Development and psychometric exploration of a semi-structured clinical interview for Misophonia

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

BACKGROUND

Misophonia is a disorder characterized by an intense emotional reaction to specific sounds, often leading to significant distress and impairment in daily functioning. Acceptance and commitment therapy (ACT) is a promising psychotherapy for treating misophonia, but has only been previously tested in case studies. This paper presents a protocol for the first randomized controlled trial (RCT) assessing the efficacy and feasibility of ACT supplemented by audiological interventions for misophonia versus progressive relaxation training (PRT).

METHODS

The outlined protocol is a RCT with 60 adults with misophonia. After undergoing a comprehensive psychological and audiological evaluation, participants were randomly assigned to ACT (n = 30) or PRT (n = 30). All participants completed clinician-administered and self-report assessments at baseline, post-intervention, 3-month follow-up, and 6-month follow-up. The primary outcome was misophonia severity and impairment measured via clinical interview. Secondary outcomes included disgust, anger, sensory sensitivities, well-being, distress, and psychological flexibility.

DISCUSSION

This paper outlines the rationale of using ACT supplemented by audiological methods for misophonia with the novel therapeutic target of enhancing psychological flexibility. The results of this randomized controlled trial will help determine if ACT is an efficacious and acceptable treatment for misophonia. This trial will also help clarify active psychological mechanisms of misophonia, and assess whether this combination of psychological and audiological services can effectively help individuals with misophonia.

Audiological Characteristics of a Sample of Adults With Misophonia

PURPOSE

The aim of this study was to describe the audiological test results from a sample of 60 adults with self-reported misophonia.

METHOD

Audiological testing was completed prior to participant randomization in a controlled trial for misophonia treatment. Participants completed the Inventory of Hyperacusis Symptoms Survey (IHS), the Tinnitus and Hearing Survey (THS), the Misophonia Questionnaire (MQ), and behavioral and objective audiometric measures.

RESULTS

Hearing thresholds were less than 25 dBHL for 97% of the participants. Loudness discomfort levels for tonal stimuli suggested hyperacusis in 25% of the sample. Total scores on the IHS indicated that 12% met the clinical cutoff for hyperacusis, and, on the THS, 27% experienced problems with tinnitus, 77% experienced problems with hearing, and 53% experienced problems with sound tolerance. On the MQ, 37% indicated mild levels of misophonia and 58% indicated moderate levels. For speech-in-noise testing, a mild signal-to-noise ratio loss was present for 15% of participants. Most of the participants had present distortion product otoacoustic emissions (DPOAEs).

CONCLUSIONS

Audiological data on individuals with misophonia are lacking. In this article, we present results from audiological testing on 60 adults with self-reported misophonia. Most had normal peripheral hearing sensitivity based on pure-tone audiometry and DPOAE measures; some had difficulties with sound sensitivities and understanding speech-in-noise, self-report indicated problems with hyperacusis, tinnitus, and hearing difficulty.

Using a standardized sound set to help characterize misophonia: The International Affective Digitized Sounds

Misophonia is a condition characterized by negative affect, intolerance, and functional impairment in response to particular repetitive sounds usually made by others (e.g., chewing, sniffing, pen tapping) and associated stimuli. To date, researchers have largely studied misophonia using self-report measures. As the field is quickly expanding, assessment approaches need to advance to include more objective measures capable of differentiating those with and without misophonia. Although several studies have used sounds as experimental stimuli, few have used standardized stimuli sets with demonstrated reliability or validity. To conduct rigorous research in an effort to better understand misophonia, it is important to have an easily accessible, standardized set of acoustic stimuli for use across studies. Accordingly, in the present study, the International Affective Digitized Sounds (IADS-2), developed by Bradley and Lang (Bradley MM et al., 2007), were used to determine whether participants with misophonia responded to certain standardized sounds differently than a control group. Participants were 377 adults (132 participants with misophonia and 245 controls) recruited from an online platform to complete several questionnaires and respond to four probes (arousal, valence, similarity to personally-relevant aversive sounds, and sound avoidance) in response to normed pleasant, unpleasant, and neutral IADS-2 sounds. Findings indicated that compared to controls, participants with high misophonia symptoms rated pleasant and neutral sounds as significantly more (a) arousing and similar to trigger sounds in their everyday life, (b) unpleasant and (c) likely to be avoided in everyday life. For future scientific and clinical innovation, we include a ranked list of IADS-2 stimuli differentiating responses in those with and without misophonia, which we call the IADS-M.

A neuropsychological study of misophonia

BACKGROUND AND OBJECTIVES

Misophonia is a recently identified condition characterized by negative emotional responsivity to certain types of sounds. Although progress has been made in understanding of neuronal, psychophysiological, and psychopathological mechanisms, important gaps in research remain, particularly insight into cognitive function. Accordingly, we conducted the first neuropsychological examination of misophonia, including clinical, diagnostic, and functional correlates.

METHODS

A misophonia group (n = 32) and a control group (n = 64) were screened for comorbidities using a formal semi-structured interview and completed a comprehensive neuropsychological battery and self-report measures of depression, anxiety, stress, impulsivity, and functional impairment.

RESULTS

The misophonia group significantly underperformed the control group on only 2 neuropsychological outcomes involving verbal memory retrieval. Subscales of the Misophonia Questionaaire (MQ) were inversely correlated only with measures of attention. The misophonia group reported significantly higher anxiety symptoms, behavioral impulsivity, and functional impairments, and had numerically higher rates of ADHD and OCD.

LIMITATIONS

To facilitate comparability, in lieu of a formal diagnostic algorithm for misophonia, we used a commonly used empirical definition for group allocation that has been utilized in numerous previous studies.

CONCLUSIONS

Misophonia was associated with a reduction in performance on a minority of cognitive tasks and a modest increase in some psychological symptoms and comorbid conditions. Correlational data suggest that difficulties with attention regulation and impulsivity may play a role in misophonia, albeit attention functions were intact. Results should be interpreted with caution given the variability in diagnostic definitions, and more research is needed to understand cognitive functioning under 'cold' conditions in misophonia.

Phenotyping misophonia: Psychiatric disorders and medical health correlates

Misophonia is characterized by decreased tolerance to specific sounds and associated stimuli that causes significant psychological distress and impairment in daily functioning (Swedo et al., 2022). Aversive stimuli (often called “triggers”) are commonly repetitive facial (e.g., nose whistling, sniffling, and throat clearing) or oral (e.g., eating, drinking, and mouth breathing) sounds produced by other humans. Few empirical studies examining the nature and features of misophonia have used clinician-rated structured diagnostic interviews, and none have examined the relationship between misophonia and psychiatric disorders in the Diagnostic and Statistical Manual-5th version (DSM-5; American Psychiatric Association, 2013). In addition, little is known about whether there are any medical health problems associated with misophonia. Accordingly, the purpose of the present study was to improve the phenotypic characterization of misophonia by investigating the psychiatric and medical health correlates of this newly defined disorder. Structured diagnostic interviews were used to assess rates of lifetime and current DSM-5 psychiatric disorders in a community sample of 207 adults. The three most commonly diagnosed current psychiatric disorders were: (1) social anxiety disorder, (2) generalized anxiety disorder, and (3) specific phobia. The three most common lifetime psychiatric disorders were major depressive disorder, social anxiety disorder, and generalized anxiety disorder. A series of multiple regression analyses indicated that, among psychiatric disorders that were correlated with misophonia, those that remained significant predictors of misophonia severity after controlling for age and sex were borderline personality disorder, obsessive compulsive disorder, and panic disorder. No medical health problems were significantly positively correlated with misophonia severity.

Psychometric validation of a brief self-report measure of misophonia symptoms and functional impairment: The duke-vanderbilt misophonia screening questionnaire

Misophonia is a newly described disorder of sound tolerance characterized by strong negative emotional reactions to specific "trigger" sounds, resulting in significant distress, pathological avoidance, and impairment in daily life. Research on misophonia is still in its infancy, and most existing psychometric tools for assessing misophonia symptoms have not been extensively validated. The purpose of the current study was to introduce and psychometrically validate the duke-vanderbilt Misophonia Screening Questionnaire (DVMSQ), a novel self-report measure of misophonia symptoms that can be used to determine misophonia "caseness" in clinical and research settings. Employing large online samples of general population adults (n = 1403) and adults on the autism spectrum (n = 936), we rigorously evaluated the internal structure, reliability, validity, and measurement invariance of the DVMSQ. Results indicated that 17 of the 20 original DVMSQ items fit well to a bifactor structure with one "general misophonia" factor and four specific factors (anger/aggression, distress/avoidance, impairment, and global impact). DVMSQ total and subscale scores were highly reliable in both general population and autistic adult samples, and the measure was found to be approximately invariant across age, sex, education level, and autism status. DVMSQ total scores also correlated strongly with another measure of misophonia symptoms (Duke Misophonia Questionnaire-Symptom Scale), with correlations between these two measures being significantly stronger than correlations between the DVMSQ and scales measuring other types of sound intolerance (Inventory of Hyperacusis Symptoms [General Loudness subscale] and DSM-5 Severity Measure for Specific Phobia [modified for phonophobia]). Additionally, DVMSQ items were used to operationalize diagnostic criteria for misophonia derived from the Revised Amsterdam Criteria, which were further updated to reflect a recent consensus definition of misophonia (published after the development of the DVMSQ). Using the new DVMSQ algorithm, 7.3% of general population adults and 35.5% of autistic adults met criteria for clinically significant misophonia. Although additional work is needed to further investigate the psychometric properties of the DVMSQ and validate its theory-based screening algorithm using best-estimate clinical diagnoses, this novel measure represents a potentially useful tool to screen for misophonia and quantify symptom severity and impairment in both autistic adults and the general population.