Misophonia Treatment Perceptions and Sensory History Study

Informed Consent

To participate in this research study, the researchers conducting the work are required to give you all of the information you will need for the study before, during, and after. This process is called informed consent. This study is only for persons over the age of 18 years old. The principle researcher on this study is Shaylynn Hayes-Raymond, who holds a MA. Shaylynn is also the director of the IMF. This study received expedited IRB approval through the IMF. If you have questions about this study you can contact shaylynn@misophoniafoundation.com for further information. This study is done through The International Misophonia Foundation, a non-profit in Missouri, USA. All submissions to this study are anonymous and researchers will not know who made submissions. If you wish to withdraw consent, please exit the study at any time without clicking the final "Submit" button. All incomplete responses will be deleted. This study should take roughly 1-2 hours.

DMQ Screener

Have you ever felt what you would consider irritated, annoyed, distressed, angry, or fearful of certain sounds in the past month? These sounds can include: whistling, chewing, sneezing, coughing, scraping, snoring, and others. If so, please rate the extent to which the bothersome sound/sounds and your reactions to them negatively affected the following in the past month, on average. Please use the following rating scale:
0 - Not at all

1 - A little

2 - Moderately

3 - Quite a bit

4 - Extremely

My ability to be with other people.(Required)

My performance at work or school.(Required)

The quality of my romantic relationships.(Required)

My ability to function in daily activities without help (such as earbuds, headphones, accommodations/leaving room).(Required)

How much I enjoy spending time with my family.(Required)

My ability to work with others.(Required)

My self‐esteem.(Required)

My ability to maintain employment.(Required)

The quality of my relationships with my friends.(Required)

How connected I feel to other people.(Required)

My ability to live with other people (e.g. roommate, partner(Required)

My ability to “be myself”.(Required)

Adult Sensory History

Scoring Key: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

Visual and Spatial Processing

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

Blink at bright lights or seem irritated by them?(Required)

Become easily distracted by visual stimulation?(Required)

Avoid or have difficulty with eye contact?(Required)

Keep lights very low or off in house or prefer to use low watt bulbs?(Required)

Keep shades pulled down?(Required)

Prefer to have a limited number of items in the house or on the walls?(Required)

Dislike bright colored clothing?(Required)

Dislike furniture or rugs with patterns or flowers?(Required)

Overly attend to small visual details?(Required)

See people in two dimensions?(Required)

Prefer to look from the side?(Required)

Like to stare at lights or oncoming headlights?(Required)

Prefer wall and/or ceilings painted dark colors?(Required)

Like to watch fast-changing TV segments or often “channel surf”?(Required)

See only parts of a room at a time?(Required)

See through a haze or fog?(Required)

See double?(Required)

Have difficulty finding your way from a map?(Required)

Have difficulty focusing to thread a needle?(Required)

Have difficulty looking for items on a grocery shelf?(Required)

Tend to draw some numbers or letters backwards?(Required)

Have difficulty doing puzzles?(Required)

Have difficulty interpreting drawings in comics or cartoons?(Required)

Have difficulty matching socks?(Required)

Have difficulty finding a familiar face in a crowd?(Required)

Have difficulty figuring out how to arrange furniture in a room?(Required)

Have difficulty following traffic signs while driving?(Required)

Have trouble following objects with your eyes?(Required)

Have difficulty locating the appropriate aisle in a store?(Required)

Auditory and Language Processing

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

Seem overly sensitive to sounds?(Required)

Become distracted by lots of noise?(Required)

Become distracted by background noises such as refrigerators?(Required)

Avoid going places that may be too loud?(Required)

Feel angry when there is too much noise?(Required)

Become bothered by the hum of a fan or light?(Required)

Attend to intruding noises like mowers, planes going overhead or sirens more than most people?(Required)

Have difficulty understanding the words to a song when listening to music?(Required)

Have difficulty attending to a conversation when there is background noise?(Required)

Seem to have trouble remembering or understanding what is said?(Required)

Have trouble finding the language to express what you want?(Required)

Have trouble following two or three verbal directions given at once?(Required)

Movement (Vestibular Processing)

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

Avoid fast carnival rides that spin or go up and down?(Required)

Avoid roller coasters?(Required)

Dislike flying in airplanes?(Required)

Become carsick easily?(Required)

Become upset when head is tilted backwards (e.g., as in hair washing or showering)?(Required)

Have difficulty if not in the front seat while riding in a car?(Required)

Seek fast movement activities (e.g., biking, skiing, carnival rides)?(Required)

Dislike roughhousing?(Required)

Rock in your seat?(Required)

Enjoy jumping a lot?(Required)

Shake/rock/bang your head?(Required)

Seem fearful of heights?(Required)

Dislike elevators or escalators?(Required)

Hesitate or avoid climbing ladders?(Required)

Seem fearful of catching balls?(Required)

Hesitate going up or down stairs?(Required)

Have difficulty riding a bike?(Required)

Have difficulty merging while driving onto a freeway?(Required)

Have difficulties with balance?(Required)

Fall when on a bus, car or subway that stops quickly?(Required)

Have difficulty driving a car?(Required)

Dislike having your eyes covered?(Required)

Experience things as moving which are not moving?(Required)

Have difficulty traveling through a tunnel without feeling uncomfortable?(Required)

Have difficulty finding a seat in a dark movie theater?(Required)

Get disoriented in space easily?(Required)

Have trouble discriminating fast and slow motion?(Required)

Have difficulty when crossing over bridges?(Required)

Taste and Smell

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

React negatively or seem overly sensitive to odors (e.g., perfume, foods, cleaners)?(Required)

React negatively to the taste of foods?(Required)

React negatively to the texture of foods?(Required)

Find it uncomfortable to eat at restaurants because of food or smells?(Required)

Have more difficulty eating textured than smooth foods?(Required)

Have difficulty eating smooth foods with a few lumps (e.g., soup)?(Required)

Lick, suck or chew on non-food items (e.g., hair, pencils)?(Required)

Tend to explore with smells, or deliberately smell objects?(Required)

Like drinks/food that are only room temperature, not hot or cold?(Required)

Feel as though all foods taste the same?(Required)

Seek out crunchy or chewy foods?(Required)

Touch (Tactile Processing)

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

Become irritated by tags in the back of your shirts?(Required)

Become bothered by clothing or socks?(Required)

Avoid getting your hands into messy things?(Required)

Tend to be more sensitive to pain than others?(Required)

Become especially bothered by small cuts?(Required)

Notice irritating bumps on your bed sheets?(Required)

Over or under dress for the temperature?(Required)

Seem overly sensitive to food or water temperature?(Required)

Crave being held or cuddled?(Required)

Prefer tight exercise-type clothing?(Required)

Seem excessively ticklish?(Required)

Prefer to touch rather than be touched?(Required)

Dislike light touch in intimate relationships?(Required)

Become very angry/annoyed when bumped or pushed unexpectedly?(Required)

Dislike having your arms or back stroked?(Required)

Become bothered by people sitting/standing too close to you?(Required)

Dislike haircutting or shampooing?(Required)

Dislike fingernail or toenail cutting?(Required)

Have difficulty petting animals due to feeling of fur?(Required)

Tend to prefer long sleeves and pants regardless of weather?(Required)

Dislike water running onto your face in the shower?(Required)

Dislike going barefoot?(Required)

Strongly dislike showers?(Required)

Become extremely irritated when splashed with water?(Required)

Dislike shaving?(Required)

Mouth objects or clothing frequently?(Required)

Tend not to feel pain as much as others?(Required)

Seem oblivious to bruises and heavy falls?(Required)

Tend to examine objects by touching them thoroughly with your hands?(Required)

Have difficulty finding objects in your pockets or purse without looking?(Required)

Have difficulty applying shaving cream thoroughly to your face or legs?(Required)

Have difficulty recognizing food stuck on your face or the need to blow your nose?(Required)

Need to have coarse textures next to your skin?(Required)

Proprioception

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

Tend to bump into things?(Required)

Over or underestimate amount of force needed for a task?(Required)

Seem shaky when doing fine motor tasks?(Required)

Tend to grasp objects very tightly?(Required)

Tend to break many objects?(Required)

Tend to drop things easily?(Required)

Tend to eat in a sloppy manner?(Required)

Tend to spill liquids?(Required)

Have trouble chewing?(Required)

Think of yourself as clumsy?(Required)

Postural Control

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

Tend to move in and out of your chair while eating or doing work?(Required)

Prefer to stand while working?(Required)

Find physical activity organizing when overloaded or irritated?(Required)

Grimace or move tongue while doing fine motor tasks?(Required)

Tire easily with physical activity?(Required)

Slump while sitting?(Required)

Keep your mouth open?(Required)

Chew with your mouth open?(Required)

Hold a pencil differently than most people?(Required)

Experience fatigue in your hand with writing?(Required)

Tend to be slow in eating?(Required)

Motor Coordination (Praxis Skills)

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

Find small manipulative activities difficult?(Required)

Avoid fine motor activities?(Required)

Have difficulty following the steps of a recipe?(Required)

Take a long time to do most motor tasks?(Required)

Have difficulty planning a dinner, including setting the table, organizing timing of meals, etc.?(Required)

Tend to be slow in dressing?(Required)

Misunderstand meaning of words in relation to movement or body position (e.g., up, down, behind)?(Required)

Have difficulty with motor tasks that have several steps?(Required)

Dislike participating in sports or games?(Required)

Have difficulty learning exercise steps or routines?(Required)

Have difficulty reproducing a rhythm with your hands?(Required)

Lose track of the sequence of an activity?(Required)

Social/Emotional

Please answer how often you do the following with the following scale in mind: 5 = You almost Always respond this way (e.g., more than 95% of the time) 4 = You Often respond this way (e.g., about 70 - 95% of the time) 3 = You Sometimes respond this way (e.g., about 30 - 69% of the time) 2 = You Rarely respond this way (e.g., about 5 - 29% of the time) 1 = You Never respond this way (e.g., less than 5% of the time)

How often do you do the following?

Tend to prefer to be alone?(Required)

Have a strong desire for sameness and routine?(Required)

Seem sensitive to criticism?(Required)

Lack self-confidence?(Required)

Tend to be quiet and withdrawn?(Required)

Feel discouraged or depressed?(Required)

Tend to crave attention?(Required)

Have strong outbursts of anger?(Required)

Have trouble getting along with others?(Required)

Tend to be active and aggressive?(Required)

Tend to lack carefulness?(Required)

Tend to be impulsive?(Required)

Tend to be easily frustrated?(Required)

Have difficulty separating from parents or other loved ones?(Required)

Have fears of leaving your home on a daily basis?(Required)

Have panic attacks?(Required)

Have anxiety attacks?(Required)

Treatment Perceptions

Please answer each statement based on how accurate they are for you.

The practitioner was knowledgeable on misophonia(Required)

Before seeking treatment my misophonia was impacting my life regularly(Required)

Misophonia symptoms did not go away at all(Required)

Misophonia symptoms went away for longer than 30 days after treatment(Required)

Misophonia symptoms went away for longer than 90 days after treatment(Required)

Misophonia symptoms went away for longer than 6 months after treatment(Required)

Misophonia symptoms went away for longer than 1 year after treatment(Required)

Misophonia symptoms went away and did not come back(Required)

Treatment Follow Up

Please answer the following questions in a yes or no format.

The treatment provider contacted me 30 days after treatment to see if positive results continued(Required)

Not Applicable	No	Yes

The treatment provider contacted me 90 days after treatment to see if positive results continued(Required)

Not Applicable	No	Yes

The treatment provider contacted me 6 months after treatment to see if positive results continued(Required)

Not Applicable	No	Yes

The treatment provider contacted me 1 year after treatment to see if positive results continued(Required)

Not Applicable	No	Yes

The treatment provider did not contact me to see if results continued(Required)

Not Applicable	No	Yes

If the treatment did not work, did you report this to the practitioner?(Required)

Not Applicable	No	Yes

If treatment did not work, and you did not report this to the practitioner, were any of the following reasons why?(Required)

I did not want to be rude

I felt pressured into saying it worked

I did not want to hurt their feelings

I did not know how to contact them

I thought I was the problem, not the treatment

I was too anxious to reach out

I felt the pracitioner tried their best, even though it didn't work

Not Applicable

Other

If treatment did not work, and you did not report this to the practitioner, could you explain in more detail why?(Required)

If treatment did not work, and you did report this to the practitioner, how did they react? Were they receptive?(Required)

Study Submission and Consent

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