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theses

This single-subject, mixed-method, behavioral analytic case-study dissertation presents a systematic, 12-session cognitive behavior therapy (CBT) treatment of “Zara,” an undergraduate student with severe misophonia. Misophonia is a rare condition characterized by an aversive response of sympathetic nervous system (SNS) activation and negative emotions (e.g. anger, disgust, and/or anxiety) elicited by the presence of specific and commonly encountered sounds (e.g. lip-smacking, chewing). Distress caused by trigger sounds and efforts to avoid and escape from these sounds often result in impairment in functioning. The goals of this case study are to (1) detail the assessment process used; (2) document and analyze the successful implementation of the CBT intervention; and (3) evaluate hypotheses regarding the mechanisms of change. The intervention utilized an A-B research design with a six-month follow-up. The independent variable consisted of a multi-component treatment that included skills training in cognitive restructuring, mindfulness and exposure procedures. The treatment was designed to reinforce adaptive and appropriate coping responses and extinguish the aversive respondent conditioned responses and the negatively reinforced inappropriate coping responses. The dependent variables included both behavioral outcomes (e.g. inappropriate coping behaviors, avoidance, and social interference) and subjective report outcomes (e.g. sensitivity to sounds, distress, and reported SNS response). The Amsterdam Misophonia Scale and the Misophonia Questionnaire were collected to evaluate changes in misophonia symptoms. At the end of treatment, the intervention was associated with a substantial improvement in all dependent variable measures. The largest reduction in symptoms occurred following session five, the first session with prolonged exposure exercises. At the six-month follow-up, which was completed by an independent evaluator, Zara reported an increase in her subjective “sensitivity” to trigger sounds; however, she remained at post-treatment levels in terms of her subjective SNS distress, use of inappropriate coping behaviors, avoidance, social interference, and overall misophonia symptoms. These findings support the role of two mechanisms of change as being responsible for Zara’s long-term relief: (a) skills training in cognitive restructuring; and (b) the expectancy violation and behavioral experimentation components of exposure therapy. The case concludes with a discussion of the intervention’s limitation and recommendations for future research.

ETD_9262

Psy.D.

Includes bibliographical references

by David A. Singer

doi:10.7282/T33J3HKH

ETD doctoral

The author owns the copyright to this work.