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

doi:10.1002/da.23127

Cognitive behavioral therapy for misophonia: A randomized clinical trial

Depress Anxiety. 2020 Dec 18;38(7):708-718. doi: 10.1002/da.23127. Online ahead of print.

Authors

Inge J Jager¹, Nienke C C Vulink¹, Isidoor O Bergfeld^{1

2}, Arnoud J J M van Loon¹, Damiaan A J P Denys^{1

2

3}

Affiliations

¹ Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
² Amsterdam Brain and Cognition, Amsterdam, The Netherlands.
³ Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.

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.