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(Schröder et al., 2017)

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Misophonia

Dv Limitations • Use of a non-validated outcome scale (A-MISO-S). • No blinded raters; symptom severity rated by therapists. • Open-label design with waitlist control (not an RCT). • No follow-up assessment; long-term effects unknown. • No measure of overall functional improvement. • Reliance on qualitative patient feedback for therapy evaluation.

Dv Future Directions • Conduct RCTs with validated outcome measures. • Include functional outcome assessments and longer follow-up periods. • Determine which specific CBT components are most effective. • Examine personality traits and types/quantity of triggers as potential moderators of treatment response.

Dv Relevance • this study evaluates the efficacy of CBT and investigate the treatment outcome predictive power of clinical and demographic characteristics. • an early study showing the effectiveness of CBT • claims to be the first treatment study for Misophonia

Cognitive behavioral therapy is effective in misophonia: An open trial

Status:: #status/Bare-bones-review

Metadata

Item Type: #journalArticle
Authors: Arjan Schröder, Nienke Vulink, Arnoud van Loon, Damiaan Denys
Date: 08/2017
Date Added: 2020-01-15
URL: https://linkinghub.elsevier.com/retrieve/pii/S0165032716321681
DOI: 10.1016/j.jad.2017.04.017
Cite key: schroderCognitiveBehavioralTherapy2017
Topics: primary Resources
Tags: #Misophonia

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.

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Background/Purpose	Background- • while there is a great burden to being misophonic, there is little evidence on effective treatment methods. • this study evaluates the efficacy of CBT and investigate the treatment outcome predictive power of clinical and demographic characteristics. • Misophonia is an underrecognized psychiatric condition that severely impacts social and occupational functioning. • Patients experience disproportionate anger or disgust toward specific repetitive human-generated sounds. • Prior studies lacked validated measures and included only anecdotal or case report-level evidence for treatment. • CBT had shown promise in preliminary cases, but robust, evidence-based treatments were missing. Purpose- • Primary: Evaluate the efficacy of group CBT for misophonia. • Secondary: Identify clinical or demographic predictors of treatment response.
Participants/samples	• N = 90 adult patients (65F, 25M), mean age = 35.8 years, mean symptom duration = 23.2 years. • Excluded: substance dependence, bipolar disorder, autism spectrum disorders, psychosis. • Recruited from an outpatient psychiatric clinic (AMC, University of Amsterdam). • Diagnostic confirmation conducted by expert psychiatrists.
Measures	• A-MISO-S: Severity of misophonia (0–24), used at T0, T1, and T2. • CGI-I: Post-treatment improvement rated by clinicians. • SCL-90: General psychopathology index. • Additional symptom characterizations: triggered emotion (anger vs. anger+disgust), presence of irritability to ambient sounds.
Procedures	stimuli • Personal audio-visual clips of misophonic triggers created and manipulated using software (Audacity). • Mood boards reflecting emotional response to misophonia. Task/Experiment • 8-session group CBT (some groups had 7 sessions due to logistics). • Techniques: • Task concentration training (e.g. shifting attention in misophonic situations). • Counterconditioning (pairing misophonic triggers with positive imagery). • Stimulus manipulation (modifying trigger sounds). • Relaxation training (to reduce physiological arousal). • Conducted in groups of 6–9 patients by experienced CBT clinicians.
Results	• 48% (N=42) met criteria for treatment response (CGI-I score of 1 or 2 + ≥30% reduction on A-MISO-S). • 9% (N=8) reached symptom remission. • Mean A-MISO-S decreased from 13.6 (T0) to 9.1 (T2); no significant change during waitlist period. • Higher baseline A-MISO-S scores significantly predicted greater symptom reduction. • The presence of disgust (vs. anger only) significantly predicted treatment response (OR = 2.576, p = .038). -
Discussion/Limits	Conclusion- • Group CBT is an effective treatment for misophonia in ~50% of patients. • Key therapeutic techniques (counterconditioning, stimulus manipulation, etc.) target misophonia-specific symptom dimensions. • Higher initial symptom severity and presence of disgust were associated with better outcomes.
Limitations::	• Use of a non-validated outcome scale (A-MISO-S). • No blinded raters; symptom severity rated by therapists. • Open-label design with waitlist control (not an RCT). • No follow-up assessment; long-term effects unknown. • No measure of overall functional improvement. • Reliance on qualitative patient feedback for therapy evaluation.
Future Directions::	• Conduct RCTs with validated outcome measures. • Include functional outcome assessments and longer follow-up periods. • Determine which specific CBT components are most effective. • Examine personality traits and types/quantity of triggers as potential moderators of treatment response.
Relevance::	• this study evaluates the efficacy of CBT and investigate the treatment outcome predictive power of clinical and demographic characteristics. • an early study showing the effectiveness of CBT • claims to be the first treatment study for Misophonia

My notes

Key Terms

Misophonia – A psychiatric disorder characterized by intense emotional reactions (anger and/or disgust) to specific human sounds like chewing or breathing.
CBT (Cognitive Behavioral Therapy) – A structured, time-limited psychological treatment aiming to alter maladaptive thought patterns and behaviors.
A-MISO-S (Amsterdam Misophonia Scale) – A clinician-rated scale (0–24) developed to assess severity of misophonia symptoms.
CGI-I (Clinical Global Impression – Improvement Scale) – A 7-point scale used by clinicians to assess the degree of patient improvement following treatment.
Task Concentration Exercises – Behavioral interventions designed to reduce attentional bias by training patients to focus away from misophonic triggers.
Counterconditioning – A technique that pairs aversive stimuli with positive or neutral stimuli to reduce negative emotional reactions.
Stimulus Manipulation – Patient-driven modification of misophonic trigger sounds to reduce perceived uncontrollability.
Relaxation Exercises – Techniques aiming to lower physiological arousal and emotional reactivity in misophonia contexts.

Misc Notes

Therapeutic Component Effectiveness (from patient feedback):

Task concentration: Effective in redirecting attention from triggers.
Counterconditioning: Helped reframe aversive stimuli (e.g., chips vs. snow crunch).
Stimulus manipulation: Reduced sense of uncontrollability and increased engagement.
Relaxation: Lowered physical arousal and improved coping with trigger exposure.
Group format: Peer recognition and support were inherently therapeutic.

Treatment Duration/Frequency:

Authors note that 8 sessions may be insufficient; more frequent/intensive sessions could yield better outcomes.

Heterogeneity:

High variability in misophonia triggers may obscure some predictive effects. The type and number of triggers were not analyzed.

Model Development:

The authors propose a misophonia model based on hyper-focus and affective dysregulation; current findings tentatively support this conceptualization.

Zettlekasten

Schroder 2017 findings on the use of CBT to treat Misophonia