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Adeel [0:00]: Yeah, no no, thank you for thank you for signing up. all right, yeah, so I'll do my little intro and then we c we can get going. So Nimrod, welcome to the podcast. Great to have you here.
19503442 [0:14]: Thank you very much. I'm happy to be here too.
Adeel [0:16]: Yeah. So yeah, do you wanna tell us? I'd like to start off with kinda like you know, roughly where you're located and and then kinda a little bit about what you do.
19503442 [0:26]: Okay, so I'm based in Tel Aviv in Israel. I'm working as a CBT therapist, but I'm actually a social worker in my profession. I'm working with the Misophonia for about three, four years now.
Adeel [0:38]: Okay.
19503442 [0:54]: since I met Dr. Jenny Gregory in a CBT convention. It was just fascinating and very interesting to see the work that she's done. It was very interesting, so I tried it here in Israel. It was very meaningful for the people that...
Adeel [0:59]: Yeah, okay. Yep.
19503442 [1:23]: learned it and it was amazing.
Adeel [1:27]: Great, okay. Yeah, we have that connection with Dr. Gregory with with yeah, that that's that's awesome. so yeah, I guess so you don't have misophonia yourself, right? But you treat a lot of people with misophonia, is that that what I'm hearing?
19503442 [1:40]: Myself, I suffer from tinnitus, which is not the same, but I can relate for the problem about being more stressful and then the sound can be more effective, more... Sorry. More stressful, yeah. More stressful and...
Adeel [1:56]: Yeah. Distressing if you're stressed out. Yeah.
19503442 [2:08]: So I can relate to the idea that I shouldn't try to make myself calmer, you know, and I need to focus on different strategies for that.
Adeel [2:17]: Right. Gotcha. Okay. Yeah. Yeah. So okay, so yeah, it's so to back up a little bit, it sounds like you were you were a therapist for a while and then it was and then it was really only about three or four years ago that you i did you do you have is that when you had maybe your first patient or you started to see a an uptick in the number of people coming in with misophia symptoms?
19503442 [2:47]: So a few years ago on that convention that I met Dr. Gregory, she had a very specific workshop about misophonia, obviously. And it was something that really enlightened me that there is a way to help people living with misophonia because I met patient
Adeel [3:04]: Yeah.
19503442 [3:16]: that had this and I tried to help them in different ways. But I yet to see a serious protocol, CBT protocol that maybe can help. So it was something that really was amazing to see. And when I got back to Israel, it was actually June, same as now, almost.
Adeel [3:42]: Mm-hmm. Yeah.
19503442 [3:46]: I got back to Israel and I tried to help one patient that had misophonia with that method. I'm not sure if everybody knows it, so part of the method is to use something that is very controversial. When I see the, you know, all the different... possibilities that people talk about. that possibility of using audio recording and video recording as Jane suggested, it's controversial. So the idea that she suggested is to use the audio recording, very specific sounds, not very stressful.
Adeel [4:20]: Mm-hmm. Mm. You're right. Mm-hmm.
19503442 [4:42]: And also the other component that was very nice is to use a video of a cute animal that allegedly made that sound. the thing that I was thinking about that, okay, maybe it will help people feel less stressful because there is a cute animal, but the patient that I tried it with, the first one and then the other one,
Adeel [4:50]: Mm.
19503442 [5:11]: at the others, they actually said that it's not about the animal. Yeah, sometimes some of them can imagine an animal, cute animal in front of them when they feel stressed. So that's okay. But it was something that really helped them just shift focus from the idea that they should do something about the noise. And then they can just
Adeel [5:12]: Right. Yeah. Yeah. Mm-hmm.
19503442 [5:40]: keep doing what they learned in the practice, in the strategy for relaxation, muscle relaxation of course, not the stress, stress is still there. And the focus for whatever they hear, can be the stressful stimuli or other things that are there, that are just normal things.
Adeel [5:55]: Right. Right.
19503442 [6:10]: And of course, if they see something, it can be the cute animal, but probably the animal won't be there in the real life. So they just look at the other things that they see and it helps them to stay there and to feel more at control, even though they cannot do so.
Adeel [6:17]: Right. Yeah. Yeah, it sounds like it's it's about kind of restructuring the association of what the brain perceives is the source of the sound and making the brain think that or understand that it's or or tr trying to make the brain associate with something that's not non threatening. 'Cause I think a lot of the the the source of the fight or flight is, you know, something in your something in your mind is associating danger. to you know to the sound. So if you can try to replace it with a cute animal or or like you said, yeah, something in the environment which is non which is which has been w which your which your brain has assign you know realizes is completely non threatening that can you know calm you down and and and it sounds like maybe give your brain that space to kinda like do the relaxation, like further techniques, I I guess. Is that is that kind of how you is that part of the protocol?
19503442 [7:27]: I can guess other researchers that I read about this type of problems with the stimulus of sight or hearing. So they say the same thing as James said, you shouldn't do it very strictly and aggressively, you know, get your patient to be
Adeel [7:34]: Mm-hmm.
19503442 [7:56]: on the same spot that is having this issue and this problem, try to do it in different ways as she suggested as a cute animal's video or this almost harmful audio recording because sometimes it can be boring, you know, it's cool. And then they learn to stay focused strictly
Adeel [8:09]: Yeah. Mm-hmm. Right. Right.
19503442 [8:25]: on the information from that sense, it can be hearing or sight, and once they see as much information as possible from that sense, which is the opposite of the common sense, because they want to avoid, people want to avoid whatever is stressful, so when they can be mindful to that,
Adeel [8:30]: Yeah. Yeah. Right. Right.
19503442 [8:54]: So it can really help them stay there and just have this somewhat of divergence. They can look that direction, that direction, but they stay at that spot. And of course, when I help people, I really stress that we are never doing it in...
Adeel [9:07]: Yeah. Right.
19503442 [9:23]: You know, one jump to the pool, sorry for the rough sentence, but the phrase. So it's step by step. We can start choosing something easier and then go to the other thing. And it helps them really do it very easy in that sense.
Adeel [9:28]: yeah. Yeah. Yeah, and and you're right, I think I think the controversial aspect of it that you alluded to is the and I'm you know, I used to think this as well, like any exposure to sound is like exposure therapy, so it's automatically bad. But it's not quite binary. I think I think there is a th there i you we should I mean we can and should be using these sounds in a Yeah. Or, you know get people to or get minds to understand that these these sounds are are not threats and y you have to do it with with sounds. There and so I think I th I think we need to I need we need to reevaluate what's controversial. I think controversial is 'Cause I think there are therapists that basically want to close shut you into a room to kinda habituate you, but this is not about habituation. This is something a little bit more down at the neurological level. So
19503442 [10:53]: I agree.
Adeel [10:55]: interesting. And and so yeah, I mean, it I like to jump around in these conversations, but but I think, you know, you're the first person from Israel. I I always ask like in in certain countries, like what's the awareness of misophonia? And do you do you have any kind of sense of like how you know how many people bru I don't know about numbers, but just kinda like what is the awareness of misophonia in in Israel?
19503442 [11:19]: So it's a great question. I think that there is a few researchers in Tel Aviv University about misophonia. I'm not sure about the prevalence, about how many people has misophonia. I don't think they have the numbers yet because it's really fresh. But I know that awareness-wise,
Adeel [11:31]: Mm.
19503442 [11:49]: Not many people know about misophonia. I don't know, I think it's the same, you can tell me, but usually the people that look me up in the internet and the US for therapy, it can be teenagers and the kids themselves, not the parents. So it's really, people really don't know about it so much.
Adeel [12:06]: Yeah. Yeah. Yeah. And the younger kids are pr I'm I'm just assuming that they're they're reading about it or learning about it online or on on social media and identifying with the symptoms. and and and then but and then and then I also like to ask, I mean, Israel's an advanced country, but like mental health in general, I'm assuming it's probably you know, there's no s the there's about a same amount of stigma as anywhere else or it just it it's
19503442 [12:23]: It's
Adeel [12:42]: It's pretty w well well understood and or well y it's not that hard to find a therapist as opposed to, you know, some other countries I've talked to, like Eastern Europe, for example, or or you know, or Russia.
19503442 [12:55]: So I can tell you, it's only my opinion, maybe I'm mistaken, but as the person that lives in Israel and work in the mental health system privately and also as a social worker, I can tell you that in some aspects, many of the therapists in Israel are not well-trained, so not very far away from Russia and so on.
Adeel [12:59]: Yeah. Hmm. Okay. Okay. Yeah. Yeah.
19503442 [13:25]: Some of them are highly trained. It depends which population is getting the therapy from. For example PTSD, the psychotherapists are much well trained than other aspects. For example, misophonia, I think I'm the only one in Tel Aviv. Thank you.
Adeel [13:33]: Yeah. Yeah. Really? Okay. So this is actually a good question, because yeah, especially I I'm sure people might be listening to the podcast from Israel. What should pe in terms of like credentials or expertise, what should people look for in Israel if they're looking for someone to work with them f about misophonia and then mental health in general. Sounds like you have some opinions. it misophonia, but also maybe
19503442 [14:14]: What was the second question?
Adeel [14:20]: mental health in general. I'm not sure how people are if there's licensing or or you know, what should people look out for when if they're looking to get help.
19503442 [14:26]: Yes. So it's a great question because in Israel you have different ways to get help. You can go of course for a private practice to pay as much as you can and it doesn't mean that you'll get the best therapy. So about the private practice people should look for a licensed, I hope CPT therapy.
Adeel [14:47]: Yeah.
19503442 [14:57]: because other therapies are great but I'm not sure it's good for misophonia. And if you go for a... if you try to get help from public clinics, which it can be also great, it will be different method probably, in Israel people can get sometimes help from the government. I mean, I think...
Adeel [15:02]: Mm-hmm, mm-hmm. Yeah. Mm-hmm.
19503442 [15:25]: It's still the situation so misophonia it's not something that has a actually the You know the code for a for the computer for the government to exist So people need to ask as much as I understand they need to ask from their doctor from the psychiatrist or a neurologist to write in the letter for the government something that exists
Adeel [15:38]: Right. Right.
19503442 [15:54]: as anxiety or something like that, that they are really suffering from, and then they can get therapy that the government can give them, but I'm not sure it will be focused on misophonia, but it can help in other things.
Adeel [15:56]: Yeah. Right. Yeah, I think that's the same case around here because yeah, there is no billing coat and so audiologists get in on it and yeah, there's other ways to kind of work work that system. and yeah, and so you mentioned you have tinnitus. Are you yeah, I I guess, you know, this tinnitus is hyper acusis. are you Well, tonight it's just probably treated by an audiologist, but I mean are you what do you what do you think about 'cause a lot of people ask, okay, is this the same thing? Are they related? you know, even sometimes people ask about autism. I'm I'm kind of curious what you what you think about those do you do you ask about those other comorbidities when you get a patient?
19503442 [16:56]: About tinnitus, I'm very curious to know if people with misophonia has it, because it's something that sometimes can be a consequence of using the volume of the headset too much. So it can be a consequence of that. It's something that is very tricky, because tinnitus can be present right now, and then it can go off and then come back.
Adeel [17:12]: Mm, mm, mm. Yeah.
19503442 [17:27]: people can forget about it, you know. So if I ask, they, yeah, you know, I had it. So I had, in this era, I used AI actually, and I made some kind of software in a webpage, and then I really, can, I can actually put a record of a,
Adeel [17:33]: Right. Mm-hmm. Yeah.
19503442 [17:55]: a frequency which I can move around and ask them if they hear this frequency and that frequency and then I can really check if they have tinnitus even if they don't realize what I'm asking about so I really show them so it's nice
Adeel [17:57]: Mm. wow. Interesting. So you you use use the A program that that that moves sound around the the three D stage, if they're hearing if they're if they're on headphones to kinda out to move move the sound around? nice. Okay.
19503442 [18:26]: Yeah, usually people hear the tinnitus in one ear, not in both. And it can be a few frequencies. It can be a low frequency, high frequency. Sometimes it can be a frequency of like a wind, blow of a wind. And they don't really realize that all of it is tinnitus. And then when they can hear it with me, they can put the spot, put the...
Adeel [18:33]: Yeah. Gotcha. yes, yes, okay.
19503442 [18:56]: mark on it. So it's nice. I want to tell also, you asked about the differences in tinnitus, sometimes a problem, because it comes just because I'm stressful, as I said, and if it happens when I'm trying to sleep at night, I'm even more stressed. And it can be very difficult, very hard to treat, because you cannot...
Adeel [18:56]: Gotcha. Interesting. Okay. Yeah, yeah. Yeah. Right. Yeah.
19503442 [19:25]: tell people that are stressed to be calm, you know, it's not working.
Adeel [19:28]: Right. Right, right, right, right. Do you so yeah, w when you get people when you be when you get people in about misophonia, do you how much do you maybe get into their backgrounds, like their living situation, their work, their their stress, their background their childhood, for example. I'm kinda curious how much of the the con the full full context of the person that you that informs your the the protocol, if if at all.
19503442 [19:59]: It's a great question. So it's very charming for me to stay focused just on the problem, talk about misophonia, ask about misophonia, maybe about the parents and brothers and sisters' responses. That's it. It's very easy for me as a therapist. I will get an A grade for that.
Adeel [20:07]: Mm-hmm. Right. Right. Right. Right.
19503442 [20:26]: But it's not my job. My job, as you suggested, is to know the real life of the person without the problem, because we want to make his whole life better, not just remove maybe the disturbance of the musiconia. So it means that at least one or two sessions, besides from talking about the problem, I'm trying to get to know the person, his character,
Adeel [20:39]: Yeah.
19503442 [20:56]: His hobby is... And I like this kind of question because sometimes when I want to teach people how to use their hearing sense better, so they can do it with, you know, happy stuff, like they play guitar or piano, and they learn to relate to their hearing sense from a nice place, not a bad problem, you know. So it's nice.
Adeel [20:56]: Yeah. Mm-hmm. Yeah, no, that's interesting. and I f yeah, I didn't mean to cut you out, but I just inserting my own editorialization here. But I I feel like yeah, that that kind of reconnection with your senses is important. because I feel like we especially, you know, looking at working on looking at screens and and the way we go about our lives, there's so many this is so much intermediation between ourselves and our senses. We don't have time to do things like
19503442 [21:25]: and
Adeel [21:54]: like the making music or or or things like that and I feel like that that changes the the cognitive relationship we have with sound and makes it less of a danger in our head. So I feel like it's it's very qualitative but I feel like that's that's that has well, I feel like that that has to be part of the solution. and I I'm glad to hear that you're looking at the whole person. Because I think it is a multi pronged approach.
19503442 [22:25]: Yeah, definitely. I agree.
Adeel [22:28]: And d and do you do you pull in the family members? It sounds like you have a lot of children who come in. do you pull in the family members and educate them or maybe find out if, you know, there's something going on with them that may be I don't know, cascading into issues with the with the younger person?
19503442 [22:47]: I think it's very important to educate also the parents or other members of the family. Sometimes it can be just for one session to meet them to un-stigmatize the issue, to be able to practice together something or to watch a short... annoying fly video, you know, and then everybody is getting on the same page and they understand, the memory members understand that it's not very easy to just stay there and not to be disturbed. So it's very important. I also keep getting, keep giving a letter to
Adeel [23:18]: Yeah. Right.
19503442 [23:45]: to the loved ones, spouses, or if it's a girlfriend or boyfriend that are really serious. So I'm giving a letter that explains about it and then ask them to join us for the session so they know what they should do, what they shouldn't do after the session. Actually, it's very helpful. It's a really meaningful moment in therapy.
Adeel [23:54]: Mm. Right.
19503442 [24:15]: that the person that was alone was maybe accused or a judge. Now he sees that it's not him by himself, but everybody is part of the solution.
Adeel [24:19]: Right. Right, right. That's interesting 'cause yeah, I feel like obviously as we know it's the immediate surroundings that are often the triggers and then they can cause all kinds of resentment and defensiveness. and that just adds on to the fighter like the the perceived threat that the person has. So that's great. I think I think bringing those people in, if they are able to kind of like calm the situation or or not react aggressively or just be compassionate that that just reduces the the threat level in the person who has misophonia. and then along with your protocol and you know connecting with your hobbies and census, I feel like this is I don't know, this ha this must be a you know a a great you know hopefully great outcomes for for the for the patients that you have. So are you
19503442 [25:02]: .
Adeel [25:27]: You know, are you following up with people like a year later or or do you kind of like like put them on their way and hope that for hope for the best?
19503442 [25:34]: And So usually I try not to interrupt people after they finish therapy, but I really stress for each one that I will contact them for another maybe a small talk, but more for another questionnaire. Because it's really important to measure
Adeel [25:40]: Yeah. Yeah. Okay.
19503442 [26:05]: you know, objectively, if the problem is the same as we finished or something came up. And also, when we finish therapy and each therapy, it's something very common. We talk about the routine, that how can we keep our legs or foot on the gas, you know, and enjoy life.
Adeel [26:13]: Right. Yeah. Right.
19503442 [26:33]: But also there are sometimes crisis, maybe a war, unfortunately, or maybe personal issues that people can get more stressed. And when there is more stress, of course, misophonia is higher. And then it's also something that's very important for me to reach out and to see that they can practice without me. I just remind them.
Adeel [26:40]: Mm-hmm. Yeah. Yes, yes.
19503442 [27:01]: and then they can live their life, of course, with more practice on that week or two, but it won't get worse. So it's very important. I want also to talk about another issue that sometimes happens. So sometimes, especially in teenagers, you can see that they have somewhat of an obsessive or compulsive
Adeel [27:08]: Yeah. Yeah. Yeah.
19503442 [27:32]: behaviors. Of course it's not OCD, it's not the same treatment, it's not the same problem, but it can be for example when a child feels stressed and then they hurt themselves. Okay, it's a compulsory, they don't want to this pain, but it's a compulsion. And I want to tell anyone that hear me now,
Adeel [27:46]: Mm. Right.
19503442 [28:01]: So just for you to it's normal, it's okay. And it's really something that goes away when you can talk about it and you can do other strategies basically, which doesn't involve pain. And other things that maybe the family members can relate to are some obsessive rules that the person try to live for.
Adeel [28:28]: Okay. Yep.
19503442 [28:29]: So I can decide where everybody is sitting next to the table or in the right car ride, for example, which is okay. It's very okay to talk about things. It's not a bad thing. But the issue is once you have a rule, which is not something that helps, you need to change the rule. You know, it's very important not to keep adding more rules on the rules and it doesn't help. So it's okay to have rules.
Adeel [28:41]: Yeah. Mm-hmm. Right.
19503442 [28:59]: and these strategies, but it should be something that you and your family members, if you are a child of course, you really focus and see if it helps. And think about it before you do it. It's a nice game actually.
Adeel [29:11]: Yeah, that's that's yeah, no, that's that's that's those are very f excellent points because you're right, I think a lot of rules get I don't know, passed down or they're un unnecessarily rigid. I d and I think maybe misophonia is an opportunity to kind of like make sure we have perspective on rules, know where we should be flexible where we you know, shouldn't be and Yeah, and I I think I think knowing some rules are changeable is yet another thing that could signal to the brain that I'm in a safe environment. Where, you know, there's there's open communication, there is flexibility, and it's all I think related related to stress. you're I mean I mean correct me if I'm wrong, but you and and then you said you were talking about a com so the compulsion issue, you're talking about
19503442 [29:57]: Thank
Adeel [30:11]: Compulsion to inflict pain on oneself? Is that is that what is that what you're referring to? Yeah. Is there is there a clinical name for that? Yeah.
19503442 [30:16]: Yeah. And some teenagers, yeah. It's just, you know, it can be a BFRB, know, behaviors that are directed to the body and it's a repetitive thing. But it's something, it doesn't happen all the time, but people, know, teenagers, they really tend to keep it to themselves. So this is the way to handle the stress, basically. Sometimes.
Adeel [30:25]: Okay. okay. Yeah. Right. Right. Right. Yeah. No, that's that's interesting. yeah, it it's it's yeah, I I I ha I always shudder to use to say the word maladaptive, but but yeah, it's so it's a I don't I don't and I don't want to say natural, but it's a way like you said, it's a way for the body to handle stress. And I sometimes think about whether misophonia in some way is your body reacting the way we it was evolved to react kind of seek out danger, but maybe it's been kind of like misconnected to something that is not actually danger. sometimes I feel like to the to the point earlier about sensory intermediation, we have a lot of we have a lot of new things that stimulate our senses. And I don't think we've necessarily kind of like our brain is our brains have maybe not caught up to what what is what's always what's to always correctly identify what is a danger and what is not. And so sometimes it something happened in childhood or or or there's something I don't know, there's there's an environment where there's the wrong rules. Well, if there's if there's a sound around there, then maybe our brain associates danger with that as a way to signal that maybe something needs to change. so
19503442 [31:56]: I like, I really love what you said. I always love to tell to the children or adults that are coming for therapy and they are very stressful, they don't know if it will help. So I'm just telling them, listen, I don't have a time machine. I really don't know what will happen in the future. I know that we can help, help you with the problem, that it will be more easy to manage. It won't go away. if in the future some aliens will come and they will have this spaceship that will do horrible noise. So I'm not going to call you back to therapy, it's not my will, but I want you to be ready with this really strong internal sense that you will feel that you can manage it with the same thing that you learned about the current thing that is disturbing you.
Adeel [32:39]: Yeah.
19503442 [32:54]: I agree. We don't know why, but we can manage somehow to do better.
Adeel [32:56]: Yeah. Yeah. No, that's interesting. yeah, I think this is the first time on the podcast somebody's mentioned aliens coming back to trigger people's misophonias. That sounds like a a book that needs to be written. no very interesting. So so as you've been following up with people, are the questionnaires you give them something that you've come up with? Is there is there like a standard way to follow up with people?
19503442 [33:26]: So there were two questionnaires that I used. The first one, I'm not really sure which one. can check if it's important. It was a standard questionnaire, of course. And then I encountered with the new one, also standardized one, of course, validated. It was better. I was thinking myself it was better. And then I checked it, of course, with patients.
Adeel [33:30]: Mm-hmm. No Yeah. Yeah.
19503442 [33:55]: And they said, yeah, this one is more suited to my problem. So I'm using the new one.
Adeel [34:00]: Okay. Yeah, yeah. Okay. Cool. And yeah, I mean so you you know, you went to that the conference where you met Jane a while back. Are you, you know, in communication with researchers now or or other therapists and yeah, I'm kinda curious kind of like how you're keeping up with what's what's happening. 'Cause a lot a lot's a lot, at least yeah, a lot in terms of research and in the press is is moving seems like fairly quickly.
19503442 [34:29]: It's really fascinating to see this growing field in psychology, I guess in other fields, I'm in the psychology field. So I'm currently trying to be in contact with anybody I can. I myself trying to start also some researches.
Adeel [34:49]: Mm-hmm.
19503442 [34:59]: about the autism spectrum, including the phonia. And of course it will be PTSD related because of the situation in Israel. This is the place I can have my research. I think it will be very interesting because we said, we know that the stress, the higher is the stress, the higher can be the means of phonia. So I hope I will.
Adeel [35:03]: Yeah.
19503442 [35:27]: managed to learn something that will aid also other people. And I want to say also something about, you know, on top of it, I'm young, I'm 36 years old, but the...
Adeel [35:32]: Yeah. Mm-hmm. You're thirty six? yeah, you're young. You're I'm I'm almost fifty.
19503442 [35:51]: And some time ago, something like the 90s in Israel, when people had common problems today, back then, when people had anxiety or depression, it was very stigmatized, people were being labeled as lazy, and so on. Today, no one would think about it, but back then it was like that.
Adeel [35:59]: Yeah. mhm.
19503442 [36:20]: And I think I got really inspired by your podcast. And of course, researchers and other things. And it looks for me that in the future, I don't know when, it can be something that we will look upon. It will be something that people, they have respect for it. that people need their quiet place and not being stigmatized. Yeah, of course.
Adeel [36:54]: Right. And it's normal. Right, right. Yeah, no, I appreciate that. That that's kind of the reason to do the podcast is just kind of like keep rolling out stories that that are that get into the person's you know, like you do with your patients, like get into the entire person and the system around them and make it make people realize that it's a a normal part of most people's many people's lives. Normal as in, it's it's it's something that it's experienced, not that it's, you know, something that we we want. but yeah no no that's that's that's great. No, I and I would love I'd love to I mean I'd love to support anything, you know, that that helps you create if you if you wanted to and then it helps kind of create a community in in in in Israel. I don't think I've had any what yeah anyone else from Israel on. no that's great. yeah maybe when those aliens come down by then the world whole world will be ready to to kind of like take them on in the in the name of Misophonia
19503442 [37:26]: Yes. Thank Thank
Adeel [37:54]: so yeah, so yeah, so really interesting. yeah, something I don't know, yeah, I I haven't fully fledged these thoughts, but like but yeah, I mean it's it's very yeah, you're definitely in a unique spot with you know, obviously the P PTSD kind of kind of issue. Something I've thought about over the last five years is, you know, my whole thinking about misophonia has kind of like evolved. First I was like, it's it's gotta be some hardwired thing and one day we'll get a pill or something. But then it all then as I as everyone comes on in the podcast and I hear about all these childhood events and adverse childhood situations, I I got very interested in is must be PTSD or ish related. But it's not always the case. however then you know now I'm kind of in in the case where it's it's possibly because, as I alluded to earlier, we our our modern lives have kind of made our relationship with our senses and our ability to like s know what's actual distress and what's friction what's danger and what's not kind of like complicate things for for our minds. But but y but y but in terms of PTSD, I mean there are a lot of you know there are a lot of people unfortunately now and in the past have been in I mean the earthquakes or wars, deep, deep tragic PTSD situations. But I'm curious, like, there is a sometimes there is a resilience where there isn't a lot of mental health. Like, there was there was some there's a a critical theorist Captain Liu who who who who wrote about how sometimes when when Western scientists go to war regions they they introduce diagnoses which then suddenly become common in the in environments where there there was a tragedy and it's almost like, you know, to not to make it too political, but like the West is kind of like exporting diagnoses into into places where they may have had more the ability to be more resilient. I'm curious if I don't know, that's something you've ever th thought about or I could I'm I'm I'm curious to see how that would apply to misophonia and PTSD.
19503442 [40:19]: I want to suggest something. It makes sense. People are less aware about their problem once you ask them questions so they keep searching these answers afterwards and it makes it disturbing maybe. I think that misophonia is not something that people can get just from the...
Adeel [40:21]: There's a bunch of messy thoughts that like I said were not we're not very well formed, but I think there's something Yeah.
19503442 [40:47]: people being asked about. it's really an issue. In PTSD, it's really political. Political in the meaning of money. If people get recognition of PTSD in many states or maybe not government, maybe private insurance, they get money. So yeah, it's a political thing. It's money. But I want to...
Adeel [41:09]: Mm-hmm. Mm-hmm. Right. Yeah.
19503442 [41:16]: stress out that if you look at the real issue if the government or the, for getting this social work aspect, but if the government or private practice that are insurance wise, you know, so if they will do the best practice possible by this diagnosis, so they can really see if the problem exists. Okay.
Adeel [41:26]: Yeah, yeah, no, that's good. Please.
19503442 [41:46]: If people tell me I have misophonia and I try to help them with the protocol and I'm as a therapist are asking questions and trying to suggest them strategies and then I see okay They said it's misophonia, but something else is bothering them. They are not they're not being able to To do something so then I can figure out okay. Maybe I got wrong diagnosis They told me so but maybe it's wrong. Maybe I need to suggest them
Adeel [42:03]: Mm-hmm. Mm. Mm.
19503442 [42:15]: something next to it, know, phono-phobia for example. It's not instead of misophonia, but I need to treat phono-phobia, for example.
Adeel [42:19]: Mm, mm-hmm. Right. Right. Yeah, no, that that's yeah, that's super interesting. Yeah, and and and actually for people listening, could you could you because phonophobia doesn't come up on the podcast that much for some reason, but do you want to like define that a little bit? And then yeah, and yeah, I'd love to kind of like hear your thoughts on you know, parallel issues like misokinesia, the the whole visuals visual triggers if if you see that in your practice.
19503442 [42:51]: Yes. So let's start from the end. About visuals, as researchers suggest, it's part of misophonia. It's not something that may be happening. Maybe it takes time until it disturbs. As you said, if I ask about something, people will notice it. So maybe it takes time, because the thing that is more getting focused is the hearing.
Adeel [42:58]: Yes. Right. Nobody's looking at Right. Right.
19503442 [43:21]: But then when I get used to it after a few years, the sight also is part of it. It's enough only to see it and then the mind is completing the sound. Everybody of course knows it. I'm not saying anything new. So this is about the sight. So I think it's really part of misophonia. And about related problems, phonophobia. Phobia, means that even
Adeel [43:33]: Yep. It's predicting. Yeah.
19503442 [43:51]: to think about the situation, to being in a dinner or a movie or something, I only think about it and I get as a panic attack, know, as a stress and everything. So this is about the phobia thing and it can be something that if, in my honest opinion of course, it's not something that I can show in research. Yeah, it happens in Misophonia, sometimes.
Adeel [44:01]: Mm. This is a place to share it. Yeah.
19503442 [44:21]: When people go to therapy, it exists. And of course, Spontophobia, it's also a problem that is related to other things. It can happen with tinnitus, of course. So I will take a pill because I want to sleep better. And then I will have phobia from being without the pill, okay? Sleeping pill. And then if I have PTSD, and I can be very triggered from just walking on the streets,
Adeel [44:24]: Gotcha. Mm. yep.
19503442 [44:51]: and then someone will honk or a scooter will drive by and then I can have this frightening moment so I can get a phobia from being on the street and getting spooked like that. So it can be also a phono-phobia but it's not the same reason of course. The treatment is very different.
Adeel [45:08]: Mm. Gotcha. Right. Interesting. Yeah, okay. G yeah. I can see how I mean yeah, I can see how that's related and and yeah, I I always Pardon me? No, please c Yeah.
19503442 [45:22]: I wanted to add also another issue. You were asking about related problems, so hyperacoustics, something that sometimes can be related directly to misophonic triggers. What I think, I'm not sure, but I think it can be, for example, when people hear the silverware sound crashing.
Adeel [45:33]: Yes. Right. Yes.
19503442 [45:49]: or two bottles of glasses, for example, touch each other and it's something that can sometimes be very hurtful. So it can be something that maybe can be defined in hyperacoustics. So we need to address it because if it hurts, we are afraid of the pain actually. It's not only the...
Adeel [46:15]: Right.
19503442 [46:17]: the stress and the anger that just happens.
Adeel [46:21]: Right. Yeah, yeah, yeah. You're right. And hipercuses for I'm sure people listening on understand it's like it's like things are turned up like the volume is turned up. and it's probably at a f frequency level, like you know, especially high frequencies can be turned up. But it but it's you know, I I've I've heard though it seems like it's hard to distinguish if something far away is actually far away because everything just kinda seems loud. But if yeah, but to your point about visual triggers, yeah, I totally agree. Like they tend to come later and I feel like it's it's just another layer of your mind predicting what could be a dangerous situation. and I agree, like I've said this many times on the podcast, and now there is starting to be some research kind of going in this direction, trying to look at misophonia as not the main not not what we should be calling it or not the whole story. and I I agree, yeah. In a few years, I think when those aliens come down, by then we'll probably have a a new name which encompasses more of a a sensory, you know, a higher level sensory issue. So cool. Well, yeah. Sorry, go on. Yeah.
19503442 [47:39]: I just wanted to address it. another thing that I really like about Misophonia, that it's pure research, science, curiosity at their best, because it was something that, you know, I won't say the name, but it was named differently in 99, and then it was named differently a few years afterwards, and it will be continuing to change, because we need to define what is...
Adeel [48:03]: Mm-hmm.
19503442 [48:07]: the problem, to solve it. I really like this issue. It's really not a closed thing, not deal done, know, deal, sorry.
Adeel [48:09]: Right. Right. Yes. Yeah. Yeah. No, no, you're right. I I was I was I was around when it was the previous name. I don't know if I don't know if you have a reason for not mentioning it, but I can I can mention at least one of the names that I'd died I'd heard of. but it was yeah, I think it was like Selective Sound Sensitivity Syndrome. But Yeah.
19503442 [48:39]: The reason I didn't say the name is because it can be a triggering sound. is why. Yes.
Adeel [48:45]: okay, okay. yeah, good point. That's a lot of yes, right. There's a lot of sounds. good good catch. no s super interesting. Well, yeah, no, I love what you said about and that's I think why I'm still kind of like my thinking is evolving and why I like to think about misophonia is because it does involve all the things you said, curiosity, science, psychology, but for for me now it's also
19503442 [48:52]: Yes,
Adeel [49:15]: Al also involving like philosophy, critical theory, literature. you know, I'm reading Marcel Proust and it's very much about experiences of the senses. And so yeah, it's just a fascinating doorway into into a lot of interesting things about about the human experience. so yeah, thanks for mentioning that. I mean, we're getting close to a about an hour It's it's flown by. Last time I looked, it was like twenty three minutes in and now we're like you know, more than twice that. But this has been a super fascinating conversation. Is there anything else you wanna share or I don't know, links or calls to action that you wanna share for people in Israel or around the world?
19503442 [50:02]: So I want to try to help as many people as I can. If anyone that are interested that are in us right now would like to use any of the audio recordings or the videos of the cute animals that are related to, if anybody want to use it, I really offer. a sincere help or if researchers want to check it or anything. I always tell to my patient that this protocol is nice. were some cases that were looked and it was nice, but it's not a really serious research yet. It's not enough years. So any researchers or people that want to try it, for themselves and to see how it goes. I really would love to, know, anything is online today. So it's really easy.
Adeel [51:08]: Yeah. it was interesting. I and I have no idea what the legality of of this or or the ethics of this would be 'cause I the Misophonia podcast app that I have has, you know, obvious obviously has all the episodes. It had but it has a bunch of resources, but it also has a place for f tools like relaxation like sound tools, but then also there is a I think it was actually an Israeli team that had come up with a a kind of a an a a digital a digital app kind of way to go through a a a fixed set of sessions in in a digital tool. And actually inspired by that paper, I incorporated it into the app. So I'm wondering if in the app I could, you know, have the audio and the video from from what from what you're talking about and just kinda like I'll obviously I won't like it's not gonna be like I can't call it like
19503442 [52:01]: Goods.
Adeel [52:06]: therapy, but maybe there's a way to kinda get feedback from people and just have that as a distribution method. So
19503442 [52:10]: I think it will be great. Of course, people that are trying to do self-implicant therapy, so it's not the same. But some levels of misophonia, it's possible to just read a book, practice, or online. Of course, it can be helpful.
Adeel [52:22]: Right, right. Yeah. Yeah. Yeah. Yeah. And I think it like it it demystifies what happens in a session 'cause I think to this day a lot of people still don't understand what, you know, if they go to Nimrod, what are you what do you what are you gonna do? And so I think this kinda helps to un remove the veil a little bit. So
19503442 [52:48]: I think you are right. People that are talking with me, sometimes they hear, this is the therapy, I will need to listen to audios. So it's very stressful and I think that it's very easy to try it and to see. Of course, I really hope that people will go to a therapist in their country and their language and of course...
Adeel [52:57]: Right. Right, right. Yeah. Right. Yeah. Yeah.
19503442 [53:17]: It's very easy and everybody that would like could use it. It can be very helpful.
Adeel [53:27]: Right, right. cool. Well, yeah, Nimrod, this it's been a fascinating yeah, conversation and yeah, I'm gr it's I'm grateful for what you're I'm sure people in Israel are grateful that they have, you know, now start to have therapist that they can go to for help about misophonia and hopefully a community forms around that. But yeah, I wish you the best and and yeah, thanks thanks for coming on the show.
19503442 [53:52]: Thank you very much for having me. It was fascinating.
Adeel [53:56]: And cut. And that's kinda how I know to to stop the recording. I'll just hit re