Listening to People with Misophonia: Exploring the Multiple Dimensions of Sound Intolerance Using a New Psychometric Tool, the S-Five, in a Large Sample of Individuals Identifying with the Condition

Round 1

Reviewer 1 Report

The manuscript is brilliantly written. The research described in it was carried out in an exemplary manner. Therefore, I do not have any remarks. I believe that the text as such is suitable for publishing.

Author Response

The manuscript is brilliantly written. The research described in it was carried out in an exemplary manner. Therefore, I do not have any remarks. I believe that the text as such is suitable for publishing.

We thank the reviewer for their kind words. They truly mean a lot to our team.

Reviewer 2 Report

In this paper the authors present and psychometrically evaluate a new, multidimensional measure of misophonia, the S-Five.

Section 1 must be improved. The introductory part is fine even if you need to change the format of the citations. You must work on the final part in which you introduce your work, try to explain systematically where your work differs from the ones you mentioned. You must properly introduce your work, specify well what were the goals you set yourself and how you approached the problem. At the end of the section, add an outline of the rest of the paper, in this way the reader will be introduced to the content of the following sections.

Section 2 must be improved. You need to describe the methodologies used in more detail. Starting from the elaboration of the items, did you follow the methodologies indicated by the standards? Furthermore, you must adequately introduce the indices used for the evaluation of the performance of your method (measures of goodness of fit) and for the validation of the model. Also, in this section you should explain in detail the whole procedure of your S-Five method. Add a diagram to visually clarify the flow of actions.

Section 3 must be improved. In this section you will find the results of your search. You should present them more effectively. First of all, it improves figures 3 and 4, as they are illegible. ou have many tables with a lot of data, try to organize them better. You also often use the item codes, but in this way it is difficult for the reader to follow the flow of information. Finally, but essential, it shows how your test works which as you said is a measure of misophonia. How the measure? Give an example.

Section 4 must be improved. This section is very long, I would divide it into two: Discussions, Conclusions. In the first you discuss your methodology, then in the conclusions you summarize your work highlighting the improvements made compared to the methods already present, and indicating the weaknesses. Paragraphs are missing where the possible practical applications of the results of this study are reported. What these results can serve the people, it is necessary to insert possible uses of this study that justify their publication. They also lack the possible future goals of this work. Do the authors plan to continue their research on this topic?

Reference list must be improved. Use a correct format (APA, MLA, Chiacago, Harvard etc)

35)” Potgieter, MacDonald [9]” Use the following format for citations: Potgieter et al. [9]. In the reference use the following format: Potgieter, I., MacDonald, C., Partridge, L., Cima, R., Sheldrake, J., & Hoare, D. J. (2019). Misophonia: A scoping review of research. Journal of clinical psychology, 75(7), 1203-1218.

Use these format for all the citations and references.

I have seen that you often use this abbreviation, so I will not repeat this advice again, it also applies to the other occurrences.

41) [MQ; 6] ? Check this citation . Change in Misophonia Questionnaire (MQ) [6]. I have seen that you often use this format, so I will not repeat this advice again, it also applies to the other occurrences.

52) Do not use abbreviation such as e.g. I have seen that you often use this abbreviation, so I will not repeat this advice again, it also applies to the other occurrences.

114) “7-point scale” Add a scale example. Add references to allow readers to learn more about the topic.

119) Improve the Figure 1 Caption. The reader should be able to read the figure without the need to retrieve the information in the paper. Try to summarize the essential parts of the Figure and what you want to explain with it. Specify the terms.

111-161) In this subsection you introduce the items of the questionnaire. It is a listening test. Did you use the rules for the elaboration of the questionnaire? There are specifics to be respected in order to properly process the questions to be included in a questionnaire.

254-255) How were the audiometric abilities of the participants assessed? Have they undergone an audiometric test? This is an essential condition for validating your research.

408) Figure 3 needs to be improved, so nothing can be read. you have to think of another way to present these results.

417) Figure 4 needs to be improved, so nothing can be read. you have to think of another way to present these results.

Author Response

We would like to thank the reviewer for their comments and advice as we truly believe they have significantly improved the manuscript. We hope that we have sufficiently responded to all comments and have followed the reviewer’s advice.

In this paper the authors present and psychometrically evaluate a new, multidimensional measure of misophonia, the S-Five.

Section 1 must be improved. The introductory part is fine even if you need to change the format of the citations. You must work on the final part in which you introduce your work, try to explain systematically where your work differs from the ones you mentioned. You must properly introduce your work, specify well what were the goals you set yourself and how you approached the problem. At the end of the section, add an outline of the rest of the paper, in this way the reader will be introduced to the content of the following sections.

 All citations have been now checked and corrected.

We updated the introduction by adding:

The most recent misophonia scale published is the Duke Misophonia Questionnaire (DMQ). This is a comprehensive 86-item tool comprise of 9 standalone scales (Trigger frequency, Affective Responses, Physiological Responses, Cognitive Responses, Coping Before, Coping During, Coping After, Impairment and Beliefs). These scales were designed and tested as separate scales, and then combined to form two composite scales, the Symptom Scale (combining the three “responses” subscales) and the Coping Scale (combining the three coping subscales).

These two recently published measures, MisoQuest and DMQ, offer improvements on the pre-existing scales, most of which were limited in scope and not fully validated. The DMQ is the most extensive tool published to date, with two composite scales capturing many of the components identified in the recently published “consensus definition” of misophonia (for pre-print, see[12]. At this stage, there are no published scales that have been developed using multidimensional reflective latent variables models with the purpose of identifying the dimensions of misophonia. The present study aimed to develop a short and straightforward tool that would be able to provide reliable and valid measurement of misophonia, capturing the rich and varied experience of the phenomenon. The theoretical background for the item development is described below

We re-wrote the last paragraph of the introduction to address the comment (track changes were used in the main manuscript):

The aim of the present study was to develop and test a self-reported measurement tool that would capture the multidimensional nature of misophonia. We had four main goals.

1. To develop a tool that would be multidimensional, identifying and measuring the complex nature of the misophonic experience.
2. To make the tool brief enough to use routinely for evaluations in both research and clinical practice
3. To ensure excellent psychometric properties, including being unbiased with respect to gender and age of the respondent.
4. To create a supplementary scale to quantify the burden of triggers, capturing the nature of reactions, number of triggers, intensity of the reaction and the synergy of number and intensity. We aimed to do this with a flexible format to allow researchers and clinicians to add or remove sounds.

To address the final comment, we added a description of the paper in a brief format. We thank the reviewer for suggesting this as we too think it greatly improves the flow of the manuscript.

In this article, we describe the methodological steps taken, and reveal the psychometric value of the final tool. We present first the steps taken in the development of the items content and the three different waves of sampling and item refinement. We then explore the dimensionality of the final tool, and within each dimension we provide evidence of the reliability and the validity of the measurement. We then describe in detail the triggers checklist and the construction of its summary scores.

1. Section 2 must be improved. You need to describe the methodologies used in more detail. Starting from the elaboration of the items, did you follow the methodologies indicated by the standards? Furthermore, you must adequately introduce the indices used for the evaluation of the performance of your method (measures of goodness of fit) and for the validation of the model. Also, in this section you should explain in detail the whole procedure of your S-Five method. Add a diagram to visually clarify the flow of actions.

The development of the scale is in line with the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN; Mokkink et al., 2010; De Vet et al., 2011) and the scale was evaluated using the Contemporary Psychometrics Checklist (ConPsy; Khadjesari et al., 2020). COSMIN provides guidance of general standards for developing and evaluating measurement tools, and specific standards for each of the measurement properties, such as structural validity, content validity, criterion validity among others. We thank the reviewer for pointing out that we need to inform the readers about the guidelines we followed. We added in Material and Methods section:

For the development of the scale and for establishing the analysis plan we followed the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN; Mokkink et al., 2010; De Vet et al., 2011) and the Contemporary Psychometrics Checklist (ConPsy; Khadjesari et al., 2020) recommendations.

We have now replaced the diagram in Figure 1, with a much more detailed on which presents all stages and analysis done at each wave. The measures of fit used are presented in Methods, paragraph 2.4 onwards.

2. Section 3 must be improved. In this section you will find the results of your search. You should present them more effectively. First of all, it improves figures 3 and 4, as they are illegible. You have many tables with a lot of data, try to organize them better. You also often use the item codes, but in this way it is difficult for the reader to follow the flow of information. Finally, but essential, it shows how your test works which as you said is a measure of misophonia. How the measure? Give an example.

We have now tried to improve all tables and Figures, as per the reviewer’s recommendations. In particular:

• The tables have now the same format and explanations for abbreviations have been added to the end of each table.
• We deleted Figure 4, as the information provided was also available in Table 4. However, we kept Figure 3 as we would need several tables to demonstrate the same results. We did however improve it and made sure that now has higher resolution that makes reading the plot easier. We hope that the reviewer will agree with us.
• We removed the codes and used the short versions of the item statements to make it easier to the reader. The full statements are presented in the Appendix.

3. Section 4 must be improved. This section is very long, I would divide it into two: Discussions, Conclusions. In the first you discuss your methodology, then in the conclusions you summarize your work highlighting the improvements made compared to the methods already present, and indicating the weaknesses. Paragraphs are missing where the possible practical applications of the results of this study are reported. What these results can serve the people, it is necessary to insert possible uses of this study that justify their publication. They also lack the possible future goals of this work. Do the authors plan to continue their research on this topic?

We thank the reviewer for their comment which prompted us to substantially improve the discussion:

• We split our discussion into sections with subheadings
• we added information about our future work within the limitations section, and
• added practical applications to our concluding remarks

4. Reference list must be improved. Use a correct format (APA, MLA, Chiacago, Harvard etc)

• 35)” Potgieter, MacDonald [9]” Use the following format for citations: Potgieter et al. [9]. In the reference use the following format: Potgieter, I., MacDonald, C., Partridge, L., Cima, R., Sheldrake, J., & Hoare, D. J. (2019). Misophonia: A scoping review of research. Journal of clinical psychology, 75(7), 1203-1218.
• 41) [MQ; 6] ? Check this citation . Change in Misophonia Questionnaire (MQ) [6]. I have seen that you often use this format, so I will not repeat this advice again, it also applies to the other occurrences.

Thank you for pointing out these errors. Corrected throughout the manuscript.

5. Minor comments

• 52) Do not use abbreviation such as e.g. I have seen that you often use this abbreviation, so I will not repeat this advice again, it also applies to the other occurrences.

Abbreviations such as e.g. and i.e. have been replaced throughout the document.

• 114) “7-point scale” Add a scale example. Add references to allow readers to learn more about the topic.

The rating scale has been added as follows:

These items, measured on a 7-point scale (from 1 - Not at all true to 7 - Completely true), were administered to 853 individuals, who were invited to provide detailed feedback.

This is the first paper to be published referring to the different waves of the S-Five study, so no other reference exists to use. We have however now replaced the flow chart with a new one, more detailed and improved, to ensure that the stages of the development are properly highlighted.

• 119) Improve the Figure 1 Caption. The reader should be able to read the figure without the need to retrieve the information in the paper. Try to summarize the essential parts of the Figure and what you want to explain with it. Specify the terms.

Corrected to

Figure 1. Flow chart of the process and methodology of developing the scale of four waves of data collection

• 111-161) In this subsection you introduce the items of the questionnaire. It is a listening test. Did you use the rules for the elaboration of the questionnaire? There are specifics to be respected in order to properly process the questions to be included in a questionnaire.

The S-Five is a self-reported measure relying on people’s memory of the distress they experience due to sounds. During this study, the participants were not exposed to sounds. For the statements section and the triggers section we followed the COSMIN guidelines (please see also comment 2).

• 254-255) How were the audiometric abilities of the participants assessed? Have they undergone an audiometric test? This is an essential condition for validating your research.

Participants did not undergo audiometric tests; audiometry testing was conducted in a previous study by Jager et al (2020) and found no remarkable results and was discontinued so as not to add unnecessary testing. We agree that this would be a good focus for future discriminant validity studies and have included that in our discussion as a future focus.

Added to Limitations:

We did not complete audiometry testing in our participants. This may be useful to include in future studies for discriminative validity, although one large misophonia study [12] initially used this procedure and after finding no meaningful results, they discontinued the procedure to minimise burden on patients

 408) Figure 3 needs to be improved, so nothing can be read. you have to think of another way to present these results.

• 417) Figure 4 needs to be improved, so nothing can be read. you have to think of another way to present these results.

We deleted Figure 4, as the information provided was also available in Table 4. However, we kept Figure 3 as we would need several tables to demonstrate the same results. We did however improve it and made sure that now has higher resolution that makes reading the plot easier. We hope that the reviewer will agree with us.

Reviewer 3 Report

Thanks for recommending me as a reviewer. The aim of this paper was to present and psychometrically evaluate a new, multidimensional measure of misophonia, the S-Five. If authors complete minor revisions, the quality of the study will be further improved.

1. The introduction section is well written. If the authors describe the theoretical background of Misophonia more specifically in the introduction section, it can help readers understand.

2. In the Methods section, the author well described the subjects of the study, sampling, and methods (ex. factor analysis).

3. The resolution in Figure 3 is too low.

Author Response

Thanks for recommending me as a reviewer. The aim of this paper was to present and psychometrically evaluate a new, multidimensional measure of misophonia, the S-Five. If authors complete minor revisions, the quality of the study will be further improved.

 We thank the reviewer for their supporting comments.

1. The introduction section is well written. If the authors describe the theoretical background of Misophonia more specifically in the introduction section, it can help readers understand.

We have now review and improved both the introduction and discussion section and we hope that the reviewer will agree with us that the new version sufficiently informs the reader on the theoretical background of misophonia and current research findings.

2. In the Methods section, the author well described the subjects of the study, sampling, and methods (ex. factor analysis).

We thank the reviewer for their kind words.

3. The resolution in Figure 3 is too low.

We have addressed the Figure 3 issue by providing an image with higher resolution.

Round 2

Reviewer 2 Report

The authors addressed all the reviewer's comments with sufficient attention and modified the paper consistently with the suggestions provided. The new version of the paper has improved significantly both in the presentation that is now much more accessible even by a reader not expert in the sector, and in the contents that now appear much more incisive.

Minor revision

It remains to arrange the text in Figures 3 and 4. As it is it is not clearly legible, this will create problems in the imaging phase of the paper. In addition, the tables must also be arranged, some of them are arranged on several pages, it would be advisable to have them contained in a single page. If this is not possible, then it will be necessary to repeat the table header on the next page. Finally we need to remove the space that appears before some tables.

Author Response

We thank the reviewer for acknowledging our efforts  and we do agree that under the reviewers' guidance the manuscript has improved a lot. 

We have now ensured that each table spans only through one page and that extra spaces have been removed. Figure 4 has been removed as redundant and Figure 3 is improved in terms of resolution. We will upload the original file, in case this helps with printing.

Kind regards,

The authors team