Very little is known about the nature of Misophonia, or its causes and correlates, compared to other known clinical phenomena. This means that we truly don't know the boundaries around what Misophonia is, and what it is not. Until we better understand what it is, it will be difficult to obtain funding from the NIH or other funding agencies to develop and test treatments for Misophonia.

In this study, we will collect a range of measures related to the causes and correlates of Misophonia. For example, we will use gold standard psychiatric interviews to examine whether Misophonia is differentially related to any specific psychiatric disorders. We will use laboratory psychophysiological methods to differentiate Misophonia and other clinical conditions on measures related to emotional reactivity. And, importantly, we will use ecological momentary assessment methods to characterize the temporal dynamics of Misophonia symptoms and difficulties regulating emotions over time compared to other clinical conditions.

You may be eligible for this research study if you are 18 to 65 years old and belong to one of these 3 groups:

• Extraordinarily bothered by sounds such as chewing, slurping, throat clearing, finger tapping, foot shuffling, keyboard tapping, rustling, nasal sounds, pen clicking, etc.
• Tend to feel very anxious a lot of the time
• Generally upbeat with no mental health problems (a healthy control)

The Duke Center for Misophonia and Emotion Regulation is collaborating with lab members of Dr. Jessilyn Dunn (Duke Department of Biomedical Engineering) and Dr. Maria Gorlatova (Duke Department of Electrical & Computer Engineering). Our goal is to utilize augmented reality (AR) technology and wearables to intervene with and identify emotional responses to misophonia triggers and their contexts. 

This was a sub-study of our larger Phenotyping Assessment Study with the goal of getting a better sense of what Misophonia looks like on a day-to-day, super granular level. We can use EMA to better understand the relationship between various factors that impact behavior and well being in the context of Misophonia. This information can then hopefully be used to develop more effective strategies and interventions for those with Misophonia and supporting their well being.

EMA is a research method that involves collecting real time data, though the use of an app, from participants through a 10-day period. This research app, allowed participants to record their experiences at specific timepoints throughout the day and allowed our CMER team to gather many timepoints of data in "real time" as the participants went through their normal routine in their own environments. 

We just completed enrolling our last participant to our EMA sub-study and plan to begin analyzing the data and prepare and prep it for a manuscript over the next year. Thanks to all those who participated!

While we continue to work on better understanding Misophonia, it is also important to identify treatments that can help people who are currently suffering. Further, it is important that the treatments we provide are acceptable to the people who receive them. In this study, participants completed one of two treatments we felt can help manage symptoms of Misophonia: The Unified Protocol or Process-Based Therapy. Both treatments used evidence-based psychological principles (e.g., managing attention or behavior) in a flexible manner and focused on developing skills to help reduce the distress and impairment associated with Misophonia. The aims of this study were (1) to explore the acceptability and feasibility of these treatments for individuals who experience Misophonia and (2) to examine whether these treatments help reduce symptoms associated with Misophonia.

The aim of this study was to validate a set of standardized sounds to use in research for those suffering from Misophonia. An additional aim of this study was to explore interpersonal functioning in the context of Misophonia.

While we continue to learn how to best understand and assess misophonia, it is also important to develop treatments that can help those who are suffering. The purpose of this study was to adapt an existing treatment, the Unified Protocol, to meet the needs of adults with misophonia. The Unified Protocol has been shown to help adults with conditions such as anxiety and depression, and we felt it can help with misophonia as well. This study (PI: Robbins & transferred to McMahon) funded by the REAM foundation/Misophonia Research Fund (MRF), was conducted in two phases. In Phase 1 we delivered the Unified Protocol to adults with misophonia and received feedback about how helpful and acceptable the treatment was to them. We then revised the treatment based on this feedback and delivered the revised treatment to patients in Phase 2 to ensure the changes are helpful. Participants who completed the assessment portion of the phenotyping study and met eligibility criteria were able to participate. We are have completed both phases of the study and are in the process of writing the manuscript.

Email psychcmer@dm.duke.edu for more information.

In order to develop treatments for Misophonia, it is important to gain a better understanding about what is happening in the brain when people with Misophonia (and those without) are triggered by misophonic and non-misophonic cues. In this study (PI: Neacsiu) funded by the REAM Foundation and supported by CMER, the primary aim was to disentangle the brain circuitry dysfunction in Misophonia when compared to highly emotional dysregulated adults without Misophonia. A secondary aim was to examine changes in misophonic distress and regulation when applying inhibitory, excitatory, or sham repetitive transcranial magnetic stimulation (rTMS) over key neural networks. This study is completed and the manuscript is currently in process and under review for publication.

This study aimed to develop and validate a semi-structured clinical interview to assess Misophonia in adults by means of two phases. The first phase of the study involved piloting an initial version of the interview within a small sample to evaluate feasibility and acceptability of the instrument by participants with Misophonia. Participants who completed the assessment portion of the phenotyping study and met eligibility criteria were able to participate in the first phase.

After integrating participant and expert feedback, Phase 2 involved administration of the Misophonia interview to a large sample of adults with Misophonia. The outcome of this study is a validated interview that clinicians can use with their patients to better understand their symptoms and the impact of Misophonia in their everyday lives, and that researchers can use in future research on this sound-intolerance condition. This interview is available on our website to use freely.