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BACKGROUND INFORMATION

This study explored how difficulties with emotion regulation, anger, and anxiety relate to the severity of misophonia symptoms. Emotion regulation is a concept from psychology and mental health research. This concept refers to the ways our brains and bodies automatically respond to intense feelings—and how we can gradually build strategies to recover more easily after those reactions occur. Anger, anxiety, and emotion regulation occur in many different disorders and there are evidence-based or research-supported therapies that already exist to help people build strategies to improve them.

Understanding the links between these features and misophonia can help point clinicians in the right direction when deciding the best therapies to adapt for misophonia now, as research advances toward targeted treatments in the years ahead.

METHODS

Participants completed established questionnaires assessing misophonia, anxiety, anger, and six aspects of emotion regulation, such as emotional awareness, impulse control, and acceptance. Overall, the research team collected and analyzed data from 205 adults who reported misophonia symptoms and impairment. Using network analysis, a method that maps how psychological factors are interconnected, the researchers identified which emotional processes most strongly relate to misophonia severity.

RESULTS

Of the different psychological factors evaluated, misophonia severity was most strongly associated with nonacceptance of emotions, anxiety, and anger. The researchers discussed the following key findings that point experts towards the best next steps for adapting existing therapies to misophonia and further research.  

KEY FINDINGS

(1) Nonacceptance of emotions may play a larger role in misophonia severity than previously understood. The study found that difficulty accepting one’s emotional states without judgment can influence other important processes that support healthy emotion regulation and may contribute to heightened anger. Together, these effects suggest that nonacceptance may be intensifying several factors that contribute to misophonia. This finding points to a promising target for existing therapeutic interventions.

(2) Anxiety and hypervigilance were linked to greater misophonia severity. The study found that higher anxiety—particularly the constant sense of alertness or “on edge” feeling known as hypervigilance—was associated with more intense misophonia symptoms. This heightened state can drain attention, increase emotional reactivity, and make it harder to use coping strategies effectively. Interventions that help calm this underlying arousal may lessen distress and improve daily functioning.

(3) Greater anger and frustration responses were linked to higher misophonia severity. This finding echoes prior research showing that irritation and frustration are common reactions to trigger sounds. This anger may arise when triggers interrupt focus or block goal-directed actions, intensifying distress in daily settings. Targeting anger regulation in therapy could help individuals respond to triggers with less emotional escalation and improve overall coping.

These findings suggest that existing treatments that help people increase emotional acceptance, reduce anxiety, and manage anger may be especially effective in reducing symptom severity and improving daily functioning. Ultimately, these findings inform how clinicians may select from existing treatment methods, tailor them for misophonia, and determine the best next steps for future research.

Research Paper: Examining the role of emotion regulation, anger, and anxiety in misophonia: A network model

Authors: Matthew R Hanna, Amanda C Collins, Yanyan Shan, Bill Chen, Siyuan Wang, M Zachary Rosenthal

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ABOUT THE RESEARCH TEAM

This study was led by graduate student Matthew Hanna in Dr. Zachary Rosenthal’s Lab at Duke University. Zachary Rosenthal, PhD,  is on the MRF Scientific Advisory Board and is the Director of the Duke University Center for Misophonia and Emotion Regulation (CMER).  CMER is the first center of excellence for misophonia research, contributing a wide range of research discoveries that are helping to shape best practices around diagnosis and treatment of misophonia.

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