Research & References

1. Dozier, Thomas H. "Counterconditioning Treatment for Misophonia." Clinical Case Studies, vol. 14, no. 5, 2015, pp. 374–387.
This case study presents one of the earliest published treatments for misophonia. Dozier conceptualizes misophonia as a conditioned response and describes a counterconditioning intervention in which positive stimuli are paired with reduced-intensity trigger sounds. The reported outcome was a progressive reduction in the participant's misophonic response, suggesting counterconditioning may be a promising behavioral treatment approach. (Sage Journals)
2. Dozier, Thomas H. "Etiology, composition, development and maintenance of misophonia: A conditioned aversive reflex disorder." Psychological Thought 8.1 (2015): 114.

Misophonia is a recently identified condition in which an individual has an acute reaction of hatred or disgust to a specific commonly occurring sound. We propose that misophonia is a form of conditioned behavior that develops as a physical reflex through Pavlovian conditioning. Although misophonia is generally considered to be a one-step reaction, in which the sound elicits rage or disgust, as well as typical autonomic responses associated with these emotions, we propose that misophonia is a two-step reaction, in which the sound elicits an aversive conditioned physical reflex, and the aversive conditioned physical reflex elicits hatred or disgust. We also propose that the emotional response to trigger stimuli creates a Pavlovian conditioning paradigm that maintains or strengthens the misophonic physical reflex. Finally, we propose that new misophonic trigger stimuli are developed through the pairing of a neutral stimulus with a misophonic trigger stimulus. We suggest that a better name for misophonia is Conditioned Aversive Reflex Disorder (CARD) since it focuses attention on the reflexive nature of this condition and incorporates multiple stimuli modalities. A counterconditioning treatment for misophonia is presented with brief case descriptions which demonstrate the conditioned reflex nature of this disorder.

3. Dozier, Thomas H. "Treating the initial physical reflex of misophonia with the neural repatterning technique: A counterconditioning procedure." Psychological Thought 8.2 (2015): 189.
Misophonia is a condition in which a person has an acute emotional response of anger or disgust to a commonly occurring innocuous auditory or visual stimulus referred to as a trigger. This case details the effective treatment of misophonia in a young woman that included a counterconditioning treatment called the Neural Repatterning Technique (NRT), which combines a continuous positive stimulus and a reduced intensity, intermittent trigger. The treatment was delivered via the Misophonia Trigger Tamer smartphone app and all treatments were conducted independently by the patient. In this patient, the trigger elicited a physical reflex of contraction of the flexor digitorum profundus, which caused her to clench her fist. To enhance the effect of the NRT treatment, Progressive Muscle Relaxation was incorporated to increase her ability to deliberately relax the affected muscle during treatment. During NRT treatment sessions, the patient experienced a weak physical reflex to the reduced trigger stimulus but no emotional response. Her emotional response of misophonia was not treated, but when the physical reflex extinguished, the emotional response also extinguished. This case indicates that the misophonic response includes a Pavlovian-conditioned physical reflex. It is proposed that the trigger elicited the physical reflex and the physical reflex then elicited the conditioned emotional response that is characteristic of misophonia. Because of the conditioned reflex nature of misophonia, it is proposed that a more appropriate name for this disorder would be Conditioned Aversive Reflex Disorder
4. Dozier, Thomas H. "Understanding and overcoming misophonia: a conditioned aversive reflex disorder." Livermore, CA: Misophonia Treatment Institute; 2017.
Understanding and Overcoming Misophonia: A Conditioned Aversive Reflex Disorder (2nd Edition) presents a comprehensive examination of misophonia, a condition characterized by intense emotional and physiological reactions to specific sounds and associated visual stimuli. Building on clinical observations, behavioral science, and emerging neuroscience, this edition advances the hypothesis that misophonia is a conditioned aversive reflex disorder in which trigger stimuli become linked through Pavlovian conditioning to involuntary physical reflexes that precede emotional distress. The book integrates findings from brain imaging studies, physiological research, and clinical practice to explain the etiology, development, and maintenance of the disorder while distinguishing misophonia from related sensory and psychiatric conditions. It provides practical assessment strategies, evidence-informed management techniques, and treatment approaches for children and adults, emphasizing interventions designed to reduce conditioned reflex responses and improve daily functioning. Expanded with updated research, additional case examples, and enhanced guidance for families and clinicians, the second edition offers a framework for understanding the mechanisms underlying misophonia and presents practical tools to reduce symptom severity and improve quality of life for individuals affected by this often misunderstood condition.
5. Dozier, Thomas H., Michelle Lopez, and Christopher Pearson. "Proposed Diagnostic Criteria for Misophonia: A Multisensory Conditioned Aversive Reflex Disorder." Frontiers in Psychology, vol. 8, 2017, article 1975.

This article proposes diagnostic criteria intended to standardize identification of misophonia. The authors argue that misophonia is best understood as a conditioned aversive reflex disorder involving both auditory and visual triggers and recommend criteria to distinguish it from other psychiatric and neurological conditions. (PubMed Central (PMC))

6. Dozier, Thomas H., and Kate L. Morrison. "Phenomenology of Misophonia: Initial Physical and Emotional Responses." American Journal of Psychology, 2017
The study examines the sequence of reactions experienced by people with misophonia. It reports evidence that an immediate physical response typically precedes the emotional reaction, supporting the hypothesis that conditioned physical reflexes play a central role in the disorder's development and maintenance. (Misophonia Institute)
7. Quek, Tian Ci, et al. "Misophonia in Singaporean psychiatric patients: a cross-sectional study." International journal of environmental research and public health 15.7 (2018): 1410.
Misophonia, also known as selective sound sensitivity syndrome, is a condition characterized by strong dislike of specific sounds with accompanying distressing reactions. To date, misophonia is still poorly understood. This study aimed to identify factors associated with severity of misophonic symptoms in Singaporean psychiatric patients. Ninety-two psychiatric patients were recruited from a large teaching hospital in Singapore in a cross-sectional study. Socio-demographics, severity of depression, anxiety and stress, and severity of misophonic symptoms were analyzed. Correlation analysis showed that anxiety, depression, and stress scores—as measured by the Depression, Anxiety and Stress Scales-21 (DASS-21)—were significantly positively correlated with the Amsterdam Misophonia Scale (A-MISO-S) scores. After adjustment for confounding factors, multivariate regression analysis showed that anxiety (β = 0.385, p = 0.029) remained significantly associated with A-MISO-S. Age, gender, depression, and stress were not significantly associated with the severity of misophonia. The findings showed that the severity of anxiety was associated with severity of misophonia in Singaporean psychiatric patients. Further research is needed to explore the nature of misophonia and its relationship with other psychiatric disorders. [In this study, 66% of participants reported misophonia symptoms: 45.6% mild to moderate; 12% severe to extreme.]
8. Dozier, Thomas H., Leighton Grampp, and Michelle Lopez. "Misophonia: Evidence for an Elicited Initial Physical Response." Universal Journal of Psychology, vol. 8, no. 2, 2020, pp. 27–35.
Using electromyography (EMG) and direct observation, the authors investigate whether trigger stimuli produce immediate involuntary physical responses. Their findings support the existence of an elicited physical response preceding emotional distress, providing physiological evidence for the conditioned-reflex model of misophonia. (HRPUB)
9. Claiborn, James M., et al. "Misophonia phenomenology, impact, and clinical correlates. Psychological Thought 13.2 (2020); 13(2): 349.

Misophonia is a newly recognized condition involving adverse emotional reactions to environmental sounds, most often produced by other people. This study reports results of a survey describing the phenomenology of misophonia based on a large sample. Survey data were collected from individuals self-identified as having misophonia. A total of 1,061 individuals reported specific distressing reactions to sounds, and responses indicating severity of misophonia and perceived comorbidity. Over 82% of respondents were female. The average age of the study participants was 37.49 years (SD = 12.24; range from 18 to 72). Most respondents reported multiple triggers and adverse emotional reactions, as well as multiple coping responses. The majority of respondents reported comorbid diagnoses. Misophonia severity is described, as well as impact on quality of life. A minority of respondents had some experience with treatment and most reported no change in symptoms. Treatments reported for misophonia were typically ineffective, and once developed, misophonia symptoms persist. The results of the study showed that misophonia is a newly recognized condition that appears to have important impact on people’s lives. It typically develops in early life, and is associated with a reduced quality of life, substantial comorbidity, negative emotional experiences, and behaviors that are likely to impact interpersonal relationships.

10. Dibb, B., Sarah Elizabeth Golding, and T. H. Dozier. "The development and validation of the Misophonia response scale." Journal of psychosomatic research 149 (2021): 110587.

Objective: Most current Misophonia scales are not validated, do not include both emotional and physiological responses to triggers, and/or focus only on auditory triggers. This research aimed to develop and validate a measure of the magnitude of the Misophonic response that addressed these omissions.

Method: Three studies were carried out with individuals with self-diagnosed Misophonia. In study 1, expert opinion and participants commented on initial items to determine both face and content validity. In study 2, scale structure, reliability, and convergent and discriminant validity were determined using correlations, principal component analysis (PCA), and reliability analysis. In study 3, factor structure was confirmed in another sample of participants using confirmatory factor analysis (CFA).

Results: The final 22-item scale assesses the magnitude of responses to triggers across any sensory modality. There are three subscales (emotional, physiological, and participation in life), with three additional items measuring frequency of triggers, avoidance of triggers, and time taken to recover from the triggers. The final scale showed suitable discriminant and convergent validity, with good internal consistency (Cronbach's alphas range 0.77 to 0.89). The three-component solution extracted using PCA explained 53.97% of variance, with all items loading between 0.45 and 0.84. The structure was confirmed with CFA (χ2 = 269.01, p < .001; CFI = 0.96; TLI = 0.96 and RMSEA = 0.045 (CI 0.037–0.053). Conclusion: The Misophonia Response Scale, which is valid and reliable, will facilitate understanding of Misophonia as it is short and easy to use for self-report in research.

11. Ferrer-Torres, Antonia, and Lydia Giménez-Llort. "Confinement and the hatred of sound in times of COVID-19: a Molotov cocktail for people with misophonia." Frontiers in psychiatry 12 (2021): 627044.

Forced strict confinement to hamper the COVID-19 pandemic seriously affected people suffering from misophonia (M+) and those living with them. Misophonia is a complex neurophysiological and behavioral disorder of multifactorial origin, characterized by an intense physiological and emotional response produced by intolerance to auditory stimuli of the same pattern, regardless of physical properties. The present work studied the secondary impact that strict confinement caused in 342 adults (224 women: 118 men) regularly attending a medical psychological center in Barcelona. Misophonia, usually underdiagnosed, showed a prevalence of 35%, the same for women (37%) than men (31%)...

12. Dozier, Thomas H. "Case study of Relaxation and Counterconditioning Therapy for Misophonia: A Conditioned Aversive Reflex Disorder." Psychological Thought 15.1 (2022): 285.
This article presents a case study of conceptualization of misophonia as a conditioned aversive reflex disorder consisting of a physical (e.g., muscle) reflex elicited by the misophonic trigger stimulus and subsequent emotional, physiological, and behavioral responses. This case describes a successful behavioral treatment of a middle-aged woman who was disabled by severe misophonia. The treatment included identifying the initial physical reflex, progressive muscle relaxation, and counterconditioning the initial physical reflex. Counterconditioning was accomplished by relaxing the initial physical reflex muscle during exposure to in vivo trigger stimuli, while using ambient sound as needed to reduce the severity of the misophonic response. The overall severity of misophonia reduced over the course of the 13-week treatment, based on client self-report. Data were analyzed using recovery percentage formula. The recovery percentage average of 3 scales was 82.1% at end of treatment and 93.1% at 1-year follow-up. In this case, when the initial physical reflex’s muscle was held relaxed by the patient when exposed to trigger stimuli, the initial physical reflex and the emotional reflex diminished and extinguished.
13. Swedo, Susan E., et al. "Consensus definition of misophonia: A delphi study." Frontiers in neuroscience 16 (2022): 841816.
Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, the authors conducted a study to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.
14. Dozier, Thomas, and Nathanael Mitchell. "Novel Five-Phase Model for Understanding the Nature of Misophonia, a Conditioned Aversive Reflex Disorder." F1000Research, vol. 12, article 808, 2023.
This paper proposes a five-phase model describing how misophonia develops and persists. The model integrates conditioned reflexes, autonomic activation, emotional responses, coping behaviors, and long-term maintenance, with the goal of providing a comprehensive framework for research and treatment. (F1000Research)
15. Dixon, Laura J., et al. "Prevalence, phenomenology, and impact of misophonia in a nationally representative sample of US adults." Journal of psychopathology and clinical science 133.5 (2024): 403.

Misophonia is characterized by decreased tolerance for and negative reactions to certain sounds and associated stimuli, which contribute to impairment and distress. Research has found that misophonia is common in clinical, college, and online samples; yet, fewer studies have examined rates of misophonia in population-based samples. The current study addresses limitations of prior research by investigating misophonia prevalence, phenomenology, and impairment in a large, nationally representative sample of adults in the United States. Probability-based sampling was used to administer a survey to a representative sample of U.S. households. Data were adjusted with poststratification weights to account for potential sampling biases and examined as weighted proportions to estimate the outcomes. The sample included 4,005 participants (51.5% female; 62.5% White). Sensitivity to misophonia sounds was reported by 78.5% of the sample, and 4.6% reported clinical levels of misophonia. Results demonstrated significant demographic differences in misophonia symptom severity. Specifically, significantly higher misophonia symptoms were observed for participants who identified as female, less than 55 years old, less than a high school education, never married, lower income, and those working part time, compared to each of the respective comparison groups. Those with clinically significant misophonia symptoms reported that symptoms often onset in childhood and adolescence, were persistent, and contributed to severe impairment in at least one life domain. These findings provide a prevalence estimate of misophonia in the general population of the United States and inform our understanding of who is affected by misophonia. (PsycInfo Database Record (c) 2025 APA, all rights reserved)