Characterizing the cognitive dimensions of misophonia using a qualitative approach: from in-the-moment appraisals to intrusive thoughts about prior sounds

Objective Misophonia involves intense affective and physiological reactions to everyday sounds, yet the accompanying negative cognitive processes are understudied. The objective of this study was to qualitatively characterize cognitions that occur during and after misophoniasounds.Method We used inductive content analysis to analyse the open ended responses from 60 treatment-seeking adults using the Duke Misophonia Interview.Results During exposure, participants reported: (1) self-critical/self-devaluing thoughts related to one’s reactions to misophonicsounds, (2) externalizing appraisals of others as rude orinconsiderate, (3) intrusive aggressive thoughts, and (4)escape-focused cognitions. After exposure, they described: (1) regret and guilt about their reactions, (2) social worries about how other sperceived them, and (3) intrusive or repetitive memories of prior sound experiences.Conclusion These themes highlight how cognition play a central role in misophonia in the moment and afterwards, with post-misophonic-event processes extending distress beyond exposure to the sound itself. Clinical implications from these themes include screening for these thought patterns, targeting maladaptive self-appraisals, addressing regret and rumination, and channelling escape-related cognitions towards functional coping strategies. Future work should utilizereal-time assessment and more diverse samples to test how these cognitive processes maintain misophonia and to inform tailoredinterventions.