Misophonia Treatment: Cognitive Reappraisal Pilot Study

A new study testing a specific cognitive therapy technique for misophonia has yielded promising early results. Researchers Marta Siepsiak, Andrzej Śliwerski, and Anna Turek-Wojnarowicz designed a protocol based on cognitive reappraisal—a core method in cognitive behavioral therapy—and found it significantly reduced one of the most distressing aspects of the condition: the intense anger and blame directed at the source of trigger sounds.

Testing a Practical Cognitive Therapy Protocol

The team recruited 23 adults with misophonia, confirming their symptoms through structured interviews. Their approach was designed to be feasible, consisting of a single 90-minute group session followed by three individual 30-minute online sessions spread over four weeks.

To measure any changes, they used the S-Five scale, a detailed questionnaire that breaks down misophonia symptoms into five distinct areas: internalizing appraisals (like feeling distressed), externalizing appraisals (like feeling anger toward the trigger source), impact on life, outbursts, and coping strategies. Participants completed this scale at two time points before treatment started and once after it ended. The researchers also conducted semi-structured group interviews to gather qualitative feedback on the participants’ experiences.

The study, published in Frontiers in Psychiatry, is one of the first to evaluate a tailored cognitive intervention for misophonia in an ecologically valid setting, meaning it was tested in a format that could realistically be offered in a clinical practice. You can read the full paper via its DOI: 10.3389/fpsyt.2026.1744882.

Significant Reduction in Externalizing Anger

The quantitative data showed a clear, positive effect. Between the two pre-treatment assessments, three of the five S-Five subscales showed no significant change, partially confirming that participants’ symptoms were stable before the intervention began. This stability makes the post-treatment changes more meaningful.

After the four-week protocol, a significant reduction was observed in the “externalizing appraisals” subscale (Estimate = -8.47, SE = 2.32, t (42.45) = -3.65, p < 0.001). This subscale measures feelings of anger, blame, and negative judgments directed at the person or thing making a trigger sound—a common and socially isolating reaction in misophonia. Improvements were also seen across the other subscales, though the change in externalizing responses was the most statistically robust.

Participants Reported Feeling Less Alone

The qualitative findings were equally important. In group interviews, participants highlighted a profound sense of isolation often experienced with misophonia. The single group session was particularly valued, as it provided a rare opportunity to connect with others who shared the same condition. This aligns with broader discussions on the social impact of misophonia, such as those covered in our article on Misophonia Awareness and Stress in Students.

However, the feedback also pointed to a gap. Participants expressed a need for more individualized support, suggesting that while group formats are beneficial for reducing isolation, personalization is key for effective management. This nuance is critical for clinicians developing programs, complementing existing resources like our guide on Managing Misophonia in Adolescents and Young Adults.

Implications for Future Misophonia Treatment

This study offers several practical insights. First, it provides preliminary evidence that cognitive reappraisal—a technique where individuals learn to reinterpret the meaning and emotional impact of trigger sounds—can be a helpful component in managing misophonia. The protocol was short and delivered online, suggesting it could be a scalable addition to existing therapeutic frameworks.

Second, the mixed-method design underscores the importance of listening to patient perspectives. The craving for individualized care, even within a structured protocol, tells researchers and therapists that flexibility and personalization must be built into future programs. This patient-centered approach is a theme across auditory health conditions, as discussed in our overview of Integrated Auditory Health: From Hearing Loss to Tinnitus.

The authors conclude that cognitive reappraisal shows promise as a treatment component worthy of further, controlled evaluation. For those living with misophonia, this research represents a step toward building evidence-based tools that address both the intense emotional reactions and the profound social isolation that define this condition.