Misophonia is a condition characterised by intense emotional reactions to sounds that would not bother most people. Currently, there is no widely accepted and effective treatment for misophonia. Most published studies on treatment have used behavioural therapy, cognitive interventions, or audiological treatments; however, there is no comparison of the effectiveness of these approaches. This 6-week study aimed to compare the effects of brief, self-administered versions of exposure and tinnitus retraining therapy (TRT) in 58 adults with misophonia. The participants, randomly assigned to the two treatment groups and a wait-list group, were assessed at three time points (baseline, week 3, and week 6). The exposure group was given self-exposure homework assignments, where the patient was expected to self-expose to the live or recorded misophonic sound that was agreed upon during the week 0 assessment, for 20–40 minutes, three times a week. The patients in the TRT group were given a set of pre-recorded music pieces and asked to listen to any piece of their choosing for 20–40 minutes a day, three times a week. Self-report measures of misophonia severity (Misophonia Checklist), and interference due to symptoms were rated at each time point by the patients. The assessor also rated improvement at each time point. The study is registered in ClinicalTrials.gov (registration no. NCT05993286). The Intention to Treat (ITT) analyses revealed no difference between the three groups in terms of self-rated misophonia severity at week 6. The assessor-rated percentage of improvement favoured exposure, although the response rate was very low; only six out of 39 participants were rated as moderately or much improved, five of whom were in the exposure therapy group. The results underscore the need for finding ways to increase treatment response in misophonia.

Auditory hallucinations present a significant challenge. Despite advances in treatment with novel antipsychotic agents, there are still a significant number of non-responders to standard therapy. We describe the case of a young patient with treatment resistant auditory hallucinations, with positive outcomes after being fitted with auditory sound generators commonly used for the treatment of tinnitus. As far as we are aware, this is only the third case so far described in the literature.