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In a 2026 study, Woolley aimed to qualitatively characterize negative cognitions during and after misophonia triggers by analyzing interview responses from 60 treatment-seeking adults. many of the thinking patterns described by the subjects fit into the framework of internalizing vs externalizing appraisals. This framework, applied to the context of Misophonia, sees the difference of such appraisals as when subjects blame themselves or interpret there reactions to triggers as personal failings ( internalizing) vs when subjects attribute blame to others for being rude or inconsiderate (externalizing) (Woolley et al., 2026a page 10)