Cognitive Reappraisal in Misophonia Treatment: Pilot Study

A new study has found that a specific cognitive behavioral therapy technique significantly reduced externalizing anger responses to misophonia triggers. The research, led by Marta Siepsiak, Andrzej Śliwerski, and Anna Turek-Wojnarowicz, provides preliminary evidence for a structured, brief cognitive reappraisal intervention tailored for this challenging condition.

### Testing a Core CBT Technique for Misophonia

Misophonia is a condition marked by intense emotional and physiological reactions to specific, often ordinary, sounds like chewing or breathing. While cognitive behavioral therapy is considered a promising approach, few studies have tested its core components specifically for misophonia in structured programs.

This study focused on cognitive reappraisal (CR), a technique where individuals learn to identify and change unhelpful thought patterns about a triggering situation. The researchers developed a dedicated protocol to teach adults with misophonia how to apply CR to their sound triggers. Their goal was to assess if the program was feasible and acceptable to participants, and to gather initial data on its effects.

### A Brief, Hybrid Online Intervention

The research team recruited 23 adults with misophonia, confirming their diagnosis with structured interviews. The intervention was concise, delivered over four weeks. It began with a single 90-minute online group session to introduce the principles of cognitive reappraisal. This was followed by three individual 30-minute online sessions, where participants could practice applying the techniques to their personal trigger sounds with a therapist’s guidance.

To measure impact, the team used the S-Five questionnaire, a comprehensive tool that assesses misophonia across five subscales: internalizing appraisals, externalizing appraisals, perceived threat, impact on functioning, and outbursts. Participants completed this questionnaire at two time points before treatment started and once after the four-week program ended. The dual pre-treatment assessments helped establish that symptoms were stable prior to the intervention. Following the treatment, the researchers also conducted semi-structured group interviews to collect detailed qualitative feedback on the participants’ experiences.

### Significant Reduction in Externalizing Anger

The quantitative results showed a clear positive signal. Comparisons between the two pre-treatment assessments found no significant changes in three of the five symptom areas, confirming baseline stability. After the four-week CR program, however, a statistically significant improvement was recorded.

The most pronounced effect was on the “externalizing appraisals” subscale, which measures feelings of anger and blame directed outward at the person or source making the trigger sound. Participants’ scores in this area dropped significantly after treatment (Estimate = -8.47, SE = 2.32, t (42.45) = -3.65, p < 0.001). Scores on the other S-Five subscales also showed similar patterns of improvement, suggesting a broader positive effect. The qualitative data added essential context. Participants consistently described feelings of isolation and misunderstanding due to their misophonia. They valued the group session highly, as it provided a rare sense of community and validation. “Hearing others describe the same experiences was incredibly powerful,” one participant noted. However, they also emphasized that the condition is highly individual. The feedback pointed to a strong desire for more personalized strategies beyond the core techniques, indicating that a one-size-fits-all approach is insufficient. ### Practical Implications for Treatment Development This study, available in *Frontiers in Psychiatry* (DOI: 10.3389/fpsyt.2026.1744882), moves the field forward in several concrete ways. First, it demonstrates that a brief, structured cognitive reappraisal protocol is both feasible and acceptable to individuals with misophonia. The hybrid model of group psychoeducation followed by individual practice could serve as a template for efficient therapy delivery.

Second, the significant reduction in externalizing responses is clinically meaningful. Anger and blame can severely damage personal relationships and increase distress. A technique that helps mitigate this reaction could improve daily functioning and social well-being. This aligns with broader therapeutic goals for managing misophonia in teens and young adults, where emotional regulation is often a primary focus.

Finally, the participant feedback is a critical guide for future work. The appeal of the group format suggests that support groups or group therapy components could be a valuable element of comprehensive care. Simultaneously, the call for more individualized support underscores that cognitive reappraisal must be flexible and integrated into a broader, person-centered treatment plan. This need for tailored approaches echoes findings in related areas, such as research on personalized tinnitus treatments.

The authors are clear that this is a preliminary, uncontrolled study. The next necessary step is a randomized controlled trial comparing cognitive reappraisal to a control condition or other active treatments. Nevertheless, the results provide a solid foundation for such research. Cognitive reappraisal has earned its place as a serious candidate for inclusion in the first generation of evidence-based protocols specifically designed for misophonia, moving beyond generic anxiety management to address the condition’s unique cognitive and emotional profile.