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Natalini E, Fioretti A, Eibenstein R, Eibenstein A. Metacognitive Interpersonal Therapy for Misophonia: A Single-Case Study. Brain Sci 2024; 14:717. [PMID: 39061457 PMCID: PMC11274575 DOI: 10.3390/brainsci14070717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Misophonia is a chronic condition in which the exposure to specific sounds increases the arousal and recurrence of specific intense negative emotions. We hypothesized that misophonia may be strongly related to maladaptive interpersonal schemas that create difficulties in interpersonal relationships. Subjects with maladaptive interpersonal schemas think that other people try to subjugate, criticize, dominate, exploit, deceive, disregard, and humiliate them. Furthermore, these patients typically endorse a representation of self as mistreated, constricted, harmed, damaged, humiliated, impotent, inadequate, or fragile. METHODS We describe the course of a treatment of Metacognitive Interpersonal Therapy (MIT) in a young man presenting misophonia and co-occurrent obsessive-compulsive personality disorder (OCPD) and avoidant personality disorder (AvPD), with narcissistic traits and normal hearing. We collected qualitative and quantitative data at the beginning of the intervention and at 2 years follow-up. RESULTS The therapy aimed at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. The results reported a significant decrease in misophonia; behavioural experiments were used to increase the quality of social relationships and tolerance to the trigger sounds. CONCLUSIONS MIT can be an effective therapy for the treatment of misophonia.
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Affiliation(s)
- Eleonora Natalini
- Tinnitus Center, European Hospital, Via Portuense 700, 00149 Rome, Italy; (E.N.); (R.E.)
| | - Alessandra Fioretti
- Tinnitus Center, European Hospital, Via Portuense 700, 00149 Rome, Italy; (E.N.); (R.E.)
| | - Rebecca Eibenstein
- Tinnitus Center, European Hospital, Via Portuense 700, 00149 Rome, Italy; (E.N.); (R.E.)
| | - Alberto Eibenstein
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Bodo CR, Salcudean A, Nirestean A, Lukacs E, Lica MM, Muntean DL, Anculia RC, Popovici RA, Neda Stepan O, Enătescu VR, Strete EG. Association between Chronic Misophonia-Induced Stress and Gastrointestinal Pathology in Children-A Hypothesis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:699. [PMID: 38929278 PMCID: PMC11201990 DOI: 10.3390/children11060699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
Misophonia is a neurophysiological disorder with behavioral implications, is complex and multifactorial in origin, and is characterized by an atypical and disproportionate emotional response to specific sounds or associated visual stimuli. Triggers include human-generated sounds, mainly sounds related to feeding and breathing processes, and repetitive mechanical sounds. In response to the triggering stimulus, the patient experiences immediate, high-intensity, disproportionate physical and emotional reactions that affect their quality of life and social functioning. The symptoms of misophonia can occur at any age, but onset in childhood or adolescence is most common. Affected children live in a constant state of anxiety, suffer continuous physical and emotional discomfort, and are thus exposed to significant chronic stress. Chronic stress, especially during childhood, has consequences on the main biological systems through the dysregulation of the hypothalamic-pituitary-adrenal axis, including the gastrointestinal tract. Here, we provide arguments for a positive correlation between misophonic pathology and gastrointestinal symptoms, and this hypothesis may be the starting point for further longitudinal studies that could investigate the correlations between these childhood vulnerabilities caused by misophonia and their effect on the gastrointestinal system. Further research to study this hypothesis is essential to ensure correct and timely diagnosis and optimal psychological and pharmacological support.
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Affiliation(s)
- Cristina Raluca Bodo
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine and Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Târgu Mureș, Romania; (C.R.B.); (M.M.L.)
| | - Andreea Salcudean
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine and Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Târgu Mureș, Romania; (C.R.B.); (M.M.L.)
| | - Aurel Nirestean
- Department of Psychiatry, George Emil Palade University of Medicine and Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Târgu Mureș, Romania; (A.N.); (E.L.); (E.G.S.)
| | - Emese Lukacs
- Department of Psychiatry, George Emil Palade University of Medicine and Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Târgu Mureș, Romania; (A.N.); (E.L.); (E.G.S.)
| | - Maria Melania Lica
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine and Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Târgu Mureș, Romania; (C.R.B.); (M.M.L.)
| | - Daniela Lucia Muntean
- Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, George Emil Palade University of Medicine and Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Târgu Mureș, Romania;
| | | | - Ramona Amina Popovici
- Department of Dental Preventive Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Oana Neda Stepan
- Department VIII-Neurosciences, Discipline of Psychiatry, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.N.S.); (V.R.E.)
| | - Virgil Radu Enătescu
- Department VIII-Neurosciences, Discipline of Psychiatry, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.N.S.); (V.R.E.)
| | - Elena Gabriela Strete
- Department of Psychiatry, George Emil Palade University of Medicine and Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Târgu Mureș, Romania; (A.N.); (E.L.); (E.G.S.)
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Gregory J, Graham T, Hayes B. Targeting beliefs and behaviours in misophonia: a case series from a UK specialist psychology service. Behav Cogn Psychother 2024; 52:33-48. [PMID: 37855114 PMCID: PMC7615577 DOI: 10.1017/s1352465823000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Misophonia, a disorder of decreased sound tolerance, can cause significant distress and impairment. Cognitive behavioural therapy (CBT) may be helpful for improving symptoms of misophonia, but the key mechanisms of the disorder are not yet known. AIMS This case series aimed to evaluate individual, formulation-driven CBT for patients with misophonia in a UK psychology service. METHOD A service evaluation of one-to-one therapy for patients with misophonia (n=19) was conducted in a specialist psychology service. Patients completed an average of 13 hours of therapy with a focus on the meaning applied to their reactions to sounds and associated behaviours. Primary outcome measures were the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Scale (A-MISO-S). Repeated measures t-tests were used to compare scores from pre-treatment to follow-up, and reliable and clinically significant change on the MQ was calculated. RESULTS Scores significantly improved on both misophonia measures, with an average of 38% change on the MQ and 40% change on the A-MISO-S. From pre-treatment to follow-up, 78% of patients showed reliable improvement on the MQ and 61% made clinically significant change. CONCLUSIONS Limitations included a lack of control group, small sample size, and the use of an outcome measure that had not been thoroughly validated for a treatment-seeking sample. These results suggest that one-to-one, formulation-driven CBT for misophonia is worth exploring further using experimental design. Potential mechanisms to explore further include feared consequences of escalating reactions, the role of safety-seeking behaviours and the impact of early memories associated with reactions to sounds.
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Affiliation(s)
- Jane Gregory
- Department of Experimental Psychology, University of Oxford
- Oxford Health NHS Foundation Trust
- South London and Maudsley NHS Foundation Trust
| | - Tom Graham
- Oxford Health NHS Foundation Trust
- South London and Maudsley NHS Foundation Trust
| | - Brett Hayes
- South London and Maudsley NHS Foundation Trust
- Salomons Institute for Applied Psychology, Canterbury Christ Church University
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Möllmann A, Heinrichs N, Illies L, Potthast N, Kley H. The central role of symptom severity and associated characteristics for functional impairment in misophonia. Front Psychiatry 2023; 14:1112472. [PMID: 37056403 PMCID: PMC10086372 DOI: 10.3389/fpsyt.2023.1112472] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/08/2023] [Indexed: 04/15/2023] Open
Abstract
Misophonia is characterized by a preoccupation with and strong emotional and behavioral reactions to certain triggers, mostly sounds related to eating and breathing. We applied functional impairment due to misophonic symptoms as a central criterion to investigate differences between clinical misophonia and normative decreased sound tolerance in a large non-random sample of n = 1,881 individuals from an online survey. We assessed the frequency of self-reported misophonia symptoms across various symptom measures, compared severity, triggers and emotional reactions, general psychopathology, interpersonal emotion regulation, and quality of life between both groups with and without functional impairing misophonia. Individuals with functional impairment due to misophonia (n = 839) revealed significantly higher general psychopathology symptoms, lower interpersonal emotion regulation skills, and lower quality of life than individuals without impairment (n = 1,042). Anxious/distressed and annoyed reactions to triggers were experienced more frequently compared to emotional reactions of disgust and sadness or depression in both groups. Overall, the group differences were primarily quantitative in nature. We discuss practical implications regarding classification and treatment and provide cutoffs for each symptom measure derived from group assignment for functional impairment.
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Affiliation(s)
- Anne Möllmann
- Department of Psychology, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
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Smith EEA, Guzick AG, Draper IA, Clinger J, Schneider SC, Goodman WK, Brout JJ, Lijffijt M, Storch EA. Perceptions of various treatment approaches for adults and children with misophonia. J Affect Disord 2022; 316:76-82. [PMID: 35970326 PMCID: PMC9884516 DOI: 10.1016/j.jad.2022.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Eleanor E A Smith
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Isabel A Draper
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Jane Clinger
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Sophie C Schneider
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | | | - Marjin Lijffijt
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Eric A Storch
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA.
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Pfeiffer E, Allroggen M, Sachser C. [Misophonia in Childhood and Adolescence: A Narrative Review]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 51:222-232. [PMID: 35856746 DOI: 10.1024/1422-4917/a000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Misophonia in Childhood and Adolescence: A Narrative Review Abstract. Misophonia describes a phenomenon in which the affected children and adolescents show a strong negative physiological and emotional reaction when confronted with specific (misophonic) auditory stimuli (most commonly eating or breathing sounds). Several studies with adults yielded prevalence rates between 6 % and 20 % in various (clinical) samples, but the representativeness of samples was largely limited. More than 80 % of the first manifestation of symptoms occurs during childhood and adolescence. Regarding comorbid disorders, studies show great heterogeneity, with estimates ranging from 28-76 % of comorbid mental disorders and approximately 25 % with comorbid physical disorders. The exact etiology is currently not well studied. Initial neurophysiological explanations and imaging studies point to a specific physiological response in misophonia patients. Although many case reports are now available, and diagnostic criteria and measurement tools have been developed, misophonia currently does not represent a distinct neurological, audiological, or psychiatric disorder in the DSM-5 or ICD-11.
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Affiliation(s)
- Elisa Pfeiffer
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universität Ulm, Deutschland
| | - Marc Allroggen
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universität Ulm, Deutschland
| | - Cedric Sachser
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universität Ulm, Deutschland
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Ferrer-Torres A, Giménez-Llort L. Misophonia: A Systematic Review of Current and Future Trends in This Emerging Clinical Field. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6790. [PMID: 35682372 PMCID: PMC9180704 DOI: 10.3390/ijerph19116790] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Antonia Ferrer-Torres
- L’Alfatier-Centro Médico Psicológico, 08025 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Lydia Giménez-Llort
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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Jager I, Vulink N, van Loon A, van der Pol M, Schröder A, Slaghekke S, Denys D. Synopsis and Qualitative Evaluation of a Treatment Protocol to Guide Systemic Group-Cognitive Behavioral Therapy for Misophonia. Front Psychiatry 2022; 13:794343. [PMID: 35836662 PMCID: PMC9275669 DOI: 10.3389/fpsyt.2022.794343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Inge Jager
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam, Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Arnoud van Loon
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marthe van der Pol
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Simone Slaghekke
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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