Comparing the Effectiveness of Exposure Therapy Based on Stress Management and Dialectical Behavior Therapy on Cognitive flexibility and Impulsivity in People with Misophonia Signs.

Document Type : Research Paper

Authors

Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Iran

10.22038/mjms.2025.92154.5160

Abstract

Introduction:Misophonia, as an emerging psychological phenomenon, can lead to difficulties in impulse control and reduced cognitive flexibility. Therefore, the present study aimed to compare the effectiveness of stress management–based exposure therapy and dialectical behavior therapy (DBT) on cognitive flexibility and impulsivity in individuals with misophonia symptoms.
Method:This study employed a quasi-experimental single-subject design (A-B-A) with a baseline and multiple follow-up phases. The statistical population comprised all individuals with misophonia who visited counseling centers in Mashhad during 2023–2024 (N = 83). Eight participants diagnosed with misophonia were randomly assigned to two groups: dialectical behavior therapy (n = 4) and exposure therapy based on stress management (n = 4). Data were analyzed using improvement percentage indices, reliable change indices, and visual analysis, with SPSS-27 software applied for statistical processing.
Results:The results indicated that although the improvement percentages of cognitive flexibility in both therapeutic groups—dialectical behavior therapy (56.80%) and stress management–based exposure therapy (53.64%)—were clinically significant, the highest level of improvement belonged to the DBT group. Furthermore, the improvement percentages of impulsivity in both therapy groups were not clinically significant; however, the best improvement rate in impulsivity during the follow-up phase was observed in the DBT group (16%).
Conclusion:Based on the findings, dialectical behavior therapy, through its emphasis on emotion acceptance and emotion regulation skills training, enhances cognitive flexibility and improves impulse control in individuals with misophonia. These results highlight the effectiveness of the dialectical approach in improving cognitive–emotional adaptability among individuals experiencing heightened sensitivity to specific sounds.

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Medical Journal of Mashhad university of Medical Sciences
Volume 69, Issue 1
May 2026
Pages 66-82

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