learned or an acquired emotional response. And the reason to believe it's an acquired emotional response is that most of the people with misophonia have an onset at some point in time for specific sounds. And so that usually, if it was just a biological or a neurological defect, you wouldn't find the same relationship with each person's story. And so I started figuring out what can we do? How can we apply the research in learning, the neurological reflex learning to misophonia? And I just went in.

Adeel [7:05]: Yeah. So you're like, okay, there's not much research. And so you, so you, one of your hypotheses early on was that because there were so many similarities and, you know, we, we know that there's, there's, it's almost kind of a, many ways of carbon copy everyone's condition that there's something maybe kind of a shared experience, like a shared environmental experience that was, that's kind of conditioning us in, in, in similar ways.

Dozier [7:28]: Yeah. But ideal, everybody's different. That's the thing is that it feels like everybody's the same because we all react to chewing sounds. Well, only, only 95% of the people react to chewing sounds. So that means there's 5% that don't. And people react to, one person reacts to the chewing sounds only of their little brother. And not to anyone else's chewing sound. And another person at response, you know, is triggered by the chewing sounds of their father. So all of these sounds have to be sounds that a person has experience with.

Adeel [8:09]: Gotcha. Okay. Yeah. So you are right. So you are, your hypothesis was, sorry, I kind of misunderstood. So it is that there are variations that we're being conditioned to so that we all have slightly different, similar looking, but slightly different responses.

Dozier [8:27]: Right. Which indicate that it takes individual personal experience with those sounds to develop misophonia.

Adeel [8:34]: Gotcha. Okay. And so when you had that hypothesis, what were some of your early methods of dealing with this?

Dozier [8:47]: So I looked into counter conditioning, which is a way of changing a reflex by having a very different situation. And there was a research, this Ponovic guy, I did a series of articles on PTSD treatment where you had very positive, relaxing, highly endorphin, you know, feel good discussions. And then there's a little bit of insert of remembering the PTSD experience and then going back to these very positive experiences. And so I thought, okay, that's the only thing I can find on counter conditioning. Let's see. And I had a couple of people who wanted to give it a try. Let's see if we can do this with misophonia.

Adeel [9:39]: Like a good engineer.

Dozier [9:41]: I had three people, one of whom dropped out, one of whom just almost very quickly stopped being triggered, and another who over a quarter... So the number of weeks made drastic improvement. I think I was lucky in those cases. Because they were easy to respond, people everyone's not that easy to does not respond that well. But I saw that in fact it could change and that that got me engaged even more. And it introduced me to. The concept that we're not dealing with. Just an emotional response. we're also dealing with a physical reflex response. And that's kind of foreign to most people with misophonia because what you experience so vividly are the emotions of misophonia and then the subsequent physiological distress and mental torment that follows on. But what I found in the second person I worked with that we were having progress, she described her misophonia response to a trigger as having a shovel run through her chest and out her back. And she was having this really strong physical sensation in her chest, which we believe now was a gasp for breath. with her windpipe closed off. And so in the first article that I published on misophonia, counter conditioning treatment for misophonia, one of the peer reviewers said, hey, you're bringing up this physical thing in your article and it's not in the abstract. Tom, this should be in the abstract. This is unique. From that point, I've done a lot of studying. on the conditioned physical response of misophonia. And so that was a really startling effect that the emotions were separate from this physical response.

Adeel [12:11]: Oh, so that the fight or flight kind of, I need to get out of here, I'm panicking, was not there or it was separate from the... It was not there at all.

Dozier [12:19]: And in fact, if you look at any of my presentations where I draw, this is misophonia, there's the trigger. There is a physical reflex in your body somewhere that in response to an auditory trigger, it happens about 200 milliseconds after the onset of the auditory trigger. And then there is an emotional reflex that's being driven out of your anterior insula. This is according to the Kumar study, uh, anterior insular cortex and the ventromedial prefrontal cortex, which are both cerebral structures. These are not in your emotions, uh, in your limbic system. And then, then that fires down into the amygdala and the hippocampus, and then you have the extreme emotional response. So, um, after seeing this one person with this physical flinch, and by the way, after the, after the extreme emotional response, You then have physiological distress. Your heart rate goes up. You have tight muscles. You have the cortisol and other hormones are raging through your body, and you're having this fight-or-flight response. You're mimicking. You're doing things, putting your hands over your ears. All of that response change. occurs, but it's triggered initially by this physical reflex. So one of my other early patients was a 10 year old girl who was only triggered by her six year old brother's chewing. And by the way, they had all these fights at the dinner table where he had his allergies. So he always chewed with his mouth open. and they were screaming at each other saying, stop yelling, stop staring at me. No, you stop staring at me. And she was standing up and sticking her arms out and pointing at the boy and yelling. And so her mom brought her to my office and we had her laid out on a massage table to try counter conditioning where we were going to have mom, you know, give her a back rub and let her relax. And she's going to hear a little bits of her brother chewing. And I asked her before we started, I said, do you have a physical reaction to these triggers? She says, no, I don't. I just feel rage. And she was very insistent. So I had my little sound editor here. And I could just get a little kind of a tiny, tiny trigger where she would barely start the reaction. And we could see her shoulders jumping. Her arms and shoulders would jump every time she heard this trigger. And after we'd finished, I said, did you feel anything physically? She says, yes, I felt it in my arms and in my legs. Mom and I hadn't seen the legs, but we could very visibly see the shoulder and arm movement. And I said, oh, and what emotions did you have? She says, oh, none.

Adeel [15:32]: Well, this is while mom was relaxing her or back rubbing. And so it appeared that the physical reaction was there, which you surmise is kind of that initial, probably kind of hidden to most of us, but it's kind of like in the chain of events, kind of hidden into most of us. And you were trying to discover that. And then she was saying when she was relaxed, there was no kind of that emotional,

Dozier [16:02]: reaction was gone and right and that trigger was only like a two percent of a real trigger so it was a it was a very very small good if she had had a big trigger laying there in front of us she would have had the emotional reaction but what it was was just a little blip to her muscles

Adeel [16:22]: Gotcha. Interesting. Okay, yeah, so this is kind of, I guess, what your, I don't know if I get to your apps at some point, but this is kind of part of, I think, what the trigger tamer does is it takes a sound and it kind of incrementally makes the, like, reveals the trigger to you at a longer duration, and so it starts off.

Dozier [16:43]: No, no, at a shorter duration. Basically, it takes a trigger, which might be two seconds of the sound. Right. And it drops it down to maybe whatever you set it to at point, say, .300 milliseconds, .3 seconds. Right. And at 2% volume.

Adeel [17:01]: Oh, I see. Okay. So it, oh, okay. Right. It drops it down and then it lowers the volume. Okay. And then the idea is to kind of.

Dozier [17:09]: And you have all control on that.

Adeel [17:10]: Oh, gotcha, gotcha. And the idea is to kind of find where the point at which you start to get triggered, like find that physical response.

Dozier [17:23]: Right. There's actually an app called the Misophonia Reflex Finder, which is just focused on playing a recorded trigger, very small, very soft, and very short, and to help you find that physical response. The trigger tamer is really set up so that you can be listening to music or playing video games or jogging or walking in the woods. And feeling something that's really positive and you get just this little bitty tiny blip of a trigger and it will extinguish. It will decay and go away because you're having a very positive, overwhelming experience. overwhelmingly positive experience that's counter conditioning gotcha it's kind of like a reverse pavlovian so you're you're trying to introduce little blips during periods of you know just feeling good like uh right i see i see yep and what people don't understand and it's very poorly researched um those of you of us who've had a a college psychology introductory psychology class You learn about Pavlovian conditioning where they would ring a bell and give the dog the meats and the dog would salivate and repeat that process. Ring a bell, no meat, the dog salivate. And they said, well, the bell becomes associated with the meat so that the bell acts like the meat. Well, brain imaging doesn't support that. What brain imaging supports is that your brain is trying to see patterns and patterns. and predict and do those patterns automatically for you so the brain saw the bell neurons firing and notice the salivation gland neurons activating and it saw that pattern and so the bell would then directly elicit the salivation gland action so this is it's not a pairing it's not a pairing with the with the meat that causes, the bell and the meat pairing is not what causes the conditioning to occur. And this was a real mystery to me because if you needed to have this neutral stimulus and the unconditioned stimulus, that's the meat, and the unconditioned response, that's the salivation, where is this in misophonia? You don't find any equivalent of the meat in Pavlovian conditioning from misophonia. Well, what other research and the brain imaging shows is that any time the body does an action after a stimulus, the lizard brain, your autonomic nervous system, your reptilian brain is watching and it sees that pattern. And when it sees that pattern, then it causes the reflex. So, for example, this has plagued surgeons for decades. Before we had cell phones, before we had smartphones, we had cell phones. Before we had cell phones, we had pagers. And so a surgeon would have a pager, and when the hospital had to get a hold of them in an emergency, the pager would go off. Well, Gene Lipoff was a trauma center surgeon. Now, a trauma center is going to have the most ugly cases being brought into it. And every time his pager went off, he would think, oh no, what am I gonna have to deal with this time? Dreading going to work. Well, with that dread emotion, his shoulders tense slightly. And after about a month, the pager goes off and his shoulders just pop up. And then he thinks, oh no, what am I gonna have to deal with? I said, Gene, how long did that shoulder flinch persist? He says, until I got a different, job and got rid of my pager every time the pager went off my shoulders popped up that's a conditioned aversive reflux and that's misophonia and his his experience was not unique i was talking with a a woman about this and she says like my husband i said what do you mean she goes well he's a surgeon but nowadays instead of having a pager you have a pager app and with a pager app you can set your own alert tone So every week he changes his alert tone to prevent the physical reflex from developing. So this, what happens is you hear a sound, you have some thought that's going to upset mom, that's a violation of a rule, that's not fair. I'm worried about that. And with that thought is a muscle tightening. And so it's a sound thought muscle tighten, sound thought muscle tightens. The lizard brain sees that predictable response, sound, and it tasers you, boop, and it zaps you. My wife has pet chickens. And a couple of years ago, she came into my office and said, Tom, you've got to do something about the chickens. They're driving me crazy. I said, what are they doing? She goes, they're clucking. They're supposed to cluck their chickens. Right, right. She goes, no, no, no, no. Buffy starts squawking and then Susie starts squawking. They're both squawking and then Roxy starts squawking too. And it's so loud, I can't stand it. Well, she also is a very nice lady who doesn't want to offend the neighbors. And she doesn't want the neighbors to complain about her chickens. so when they started squawking she thought that's so loud the neighbors are going to hear it and she held her breath they squawk again she holds her breath and goes oh no the neighbors may be upset and so with that with the lizard brain saw i hear that squawking and i see the muscles in the the breathing muscles in the chest freeze they lock up in both directions And so she had to breathe slowly in and out while the chickens were squawking and the reflex went away and her mesothonia went away to that trigger.

Adeel [24:01]: Yeah, I mean, these are the kinds of little worries of like what other people are going to think. These are the kinds of like micro tensions and behaviors that one experiences growing up, you know, around the ages, especially around the ages where it seems like a lot of us get our onset. Yes. And on the reverse side, it's like we talk about this almost every episode. It's like if you can reduce the amount of stress in your life or your situation, suddenly I know I can handle it a lot better. And I'm curious, actually, another thing that comes up is, speaking of Pavlovian, I was curious your thoughts actually of, we've talked about sounds, but visual triggers come up a lot.

Dozier [24:45]: Absolutely.

Adeel [24:45]: I'm wondering how do you connect the dots there with visual triggers? Is this kind of another kind of aspect of our reptilian brain connecting something?

Dozier [24:57]: It's exactly the same mechanism. This is the same mechanism that caused you to like your mother's voice when you were a baby. It's just classical conditioning. So with the way classical conditioning works, whatever your body is doing in the first two seconds or so after a stimulus, the brain sees, it sees it repeating, it does it automatically as a reflex. So if you think of something... like a visual trigger of somebody chewing you you see them chewing and you hear them and your and your muscles flinch and you have your mesophonic reaction right that repeats a few times and your brain goes i saw that jaw move i saw that muscle tighten i'll do it for you and and then you have then you have a a visual trigger now about one percent of the people in a very large study that I did had their initial trigger to be not to be auditory not visual and so they had somebody wiggling their their foot and they had a negative thought or an anxiety thought and they tensed up and that wiggling the foot was their first trigger or one lady had a friend who just she kept doing this and so it was kind of annoying to her that she would take her thumb and pick at the cuticle on her little finger right and that thumb picking at the cuticle became a visual trigger so any any stimulus can become a trigger stimulus if there is a predictable thought and physical action following it. Gotcha.

Adeel [27:05]: Yeah, yeah.

Dozier [27:06]: And these actions are so unconscious that we do that we would never think that, oh, when I see someone doing that, I tense my, I curl my toes or something like that. But we do things like that.

Adeel [27:21]: Yeah. I mean, visual triggers is something that, uh, almost universally, it just, it, it seems to develop later. Like people always say that, you know, their number of triggers are multiplying and then visual triggers come on and they get kind of very, very, uh, discouraged, but, um, well, that's, that's a whole other story, right? You know, we kind of talk about how to try to reduce stress in your life. Um, uh, try to have more control of your environment, but, but yeah, visual triggers is something that kind of tend to, it seems to develop later and, and kind of make sense that it would be, um, That, you know, your brain, I always say in the podcast, it's like your brain is just almost kind of warning you that your previous trigger, so your previous condition, Miss Phonia, is about to get triggered.

Dozier [28:04]: And so it's... Yeah, and that can very well happen. But with, let's say with a visual trigger, it's what your body is doing after that visual stimulus. So if I'm triggered, if I clench my fist when I hear somebody chew, And I see their jaw and hearing them chew, I'm clenching my fist so that jaw movement goes with the fist clench, jaw movement, fist clench. Then the lizard brain sees, notices jaw movement, fist clench, and then it's no longer a prediction. It may have started as a prediction, but it's no longer a prediction. And now it's jaw move, immediately the brain goes boop and hits those muscles. in the study we did it was about 350 milliseconds about a third of a second between so it's a little bit slower than for the auditory response to to flinch those muscles but if the person is doing something totally different like twirling their hair then i think there's something about people with mesophonia that have a lot of anxiety and worry about triggers and you know, kind of responsive to the, over responsive to the world around you. And so that person's twirling their hair. You may then, if you clench your fist for eating sounds, you may, you know, tighten your thighs when you see somebody twirling their hair. And so now for eating triggers, your fist clench, for hair twirling, your thighs clench. And in a study we did, 42% had different reflexes for different types of triggers.

Adeel [29:57]: So you had them all come into your office, so you had to observe them yourself, probably, right? Or was it maybe they're using one of the apps to kind of discover?

Dozier [30:07]: So we did two things.

Adeel [30:10]: You mean for the study or for... Actually, the study, I'm just curious about this particular study where you said 42% had different responses. Reflexes, sorry. Yeah.

Dozier [30:23]: What we did, a response is correct also. What we did is we did it by video chat.

Adeel [30:29]: Ah, gotcha.

Dozier [30:30]: And so we had each person experience two auditory triggers and one visual trigger. And we did them there. We tried to make it so short, so soft that it didn't trigger them to start with. And then we would bring it up until they would just just barely start to notice something. And then we would have them tell us, what did you see? And what did you feel? Sorry, what did you feel? And what emotions did you have? And so we recorded that.

Adeel [31:06]: Gotcha. And, uh, oh, and yeah, let me, um, you know, I want to ask you, since you mentioned something about, uh, you know, misophones being more aware of their surroundings, a couple of questions, uh, uh, people were curious about when I, you know, when I mentioned that you were coming on, one, one is, one was just like, somebody was asking, is related to OCD or are there, what do you, what do you think about these comorbidities around misophonia? Are people Is there a direct enough link or worth pursuing more research as to whether misphonic people are more likely to have anxiety or OCD or be quote-unquote highly sensitive people? Or are those kinds of coincidences and misphones just happen to be maybe a little bit more sensitive?

Dozier [31:53]: Well, I believe it's not a coincidence, but it's not a requirement. So... In one of the studies, and I'm just going to kind of go from memory of this, about half of the people had had depression and about, I'm thinking about a third to a half somewhere in that area had had anxiety. So I think there's something about being an anxious person who is more likely to respond to the world around them, which is going to set you up to get misophonia. So I don't respond to the neighbors the way my wife responds to the neighbors. She's a little more anxious in that regard and doesn't want to offend. So the chickens could have squawked all day long and I would have never reacted to them. So having that sensitive personality in tune with other people's feelings, having anxiety, being sensory sensitive, sensory processing disorder increases the likelihood of you developing misophonia so there are genetic characteristics and probably at least a third of the people that are going in for psychiatric help also have misophonia and don't know it.

Adeel [33:22]: Ah, a third going in for... So there is a comorbidity there. Yeah, so a third going in for any kind of like other psychiatric condition like anxiety or OCD, you think probably roughly have... Ms. Swinney might not know it.

Dozier [33:41]: Correct. There was an exit survey at a Singapore psychiatric clinic. So these were people who had finished the... their work on whatever they were there for. And almost everyone took the survey. Two thirds had mild misophonia or worse. Two thirds, 66%. There's another set of data point that I can't say because I'm seeing the data as a reviewer, but it looks like about a third of the people that were that were participating not for misophonia had misophonia. So there's a high percentage of prevalence of misophonia among the people who would be seeking help for other conditions. But there's a pretty high prevalence just in the general public. It's probably maybe 12% or so in the general public that have misophonia. So it's very common.

Adeel [34:54]: And just to be clear, because you mentioned genetics earlier, from what you've studied, misophonia seems to be a developed condition. Absolutely. Not something in the brain that kind of came out of the womb that way. It's developed based on association with something somebody experienced growing up.

Dozier [35:20]: Right, so the neurology that causes these conditioned reflexes is working probably before birth. But at birth, a baby hears their mother talking, they get picked up. They hear their mother talking, they get picked up. And mother talking, mother's soothing voice becomes a trigger to elicit a relaxation response. It is that same neurology that causes a trigger to develop. So misophonia doesn't develop because there is a chemical imbalance in your brain or neurons are misfiring or there is a defect in some structure in your cerebrum. It's simply normal neurology in an accidental situation.

Adeel [36:18]: Gotcha. And that develops in, you know, sometime in the first 10, 15 years of one's life.

Dozier [36:25]: Yeah, be careful there because misophonia, about 10% of the people who develop misophonia develop it as adults.

Adeel [36:35]: Right. So, yeah, I was going to lead to there. There have been a couple of people who come on. One gentleman developed it. And not a lot of people developed it as adults, but one gentleman developed it. Yeah, in his early 40s because after their second child, because there was kind of like your wife and the chickens, there was a lot of tiptoeing around the house because this child would kind of like, you know, be disturbed quite easily. So he, yeah, he says that's when it developed was just the last couple of years.

Dozier [37:11]: So any time there was a stimulus, a negative thought, with a with an appropriate muscle tightening which there always will be repeat that pattern and you become you develop misophonia what one man in his late 20s had an apartment bedroom with a tree growing you know up up and high but by his bedroom on the upper upper level and a pair of mockingbirds built their nest in the tree now doesn't that sound cute oh my goodness baby birds outside your window yes the only problem is that the male mockingbird chirps 24 hours a day wow and that was his first trigger gotcha yeah that's uh that would that would definitely get uh make most people notice so it and it by the way misophonia is to any parents who hear this, misophonia is also contagious. Because if you hear, if you don't have a particular trigger, but you hear a trigger for your child, you're gonna have a negative thought associated with that. Sound, oh no, oh no, oh no, Sarah's gonna be triggered. And it's very easy to develop a trigger to one of your child's trigger sounds, even if you don't have misophonia. The mom of the little girl with the shoulder flinch, she heard one of the kids clicking his fingernail against his teeth in the car, and she was concerned that her daughter would develop that as a trigger, and she tried to get the boy to stop. She couldn't get the boy to stop. A mom who didn't have misophonia developed that as her first trigger.

Adeel [39:03]: Gotcha. Okay. Okay. Again, negative, negative association with, with a sound. At any age, at any age is what you were noticing.

Dozier [39:15]: Yes. At any age. But, but think of that negative association as a sound, a tightening muscle, a sound, a tightening muscle. Gotcha. And that's what develops is sound is the tightening muscle that so that you are literally being tasered when you hear a trigger. You're being physically assaulted a deal. somewhere in your body.

Adeel [39:45]: Yeah. So then let's get, let's talk to maybe a little bit, we haven't talked about too much about treatment yet. We talked a little bit about the, um, a couple of the apps you've, you've worked on the fine trigger app and then trigger tamer. Um, are these, are these the tools that you use in, in most of your, your treatments or, uh, when you have people come in or on video, um, what do you, what do you find is kind of most, most effective?

Dozier [40:09]: So, we typically start by developing the skill of relaxing your muscles on demand. The vast majority of people with misophonia are tense a lot of the times, anxious, and developing the skill of relaxing your muscle on demand is done through progressive muscle relaxation training. Now, yoga, mindfulness, Traditional meditation and progressive muscle relaxation all help you reduce your overall state of tension and distress and get into a very deep relaxation. But only progressive muscle relaxation allows you to develop the skill, the neurological connections to relax your muscles on demand.

Adeel [41:05]: Sorry. Go ahead. I was going to ask. Some people will be listening thinking that it's just, oh, I just need to put on some relaxing music and just relax overall. But are you trying to localize it to specific muscles that you're noticing are getting triggered or responding to the misophonia? Or is it just kind of an overall relaxation that's kind of what you're doing?

Dozier [41:33]: It depends. It depends on the person. If the person has some level of anxiety and distress in general, then we really want to do it overall. And if the person is a little bit older, capable of doing the muscle relaxation training, then we do it overall. If they are at a level that you're not going to get them to do the full muscle relaxation training, we work on specific muscles. But generally what I ask people to do is use, this is another app, the Misophonia Muscle Relaxation Training app, which is available for iPhone and Android. And it provides the muscle relaxation training sessions. And what I ask people to do, and they take about 15 to 20 minutes. And so with new patients, I asked them to do three sessions a day, you know, morning, afternoon, evening, but to find a time. And then once they get into this, it takes about 15 minutes of session. So it's about 45 minutes, but still that's a significant commitment. But I've found that when people make that significant of a commitment to developing the skill of relaxing on demand, that they've developed that skill quickly enough so that they can start using that skill of relaxing when they're going into a room where there might be triggers. They can relax immediately after a trigger, which shortens your anger response. And they can relax and stay relaxed through trigger situations that they would be naturally encountering anyway, and that will change that reflex response. and it will decay, it will go down. That is a form of counter conditioning.

Adeel [43:33]: Yeah, one thing that we've mentioned a number of times on the show is that kind of, well, more of a vague version of that idea of, well, if you know you're gonna be walking into a room that might trigger you, just tell your brain that, or talk to your brain, tell it that, you know, no one's here to hurt you, just basically trying to relax yourself. Right. Now, people don't always remember that, but maybe that's part of the thing you're trying to train.

Dozier [44:04]: So one of the things you can tell your brain, so you can do that talk yourself down, but if you develop the skill, like a sports skill, like playing a piano, of letting your muscles go limp, getting rid of all the extra tension in, say, five or ten seconds, then as you're walking toward that room you can simply say relax all my muscles and progressive muscle relaxation was developed for anxiety because people with anxiety have a lot of tense muscles that become tensed um not thoughtfully but but just you know automatically because they're having the worries that they're having and so just physically relaxing your muscles brings that anxiety level down as you walk into that room where there may be triggers.

Adeel [45:03]: Right. And what are you noticing in terms of, you know, obviously you've probably trained many people in progressive muscle relaxation. I'm curious, like, does it take a while to, does it take a while to do, is there a relapsing? Like are people... Does this need to be continued for a while? What's the efficacy of this technique?

Dozier [45:28]: So what I ask people to do is the three sessions a day for the first week. Then we add some little practical exercises of just letting your muscles go limp called ragdoll. And then you do that three months, three a day for the next week. And then you start tapering down to like one a day. But beyond the muscle relaxing, you have to relax the right muscles around the triggers. And it's so easy to forget that the natural experience of a trigger causes, you hear the trigger, your muscle, let's say your hands tighten just slightly, You get the emotional response, and as soon as you get that emotional response, that's probably before a half second of the trigger has already happened. You're into the emotions, and you're clenching those fists again because you're upset. So the natural response to triggers causes the physical reflex to strengthen and causes the emotional reflex to strengthen. So if a person doesn't, pay attention, isn't aware, then they can regrow these responses and grow new responses, new triggers also very easily.

Adeel [47:00]: Gotcha. So it's something you just need to always be mindful of, obviously. Correct. And tell us maybe something about some of the success stories that you've seen. I guess you get a lot of probably based on your, I'm assuming you get a lot of families coming in, especially based on your initial kind of work as a parent coach. I'm always worried about if kids have misophonia, is this going to affect their schooling? And this could have all kinds of domino effects throughout their lives. Have you seen kids really turn around and become really successful?

Dozier [47:47]: Yes. And part of it depends on the reflex that the person has and their family support. and there are tolerance for weak triggers, the individuals who are experiencing a fair number of triggers in their world, that they just, you know, the world doesn't conform to them, can just start relaxing those muscles and do the relaxation training and relax those muscles and then the triggers start to die out. So I worked with one woman who was 47, And she had quit her job two years earlier because her boss would not help her, not accommodate her. And in fact, in one of those discussions, he took his pen and he clicked it in her face, which was the trigger, and she just quit. She moved into a bedroom in her parents' basement and for two years had spent 95% of her time alone or with headphones to block triggers. she had a very clear jaw reflex. And she basically eliminated her misophonia in 10 weeks.

Adeel [49:07]: So focusing on relaxation and then... Relaxing that jaw.

Dozier [49:13]: And relaxing the jaw and doing the muscle relaxation training because she also had PTSD and a lot of anxiety. And so the general benefits of the muscle relaxation training helped. It improved her sleep. She relaxed her jaw around triggers and her triggers faded away. I worked quite a different situation with this young lady who had very severe misophonia to her parents' voices and the mouth sounds when they're talking and eating triggers and a number, a long list of triggers. And so she started relaxing and doing the work. She improved quite a bit to start with, but then just slowed. She just kept slowly getting rid of one trigger and another trigger and then she was eating with her family and then she was talking with her family with her mom and her dad every evening and you know at at 32 weeks we were meeting about once a month to keep her on track for 30 minutes. So we haven't 30 minute meeting once a month. And at the end she. had one person where she worked that would whistle. And when he would come into work whistling, she would be distracted from what she was doing. She'd be mildly triggered. She would turn back to what she was doing and carry on. And she would completely stop being triggered by that sound. That was her only trigger left in her life. It was just that one. But it was seven months of, Not doing PMR every day, just seven months of that when there were triggers, probably the last two thirds of it was just when there were triggers, just trying to relax and carry on. So it can be very short, can be very long.

Adeel [51:08]: And so PMR is kind of the main treatment tool that you're using currently?

Dozier [51:18]: PMR and counter conditioning. The counter conditioning can often occur when there are when there are naturally occurring triggers so that you do the PMR and you say, OK, every time I hear a trigger, my reflexes in my hands, I'm going to try to relax, but I'm especially going to let my hands go. And. that the triggers just start going. Got it.

Adeel [51:44]: Okay. So that's PMR. And then counter conditioning was when you introduced that kind of like low sound in the, not in the background.

Dozier [51:51]: You can do counter conditioning is doing something different when you're in a trigger situation. So, or having a positive situation. So, so just relaxing your hands, you know, for a person who has a fist clench reflex, just relaxing their hands and carrying on creates a counter conditioning experience because the brain is saying, I'm trying to clinch those hands, but I'm seeing that they're relaxed and that creates a lizard brain retraining or a learning opportunity. So it's, it's muscle relaxation training to develop the skill of being able to relax, understanding the physical nature of misophonia for you as an individual. and the way it strengthens and decays, then having those critical muscles relaxed when you're hearing triggers. That can either be because you're having fun, you're doing the trigger tamer, you're playing games, you're just relaxing around naturally occurring triggers. All of those fall into the counter conditioning realm. And then avoiding prolonged misophonia distress. I emphasize the need to not torture yourself with triggers. Turn up the noise. Close your eyes. When I say turn up the noise, I mean use a noise app, for example. A lot of people say, well, I eat with my family, but I like to listen to music. That's really hard with teenagers because they really like music. But a good noise app with rain sound or thunder or... can be much better at blocking the triggers so that they set their phone to let's say seven clicks of volume. And now I can relax at dinnertime because the triggers are weakened by the background noise. And then next week or next month, I might find I only need six clicks of noise or five clicks of noise. And so they can slowly reduce that noise by being relaxed in that situation and that's the counter conditioning. So avoid the prolonged misophonia distress. Don't get tough. We don't want any misophonia warriors who face this head on. I say I want you to be a misophonia wimp. I want you to protect yourself, accept mild triggers, but not prolonged distress. And then that that leads to opportunities of counter conditioning. And then prolonged support. ongoing support from me I have found in multiple cases where a person initially responds extremely well and they say wow this is so great thanks Tom and they cancel their next appointment and then a few weeks later or like 10 weeks later they're like they've made no progress or they've gotten back worse again because they went their their natural unconscious response to triggers took over and they were you know, getting bad again.

Adeel [55:07]: Gotcha. Yeah, one thing related to wearing or having a rain sound and stuff, some people are, you know, express concern where they feel like they live in headphones all the time. And it seems like it's kind of almost the opposite of like your kind of you're conditioning because you're kind of more avoiding and so you're never probably really developing the skills that you're that you're that you're training do you find is there kind of like a tension there uh or can they can they kind of work kind of complementary to each other well actually there it depends on what you're using the noise for if you're using the noise to make it so loud

Dozier [55:48]: that you're masking all the triggers.

Adeel [55:50]: I think that's what most people, whether they admit it or not, are trying to do.

Dozier [55:54]: Then it doesn't help you. If, however, you're, let's suppose on a scale of 0 to 10, a trigger would be an 8, and your ability to relax was at a 3. Well, if you experience triggers and try to relax in that situation, your triggers are going to get worse and worse and worse. But if you use the noise to bring that trigger down to a two and your ability to relax this at a three, then with time, that lizard brain reflex can go down and decay. So it would go from a two down to a one. And at that level, you may let the volume go up a little bit, go down a little bit. So you get a little more triggers and then you're getting these just weak triggers. It's weak triggers and relaxing or happy activities that cause the misophonia to decay and go away.

Adeel [56:52]: Got it. So use background sounds to relax yourself, not to mask the sounds.

Dozier [56:59]: Let's say we use... we use the background sounds to partially mask. How about that?

Adeel [57:04]: Yeah, gotcha, gotcha. Cool.

Dozier [57:06]: To reduce the severity of the reflex. Right, right.

Adeel [57:09]: So, and yeah, and one thing, yeah, it was interesting. I don't know why I hadn't, I didn't realize that your, like the Trigger Tamer app was, you know, very short clips of, or low volume clips. Because, you know, some people, when they hear Trigger, Here you describe what your treatment option is. It seems like exposure therapy, but this is not exposure therapy, right? We want to be clear on that.

Dozier [57:40]: This is counter conditioning. This is counter conditioning. This is not what we call exposure therapy at all.

Adeel [57:46]: Gotcha. And what would you say, so, you know, there's just like, you know, there's various research groups and stuff around the world. And it seems like some people are very skeptical of everybody else's, you know, of basically anyone's kind of trying to promote like a treatment or a cure. Are you, you know, what do you say to people who are kind of, you know, very skeptical i would say about uh that hearing about who are you know or not maybe studying this in a lab like um do you call this like a cure a treatment i call it a treatment right because um some people that i worked with don't remember the last time that they were triggered others still have weak triggers and they still have to

Dozier [58:38]: Consciously worry about relaxing and taking care of themselves, although it's you know, maybe only. You know 5 is a 95% reduction. That's still not a cure, right? We're not talking about a bacteria in the body that we can eliminate and cure the person we're talking about. Normal human neurology. Just because you get rid of all of your triggers doesn't mean you're not going to develop a new one. My daughter did that she. got rid of all of her triggers and developed a visual trigger to kids swinging their legs and it developed from scratch after she had eliminated all of her other misophonia triggers so back to your question what do we call it and you talk to ask about the research first definitely it's treatment and it's definitely uh does not work for everyone we probably have of the people i see probably 10 to 15% really don't qualify for what I'm doing. And I would refer them to secret repatterning hypnotherapy, which works a different way. Then maybe 20% don't engage. It's just, they're not, it's not, they're not motivated to put in the effort to learn how to relax their muscles. And then probably 10% of those, another 10% just don't respond to the treatment. So yeah, this is not for everyone, but it definitely goes at the heart of the misophonia response. Now, you mentioned research. And there are currently no research studies that I have participated with or which I'm aware of that are investigating misophonia as a conditioned physical flinch. There was a big, the Reem Foundation research work that was put together. The people putting together the information on that talked to me. I explained this, this all to them. I sent them articles. When they wrote it up in there, this is misophonia study. they did not include the initial physical reflex as a as a theory for misophonia so the people out there in the research domains that are investigating misophonia are investigating it primarily as a learned emotional reflex disorder or just an anger general anger disorder so There's not much I can do about that because they're in academia and I'm not.

Adeel [61:37]: Right. Yeah. It seems like the direction of, I guess, the popular Misfunny research seems to be either, you know, like literally a disorder of the brain, something maybe people are born with or but not so much a kind of a physical reflex, which I think is what you focused on here. Right. And it's just interesting that there's like camps that seem to be very kind of like stuck in their very kind of, kind of, it's almost like a team kind of phenomena or something. where people are very focused on their own theories. It's kind of early days, and it's not... Not every avenue has been researched completely, it seems like, especially this particular one with the physical reflexes here. Have you talked to the Ring Foundation of maybe being funded to do some research, or are they really focused on other avenues?

Dozier [62:48]: Well, when I talk to the Reem Foundation or the person who developed the This Is Misophonia about them not including what I told them, they go, oh, yeah, we did. It's here. I go, well, that's, you know, you basically describe it as a fight or flight reflex. Not ask what's driving the misophonia. And so as far as I know, there's no, I have not had contact with them. I'm I'm actually considering trying to raise funds to do this research, but getting someone in academic world to do it. So that maybe it could, it could, and I've thought about trying to talk to the Reem Foundation, have not done that, but I guess I probably should.

Adeel [63:36]: Is there any upcoming research that you've heard of that might be kind of interesting? I don't know if Kumar has any other anything come up. I'm just curious if you've heard anything through the grapevine of some interesting directions that you find promising based on what you've seen.

Dozier [63:55]: I do not. Suckbender and I had talked about doing a kind of a summary article of This is Misophonia. He supports the work that I do. I support, definitely everyone supports the work he does. But where we would talk about Misophonia as an learned physical flinch that triggers the emotions that he's well documented in his study. And we just haven't gotten to it. I don't think we're going to now. was going to do it a year ago and and then send it to me for me to add my stuff into it but we just We're just both too busy. Gotcha.

Adeel [64:41]: Gotcha. And I'm also curious about, yeah, also about accommodations and how, I don't know, Dr. Johnson is always talking about how there's no code for this. Like, how do you, do you advise people on how to get accommodations in the various places they are, like at work, like while they're, you know, while they're learning these skills, like how, you know, what are some other ways that people can kind of just get on with their lives a little bit easier?

Dozier [65:09]: Well, accommodations are great, and accommodations have nothing to do with codes. If you look at the Americans with Disabilities Act, there are no codes in that document. There's no mentions of physical or emotional disabilities in that document. A disability, according to that document, is a condition which has a substantial... impact on one or more areas of a person's life, one or more domains of their life. So you don't even need a letter.

Adeel [65:46]: You do need a letter just for kind of like maybe reinforcement of the condition.

Dozier [65:53]: Right. Typically, institutions, schools, businesses will want some documentation of a condition. So I provide letters to people that basically say that I call a pseudo diagnosis. You know, Adeel has contacted me for help in treatment of his misophonia. This is what misophonia is, blah, blah, blah, blah, blah, blah, blah. This is how misophonia qualifies for the Americans with Disability Act. Here are some recommended Accommodations to consider, nowhere in there do I say I give Adeel a diagnosis of misophonia, but I talk as if he had one. So that usually works. Some places require a diagnosis of misophonia from a licensed clinician, like a doctor or psychologist, and those can be provided just you give them a diagnosis. The person has something that we call misophonia.

Adeel [67:02]: Yeah, I guess the only thing with the code is for insurance purposes, I guess, is what... And I have had some people who have insurance covered the work that I do with them.

Dozier [67:17]: The code I say is that it's an abnormal reflex. R29.2 abnormal reflex. And that's what I provide treatment for.

Adeel [67:29]: Gotcha, okay.

Dozier [67:31]: I don't say that I diagnose them with that because I'm a behaviorist. I don't diagnose, but that's the code that I provide treatment for. And I provide a health behavior assessment and a health behavior intervention.

Adeel [67:48]: Gotcha. Okay. Okay. Well, I guess we're heading up again to the top there. We had a little bit of an interruption earlier on, but I kind of want to start to wrap up, but I want to just give you the chance to kind of like, you know, let the listeners know, you know, anything you want to, you want to tell people like here on, you know, December 14th, 2020, like what, what hope is there for people? And what kind of what should they do? Maybe actually this might be a chance for you to kind of mention some of the products that you have available. Like, you know, what would you like to tell the listeners, many of whom have, you know, maybe not have heard of you. They're from around the world.

Dozier [68:31]: So learn to relax. First off, there is hope for misophonia. It is caused by normal brain neurology. and it can change to cause the mesophonia and it can change to go away. We know of two effective treatment methods that are, again, these are not, you know, full research proven. It's just what we as clinicians do and see what works. But there's the, I call it relaxation and counter conditioning therapy, RCT. which is go get the Misophonia Muscle Relaxation Training app, do it three times a day, do three sessions a day for a week, start trying to relax around triggers in general, keep doing three sessions a day for another week, and then start tapering off from that, and find opportunities to reduce your reflexes. If you don't know where you're, I mean, most people do not know, do not find their initial physical reflex without help, but just relaxing around triggers can make a big difference. I work with people by video chat all over the world, all over the English speaking world. And there's a treatment called secret repatterning hypnotherapy, which we just saw on announcements that Chris Pearson has just completed training of a German speaking secret repatterning hypnotherapist. And there's, I think, five in the UK area that are trained in this. And this works primarily on the emotional reflex. Secret repatterning hypnotherapy works primarily on the emotional reflex. So quite distinctively different, but it uses the same model of a stimulus, a flinch, an emotional reflex, And then all the distress response.

Adeel [70:35]: Gotcha. Yeah, I was going to ask about that because you did mention that there's a certain portion of your potential clients that you refer to hypnotherapy. And yeah, I was curious, where do you send people if it's not working for, if your treatment option is not working? And that's, in your opinion, one of the next leading candidates?

Dozier [71:02]: It may even be more leading than what I provide. So it's an excellent treatment with over 1,000 people that have been treated with it and some very good responses. But this is not, don't go call your local hypnotherapist. This is a very particular treatment developed specifically for misophonia.

Adeel [71:31]: Gotcha. Yeah, so not your local party favorite hypnotherapist. Go to somebody who's been trained particularly for this.

Dozier [71:41]: Yeah, because typically hypnotherapy, typical hypnotherapy produces no results or short-term results. Rarely would it produce long-term results.

Adeel [71:54]: Gotcha. Okay. Yeah. We'll have to, we'll have to try to get that Chris Pearson on, but, but yeah, in the meantime, I want to, I'll see, I'll have links to misophoniainstitute.org, misophoniatreatment.com, the, the apps you've been, you've developed. Is there anything else to you that maybe we should include before we sign off?

Dozier [72:17]: I just say there's hope. There really is hope.

Adeel [72:21]: Right.

Dozier [72:21]: Because we've learned so much in the last eight years.

Adeel [72:26]: Yeah, it's amazing. I mean, the term has been around for a little bit more than eight years, but it seems like there's been a real snowball of awareness and connection maybe. And maybe it's partly due to the rise of social networks, but we've all kind of like, there's been a flurry of activity. It's been exciting.

Dozier [72:44]: Yes. And because they also hit mainstream media, the New York Times article, Kelly Ripa talking about it. So even for those of you who follow American football and know who Peyton and Eli Manning are, the two brothers that are quarterbacks, Peyton Manning has misophonia.

Adeel [73:03]: I did not know that.

Dozier [73:04]: And it made a news report that Peyton Manning has misophonia. And they had a clip of him hearing Eli eat a bag of potato chips and him bellyaching and complaining. It's got a lot more publicity out. People are really starting to learn, so I think the future is bright. There is hope. Hang in there. And don't let it get you down.

Adeel [73:32]: Well, let's, let's leave it on that. Those are great words to, to live by it. We'll want to thank, uh, Tom Dozier, um, big, uh, big, big part of the Misfunny community, uh, major part of the conversation. And it's been an honor to have you and talk to you and, um, yeah, for folks listening, check out, uh, well, obviously read up on Tom, check out the show notes and, uh, yeah, this won't be the last time we hear from Tom, I'm sure. So, uh, um, yeah, thanks again, Tom, and good luck with everything.

Dozier [74:01]: Thank you, Adeel. It's been my pleasure. Take care.

Adeel [74:04]: Thank you, Tom. A great conversation. I'm glad you all stayed till the end to listen. Hopefully you understand Tom a little better and understand his approach to Misophonia. If you're enjoying the show, don't forget to leave a little review. I'll see you next week for the start of season four. Give us a follow in the meantime on Instagram or Facebook at Misophonia Podcast or Twitter at Misophonia Show. Music as always is by Moni. And until next week, wishing you peace and quiet.

Unknown Speaker [74:38]: Thank you.