Cognitive behavioral therapy for misophonia: A randomized clinical trial

Inge J Jager, Nienke C C Vulink, Isidoor O Bergfeld, Arnoud J J M van Loon, Damiaan A J P Denys, Inge J Jager, Nienke C C Vulink, Isidoor O Bergfeld, Arnoud J J M van Loon, Damiaan A J P Denys

Abstract

Background: Patients with misophonia suffer from anger or disgust confronted with specific sounds such as smacking or breathing. Avoidance of cue-related situations results in social isolation and significant functional impairment. This is the first randomized, controlled cognitive behavioral therapy (CBT) trial for misophonia, evaluating the short- and long-term efficacy.

Methods: The evaluator-blinded, randomized clinical trial was conducted from May 2017 until December 2018 at an academic outpatient clinic. Misophonia patients were randomly assigned to 3 months of weekly group-CBT or a waiting list and tested at baseline, 3 months (following CBT or waiting list), 6 months (after cross-over), and 15/18 months (1-year follow-up). CBT consisted of task concentration and arousal reduction, positive affect labeling, and stimulus manipulation. Co-primary outcomes were symptom severity assessed by the Amsterdam Misophonia Scale-Revised (AMISOS-R) and improvement on the Clinical Global Impression-Improvement (CGI-I). Secondary outcomes were self-assessed ratings of general psychopathology (Symptom Checklist-90-Revised [SCL-90-R]) and quality of life (five-dimensional EuroQol [EQ5-D], Sheehan Disability Scale [SDS], WHO Quality of Life-BREF [WHOQoL-BREF]).

Results: In all, 54 out of 71 patients were included (mean age, 33.06 [SD, 14.13] years; 38 women [70.4%]) and 46 (85%) completed the study. In the randomized phase, CBT resulted in statistically significant less misophonia symptoms in the short-term (-9.7 AMISOS-R; 95% CI, -12.0 to -7.4; p < .001, d = 1.97). The CBT group had an observed clinical improvement (CGI-I < 3) in 37% compared to 0% in the waiting list group (p < .001). The effect of CBT was maintained at 1-year follow-up on primary and secondary outcomes.

Conclusions: This first randomized control trial shows both short-term and long-term efficacy of CBT for misophonia.

Keywords: cognitive behavioral therapy; misophonia; psychotherapy; randomized clinical trial; treatment.

Conflict of interest statement

The authors declare that there are no conflict of interests.

© 2020 The Authors. Depression and Anxiety Published by Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
CONSORT diagram of participants in a study of CBT for misophonia. CBT, cognitive behavioral therapy; FU, follow‐up; WL, waiting list
Figure 2
Figure 2
Results for co‐primary outcomes at all assessments (PP). AMISOS‐R, Amsterdam Misophonia Scale‐Revised; CBT, cognitive behavioral therapy; CGI‐I, Clinical Global Impression‐Improvement; PP, per‐protocol

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Source: PubMed

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