Process-Based Misophonia Treatment: Initial Outcomes

A new study provides the first real-world test of a cognitive therapy technique for misophonia, finding it significantly reduced the anger and blame that people direct toward the source of their trigger sounds. Researchers Marta Siepsiak, Andrzej Śliwerski, and Anna Turek-Wojnarowicz developed a tailored Cognitive Reappraisal (CR) protocol and found it was both feasible and acceptable to participants, offering a clear path for more rigorous future trials.

**What is Cognitive Reappraisal and How Was It Tested?**

Cognitive reappraisal is a psychological technique where individuals learn to change the way they think about a situation to alter its emotional impact. For someone with misophonia, this might involve reframing thoughts about a person making a chewing sound from “They are doing this to annoy me” to “This sound is uncomfortable for me, but it is a normal, involuntary bodily function for them.”

The research team recruited 23 adults with misophonia, confirming their condition through structured interviews. To establish a baseline, they assessed participants’ symptoms at two time points before any treatment began. The intervention itself was delivered over four weeks, starting with a single 90-minute group session to introduce the concepts, followed by three individual 30-minute online sessions for personalized practice and support.

Symptoms were measured using the S-Five scale, which evaluates five core aspects of misophonia: internalizing appraisals, externalizing appraisals, perceived threat and avoidance, outbursts, and impact on functioning. The researchers also conducted semi-structured group interviews after the treatment to gather qualitative data on participants’ experiences.

**Significant Reduction in Anger and Blame Toward Triggers**

The analysis showed stability in the condition during the pre-treatment phase, with no significant changes in three of the five S-Five subscales. This helped rule out the possibility that symptom changes were due simply to the passage of time.

After the four-week CR intervention, the results were clear. The most pronounced improvement was in the “externalizing” subscale, which measures reactions like anger, blame, and resentment directed at the source of a trigger sound. The statistical analysis showed a strong treatment effect (Estimate = -8.47, SE = 2.32, t(42.45) = -3.65, p < 0.001). Similar positive trends were observed across the other S-Five subscales, indicating broad, though preliminary, benefits. “The significant post-treatment reduction in externalizing responses is important,” the authors note in their paper published in *Frontiers in Psychiatry*. “These reactions are often the most socially damaging and distressing part of the misophonia experience, fueling conflict and guilt.” **Participants Valued Community But Wanted More Personalization** The qualitative findings added depth to the numbers. A strong theme was the profound sense of isolation felt by people living with misophonia. Many participants described the relief of simply being in a group with others who understood their experience, validating the therapeutic value of a shared format. This mirrors findings in broader integrated auditory health approaches, which recognize the psychosocial impact of sound tolerance disorders.

However, participants also voiced a clear need for more tailored support. The group format was appreciated for solidarity, but the individual sessions were considered essential for addressing personal, specific trigger scenarios. This feedback directly informs how future therapies might be structured, perhaps blending group education with more extensive one-on-one cognitive behavioral therapy (CBT) work. The desire for individualized care aligns with trends across hearing health, where personalized approaches, such as those explored in our review of sensorineural hearing loss treatments, are increasingly emphasized.

**Practical Implications and the Path Forward**

This study, accessible via DOI: 10.3389/fpsyt.2026.1744882, is not a definitive test of efficacy. As an uncontrolled pilot study, its primary goals were to check feasibility and gauge initial signals of effect. It succeeded on both counts, proving that a structured CR protocol can be delivered and is well-received by patients.

The findings make a strong case for including cognitive reappraisal as a component in larger, randomized controlled trials for misophonia treatment. It offers a specific tool to address the hostile attributions and reactive anger that can ruin relationships and compound distress. This psychological approach could potentially be combined with other strategies, such as sound therapy or the neuro-modulation techniques showing promise for related conditions like hyperacusis.

For clinicians and patients, the message is one of cautious optimism. While no standard treatment yet exists, this research adds to the evidence that CBT-based techniques, and CR in particular, are a rational and acceptable starting point for therapeutic work. The participant feedback underscores a critical principle: effective treatment must address both the universal need for validation and the highly individual nature of misophonia triggers and life contexts. Future research will need to build on this foundation, creating flexible protocols that can be adapted to the person, not just the diagnosis.