Cognitive behavioral therapy for misophonia: A randomized clinical trial

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.