AUTHOR=Siepsiak Marta , Śliwerski Andrzej , Turek-Wojnarowicz Anna , Araszkiewicz Weronika , Gambin Małgorzata , Rosenthal Mark Zachary 
  
TITLE=Cognitive reappraisal as a component of process-based misophonia treatment: a mixed-methods pilot study of feasibility, acceptability and initial outcomes
  
JOURNAL=Frontiers in Psychiatry
  
VOLUME=Volume 17 - 2026
  
YEAR=2026
  
URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2026.1744882
  
DOI=10.3389/fpsyt.2026.1744882
  
ISSN=1664-0640
  
ABSTRACT=ObjectiveMisophonia is a subtype of decreased sound tolerance associated with significant distress and reduced quality of life. Although no evidence-based treatments exist specifically for misophonia, cognitive behavioral therapies (CBTs) show promise. Cognitive reappraisal (CR), a core transdiagnostic CBT intervention, is frequently used in experimental studies, however, its effects on misophonia in ecologically valid conditions remain untested. Similarly, the needs and perspectives of individuals with misophonia regarding treatment are underexplored. This study developed and evaluated a CR protocol tailored for misophonia, assessing feasibility, acceptability and satisfaction, as well as preliminary assessment of the intervention outcomes through an uncontrolled quantitative as well as qualitative design.MethodsThe intervention included a 90-minute group session and three 30-minute individual online sessions over four weeks. Adults (N = 23) were recruited using structured interviews. Misophonia symptoms were assessed at two pre-treatment time points and post-treatment. Semi-structured group interviews explored participants’ experiences.ResultsNo significant changes were observed between the two pre-treatment assessments in three of the five symptom subscales, partially confirming baseline symptom stability. In contrast, a significant post-treatment reduction in externalizing responses to misophonia triggers was observed (Estimate = -8.47, SE = 2.32, t(42.45) = -3.65, p < 0.001), with similar improvements across other S-Five subscales. Qualitative data highlighted feelings of isolation, appreciation for the group format, and a need for more individualized support.ConclusionCR shows promise as a component of misophonia treatment that warrants further controlled evaluation. The participant’s feedback highlights the importance of tailoring interventions to individual needs and patient perspectives.