EMDR for Misophonia, a pilot study

Our research group at the Academic Medical Center (AMC) in Amsterdam proposed
the first diagnostic criteria (Schröder et al 2013) for misophonia based on the
extensive research. Individuals with misophonia experience extreme negative
emotions such as anger and disgust when they are exposed to specific human
sounds, such as chewing or sniffing. These negative emotions cause individuals
to avoid situations where they might be exposed to the trigger sound,
compromising the ability to function in daily life. For these symptoms an
experimental group therapy was developed at the same department. In the last
years, Cognitive behavioural therapy (CBT) in a group has led to a reduction of
misophonia symptoms in a considerable number of participating patients. In
fact, based on pre- and post-treatment A-MISO-S scores, a reduction of at least
35% of the total score was found in 53% of the patients (Schröder et al, 2017).
At this moment we conduct a RCT, comparing CBT treatment to a waiting list at
our department (METC; project 2016_295 Cognitive behavioral therapy for
Misophonia, RCT).

Since a number of patients do not benefit from our treatment, other treatment
options should be investigated. Misophonia can be seen as a conditioned
emotional response to the trigger stimuli (Jastreboff & Jastreboff, 2015),
possibly mediated by cognitions. Eye Movement Desensitisation and Reprocessing
(EMDR) is, as CBT, an effective technique to re-evaluate the conditioned
response when there*s a Post-Traumatic Stress Disorder (PTSD) (Korrelboom & Ten
Broeke, 2010). Besides of a few case studies (e.g. Dozier, 2015), no
systhematic evidence shows a link between PTSD and misophonia. Schröder et al
(2013) found no comorbidity with PTSD (2013) in their misophonia sample (n=42).
In our new sample (n=622) we found 0,02% comorbidity with PTSD. There*s
growing evidence for the use of EMDR for *minor trauma*, in other words for
damaging learning experiences that can explain the start or worsening of
specific psychiatric symptoms. For example in a recently published randomized
controlled trial by Marsden et al (2017) comparing EMDR and CBT for
obsessive-compulsive disorder, EMDR and CBT had comparable completion rates and
clinical outcomes. There*s also clinical evidence that that EMDR can be
effective for treating misophonia, for example in a case study of a patient
with PTSD and misophonia by Ross (2015).

We expect that the positive outcome of EMDR with misophonia is dependent on the
taxation of the symptoms; only when there*s a clear link between misophonia
complaints and damaging learning experiences, EMDR can have a positive effect
and will result in a reduction of emotional responses following misophonic
stimuli; improvement in social functioning due to the reduction of both
negative emotions and avoidance, and improvement in overall quality of daily
life.

To evaluate the effect of Eye Movement Desensitisation and Reprocessing (EMDR)
as an alternative or additional therapy for misophonia.

The present study entails a pilot study for patients suffering from misophonia.
The patients will be approached as they are on the waitinglist for the group
CBT.

All patients will, before they are included in this study, at first have an
assessment to establish if there are damaging learning experiences that can
explain the start or worsening of the symptoms (using the protocol of *the
First Method* De Jongh et al, 2010). If they have such experiences, they will
receive 1-5 sessions individual EMDR conform basic protocol (De Jongh & Ten
Broeke, 2003). Assessments of the misophonia complaints will take place before
the start and at the end of treatment.

Participants will have to come to the AMC for individual EMDR 1-5 sessions of
60-90 minutes. Furthermore, participants will fill in a small package of
questionnaires two times (15-30 minutes). In total, participants will spend a
mean of 8 hours on this study. To our knowledge there are no risks involved.