Targeting beliefs and behaviours in misophonia: a case series from a UK specialist psychology service.

BACKGROUND: Misophonia, a disorder of decreased sound tolerance, can cause significant distress and impairment. Cognitive behavioural therapy (CBT) may be helpful for improving symptoms of misophonia, but the key mechanisms of the disorder are not yet known. AIMS: This case series aimed to evaluate individual, formulation-driven CBT for patients with misophonia in a UK psychology service. METHOD: A service evaluation of one-to-one therapy for patients with misophonia (n=19) was conducted in a specialist psychology service. Patients completed an average of 13 hours of therapy with a focus on the meaning applied to their reactions to sounds and associated behaviours. Primary outcome measures were the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Scale (A-MISO-S). Repeated measures t-tests were used to compare scores from pre-treatment to follow-up, and reliable and clinically significant change on the MQ was calculated. RESULTS: Scores significantly improved on both misophonia measures, with an average of 38% change on the MQ and 40% change on the A-MISO-S. From pre-treatment to follow-up, 78% of patients showed reliable improvement on the MQ and 61% made clinically significant change. CONCLUSIONS: Limitations included a lack of control group, small sample size, and the use of an outcome measure that had not been thoroughly validated for a treatment-seeking sample. These results suggest that one-to-one, formulation-driven CBT for misophonia is worth exploring further using experimental design. Potential mechanisms to explore further include feared consequences of escalating reactions, the role of safety-seeking behaviours and the impact of early memories associated with reactions to sounds.

Misophonia in the UK: Prevalence and norms from the S-Five in a UK representative sample.

What is the reality of the misophonic experience in the general population? This is a study on misophonia in a large sample, representative of the UK general population. The study utilises a multidimensional psychometric tool, the S-Five, to study the intensity of the triggering misophonic sounds in everyday activities, the emotions/feelings related to them, and the norms of the key components of the misophonic experience: internalising and externalising appraisals, perceived threat and avoidance behaviours, outbursts, and the impact on functioning. Based on the S-Five scores and a semi-structured interview delivered by clinicians who specialise in misophonia, the estimated prevalence of people for whom symptoms of misophonia cause a significant burden in their life in the UK was estimated to be 18%. The psychometric properties of the S-Five in the UK general population were also evaluated and differences across gender and age were explored. Our results show that the five-factor structure is reproduced, and that the S-Five is a reliable and valid scale for the measurement of the severity of the misophonic experience in the general UK population.

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review.

BACKGROUND: Telemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed. OBJECTIVE: This rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms. METHODS: Rapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including "gray literature," to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups. RESULTS: A total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed. CONCLUSIONS: Service user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910.

Oppositional Defiant Disorder Is Better Conceptualized as a Disorder of Emotional Regulation.

OBJECTIVE: It has been reported that Oppositional Defiant Disorder (ODD) can be differentiated into distinct subtypes associated with different outcomes in adulthood. We examined whether ODD is conceptually independent and coherent, and whether ODD and Conduct Disorder (CD) are expressions of the same core deficit. METHOD: The data come from a sample of 4,380 children for whom SNAP rating scales were available. Parallel analysis was performed on the eight-item ODD diagnostic items and on the SNAP-90 scale. These were factor analyzed and the components were correlated. RESULTS: ODD has one underlying factor, whereas the parent-rated SNAP has nine underlying factors. ODD items grouped together with emotional lability and irritability items, which did not group with CD. Confirmatory factor analysis supported the separation of ODD and CD but not ODD and emotion dysregulation. CONCLUSION: The expanded ODD factor more likely captures a disorder of emotion regulation, rather than a disruptive behavior disorder.

Transfer of route learning from virtual to real environments.

The authors investigated the extent to which route learning in a virtual environment (VE) transfers to the real world. In Experiment 1, active VE exploration, on its own or with a map, produced better transfer of training than either no VE training at all or passive VE training; however, transfer was achieved after shorter training times with the map. Experiment 2 demonstrated that VE + map training was not superior to training with a map alone, and Experiment 3 demonstrated that the poorer performances observed after passive VE training were not simply due to a lack of attention but to the lack of active navigational decisions. The authors concluded that the present VE technology does not provide better route learning than studying a map.