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Using Desensitization and Counterconditioning for Noise Phobias

Using Desensitization and Counterconditioning for Noise Phobias

Understanding Noise Phobias

Noise phobias, also known as phonophobia, are excessive, irrational fears of certain sounds. Some common triggers for noise phobias include thunderstorms, fireworks, loud music, vacuum cleaners, and traffic noises. However, any sound can become a phobic stimulus if the fear becomes excessive and distressing. The sound does not need to be objectively loud or dangerous to provoke anxiety and avoidance in someone with a noise phobia.

The symptoms of phonophobia can include:

  • Extreme anxiety when anticipating exposure to certain noises
  • Panic attacks triggered by noises
  • Avoidance of situations where feared noises may occur
  • Difficulty sleeping due to noise anxiety
  • Nausea, dizziness, racing heart rate when hearing feared noises
  • Inability to focus or think clearly when noises are present

Noise phobias can develop after a traumatic experience involving loud or alarming sounds, or they can stem from a naturally anxious temperament. Genetics and brain chemistry likely play a role. Noise phobias can occur at any age, although they often develop in childhood. Without treatment, they tend to persist and cause impairment in daily functioning.

How Desensitization and Counterconditioning Work

Desensitization and counterconditioning are commonly used together in a technique called "systematic desensitization." This technique is based on principles of classical conditioning and operant conditioning.

Classical conditioning explains how a neutral stimulus can become associated with a pleasurable or unpleasant response. If a loud noise regularly precedes something unpleasant, like a panic attack, the noise itself can eventually trigger anxiety even without the panic attack occurring. Counterconditioning aims to replace this learned association between the noise and anxiety with a new association between the noise and something pleasant or relaxing.

Operant conditioning focuses on how behaviors are shaped by their consequences. Avoidance of feared situations, reassurance seeking, and other safety behaviors are negatively reinforced when they result in anxiety relief. Desensitization progressively exposes someone to incremental levels of a feared stimulus while preventing avoidance and safety behaviors. This teaches the person that exposure is tolerable and anxiety will decrease over time.

Systematic desensitization combines these two approaches. The person learns relaxation skills and then works through a hierarchy of noise exposure situations, from least to most anxiety provoking. With each step, the noise is paired with relaxation until it no longer causes an anxious response.

Creating a Hierarchy for Exposure

A key initial task is developing a hierarchy of noise exposure situations to work through. This hierarchy should contain 10-15 steps starting with noises that provoke only minimal anxiety. The final steps should involve exposure to the most anxiety-provoking noises.

It can help to divide the hierarchy into categories such as:

  • Recordings of noises
  • Noises generated in therapy sessions
  • Real-life exposure homework assignments

Within each category, rank the exposure scenarios from least distressing to most. For example, recordings could progress from quiet thunder to loud thunder to fireworks. In vivo exposures may start with turning on a vacuum in another room, then work up to using the vacuum directly around the person.

The person should rate their subjective units of distress (SUDS) for each item on a 0-10 scale. Noises provoking SUDS under 3-4 are appropriate starting points. The later steps should include noises likely to initially provoke SUDS ratings around 8-10.

It is also helpful to develop two hierarchies – one focused on thunderstorms and another on a different noise like vacuum cleaners. Addressing two different phobic stimuli helps ensure progress generalizes.

Developing Relaxation Skills

Before starting exposures, the person needs to learn relaxation techniques. Being able to relax inhibits anxiety and allows new non-fearful associations to form more effectively in the presence of noises. Useful skills include:

  • Deep breathing exercises
  • Progressive muscle relaxation
  • Calming imagery such as picturing a peaceful place
  • Mindfulness and meditation
  • Positive self-talk

Practice these techniques daily until the person feels confident using them to induce relaxation. Some people may benefit from recording relaxation exercises to listen to during desensitization sessions. Biofeedback tools that measure muscle tension can also enhance awareness of anxiety cues.

Relaxation skills give a sense of control over anxiety levels. This can motivate continued progress on exposures. Mastering relaxation before starting serves as an initial accomplishment.

Introducing Noises in a Relaxed State

Now the person is ready to start working through the hierarchy by listening to recordings of noises while using their relaxation skills. Sessions may last 45-60 minutes and should occur 2-3 times per week.

Begin with an initial relaxation period of about 10 minutes. Once relaxed, introduce the first noise on the hierarchy at a low volume. Loop the recording so the noise continues playing in the background. After a minute, check the person's SUDS rating. If it remains below 4, continue relaxation and exposure for a few more minutes before ending the session.

Over multiple sessions, increase the volume gradually while maintaining a relaxed state. When the person can remain relaxed at high exposure levels, move up the hierarchy to more distressing noises. Complete at least 3 sessions at each step until habituation occurs. Expect some ups and downs. Return to an earlier step if needed until relaxation is achieved again.

Exposure should continue until all noises on the hierarchy, at full volume, elicit low SUDS ratings. Mastery of recordings indicates readiness to start real-life exposure homework.

Conducting In Vivo Exposure

In vivo exposure homework involves deliberately seeking out feared noises in real environments. This transfers the developing coping skills into everyday life. Create customized exposure assignments collaboratively with the person.

Initial homework may involve activities like:

  • Turning on loud music for a brief time at home
  • Sitting outside for 10 minutes while traffic passes by
  • Running a vacuum or blender for 2 minutes
  • Listening to a thunderstorm recording before going to sleep

Encourage the person to use their relaxation skills during homework and record their highest SUDS level. Review assignments in the next session. Troubleshoot any difficulties and develop a new assignment moving further up the exposure hierarchy.

Ideally, homework should take place frequently enough to prevent avoidance patterns from re-emerging between sessions. Coordinate with the person's schedule and current functioning to set realistic goals.

Applying Coping Strategies In-The-Moment

As real-life exposure increases, practice applying coping strategies in anxiety-provoking situations as they occur. For example, when a thunderstorm happens, guide the person to:

  • Recognize their anxious response
  • Remind themselves "This noise cannot hurt me, even though I feel anxious."
  • Focus on using slow breathing
  • Listen closely to the thunder rather than trying to block it out
  • Refrain from reassurance seeking or other unhelpful coping behaviors
  • Notice their anxiety decreasing without escaping the situation
  • Reward themselves for tolerating the exposure

This exercise strengthens the developing ability to manage noise fears as they arise naturally. Anxiety is likely to occur during this transition period. Offer encouragement to stick with the coping strategies, even if anxiety does not decrease immediately. With repetition, the new skills will become automatic over time.

Troubleshooting Setbacks

Expect setbacks when confronting entrenched fears. If progress stalls, explore potential roadblocks:

  • Is the hierarchy too ambitious? Return to an earlier step.
  • Are new stressors interfering with relaxation? Address other issues.
  • Is avoidance occurring between sessions? Increase homework frequency.
  • Does an unhelpful thought pattern need restructuring? Work on cognitive skills.
  • Are safety behaviors sneaking in? Eliminate subtle crutches.

Also re-evaluate the structure of sessions. Areas to adjust can include:

  • Increasing initial relaxation time
  • Adjusting volume level increments
  • Using noise recordings in real-world settings
  • Practicing exposures at the time of day when anxiety is highest

Improving the technique and customizing the process can get things moving again. Switching up stimuli can also be helpful – alternate sessions focused on thunderstorms versus vacuum cleaners.

Maintaining Gains Over Time

After completing the desensitization process, practice is essential to maintain gains. Encourage the person to:

  • Continue using relaxation and coping strategies when encountering noises
  • purposefully expose themselves to feared noises on a regular basis
  • make recordings of noises to use for refreshers sessions
  • avoid relying on noise cancellation devices or other crutches
  • reinforce themselves for tolerating exposures without escaping

Gently confront any backsliding without criticism. Renewed avoidance, safety behaviors, or reassurance seeking signals the need for more practice. Success is achievable with persistence.

In summary, systematic desensitization using relaxation paired with gradual noise exposure provides an effective path for overcoming phonophobias. Building coping skills and facing fears progressively can liberate people from noise anxiety. With practice over time, freedom from phobic responses is an attainable goal.

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