Properties (17)
Id 9199f036-1c59-428c-b9da-ae1b6186de07
Year 2024
Abstract Introduction: Misophonia is an increasingly recognized disorder characterized by negative emotional and sensory reactions to specific noises. Although misophonia most often begins in childhood, there has been minimal research on its clinical presentation in youth. This qualitative study explored cognitive behavioral processes that are involved in misophonia and its associated functional impairment in young people and their families. Methods: Focused interviews were conducted with 20 youth with misophonia (ages 10–17) and their parents. Thematic analyses of these interviews using a cognitive behavioral theoretical framework were conducted. Results: A number of themes were identified, which included internalizing and externalizing cognitive behavioral processes at the individual level (e.g., hypervigilance, anticipatory anxiety, escape, automatic negative attributions), secondary emotional and functional consequences (e.g., negative perception of self, guilt, anxiety, depression, emotional exhaustion, concentration difficulties at school), as well as significant impacts to school, social life, and particularly to family life (e.g., conflict/tension, anger and resentment, family accommodation). These themes are integrated in a proposed theoretical model. Discussion: Misophonia is characterized by several transdiagnostic cognitive behavioral processes, including avoidance, maladaptive cognitions, emotional reactivity, and family communication difficulties, as well as significant functional impairment. Developing treatments that target these processes has the potential to help youth overcome misophonia and improve the quality of life of youth and their families.
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Aliases
- “How Can I Get Out of This?
- (Guzick et al., 2024)
Import Date 05-06-2026
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Dv Authors Andrew Giles Guzick, Catherine Elizabeth Rast, Brenna Burns Maddox, Servando Rodriguez Barajas, Jane Clinger, Joseph McGuire, Eric A. Storch,
Dv Initial Source Misophonia MOC
Dv Status #status/Bare-bones-review
Dv Limitations • Predominantly white, female, high-SES, educated sample. • Self-selected primarily from online misophonia forums. • Limited family structure diversity. • No data from other family members (siblings, grandparents). • Age range broad without developmental analysis.
Dv Future Directions • Recruit community samples for diversification and generalization. • Include diverse family structures. • Solicit data from siblings and other relatives. • Investigate developmental changes across ages. • Further analysis of treatment and diagnosis experiences and family priorities.
Dv Relevance • a phenomenological study looking at the impact of Misophonia on individual function and family dynamics. • a good source for looking at the familial impacts and lived experiences of Misophonia • describes a cognitive behavioral trigger cycle
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“How Can I Get Out of This?”: A Qualitative Study of the Phenomenology and Functional Impact of Misophonia in Youth and Families
Status:: #status/Bare-bones-review
Metadata
- Item Type: #journalArticle
- Authors:: Andrew Giles Guzick, Catherine Elizabeth Rast, Brenna Burns Maddox, Servando Rodriguez Barajas, Jane Clinger, Joseph McGuire, Eric A. Storch,
- Date:
- Date Added: 1729478192000
- URL: https://karger.com/doi/10.1159/000535044
- DOI: 10.1159/000535044
- Cite Key: guzickHowCanGet2024
- Topics: [object Object]
- Tags:: #Misophonia, #Bare-bones-review-🦴, #sensory-over-responsiveness, #Phenomenology, #CBT,
- PDF Attachments
Abstract
| Background/Purpose | Background- • Misophonia involves strong negative emotional reactions to specific sounds and visual cues. • Triggers most often involve human-produced oral sounds. • Misophonia associated with quality of life impairments and co-occurring psychopathology. • Onset most often in childhood; minimal research on youth presentation. • Adult phenomenology characterized via S-Five, DMQ, SMS scales. • Common adult emotional reactions: anger, annoyance, irritation, disgust, anticipatory anxiety. • Prior CBT models emphasize need for control, perfectionism, avoidant coping, hyperfocus, associative learning, emotion regulation difficulties. • One adult RCT showed an 8 week group based CBT protocol was superior to a waitlist control. • Most prior research used adults, psychometric methods, or case studies. • Qualitative methods suited to early-stage phenomenology research. Purpose- • Use qualitative methods to investigate clinical presentation and functional impairment of misophonia in youth. • Apply a family-based cognitive behavioral perspective focused on thoughts, behaviors, and subjective physiological experiences. |
| Participants/samples | • 20 youth-parent dyads recruited via internet, prior study contacts, professionals. • Youth ages 10–17, mean 13.45. • 80% female youth; 100% white; predominantly high SES. • Inclusion: misophonia diagnosis via Misophonia Assessment Interview updated with Delphi consensus criteria; ages 10–20; English-speaking; US-based. • Exclusion: inability to participate in open-ended interview; active psychosis or suicidal ideation. - |
| Measures | • Misophonia Assessment Interview (MAI) for diagnosis and trigger/avoidance/interference characterization. • Demographics survey. • Semi-structured focused interview developed by investigative team. |
| Procedures | • Prescreening call for eligibility. • Virtual visit with informed consent, MAI administration, demographics, focused interview. • Parents and children interviewed separately. • Interviews 30–60 minutes; recorded and transcribed. • Thematic analysis: transcription, code generation, theme search, theme review, defining/naming, reporting. • Coding via MAXQDA with cognitive behavioral framework. • Double-coding by first two authors; modified system until ≥80% overlap; 20% of remaining transcripts double-coded with 82% agreement. • Memos shared with investigators and participating families for feedback. |
| Results | Trigger characteristics • Most common triggers: breathing/sniffing/yawning; eating/chewing; tapping; throat clearing. • Most common emotional response: anger; followed by annoyance/irritation, distress, disgust. • Most common reactive behaviors: loss of self-control, yelling/hurtful speech. • Sounds upsetting most often due to nature of sound (95%) and specific pattern (80%). Cognitive behavioral processes around triggers • Active and preparatory avoidance common, especially headphone use and situational withdrawal. • Anticipatory anxiety described in anticipation of emotional reaction and consequences of aggressive responses. • Hypervigilance and lack of attentional control once triggered; difficulty disengaging. • Family accommodations widespread: trigger avoidance, announcement before triggers, background noise, item changes, plan modifications. • Strong automatic emotional reactions with "fight or flight" sensation; difficulty articulating thoughts during episodes. • Tension behavioral and subjective; sometimes sustained post-trigger. • Urge to escape often near-automatic and defensive. • Automatic negative attributions about others, often with awareness of irrationality. • Coping via redirecting attention and relaxation strategies less frequent than avoidance/escape. • Aggression most often verbal, directed at parents and siblings; sometimes physical/property damage; followed by guilt/regret. Daily individual impacts • Negative perception of self including shame and guilt. • Negative outlook of future including hopelessness and catastrophizing. • Somatic symptoms attributed to muscle tension (headaches, stomachaches). • Secondary anxiety, depression, emotional exhaustion. • High emotional burden during school day with exhaustion upon returning home. • School accommodations or homeschooling common; accommodations helpful but linked to missing social/learning components. • Concentration difficulties at school without reported academic decline liekly due to sample specific availability of accommodations and homeschooling/veritual schooling . Interpersonal impacts • Family conflict and tension with "walking on eggshells" experience. • Increased arguments; aggression more pronounced toward family than others. • Reduced family time; chosen avoidance to prevent reactions. • Family anger and resentment moderated by understanding and reaction severity. • Bullying, victimization, and lack of understanding at school in some cases. • Stress in social situations including altered perceptions of others. • Social withdrawal from people and leisure activities. |
| Discussion/Limits | Conclusion- • Misophonia in youth is an emotionally exhausting syndrome affecting entire family systems. • Families showed congruence in overwhelming emotional reactions, fight/flight urges, escape behavior, family tension, and attentional disengagement difficulties. • Misophonia produces significant mental health and functional impairment across family, social, and academic domains. • Childhood misophonia uniquely implicates parent and sibling roles, family accommodation, and the school context. • Candidate CBT targets include distress tolerance for emotional/physiological reactivity, mindfulness for attentional control, acceptance/reframing for maladaptive cognitions, gradual exposure for avoidance/escape, and supportive communication for parent-child conflict. • Family factors should be incorporated into misophonia assessment and family-based therapy. • Formal school accommodations mitigate functional impairment in the school setting.. |
| Limitations:: | • Predominantly white, female, high-SES, educated sample. • Self-selected primarily from online misophonia forums. • Limited family structure diversity. • No data from other family members (siblings, grandparents). • Age range broad without developmental analysis. |
| Future Directions:: | • Recruit community samples for diversification and generalization. • Include diverse family structures. • Solicit data from siblings and other relatives. • Investigate developmental changes across ages. • Further analysis of treatment and diagnosis experiences and family priorities. • CBT development for childhood misophonia should prioritize modular or process-based frameworks over multicomponent packages, which risk diluting central techniques. |
| Relevance:: | • a phenomenological study looking at the impact of Misophonia on individual function and family dynamics. • a good source for looking at the familial impacts and lived experiences of Misophonia • describes a cognitive behavioral trigger cycle |
Notes
key terms and concepts
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misophonia – disorder characterized by strong negative emotional reactions to specific sounds and visual cues.
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trigger – specific sound or visual cue that evokes a misophonic reaction; most often human-produced oral sounds.
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family accommodation – modifications household members make to minimize impact of misophonia-related reactions.
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preparatory avoidance – avoiding situations where triggers are expected.
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active avoidance/distraction – measures taken when encountering triggers, most commonly using headphones.
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automatic negative attributions – near-automatic hostile interpretations of others (e.g., believing others make noises on purpose).
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thematic analysis – qualitative coding approach following Braun & Clarke's six-phase framework.
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Proposed conceptual model (Figure 1)
- Cognitive Behavioral Trigger Cycle: Trigger Anticipation → Trigger → Near-Automatic Trigger Response → Secondary Response.
- Anticipation phase: active/preparatory avoidance, anticipatory anxiety, hypervigilance, family accommodation.
- Near-automatic phase: urge to escape, attentional control loss, overwhelming emotional experience, automatic negative attributions, tension.
- Secondary response phase: redirecting attention, relaxation, escape, aggression.
- Daily Individual Impacts encompass Emotional/Somatic and School domains.
- Interpersonal Impacts encompass Family and Social domains.
- Family and Emotional/Somatic depicted as most salient.
contextual statement
In a 2024 study, Guzick attempted to characterize the phenomenology and functional impact of misophonia in youth from a cognitive behavioral perspective by conducting semi-structured focused interviews with 20 youth (ages 10–17) with misophonia and their parents, using thematic analysis of MAI-confirmed cases.