Article

Cognitive behavioral therapy is effective in misophonia: An open trial

April 2017
Journal of Affective Disorders 217:289-294

DOI:10.1016/j.jad.2017.04.017

Authors:

Arjan Schröder

Amsterdam UMC

Nienke Vulink

Academisch Medisch Centrum Universiteit van Amsterdam

Damiaan Denys

AmsterdamUMC

Background: Misophonia is a psychiatric disorder in which ordinary human sounds like smacking or chewing provoke intense anger and disgust. Despite the high burden of this condition, to date there is no evidence-based treatment available. In this study we evaluated the efficacy of cognitive behavioral therapy (CBT) and investigated whether clinical or demographic characteristics predicted treatment response. Methods: Ninety patients with misophonia received eight bi-weekly group CBT sessions. Treatment response was defined as a Clinical Global Impression - Improvement Scale (CGI-I) score at endpoint of 1 or 2 (very much or much improved) and a 30% or greater reduction on the Amsterdam Misophonia Scale (A-MISO-S), a measure of the severity of misophonia symptoms. Results: Following treatment 48% (N=42) of the patients showed a significant reduction of misophonia symptoms. Severity of misophonia and the presence of disgust were positive predictors of treatment response. Limitations: The A-MISO-S is not a validated scale. Furthermore, this was an open-label study with a waiting list control condition. Conclusions: This is the first treatment study for misophonia. Our results suggest that CBT is effective in half of the patients.

Cognitive behavioral therapy is effective in misophonia: An open trial

Data

April 2017

Arjan Schröder · Nienke Vulink · Arnoud J. van Loon · Damiaan Denys

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Understanding the misophonic experience: a mixed method study

Article

Full-text available

Feb 2025

Misophonia is a poorly understood condition in which intense distress is experienced in response to mostly orofacial stimuli. To better understand why specifically anger and disgust seem to characterize this distress, we investigated meanings conveyed by misophonic trigger stimuli in two studies. Study 1 explored these meanings and emotions in two small focus groups (n = 3, n = 5) of misophonia sufferers. Four meaning—themes were generated based using reflexive thematic analysis: “intrusion,” “violation,” “offense,” and “lack of autonomy.” Also, four emotional reaction themes were constructed: “anger/defensive rage,” “disgust,” “fear,” and “safety behaviors.” Study 2 aimed to corroborate the findings of Study 1 in a large, independent sample. To this end, misophonia symptom severity was assessed in 431 young adults using the Amsterdam Misophonia Scale (A-Miso-S). Participants rated the extent to which the meanings and reactions identified in Study 1 matched their experiences with prototypical misophonic trigger stimuli. The meanings showed a positive, moderate correlation with misophonia symptom severity and accounted for 35.15% of the variance in A-Miso-S scores. An exploratory factor analysis identified two factors explaining 50% of the variance in the meanings and reactions. Factor 1, “Avoidance of intrusive/disgusting stimuli” had high and unique loadings on avoidance, intrusion, and disgust. Factor 2, “Autonomy/Violation,” had high and unique loadings on violation, lack of autonomy, offense, and defensive rage. These findings suggest that the meanings of intrusion, violation, and lack of autonomy are inherent to the misophonic experience, with potential implications for treatment strategies.

Misophonia as a New Obsessive-compulsive Related Disorder?

Chapter

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Jan 2025

Effects of cognitive behavioral therapy for misophonia: A systematic review

Preprint

Full-text available

Dec 2024

Background: Misophonia is a condition characterized by intense physical and emotional reactions to everyday sounds, commonly known as triggers. Despite its prevalence, with estimates suggesting that 6% to 20% of students are affected, research on effective treatments remains limited. Misophonia is believed to stem from enhanced connectivity between the limbic system and auditory structures, rather than auditory abnormalities. Comorbidities with mental disorders such as PTSD, OCD, and major depressive disorder are common. While no definitive treatment has been established, cognitive behavioral therapy (CBT) shows promise. Studies indicate that CBT can reduce distress and improve coping strategies, with significant symptom improvement reported after CBT interventions. Methods: We included randomized controlled trials, open-label studies, and pilot cases focused on misophonia, using PubMed, PsycINFO, Web of Science, and Google Scholar for our search. Non-English studies, animal research, and case reports were excluded. Data extraction covered study parameters and outcomes, and biases were evaluated using the Cochrane Collaboration method. Results: Screening 28 studies led to inclusion of six, including randomized controlled trials and an open-label study. Results show cognitive behavioral therapy (CBT) significantly reduces misophonia symptoms, with studies reporting up to 48% improvement in A-MISO-S scores and sustained benefits over time. These findings underscore CBT’s potential as a promising treatment for misophonia, though further research is needed to establish standardized protocols and long-term efficacy. Conclusion: This systematic review confirms CBT as effective for treating misophonia, highlighting its symptom reduction and quality of life improvements. Further research is needed to refine CBT protocols and explore alternative treatments.

Current Trends in the Treatment of MisophoniaMizofoni Tedavisinde Güncel Yaklaşımlar

Article

Jun 2024

Misophonia is a disorder characterized by emotional and physiological responses that occur in response to certain auditory stimuli. Visual, tactile, and olfactory stimuli, primarily oral and nasal sounds such as eating, nose, and respiratory sounds, reveal misophonic responses. People with misophonia may have difficulty in social interactions, and work or school performance may be adversely affected. Misophonia symptoms can also cause anxiety, depression, and other mental health problems. Physiological reactions in the body, such as pain, sweating, tachycardia, hot flashes, and breathing difficulties, negatively affect people's physical health. For this reason, people's physical and mental health and quality of life are significantly affected. The absence of agreed diagnostic criteria for the diagnosis of misophonia and the lack of sufficient data to classify it as a psychiatric disorder has led to the lack of validated treatment guidelines. However, there are treatment recommendations discussed in the literature for misophonia, which has a prevalence of 20% in a limited number of studies and negatively affects the functionality of the individual. In the management of misophonia, tinnitus re-education therapy (TRT) was used as audiological treatment, antidepressants, and anxiolytics were used as pharmacological treatment and cognitive behavioral therapies were used as therapy. Other suggested treatment recommendations are neural remodeling technique, sequential remodeling hypnotherapy, trauma prevention technique, and trauma and tension reduction exercises. This review aims to present the treatment approaches available in the literature together and to understand the need for experimental evidence for treatment methods.

Targeting beliefs and behaviours in misophonia: a case series from a UK specialist psychology service

Article

Full-text available

Oct 2023
BEHAV COGN PSYCHOTH

Background: Misophonia, a disorder of decreased sound tolerance, can cause significant distress and impairment. Cognitive behavioural therapy (CBT) may be helpful for improving symptoms of misophonia, but the key mechanisms of the disorder are not yet known. Aims: This case series aimed to evaluate individual, formulation-driven CBT for patients with misophonia in a UK psychology service. Method: A service evaluation of one-to-one therapy for patients with misophonia (n = 19) was conducted in a specialist psychology service. Patients completed an average of 13 hours of therapy with a focus on the meaning applied to their reactions to sounds and associated behaviours. Primary outcome measures were the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Scale (A-MISO-S). Repeated measures t-tests were used to compare scores from pre-treatment to follow-up, and reliable and clinically significant change on the MQ was calculated. Results: Scores significantly improved on both misophonia measures, with an average of 38% change on the MQ and 40% change on the A-MISO-S. From pre-treatment to follow-up, 78% of patients showed reliable improvement on the MQ and 61% made clinically significant change. Conclusions: Limitations included a lack of control group, small sample size, and the use of an outcome measure that had not been thoroughly validated for a treatment-seeking sample. These results suggest that one-to-one, formulation-driven CBT for misophonia is worth exploring further using experimental design. Potential mechanisms to explore further include feared consequences of escalating reactions, the role of safety-seeking behaviours and the impact of early memories associated with reactions to sounds.

Novel five-phase model for understanding the nature of misophonia, a conditioned aversive reflex disorder

Article

Full-text available

Oct 2023

Background: Misophonia is a recently identified condition in which a person perceives a subtle stimulus (e.g., eating sounds, hair twirling) and has an intense, negative emotional response. Misophonia cannot be classified with established nosological systems. Methods: We present a novel five-phase model of misophonia from a cognitive-behavioral framework. This model identifies a learned reflex of the autonomic nervous system as the primary etiology and maintenance of misophonia. Phase one is anticipatory anxiety and avoidance. Phase two is a conditioned physical reflex (for example, the tensing of calf muscles) that develops through stimulus-response Pavlovian conditioning. Phase three includes intense negative emotional responses and accompanying physiological distress, thoughts, urges, and emotion-driven behavior. Phase four is the individual’s coping responses to emotional distress, and phase five is the environmental response and resulting internal and external consequences of the coping behaviors. Each phase helps explain the maintenance of the response and the individual’s impairment. Results: Anticipatory anxiety and avoidance of phase one contribute to an increased arousal and awareness of triggers, resulting in increased severity of the trigger experience. Both the Pavlovian-conditioned physical reflex of phase two and the emotion-driven behavior caused by the conditioned emotional response of phase three increase with in vivo exposure to triggers. A newly identified feature of phase four is a covert review of the trigger experience. Phase five includes the consequences of those behaviors with internal consequences of beliefs and new emotions (e.g., shame, guilt) based on environmental responses to anger and panic. Conclusions: We assert the Mitchell-Dozier model provides a novel framework to understanding misophonia as a multi-sensory reflex condition. Our model states that misophonia initially develops as a Pavlovian-conditioned physical reflex and subsequent conditioned emotional responses. Treatments that identify patients’ specific conditioned physical reflex of phase two have shown promising early results, further supporting this model

Disgust and Anxiety Sensitivity as Vulnerability Factors in Misophonia

Article

Full-text available

Jan 2023

Objective: This study was aimed at exploring the association between disgust sensitivity and misophonia. We explored the mediating mechanisms underlying this relationship by specifically examining the mediating role of components of anxiety sensitivity in this association. Methods: Two hundred and thirteen individuals completed the online measures of disgust sensitivity, anxiety sensitivity and misophonia. Results: The results indicated that core disgust was significantly and positively associated with misophonic distress and aggressive behavioral reactions to triggers of misophonia but failed to correlate with nonaggressive reactions to the distress elicitors. Furthermore, the social concerns component of anxiety sensitivity partly mediated the association between core disgust and misophonic distress and the cognitive concerns component of anxiety sensitivity served as a mediator in the relationship of core disgust and aggressive behavioral reactions to misophonic distress elicitors. Direct effects of core disgust on misophonic distress were also found. Conclusions: Results highlight the significance of identifying the mechanisms that underlie the mediated paths between core disgust and emotional-behavioral features of misophonia. Findings point to a distinction between misophonia and obsessive compulsive and related disorders. Theoretical implications involving ‘not just right experiences’, sociomoral disgust and mental contamination are discussed.

Novel five-phase model for understanding the nature of misophonia, a conditioned aversive reflex disorder

Article

Full-text available

Aug 2023

Background: Misophonia is a recently identified condition in which a person perceives a subtle stimulus (e.g., eating sounds, hair twirling) and has an intense, negative emotional response. Misophonia cannot be classified with established nosological systems. Methods: We present a novel five-phase model of misophonia from a cognitive-behavioral framework. This model identifies a learned reflex of the autonomic nervous system as the primary etiology and maintenance of misophonia. Phase one is anticipatory anxiety and avoidance. Phase two is a conditioned physical reflex (for example, the tensing of calf muscles) that develops through stimulus-response Pavlovian conditioning. Phase three includes intense negative emotional responses and accompanying physiological distress, thoughts, urges, and emotion-driven behavior. Phase four is the individual’s coping responses to emotional distress, and phase five is the environmental response and resulting internal and external consequences of the coping behaviors. Each phase helps explain the maintenance of the response and the individual’s impairment. Results: Anticipatory anxiety and avoidance of phase one contributes to an increased arousal and awareness of triggers, resulting in increased severity of the trigger experience. Both the Pavlovian-conditioned physical reflex of phase two and the emotion-driven behavior caused by the conditioned emotional response of phase three increase with in vivo exposure to triggers. Phase four includes internal and external coping behaviors to the intense emotions and distress, and phase 5 includes the consequences of those behaviors. Internal consequences include beliefs and new emotions based on environmental responses to anger and panic. For example, the development of emotions such as shame and guilt, and beliefs regarding how ‘intolerable’ the trigger is. Conclusions: We assert misophonia is a multi-sensory condition and includes anticipatory anxiety, conditioned physical reflexes, intense emotional and physical distress, subsequent internal and external responses, and environmental consequences.

Novel five-phase model for understanding the nature of misophonia, a conditioned aversive reflex disorder

Article

Full-text available

Jul 2023

Background: Misophonia is a recently identified condition in which a person perceives a subtle stimulus (e.g., eating sounds, hair twirling) and has an intense, negative emotional response. Misophonia cannot be classified with established nosological systems. Methods: We present a novel five-phase model of misophonia from a cognitive-behavioral framework. This model identifies a learned reflex of the autonomic nervous system as the primary etiology and maintenance of misophonia. Phase one is anticipatory anxiety and avoidance. Phase two is a conditioned physical reflex (for example, the tensing of calf muscles) that develops through stimulus-response Pavlovian conditioning. Phase three includes intense negative emotional responses and accompanying physiological distress, thoughts, urges, and emotion-driven behavior. Phase four is the individual’s coping responses to emotional distress, and phase five is the environmental response and resulting internal and external consequences of the coping behaviors. Each phase helps explain the maintenance of the response and the individual’s impairment. Results: Anticipatory anxiety and avoidance of phase one contributes to an increased arousal and awareness of triggers, resulting in increased severity of the trigger experience. Both the Pavlovian-conditioned physical reflex of phase two and the emotion-driven behavior caused by the conditioned emotional response of phase three increase with in vivo exposure to triggers. Phase four includes internal and external coping behaviors to the intense emotions and distress, and phase 5 includes the consequences of those behaviors. Internal consequences include beliefs and new emotions based on environmental responses to anger and panic. For example, the development of emotions such as shame and guilt, and beliefs regarding how ‘intolerable’ the trigger is. Conclusions: We assert misophonia is a multi-sensory condition and includes anticipatory anxiety, conditioned physical reflexes, intense emotional and physical distress, subsequent internal and external responses, and environmental consequences.

A systematic review of treatments for misophonia

Article

May 2023

Research into misophonia treatments has been limited and it is unclear what treatment approaches may be effective. This systematic review extracted and synthesized relevant treatment research on misophonia to examine the efficacy of various intervention modalities and identify current trends in order to guide future treatment research. PubMed, PsycINFO, Google Scholar, and Cochrane Central were searched 4using the keywords "misophonia," "decreased sound tolerance," "selective sound sensitivity," or "decreased sound sensitivity." Of the 169 records available for initial screening, 33 studied misophonia treatment specifically. Data were available for one randomized controlled trial, one open label trial, and 31 case studies. Treatments included various forms of psychotherapy, medication, and combinations of the two. Cognitive-behavioral therapy (CBT) incorporating various components has been the most often utilized and effective treatment for reduction of misophonia symptoms in one randomized trial and several case studies/series. Beyond CBT, various case studies suggested possible benefit from other treatment approaches depending on the patient's symptom profile, although methodological rigor was limited. Given the limitations in the literature to date, including overall lack of rigor, lack of comparative studies, limited replication, and small sample size, the field would benefit from the development of mechanism-informed treatments, rigorous randomized trials, and treatment development with an eye towards dissemination and implementation.

The lived experiences of people with misophonia in educational, work, and everyday settings: an Interpretative Phenomenological Analysis

Preprint

Full-text available

May 2023

Background and Objectives Misophonia is a condition characterised by the experience of negative emotional and physiological reactions to specific sounds, such as chewing, pen tapping or sniffing (Potgieter et al., 2019). People suffering from misophonia experience irrational and disproportionate feelings of anger, disgust, and harm ideation that negatively impact their lives. The current study aims to address a gap in the literature by exploring people’s lived experience with self-diagnosed misophonia in educational, work, and everyday settings. Methods Five interviews were conducted with individuals who self-diagnosed as having misophonia. Interview transcripts were analysed using Interpretative Phenomenological Analysis. Results The analysis revealed four superordinate themes: ‘Phenomenology of the misophonia reaction’, ‘Susceptibility to triggering sounds’, ‘Coping strategies when triggered’, and ‘Levels of attention and concentration’. Misophonia was reported as having wide-ranging effects on mental health and familial/social relationships. Coping strategies that re-direct attention and concentration, such as mindfulness techniques, were reported to be effective in ameliorating aversive reactions. Conclusions The findings provide the first phenomenological insight into misophonia through ideographical analysis of a small number of cases. Future research and implications of the study are discussed.

Clinical Considerations for Integrating Ethical Principles of Beneficence in the Development of Evidence-Based Interventions: The case of Pediatric Misophonia

Article

Full-text available

Sep 2024

Misophonia is a condition involving decreased tolerance and intense responses to specific sounds, often those that are human-generated and repetitive in nature. Misophonia frequently onsets during childhood and is associated with significant distress, impairment, and diminished quality of life. While misophonia research remains nascent and no definitive practice guidelines exist at present, extant studies offer several promising potential avenues in intervention development for adults with misophonia. However, such research is comparatively limited for youth. Before widespread adoption of promising treatments, it is important to consider the potential for harm or non-beneficence that may arise from the mis-informed application of such treatments. In this article, we identify several potential pitfalls within intervention development for pediatric misophonia and provide recommendations to circumvent them. To that end, we focus on the following three topic areas: (a) challenges arising when psychological mechanisms are not considered in intervention development, (b) importation of a cognitive-behavior therapy (CBT) framework for obsessive-compulsive spectrum disorders without nuanced tailoring to misophonia, and (c) neglecting to include individuals with lived experience in the process of intervention development research. Considering these key areas within misophonia intervention development will be critical for upholding beneficence and minimizing harm in treatment of misophonia across the lifespan.

Beyond sound irritation: cross-cultural evidence on the robustness of the five aspects of misophonic experience measured by the S-Five in a Polish sample

Article

Full-text available

Jun 2024

Misophonia is commonly associated with negative emotional or physiological responses to specific sounds. However, the consensus definition emphasizes that misophonia entails much more than that. Even in cases of subclinical misophonia, where individuals do not meet the disorder criteria, the experience can still be burdensome, despite not currently causing significant distress or impairment. The S-Five is a psychometric tool for comprehensive assessment of five aspects of misophonic experience: internalizing, externalizing, impact, threat, and outburst, and includes S-Five-T section to evaluate feelings evoked by triggering sounds and their intensity. We examined whether the five-factor structure developed in the UK could be replicated in a Polish sample, including individuals with and without self-identified misophonia. The Polish version of the S-Five was translated and tested on 288 Polish-speaking individuals. Comprehensive psychometric evaluation, including factor structure, measurement invariance, test–retest reliability, internal consistency, and concurrent validity evaluations, was conducted on the translated scale. Exploratory factor analysis suggested similar structure to the original English study, while bootstrap exploratory graph analysis showed the factor structure to be reproducible in other samples. The scale was found to be bias free with respect to gender, internally consistent and stable in time, and evidence of validity was provided using MisoQuest and Misophonia Questionnaire. These results offer support for the cross-cultural stability of the five factors and provide preliminary evidence for the suitability of the Polish version for clinical and research purposes. The study also investigated five facets of misophonia, triggering sounds, emotional responses, and their associations with symptoms of psychopathology across various cultures. It underscores the central role of anger, distress, and panic, while also highlighting the mixed role of irritation and disgust in misophonia across different cultural contexts. Mouth sounds evoked the most pronounced reactions compared to other repetitive sounds, although there were discernible cultural differences in the nature and intensity of reactions to various trigger sounds. These findings hold significant implications for future research and underscore the importance of considering cultural nuances in both research and the clinical management of misophonia.

Abnormal Sensory Reactivity in the Child and Adolescent Psychiatry Clinic: Assessment, Management, and Treatment

Article

Full-text available

Mar 2020

Clinical interest in abnormal sensory processing has evolved since the mid-twentieth century from initial work by Anna Aryes,1 a prominent occupational therapist, and Leo Kanner, known to many as the father of autism. Aryes, while observing children with learning disabilities, conceived of a field of sensory integration dysfunction, a disorder related to neurological impairment in “detecting, modulating, discriminating, and responding to sensory information”.1 There is increasing recognition today that differences in sensory processing are transdiagnostic and encountered by a multitude of clinical practitioners, including psychiatrists, neurologists, occupational therapists, audiologists, and pediatricians, among others. It is thus of vital importance for child psychiatrists to recognize those differences, distinguish them from autism and other diagnostic categories, and conceptualize approaches to treatment.

The unified protocol for transdiagnostic treatment of emotional disorders for misophonia: a pilot trial exploring acceptability and efficacy

Article

Full-text available

Feb 2024

Introduction Misophonia is a recently defined disorder characterized by distressing responses to everyday sounds, such as chewing or sniffling. Individuals with misophonia experience significant functional impairment but have limited options for evidenced-based behavioral treatment. To address this gap in the literature, the current pilot trial explored the acceptability and efficacy of a transdiagnostic cognitive-behavioral approach to treating symptoms of misophonia. Methods This trial was conducted in two studies: In Study 1, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was delivered to eight patients in order to receive feedback to guide revisions to the treatment to suit this population. In Study 2, ten patients received the revised UP treatment to explore its acceptability and preliminary efficacy. This study used a single-case experimental design with multiple baselines, randomizing patients to either a 2-week baseline or 4-week baseline prior to the 16 weeks of treatment, followed by four weeks of follow-up. Results The findings from these studies suggested that patients found both the original and adapted versions of the UP to be acceptable and taught them skills for how to manage their misophonia symptoms. Importantly, the findings also suggested that the UP can help remediate symptoms of misophonia, particularly the emotional and behavioral responses. Discussion These findings provide preliminary evidence that this transdiagnostic treatment for emotional disorders can improve symptoms of misophonia in adults.

Üniversite Öğrencilerinde Mizofoninin Yaygınlığı ve Durumluk-Sürekli Kaygı ile İlişkisi: Kesitsel Bir Araştırma Prevalance of Misophonia and its Relationship with State-Trait Anxiety in University Student: A Cross-Sectional Study

Article

Full-text available

Jan 2023

Amaç: Mizofoni duygusal, fizyolojik ve davranışsal tepkileri tetikleyen belirli seslere karşı azalmış bir ses tolerans problemidir. Şiddetine bağlı olarak kişilerin sosyal, eğitim, iş hayatlarını ve genel yaşam kalitelerini olumsuz şekilde etkileyebilmektedir. Bu çalışma-nın amacı, lisans öğrencilerinde mizofoni yaygınlığını ve mizofoninin durumluk-sürekli kaygı ile ilişkisini incelemektir. Gereç ve Yön-temler: Bu çalışma, 119 üniversite öğrencisi ile yürütülmüştür. Ça-lışmada mizofoni seviyesini belirlemek için Mizofoni Ölçeği, durumluk kaygı ve sürekli kaygı düzeyini belirlemek için Durumluk-Sürekli Kaygı Ölçeği kullanılmıştır. Bulgular: Yüz on dokuz katı-lımcının 25'inde (%21) klinik olarak anlamlı mizofoni bulunmuştur. Katılımcıların diğer insanlara kıyasla hassasiyeti olduğunu belirttik-leri en yüksek oranlı maddenin yemek yeme sesleri olduğu görülm-üştür (örneğin çiğneme, yutma, ağız şapırdatma, höpürdetme gibi) (%31,1). Mizofoni skorları ile Durumluk Kaygı Ölçeği skorları (r=0,311; p<0,001) ve Sürekli Kaygı Ölçeği skorları (r=0,389; p<0,001) arasında istatistiksel olarak anlamlı ilişki saptanmıştır. Kli-nik olarak anlamlı mizofoni olma durumuna göre durumluk kaygı pu-anları (U=869,00; p<0,05) ve sürekli kaygı puanları (t (117) =-2,749; p<0,05) açısından istatistiksel olarak anlamlı fark bulunmuştur. Sonuç: Üniversite öğrencilerinin yaklaşık 1/4'ünde klinik olarak an-lamlı mizofoni görülmüştür. Klinik olarak anlamlı mizofonisi olan öğrencilerin durumluk ve sürekli kaygı düzeyleri daha yüksektir. Mi-zofoni ile durumluk-sürekli kaygı orta düzeyde ilişkilidir. Mizofonin yaygınlığı göz önüne alındığında mizofoniye yönelik farkındalığın ve tanı-müdahale yöntemlerinin yaygınlaştırılması önerilmektedir. Anah tar Ke li me ler: Mizofoni; mizofoni prevalansı; durumluk-sürekli kaygı ABS TRACT Objective: Misophonia is a disorder where individuals experience decreased tolerance to certain sounds that trigger intense emotional, physiological or behaviour responses in them. Depending on its severity, it can negatively affect individuals social, educational, professional lives and overall quality of life. This study aimed to determine the prevalence of misophonia and its relationship with state-trait anxiety in undergraduate students. Material and Methods: This study was conducted with 119 undergraduate students. Misophonia Questionnaire was used to identify misophonia level, and State-Trait Anxiety Inventory was used to determine state anxiety and trait anxiety level. Results: Of 119 participants, 25 (21%) were found to have clinically significant misophonia. Sound of people eating (e.g. chewing, swallowing, lips smacking, slurping, etc.) were the items to which participants were most likely to report being sensitive compared to other people (31.1%). There was a significant relationship between misophonia scores and state anxiety score (r=0.311; p<0.001) and trait anxiety score (r=0.389; p<0.001). A statistically significant difference was found in state anxiety scores (U=869.00; p<0.05) and trait anxiety scores (t (117) =-2.749; p<0.05) according to the presence of clinically significant misophonia. Conclusion: Approximately quarter of university students have clinically significant misophonia. Students with clinically significant miso-phonia have higher state-trait anxiety levels. Misophonia is moderately associated with state-trait anxiety level. Considering the prevalence of misophonia, it is recommended that awareness, diagnosis and intervention methods for misophonia should be expanded. Considering the prevalence of misophonia, it is recommended that awareness and diagnostic intervention methods for misophonia should be expanded.

Session-by-session change in misophonia: a descriptive case study using intensive CBT

Article

Full-text available

Jul 2023

There is preliminary evidence that CBT may be helpful for improving symptoms of misophonia, but the key mechanisms of change are not yet known for this disorder of decreased tolerance to everyday sounds. This detailed case study aimed to describe the delivery of intensive, formulation-driven CBT for an individual with misophonia and report on session-by-session outcomes using a multi-dimensional measurement tool (SFive). The patient was offered 12 hours of treatment over five sessions, using transdiagnostic and misophonia-specific interventions. Reliable and clinically significant change was found from baseline to one-month follow-up. Visual inspection of outcome graphs indicated that change occurred on the ‘outbursts’ and ‘internalising appraisals’ SFive subscales following assessment, and on the ‘emotional threat’ subscale after the first treatment session. The other two subscales started and remained below a clinically significant level. The biggest symptom change appeared to have occurred after the second session, which included interventions engaging with trigger sounds. The results demonstrated the individualised nature of misophonia, supporting the use of individually tailored treatment for misophonia and highlighting the importance of using a multi-dimensional measurement tool. Key learning aims • (1) To understand misophonic distress from a CBT perspective. • (2) To learn a formulation-driven approach to misophonia. • (3) To apply transdiagnostic interventions to misophonia. • (4) To learn about misophonia-specific interventions. • (5) To consider the value of a multi-dimensional measure of misophonia.

The New York Misophonia Scale (NYMS): A New Instrument to Identify Misophonia in the General Population

Article

Jul 2023

Misophonia is a condition in which certain sounds and behaviors elicit distress that ranges from mild annoyance to disgust or anger. The aim of this research was to develop and validate an instrument to screen for misophonia in the general population. Study 1 developed and explored the factor structure and item quality of the New York Misophonia Scale (NYMS), which originally included 42 triggers and 13 behavioral reactions. A sample of 441 American adults responded to the instrument via social media platforms. Of the original 42 triggers, 25 clustered into 4 factors: repetitive actions, mouth sounds, ambient object sounds, and ambient people sounds. The 13 behavioral reactions loaded on to 2 factors, aggressive and nonaggressive reactions. Study 2 evaluated the psychometric properties of the final version of the NYMS using a sample of 200 American adults. The results supported the validity of the factor structure and the reliability of the final version of the NYMS from Study 1. Finally, Study 3 explored the concurrent and convergent validity of the final version of the NYMS with the Misophonia Questionnaire (MQ) and the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF). A sample of 171 adult participants completed all of the scales. Good concurrent validity was found with the MQ and good convergent validity was found with the DERS-SF. Overall, the NYMS appears to be a useful and promising instrument for assessing misophonia triggers, severity of distress elicited, and behavioral reactions to the distress in the general population.

Treatment of Misophonia

Article

Apr 2023

� Introduces misophonia and reviews published psychotherapy treatment studies. � Outlines a multi-disciplinary strategy for treatment. � Describes the application of two transdiagnostic psychotherapies with emerging evidence in misophonia (Unified Protocol and Process-Based Therapy). � Suggests an agenda for future research and treatment development.

Positive Attributable Visual Sources Attenuate the Impact of Trigger Sounds in Misophonia

Article

Full-text available

Nov 2024

Misophonia is characterized by strong negative reactions to everyday sounds, such as chewing, slurping or breathing, that can have negative consequences for daily life. Here, we investigated the role of visual stimuli in modulating misophonic reactions. We recruited 26 misophonics and 31 healthy controls and presented them with 26 sound-swapped videos: 13 trigger sounds paired with the 13 Original Video Sources (OVS) and with 13 Positive Attributable Visual Sources (PAVS). Our results show that PAVS stimuli significantly increase the pleasantness and reduce the intensity of bodily sensations associated with trigger sounds in both the misophonia and control groups. Importantly, people with misophonia experienced a larger reduction of bodily sensations compared to the control participants. An analysis of self-reported bodily sensation descriptions revealed that PAVS-paired sounds led participants to use significantly fewer words pertaining to body parts compared to the OVS-paired sounds. We also found that participants who scored higher on the Duke Misophonia Questionnaire (DMQ) symptom severity scale had higher auditory imagery scores, yet visual imagery was not associated with the DMQ. Overall, our results show that the negative impact of misophonic trigger sounds can be attenuated by presenting them alongside PAVSs.

Psychometric Validation of the New Misophonia Screening List—Child and Youth and AMISOS-Y (Dutch Child- and Parent-Report Versions) for Assessing Misophonia in Youth

Article

Full-text available

Nov 2024
CHILD PSYCHIAT HUM D

Misophonia is a recently identified disorder of decreased sound tolerance that often originates in childhood. Currently, there is a lack of validated questionnaires for screening and assessing misophonia severity in children/adolescents. This paper presents an iterative validation process of two innovative (parallel child-/parent-reported) questionnaires: the Misophonia Screening List—Child and Youth for screening, and the Amsterdam Misophonia Scale—Youth (AMISOS-Y) for assessing misophonia severity in youth. After instrument refinement, we performed ROC curve, reliability, and principal component analyses, and assessed concurrent, convergent and divergent validity, on a combined sample (aged 8–18; clinical sample N = 94 youth, 95 parents; control group screening N = 197 youth, 56 parents; control group AMISOS-Y N = 192 youth, 55 parents). Both questionnaires were unidimensional and displayed excellent psychometric properties (α = 0.95–0.96). Future replication studies are needed in community and clinical samples to contribute to a unified diagnostic framework. Trial registered 09/2021: NL-OMON20775.

Clinical Characteristics of a Treatment Seeking Sample of Adults with Misophonia: Onset, Course, Triggers, Context, and Comorbidity

Article

Oct 2024

Misophonia is characterized by intense emotional reactions to specific repetitive sounds. The clinical characteristics and developmental course of misophonia remain underexplored, particularly in treatment-seeking adults. In this study, we characterized the onset, symptom progression, trigger noises, and psychiatric comorbidities associated with misophonia. Additionally, we investigated the relationships between these clinical attributes and the severity of self- and clinician-rated misophonia symptoms. The sample included 60 adults with misophonia enrolled in a randomized controlled trial. Most participants (79%) reported symptom onset in childhood and early adolescence, with symptoms often worsening over time. All participants reported being bothered by human produced sounds. However, responses to trigger noises vary based on the context surrounding the sound. Those who reported equivalent distress across misophonic triggers –regardless of the individual producing the sound—endorsed significantly higher self-reported misophonia symptoms. Approximately half of the sample met diagnostic criteria for another psychiatric condition, with attention-deficit hyperactivity disorder and generalized anxiety disorder being the most prevalent. These findings underscore the complexity of misophonia and highlight the importance of considering the individual clinical histories and contextual factors influencing reactions to misophonic sounds.

Acceptance and Commitment Therapy for an Emerging Adult Female With Misophonia: A Case Study

Article

Full-text available

Sep 2024

Misophonia is characterized by decreased tolerance to idiosyncratic and repetitive human-generated sounds (ie, triggers), coupled with affective-based reactions that result in impairment and distress. Often having its onset in youth, misophonia can become especially prominent during key developmental periods, including emerging adulthood. While efforts to develop interventions for misophonia remain ongoing, a consensus has not yet been reached concerning recommended first-line treatments. Acceptance and commitment therapy (ACT), which has demonstrated efficacy in treating various psychiatric disorders via targeting psychological flexibility processes, represents one potentially feasible approach for addressing misophonia. This case study describes the application of an individually delivered, 12-session ACT intervention for a black female in her early 20s with misophonia. Descriptive data collected at 4 time points (pretreatment, mid-treatment, posttreatment, and at 2-month follow-up) suggested the potential promise of ACT as a treatment for misophonia, improving psychological flexibility processes and reducing secondary depression and anxiety symptoms. Findings are discussed in the context of the possible mechanisms of ACT most likely responsible for misophonia-related clinical improvement. More rigorous studies (eg, clinical trials) are needed to confirm promising findings from existing case studies.

Metacognitive Interpersonal Therapy for Misophonia: A Single-Case Study

Article

Full-text available

Jul 2024
BSRCCS

Background: Misophonia is a chronic condition in which the exposure to specific sounds increases the arousal and recurrence of specific intense negative emotions. We hypothesized that misophonia may be strongly related to maladaptive interpersonal schemas that create difficulties in interpersonal relationships. Subjects with maladaptive interpersonal schemas think that other people try to subjugate, criticize, dominate, exploit, deceive, disregard, and humiliate them. Furthermore, these patients typically endorse a representation of self as mistreated, constricted, harmed, damaged, humiliated, impotent, inadequate, or fragile. Methods: We describe the course of a treatment of Metacognitive Interpersonal Therapy (MIT) in a young man presenting misophonia and co-occurrent obsessive–compulsive personality disorder (OCPD) and avoidant personality disorder (AvPD), with narcissistic traits and normal hearing. We collected qualitative and quantitative data at the beginning of the intervention and at 2 years follow-up. Results: The therapy aimed at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. The results reported a significant decrease in misophonia; behavioural experiments were used to increase the quality of social relationships and tolerance to the trigger sounds. Conclusions: MIT can be an effective therapy for the treatment of misophonia.

A social cognition perspective on misophonia

Article

Full-text available

Jul 2024

Misophonia is commonly classified by intense emotional reactions to common everyday sounds. The condition has an impact both on the mental health of its sufferers and societally. As yet, formal models on the basis of misophonia are in their infancy. Based on developing behavioural and neuroscientific research we are gaining a growing understanding of the phenomenology and empirical findings in misophonia, such as the importance of context, types of coping strategies used and the activation of particular brain regions. In this article, we argue for a model of misophonia that includes not only the sound but also the context within which sound is perceived and the emotional reaction triggered. We review the current behavioural and neuroimaging literature, which lends support to this idea. Based on the current evidence, we propose that misophonia should be understood within the broader context of social perception and cognition, and not restricted within the narrow domain of being a disorder of auditory processing. We discuss the evidence in support of this hypothesis, as well as the implications for potential treatment approaches. This article is part of the theme issue ‘Sensing and feeling: an integrative approach to sensory processing and emotional experience’.

Association between Chronic Misophonia-Induced Stress and Gastrointestinal Pathology in Children—A Hypothesis

Article

Full-text available

Jun 2024

Misophonia is a neurophysiological disorder with behavioral implications, is complex and multifactorial in origin, and is characterized by an atypical and disproportionate emotional response to specific sounds or associated visual stimuli. Triggers include human-generated sounds, mainly sounds related to feeding and breathing processes, and repetitive mechanical sounds. In response to the triggering stimulus, the patient experiences immediate, high-intensity, disproportionate physical and emotional reactions that affect their quality of life and social functioning. The symptoms of misophonia can occur at any age, but onset in childhood or adolescence is most common. Affected children live in a constant state of anxiety, suffer continuous physical and emotional discomfort, and are thus exposed to significant chronic stress. Chronic stress, especially during childhood, has consequences on the main biological systems through the dysregulation of the hypothalamic–pituitary–adrenal axis, including the gastrointestinal tract. Here, we provide arguments for a positive correlation between misophonic pathology and gastrointestinal symptoms, and this hypothesis may be the starting point for further longitudinal studies that could investigate the correlations between these childhood vulnerabilities caused by misophonia and their effect on the gastrointestinal system. Further research to study this hypothesis is essential to ensure correct and timely diagnosis and optimal psychological and pharmacological support.

A Preliminary Analysis of the Clinical Effectiveness of Audiologist-Delivered Cognitive Behavioral Therapy Delivered via Video Calls for Rehabilitation of Misophonia, Hyperacusis, and Tinnitus

Article

Full-text available

Apr 2024
Am J Audiol

Purpose Cognitive behavioral therapy (CBT) is a key intervention for management of misophonia, hyperacusis, and tinnitus. The aim of this study was to perform a preliminary analysis comparing the scores for self-report questionnaires before and after audiologist-delivered CBT via video calls for adults with misophonia, hyperacusis, or tinnitus or a combination of these. Method This was a retrospective cross-sectional study. The data for 37 consecutive patients who received CBT for misophonia, hyperacusis, or tinnitus from a private institute in the United Kingdom were analyzed. Self-report questionnaires taken as part of routine care were as follows: 4C Questionnaires for tinnitus, hyperacusis, and misophonia (4C-T, 4C-H, and 4C-M, respectively), Tinnitus Impact Questionnaire (TIQ), Hyperacusis Impact Questionnaire (HIQ), Misophonia Impact Questionnaire (MIQ), Sound Sensitivity Symptoms Questionnaire (SSSQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T). Responses were also obtained to other questionnaires related to tinnitus, hyperacusis, insomnia, and anxiety and mood disorders. A linear mixed-model method was used to assess the changes in response to the questionnaires pretreatment and posttreatment. Results Pretreatment–posttreatment comparisons showed that scores for the 4C-T, 4C-H, 4C-M, TIQ, HIQ, MIQ, SSSQ, and SAD-T improved, with effect sizes of 1.4, 1.2, 1.3, 2.6, 0.9, 0.7, 0.9, and 1.4, respectively (all p < .05). Conclusions This preliminary analysis suggests that CBT via video calls may be effective in reducing the impact of misophonia, hyperacusis, and tinnitus. However, this study did not have a control group, so its results need to be interpreted with caution.

Trans-diagnostic cognitive behavioral therapy (CBT) approach for managing Misophonia:A case report

Article

Full-text available

Apr 2024
Indian J Clin Psychol

Background: Misophonia is a rare neuro-behavioral condition characterized by hatred to some specific sounds. It has a strong connection with clinical psychology in terms of its trans-diagnostic nature and management. Design: single case-study design. Intervention: A Cognitive Behavioral Therapy (CBT) based management was done in which distress tolerance skills, habituation via exposure sessions and cognitive restructuring was implemented in 25 sessions. Results and Conclusion: A significant outcome was seen in terms of her distress and functionality. On Misophonia assessment questionnaire(MAS) score was reduced from 50 to 10, on Hamilton anxiety rating scale (HAM-A) it was reduced from 18 to 5 and on visual analogue scale (VAS) score was reduced from 10 to 3.

The impact of misophonia on dental care - a study

Article

Full-text available

Mar 2023

Misophonia is frequently typified as a condition in which certain sounds elicit an emotional or physiological response, or both, that some might perceive as unreasonable given the circumstances. These reactions can range from anger and annoyance to panic and the need to flee. We aimed to look at this from the perspective of dentists and their patients, providing some initial data on the experiences of patients in a cohort of 34 individuals. Each of these individuals was seeking therapy to remediate misophonia symptoms, not necessarily having specifically mentioned the impact of the condition on their oral health. Misophonia (denoted as 'hatred of sound') recently has been recognised as a 'complex neurobehavioural syndrome phenotypically characterised by heightened autonomic nervous system arousal and negative emotional reactivity…'. 1 in response to certain repetitive and pattern based sounds. Our results clearly showed that individuals with misophonia have a tendency to not attend for routine health care appointments and that dental treatment is more affected than GP attendance.

"I'm sure Dr Jekyll had misophonia": A Reflexive Thematic Analysis (RTA) examining lived experience patterns in misophonia and the usefulness of Reddit as an online support network

Preprint

Full-text available

Dec 2023

Misophonia, commonly referred to as the ‘hatred of sounds’ disorder (despite lack of official classification in the diagnostic tools), has largely been investigated with the purpose of establishing a mechanism responsible for the disorder. Perpetuating the emergence of two main gaps within the literature; i) lack of large-scale lived experience research, and ii) lack of investigation towards the online support networks that are becoming increasingly utilised and available to misophonic individuals. To address these gaps, this project utilised the r/misophonia subreddit as a data collection source to examine the presence of lived experience patterns in people with misophonia, and to assess the usefulness of online support networks. The dataset included 26 reddit posts (10 from the year 2021, and 16 from the year 2022) which were randomly sampled using an application programming interface (API), and then analysed qualitatively using reflexive thematic analysis (RTA). Overall, the findings portrayed that misophonic individuals share a plethora of lived experiences, and regarding the use of online support networks, such as the r/misophonia subreddit, these were represented as largely positive environments (via. Providing support, freedom of expression, and a place to vent). However, there were also negative implications of using online social networks, for example, they can become environments of perpetuating negativity where discussions of self-harm, and suicide may take place

Misophonia in Children and Adolescents: Age Differences, Risk Factors, Psychiatric and Psychological Correlates. A Pilot Study with Mothers’ Involvement

Article

Full-text available

Sep 2023
CHILD PSYCHIAT HUM D

Misophonia is a type of disorder characterized by decreased sound tolerance. While it typically begins in childhood, research on its characteristics in this population is limited. We assessed 90 children aged 7–18 with and without misophonia, along with their mothers, using interviews, questionnaires, and performance-based tests. Younger children with misophonia were more likely to use aggression in response to triggers than older, while adolescents largely reported self-harm during triggers. Children with misophonia did not differ from their peers in terms of ADHD, ODD, ASD, dyslexia, social and emotional competencies, head injuries, epilepsy, tinnitus, being prematurely born, or delivered via cesarean sections. However, they had significantly higher symptoms of anxiety and depression, more frequent occurrences of OCD, migraines, and psychosomatic complaints. Their mothers self-reported postpartum depression significantly more frequently than mothers in the control group. There is a need for further research on pediatric misophonia, with the involvement and assessment of parents.

The neurophysiological approach to misophonia: Theory and treatment

Article

Full-text available

Mar 2023

Clinical observations of hundreds of patients who exhibited decreased tolerance to sound showed that many of them could not be diagnosed as having hyperacusis when negative reactions to a sound depend only on its physical characteristics. In the majority of these patients, the physical characteristics of bothersome sounds were secondary, and patients were able to tolerate other sounds with levels higher than sounds bothersome for them. The dominant feature determining the presence and strength of negative reactions are specific to a given patient's patterns and meaning of bothersome sounds. Moreover, negative reactions frequently depend on the situation in which the offensive sound is presented or by whom it is produced. Importantly, physiological and emotional reactions to bothersome sounds are very similar (even identical) for both hyperacusis and misophonia, so reactions cannot be used to diagnose and differentiate them. To label this non-reported phenomenon, we coined the term misophonia in 2001. Incorporating clinical observations into the framework of knowledge of brain functions allowed us to propose a neurophysiological model for misophonia. The observation that the physical characterization of misophonic trigger was secondary and frequently irrelevant suggested that the auditory pathways are working in identical manner in people with as in without misophonia. Descriptions of negative reactions indicated that the limbic and sympathetic parts of the autonomic nervous systems are involved but without manifestations of general malfunction of these systems. Patients with misophonia could not control internal emotional reactions (even when fully realizing that these reactions are disproportionate to benign sounds evoking them) suggesting that subconscious, conditioned reflexes linking the auditory system with other systems in the brain are the core mechanisms of misophonia. Consequently, the strength of functional connections between various systems in the brain plays a dominant role in misophonia, and the functional properties of the individual systems may be perfectly within the norms. Based on the postulated model, we proposed a treatment for misophonia, focused on the extinction of conditioned reflexes linking the auditory system with other systems in the brain. Treatment consists of specific counseling and sound therapy. It has been used for over 20 years with a published success rate of 83%.

A randomized controlled trial evaluating an mHealth intervention for anger-related cognitions in misophonia

Article

Mar 2025
J AFFECT DISORDERS

Assessment of auditory conditions in misophonia treatment research: a scoping review

Article

Feb 2025
Int J Audiol

Aberrant salience signaling in auditory processing in schizophrenia: Evidence for abnormalities in both sensory processing and emotional reactivity

Article

Oct 2024

Acceptance and commitment therapy versus progressive relaxation training for misophonia: Randomized controlled trial protocol, interventions, and audiological assessments

Article

Aug 2024

Background Misophonia is a disorder characterized by an intense emotional reaction to specific sounds, often leading to significant distress and impairment in daily functioning. Acceptance and commitment therapy (ACT) is a promising psychotherapy for treating misophonia, but has only been previously tested in case studies. This paper presents a protocol for the first randomized controlled trial (RCT) assessing the efficacy and feasibility of ACT supplemented by audiological interventions for misophonia versus progressive relaxation training (PRT). Methods The outlined protocol is a RCT with 60 adults with misophonia. After undergoing a comprehensive psychological and audiological evaluation, participants were randomly assigned to ACT (n = 30) or PRT (n = 30). All participants completed clinician-administered and self-report assessments at baseline, post-intervention, 3-month follow-up, and 6-month follow-up. The primary outcome was misophonia severity and impairment measured via clinical interview. Secondary outcomes included disgust, anger, sensory sensitivities, well-being, distress, and psychological flexibility. Discussion This paper outlines the rationale of using ACT supplemented by audiological methods for misophonia with the novel therapeutic target of enhancing psychological flexibility. The results of this randomized controlled trial will help determine if ACT is an efficacious and acceptable treatment for misophonia. This trial will also help clarify active psychological mechanisms of misophonia, and assess whether this combination of psychological and audiological services can effectively help individuals with misophonia.

Prevalence of Misophonia and Its Characteristics among Amity University Students in India

Article

Full-text available

Jun 2024

Purpose Misophonia is a disorder characterized by decreased tolerance to specific sound stimuli. The main aim of our study is to investigate the prevalence of misophonia and its nature among Amity University students in India. Materials and Methods A cross-sectional design study was conducted among Amity University students via the online survey. A revised version of the Amsterdam Misophonia Scale was distributed among university students. SPSS software version 25.0 was used for the statistical analysis. Descriptive statistics and a Chi-square test were done to see the association among variables. Results The data were collected from 607 university students. Our study showed the prevalence of clinically significant misophonia to be 17.63% among university students. The result showed that the sounds produced by the human mouth, such as chewing and swallowing, are the most common triggers for misophonia. The Chi-square test result showed a significant association between gender, family history, and occurrence of misophonia. Conclusion Our study concludes that misophonia is a highly prevalent disorder in the Indian population which could significantly impact the sufferers’ quality of life. The assessment protocol and treatment approaches available for misophonia and its efficacy are relatively unclear. Our study’s findings may be the guiding tool to develop better assessment and management protocols for helping individuals suffering from misophonia.

Hypersensitivity to Sounds

Chapter

Mar 2024

The vocabulary and terminology used with regard to hypersensitivity to sounds are varied and imprecise. In this chapter, we explore and clarify understanding of hypersensitivity to sounds in adults, by identifying specific forms of decreased sound tolerance, such as recruitment, phonophobia, and misophonia. Due to the ill-defined terminology and insufficient literature, clear distinctions between diagnoses are hampered. These disorders of sound tolerance can be part of a more general medical disorder and, as such, have multiple comorbidities. Furthermore, they are complex and involve physiological and psychological aspects. As such, cognitive behavioural therapy and exposure therapy are often proposed for treatment, but evidence is lacking. Recently, there is a substantial and growing interest within both the clinical and research communities regarding decreased sound tolerance. Further progress can be made by reaching a consensus on the definition of loudness tolerance disorders and its subtypes, as well as investigating the treatment of these subtypes.

Misophonia Sound Recognition Using Vision Transformer

Conference Paper

Jul 2023

Gender-Specific Correlations Between Misophonia and ADHD, OCD, and Autism-Related Traits in Adolescent Outpatients

Article

Jan 2023

الميسوفونيا كعرض تنبؤي لنوبات الغضب لدى عينة من مرضى الوسواس القهري (دراسة سيكومترية كلينيكية)

Article

Jan 2023

Mizofoni Ölçeği'nin Türkçe Formunun Geçerlik ve Güvenirlik Sınama Çalışması Validity and Reliability Testing Study of the Turkish Version of the Misophonia Scale

Article

Full-text available

Aug 2023

Mizofoni, şiddetli duygusal veya fizyolojik tepkileri tetikleyen belirli seslere karşı azalmış bir ses tolerans bozukluğu durumudur. Mizofonisi olan bireyler yemek çiğneme, dudak şapırdatma, nefes alıp verme gibi diğer insanlar tarafından önemsiz olarak bulunan spesifik seslere karşı tiksinme, kaygı, kızgınlık hissedebilmekte ve bazen öfke nöbetleri yaşayabilmektedir. Mizofoninin prevalansı, değerlendirme ve yönetimi konusunda fikir birliği yoktur. Mizofoni araştırmalarının önündeki en büyük engellerden biri psikometrik açıdan güçlü değerlendirme araçlarının azlığıdır. Bu çalışmanın amacı Mizofoni Ölçeği'nin (Misophonia Questionnaire; Wu ve ark., 2014) Türkçe uyarlamasını yaparak mizofoniye yönelik klinik ve populasyon temelli değerlendirmeler için ölçüm aracı ihtiyacını gidermektir. Araştırma, yaşları 18-26 arasında değişen Başkent Üniversitesinde lisans düzeyinde öğrenim gören 638 öğrenci ile gerçekleştirilmiştir. Yapı geçerliği kapsamında açımlayıcı (N = 420) ve doğrulayıcı faktör analizi (N = 218) uygulanmış, içtutarlılık ve ayırt edici geçerlik sınamaları gerçekleştirilmiştir. Güvenirlik için ise iç tutarlılık, yarıya bölüm ve test-tekrar test yöntemleri kullanılmıştır. Açımlayıcı faktör analizinde ölçeğin mizofoni semptomları, mizofoni duygu ve davranışlar-kaçınma ve içselleştirme, mizofoni duygular ve davranışlar-saldırganlık ve dışsallaştırma olmak üzere üç faktörlü bir yapıya sahip olduğu gözlenmiştir. Doğrulayıcı faktör analizinde söz konusu üç faktörlü yapı için uyum indeksleri kabul edilebilir sınırlar içinde bulunmuştur. Ayırt edici geçerlik sonucunda, klinik olarak mizofonisi olanların olmayanlara göre tüm faktörlerde daha yüksek ortalamaya sahip olduğu görülmüştür. Ölçeğin bütünü için Cronbach Alfa iç tutarlılık katsayısının .89 (faktörler için sırasıyla .79, .85 ve .83), yarıya bölüm güvenirlik katsayısının .83 (faktörler için sırasıyla .86, .87 ve .81) ve test-tekrar test güvenirlik katsayısının .78 olduğu bulunmuştur. Bu çalışma ile genel örneklemde mizofoniyi değerlendirme amacı ile kullanılabilecek Mizofoni Ölçeği Türkçeye kazandırılmıştır. Yapılan psikometrik analizler sonucunda Mizofoni Ölçeği'nin geçerliğini ve güvenirliğini destekleyen verilere ulaşılmıştır.

Psikoloji Çalışmaları Studies in Psychology Mizofoni Ölçeği'nin Türkçe Formunun Geçerlik ve Güvenirlik Sınama Çalışması Validity and Reliability Testing Study of the Turkish Version of the Misophonia Scale This work is licensed under Creative Commons Attribution-NonCommercial 4.0 International License

Article

Aug 2023

Z Mizofoni, şiddetli duygusal veya fizyolojik tepkileri tetikleyen belirli seslere karşı azalmış bir ses tolerans bozukluğu durumudur. Mizofonisi olan bireyler yemek çiğneme, dudak şapırdatma, nefes alıp verme gibi diğer insanlar tarafından önemsiz olarak bulunan spesifik seslere karşı tiksinme, kaygı, kızgınlık hissedebilmekte ve bazen öfke nöbetleri yaşayabilmektedir. Mizofoninin prevalansı, değerlendirme ve yönetimi konusunda fikir birliği yoktur. Mizofoni araştırmalarının önündeki en büyük engellerden biri psikometrik açıdan güçlü değerlendirme araçlarının azlığıdır. Bu çalışmanın amacı Mizofoni Ölçeği'nin (Misophonia Questionnaire; Wu ve ark., 2014) Türkçe uyarlamasını yaparak mizofoniye yönelik klinik ve populasyon temelli değerlendirmeler için ölçüm aracı ihtiyacını gidermektir. Araştırma, yaşları 18-26 arasında değişen Başkent Üniversitesinde lisans düzeyinde öğrenim gören 638 öğrenci ile gerçekleştirilmiştir. Yapı geçerliği kapsamında açımlayıcı (N = 420) ve doğrulayıcı faktör analizi (N = 218) uygulanmış, içtutarlılık ve ayırt edici geçerlik sınamaları gerçekleştirilmiştir. Güvenirlik için ise iç tutarlılık, yarıya bölüm ve test-tekrar test yöntemleri kullanılmıştır. Açımlayıcı faktör analizinde ölçeğin mizofoni semptomları, mizofoni duygu ve davranışlar-kaçınma ve içselleştirme, mizofoni duygular ve davranışlar-saldırganlık ve dışsallaştırma olmak üzere üç faktörlü bir yapıya sahip olduğu gözlenmiştir. Doğrulayıcı faktör analizinde söz konusu üç faktörlü yapı için uyum indeksleri kabul edilebilir sınırlar içinde bulunmuştur. Ayırt edici geçerlik sonucunda, klinik olarak mizofonisi olanların olmayanlara göre tüm faktörlerde daha yüksek ortalamaya sahip olduğu görülmüştür. Ölçeğin bütünü için Cronbach Alfa iç tutarlılık katsayısının .89 (faktörler için sırasıyla .79, .85 ve .83), yarıya bölüm güvenirlik katsayısının .83 (faktörler için sırasıyla .86, .87 ve .81) ve test-tekrar test güvenirlik katsayısının .78 olduğu bulunmuştur. Bu çalışma ile genel örneklemde mizofoniyi değerlendirme amacı ile kullanılabilecek Mizofoni Ölçeği Türkçeye kazandırılmıştır. Yapılan psikometrik analizler sonucunda Mizofoni Ölçeği'nin geçerliğini ve güvenirliğini destekleyen verilere ulaşılmıştır.

Misophonia: A Review of the Literature and Its Implications for the Social Work Profession

Article

Jul 2023

Misophonia is a chronic condition that describes aversion to specific auditory stimuli. Misophonia is characterized by physiological responsivity and negative emotional reactivity. Specific sounds, commonly referred to as “triggers,” are often commonplace and sometimes repetitive. They include chewing, coughing, slurping, keyboard tapping, and pen clicking. Common emotional responses include rage, disgust, anxiety, and panic while physical responses include muscle constriction and increased heart rate. This literature review identifies research priorities, limitations, and new directions, examining the implications of misophonia for the social work profession. Misophonia is largely absent from the social work literature. However, the profession is uniquely equipped to understand, screen for, and effectively treat misophonia in direct practice or within interprofessional treatment teams. By conceptualizing misophonia as idiosyncratic and contextual, social workers would enhance the existing body of research by applying an ecological perspective which captures the interaction of individuals and environments in producing human experience. Such an approach would assist clients and clinicians in developing treatment plans that consider the roles of social and physical environments in the development and course of misophonia. A discussion of current limitations within the misophonia literature further emphasizes the need for new perspectives.

Misophonia in Children and Adolescents: Age Differences, Risk Factors, Psychiatric and Psychological Correlates. A Pilot Study With Mothers’ Involvement

Preprint

Full-text available

Apr 2023

Misophonia is a debilitating disorder characterized by decreased sound tolerance. While it typically begins in childhood, research on its characteristics in this population is limited. We assessed 90 children aged 7–18 with and without misophonia, along with their mothers, using interviews, questionnaires, and performance-based tests. Younger children with misophonia were more likely to use aggression in response to triggers than older, while adolescents largely reported self-harm during triggers. Children with misophonia did not differ from their peers in terms of ADHD, ODD, ASD, dyslexia, social and emotional competencies, head injuries, epilepsy, tinnitus, being prematurely born, or delivered via cesarean sections. However, they had significantly higher symptoms of anxiety and depression, more frequent occurrences of OCD, migraines, and psychosomatic complaints. Their mothers self-reported postpartum depression significantly more frequently than mothers in the control group. There is a need for further research on pediatric misophonia, with the involvement and assessment of parents.

Awareness and perspectives of audiologists on assessment and management of misophonia in India

Article

Full-text available

Feb 2023

Background: The assessment and management of misophonia need a team approach, and audiologists are essential team members. However, the role of an audiologist in this condition is not well understood, and there is a lack of awareness even among professionals about their role in the assessment and management of misophonia. Purpose: The main aim of our study is to document the present level of awareness and knowledge about misophonia assessment and management among audiologists in India. Methods: A descriptive cross-sectional study was carried out among audiologists from all over India. Descriptive statistical procedures were measured based on the type of questions being addressed, and a non-parametric chi-square test was done to see the association among variables. Results: The results show a lack of knowledge about misophonia even among audiologists, as only 15.3% of the audiologist reported being confident in handling cases with misophonia. Conclusion: Although the exact assessment and management of misophonia is still the topic of debate, it is clear that audiologists are the team's key members. However, the results clearly show a lack of confidence in handling cases of misophonia among audiologists in India. This result shows the future need for Research in misophonia from an audiological perspective

Mizofoni Ölçeği’nin Türkçe Formunun Geçerlik ve Güvenirlik Sınama Çalışması

Article

Full-text available

Apr 2022

Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents to Misophonia: A Case Example

Article

Feb 2022

Misophonia is a condition in which individuals suffer a wide range of intense emotions in response to sound triggers. Emotions such as anxiety, irritability, and disgust may lead individuals to engage in avoidance behaviors to escape or suppress sound triggers. Transdiagnostic treatment may serve as a practical intervention for misophonia as it addresses a broad scope of emotions and physiological sensations. This paper presents the first reported case example of misophonia treated with a transdiagnostic treatment protocol, the Unified Protocol for Emotional Disorders in Adolescents (UP-A). In this case, the UP-A was efficacious in treating a client with autism spectrum disorder, comorbid misophonia and anxiety symptoms. The client evidenced reliable change in misophonia and related problems. Future research should investigate the efficacy of the UP-A in a larger sample of youth with misophonia, as well as assess mechanisms of change in transdiagnostic treatment of this disorder in youth.

Does context matter in misophonia? A multi-method experimental investigation

Article

Full-text available

Jan 2023

Introduction Misophonia is a recently defined disorder in which certain aversive repetitive sounds and associated stimuli elicit distressing and impairing affective, behavioral, and physiological responses. The responses in misophonia may be stronger when the sound is produced by close friends and family, suggesting that the context in which a triggering cue occurs may have an important role in misophonia. As such, the goal of this study was to test experimentally whether the context of the sound source influences affective and psychophysiological responses to triggering stimuli in misophonia. Methods Sixty one adults with misophonia and 45 controls listened to audio recordings (8 s) of human eating, animals eating, and human mouth smacking sounds (without eating). After a break, the same audio recordings were presented embedded within videos of human eating (congruent stimuli), animals eating (congruent stimuli), and, in the mouth smacking condition, with visually incongruent stimuli (hands playing in mud or in a bowl with a watery dough). Psychophysiological responses—skin conductance response (SCR) and heart rate (HR), and self-reported affective responses (valence, arousal, dominance) were gathered during the experiment in a laboratory. Results Participants with misophonia assessed all the stimuli as more negative and arousing than the controls, and reported feeling less dominant with respect to the sounds. Animal and mouth smacking sounds were assessed by all the participants as less negative and arousing than human eating sounds, but only in the audio-video conditions. SCR data partially confirmed increased psychophysiological arousal in misophonia participants during an exposure to mouth sounds, but did not reflect the self-report changes in response to different contexts. Misophonia participants had deeper deceleration of HR than controls during human eating sound with congruent video stimuli, while there was no group difference during human mouth smacking with incongruent video stimuli. Conclusion Results suggest that the context of mouth sounds influences affective experiences in adults with misophonia, but also in participants without misophonia. Presentation of animal eating sounds with congruent visual stimuli, or human mouth smacking sounds with incongruent stimuli, decreased self-report reaction to common misophonic triggers.

حساسية الصوت الانتقائية (الميسوفونيا) وعلاقتها بمستوى القلق الاجتماعي لدى الأطفال المعاقين بصريًا The effect of selective sound sensitivity disorder (Misophonia) on social anxiety level among impaired children

Article

Dec 2022

غادة عبد السلام محمد

Treating the Initial Physical Reflex of Misophonia With the Neural Repatterning Technique: A Counterconditioning Procedure

Article

Full-text available

Oct 2015

Thomas Dozier

Misophonia is a condition in which a person has an acute emotional response of anger or disgust to a commonly occurring innocuous auditory or visual stimulus referred to as a trigger. This case details the effective treatment of misophonia in a young woman that included a counterconditioning treatment called the Neural Repatterning Technique (NRT), which combines a continuous positive stimulus and a reduced intensity, intermittent trigger. The treatment was delivered via the Misophonia Trigger Tamer smartphone app and all treatments were conducted independently by the patient. In this patient, the trigger elicited a physical reflex of contraction of the flexor digitorum profundus, which caused her to clench her fist. To enhance the effect of the NRT treatment, Progressive Muscle Relaxation was incorporated to increase her ability to deliberately relax the affected muscle during treatment. During NRT treatment sessions, the patient experienced a weak physical reflex to the reduced trigger stimulus but no emotional response. Her emotional response of misophonia was not treated, but when the physical reflex extinguished, the emotional response also extinguished. This case indicates that the misophonic response includes a Pavlovian-conditioned physical reflex. It is proposed that the trigger elicited the physical reflex and the physical reflex then elicited the conditioned emotional response that is characteristic of misophonia. Because of the conditioned reflex nature of misophonia, it is proposed that a more appropriate name for this disorder would be Conditioned Aversive Reflex Disorder.

Misophonia: current perspectives

Article

Full-text available

Aug 2015

Misophonia is characterized by a negative reaction to a sound with a specific pattern and meaning to a given individual. In this paper, we review the clinical features of this relatively common yet underinvestigated condition, with focus on co-occurring neurodevelopmental disorders. Currently available data on the putative pathophysiology of the condition can inform our understanding and guide the diagnostic process and treatment approach. Tinnitus retraining therapy and cognitive behavior therapy have been proposed as the most effective treatment strategies for reducing symptoms; however, current treatment algorithms should be validated in large population studies. At the present stage, competing paradigms see misophonia as a physiological state potentially inducible in any subject, an idiopathic condition (which can present with comorbid psychiatric disorders), or a symptomatic manifestation of an underlying psychiatric disorder. Agreement on the use of standardized diagnostic criteria would be an important step forward in terms of both clinical practice and scientific inquiry. Areas for future research include phenomenology, epidemiology, modulating factors, neurophysiological underpinnings, and treatment trials.

The impact of comorbid personality problems on response to IAPT treatment for depression and anxiety

Article

Full-text available

Jul 2015

The UK's Improving Access to Psychological Therapies (IAPT) initiative provides evidence-based psychological interventions for mild to moderate common mental health problems in a primary care setting. Predictors of treatment response are unclear. This study examined the impact of personality disorder status on outcome in a large IAPT service. We hypothesised that the presence of probable personality disorder would adversely affect treatment response. We used a prospective cohort design to study a consecutive sample of individuals (n = 1249). Higher scores on a screening measure for personality disorder were associated with poorer outcome on measures of depression, anxiety and social functioning, and reduced recovery rates at the end of treatment. These associations were not confounded by demographic status, initial symptom severity nor number of treatment sessions. The presence of personality difficulties independently predicted reduced absolute change on all outcome measures. The presence of co-morbid personality difficulties adversely affects treatment outcome among individuals attending for treatment in an IAPT service. There is a need to routinely assess for the presence of personality difficulties on all individuals referred to IAPT services. This information will provide important prognostic data and could lead to the provision of more effective, personalised treatment in IAPT. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Counterconditioning Treatment for Misophonia

Article

Full-text available

Jan 2015
Clin Case Stud

Thomas Dozier

Misophonia is a recently identified discrete and independent condition that cannot be classified using DSM-V criteria. With misophonia, a trigger stimulus elicits a reaction starting with irritation or disgust that immediately escalates. The trigger stimulus can be any typically occurring sound. The reaction is both extreme and irrational, and can include feelings of hate, anger, rage, and disgust. This response is perceived as involuntary, and individuals report feeling a loss of self-control. Misophonia can be conceptualized as a conditioned response to the trigger stimulus. This article describes a counterconditioning treatment of a middle-aged woman for misophonia that involved pairing a positive stimulus with a reduced trigger stimulus. Under these conditions, the misophonic response to the stimulus progressively weakened. Four distinct trigger stimuli were addressed in a multiple baseline treatment format. The overall severity of misophonia and the strength of the misophonic responses to triggers reduced over the course of the treatment, based on client self-assessments. These indicated large reductions in severity of misophonia and response to individual triggers, both at the end of treatment and at 10 months posttreatment. During treatment, responses to low intensity trigger stimuli were purely physical and independent of any emotional response. This demonstrated that, in this case, misophonia included a conditioned physical reflex to the trigger stimulus. It is proposed that misophonia consists of an aversive physical reflex elicited by the trigger stimulus and an emotional response elicited by the aversive physical reflex.

Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia)

Article

Full-text available

Apr 2014

Decreased sound tolerance (DST) is an underappreciated condition that affects the lives of a significant portion of the general population. There is lack of agreement regarding definitions, specific components, prevalence, methods of evaluation, and methods of treatment. Limited data are available on the results of treatments. Research is scant and constrained by the lack of an animal model. This article proposes a definition of DST and its division into hyperacusis and misophonia. The potential mechanisms of these phenomena are outlined, and the results of treatment performed at Emory University are presented. Out of 201 patients with DST, 165 (82%) showed significant improvement. Of 56 patients with hyperacusis (with or without misophonia), 45 (80%) showed significant improvement. This proportion was higher for the group with hyperacusis and concurrent misophonia (33 of 39, or 85%) and lower for patients with hyperacusis only (13 of 17, or 76%). Effectiveness of treatment for misophonia with or without hyperacusis was identical (152 of 184, 83% and 139 of 167, 83%, respectively, for misophonia accompanied by hyperacusis and for misophonia only). Even with current limited knowledge of DST, it is possible to propose specific mechanisms of hyperacusis and misophonia and, based on these mechanisms, to offer treatments in accordance with the neurophysiological model of tinnitus. These treatments are part of Tinnitus Retraining Therapy (TRT), which is aimed at concurrently treating tinnitus and DST and alleviating the effects of hearing loss. High effectiveness of the proposed treatments support the postulated mechanisms.

Decreased sound tolerance: hyperacusis, misophonia, diplacousis, and polyacousis

Article

Full-text available

Mar 2015

Definitions, potential mechanisms, and treatments for decreased sound tolerance, hyperacusis, misophonia, and diplacousis are presented with an emphasis on the associated physiologic and neurophysiological processes and principles. A distinction is made between subjects who experience these conditions versus patients who suffer from them. The role of the limbic and autonomic nervous systems and other brain systems involved in cases of bothersome decreased sound tolerance is stressed. The neurophysiological model of tinnitus is outlined with respect to how it may contribute to our understanding of these phenomena and their treatment. © 2015 Elsevier B.V. All rights reserved.

Psychological treatments: A call for mental-health science

Article

Full-text available

Jul 2014

Clinicians and neuroscientists must work together to understand and improve psychological treatments, urge Emily A. Holmes, Michelle G. Craske and Ann M.

Patterns of Nonemergent Visits to Different Healthcare Facilities on the Same Day: A Nationwide Analysis in Taiwan

Article

Full-text available

Apr 2014
TSWJ

Doctor shopping is a common phenomenon in many countries. However, patterns of switching healthcare facilities on the same day were little known. The data were obtained from the longitudinal cohort datasets (LHID2010) of Taiwan's National Health Insurance Research Database in 2010. Of 1,000,000 persons of the cohort with 13,276,928 nonemergent visits, 185,347 patients had visited different healthcare facilities within one day, with a total of 672,478 visits and 337,260 switches between facilities in 329,073 patient-days. While 63.0% (n = 212,590) of all switches occurred between facilities of the same accreditation level, 14.1% (n = 47,664) moved from lower to higher level, and 22.8% (n = 77,006) moved in the opposite direction. In 33,689 switches, patients moved to the same specialty of another facility. In 48,324 switches, patients moved to another facility with the same diagnosis, and the most frequent diagnoses were diseases of the digestive system (11,148) and diseases of the respiratory system (10,393). In a densely populated country without strict referral regulation, a high percentage of Taiwanese people had the experience of visiting different healthcare facilities on the same day. The system of family physicians as personal doctors and gatekeepers to healthcare might ameliorate the harmful impact.

Diminished N1 Auditory Evoked Potentials to Oddball Stimuli in Misophonia Patients

Article

Full-text available

Apr 2014

Misophonia (hatred of sound) is a newly defined psychiatric condition in which ordinary human sounds, such as breathing and eating, trigger impulsive aggression. In the current study, we investigated if a dysfunction in the brain's early auditory processing system could be present in misophonia. We screened 20 patients with misophonia with the diagnostic criteria for misophonia, and 14 matched healthy controls without misophonia, and investigated any potential deficits in auditory processing of misophonia patients using auditory event-related potentials (ERPs) during an oddball task. Subjects watched a neutral silent movie while being presented a regular frequency of beep sounds in which oddball tones of 250 and 4000 Hz were randomly embedded in a stream of repeated 1000 Hz standard tones. We examined the P1, N1, and P2 components locked to the onset of the tones. For misophonia patients, the N1 peak evoked by the oddball tones had smaller mean peak amplitude than the control group. However, no significant differences were found in P1 and P2 components evoked by the oddball tones. There were no significant differences between the misophonia patients and their controls in any of the ERP components to the standard tones. The diminished N1 component to oddball tones in misophonia patients suggests an underlying neurobiological deficit in misophonia patients. This reduction might reflect a basic impairment in auditory processing in misophonia patients.

Psychological Group-Treatments of Social Anxiety Disorder: A Meta-Analysis

Article

Full-text available

Dec 2013
PLOS ONE

A few meta-analyses have examined psychological treatments for a social anxiety disorder (SAD). This is the first meta-analysis that examines the effects of cognitive behavioural group therapies (CBGT) for SAD compared to control on symptoms of anxiety. After a systematic literature search in PubMed, Cochrane, PsychINFO and Embase was conducted; eleven studies were identified that met the inclusion criteria. The studies had to be randomized controlled studies in which individuals with a diagnosed SAD were treated with cognitive-behavioural group therapy (CBGT) and compared with a control group. The overall quality of the studies was moderate. The pooled effect size indicated that the difference between intervention and control conditions was 0.53 (96% CI: 0.33-0.73), in favour of the intervention. This corresponds to a NNT 3.24. Heterogeneity was low to moderately high in all analyses. There was some indication of publication bias. It was found that psychological group-treatments CBGT are more effective than control conditions in patients with SAD. Since heterogeneity between studies was high, more research comparing group psychotherapies for SAD to control is needed.

A brief course of cognitive behavioural therapy for the treatment of misophonia: A case example

Article

Full-text available

Oct 2013

Misophonia is a condition of unknown cause characterized by atypically intense negative physiological and emotional reactions to hearing certain sounds – most often those associated with oral functions. Individuals with misophonia often report high levels of psychological distress and avoidance behaviours that seriously compromise their occupational and social functioning. As of yet, no effective treatment of misophonia has been identiﬁed, and health care providers often struggle when they encounter clients who have it. This case report describes the assessment, case formulation, and treatment of a client with misophonia using cognitive behavioural therapy (CBT), and serves as an initial contribution to the evidence base for the efﬁcacy of CBT in the treatment of misophonia. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9048839&fulltextType=RV&fileId=S1754470X13000172

Misophonia: physiological investigations and case descriptions

Article

Full-text available

Jun 2013
FRONT HUM NEUROSCI

Misophonia is a relatively unexplored chronic condition in which a person experiences autonomic arousal (analogous to an involuntary “fight-or-flight” response) to certain innocuous or repetitive sounds such as chewing, pen clicking, and lip smacking. Misophonics report anxiety, panic, and rage when exposed to trigger sounds, compromising their ability to complete everyday tasks and engage in healthy and normal social interactions. Across two experiments, we measured behavioral and physiological characteristics of the condition. Interviews (Experiment 1) with misophonics showed that the most problematic sounds are generally related to other people's behavior (pen clicking, chewing sounds). Misophonics are however not bothered when they produce these “trigger” sounds themselves, and some report mimicry as a coping strategy. Next, (Experiment 2) we tested the hypothesis that misophonics' subjective experiences evoke an anomalous physiological response to certain auditory stimuli. Misophonic individuals showed heightened ratings and skin conductance responses (SCRs) to auditory, but not visual stimuli, relative to a group of typically developed controls, supporting this general viewpoint and indicating that misophonia is a disorder that produces distinct autonomic effects not seen in typically developed individuals.

Misophonia: Diagnostic Criteria for a New Psychiatric Disorder

Article

Full-text available

Jan 2013
PLOS ONE

Background Some patients report a preoccupation with a specific aversive human sound that triggers impulsive aggression. This condition is relatively unknown and has hitherto never been described, although the phenomenon has anecdotally been named misophonia. Methodology and Principal Findings 42 patients who reported misophonia were recruited by our hospital website. All patients were interviewed by an experienced psychiatrist and were screened with an adapted version of the Y-BOCS, HAM-D, HAM-A, SCL-90 and SCID II. The misophonia patients shared a similar pattern of symptoms in which an auditory or visual stimulus provoked an immediate aversive physical reaction with anger, disgust and impulsive aggression. The intensity of these emotions caused subsequent obsessions with the cue, avoidance and social dysfunctioning with intense suffering. The symptoms cannot be classified in the current nosological DSM-IV TR or ICD-10 systems. Conclusions We suggest that misophonia should be classified as a discrete psychiatric disorder. Diagnostic criteria could help to officially recognize the patients and the disorder, improve its identification by professional health carers, and encourage scientific research.

Exposure-based treatment for anger problems: Focus on the feeling

Article

Full-text available

Jun 1997
COGN BEHAV PRACT

Excessive anger can foster health problems and damage relationships. Traditional methods for treating individuals with anger-related problems have employed skills training and relaxation methods. This paper proposes that anger and anxiety share many clinical features, and that intervention models that have been effectively employed in the treatment of anxiety disorders can also be used safely in the treatment of anger-related difficulties. Specifically, exposure and response prevention can be effectively integrated with other cognitive behavioral approaches in the treatment of anger problems. Procedures for conducting these treatments are described. Examples are drawn from clinical work with New York City traffic agents, dysfunctional couples, aggressive children, and outpatients self-referred for anger problems.

Reappraising the Situation and Its Impact on Aggressive Behavior

Article

Full-text available

Dec 2011
Pers Soc Psychol Bull

Much work has focused on how reappraisal is related to emotions, but not behaviors. Two experiments advanced aggression theory by (a) testing how cognitive and attributional forms of reappraisal are related to aggressive affect and behavior, (b) testing variables that theoretically mediate the relation between attributional reappraisal and aggressive behavior, (c) testing the moderating influences of cognitive and attributional reappraisal on aggressive behavior, and (d) developing and testing an intervention aimed at reducing vengeance through reappraisal training. Study 1 used an essay writing task in a 3 (feedback: provocation, no feedback, praise) × 2 (mitigating information: present, absent) experimental design. Provoked participants who did not receive mitigating information were significantly more aggressive than provoked participants who received mitigating information. State vengeance was a significant mediator. Study 2 examined an experimental intervention on vengeance over a 16-week semester. Intervention participants who had the largest increase in reappraisal displayed the greatest decrease in vengeance. Overall, these findings suggest that reappraisal reduces vengeance and aggressive behavior.

Replicating and extending the good-enough level model of change: Considering session frequency

Article

Full-text available

Jul 2011
PSYCHOTHER RES

The good-enough level (GEL) model posits that the rate of change in psychotherapy is related to the total dose of therapy. The psychotherapy dose-response literature has typically measured dose as number of sessions attended without considering the number of days or weeks it takes to complete the sessions (session frequency). The current study sought to replicate the GEL model and explore if session frequency moderates the influence that the number of sessions has on the rate of change in psychotherapy. An archived naturalistic data set with a US university counseling center sample (n=1,207), with treatment progress measured using the Outcome Questionnaire-45 (Lambert et al., 1996), was used. Our results are consistent with the GEL model (i.e., clients who attended fewer sessions evidenced faster rates of change), but extended it by showing that the rate of change was also influenced by session frequency (i.e., clients who attended more sessions on average per week demonstrated more rapid improvement). Evidence suggests that clinicians and researchers should give consideration to session frequency, both in their work with clients and how "dose" is operationalized in psychotherapy research.

Counterconditioning: An Effective Technique for Changing Conditioned Preferences

Article

Full-text available

Apr 2010

The evidence for the effectiveness of counterconditioning as a strategy for changing conditioned preferences is rather scarce and inconclusive. The present experiment reinvestigated this issue and compared the effect of further conditioning, extinction, and a counterconditioning procedure on recently acquired conditioned preferences in a picture-taste paradigm. Self-report and affective priming data indicated that whereas further conditioning and extinction trials were ineffective in fully eliminating the previously acquired evaluations, the counterconditioning treatment did succeed in doing this. A follow-up valence assessment revealed that all these effects persisted after a 7-day delay period.

Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression

Article

Full-text available

Aug 2009

A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks. Chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three prescriptive variables-marriage, unemployment, and having experienced a greater number of recent life events-were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Thus, 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 prescriptive variables identify groups who appear to respond particularly well to cognitive therapy.

Exposure and Ritual Prevention for Obsessive-Compulsive Disorder: Effects of Intensive Versus Twice-Weekly Sessions

Article

Full-text available

Apr 2003

Exposure and ritual prevention (ERP) is the most effective treatment for obsessive-compulsive disorder (OCD), yet the intensive treatment schedule often described is not transportable to many settings. In the present study, the authors examined whether a twice-weekly (TW) ERP program reduced the effectiveness of intensive (IT) ERP. Forty OCD patients received 15 sessions of ERP: 20 received daily treatment over 3 weeks and 20 received twice weekly therapy over 8 weeks. Results indicated that both programs were effective. The effect of therapy schedule was moderate, with a trend toward more improvement in the intensive group at posttreatment. No differences were found at follow-up; some evidence of relapse was found with IT but not TW.

Comparative Efficacy, Speed, and Adverse Effects of Three PTSD Treatments: Exposure Therapy, EMDR, and Relaxation Training

Article

Full-text available

Apr 2003

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.

Predictors of response to medication and cognitive therapy in the treatment of moderate to severe depression

Article

Jan 2010

Jay C Fournier

Despite abundant empirical evidence demonstrating that cognitive therapy and antidepressant medications are effective treatments for depression, neither treatment appears to work equally well for all patients. In the three studies contained in this dissertation, I examined data from a recent clinical trial comparing cognitive therapy and antidepressant medications in order to identify variables associated with response to these two treatments. ^ In the first study, I examined the differential effects of personality pathology on short-term response and longer-term sustained response in the two treatments. Patients without personality disorders responded better to cognitive therapy than to medication treatment, whereas the reverse was true for patients with a comorbid personality disorder. The positive response to medications among patients with personality disorders was sustained only when those patients were continued on medications during the 12 month follow-up. Patients with personality disorders who were withdrawn from medications evidenced an extremely low sustained response rate. ^ In the second study, I investigated whether a comprehensive set of baseline patient characteristics was associated with treatment response Findings indicated that chronic depression, older age, and lower intelligence each predicted relatively poor response irrespective of the treatment that was received. In addition, three prescriptive predictors of treatment response were identified. Patients who were married, unemployed, or experiencing a relatively large number of life events evidenced superior response to cognitive therapy relative to medications. ^ In the third study, I examined four subsets of depressive symptoms and found no evidence that the severity of these symptoms at intake predicted differential response to the two treatments. In addition, I examined change in the magnitude of these symptom sets over the course of treatment and found that cognitive therapy produced greater change in the atypical vegetative symptoms of depression (specifically hypersomnia) relative to medication treatment. ^ Several prognostic and prescriptive predictors of treatment outcome were identified in this work. These findings, if replicated, would have clear clinical utility for the appropriate matching of treatments to patients. In addition, the pattern of findings should also help to refine theories that seek to explain the mechanisms through which these two treatments generate their therapeutic effects.

Intensive cognitive-behavioral therapy for comorbid misophonic and obsessive-compulsive symptoms: A systematic case study

Article

Apr 2016

Task concentration training and fear of blushing

Article

Dec 1997

Self-focused attention (SFA) is considered to be an important factor in the maintenance of social phobia. It is argued that this might be especially so in erytrophobia since physiological arousal (notably blushing) serves to focus attention inwards and heightened SFA may cause a blushing reaction. From this perspective, a treatment strategy is proposed that specifically aims at reducing SFA in erytrophobics. Two case studies are presented to illustrate the clinical use of task concentration training. Results revealed that task concentration training strongly decreased blushing propensity, fear of blushing, avoidance behaviour, and negative beliefs about the consequences of blushing. (C) 1997 John Wiley & Sons, Ltd.

Groups cognitive behavioral therapies of obesity

Article

Jan 1998

A person-centered approach was developed in order to overcome the frequently unfavorable outcomes of weight-centered, rigid diet based therapy of obesity. Cognitive behavioural therapy (CBT) was chosen on account of 1- its humanistic nature and 2-the possibility it offers to use methods which are validated, pragmatic, and potentially effective against negative psychological consequences of diet-induced cognitive restriction. A 15-week- program of group CBT was proposed by a psychologist and a dietician to 63 obese women, followed by relapse-prevention meetings scheduled at long intervals. Follow-up at 15 months showed marked and sustained improvements in weight as well as in psychological parameters.

The SCL-90: An outpatient psychiatric rating scale

Article

Jan 1973
Psychopharmacol Bull

Clinical global impressions, in ECDEU assessment manual for psychopharmacology (revised)

Article

Jan 1976

W. Guy

Effective behavioural strategies for reducing disgust in contamination-related OCD: A review

Article

Jul 2015

Disgust is an understudied but important emotion in various psychological disorders. Over the last decade, increasing evidence suggests that disgust is also present in various subtypes of obsessive-compulsive disorder (OCD), especially in contamination-related OCD (C-OCD). The treatment of choice for C-OCD is exposure with response prevention, originally designed to reduce fear-associated emotions thought to be acquired through Pavlovian conditioning (PC). However, disgust has been proposed to be acquired through evaluative conditioning (EC) and according to the referential model of this form of learning, there are functional differences between PC and EC that need to be considered in the treatment of disgust-related responses. Alternative strategies suggested by EC-based models include counterconditioning (contingent presentation of the CS with a US of opposite valence) and US revaluation (contingent presentation of the US with US of opposite valence). Drawing on the referential model, this paper reviews evidence for the effectiveness of each strategy to identify the most theoretically sound and empirically valid intervention to reduce disgust in C-OCD. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cognitive-Behavioral Therapy for 2 Youths With Misophonia: (Case Report)

Article

May 2015
J CLIN PSYCHIAT

Misophonia is an impairing syndrome with typical onset during childhood and is characterized by extreme sound sensitivities to selective auditory stimuli that elicit avoidance, anxiety, irritability, and/or outbursts. To date, there exists only 1 case report of cognitive-behavioral therapy (CBT) and no published information on pharmacologic intervention for misophonia. Although Bernstein et al demonstrated that misophonia-related symptoms could be managed with CBT when triggers are encountered, they did not objectively measure misophonia symptom improvement. © Copyright 2015 Physicians Postgraduate Press, Inc.

Negative Urgency and Emotion Regulation Strategy Use: Associations With Displaced Aggression

Article

Mar 2015
AGGRESSIVE BEHAV

The numerous public health consequences of interpersonal aggression highlight the necessity of a comprehensive understanding of factors influencing its perpetration. This study examined direct and interactive associations between negative urgency and emotion regulation strategy use in predicting displaced aggression under conditions of negative mood. Participants were 197 male and female undergraduate students who were randomly assigned to employ either cognitive reappraisal or expressive suppression in response to a negative mood induction. Immediately afterwards, participants engaged in an analog displaced aggression task. Results revealed direct, positive associations between negative urgency and aggression. In addition, the use of suppression was associated with greater aggression than was the use of reappraisal alone. Counter to the hypothesis, there were no interactive effects between negative urgency and emotion regulation strategy use in predicting aggression. Findings suggest reducing negative urgency and use of suppression as potential intervention targets for individuals who engage in aggressive behavior. Aggr. Behav. 9999:XX-XX, 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Misophonia: Incidence, Phenomenology, and Clinical Correlates in an Undergraduate Student Sample

Article

Oct 2014
J CLIN PSYCHOL

Objective Individuals with misophonia display extreme sensitivities to selective sounds, often resulting in negative emotions and subsequent maladaptive behaviors, such as avoidance and anger outbursts. While there has been increasing interest in misophonia, few data have been published to date.Method This study investigated the incidence, phenomenology, correlates, and impairment associated with misophonia symptoms in 483 undergraduate students through self-report measures.ResultsMisophonia was a relatively common phenomenon, with nearly 20% of the sample reporting clinically significant misophonia symptoms. Furthermore, misophonia symptoms demonstrated strong associations with measures of impairment and general sensory sensitivities, and moderate associations with obsessive-compulsive, anxiety, and depressive symptoms. Anxiety mediated the relationship between misophonia and anger outbursts.Conclusion This investigation contributes to a better understanding of misophonia and indicates potential factors that may co-occur and influence the clinical presentation of a person with misophonia symptoms.

Pediatric misophonia with comorbid obsessive-compulsive spectrum disorders

Article

Nov 2013

Misophonia is a potentially debilitating condition characterized by increased sensitivity to specific sounds, which cause subsequent behavioral and emotional responses. The nature, clinical phenomenology and etiology of misophonia remain unclear, and misophonic clinical presentations are not currently accounted for by existing psychiatric or audiological disorders. We present a case of pediatric misophonia in the context of comorbid obsessive-compulsive disorder and Tourette's syndrome. Given the interrelationships among obsessive-compulsive spectrum disorders and misophonia, these disorders may share underlying pathophysiology, particularly within the dopaminergic and serotonergic neural systems. Clinical (i.e., treatment) and theoretical implications are discussed.

Cognitive-Behavioral Therapy in the Treatment of Anger: A Meta-Analysis

Article

Feb 1998

Anger has come to be recognized as a significantsocial problem worthy of clinical attention andsystematic research. In the last two decades,cognitive-behavioral therapy (CBT) has emerged as themost common approach to anger management. Theoverall efficacy of this treatment has not beenascertained, and therefore, it was decided to conduct ameta-analysis of this literature. Based on 50 studiesincorporating 1,640 subjects, it was found that CBT produceda grand mean weighted effect size of .70, indicatingthat the average CBT recipient was better off than 76%of untreated subjects in terms of anger reduction. This effect was statistically significant,robust, and relatively homogeneous across studies. Thesefindings represent a quantitative integration of 20years of research into a coherent picture of theefficacy of CBT for anger management. The results alsoserve as an impetus for continued research on thetreatment of anger.

SCL-90, Handleiding bij een Multidimensionele Psychopathologie-indicator

Article

Jan 1986

How much psychotherapy is needed to treat depression? A metaregression analysis

Article

Mar 2013

The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

Article

Oct 2012

Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.

Physiological arousal, reactive aggression, and the induction of an incompatible relaxation response

Article

Jun 1998
AGGRESS VIOLENT BEH

Paul D Tyson

This review examines the major cognitive/social approaches to reducing reactive aggression and their interdependency on neural mechanisms associated with arousal. According to psychological theory, physiological arousal serves as a nonspecific energizer of cognitively defined emotions. Physiological models emphasize a bottom-up approach, many higher cortical functions serve to reduce heightened arousal and these reductions are essential before cognitive techniques can modulate aggressive behavior. Higher cortical functions are associated with complex cognitive processes necessary for self-control, anticipating consequences, and behavioral inhibition. Heightened arousal interferes with cognitive performance; disinhibiting aggression and reinforcing behavior that reduces arousal. Studies manipulating empathy, humor and sexual content have demonstrated efficacy of incompatible responses to reduce anger and aggression, but when attributions are negative and arousal high all of these manipulations can increase chances of overt aggression. The incompatible response hypothesis is extended beyond empathy, humor, and sexual arousal to include relaxation techniques for prevention and control of aggression. Cognitive-behavioral therapeutic programs have successfully reduced aggression by combining relaxation, systematic desensitization, and biofeedback with cognitive restructuring and anger management training.

Obsessive Compulsive Personality Disorder as a Predictor of Exposure and Ritual Prevention Outcome for Obsessive Compulsive Disorder

Article

Aug 2011

Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ≥ 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome.

Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: A meta-analysis

Article

Aug 2010

It is not well-known whether self-report measures and clinician-rated instruments for depression result in comparable outcomes in research on psychotherapy. We conducted a meta-analysis in which randomized controlled trials were included examining the effects of psychotherapy for adult depression. Only studies were included in which both a self-report and a clinician-rated instrument were used. We calculated the effect size (Hedges' g) based on the self-report measures, the effect size based on the clinician-rated instruments, and the difference between these two effect sizes (Deltag). A total of 48 studies including a total of 2462 participants was included in the meta-analysis. The differential effect size was Deltag=0.20 (95% CI: 0.10-0.30), indicating that clinician-rated instruments resulted in a significantly higher effect size than self-report instruments from the same studies. When we limited the effect size analysis to those studies comparing the HRSD with the BDI, the differential effect was somewhat smaller, but still statistically significant (Deltag=0.15; 95% CI: 0.03-0.27). This meta-analysis has made it clear that clinician-rated and self-report measures of improvement following psychotherapy for depression are not equivalent. Different symptoms may be more suitable for self-report or ratings by clinicians and in clinical trials it is probably best to include both.

Discovering statistics using IBM SPSS statistics

Article

Jan 2005

Andy Field

SCL-90: An outpatient psychiatric rating scale—preliminary report

Article

Feb 1973
Psychopharmacol Bull

Imaginal exposure for anger reduction in adult outpatients: A pilot study

Article

Sep 2000
J BEHAV THER EXP PSY

Although exposure procedures have been widely accepted in the treatment of anxiety disorders, they have rarely been applied to the treatment of anger. The present paper describes an initial attempt to apply an imaginal exposure strategy to adult outpatients (n = 6) referred for anger management. This investigation reflects an empirical clinical practice approach rather than a controlled outcome study. Thus, this paper provides a clinical description of the imaginal exposure program, pre-to-posttest effectiveness data, an exploration of habituation patterns for each participant, and 15-month follow-up data from several patients. In considering the impact of the intervention, statistically significant change was found on most anger variables, the majority of patients met a criteria for clinically significant improvement on important indices of anger, and treatment effect sizes were large and compared favorably to previously studied interventions. Process data revealed a consistent habituation effect, across patients and anger stimuli, in response to repeated exposure practice. Participants' satisfaction was also positive. Finally, statistically significant and clinically meaningful change was evident at 15-months following the intervention. Data from the current pilot project are encouraging and hopefully will stimulate more methodologically rigorous clinical trials.

Efficacy of Sertraline in the Long-Term Treatment of Obsessive-Compulsive Disorder

Article

Feb 2002

Obsessive-compulsive disorder (OCD) typically begins early in life and has a chronic course. Despite the need for long-term treatment, the authors found no placebo-controlled studies that have examined the relapse-prevention efficacy of maintenance therapy. Patients who met criteria for response after 16 and 52 weeks of a single-blind trial of sertraline were randomly assigned to a 28-week double-blind trial of 50-200 mg/day of sertraline or placebo. Primary outcomes after the double-blind trial were full relapse, dropout due to relapse or insufficient response, or acute exacerbation of OCD symptoms. Of 649 patients at baseline, 232 completed 52 weeks of the single-blind trial and met response criteria. Among the 223 patients in the double-blind phase of the study, sertraline had significantly greater efficacy than placebo on two of three primary outcomes: dropout due to relapse or insufficient clinical response (9% versus 24%, respectively) and acute exacerbation of symptoms (12% versus 35%). Sertraline resulted in improvement in quality of life during the initial 52-week trial and continued improvement, significantly superior to placebo, during the subsequent 28-week double-blind trial. Long-term treatment with sertraline was well tolerated. Over the entire study period, less than 20% of the patients stopped treatment because of adverse events. Sertraline demonstrated sustained efficacy among patients responding to treatment and was generally well tolerated during the 80-week study. During the study's last 28 weeks, sertraline demonstrated greater efficacy than placebo in preventing dropout due to relapse or insufficient clinical response and acute exacerbation of OCD symptoms.

Prolonged exposure counterconditioning as a treatment for chronic posttraumatic stress disorder

Article

Feb 2003
J ANXIETY DISORD

Nenad Paunovic

A counterconditioning model is presented from which the behavioral treatment prolonged exposure counterconditioning (PEC) was developed. The first part of a PEC session is intended to increase trauma exposure tolerance and counter numbing symptoms, the second to elicit trauma responses fully, and the third to weaken trauma responses. The first client with chronic posttraumatic stress disorder (PTSD) who was treated with PEC is presented. A statistical technique for analyzing single-case subject designs was used to evaluate the treatment. PEC effectively decreased the client's PTSD and associated psychopathology. Crucial differences between PEC and other behavioral treatments are discussed. An associative functional model is presented as a potentially useful conceptualization of PTSD, depression, and other anxiety disorders.

Task concentration training versus applied relaxation, in combination with cognitive therapy, for social phobia patients with fear of blushing, trembling, and sweating

Article

Sep 2006
BEHAV RES THER

Susan Bögels

Social phobia patients with fear of blushing, trembling, sweating and/or freezing as main complaint (N = 65) were randomly assigned to either task concentration training (TCT) or applied relaxation (AR) both followed by cognitive therapy (CT). Measurements took place before and after wait-list, after TCT or AR (within-test), after CT (post-test), at 3-months and at 1-year follow-up. Effects were assessed on fear of showing bodily symptoms (the central outcome variable), social phobia, other psychopathology, social skills, self-consciousness, self-focused attention, and dysfunctional beliefs. No changes occurred during wait-list. Both treatments were highly effective. TCT was superior to AR in reducing fear of bodily symptoms and dysfunctional beliefs at within-test. This difference disappeared after CT, at post-test and at 3-months follow-up. However, at 1-year follow-up the combination TCT-CT was superior to AR-CT in reducing fear of bodily symptoms, and effect sizes for TCT-CT reached 3. Furthermore, at all assessment moments TCT or the combination TCT-CT was superior to AR-CT in reducing self-consciousness and self-focused attention. The superior long-term effect of TCT on fear of showing bodily symptoms is explained by lasting changes in attentional focus.

High dose escitalopram for the treatment of obsessive-compulsive disorder

Article

Mar 2008
INT CLIN PSYCHOPHARM

The aim of this study was to evaluate the efficacy and tolerability of high-dose escitalopram in patients suffering from obsessive-compulsive disorder (OCD). In an open-label, 16-week prospective study, patients with OCD received escitalopram at a dose of 20 mg/day for 3 weeks, after a 1-week titration at 10 mg/day. Patients who did not achieve a > or =25% reduction from baseline in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score during these 4 weeks were continued on higher doses of escitalopram (maximum 50 mg/day) for 12 weeks. The primary efficacy measure of OCD symptoms was change from baseline in the Y-BOCS score. Overall, 67 patients (33 women, 34 men) with a mean Y-BOCS score of 29.6 entered the study. After 4 weeks of standard-dose escitalopram treatment, one patient discontinued owing to pregnancy, and two patients achieved a reduction in Y-BOCS > or =25%. Consequently, 64 patients were eligible to receive high-dose escitalopram (mean dose, 33.8 mg/day at endpoint). At endpoint, high-dose escitalopram had significantly improved the OCD symptoms (Y-BOCS score) and all the other efficacy measures (P<0.001), compared with baseline. Escitalopram was also well tolerated, with no discontinuations during the 12-week high-dose phase. The only reported adverse drug reactions were dry mouth (n=8, 12.1%) and decreased sexual desire (n=21, 31.8%). Preliminary investigation shows that high-dose escitalopram is an efficacious and well tolerated treatment for patients suffering from severe OCD. Randomized, blinded studies are needed to reinforce these findings.

Borderline Personality Characteristics and Treatment Outcome in Cognitive-Behavioral Treatments for PTSD in Female Rape Victims

Article

Apr 2008
BEHAV THER

Many studies report that comorbid borderline personality pathology is associated with poorer outcomes in the treatment of Axis I disorders. Given the high rates of comorbidity between borderline personality pathology and posttraumatic stress disorder (PTSD), it is essential to determine whether borderline symptomatology affects PTSD treatment outcome. This study examined the effects of borderline personality characteristics (BPC) on 131 female rape victims receiving cognitive-behavioral treatment for PTSD. Higher BPC scores were associated with greater pretreatment PTSD severity; however, individuals with higher levels of BPC were just as likely to complete treatment and also as likely to show significant treatment response on several outcome measures. There were no significant interactions between type of treatment and BPC on the outcome variables. Findings suggest that women with borderline pathology may be able to benefit significantly from cognitive-behavioral treatment for PTSD.

Aangrijpingspunt van de behandeling (II): interventies die de intrinsieke betekenis van de UCS/UCR representatie beïnvloeden. Geïntegreerde cognitieve gedragstherapie. Handboek voor theorie en praktijk

Jan 2004
329-371

K Korrelboom
E Ten Broeke

Korrelboom, K., Ten Broeke, E., 2004. Aangrijpingspunt van de behandeling (II): interventies die de intrinsieke betekenis van de UCS/UCR representatie beïnvloeden. Geïntegreerde cognitieve gedragstherapie. Handboek voor theorie en praktijk. Uitgeverij Coutinho, Bussum, The Netherlands, pp. 329-371.

Jan 1997
J AFFECT DISORDERS
289-294

K A Philips
E Hollander
S A Rasmussen
B R Aronowitz
C Decaria

Philips, K.A., Hollander, E., Rasmussen, S.A., Aronowitz, B.R., DeCaria, C., et al., 1997. A A.E. Schröder et al. Journal of Affective Disorders 217 (2017) 289-294

The Theory and Practice of Group Psychotherapy

Jan 2005

I D Yalom
M Leszcz

Yalom, I.D., Leszcz, M., 2005. The Theory and Practice of Group Psychotherapy, 5th edition. Basic Books, New York, NY.

Borderline personality characteristics and treatment outcome in cognitive-behavioral treatments for PTSD in female rape victims

Jan 2008
BEHAV THER
72-78

S B Clarke
S L Rizvi
P A Resick

Clarke, S.B., Rizvi, S.L., Resick, P.A., 2008. Borderline personality characteristics and treatment outcome in cognitive-behavioral treatments for PTSD in female rape victims. Behav. Ther. 39, 72-78. http://dx.doi.org/10.1016/j.beth.2007.05.002. Borderline.