Digital Intervention for Adults With Misophonia: A Randomized Controlled Trial

The S-Five is a 25-item self-report measure of misophonia severity. Items (e.g., "I feel trapped if I cannot get away from certain noises") are rated on a 0 (not at all true) to 10 (completely true) ordinal scale with total scores ranging from 0 to 250. The S-Five consists of five latent factors: (1) externalizing appraisals (e.g., blaming others for making sounds), (2) internalizing appraisals (e.g., negative self-judgments triggered by misophonia), (3) impact on functioning (e.g., social and occupational impact), (4) outburst (e.g., experiences of aggression or fear of losing control), and (5) threat (e.g., feeling trapped or helpless). The S-Five demonstrates good internal consistency and convergent validity with other misophonia measures (Vitoratou et al., 2023).

The Miso-AAQ is a 7-item self-report measure of misophonia-specific psychological inflexibility, adapted from the AAQ-III (Ong et al., 2019). Items (e.g., "I'm so afraid of my reactions to sounds that I don't do things I care about" are rated from 1 (never true) to 7 (always true) Likert scale. Total scores range from 7 to 49 with higher scores indicating greater misophonia-specific psychological inflexibility. Preliminary validation from a treatment seeking sample of adults with misophonia suggest good internal consistency and convergent validity (Capel et al., 2025).

The CompACT is a 23-item self-report measure of psychological flexibility. Items (e.g., "I make choices based on what is important to me, even if it is stressful) are rated on a 7-point Likert scale from 0 (strongly disagree) to 6 (strongly agree), with 12 items reverse-scored. Total scores range from 0 to 138 with higher scores indicating greater psychological flexibility. The CompACT demonstrates good internal consistency and convergent validity (Francis et al., 2016).

The DASS-21 is a 21 item self-report measure of distress comprised of three 7-item subscales: (1) depression, (2) anxiety, and (3) stress. Items are rated from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time), with higher scores indicating greater symptom severity. Subscale scores are summed and multiplied by two, yielding scores ranging from 0-42 for each subscale.

The MHC-SF is a 14-item self-report measure of well-being. Items assess emotional, social, and psychological well-being, rated on a 6-point Likert scale from 0 (never) to 5 (every day). A total score is calculated from summing all items and ranges from 0 to 70, with higher scores reflecting greater well-being. The MHC-SF has demonstrated strong internal consistency and validity in prior studies (Lamers et al., 2011).

The I-HEARTS is a 25-item self-report measure assessing internalized health-related stigma, adapted here to reference misophonia specifically. Items (e.g., "I am embarrassed or ashamed that I have misophonia") are rated on a 1 (strongly disagree) to 7 (strongly agree) Likert scale, with higher scores indicating greater internalized stigma. The scale yields a total score and three subscales: (1) perceived and anticipated stigma, (2) stereotype application and self-devaluation, and (3) stigma resistance (reverse-scored). Validation in a large sample of adults with chronic health conditions demonstrated strong internal consistency, test-retest reliability, and convergent validity with related constructs such as shame, loneliness, and depression (Pearl et al., 2024).

The IRI-PT is a 7-item self-report subscale assessing the tendency to adopt others' psychological perspectives. Items (e.g., "Before criticizing somebody, I try to imagine how I would feel if I were in their place") are rated from 0 (does not describe me well) to 4 (describes me very well). Total scores range from 0 to 28, with higher scores indicating greater perspective-taking propensity. The IRI-PT has demonstrated good internal consistency and validity as a measure of perspective taking (Davis, 1980).