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Cognitive behavioral therapy is effective in misophonia: An open trial
Abstract
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.
Supplementary resource (1)
... Many successful treatment cases applied components of a cognitive-behavioral framework (CBT) and acceptance based (acceptance and commitment therapy, ACT) interventions (Aazh et al., 2019;Alekri and Saif, 2019;Altýnöz et al., 2018;Bernstein et al., 2013;Cecilione et al., 2021;Dozier, 2015aDozier, , 2022Dover and McGuire, 2021;Hocaoǧlu, 2018;McGuire et al., 2015;Muller et al., 2018;Reid et al., 2016;Robinson et al., 2018;Roushani and Honarmand, 2021;Schneider and Arch, 2017;Tonarely-Busto et al., 2022;Vanaja and Abigail, 2020). The success of misophonia treatment trials using CBT and ACT components also provides support for the theory that misophonia is a learned condition (Frank and McKay, 2019;Rabasco and McKay, 2021;Schröder et al., 2017). Recently, Cowan et al. (2022) proposed a psychological model of misophonia which includes a recurring, circular interconnection of distress from sound, rigidity regarding sounds, and increased awareness of sounds. ...
... A trigger thus creates a conditioning event because the muscle response after the reflex is stronger than the reflex response alone. This proposition is consistent with the report that mere exposure to misophonic triggers generally increases misophonia symptoms rather than reducing them (Schröder et al., 2017). We therefore posit that typical exposure to misophonic triggers maintains or strengthens the IPR. ...
... Application of this model to applied misophonia research may be even more important. Several studies have reported success in reducing misophonia severity using CBT techniques (Frank and McKay, 2019;Jager et al., 2021;Schröder et al., 2017). Specific components of reducing the IPR and covert mental review may be added to existing protocols to determine additional treatment benefit. ...
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.
... Many successful treatment cases applied components of a cognitive-behavioral framework (CBT) and acceptance based (acceptance and commitment therapy, ACT) interventions (Aazh et al., 2019;Alekri and Saif, 2019;Altýnöz et al., 2018;Bernstein et al., 2013;Cecilione et al., 2021;Dozier, 2015aDozier, , 2022Dover and McGuire, 2021;Hocaoǧlu, 2018;McGuire et al., 2015;Muller et al., 2018;Reid et al., 2016;Robinson et al., 2018;Roushani and Honarmand, 2021;Schneider and Arch, 2017;Tonarely-Busto et al., 2022;Vanaja and Abigail, 2020). The success of misophonia treatment trials using CBT and ACT components also provides support for the theory that misophonia is a learned condition (Frank and McKay, 2019;Rabasco and McKay, 2021;Schröder et al., 2017). Recently, Cowan et al. (2022) proposed a psychological model of misophonia which includes a recurring, circular interconnection of distress from sound, rigidity regarding sounds, and increased awareness of sounds. ...
... A trigger thus creates a conditioning event because the muscle response after the reflex is stronger than the reflex response alone. This proposition is consistent with the report that mere exposure to misophonic triggers generally increases misophonia symptoms rather than reducing them (Schröder et al., 2017). We therefore posit that typical exposure to misophonic triggers maintains or strengthens the IPR. ...
... Application of this model to applied misophonia research may be even more important. Several studies have reported success in reducing misophonia severity using CBT techniques (Frank and McKay, 2019;Jager et al., 2021;Schröder et al., 2017). Specific components of reducing the IPR and covert mental review may be added to existing protocols to determine additional treatment benefit. ...
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.
... After 7-8 group CBT sessions, 90 total patients reported a mean reduction of 4.5 points on the A-MISO-S. Overall, nearly half of the patients experienced at least a 30% reduction on the A-MISO-S [43]. Lewin et al. [28] published a case series (N = 4) from an ongoing RCT examining the effect of a transdiagnostic CBT protocol known as the Unified Protocol. ...
... Anecdotal improvement was reported after anywhere from 7 to 23 treatment sessions of 30 min each [9][10][11]. Subsequent studies, including the seminal study by Jager and colleagues (2020), have implemented counter-conditioning components in conjunction with other techniques [43,7]. ...
... While there is promise in various CBT protocols, it is unclear what components are most effective and contribute to response. For example, the current protocols described by Jager et al. [22] and Schröder et al. [43] include elements that are not classically thought of as exposure, but carry elements of exposure in the introduction of trigger sounds during counter-conditioning procedures, which involve pairing a misophonia trigger with a pleasant stimulus to develop a new positive association with the trigger. It remains unclear which of these modalities contribute to the positive outcomes reported in these initial reports; dismantling studies are needed to understand core treatment components that contribute to outcome. ...
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.
... 9 Research in the field of misophonia and related factors is limited in the world, and this limited number have mostly been done on people who have referred to clinics. 9,10 In previous studies, misophonia has sometimes been associated with disorders such as anxiety, obsessive-compulsive disorder, depression, eating disorders, Tourette's syndrome, and tinnitus. [9][10][11] Some studies suggest that while misophonia has unique clinical features with a neurophysiological mechanism, it may be associated with psychiatric symptoms. ...
... 9,10 In previous studies, misophonia has sometimes been associated with disorders such as anxiety, obsessive-compulsive disorder, depression, eating disorders, Tourette's syndrome, and tinnitus. [9][10][11] Some studies suggest that while misophonia has unique clinical features with a neurophysiological mechanism, it may be associated with psychiatric symptoms. 11,12 In most of these studies, small samples have been used; therefore, it is necessary to determine the statistical relationship between misophonia and other disorders in large samples more precisely; also, the accurate identification of the factors related to misophonia can play an important role in preventing this disorder. ...
... 11,12 In most of these studies, small samples have been used; therefore, it is necessary to determine the statistical relationship between misophonia and other disorders in large samples more precisely; also, the accurate identification of the factors related to misophonia can play an important role in preventing this disorder. 10,13 Although misophonia is not mentioned in any recent psychiatric classification systems, IJCBNM October 2022; Vol 10,No 4 Schröder believes that misophonia should be considered as a new mental disorder in the spectrum of obsessive-compulsive disorders. 10 Obsessive-compulsive disorder is characterized by a variety of symptoms, including disturbing thoughts, anxiety, and coercion that significantly interfere with a person's normal routine of life, job performance, routine social activities or relationships. ...
Background:
Misophonia is a severe emotional response to repetitive sounds. This disorder may limit a person's communication, reduce his/her ability, or disrupt his/her social and personal life. This study aimed to determine the prevalence of Misophonia and its relationship with obsessive-compulsive disorder, anxiety, and depression in undergraduate students of Shiraz University of Medical Sciences.
Methods:
The present study is an analytical descriptive study conducted in October 2020. The study samples consisted of 390 undergraduate students of Shiraz University of Medical Sciences. A relative and systematic sampling method was used. In this study, demographic questionnaire, misophonia questionnaire (A score of 7 or higher is considered as misophonia), Beck anxiety questionnaire, Beck depression questionnaire, and Maudsley obsessive-compulsive inventory questionnaire were used, and the data were analyzed using SPSS 24 software. In this study, chi-square test was used to examine the relationship between the variables. Due to the non-normality of the data, the Spearman correlation coefficient was used for data analysis. The significance level was considered equal to and less than 0.05.
Results:
Of the 390 participants in the study, 93 (23.8%) had experienced misophonia. Among these 93 students, 37 (39.8%) had obsessive-compulsive disorder, 8 (8.6%) suffered anxiety, and 9 (9.7%) were depressed. There was a significant and direct relationship between misophonia and obsessive-compulsive disorder,anxiety and depression respectively(P<0.001).
Conclusion:
Due to the prevalence of misophonia among students and its direct relationship with obsessive-compulsive disorder, anxiety and depression, we recommend that future studies should be conducted to find the ways to prevent and reduce the incidence of misophonia.
... How misophonia develops is currently unclear (Schröder et al., 2017;Rouw and Erfanian, 2018;Lewin et al., 2021). One study found that 77% of participants self-reported symptoms worsening with age , whereas another study found a negative association between age and misophonia severity (Vitoratou et al., 2021). ...
... Treatments like exposure therapy have not been as successful in case studies to treat misophonia due to non-compliance (Hadjipavlou et al., 2008), and studies that have looked at medication alone or counterconditioning are limited to a handful of case studies (Dozier, 2015a,b;McGuire et al., 2015;Tunç and Başbug, 2017;Vidal et al., 2017). In comparison, cognitive-behavioral therapy seems to be successful in reducing misophonia in adults (Bernstein et al., 2013;McGuire et al., 2015;Reid et al., 2016;Potgieter et al., 2019;Jager et al., 2021), and perhaps also in younger populations (see Lewin et al., 2021 for a preliminary proof of concept); however, those with a higher severity of misophonia symptoms seem more likely to respond to treatment (Schröder et al., 2017). The effectiveness of cognitive-behavioral therapies in reducing the severity in misophonic symptoms could implicate two mechanisms in the development of misophonia, which await larger-scale treatment dismantling studies to explore. ...
... The effectiveness of cognitive-behavioral therapies in reducing the severity in misophonic symptoms could implicate two mechanisms in the development of misophonia, which await larger-scale treatment dismantling studies to explore. For the first mechanism, if the behavioral components represent the active therapeutic ingredients, such findings would point to a role of learning in misophonia, in which initial hyperarousal in response to a specific sound or sounds might lead to associations between those sounds and aversive emotional and physiological responses (Schröder et al., 2017). For the second, if individuals were to use maladaptive behaviors (such as avoidance) to escape trigger sounds, this would further exacerbate symptoms of misophonia over time, which behavioral interventions would help mitigate (Lewin et al., 2021). ...
Misophonia can be characterized both as a condition and as a negative affective experience. Misophonia is described as feeling irritation or disgust in response to hearing certain sounds, such as eating, drinking, gulping, and breathing. Although the earliest misophonic experiences are often described as occurring during childhood, relatively little is known about the developmental pathways that lead to individual variation in these experiences. This literature review discusses evidence of misophonic reactions during childhood and explores the possibility that early heightened sensitivities to both positive and negative sounds, such as to music, might indicate a vulnerability for misophonia and misophonic reactions. We will review when misophonia may develop, how it is distinguished from other auditory conditions (e.g., hyperacusis, phonophobia, or tinnitus), and how it relates to developmental disorders (e.g., autism spectrum disorder or Williams syndrome). Finally, we explore the possibility that children with heightened musicality could be more likely to experience misophonic reactions and develop misophonia.
... Specifically, misophonia has been found to be associated with anxiety, depression, and personality disorder symptoms, with anxiety as a mediator between personality disorder symptoms and misophonia (Cassiello-Robbins et al., 2021). As such, different forms of cognitive behavioral therapy, including transdiagnostic and counterconditioning approaches (Schröder et al., 2017;Lewin et al., 2021), and inhibitory learning approaches (Frank and McKay, 2019) that address emotional responses and contextual factors around a trigger stimulus-response pairing have shown some promising results. As the field continues to learn more about misophonia, it is possible that these clinical approaches may be complemented by the cross-sensory remapping approach we introduced here. ...
... Existing research has already begun exploring how stimuli manipulation can be used in cognitive behavioral therapy (CBT) to alleviate misophonic trigger reactions. Schröder et al. (2017) conducted group CBT sessions with four main therapeutic exercises, including stimuli manipulation and counterconditioning where participants manipulated aspects of their own trigger sounds such as the pitch, duration of sound, and associations with visual stimuli. As part of this exercise, participants combined trigger sounds with pleasant stimuli, and were tasked with decreasing avoidant coping strategies when listening and watching their own stimuli at home. ...
... The researchers found that stimulus manipulation "helped to decrease the uncontrollability over misophonic triggers" and that the stimulus-grounded practice resulted in participants "feeling less overwhelmed by misophonic sounds" (Schröder et al., 2017, p. 292). We see our work as complementary to Schröder et al. (2017)'s CBT practice, and believe the Sound-Swapped Video Database provides researchers an opportunity to scale a stimulus-grounded intervention for counterconditioning with larger populations. ...
Misophonia has been characterized as intense negative reactions to specific trigger sounds (often orofacial sounds like chewing, sniffling, or slurping). However, recent research suggests high-level, contextual, and multisensory factors are also involved. We recently demonstrated that neurotypicals’ negative reactions to aversive sounds (e.g., nails scratching a chalkboard) are attenuated when the sounds are synced with positive attributable video sources (PAVS; e.g., tearing a piece of paper). To assess whether this effect generalizes to misophonic triggers, we developed a Sound-Swapped Video (SSV) database for use in misophonia research. In Study 1, we created a set of 39 video clips depicting common trigger sounds (original video sources, OVS) and a corresponding set of 39 PAVS temporally synchronized with the OVS videos. In Study 2, participants (N = 34) rated the 39 PAVS videos for their audiovisual match and pleasantness. We selected the 20 PAVS videos with best match scores for use in Study 3. In Study 3, a new group of participants (n = 102) observed the 20 selected PAVS and 20 corresponding OVS and judged the pleasantness or unpleasantness of each sound in the two contexts accompanying each video. Afterward, participants completed the Misophonia Questionnaire (MQ). The results of Study 3 show a robust attenuating effect of PAVS videos on the reported unpleasantness of trigger sounds: trigger sounds were rated as significantly less unpleasant when paired with PAVS with than OVS. Moreover, this attenuating effect was present in nearly every participant (99 out of 102) regardless of their score on the MQ. In fact, we found a moderate positive correlation between the PAVS-OVS difference and misophonia severity scores. Overall our results provide validation that the SSV database is a useful stimulus database to study how misophonic responses can be modulated by visual contexts. Here, we release the SSV database with the best 18 PAVS and 18 OVS videos used in Study 3 along with aggregate ratings of audio-video match and pleasantness (https://osf.io/3ysfh/). We also provide detailed instructions on how to produce these videos, with the hope that this database grows and improves through collaborations with the community of misophonia researchers.
... This patient meets all criteria proposed by the Amsterdam UMC in 2020. The revised Amsterdam Misophonia Scale [AMISOS-R; (29)] indicates she has severe to extreme misophonia (range [31][32][33][34][35][36][37][38][39][40]. The labels in parentheses are links to the main elements of Figure 3. ...
... This G-CBT manual has been used in two clinical trials by our research group where it has been efficacious in treating misophonia in Dutch adults (20,39). The effectiveness of the first version of this protocol for group treatment has been examined with good results (39). ...
... This G-CBT manual has been used in two clinical trials by our research group where it has been efficacious in treating misophonia in Dutch adults (20,39). The effectiveness of the first version of this protocol for group treatment has been examined with good results (39). Almost half of the 90 patients studied had over 30% symptom reduction (P < 0.001) and were clinically assessed as "much improved" or "very much improved" on the Clinical Global Impression-Improvement (CGI-I) (40). ...
Misophonia is a disorder in which patients suffer from anger or disgust when confronted with specific sounds such as those associated with eating or breathing, causing avoidance of cue related situations resulting in significant functional impairment. Functional magnetic resonance imaging studies suggest misophonia is associated with increased activity in the auditory cortex and salience network, which might reflect increased vigilance toward specific misophonia triggers. New treatments have been developed and investigated in the last years in which this vigilance plays an important role. This is a synopsis of the first group protocol for systemic Cognitive Behavioral Therapy (G-CBT) for misophonia. We discuss the model of CBT for misophonia, provide a detailed guide to the treatment illustrated with a case study, discuss advantages, limitations, and possible pitfalls by a qualitative evaluation of the protocol, and review evidence for the protocol.
... The estimates differ because they are speculative rates, as the degree of misophonic symptoms has been assessed by self-administered scales, which lack a full psychiatric assessment [39]. The above figures are not generalizable but suggest that this is a real health problem that requires attention, as misophonia scores are associated with scales of functional impairment [5,15], specifically in the school or work, social, and family context [5]. ...
... Clinical anamnesis is an essential tool for recognizing misophonic symptomatology, which will also provide information on the onset and course of the disorder, the triggering stimuli, and the patient's emotional and physiological reactions. Authors have emphasized the importance of a complete evaluation that involves the interview of the psychiatrist and/or psychologist, to know the presence of comorbid conditions, as well as the use of drugs or psychoactive substances [24,39]. ...
... To have a better understanding of the causes of misophonia, it should be taken into account that there may be individual differences that determine that only a group of people develop this aversion to sounds. This specificity of stimuli and symptomatology could be due to neurobiological alterations [1,2,10,32,39,[45][46][47][48][49], and/or genetic predisposition [20,23,40,41,43], which, in conjunction with learning or conditioning [3,4,24,35,52,53,56], result in the development of misophonia. From this it can certainly be concluded that in order to understand the etiology of this disorder, it is essential to approach it from a multifactorial perspective. ...
Misophonia is a scarcely known disorder. This systematic review (1) offers a quantitative and qualitative analysis of the literature since 2001, (2) identifies the most relevant aspects but also controversies, (3) identifies the theoretical and methodological approaches, and (4) highlights the outstanding advances until May 2022 as well as aspects that remain unknown and deserve future research efforts. Misophonia is characterized by strong physiological, emotional, and behavioral reactions to auditory, visual, and/or kinesthetic stimuli of different nature regardless of their physical characteristics. These misophonic responses include anger, general discomfort, disgust, anxiety, and avoidance and escape behaviors, and decrease the quality of life of the people with the disorder and their relatives. There is no consensus on the diagnostic criteria yet. High comorbidity between misophonia and other psychiatric and auditory disorders is reported. Importantly, the confusion with other disorders contributes to its underdiagnosis. In recent years, assessment systems with good psychometric properties have increased considerably, as have treatment proposals. Although misophonia is not yet included in international classification systems, it is an emerging field of growing scientific and clinical interest.
... Given the nature of misophonia, different therapeutic components such as cognitive reconstruction, relaxation, anger management training, exposure, and response prevention have been used as CBT to alleviate symptoms and improve misophonia. The results of CBT-based studies indicate the satisfactory outcomes of this therapy for their participants (10,(12)(13)(14)(15)(16)(17)(18). Nonetheless, some patients do not respond to CBT or are resistant to exposure, whereas many therapists do not feel comfortable in the implementation of exposure (19). ...
... However, the effect of treatment over time (pre-test, post-test, and follow-up) was significant in both groups, and the clinical significance of treatment was 69% in OG-CBT and 53% in OG-MACT, showing, according to group members, that the maximum attendance at meetings and exercises was directly related to the effectiveness 6 Iran J Psychiatry Behav Sci. 2022; 16(2):e120159. in which 90 patients with misophonia were treated as a group using the CBT approach; although in the present study, the clinical significance of OG-CBT was greater than Schroder et al. (12) study (68% vs. 48%), the treatment process might influence this outcome. In a randomized controlled trial, Jager et al. (16) compared CBT treatment with the control group and found that CBT treatment was significant compared to the control group. ...
... In a randomized controlled trial, Jager et al. (16) compared CBT treatment with the control group and found that CBT treatment was significant compared to the control group. Other studies that have examined CBT in the treatment of misophonia have been case studies, and all of them have confirmed the effectiveness of this treatment (10,(12)(13)(14)(15), in line with the present study. In the case of OG-MACT, only one case study was conducted in line with the present study, which confirmed the effectiveness of both treatments (3). ...
Background: Misophonia is a disorder in which people show negative emotions such as anger, disgust, and anxiety about certain sounds, such as mouth and nose sounds, as well as some repetitive sounds. This disorder has a high prevalence and causes many problems for patients. Objectives: This study aimed to examine and compare the effectiveness of two therapies, including online group-mindfulness and acceptance‐based therapy (OG-MACT) and online group-cognitive-behavioral therapy (OG-CBT) in patients with misophonia. Methods: This study was a two-group random assignment pretest-posttest design. Thirty-eight participants were recruited using convenience sampling and randomly assigned to OG-CBT (n = 19) and OG-MACT (n = 19) groups. The statistical population included patients with misophonia (a score higher than seven on the Misophonia Questionnaire) referred to the Tehran Institute of Psychiatry from October to December 2019. They were asked to respond to online self-report questionnaires evaluating misophonia, distress tolerance, quality of life, depression, anxiety, and stress scale in three stages, including before treatment sessions, one week after the end of sessions, and during a three-month follow-up. Results: The difference in the mean scores of the scales at different times did not differ according to the type of treatment group (OG-CBT versus OG-MACT). The results showed that the effect of time was significant on misophonia scores. Over time, this finding also applies to depression, anxiety, and stress subscales in the distress tolerance questionnaire. However, there was no significant difference in the quality of life over time. The changes in misophonia were clinically significant in 53% of OG-MACT members and 69% of OG-CBT members. Discussion: According to the findings, the two online group therapies of CBT and MACT effectively reduced the symptoms of misophonia.
... There are several case studies that reported psychological interventions that were developed using existing therapeutic techniques, with many of them reporting reductions in misophonia symptoms (Bernstein et al., 2013;McGuire et al., 2015;Muller et al., 2018;Schneider & Arch, 2017). Almost half of 90 patients in an open trial showed significant reductions in misophonic symptoms (Schröder et al., 2017). Frank and McKay (2019) found evidence supporting the suitability for utilizing exposure strategies based on an inhibitory learning approach. ...
... The interventions in these studies primarily consisted of protocols that derived their components from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and dialectical behavior therapy (DBT). These components included cognitive restructuring (i.e., Bernstein et al., 2013;McGuire et al., 2015), exposure and response prevention (ERP; i. e., Frank & McKay, 2019;McGuire et al., 2015;Muller et al., 2018), counterconditioning (i.e., Dozier, 2015;Frank & McKay, 2019;Schröder et al., 2017), relaxation exercises (i.e., Schröder et al., 2017), acceptance and distress tolerance strategies (i.e., Schneider & Arch, 2017), and improving interpersonal communication skills (i.e. Bernstein et al., 2013;Muller et al., 2018). ...
... The interventions in these studies primarily consisted of protocols that derived their components from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and dialectical behavior therapy (DBT). These components included cognitive restructuring (i.e., Bernstein et al., 2013;McGuire et al., 2015), exposure and response prevention (ERP; i. e., Frank & McKay, 2019;McGuire et al., 2015;Muller et al., 2018), counterconditioning (i.e., Dozier, 2015;Frank & McKay, 2019;Schröder et al., 2017), relaxation exercises (i.e., Schröder et al., 2017), acceptance and distress tolerance strategies (i.e., Schneider & Arch, 2017), and improving interpersonal communication skills (i.e. Bernstein et al., 2013;Muller et al., 2018). ...
Misophonia is a condition characterized by strong reactions to specific sounds which are usually emitted by other people. The condition can be debilitating due to the distress and avoidance that it involves, at times resulting in significant occupational and relational dysfunction. The aim of this paper is to offer a theoretical account that can explain the phenomenology of misophonia that has been reported in the literature. To this end, we argue that misophonia emerges out of rigid character style in combination with contextual factors and classical and operant conditioning processes. Based on this model, we also offer a treatment approach called experiential acceptance and sound exposure. It consists of three main components: sound exposure, anger acceptance, and acceptance of sound triggers as an unchanging reality.
... CBT consists of four main components: task concentration exercises, positive affect labelling, stimulus manipulation, and arousal reduction. The first treatment studies with CBT showed promising results, respectively, 48% (Schröder, Vulink, Van Loon, & Denys, 2017) and 37% of the patients (Jager et al., 2020b) showed significant clinical improvement with CBT post treatment. However, CBT is ineffective for more than half of misophonia patients, who therefore require alternative treatments. ...
... Treatment options are still limited for misophonia. So far, the only well-studied intervention for misophonia is G-CBT (Jager et al., 2020b;Schröder et al., 2017). Compared to the results of the recent RCT of G-CBT, EMDR was less effective with a decrease of −6.14 vs −9.7 points (G-CBT) on the AMISOS-R post treatment, respectively, though an equal percentage of patients clinically improved, 38% with EMDR vs 37% with G-CBT on the CGI-I post treatment (Jager et al., 2020b). ...
... G-CBT as a multicomponent intervention offers more techniques from which patients can profit, extensive psychoeducation, more opportunity to practice under guidance, peer support, and support of loved ones. The empirical level of evidence is higher for G-CBT including a RCT with one 1-year follow-up, no adverse events were reported and patient's acceptability is high (Jager et al., 2020b;Schröder et al., 2017). In this pilot study, EMDR therapy time was limited by a mean of 2.6 sessions of 1 to 1.5 hours (mean total of 3.9 hours) versus 8 (group) sessions of CBT of 3 hours (mean total of 24 hours) and could therefore be more cost-effective. ...
Background
Misophonia is a disorder in which patients suffer from anger or disgust when confronted with specific sounds such as loud chewing or breathing, causing avoidance of cue-related situations resulting in significant functional impairment. Though the first treatment studies with cognitive behavioural therapy (CBT) showed promising results, an average of 50% of the patients has not improved much clinically.
Objective
The aim of this pilot study was to assess the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a trauma-focused approach in treating misophonia symptoms.
Method
A sample of 10 adult participants with misophonia was studied at the outpatient clinic of the Academic Medical Center in Amsterdam. Participants were either on the waiting list for CBT or non-responders to CBT. EMDR was focused on misophonia-related emotionally disturbing memories and delivered in a mean of 2.6 sessions of 60–90 minutes. Pre- and post-treatment self-assessed ratings of misophonia symptoms (AMISOS-R, primary outcome), of general psychopathology (SCL-90-R) and of quality of life (SDS) were administered. The co-primary outcome was the Clinical Global Impression Improvement scale (CGI-I).
Results
A paired t-test (n = 8) showed improvement on the primary outcome (−6.14 [MD], 5.34 [SD]) on the AMISOS-R (P = .023). Three of the eight patients showed clinically significant improvement measured with the CGI-I. No significant effect on secondary outcomes was found.
Conclusions
These preliminary results suggest that EMDR therapy focused on emotionally disturbing misophonia-related memories can reduce misophonia symptoms. RCTs with sufficient sample sizes are required to firmly establish the value of EMDR therapy for misophonia.
... Über die Inzidenz und Prävalenz kann bisher nur spekuliert werden [56]. Einige Forscher vermuten ein "relativ häufiges" Auftreten [10,65] [68] gaben an, unter klinisch signifikanten misophonen Symptomen zu leiden, andere Schätzungen postulierten 3 % in der Allgemeinbevölkerung [42]. ...
... Bisher publizierte oder von Einzelpersonenentwickelte Verfahrenumfassenhäufig in Kombination Verhaltenstherapien [4,43,48,56,1], die Gegenkonditionierung [15] und audiologisch-technische Verfahren. Bei der kognitiven Verhaltenstherapie (KVT, CBT, "cognitive behavioral therapy") [4,15,26,43,48] ist das Ziel das Sich-bewusst-Machen maladaptiver Muster [38], Überprüfung von Schlussfolgerungen auf ihre Angemessenheit, Korrektur von irrationalen Einstellungen und Transfer korrigierter Einstellungen ins konkrete Verhalten. ...
... Ist die Kognition inadäquat (z. B. durch Wahrnehmungsselektion und -bewertung), ist auch die Möglichkeit beeinträchtigt, Affekt und Verhalten zu korrigieren [16,56]. ...
Zusammenfassung
Die Misophonie ist eine Intoleranz auf bestimmte Alltagsgeräusche. Hierbei fungieren als „Trigger“ „menschliche Körpergeräusche“, z. B. Schlucken/Schmatzen/Atemgeräusche oder Geräusche, die von Menschen, aber nicht vom menschlichen Körper erzeugt werden (z. B. Klicken Kugelschreiberknopf), ferner Tier‑/Maschinengeräusche. Die Betroffenen verspüren sofort eine negativ-emotionale Reaktion wie Wut, Aggression, Ekel u.a. Objektivierbare Veränderungen sind Herzfrequenzerhöhung und Blutdruckveränderungen. Die emotionale Reaktion ist individuell und hängt z. B. von Geräuschart, persönlicher Vorerfahrung, sozialem Kontext oder psychologischem Profil ab. Die Misophonie ist bisher als Krankheit nicht definiert und keinem offiziellen Diagnosesystem zugeordnet, sie scheint eine eigenständige Störung zu sein: Assoziationen bestehen u. a. mit Aufmerksamkeits‑/Zwangsstörungen, Tinnitus, Hyperakusis, Autismus-Spektrum-Krankheiten. Definitionskriterien wurden 2013 veröffentlicht; verschiedene, validierte Fragebögen wurden bisher zur Misophonieausprägung entwickelt. Studien mit funktionellen MRT-Untersuchungen des Kopfes zeigten eine übermäßige Aktivierung des anterioren Inselkortex (AIC) und seiner benachbarten Regionen, die für Emotionsverarbeitung/-regulation verantwortlich sind. Bisher gibt es keine randomisierten kontrollierten Studien zur Therapie. Einzelne Publikationen beschreiben kognitive Verhaltensinterventionen, Retrainingtherapien und Schallmaskierungssysteme. Zur Triggerreduktion werden Ohrstöpsel/Musikkopfhörer verwendet. Auch HNO-Ärzte können mit Misophoniepatienten konfrontiert werden, z. B. zur Klärung des Hörvermögens oder Beratung von Therapiemöglichkeiten. Der Bericht stellt eine Übersicht des aktuellen Wissensstands zur Misophonie sowie ihrer Diagnostik und Therapie dar.
... While research on misophonia has increased in the past decade (see Potgieter et al., 2019, for a recent review), most studies have focused on the etiology and assessment of misophonia with few reports on its treatment. To date, there have been a handful of case reports and two open-label clinical trials reporting on the treatment of misophonia (Frank & McKay, 2019, or Schröder et al., 2017. Unfortunately, only four of these reports focus specifically on youth (McGuire et al., 2015;Muller et al., 2018;Reid et al., 2016;Schneider & Arch, 2017). ...
... Items are rated on a 5-point Likert type scale that ranges from 0 (none) to 4 (extreme) and summed to produce a total severity score (range: 0-24). The A-MISO has demonstrated good reliability and treatment sensitivity (Schröder et al., 2013(Schröder et al., , 2017. The A-MISO was completed by the parent primarily involved in Sally's treatment. ...
... While future research is still needed to replicate and build upon these initial findings, a family-based CBT approach shows potential to improve the lives of youth with misophonia and their families, and carries potential implications to reduce the burden of this condition across the life span. This report contributes to the growing body of misophonia treatment research that spans case reports, open-label clinical trials (Frank & McKay, 2019;Schröder et al., 2017), and clinician handbooks (Dozier, 2017). ...
Misophonia is a common condition that causes significant distress and impairment for patients and families. Despite the growing body of literature, most treatment descriptions do not incorporate objective assessment measures or detail techniques to involve family members in addressing misophonia. This case report provides a step-by-step family-based cognitive-behavioral approach to treat youth with misophonia, uses objective rating scales to monitor therapeutic improvement, and elicits feedback on the therapeutic skills used between therapy sessions. It also provides guidance on implementing inhibitory learning exposures for youth with misophonia.
... However, it is not yet known which specific interventions are most effective, nor do we understand the mechanisms of change for this disorder. A range of CBT strategies have been employed, including attention training (Bernstein et al., 2013;Schröder et al., 2017), counterconditioning, stimulus manipulation (Schröder et al., 2017), exercises involving exposure to sounds, cognitive restructuring (McGuire et al., 2015;Reid et al., 2016) and acceptance of reactions to sounds (Schneider and Arch, 2017). proposed employing inhibitory learning strategies for treatment of misophonia. ...
... However, it is not yet known which specific interventions are most effective, nor do we understand the mechanisms of change for this disorder. A range of CBT strategies have been employed, including attention training (Bernstein et al., 2013;Schröder et al., 2017), counterconditioning, stimulus manipulation (Schröder et al., 2017), exercises involving exposure to sounds, cognitive restructuring (McGuire et al., 2015;Reid et al., 2016) and acceptance of reactions to sounds (Schneider and Arch, 2017). proposed employing inhibitory learning strategies for treatment of misophonia. ...
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.
... Three open trials have been conducted to treat misophonia [36][37][38]. Schröder and colleagues [38] conducted an uncontrolled trial involving 90 adults with misophonia, showing promise for a cognitive behavioral approach using brief group therapy. In this trial, 48% of participants improved on a clinician rating of outcome, and 30% reported a significant reduction in symptoms on a self-report measure of misophonia. ...
... Three open trials have been conducted to treat misophonia [36][37][38]. Schröder and colleagues [38] conducted an uncontrolled trial involving 90 adults with misophonia, showing promise for a cognitive behavioral approach using brief group therapy. In this trial, 48% of participants improved on a clinician rating of outcome, and 30% reported a significant reduction in symptoms on a self-report measure of misophonia. ...
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Introduces misophonia and reviews published psychotherapy treatment studies.
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Outlines a multi-disciplinary strategy for treatment.
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Describes the application of two transdiagnostic psychotherapies with emerging evidence in misophonia (Unified Protocol
and Process-Based Therapy).
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Suggests an agenda for future research and treatment development.
... Although they tend to vary between individuals, there are commonalities in the categories of sounds reported as triggers. Specifically, they are often everyday sounds created by other individuals (and occasionally animals), and sometimes repetitive environmental sounds (Schröder et al., 2013(Schröder et al., , 2017Kumar et al., 2014). One study found that in a large misophonic sample (N = 575), most participants were triggered by eating sounds (96% of the sample), nasal and breathing sounds (85%), repetitive tapping (74%), and mouth/throat sounds (60%) (Jager et al., 2020). ...
... Although this is often limited to case-studies, cognitive-behavioral therapy (CBT) seems to be effective in reducing misophonia symptoms (Bernstein et al., 2013;McGuire et al., 2015) and managing levels of anger when exposed to triggers (Roushani and Honarmand, 2021). Perhaps more convincingly, Schröder et al. (2017) showed that 48% of patients (N = 90) reported a reduction of misophonia symptoms following CBT, whereas the waitinglist control group showed no reduction of misophonia. These results were observed after 3 months of treatment (short-term) and maintained a year later (long-term). ...
Individuals with misophonia, a disorder involving extreme sound sensitivity, report significant anger, disgust, and anxiety in response to select but usually common sounds. While estimates of prevalence within certain populations such as college students have approached 20%, it is currently unknown what percentage of people experience misophonic responses to such “trigger” sounds. Furthermore, there is little understanding of the fundamental processes involved. In this study, we aimed to characterize the distribution of misophonic symptoms in a general population, as well as clarify whether the aversive emotional responses to trigger sounds are partly caused by acoustic salience of the sound itself, or by recognition of the sound. Using multi-talker babble as masking noise to decrease participants' ability to identify sounds, we assessed how identification of common trigger sounds related to subjective emotional responses in 300 adults who participated in an online study. Participants were asked to listen to and identify neutral, unpleasant and trigger sounds embedded in different levels of the masking noise (signal-to-noise ratios: −30, −20, −10, 0, +10 dB), and then to evaluate their subjective judgment of the sounds (pleasantness) and emotional reactions to them (anxiety, anger, and disgust). Using participants' scores on a scale quantifying misophonia sensitivity, we selected the top and bottom 20% scorers from the distribution to form a Most-Misophonic subgroup ( N = 66) and Least-Misophonic subgroup ( N = 68). Both groups were better at identifying triggers than unpleasant sounds, which themselves were identified better than neutral sounds. Both groups also recognized the aversiveness of the unpleasant and trigger sounds, yet for the Most-Misophonic group, there was a greater increase in subjective ratings of negative emotions once the sounds became identifiable, especially for trigger sounds. These results highlight the heightened salience of trigger sounds, but furthermore suggest that learning and higher-order evaluation of sounds play an important role in misophonia.
... There have been two controlled CBT treatment studies by associates at the University of Amsterdam Schröder et al., 2017). The first study used task concentration exercises, counterconditioning, stimulus manipulation, and relaxation exercises and reported 48% of participants achieved at least a 30% reduction of misophonia severity based on the Amsterdam Misophonia Scale. ...
... Experiencing a misophonia trigger is usually very aversive and includes intense negative emotions, physiological distress, and dysregulation of thoughts, and complete recovery can vary from minutes to over 24 hours Dibb et al., 2021). Additionally, typical exposure to triggers generally increases misophonia severity (Schröder et al., 2017). To minimize the risk of abnormally severe/aversive misophonia responses, this treatment was designed to use very mild triggers in controlled settings and incidental triggers that a person experiences in normal life. ...
Misophonia is an under-studied condition in which a person has intense emotional and physiological reactions to subtle stimuli (e.g., chewing sounds or hair twirling) which cannot be classified using DSM-5 criteria. This case illustrates the conceptualization of misophonia as a conditioned aversive reflex disorder consisting of a physical (e.g., muscle) reflex elicited by the misophonic trigger stimulus and subsequent emotional, physiological, and behavioral responses. This case describes a successful behavioral treatment of a middle-aged woman who was disabled by severe misophonia. The treatment included identifying the initial physical reflex, progressive muscle relaxation, and counterconditioning the initial physical reflex. Counterconditioning was accomplished by relaxing the initial physical reflex muscle during exposure to in vivo trigger stimuli, while using ambient sound as needed to reduce the severity of the misophonic response. The overall severity of misophonia reduced over the course of the 13-week treatment, based on client self-report. Data were analyzed using recovery percentage formula. The recovery percentage average of 3 scales was 82.1% at end of treatment and 93.1% at 1-year follow-up. In this case, when the initial physical reflex's muscle was held relaxed by the patient when exposed to trigger stimuli, the initial physical reflex and the emotional reflex diminished and extinguished. This theory of misophonia, as a conditioned physical reflex to subtle stimuli, should be an essential consideration for research of the etiology, expansion, maintenance, and treatment of misophonia.
... For example, some individuals with misophonia experience difficulty in interpersonal functioning that includes avoiding social events and meals with others due to difficulty tolerating sounds (Bernstein et al., 2013). It has been found that irritability and physiological arousal can exacerbate misophonia reactions (Schröder et al., 2017). Misophonia is associated with comorbid conditions such as obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and depressive disorders (Erfanian et al., 2019;Potgieter et al., 2019). ...
... The group CBT included counterconditioning (i.e., pairing of a powerful positive stimulus with a conditioned trigger stimulus causing the conditioned reflex to diminish), attention shifting, and relaxation exercises. It was found that approximately half of the participants experienced reduced misophonia symptoms after treatment (Schröder et al., 2017). Dozier (2015) also reported using counterconditioning to treat a case of misophonia, with the client showing large reductions in the severity of misophonia and response to individual triggers by the end of treatment. ...
Misophonia, a condition marked by extreme intolerance to certain classes of sounds (e.g., respiratory or gustatory noises), has recently attracted increased research attention. As yet there are no evidence-based treatments, although some promising options are under empirical consideration. This paper presents a stress management and exposure therapy-based treatment protocol for adults with misophonia. The protocol details considerations specific to exposure therapy for misophonia, including unique considerations for developing hierarchies and example misophonia exposure exercises and exposure homework. Stress management approaches employed to facilitate engagement with exposure are also described. Two case examples are included, which illustrate the application of the misophonia treatment protocol. The first case describes treatment for a client whose misophonia symptoms are the primary focus and the second case describes treatment for a client whose misophonia symptoms are secondary to relationship difficulties. This protocol can be used to stimulate further treatment research for misophonia and guide treatment for individuals with misophonia.
... While some studies have reported higher rates, such as Guzick et al. [6] finding 21% of children with misophonia also had ADHD, or Kılıç et al. [19] reporting 20% of adult misophonia sufferers with ADHD, others have reported much lower rates. For example, only 5% of adult misophonia sufferers in the Netherlands were diagnosed with ADHD [3,20,21]. Conversely, Rosenthal et al. [7] found no relationship between ADHD and misophonia symptoms in an American sample. Due to the limited data and inconsistent findings on psychiatric comorbidities in misophonia, especially in children, our study aimed to investigate these factors in a sample of Polish-speaking children and teenagers. ...
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.
... This is based on the neurophysiological model of tinnitus and DST which does not involve a postulate of psychological or psychiatric mechanisms and does not use tools for treatment from the fields of mental disorders. Specifically, in a study presenting results of CBT for misophonia (Schroder et al., 2017) out of 90 patients, 48% showed improvement. In Jager et al. (2020) study evaluating the effectiveness of CBT in a randomized clinical trial, the authors used several scales and reported that 37% of their 54 patients showed statistical improvement (Jager et al., 2020). ...
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%.
... The CBT protocol constitutes four different techniques: task concentration exercises, counterconditioning, stimulus manipulation, and relaxation exercises. Following treatment, 48% of the patients showed a significant reduction of misophonia symptoms [43]. In a session of stimulus manipulation, the patients are instructed to change the pitch and time interval of sound triggers by using an audio-editing software, and this manipulation initiates a sense of control over their personal misophonic trigger sounds. ...
The acoustical characteristics of auditory triggers often recommended to generate the autonomous sensory meridian response (ASMR) on Internet platforms were investigated by parameterizing their sound qualities following Zwicker’s procedure and calculating autocorrelation (ACF)/interaural cross-correlation (IACF) functions. For 20 triggers (10 human- and 10 nature-generated sounds), scores (on a five-point Likert scale) of the ASMR, perceived loudness, perceived pitch, comfort, and perceived closeness to the sound image were obtained for 26 participants by questionnaire. The results show that the human-generated sounds were more likely to trigger stronger ASMR than nature-generated sounds, and the primary psychological aspect relating to the ASMR was the perceived closeness, with the triggers perceived more closely to a listener having higher ASMR scores. The perceived closeness was evaluated by the loudness and roughness (among Zwicker’s parameter) for the nature-generated sounds and the interaural cross-correlation coefficient (IACC) (among ACF/IACF parameters) for the human-generated sounds. The nature-generated sounds with higher loudness and roughness and the human-generated sounds with lower IACC were likely to evoke the ASMR sensation.
... One additional common co-occurring neuropsychiatric condition in misophonia is anxiety, which potentially amplifies the range of emotional reactivity observed in misophonia (Edelstein et al., 2013;Schröder et al., 2017;Cassiello-Robbins et al., 2021). Anxiety also potentially reflects a preemptive response to intolerable auditory stimuli (Edelstein et al., 2013;Wu et al., 2014). ...
Misophonia is a condition characterized by hypersensitivity and strong emotional reactivity to specific auditory stimuli. Misophonia clinical presentations are relatively complex and reflect individualized experiences across clinical populations. Like some overlapping neurodevelopmental and neuropsychiatric disorders, misophonia is potentially syndromic where symptom patterns rather than any one symptom contribute to diagnosis. The current study conducted an exploratory k-means cluster analysis to evaluate symptom presentation in a non-clinical sample of young adult undergraduate students (N = 343). Individuals participated in a self-report spectrum characteristics survey indexing misophonia, tinnitus severity, sensory hypersensitivity, and social and psychiatric symptoms. Results supported a three-cluster solution that split participants on symptom presentation: cluster 1 presented with more severe misophonia symptoms but few overlapping formally diagnosed psychiatric co-occurring conditions; cluster 3 was characterized by a more nuanced clinical presentation of misophonia with broad-band sensory hypersensitivities, tinnitus, and increased incidence of social processing and psychiatric symptoms, and cluster 2 was relatively unaffected by misophonia or other sensitivities. Clustering results illustrate the spectrum characteristics of misophonia where symptom patterns range from more "pure" form misophonia to presentations that involve more broad-range sensory-related and psychiatric symptoms. Subgroups of individuals with misophonia may characterize differential neuropsychiatric risk patterns and stem from potentially different causative factors, highlighting the importance of exploring misophonia as a multidimensional condition of complex etiology.
... The Committee agreed that the current literature did not yet support including language related to proposed biological, genetic, or behavioral mechanisms that may underlie misophonia. Whereas studies have postulated differential reactivity of different neural systems, such as those involved in emotional regulation, learning, and auditory processing Jastreboff, 2002, 2014;Schröder et al., 2017b), an understanding of the biological processes that underlie misophonia is currently under active investigation. The Committee concluded that postulated mechanisms do not belong in the definition at this time. ...
Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, the authors conducted a study to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.
... These findings add to the emerging literature indicating emotion regulation is relevant to understanding misophonia and has potentially important implications for intervention development [13]. Evidence-based cognitive behavioral therapies that target processes related to emotion regulation are well established for depressive, anxiety, and emotional disorders [31][32][33][34]. It is possible that the application of these treatments can help remediate symptoms of misophonia. ...
Misophonia is a newly described condition characterized by sensory and emotional reactivity (e.g., anxiety, anger, disgust) to repetitive, pattern-based sounds (e.g., throat clearing, chewing, slurping). Individuals with misophonia report significant functional impairment and interpersonal distress. Growing research indicates ineffective coping and emotional functioning broadly (e.g., affective lability, difficulties with emotion regulation) are central to the clinical presentation and severity of misophonia. Preliminary evidence suggests an association between negative emotionality and deficits in emotion regulation in misophonia. Still, little is known about (a) the relationships among specific components of emotional functioning (e.g., emotion regulation, affective lability) with misophonia, and (b) which component(s) of misophonia (e.g., noise frequency, emotional and behavioral responses, impairment) are associated with emotional functioning. Further, despite evidence that mood and anxiety disorders co-occur with misophonia, investigation thus far has not controlled for depression and anxiety symptoms. Examination of these relationships will help inform treatment development for misophonia. The present study begins to disambiguate the relationships among affective lability, difficulties with emotion regulation, and components of misophonia. A sample of 297 participants completed questionnaires assessing misophonia, emotional functioning, depression, anxiety, and COVID-19 impact. Findings indicated that misophonia severity was positively associated with each of these constructs with small to medium effect sizes. When controlling for depression, anxiety, and COVID-19 impact, results from this preliminary study suggest that (a) difficulties with emotion regulation may be correlated with misophonia severity, and (b) misophonic responses, not number of triggers or perceived severity, are associated with difficulties with emotion regulation. Overall, these findings begin to suggest that emotion regulation is important to our understanding the risk factors and treatment targets for misophonia.
... With regards to psychological interventions for misophonia, the current literature is still quite scarce, with the majority of the evidence coming from single case studies (Potgieter et al., 2019). The most commonly adopted approach is traditional cognitive behavioral therapy (CBT), which proved to be effective in a number of investigations (e.g., Bernstein et al., 2013;McGuire et al., 2015;Schröder et al., 2017). Other case studies using mindfulness and acceptance and commitment therapy (ACT; Schneider & Arch, 2017), dialectical behavioral therapy (DBT; Kamody & Del Conte, 2017), retraining counselling (Vanaja & Abigail, 2020), and counterconditioning (Dozier, 2015) also showed promising results. ...
Misophonia is a novel diagnosis characterised by extreme and uncontrollable autonomic reactions and emotional responses to selective auditory stimuli, which can significantly impair an individual’s daily life. No agreed diagnostic criteria are currently available for misophonia, and any therapeutic guidance is yet to be formalised. In this case study, a tailored psychological intervention based on the cognitive model and developed around emotion regulation principles and techniques was adopted to treat misophonia in a 16-year-old female from the United Kingdom. The treatment lasted for 15 weeks and was delivered online due to the ongoing COVID-19 social distancing regulations. The results showed that the intervention was feasible and acceptable, and effective at reducing levels of misophonic symptoms from severe to moderate/mild while also improving emotion dysregulation and overall anxiety and depression. Particular improvements were observed for specific skills such as acceptance and awareness of emotional responses and increased access to emotion regulation strategies. These findings also translated into a number of reported daily life improvements in the client’s psychological and social well-being. As the current evidence base on misophonia continues to develop, more methodologically rigorous research is warranted to build on the present findings and inform the adoption of further psychotherapeutic approaches to treat this new condition.
... The most discriminative sound was the eating sound, which is at the very core of misophonia, having three-and four-times higher discrimination parameter than all other sounds. This core element is substantially supported by previous work regardless of the populations of the sufferers [2,4,7,11,12,15,[40][41][42][43]. ...
Misophonia is characterised by a low tolerance for day-to-day sounds, causing intense negative affect. This study conducts an in-depth investigation of 35 misophonia triggers. A sample of 613 individuals who identify as experiencing misophonia and 202 individuals from the general population completed self-report measures. Using contemporary psychometric methods, we studied the triggers in terms of internal consistency, stability in time, precision, severity, discrimination ability, and information. Three dimensions of sensitivity were identified, namely, to eating sounds, to nose/throat sounds, and to general environmental sounds. The most informative and discriminative triggers belonged to the eating sounds. Participants identifying with having misophonia had also significantly increased odds to endorse eating sounds as auditory triggers than others. This study highlights the central role of eating sounds in this phenomenon and finds that different triggers are endorsed by those with more severe sound sensitivities than those with low sensitivity.
... 13 There are some reports of the successful treatment of misophonia, although overall, the evidence is not convincing. 19,20 Anecdotal reports show that some patients benefit from cognitive-behavioural therapy. 21 Another reason for the low rate of contact with mental health services among those with misophonia may be the high rate of low-level insight: those with misophonia that do not think that anything is wrong may not be motivated to seek help. ...
Background
Misophonia is defined as significant distress (anger, distress or disgust) when exposed to certain sounds that would not affect most people, such as lip smacking or gum chewing. Although misophonia is common, the aetiology, prevalence and effective treatments are largely unknown.
Aims
Based on our proposed diagnostic criteria, we examined the prevalence of misophonia and its relationship with clinical and demographic variables in a large representative population sample.
Method
We used a household sample (N = 541) of all residents aged >15 years, living in 300 homes randomly selected in Ankara city centre, Turkey. All participants were assessed at their homes by trained interviewers, for sociodemographic variables, misophonic sounds and related factors, using a semi-structured interview (the Misophonia Interview Schedule) developed for the current research.
Results
The current misophonia diagnosis prevalence was 12.8% (n = 69 of 541), although 427 (78.9%) participants reported at least one sound that was distressing. The mean number of misophonic sounds was 8.6 (s.d. 8.9, range 0–44); the figure was 17.6 in those with misophonia compared with 7.3 in those without misophonia. Of those with misophonia, only 5.8% contacted services for their condition. Predictors of misophonia diagnosis included younger age, family history of misophonia and previous contact with mental health services.
Conclusions
Our study showed that misophonia is common in the general population, may cause significant disruption in daily life and is undertreated. Although more evidence is needed to classify misophonia as a psychiatric disorder, our findings support others who claim that the condition belongs to the group of mental disorders.
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.
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 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 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.
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.
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
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.
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.
PurposeMisophonia is a neurophysiological disorder in which certain sounds trigger an intensely emotional or physiological response caused by an increased autonomic nervous system reaction to the triggers. Misophonia is a relatively new condition, and the neurophysiological mechanism behind this condition is not known yet. The assessment and management of misophonia need a team approach. Audiologists are vital members of the team. However, their roles in this condition are not well-understood. The study aims to review the neurophysiological mechanism of misophonia, highlighting the mechanism involved in the audiological pathway and directing the discussion toward applications of findings in the assessment and management of misophonia from the audiological perspective.Methods
We reviewed 12 articles from different databases to understand the neurophysiological mechanisms of misophonia. Most of the studies selected were experimental designs involving individuals with misophonia.ResultsThe result of the review revealed abnormal activation and connection among the different higher cortical structures in participants with misophonia. By signifying various neurophysiological and neuroradiological findings, the review confirms that misophonia is a neurophysiological disorder that may border between audiology, neurology, and psychiatry. Assessment of study quality reported an overall low risk of bias.Conclusions
This review highlights the need to include an audiologist as a team member in the evaluation and management of misophonia.
Objective
Misophonia is a complex disorder characterized by a heightened reaction to certain sounds and associated stimuli. While there is no uniformly accepted treatment to date, different intervention approaches are being investigated. Individual's perceptions of different misophonia treatment methods may affect compliance and satisfaction with treatment options. We sought to gather data on patient perceptions of currently available misophonia treatments.
Methods
Using an online survey, we collected data about treatment preferences, treatment usage, and diagnosis history from parents of children with misophonia (N = 141) and adults with misophonia (N = 252).
Results
Most respondents were not satisfied with misophonia treatments that they or their children had previously received. Audiologic interventions including active and passive noise cancelling and lifestyle modifications were rated as most appropriate for treatment of misophonia by both parent and adult respondents.
Limitations
Because of the descriptive nature of this study, we chose to use a completer-only approach to ensure the data reflect the true responses of participants, though this did result in a meaningful proportion of missing data. Participants were selected through convenience sampling and responses were self-reported. Individuals with more severe misophonia symptoms may be more likely to participate and complete a research survey.
Conclusions
Most interventions are considered inappropriate by parents of youth with misophonia and by adults with misophonia. This should be interpreted in the light of a general lack of misophonia-specific interventions. Findings suggest dissatisfaction with currently available treatments and an opportunity for development of effective treatment strategies corresponding to participants' preferences. Deeper understanding of treatment preferences has the potential to guide future treatment development.
Misophonia is a poorly understood and underdiagnosed disorder. People who suffer from this condition without knowing it has a notable deterioration in their quality of life, affecting their personal and social relationships. The present study characterized the self-concept of 82 people (women:men, 3:2) attending a medical psychology center in Barcelona before and after their diagnosis of misophonia and intervention to raise awareness. The social representation of misophonia was also studied in their close relatives. A lexicometric analysis using IRaMuTeQ software qualified and quantified the 164 participants' words to describe the patient's behavior (associative cards method) in a list of situations reported but not yet identified as triggers of misophonic responses. The corpus of text, branching, and the word clouds of the most used words showed a high frequency of negative qualifiers (attributed to personality) from relatives [ranking:“irritable” (n=30), “narrow-minded” (n=24) and “anxious” (n=15)] and in the self-concept of patients [ranking: “irritable” (n=34) and “anxious” (n=26), tolerant (n=24) and frank (n=18)], with higher diversification in patients than relatives (14:8 qualifiers n>10), and an increased post-intervention (17:10 qualifiers >10). The intervention strongly modified the corpus since “misophonic” and “disorder” appeared in the self-concept post-intervention, but not the concept, suggesting relatives need substantial efforts to be aware of the nature/impact of the disorder. The distribution of misophonia levels differed among sexes (higher representation of women at level 2 [56%], while men mainly were diagnosed at level 3 [50%]) while age only showed tends. Interestingly, the intervention increased 2.71 points the misophonia score obtained in a self-administered questionnaire repeated seven months later and rescued 13.4% of positive diagnoses, suggesting that for the patients to recognize the diagnosis of misophonia in themselves, they must first be aware of this concept. The individuals with less self-concept stability more frequently recognized themselves as misophonic. Besides, 21% of the variance in the change in self-concept was explained by the change in the concept of a close relative. In summary, the lack of self-concept and social representation of misophonia have strong implications for all the actors and are relevant to design interventions to reduce their impact.
Zusammenfassung. Die Misophonie beschreibt ein Phänomen, bei welchem betroffene Kinder und Jugendliche eine starke negative physiologische und emotionale Reaktion bei Konfrontation mit speziellen auditiven (misophonischen) Reizen zeigen (am häufigsten Ess- oder Atemgeräusche). Einzelne Studien mit Erwachsenen liefern bereits Prävalenzen zwischen 6 und 20 % in verschiedenen (klinischen) Stichproben, wobei eine Repräsentativität der Stichproben in den meisten Studien nur sehr eingeschränkt gegeben war. Die Erstmanifestation der Symptomatik liegt jedoch bei über 80 % der Fälle im Kindes- und Jugendalter, weshalb diese Altersgruppe besonders betrachtet werden sollte. Hinsichtlich komorbider Störungen zeigt sich auch eine große Heterogenität mit Schätzungen zwischen 28 bis 76 % an komorbiden psychischen Störungen und etwa 25 % mit komorbiden körperlichen Erkrankungen. Die genaue Ätiologie ist derzeit noch nicht ausreichend untersucht. Erste neurophysiologische Erklärungsansätze und Bildgebungsstudien weisen auf eine spezifische physiologische Reaktion bei Misophoniepatient_innen hin. Obwohl mittlerweile eine Vielzahl von Fallberichten vorliegt, Diagnosekriterien und Messinstrumente entwickelt und erste kognitiv-behaviorale Behandlungsansätze evaluiert wurden, stellt die Misophonie weiterhin keine eigenständige neurologische, audiologische oder psychiatrische Störung im DSM-5 oder der ICD-11 dar.
Background:
Hyperacusis can be defined as intolerance of certain everyday sounds, which are perceived as too loud or uncomfortable and which cause significant distress and impairment in the individual's day-to-day activities. Misophonia is defined as a high magnitude of emotional and behavioural reaction to certain sounds produced by human beings, such as eating sounds and breathing sounds. Several psychometric instruments have been developed to assess symptoms and the impact of hyperacusis and misophonia; however, to the author's knowledge, no study has evaluated and compared the methodological quality of the studies on psychometric properties of the existing instruments.
Purpose:
To systematically review the research studies assessing the psychometric properties of the instruments used for hyperacusis and misophonia and assess the quality and appropriateness of the methodologies used.
Research design:
Systematic review.
Data collection and analysis:
A systematic literature search was performed using five electronic literature databases (PubMed, Scopus, PsycINFO, Google Scholar and Web of Science). Studies were included if they were written in English and reported information about the psychometric properties of instruments measuring hyperacusis or misophonia symptoms or their impact. The quality of the studies and that of the psychometric instruments were evaluated using the consensus-based standards for the selection of health measurement instruments (COSMIN) tool.
Results:
The title and abstracts of 916 articles were screened and 39 articles were selected for full-text evaluation, with 14 articles meeting the inclusion criteria. From these 14 articles, eight different instruments (5 for hyperacusis and 3 for misophonia) were identified and reviewed comprising: (1) Hyperacusis Questionnaire (HQ), (2) Inventory of Hyperacusis Symptoms (IHS), (3) questionnaire on hypersensitivity to sound (GUF), (4) Hyperacusis Handicap Questionnaire (HHQ), (5) Short Hyperacusis Questionnaire, (6) Amsterdam Misophonia Scale (A-MISO-S), (7) MisoQuest, and (8) the Misophonia Questionnaire (MQ).
Conclusion:
None of the papers reviewed reported all the information required to meet the COSMIN standards. The studies' methodological quality varied between 'very good' and 'inadequate' depending on their grade on the COSMIN tool. There is a need for further research on the psychometric properties of the instruments included in this review.
Recent scientific studies have noted that misophonia is a complex neurophysiological and behavioural syndrome characterised by high physiological and emotional reactivity, resulting from an intolerance to specific auditory stimuli. People with this distress have emotional and behavioural responses, excessive in relation to the auditory stimulus that provokes them; in fact, these people may have outbursts of anger, severe anxiety crises, and even panic attacks. One of the questions that the first studies of this syndrome have asked was what link occurred between misophonia and certain psychological disorders such as anxiety, depression, and personality disorders. Another important research objective was to examine the differential diagnosis between misophonia and hearing disorders such as tinnitus. In view of the current literature on misophonia, it has become important to define the comorbidity and differential diagnosis of misophonia with other disorders. The next step is, through further research on clinical cases, to define the most effective psychotherapeutic techniques on misophonic symptoms, and the psychoeducational tools needed to intervene in family systems with misophonic patients. Keywords: comorbidity, differential diagnosis, psychological disorders, hearing disorders, misophonia, behavioural response, emotional response, psychoeducational tools, psychotherapeutic techniques
Although misophonia is not yet included in the primary diagnostic manuals used by psychologists or psychiatrists, proposed criteria suggest that this condition is characterized by a strong negative reaction to and avoidance of certain trigger sounds. Misophonic trigger sounds are largely human-made (e.g., chewing and slurping) and evoke responses such as disgust, irritation, and/or anger that are out of proportion to the situation and cause distress and/or impairment. Currently, there is no gold standard evidence-based treatment for misophonia. As the misophonia treatment literature grows, several important questions are arising: (1) should exposure to aversive sound triggers be included in treatment for misophonia and (2) how can clinicians best assess misophonia symptoms. This case offers one example of misophonia being successfully treated with a cognitive-behavioral approach to treatment (including exposures) in an adolescent girl. This case also offers an example of how clinicians may conduct a comprehensive assessment of misophonia symptoms. Theoretically and empirically derived recommendations for including exposure in misophonia treatment are presented. Information from this case may be helpful in informing future research, as there is a paucity of evidence-based assessment and treatment protocols for misophonia.
Misophonia (sound sensitivity) is a disorder in which people abnormally have strong and negative reactions to the sounds humans make which are ordinary, such as breathing or, chewing become enraged at people when we listen to them eating or breathing etc. The word "Misophonia" was given by audiologists Pawel and Margaret Jastreboff. Misophonia means "hatred of sound", was suggested in the year 2000 which explains the condition in which emotions, negative thoughts, and physical reactions are set off by specific sounds. It is not unexpected for people to occasionally be annoyed by some normal routine daily sounds. But for individuals with Misophonia, the sound of someone chewing, drinking water sound, making any other little sound can make them want to scream, get annoyed, angry. These reactions which are physical and emotional, which are ordinary sounds, are alike to the "fight or flight" response which may lead to panic, anxiety, and rage.
Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.
Objective:
A large number of people experience misophonia. In 2013, the Amsterdam Study Group recommended diagnostic criteria for misophonia. However, misophonia is not yet included in the Diagnostic and Statistical Manual of Mental Disorders. This report is the first report on drug use that directly affects misophonia and demonstrates a 14-year-old adolescent girl with misophonia successfully treated with fluoxetine.
Methods:
The patient's misophonia symptoms had been continuing for approximately 2 years, and her quality of life was significantly reduced. Psychotherapy conditions could not be applied, and fluoxetine 10 mg/d was started and increased to 20 mg/d after a week. At the second-month follow-up, because of partial improvement, fluoxetine dose was increased to 30 mg/d.
Results:
At the fourth-month follow-up, there was a 40% decrease in Amsterdam Misophonia Scale score with a 70% decrease in the children's global assessment scale scores. By the 16th week, the overall functionality level was good at the end.
Conclusions:
Fluoxetine may be used as an effective drug in the treatment of misophonia.
The extreme, unprecedented situations in the current COVID-19 pandemic are risk factors for psychosocial stress for the entire population. However, strict confinement had a particular impact on people suffering from misophonia and their families. Misophonia is a condition in which hearing certain sounds triggers intense anger, disgust and even severe autonomic nervous system responses. This prospective cohort study examined the impact of strict confinement (Spain, March 14–June 21, 2020) on a sample of 24 people (16 women and eight men) who had been diagnosed with moderate to extreme misophonia and were regularly attending a medical psychology center in Barcelona. The 3-month period of confinement caused general emotional maladjustment, distress, and a transitory crisis. Long-term biomonitoring of their heart variability rate (HRV) enabled to identify a significant increase in physiological arousal after the confinement period, which had already been recorded in a loss of cardiac coherence under basal rest/relaxation conditions. Certain auditory stimuli triggered adverse responses, lowered HRV scores, and an increased stress level and heart rate. Loss of cardiac coherence in their responses to these auditory stimuli (triggering mouth, nose and other sounds), as well as to non-triggering mouth, nose and other sounds was increased when compared to two assessments performed during the previous year. Despite the limited sample size, sex differences were observed in the incidence. Loss of cardiac coherence worsened with the severity of the misophonia. Most importantly, imagined or evoked triggering sounds, as well as real ones, were enough to cause the aversive responses, as displayed by the increased loss of cardiac coherence with respect to the at-rest basal level. A semi-structured interview revealed the exceptional nature of the situations, increased hyper-sensorial sensitivity, fear of being infected with or dying from COVID-19, the patients' coping strategies, and the difficulties and constraints they faced. Finally, the article gives recommendations for better management of misophonia. Improved knowledge of this disorder would help address the current lack of health and social care, hopefully preventing this shortfall's impact on social and affective relationships, which are particulary important for well-being now and in the coming periods of physical distancing measures.
Background:
College freshmen, as a special group who are far away from their parents and begin to study and live independently, will face psychological stress in adaption to the college life, which may affect their working and living conditions in the university and even after entering the society if not solved reasonably. Hence, it is necessary to explore how to relieve the psychological stress of freshmen.
Objective:
The study aimed to analyze the intervention effects of cognitive behavioral therapy on social psychological stress of freshmen under different demographic variables.
Methods:
108 freshmen of Northeast Agricultural University were divided into the experimental group and control group. The correlation between psychological stress and impulse, self-esteem, and loneliness was analyzed using structural equation model and multiple regression. The experimental group received group training for one month, while the control group did not accept any intervention. The Fear of Negative Evaluation (FNE) Scale, Interaction Anxiousness Scale (IAS), and Interpersonal Efficacy Scale (IES) were used to score students before and after activities and three months after activities. The relevant information was collected for students' self-evaluation and the evaluation results from group teachers.
Results:
The subjects' social psychological stress was positively correlated with loneliness and unplanned impulse, and negatively correlated with self-esteem (P < 0.001); the IAS and FNE scores of the experimental group after test were greatly lower than those of the control group, while the scores of affinity efficacy, communication efficacy, and emotional control were greatly higher than those of the control group (P < 0.05); the tracking IAS and FNE scores of the experimental group were greatly lower than those of the control group, while the scores of affinity efficacy, self-impression efficacy, communication efficacy, and emotional control were greatly higher than those of the control group (P < 0.05). All students in the experimental group were satisfied with the cognitive behavioral group training. Under the positive guidance of the team teacher, the students' psychological stress was released.
Conclusions:
The cognitive behavior group training based on impulse, self-esteem, and loneliness can effectively improve the affinity efficacy, self-impression efficacy, communication efficacy, and negative evaluation fear of freshmen, which is instrumental in easing the psychological stress of students and can maintain long-term effects.
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 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 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.
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.
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.
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.
Clinicians and neuroscientists must work together to understand and improve psychological treatments, urge Emily A. Holmes, Michelle G. Craske and Ann M.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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 (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.
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.
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.
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.
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.
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.
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.
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.
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.
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.