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(McGuire et al., 2015)

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Dv Initial Source Misophonia MOCMisophonia

Dv Status #status/Bare-bones-review

Dv Limitations • Case report (n = 2). • No control group. • Limited generalizability. • Pharmacologic effects not systematically evaluated. • Short-term follow-up only.

Dv Future Directions • Replication in larger, controlled trials. • Broader dissemination of CBT protocols for misophonia. • Clarification of relationship between misophonia and severe tinnitus. • Further examination of diagnostic validity and phenomenology.

Dv Relevance • an Example of a case study of successful treatment of Misophonia via CBT.

Cognitive-Behavioral Therapy for 2 Youths With Misophonia: (Case Report)

Status:: #status/Bare-bones-review

Metadata

Item Type: #journalArticle
Authors: Joseph F. McGuire, Monica S. Wu, Eric A. Storch
Date: 2015-05-27
Date Added: 2020-01-15
URL: http://www.psychiatrist.com/jcp/article/pages/2015/v76n05/v76n0504.aspx
DOI: 10.4088/JCP.14cr09343
Cite key: mcguireCognitiveBehavioralTherapyYouths2015
Topics: primary Resources
Tags: #Misophonia, #Article-review, #added-to-Misophonia-data-base, #Fully-reviewd, #noted, #reviewed, #to-be-annotated, #tags-need-to-be-checked, #zotero, #literature-notes, #reference
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Background/Purpose	Background- • Misophonia is described as an impairing syndrome with childhood onset. • Characterized by: • Selective auditory sensitivity. • Emotional reactivity (irritability, anxiety). • Behavioral dysregulation (avoidance, outbursts). • At time of publication: • Only 1 prior case report of CBT for misophonia (Bernstein et al., 2013). • No published pharmacologic treatment data. • Previous CBT report lacked objective measurement of symptom change. • Proposed diagnostic criteria had recently been introduced (Schröder et al., 2013). • Unclear association between misophonia and tinnitus. Purpose- • Present treatment of 2 youth meeting proposed diagnostic criteria for misophonia. • Objectively measure symptom change using validated rating scales. • Highlight specific CBT components used to treat misophonia. • Demonstrate feasibility and potential efficacy of CBT in pediatric misophonia.
Participants/samples	Case 1 – “Ariel • 17-year-old Caucasian female. • No psychiatric comorbidity. • Triggers: sniffing, heavy breathing, chewing, tapping. • Greater irritability/distress with familiar individuals. • Significant family accommodation. • Withdrew from school due to symptoms. • Medications: • Venlafaxine 150 mg/day. • Lisdexamfetamine 70 mg/day. • Slight improvement but persistent impairment. Case 2 – “Lilly • 11-year-old Hispanic female. • No psychiatric comorbidity. • Triggers: • Eating sounds (slurping, lip smacking, chewing). • Breathing sounds. • Tapping. • Conversations in Spanish. • Externalized distress at home (outbursts). • Internalized distress at school. • Family accommodation (eating separately, limiting conversation).
Measures	• Self-Report Misophonia Questionnaire (MQ) • Self-Report Misophonia Severity Scale (MSS) • Parent-Report MQ and MSS (Lilly only)
Procedures	• Psychoeducation provided regarding misophonia and CBT framework; treatment goal clarified as increasing tolerance of triggers without avoidance or aggression (not making sounds pleasant). • Individualized trigger hierarchy developed in early sessions. • Exposure with Response Prevention (ERP): • Gradual, repetitive, prolonged exposure to sound triggers. • Titrated by frequency, intensity, and proximity based on distress ratings. • Progression from therapist-generated to family-generated triggers. • Prevention of avoidant, aggressive, or distracting behaviors during exposure. • Cognitive restructuring used to modify maladaptive beliefs (e.g., intentionality attributions about family members’ sounds). • Family accommodation reduced systematically across treatment. • Reinforcement hierarchy implemented for Lilly to support exposure completion. • Relapse prevention strategies addressed in final sessions.
Results	• Both youths demonstrated reduction in misophonia symptoms on objective scales. • Ariel: • Reported increased ability to manage distress. • Took steps to return to public school. • Lilly: • Marked reduction in disruptive outbursts. • Family functioning restored. • Accommodation nearly eliminated.
Discussion/Limits	Conclusion- • CBT with exposure and cognitive restructuring may significantly reduce misophonia symptoms in youth. • ERP appears effective in promoting habituation to trigger-related distress. • Reduction in family accommodation is a critical treatment component. • Objective symptom measurement strengthens prior anecdotal evidence.
Limitations::	• Case report (n = 2). • No control group. • Limited generalizability. • Pharmacologic effects not systematically evaluated. • Short-term follow-up only.
Future Directions::	• Replication in larger, controlled trials. • Broader dissemination of CBT protocols for misophonia. • Clarification of relationship between misophonia and severe tinnitus. • Further examination of diagnostic validity and phenomenology.
Relevance::	• an Example of a case study of successful treatment of Misophonia via CBT.

My notes

Key Terms

Misophonia – An impairing syndrome typically beginning in childhood characterized by extreme sensitivity to selective auditory stimuli that elicit avoidance, anxiety, irritability, and/or aggressive outbursts.
Sound triggers – Specific auditory stimuli (e.g., chewing, sniffing, tapping) that provoke intense emotional and behavioral reactions.
Cognitive-Behavioral Therapy (CBT) – A structured psychotherapeutic intervention combining exposure-based techniques and cognitive restructuring to modify maladaptive behaviors and beliefs.
Exposure with Response Prevention (ERP) – A behavioral intervention involving repeated, prolonged exposure to distressing stimuli while preventing avoidance, aggressive, or safety behaviors.
Family accommodation – Behavioral modifications by family members (e.g., eating separately, minimizing conversation) to reduce the patient’s distress from triggers.
Misophonia Questionnaire (MQ) – A self- and parent-report instrument assessing misophonia symptom presence and severity (range: 0–68).
Misophonia Severity Scale (MSS) – A 1–15 severity scale modeled after the NIMH Global Obsessive-Compulsive Scale to quantify misophonia impairment.

Misc Notes

Clinical Phenomenology

Greater distress when triggers are produced by close others vs strangers (Ariel).
Differential emotional expression depending on social context (Lilly).
Significant functional impairment (school withdrawal; family disruption).

Mechanistic Implications

Habituation through exposure suggests:
- Misophonia distress may operate via conditioned emotional response mechanisms.
Cognitive distortions (intentionality attribution) may exacerbate anger.

Family Systems Component

Family accommodation maintains impairment.
Systematic reduction parallels OCD treatment models.

Clinical Takeaway

Misophonia may be conceptualized and treated similarly to OCD-spectrum conditions using ERP-based CBT.
Structured exposure and belief modification appear central to symptom improvement.

Zettelkaten

McGuire 2015 case study of successful Misophonia treatment via CBT