Investigating the Role of Stress in Misophonia: Stress as a Clinical Correlate and Its Influence on Treatment Outcomes.

Misophonia is a sound intolerance disorder characterized by strong emotional and physiological reactions to specific everyday sounds. Emerging research suggests that stress may play an important role in misophonia, yet little work has examined whether stress uniquely contributes to misophonia severity or influences treatment response. The present study examined the role of stress in misophonia using data from a randomized clinical trial of treatment-seeking adults (N = 60) comparing acceptance and commitment therapy and progressive relaxation training. First, we examined whether stress symptoms were uniquely associated with misophonia severity and impairment at baseline when accounting for anger, disgust propensity and sensitivity, anxiety, depression, obsessive-compulsive symptoms, and demographic variables. Second, we examined whether baseline stress influenced trajectories of change in misophonia outcomes over time and whether these differed across treatment conditions. Results suggested that, at baseline, stress symptoms were the only clinical correlate that uniquely predicted misophonia symptom severity and misophonia-related impairment. Baseline stress was also associated with differences in treatment trajectories, such that individuals reporting lower stress showed greater improvement in misophonia symptoms and impairment by the 6-month follow-up compared with those with higher stress. However, stress did not interact with treatment condition; both treatments performed equally regardless of stress levels. These findings suggest that stress may represent a broader psychological process associated with misophonia severity and the durability of treatment gains.