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The cognitive behavioral trigger cycle in childhood misophonia

Guzick et al. (2024) proposed a cognitive behavioral trigger cycle based on thematic analysis of 20 youth-parent dyad interviews, organizing trigger-related processes into four sequential phases: trigger anticipation (preparatory avoidance, anticipatory anxiety, hypervigilance, family accommodation), the trigger itself, near-automatic trigger response (urge to escape, lack of attentional control, overwhelming emotional experience, automatic negative attributions, tension), and secondary response (redirecting attention, relaxation, escape, aggression). The authors concluded that this cycle organizes the candidate CBT targets in childhood misophonia and clarifies which processes are pre-cognitive and reactive versus deliberate and modifiable (Guzick et al., 2024).