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BACKGROUND INFORMATION

A study by MRF funded investigator Dr. Michael Twohig tested the benefit of two different existing forms of therapy called Acceptance and Commitment Therapy (ACT) and Progressive Relaxation Training (PRT). ACT and PRT are evidence-based, skills-focused therapies that help children build coping strategies and guide parents in supportive responses. In clinical research, these are considered “behavioral therapies,” a term that refers to structured approaches that target coping and emotional responses. More specifically, ACT helps people build awareness of their internal experiences and take actions aligned with their values even when distressing emotions arise. PRT focuses on reducing physiological tension through relaxation exercises.

While not designed specifically for misophonia, adapting existing therapies offers immediate options for reducing distress as research continues toward biologically informed, targeted treatments.

METHODS

Participants were recruited through Facebook, flyers, and referrals from their established care providers. They went through an online screening questionnaire and clinical interviews to evaluate misophonia, and emotional and behavioral responses like irritation, anger, avoidance, and escape. The resulting 60 adults diagnosed with misophonia were randomly assigned to receive either ACT or PRT in 12 weekly one-hour sessions. Participants completed assessments before treatment, after treatment, and again at three- and six-month follow-ups. This study design allowed researchers to compare the benefits of these two therapeutic approaches.Both therapies were rated positively by participants.

This study utilized a randomized controlled trial (RCT), a method considered the gold standard for determining whether one approach works better than another, in which participants are randomly assigned to be in the ACT or PRT treatment groups.  

RESULTS

Both therapies were rated positively by participants and both ACT and PRT reduced misophonia severity based on clinician ratings and ratings from the participants themselves (self-reports). ACT showed slightly greater improvement on some self-report measures, but symptoms measured by clinicians revealed that both therapies were equally effective in significantly reducing misophonia symptoms. Measures of overall emotional well-being and psychological flexibility, or how easily someone adjusts to stress or challenging emotions, did not change significantly. Taken together, these findings mean that these therapies helped people manage their misophonia reactions specifically. This is compared to the possibility that these treatments could broadly change the individual’s general emotional health and ability to adapt to challenges, including the impact of misophonia.

This study is one of the first few RCTs completed for misophonia—and a critical step toward developing evidence-based care for misophonia. These findings provide evidence that structured psychotherapies can lessen misophonia symptoms. More specifically, the results highlight ACT and PRT as promising interventions with a range of benefits. These benefits were observed both by clinician and participants evaluations of the misophonia symptoms before and after the study.

The researchers also found that some participants experienced greater improvement of their misophonia than others. This finding emphasizes the need for continued research to learn whether there are features of an individual’s misophonia that are linked to experiencing more benefit from these treatment options.

This study is one of the first few RCTs completed for misophonia—and a critical step toward developing evidence-based care for misophonia.

Research Paper Title: Acceptance and commitment therapy versus progressive relaxation training for misophonia: A randomized controlled trial

Authors: Michael P. Twohig, Karen Muñoz, Julie M. Petersen, Mercedes G. Woolley, Emily M. Bowers, Marissa L. Donahue a, Doris Velasquez, Diana Ortiz, Leila K. Capel, Guadalupe G. San Miguel

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ABOUT THE RESEARCH TEAM

Michael Twohig, PhD, is a Clinical Psychologist that leads a team of researchers at the University of Utah who have contributed substantially to our understanding of the impact of behavioral therapies for people with misophonia. Emily Bowers, a graduate student in the lab and author on this paper, will be continuing this effort as the funded investigator on a 2025 Misophonia Data Discovery Award to the University of Utah. Her study will create and test an online treatment program based on ACT that aims to help circumvent barriers that can limit access to in-person therapy.

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