Cognitive Reappraisal in Misophonia Treatment Study

A four-week cognitive reappraisal intervention led to a significant reduction in the externalizing, aggressive responses that characterize misophonia, according to a new pilot study.

Testing a Core Therapy in Real-World Conditions

Misophonia, a condition marked by intense emotional and physical reactions to specific trigger sounds like chewing or breathing, impairs daily life and mental well-being. While often grouped with conditions like tinnitus and hyperacusis under decreased sound tolerance, its treatment path is less clear. Cognitive behavioral therapy (CBT) is frequently suggested, but its core components have not been rigorously tested for misophonia in practical settings.

Researchers Marta Siepsiak, Andrzej Śliwerski, and Anna Turek-Wojnarowicz designed a study to evaluate one such component: cognitive reappraisal (CR). CR involves learning to identify and change the negative thought patterns that fuel emotional distress. The team developed a specific CR protocol for misophonia and tested its feasibility, acceptability, and initial effects. Their work was published in Frontiers in Psychiatry (DOI: 10.3389/fpsyt.2026.1744882).

How the Study Was Conducted

The researchers recruited 23 adults with misophonia, confirmed through structured interviews. The intervention was delivered online over four weeks and included one 90-minute group session followed by three individual 30-minute sessions.

To measure change, participants completed the S-Five scale, a comprehensive misophonia assessment, at three points: twice before treatment began (to establish a stable baseline) and once after the intervention ended. Critically, the team also held semi-structured group interviews after the treatment to collect qualitative data on participants’ personal experiences, a perspective often missing from clinical studies.

A Significant Drop in Externalizing Anger

The quantitative results showed symptom stability between the two pre-treatment assessments, confirming that later changes were likely due to the intervention and not random fluctuation.

After the four-week CR protocol, a clear, statistically significant improvement was recorded. The most pronounced change was in “externalizing appraisals”—the feelings of anger and blame directed outwardly at the source of a trigger sound. Scores on this subscale dropped sharply (Estimate = -8.47, SE = 2.32, t(42.45) = -3.65, p < 0.001). Improvements were also seen across the other S-Five subscales measuring threat, internalizing appraisals, impact on life, and outbursts.

“This reduction in externalizing responses is important,” the authors note, “as these aggressive thoughts and urges can be particularly distressing and socially damaging for individuals with misophonia.”

Isolation, Group Support, and a Call for Personalization

The qualitative interviews provided depth to the numerical scores. A strong theme was the profound sense of isolation that comes with misophonia. Many participants described feeling alone and misunderstood in their daily struggles. This makes the positive feedback on the group session format particularly meaningful. Sharing experiences with others who “get it” was described as validating and reduced feelings of stigma.

However, this benefit was balanced by a clear request for more individualized care. Participants felt that while the group session was supportive, their personal trigger profiles and life contexts were highly specific. They expressed a need for therapy components that could be more directly tailored to their unique situations, suggesting that a purely standardized approach may not be sufficient. This feedback aligns with discussions in related literature, such as our article on Managing Misophonia in Adolescents and Young Adults, which highlights the need for adaptable strategies.

Implications for Future Treatment and Research

This pilot study offers several concrete steps forward. First, it provides preliminary evidence that cognitive reappraisal can modify a core feature of misophonia—the externalizing anger response—in a relatively short timeframe. This supports the continued investigation of CBT-based approaches for this condition.

Second, the mixed-methods approach proves vital. The quantitative data shows the intervention can work, while the qualitative data reveals how it works for people and where it falls short. The expressed need for personalization is a direct guide for clinicians developing therapeutic programs; a one-size-fits-all model is unlikely to meet all patient needs.

Finally, the study underscores that misophonia management must address both the psychological symptoms and the social isolation they cause. The therapeutic value of group support, even in a primarily cognitive protocol, should not be overlooked. As research progresses, integrating these insights with other approaches to integrated auditory health will be essential.

The authors conclude that cognitive reappraisal is a promising component for misophonia treatment but must be evaluated in larger, controlled trials. Future research should build on this pilot by comparing CR to other interventions or control groups and by explicitly testing formats that blend group support with individualized therapy plans.