The mixed-methods case study of "Zara"

Abstract

This single-subject, mixed-method, behavioral analytic case-study dissertation presents a systematic, 12-session cognitive behavior therapy (CBT) treatment of “Zara,” an undergraduate student with severe misophonia. Misophonia is a rare condition characterized by an aversive response of sympathetic nervous system (SNS) activation and negative emotions (e.g. anger, disgust, and/or anxiety) elicited by the presence of specific and commonly encountered sounds (e.g. lip-smacking, chewing). Distress caused by trigger sounds and efforts to avoid and escape from these sounds often result in impairment in functioning. The goals of this case study are to (1) detail the assessment process used; (2) document and analyze the successful implementation of the CBT intervention; and (3) evaluate hypotheses regarding the mechanisms of change. The intervention utilized an A-B research design with a six-month follow-up. The independent variable consisted of a multi-component treatment that included skills training in cognitive restructuring, mindfulness and exposure procedures. The treatment was designed to reinforce adaptive and appropriate coping responses and extinguish the aversive respondent conditioned responses and the negatively reinforced inappropriate coping responses. The dependent variables included both behavioral outcomes (e.g. inappropriate coping behaviors, avoidance, and social interference) and subjective report outcomes (e.g. sensitivity to sounds, distress, and reported SNS…