Properties (14)
Id 08546d5e-0345-4ea6-be75-9fa34fd52c78
Year 2024
Abstract Introduction Misophonia is a recently defined disorder characterized by distressing responses to everyday sounds, such as chewing or sniffling. Individuals with misophonia experience significant functional impairment but have limited options for evidenced-based behavioral treatment. To address this gap in the literature, the current pilot trial explored the acceptability and efficacy of a transdiagnostic cognitive-behavioral approach to treating symptoms of misophonia. Methods This trial was conducted in two studies: In Study 1, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was delivered to eight patients in order to receive feedback to guide revisions to the treatment to suit this population. In Study 2, ten patients received the revised UP treatment to explore its acceptability and preliminary efficacy. This study used a single-case experimental design with multiple baselines, randomizing patients to either a 2-week baseline or 4-week baseline prior to the 16 weeks of treatment, followed by four weeks of follow-up. Results The findings from these studies suggested that patients found both the original and adapted versions of the UP to be acceptable and taught them skills for how to manage their misophonia symptoms. Importantly, the findings also suggested that the UP can help remediate symptoms of misophonia, particularly the emotional and behavioral responses. Discussion These findings provide preliminary evidence that this transdiagnostic treatment for emotional disorders can improve symptoms of misophonia in adults.
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Aliases
  • The unified protocol for transdiagnostic treatment of emotional disorders for misophonia
  • (McMahon et al., 2024)
Import Date 10-24-2025
Template Version Notes •corrected error in rendering the linked PDF in metadata section • added the tag “noted” to the definition of comments to ignore ( like with the “in another note” tag. this is so that when making notes on chapters of a textbook, i can still export things for manual addition to the obsidian note without having to keep track of what has already been added ). Also moved the version notes to the yaml section • this version added the bookmarks section to auto collect all bookmarks. it also dropped the template auto fill of the initial source field because we never got it working and just overwrote it manually anyway. this version also added logic to handle “in another note” tag. annotations marked with this are completely ignored. used when i have information covered in a bigger note, but still want to highlight that part in text for visual clarity (so as to avoid duplicates of the same information) • running the import more then once will overwrite the file, so do not import again if you have made changes in obsidian that are not in the zotero article.
Dv Authors Kibby McMahon, Clair Cassiello-Robbins, Anna Greenleaf, Rachel Guetta, Emily Frazer-Abel, Lisalynn Kelley, M. Zachary Rosenthal,
Dv Initial Source >
Dv Limitations • Small sample sizes. • SCED limits generalizability. • Missing data at some timepoints.
Dv Future Directions • Larger controlled trials. • Examine long-term maintenance. • Further personalize treatment delivery (e.g., hybrid models).
Dv Relevance • describes validation of a treatment approach to misophonia which shows some promise , the Unified protocol (UP), basically a CBT approach that focuses on mechanisms shared across disorders rather then strictly focused on any single disorder ) • a good source for background info on a number of different clinical scales/structured interviews • a good source to revisit for info on the clinical side of things • showed actual good results from exposure approaches, which contradicts what Brout and others have said about Misophonia
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The unified protocol for transdiagnostic treatment of emotional disorders for misophonia: a pilot trial exploring acceptability and efficacy

Status:: #status/Bare-bones-review

Metadata

Abstract
Background/Purpose Background-
• Misophonia is a relatively new clinical concept marked by functional impairment due to intense reactions to everyday sounds.

• Prior studies indicate co-occurrence with anxiety, mood, and other emotional disorders, supporting a transdiagnostic conceptualization.

• Few evidence-based treatments exist, and only one RCT has tested CBT for misophonia specifically.

Purpose-
• Evaluate the acceptability and preliminary efficacy of the UP for treating adult misophonia symptoms.

• Study 1 tested the standard UP to gather patient feedback.

• Study 2 applied a revised UP based on Study 1 feedback to assess improved outcomes.
Participants/samples
• Study 1: 8 participants (7 women, 1 man; mean age = 35), all white.
• Study 2: 10 participants (8 women, 2 men; mean age = 33.5), racially diverse.
• Inclusion: Age 18–65, misophonia symptom criteria met via MQ.
• Exclusion: Psychosis, mania, anorexia, non-English proficiency.
Measures • Structured Clinical Interview for DSM-5 (SCID-5) and SCID-5-PD for diagnostics.

• Misophonia Questionnaire (MQ): Symptoms, emotions/behaviors, and severity.

• OASIS/ODSIS/OAnSIS: Anxiety, depression, anger severity/impairment.

• DMQ: Misophonia symptom severity, impairment, and beliefs.

• Acceptability questionnaires: Self-report and qualitative feedback.
Procedures • Randomized 2- or 4-week baseline phase, followed by 16 weekly UP sessions and 4-week follow-up.
• Study 1 used standard UP; Study 2 used revised UP with misophonia-specific adaptations (e.g., tailored psychoeducation, case examples, mindfulness scripts).
• Adaptations helped personalize skills (e.g., mindfulness, cognitive flexibility, exposure) to misophonia triggers.
• Weekly outcome tracking; compensation provided for assessment completion.

• Initial diagnostic and baseline assessment.
• Randomized to:
• 2-week baseline OR 4-week baseline.
• 16 sessions of UP.
• 4-week follow-up.
• Weekly symptom monitoring.
• DMQ administered at intake, pre-treatment, week 8, post-treatment, follow-up.

Study 1
• Standard UP protocol.

Study 2
• UP with standardized misophonia-specific examples and psychoeducation.
• Core structure maintained.
Results Study 1:
• Moderate to high acceptability and satisfaction.
• Significant reductions in emotional/behavioral misophonia responses, anxiety, and anger.
• Small improvements in misophonia symptoms and severity; no effect on depression.
• DMQ: Medium improvement in beliefs; small in symptoms and impairment.

Study 2:
• High acceptability, satisfaction, and perceived helpfulness.
• Large effects on emotional/behavioral responses, misophonia severity, and anxiety.
• Medium effects on misophonia symptoms and anger; small effects on depression.
• Improvements maintained or increased during follow-up.
Discussion/Limits Conclusion-
• The UP is a feasible, acceptable, and promising intervention for misophonia.
• Particularly effective in reducing emotional reactivity and avoidance behaviors.
Limitations:: • Small sample sizes.
• SCED limits generalizability.
• Missing data at some timepoints.
Future Directions::
• Larger controlled trials.
• Examine long-term maintenance.
• Further personalize treatment delivery (e.g., hybrid models).
Relevance:: • describes validation of a treatment approach to misophonia which shows some promise , the Unified protocol (UP), basically a CBT approach that focuses on mechanisms shared across disorders rather then strictly focused on any single disorder )
• a good source for background info on a number of different clinical scales/structured interviews
• a good source to revisit for info on the clinical side of things
• showed actual good results from exposure approaches, which contradicts what Brout and others have said about Misophonia

Notes

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McMahon 2024 showing an instance of exposure helping treat Misophonia

McMahon 2024 showing successful misophonia treatment via a unified protocol

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