Toward an Empirically and Theoretically Anchored Biopsychosocial Model of Misophonia: Sensory Sensitivity and the Extended Process Model of Emotion Regulation

Misophonia is a disorder marked by intense affective, behavioural and physiological responses to repetitive auditory stimuli made by others, commonly oral and/or facial sounds (e.g., chewing and throat-clearing) and associated cues. Research on misophonia has increased rapidly, with studies indicating it is characterized by significant psychological distress, impairment in everyday functioning and biopsychosocial processes related to impairments in sensory sensitivity (SS) and emotion regulation (ER). Using the extended process model (EPM) of ER, we outline how misophonia-related dysfunction may unfold across three recursive stages (identification, selection and implementation), with SS conceptualized as an early-stage vulnerability. From this model, we introduce process-based therapy for misophonia (PBT-M) as a pragmatic framework for person-level interventions, with the BASIC acronym (behavioural, attentional, somatic, interpersonal and cognitive) providing a flexible scaffold for selecting domain-specific treatment strategies. Through conceptual schematics and applied case illustrations, we demonstrate how SS- and ER-informed EPM mapping can enhance intervention precision and support idiographic treatment planning. We also present a modular treatment roadmap to support real-world application. This model is testable and intended to evolve with the scientific literature, offering clinicians an empirically and theoretically grounded framework for targeting the idiographic biopsychosocial processes contributing most to impairment in individuals with misophonia.