Properties (14)
Id
8b608fb8-4b21-45ca-bedb-6b4b5961b428
Year
2026
Abstract
Cssclasses
- purpleRed
Aliases
- Real-time emotional responses to trigger sounds in misophonia
- (Shan et al., 2026)
Import Date
03-19-2026
Dv Authors
Yanyan Shan, Bill Chen, Ashley A. Moskovich, Marta Siepsiak, Siyuan Wang, M. Zachary Rosenthal,
Dv Initial Source
Misophonia MOC
Dv Limitations
• Study was not preregistered.
• MQ assesses sound sensitivity broadly; hyperacusis presence unknown; results may not be specific to misophonia alone.
• More recently validated measures (DMQ, MisoQuest, S-Five, Sussex Misophonia Scale) now available; replication needed.
• Demographic homogeneity (predominantly female, White/Caucasian) limits generalizability.
• Sample size (N = 40) adequate for EMA analyses but larger samples needed for broader population assessment.
• Reliance on self-report; subject to reporting, interpretation, momentary awareness biases.
• Intensive sampling schedule may have influenced participant engagement over time.
• Naturalistic design introduces uncontrolled variability (acoustic properties, environment, social context, concurrent activities).
• Cross-sectional design precludes causal inferences.
• No objective physiological or acoustic measures.
Dv Future Directions
• Incorporate passive sensing technologies (physiological monitoring, acoustic sampling) for objective correlates. • Examine target of anger and hostility (outward vs. inward); use attribution items paired with momentary ratings. • Investigate contextual and dispositional moderators of emotional response intensity and recovery speed. • Clarify mechanisms underlying dissociation between reactivity magnitude and recovery duration. • Examine distinct cognitive, attentional, regulatory processes contributing to reactivity versus recovery. • Integrate laboratory-based paradigms with real-world assessments; include detailed contextual measurement. • Conduct longitudinal studies tracking misophonia responses over extended periods. • Replicate findings using updated assessment tools (DMQ, MisoQuest, S-Five, Sussex Misophonia Scale, Duke Misophonia Interview). • Recruit diverse samples including underrepresented groups. • Examine developmental trajectories and potential causal mechanisms. • Test whether distinct processes contribute to emotional reactivity versus recovery.
Dv Statistics
Compliance • Overall compliance 75.88% (1935 of 2550 prompts); individual M = 75.9%, SD = 25.1%, median = 86.00%, IQR = 36.9%. • Compliance by day: Day 1 86.5%; Day 2 84.85%; Day 3 79.53%; Day 4 78.21%; Day 5 75.9%; Day 6 73.85%; Day 7 72.55%; Day 8 73.71%; Day 9 70.04%; Day 10 68.38%. • Daily compliance decline: β = −1.91, SE = 0.17, t(8) = −11.08, p < .001, R² = 0.94. • Final sample (N = 40) compliance: M = 86.3%, SD = 13.1%, median = 90.0%, IQR = 16.4%. • Scheduled prompts: 86.5% (1729 of 2000); event-based prompts: 99.6% (264 of 265). Sample characteristics • MQ Severity: M = 9.05, SD = 1.30, range 7–12. • MQ Total: M = 48.18, SD = 6.30, range 38–66. • MQ Symptom subscale: M = 21.93, SD = 4.24, range 15–32. • MQ Reaction subscale: M = 26.25, SD = 3.58, range 20–36. • 70% current psychiatric diagnosis; 30% no current diagnosis. • Diagnostic complexity: 15% one diagnosis, 7.5% two, 15% three, 20% four, 7.5% five, 5% six. EMA data distribution • Total reports: 2564 (M = 64.10, SD = 9.03, range 53–101 per participant). • No-trigger: 52.8% (n = 1354); during-trigger: 25.6% (n = 656); <15 min post-trigger: 3.9% (n = 101); 16–30 min: 2.9% (n = 74); 31–60 min: 4.6% (n = 118); 1–2 h: 6.5% (n = 167); >2 h: 0.9% (n = 22); before-trigger: 2.8% (n = 72). Emotional reactivity (Objective 1) • Global negative affect: during-trigger M = 32.79, SE = 0.60 vs. no-trigger M = 19.56, SE = 0.60; t(1795) = 36.07, p < .001, d = 0.85. • Individual emotions (all p < .001): irritability trigger M = 3.59, SD = 1.03 vs. no-trigger M = 1.54, SD = 0.85; upset 2.86/1.12 vs. 1.25/0.59; anger 2.74/1.18 vs. 1.21/0.59; distress 2.83/1.16 vs. 1.32/0.64; afraid 1.23/0.61 vs. 1.07/0.28; frightened 1.20/0.54 vs. 1.04/0.22; scared 1.22/0.60 vs. 1.06/0.28. • Trigger reactions: outraged M = 2.31, SD = 1.20; confrontational M = 2.20, SD = 1.12; fearful M = 1.24, SD = 0.62; terrified M = 1.17, SD = 0.54. Recovery patterns (Objective 2) • <15 min post-trigger: significantly elevated vs. baseline t(2255) = −11.29, p < .001, d = −0.24; significantly lower than during-trigger t(2249) = −10.64, p < .001, d = −0.22. • 16–30 min: marginally elevated vs. baseline t(2249) = −3.12, p = .030, d = −0.07. • 31–60 min: no significant difference from baseline. • Individual emotions: 12 of 16 remained elevated <15 min; irritability strongest persistence t(2259) = −12.25, p < .001, d = −0.26; anger t(2258) = −9.35, p < .001, d = −0.20; hostility t(2258) = −9.36, p < .001, d = −0.20. • 16–30 min: only irritability elevated t(2251) = −3.37, p = .014, d = −0.07. •
Dv Relevance
• the first study that i know of to look at real time emotional reactivity in Misophonia resposnes . (though Real time might be a stretch seeing how it basically was just using an app to ping people randomly throughout the day and to allow for self reports manually during trigger events)
• used ecological momentary assessment (EMA) to look at real time emotional experiences of Misophonics in a trigger response, finding trends of variable recovery times across individuals ( though most fully recover in an hour)
• found a link between emotional reactivity and baseline negative affect/ Misophonia intensity
• a great source on info about real time assessments of emotional resposnes and the temporal dynamics of the Misophonic response
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Real-time emotional responses to trigger sounds in misophonia: An ecological momentary assessment study
Status:: #status/reviewed
Metadata
- Item Type: #journalArticle
- Authors:: Yanyan Shan, Bill Chen, Ashley A. Moskovich, Marta Siepsiak, Siyuan Wang, M. Zachary Rosenthal,
- Date Added: February 22, 2026
- URL: https://linkinghub.elsevier.com/retrieve/pii/S0165032726002806
- DOI: 10.1016/j.jad.2026.121429
- Cite Key: shanRealtimeEmotionalResponses2026
- Tags: #Misophonia, #Ecological-momentary-assessment, #Emotion-regulation, #Emotional-responses, #Individual-differences
- PDF Attachments
Abstract
| Background/Purpose | Background- • Misophonia characterized by intense negative emotional responses to specific sounds; growing evidence of complex multi-modal responses involving cognitive, physiological, and behavioral systems. • Prior research relies predominantly on retrospective self-report and laboratory paradigms; lacks ecological validity and temporal resolution. • Emotional responses include anger, disgust, anxiety; heightened sympathetic arousal; freeze-flight-fight behavioral patterns. • Limited understanding of real-time emotional dynamics, recovery patterns, and individual differences in naturalistic settings. • High prevalence (4.6% of U.S. adults); associated with functional impairment; co-occurring psychopathology common. • Emotion dysregulation central to misophonia; neurobiological evidence shows hyperactivation in salience/emotion regulation regions. • there is a gap in the understanding of the time course of the Misophonic response. describing the time course (rapid,, long, variable) could inform future interventions • there is a lack of info on the variability in Misophonic reactivity/response recovery that could be useful for advancing clinical understandings and broader affect science frameworks for Misophonia Purpose- • Characterize range and intensity of negative emotions during trigger versus no-trigger states. • Examine temporal recovery patterns following trigger exposure. • Evaluate individual differences in emotional reactivity and recovery trajectories. • Assess how misophonia severity influences emotional reactivity and recovery. • Investigate whether no-trigger emotional states predict triggered responses. • Examine associations between co-occurring psychiatric disorders and emotional reactivity patterns. |
| Participants/samples | • N = 40 adults (after applying ≥50% compliance criterion from initial N = 51). • Age M = 36.43 years (SD = 11.60, range 18–65); 75% female, 25% male; 82.5% White/Caucasian. • Inclusion: MQ Severity ≥7; MQ Symptoms >2; MQ Emotions/Behaviors >2. • Exclusion: current psychotic disorder, mania, anorexia nervosa; inability to read English fluently. • 70% met criteria for current co-occurring psychiatric disorder; anxiety disorders most common (60%). |
| Measures | • Misophonia Questionnaire (MQ): Symptom Scale, Emotions/Behaviors Scale, Severity Scale (7–9 moderate; 10–12 severe; 13–15 very severe). • Structured Clinical Interview for DSM-5 (SCID-5): comprehensive psychiatric assessment; lifetime and current diagnoses. • Mini-International Neuropsychiatric Interview (M.I.N.I.): screening for exclusionary conditions. • EMA emotion ratings: 16 negative emotions rated 1–5 (distressed, upset, guilty, disgusted, scared, hostile, irritated, ashamed, nervous, afraid, loathing, frightened, shaky, jittery, angry, scornful). • Trigger-specific reactions: 12 items measuring fight (yelling, argumentative, confrontational, outraged), flight/fear (terrified, fearful, frightened, scared), freeze (vacant, detached, disconnected, disengaged) responses. |
| Procedures | • Recruitment via Duke Center for Misophonia and Emotion Regulation website; online screening; telephone M.I.N.I. • Baseline assessment: SCID-5, MQ. • 10-day EMA protocol delivered to personal smartphones. • Time-based assessments: 5 random prompts daily (8 AM–10 PM); 2-hour minimum interval. • Event-based assessments: self-initiated immediately upon encountering misophonia trigger. • Trigger timing classified: during-trigger, post-trigger (<15 min, 16–30 min, 31–60 min, 61–120 min, >120 min), before-trigger, no-trigger. • Incentive: $75 for ≥50% compliance; $25 bonus for ≥85% compliance. |
| Results | Emotional reactivity during trigger vs. no-trigger • Global negative affect significantly higher during triggers versus no-trigger periods. • All 16 negative emotions showed significant increases during triggers. • Largest increases: irritability, upset, anger, distress. • Smallest increases: afraid, frightened, scared. • Most intense trigger reactions: outraged, confrontational. • Least intense trigger reactions: fearful, terrified. Temporal recovery patterns • Within 15 min post-trigger: global negative affect remained significantly elevated above baseline but lower than during-trigger. • 16–30 min post-trigger: global negative affect marginally elevated above baseline. • 31–60 min post-trigger: complete recovery; no significant difference from baseline. • 12 of 16 emotions remained elevated within 15 min; irritability persisted longest (still elevated at 16–30 min). • 52.5% of participants returned to baseline within 15 min; 72.5% within 30 min; 87.5% within 60 min; 95% within 2 hours. Individual differences • Significant within-person variability across trigger events for all 16 emotions. • Substantial between-person variability in reactivity magnitude (difference scores ranged 2.99–28.56 for global negative affect). • Highest between-person variability: hostile, disgusted, loathing. • Lowest between-person variability: afraid, scared, frightened. • ICC values ranged 0.21–0.50; within-person variability accounted for 50–79% of total variance. • Significant between-person variability in recovery trajectories; 11 of 16 emotions showed significant random-slope effects. • 97.5% of participants showed statistically significant elevation during triggers. Misophonia severity effects • Severe group reported greater intensity for distress, upset, disgust, irritability. • Severity significantly predicted irritable, upset, distressed, disgusted intensity. • Outraged reaction significantly stronger in severe group. • Recovery patterns did not differ by severity group. No-trigger emotional states predicting triggered responses • All 16 baseline emotions significantly predicted during-trigger global negative affect. • Baseline nervousness strongest predictor (R² = 0.09), followed by irritable (R² = 0.09), distressed (R² = 0.07), hostile (R² = 0.07), loathing (R² = 0.07). • Fear-related emotions showed largest effect sizes despite lower absolute intensity: frightened (β = 9.26), afraid (β = 7.64), scared (β = 6.74). Co-occurring psychiatric disorders • Significant condition (triggering vs non triggering period) × co-occurring disorder interaction. • Anxiety disorders (most common, present in 60%): panic disorder, agoraphobia, social anxiety disorder, specific phobia, generalized anxiety disorder • Mood disorders (25% current): major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder • Externalizing disorders (30%): ADHD, intermittent explosive disorder • Eating disorders (20% current): binge eating disorder, bulimia nervosa, anorexia nervosa • Trauma-related disorders (10% current): PTSD • OCD and related disorders (7.5% current): OCD, trichotillomania, excoriation disorder, body dysmorphic disorder • Personality disorders (17.5%): avoidant, obsessive-compulsive, dependent, paranoid, borderline • Trigger-related increase larger among participants with co-occurring diagnoses versus those without. • Baseline affect did not differ by co-occurring disorder status. • During-trigger affect significantly higher in participants with co-occurring conditions. Demographic effects • No significant gender differences in no-trigger affect, during-trigger affect, or emotional reactivity. • Age unrelated to emotional measures; no differences across age groups. |
| Discussion/Limits | Conclusion- • The authors conclude that anger is the primary basic emotion experienced during misophonia triggers in naturalistic settings. • The findings indicate that misophonia involves heightened global negative affect during trigger episodes compared to no-trigger periods, with large effect sizes underscoring clinical significance. • The authors conclude that emotional responses in misophonia are not primarily characterized by fear or anxiety, despite high anxiety disorder comorbidity. • The data support that emotional recovery is relatively rapid; most individuals return to baseline within 31–60 minutes. • The findings indicate irritability shows greatest persistence among emotions; anger-related states particularly resistant to rapid downregulation. • The authors conclude that misophonia is characterized by phasic, context-dependent emotional reactivity rather than chronic negative affect or persistent mood disturbance. • The data support substantial individual variability in both reactivity magnitude and recovery trajectories, with between-person differences particularly pronounced for anger-related and disgust emotions. • The findings indicate that symptom severity influences intensity of emotional responses but not recovery duration, suggesting these processes may be dissociable. • The authors conclude that baseline nervousness predicts during-trigger emotional intensity, potentially indexing heightened affective arousal or vigilance that amplifies reactivity. • The data support that co-occurring psychiatric disorders confer heightened vulnerability to state-dependent emotional escalation rather than reflecting generalized negative mood. • The authors conclude that emotional responses in misophonia extend beyond auditory sensitivity and involve broader dysfunction in emotional systems. • The findings indicate that person-specific trajectories exist; some individuals show persistently intense responses while others recover rapidly. • The authors conclude that treatment should target anger regulation, distress tolerance, and inhibitory learning-based approaches rather than traditional fear-based habituation exposure. • The data support a process-based, personalized treatment framework emphasizing collaborative case conceptualization and ongoing monitoring. • The authors conclude that anger is the primary basic emotion experienced during misophonia triggers in naturalistic settings. (page 9) |
| Limitations:: | • Study was not preregistered. • MQ assesses sound sensitivity broadly; hyperacusis presence unknown; results may not be specific to misophonia alone. • More recently validated measures (DMQ, MisoQuest, S-Five, Sussex Misophonia Scale) now available; replication needed. • Demographic homogeneity (predominantly female, White/Caucasian) limits generalizability. • Sample size (N = 40) adequate for EMA analyses but larger samples needed for broader population assessment. • Reliance on self-report; subject to reporting, interpretation, momentary awareness biases. • Intensive sampling schedule may have influenced participant engagement over time. • Naturalistic design introduces uncontrolled variability (acoustic properties, environment, social context, concurrent activities). • Cross-sectional design precludes causal inferences. • No objective physiological or acoustic measures. |
| Future Directions:: | • Incorporate passive sensing technologies (physiological monitoring, acoustic sampling) for objective correlates. • Examine target of anger and hostility (outward vs. inward); use attribution items paired with momentary ratings. • Investigate contextual and dispositional moderators of emotional response intensity and recovery speed. • Clarify mechanisms underlying dissociation between reactivity magnitude and recovery duration. • Examine distinct cognitive, attentional, regulatory processes contributing to reactivity versus recovery. • Integrate laboratory-based paradigms with real-world assessments; include detailed contextual measurement. • Conduct longitudinal studies tracking misophonia responses over extended periods. • Replicate findings using updated assessment tools (DMQ, MisoQuest, S-Five, Sussex Misophonia Scale, Duke Misophonia Interview). • Recruit diverse samples including underrepresented groups. • Examine developmental trajectories and potential causal mechanisms. • Test whether distinct processes contribute to emotional reactivity versus recovery. |
| Statistics:: | Compliance • Overall compliance 75.88% (1935 of 2550 prompts); individual M = 75.9%, SD = 25.1%, median = 86.00%, IQR = 36.9%. • Compliance by day: Day 1 86.5%; Day 2 84.85%; Day 3 79.53%; Day 4 78.21%; Day 5 75.9%; Day 6 73.85%; Day 7 72.55%; Day 8 73.71%; Day 9 70.04%; Day 10 68.38%. • Daily compliance decline: β = −1.91, SE = 0.17, t(8) = −11.08, p < .001, R² = 0.94. • Final sample (N = 40) compliance: M = 86.3%, SD = 13.1%, median = 90.0%, IQR = 16.4%. • Scheduled prompts: 86.5% (1729 of 2000); event-based prompts: 99.6% (264 of 265). Sample characteristics • MQ Severity: M = 9.05, SD = 1.30, range 7–12. • MQ Total: M = 48.18, SD = 6.30, range 38–66. • MQ Symptom subscale: M = 21.93, SD = 4.24, range 15–32. • MQ Reaction subscale: M = 26.25, SD = 3.58, range 20–36. • 70% current psychiatric diagnosis; 30% no current diagnosis. • Diagnostic complexity: 15% one diagnosis, 7.5% two, 15% three, 20% four, 7.5% five, 5% six. EMA data distribution • Total reports: 2564 (M = 64.10, SD = 9.03, range 53–101 per participant). • No-trigger: 52.8% (n = 1354); during-trigger: 25.6% (n = 656); <15 min post-trigger: 3.9% (n = 101); 16–30 min: 2.9% (n = 74); 31–60 min: 4.6% (n = 118); 1–2 h: 6.5% (n = 167); >2 h: 0.9% (n = 22); before-trigger: 2.8% (n = 72). Emotional reactivity (Objective 1) • Global negative affect: during-trigger M = 32.79, SE = 0.60 vs. no-trigger M = 19.56, SE = 0.60; t(1795) = 36.07, p < .001, d = 0.85. • Individual emotions (all p < .001): irritability trigger M = 3.59, SD = 1.03 vs. no-trigger M = 1.54, SD = 0.85; upset 2.86/1.12 vs. 1.25/0.59; anger 2.74/1.18 vs. 1.21/0.59; distress 2.83/1.16 vs. 1.32/0.64; afraid 1.23/0.61 vs. 1.07/0.28; frightened 1.20/0.54 vs. 1.04/0.22; scared 1.22/0.60 vs. 1.06/0.28. • Trigger reactions: outraged M = 2.31, SD = 1.20; confrontational M = 2.20, SD = 1.12; fearful M = 1.24, SD = 0.62; terrified M = 1.17, SD = 0.54. Recovery patterns (Objective 2) • <15 min post-trigger: significantly elevated vs. baseline t(2255) = −11.29, p < .001, d = −0.24; significantly lower than during-trigger t(2249) = −10.64, p < .001, d = −0.22. • 16–30 min: marginally elevated vs. baseline t(2249) = −3.12, p = .030, d = −0.07. • 31–60 min: no significant difference from baseline. • Individual emotions: 12 of 16 remained elevated <15 min; irritability strongest persistence t(2259) = −12.25, p < .001, d = −0.26; anger t(2258) = −9.35, p < .001, d = −0.20; hostility t(2258) = −9.36, p < .001, d = −0.20. • 16–30 min: only irritability elevated t(2251) = −3.37, p = .014, d = −0.07. • |
| Relevance:: | • the first study that i know of to look at real time emotional reactivity in Misophonia resposnes . (though Real time might be a stretch seeing how it basically was just using an app to ping people randomly throughout the day and to allow for self reports manually during trigger events) • used ecological momentary assessment (EMA) to look at real time emotional experiences of Misophonics in a trigger response, finding trends of variable recovery times across individuals ( though most fully recover in an hour) • found a link between emotional reactivity and baseline negative affect/ Misophonia intensity • a great source on info about real time assessments of emotional resposnes and the temporal dynamics of the Misophonic response |
Notes
key terms and concepts
-
Misophonia – Clinical condition characterized by intolerance to specific aversive sounds and cues; individuals respond with intense negative emotions to oral, facial, and repetitive sounds; reactions range from mild discomfort to severe distress with functional impairment across social, occupational, and educational domains.
-
Ecological Momentary Assessment (EMA) – Research methodology capturing real-time data in participants' natural environments; enhances ecological validity and allows fine-grained analysis of emotional patterns, variability, and predictors; reduces recall biases inherent in retrospective self-report.
- in this study, Participants completed baseline psychiatric interviews and questionnaires, then received smartphone surveys for 10 days that included five randomly-timed daily prompts plus self-initiated surveys whenever they encountered misophonia triggers. Each survey asked them to rate the intensity of 16 negative emotions and, when applicable, report timing and reactions to bothersome sounds.
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Emotional reactivity – Magnitude of emotional response to a stimulus; in this study, measured as difference in negative affect intensity between trigger and no-trigger states.
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Emotional recovery – Temporal dynamics of emotion intensity following a triggering event; measured as time required for affect to return to baseline levels.
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Intraclass correlation coefficient (ICC) – Statistical measure quantifying proportion of variance attributable to between-person differences versus within-person variability across repeated assessments.
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Shan et al., 2026 gaps in research with good utility
Characterizing real time course of Misophonic responses
Shan et al., 2026 findings on co occurring conditions with Misophonia