Sounds for Misophonia — Masking Trigger Noises With Noise, and Why Masking Is Not a Treatment

Misophonia is a disorder of decreased tolerance to specific sounds, or to the things associated with them. That sentence opens the consensus definition published in 2022 by Swedo and colleagues in Frontiers in Neuroscience, produced by a committee of researchers and clinicians using a modified Delphi process: candidate statements drawn from a systematic review were voted on, revised or excluded over four rounds, and a statement made the final definition only when at least four in five of the committee agreed with it. Before that paper the field had been describing the same thing in different words for two decades.

The word was coined by Pawel and Margaret Jastreboff in 2001, and the first formal diagnostic criteria came from Schröder, Vulink and Denys in PLoS One (2013), who interviewed 42 patients and found a consistent pattern: a sound, usually made by another person, provoked an immediate aversive physical reaction with anger, disgust and impulsive aggression; the intensity of that reaction led to preoccupation with the cue, avoidance and social dysfunction; and none of it fitted anywhere in the diagnostic manuals of the time. The typical triggers are the ones you would guess — eating, drinking, chewing, breathing — and for many people a matching visual cue, such as seeing someone chew, sets off the same response.

The reaction is not a figure of speech. In Kumar and colleagues’ 2017 study in Current Biology, people with misophonia listened to trigger sounds in an MRI scanner while heart rate and skin conductance were recorded. Triggers produced a greatly exaggerated response in the anterior insular cortex, a hub of the brain’s salience network, with abnormal connectivity between it and the regions that process and regulate emotion; heart rate and skin conductance rose with the triggers, and the rise was mediated by the insula’s activity. An Amsterdam group later found the same network — insula, anterior cingulate, auditory cortex — activated by video clips of lip-smacking and breathing in 21 patients against 23 controls (Schröder and colleagues, Scientific Reports, 2019).

How common it is depends on where you draw the line. Among 483 undergraduates surveyed by Wu and colleagues (Journal of Clinical Psychology, 2014), nearly 20% reported clinically significant misophonia symptoms. In 772 people weighted to represent the UK adult population, Vitoratou and colleagues (PLoS One, 2023) combined a questionnaire with clinician interviews and estimated that misophonia symptoms cause a significant burden for 18%. In a probability-based sample of 4,005 US adults, Dixon and colleagues (Journal of Psychopathology and Clinical Science, 2024) found 78.5% reporting some sensitivity to misophonia sounds but 4.6% at clinical levels. Those are three thresholds applied to a trait that shades from ordinary irritation into disability: a mild version is very common and a disabling version is not rare.

Two more facts. Most of the 300-plus people surveyed online by Rouw and Erfanian (Journal of Clinical Psychology, 2018) placed the onset in childhood or early adolescence and said it had worsened since. And in the largest clinical series, 575 confirmed cases at the Amsterdam clinic, Jager and colleagues (PLoS One, 2020) found hearing tests, neurological examination and blood work normal. The ears are fine. The problem is what the brain does with what they deliver.

Three conditions get filed together under “sound sensitivity”, and they call for different responses. Masking noise is a reasonable idea for one of them and a bad idea for another.

Hyperacusis is about loudness. Sounds other people find ordinary are experienced as uncomfortably or painfully loud, and the level of the sound is what drives the reaction. Tyler and colleagues’ review in the American Journal of Audiology (2014) groups the reactions into excessive loudness, annoyance, fear and pain. Because it is a loudness problem, adding sound is not an obviously good idea, and the sound-based approaches used for it are about gradual, controlled re-exposure rather than covering things up. That has its own page: hyperacusis and sound therapy.

Misophonia is about meaning. The Jastreboffs, who named it, describe in a 2023 paper in Frontiers in Neuroscience how their patients tolerated other sounds at higher levels than the ones that bothered them; what determined the reaction was the pattern of the sound, who made it and in what situation, not how loud it was. They add a point that matters for anyone self-diagnosing: the physiological and emotional reactions in hyperacusis and misophonia look almost identical, so the reaction cannot tell you which you have. What sets it off can.

Phonophobia is fear of sound — anxious anticipation and avoidance of sounds expected to be painful or harmful. It overlaps with the “fear” category in the hyperacusis review and often travels with hyperacusis or migraine. The emotion is dread, not the anger and disgust that dominate misophonia.

They can co-occur: in 1,084 university students, Brennan and colleagues (Ear and Hearing, 2024) found a strong positive correlation between misophonia and hyperacusis questionnaire scores. But in the Amsterdam series of 575 confirmed cases only 2% reported tinnitus and 1% hyperacusis, so for most people with misophonia the loudness system is not the one misbehaving. If loudness itself hurts, the noise on this page is the wrong tool.

Masking works on the signal, and misophonia lives in the recognition. Those two facts explain both why noise helps at the table and why it cannot do more than that.

The acoustic part is uncontroversial. A trigger sound is quiet — a chew, a swallow, a breath, a click — and a steady noise with energy in the same frequency range raises the floor under it, so its peaks stand less far above their surroundings. That is the signal-to-noise ratio, and lowering it makes any sound harder to detect and harder to identify.

The part that makes it specifically useful comes from a study that used masking noise as its instrument. Savard and colleagues (Frontiers in Neuroscience, 2022) had 300 adults listen to neutral, unpleasant and misophonia-trigger sounds buried in multi-talker babble at five signal-to-noise ratios from −30 to +10 dB, identify what they heard and rate how it made them feel. Everyone was better at picking out trigger sounds than merely unpleasant ones. The difference was in what happened once a sound became identifiable: in the most misophonic fifth of the sample, negative emotion jumped far more sharply at the point of recognition, especially for triggers. While the sound was still buried, it was just noise. The authors’ reading is that learning and higher-order evaluation of the sound, not its raw acoustics, carry much of the reaction — which is exactly the lever masking pulls. Keep the trigger below recognition and the cascade has nothing to start from.

A humbler second mechanism is attention: a steady, featureless sound gives the ear something to settle on, and makes the silent gaps between chews, in which a person with misophonia waits for the next one, less silent. That is what people describe, not a study finding.

Where it stops. Masking fails in predictable ways.

• Visual triggers. The imaging studies used video clips because seeing someone chew is a trigger in its own right. No noise touches that.
• Loud triggers. Covering a loud sound needs a louder noise, and past a certain level the noise is the problem. Masking is for quiet triggers.
• Known triggers. A partially masked sound you know is happening can still be identified, and identification is the switch. In a quiet room the noise is usually enough to blur it; in a loud one it often is not.
• The noise itself. Some people with misophonia find sustained hiss aversive. Brown is the colour least likely to, which is why it is the default; if noise irritates you, this is not your tool.

The avoidance trap. This is clinical reasoning rather than a trial result, and should be read as such. Avoidance is written into every clinical description of misophonia: the Amsterdam criteria list it among the consequences of the reaction, the UK population study measured “perceived threat and avoidance behaviours” as a core dimension, and the randomised trial below opens by noting that avoiding trigger situations leads to isolation and impairment. A masking sound that is always on is avoidance without leaving the room. For a meal, a meeting or a train journey that is a reasonable trade; as an all-day arrangement it removes every occasion on which the reaction might have been faced, and the treatments with evidence behind them work precisely by facing it in a structured way. Use noise the way you would a painkiller: for the hour that needs it, while pursuing what addresses the cause. The twenty-minute cap on this player is deliberate.

Two studies from the same Amsterdam clinic account for most of what is known about treating misophonia, and both tested cognitive behavioural therapy. Here is what they did, what they measured and what they found, including the limitations they list themselves.

Schröder and colleagues (Journal of Affective Disorders, 2017) ran the first treatment study of any kind: ninety patients, eight group CBT sessions held every two weeks. Response was defined strictly — a clinician rating of much or very much improved and a drop of at least thirty percent on the Amsterdam Misophonia Scale — and by that standard 42 of the 90 responded. More severe misophonia and disgust as a leading emotion predicted a better response. The authors list the limitations themselves: the severity scale had not been validated, and the study was open-label, with a waiting-list comparison rather than a control treatment.

Jager and colleagues (Depression and Anxiety, online December 2020, in print 2021) then ran the first randomised controlled trial. Fifty-four patients were assigned to three months of weekly group CBT or a waiting list, with evaluators blind to allocation. The therapy had named components: task concentration and arousal reduction, positive affect labelling, and stimulus manipulation. The co-primary outcomes were the revised Amsterdam Misophonia Scale and the clinician’s global impression of improvement. After the randomised phase the CBT group scored 9.7 points lower on the severity scale than the waiting-list group, a large effect by the trial’s own statistics; about a third of the CBT group met the criterion for clinical improvement and none of the waiting-list group did. The waiting-list group then crossed over, and the improvement was maintained at one-year follow-up on primary and secondary outcomes.

What that establishes: a structured CBT protocol produced measurable, lasting improvement compared with waiting, in patients at a specialist clinic. What it does not: that it works for everyone — in both studies most patients did not reach the formal response threshold, though the group improved — or that the therapy’s content, rather than attention, structure and expectation, did the work, since there was no active comparison. One randomised trial from one clinic is a thin base. It is also, by some distance, the best evidence for anything in misophonia, and the reason this page keeps pointing at a clinician rather than at itself.

The other approach with a literature grew out of tinnitus retraining therapy: counselling plus sound therapy, aimed at extinguishing the conditioned link between trigger and reaction, described in the Jastreboffs’ 2023 paper. The support they cite is their own published clinical series; we could find no randomised trial of it on PubMed. That is a reason to weight it below the CBT trials, and to notice that it, too, is a clinician-delivered programme rather than a sound you play at yourself.

When to go. If the reaction is costing you meals with your family, your ability to sit in an office, your willingness to travel or your relationships; if the intensity of your own anger frightens you; or if you have begun to organise your life around not hearing certain people — go. A general practitioner can refer you, and a psychologist who treats anxiety-spectrum problems will recognise the pattern. If what sits alongside the triggers is a general background of anxiety, the site’s anxiety page is honest about what sound can and cannot do for that, too.

Match the noise to the trigger, keep the level low, and choose the delivery for the room you are in. The three quick-sets on the player above encode this; here is the reasoning in full.

Which colour, and why. Masking works by spectral overlap, so the useful question is where a trigger’s energy sits. Soft chewing, swallowing and breathing are quiet, low-to-mid sounds; brown noise puts most of its energy at the bottom of the spectrum, so it covers them at the lowest overall level, and it is the colour people find easiest to sit with over a long meal. Crunching, lip-smacking, sniffing and keyboard or pen clicks carry more energy in the middle and upper range, where brown has little to offer; pink noise reaches them without the brightness that makes white noise tiring after an hour. White is the fallback for a sharp, high trigger pink is not quite covering; green is here because some people find it pleasant, not because it covers anything in particular. The noise colours guide has the full comparison. There is no “misophonia colour”: the right one depends on your trigger, your ears and your tolerance for hiss, and the way to find it is to try each for a minute.

The dining table. Start with brown at a modest level in one earbud, leaving the other ear open for the conversation; the earbud on the side facing the person whose sounds reach you hardest is often enough, because the goal is to blur a quiet sound, not erase the room. If the trigger is crunching rather than soft chewing, switch to pink. Be open about it if you can: an earbud at a family table reads as rudeness unless people know why, and the explanation is short.

The open office. The triggers are usually mid-range — keyboards, sniffing, clicking, someone eating at their desk — and they last all day, which is exactly when loud white noise becomes its own problem. Pink at a low level is the better default, and a small speaker on the desk, turned down, is often better than earbuds: more comfortable over hours, and it keeps you reachable. Set it so that a colleague saying your name still lands.

The commute. A bus or train supplies a low rumble that already covers the bottom of the spectrum. What gets through — sniffing, gum, someone else’s leaking headphones — sits higher, so pink is the better match, and it needs a little more level to clear the rumble than it would in a quiet room. Two limits: if you cannot hear an announcement, it is too loud, and no colour does as much on a train as noise-cancelling earbuds, which remove the rumble and leave the noise less work to do.

Volume ceilings and hearing safety. Continuous sound is easier to over-expose yourself to than music because it has no quiet moments. Three rules: raise the level from low rather than lowering it from loud; keep it where you could hold a conversation without raising your voice, because if the noise is the loudest thing you can hear it is now doing to you what the trigger was doing; and do not run it for hours through earbuds. The player stops after twenty minutes at most, and if you find you need it all day, that is information about the condition rather than a reason to keep pressing Play.

Everything on this site that is relevant to misophonia is a noise source. None of it is a treatment, and we would rather say so than be found out.

What the free web tools do: the player above and the noise generator produce white, pink, brown, green and violet noise in your browser, with a volume control and a timer, streaming nothing and storing nothing. The main generator layers a white, pink or brown bed under a binaural, isochronic or pure tone, capped at twenty minutes. The pages for brown, pink and white noise explain each colour and carry their own players; the noise colours guide compares them. The mobile app goes further on sound — 44 presets, 34 ambient beds including rain, ocean, café and fan, the Frequency Lab, no session cap — and, for this page’s purposes, that is all it goes further on.

What none of it does: it does not reduce the reaction to a trigger you can identify, it does not change what happens the next time you hear it without the noise, and it has no trial evidence in misophonia of any kind. The one study that used masking noise with misophonic listeners used it to probe the mechanism, not to test a therapy.

On the beats: a binaural beat is a low-frequency sensation created when each ear receives a slightly different tone, and it needs headphones to exist. It has nothing to do with masking — the tone is quiet and narrow and covers nothing — and what it does is its own subject, laid out on the beats versus white noise page and in the research hub. If a steady tone helps you settle at a table, the main generator will give you one with brown noise underneath, but the noise is doing the masking; we have no evidence that the tone does anything for misophonia and will not imply it.