[pdf-embedder url=”//www.misophoniainternational.com/wp-content/uploads/2017/08/Misophonia-For-Parents-PDF.pdf” title=”Misophonia For Parents PDF”]
You can also download the Misophonia For Parents PDF and easily print it.
Research of misophonia is in the very early stages. Therefore, misophonia sufferers and their loved ones are without definitive answers to many essential questions about the underlying mechanisms of the disorder, and possible treatment. However, the small amount of research on misophonia provides evidence that misophonic sounds bring about changes in the autonomic nervous system. Like the accelerator pedal in a car, misophonic trigger sounds quickly rev up the engine of our flight/fight system. One reason for this may be that when an individual with misophonia is exposed to certain sounds, their brain misinterprets these sounds as being dangerous, harmful or toxic. As a result, within milliseconds and without conscious thought, the sympathetic nervous system is thrown into high arousal. In other words, in response to trigger sounds, the body is readied for “fight/flight,” as hormonal and physiological changes take place. While this neurological and physiological response is meant to protect the body from harm, in misophonia it leads to a cascade of negative emotional, cognitive and behavioral responses. The amygdala is a part of the brain that is involved in mediating the flight/flight response.
Research at the LeDoux Lab at NYU has addressed this reactivity in the amygdala in a rodent sample. In this study, rodents were taught to associate a repetitive sound with an unpleasant stimulus. Although all the animals were exposed to the exact same stimuli, their reactions to the repetitive unpleasant sound was very different. Depending on the intensity of the reactions, they were separated into three groups: (1) typical responders, (2) under responsive, and (3) over responsive. The last group of animals demonstrated the strongest autonomic nervous system reaction in association with the repetitive auditory stimuli. By presenting the sound multiple times, researchers attempted to extinguish its unpleasant value . Results showed that the over responsive rodents (those who showed higher responses after the initial presentation of the sound together with the unpleasant stimulus) did not extinguish the physiological response (fight/flight) induced by the sound, while this response was lost in the other two groups. This suggests that the animals showing extreme reactions could not “un-learn” the association they had stored in memory. Similar to the over-responsive rodents, misophonic individuals show strong reactivity to auditory stimuli. Since the brain works in a similar way in rodents and in humans, it is possible that misophonics are resistant to extinguishing the emotional responses induced by their triggering sounds.
In the LeDoux lab, scientists have also studied a phenomenon often referred to in people as relapse prevention. Relapse is a significant problem in terms of many behavior therapies that attempt to either extinguish a particular response to particular stimuli, and/or make new and more positive associations between stimuli and nervous system responding. Interested in disorders such as Anxiety and Post Traumatic Stress Disorder (PTSD), scientists in the LeDoux lab sought ways to re-associate aversive stimuli and high autonomic nervous system arousal in rodent samples, but without relapse. Through a process called memory re-consolidation, scientists at the LeDoux Lab achieved this in rodents, and we propose to translate this into human research, specific to misophonia.
Memory is consolidated when it is moved from our short-term memory into our long-term memory. Once the memory is encoded it is referred to as a memory trace (or engram).[1] However, contrary to what we may think, recalling memory (or activating a memory trace) is not like watching a recording that replays consistently every time we watch it. Instead, each time we retrieve a memory it alters slightly, as it re-consolidates. In other words, previously consolidated memories are retrieved and then consolidated again. Research on memory re-consolidation has demonstrated that the association between a particular stimuli and high autonomic nervous system arousal can be changed when memory is unstable (at the time of re-consolidation). The result is that while the memory itself is retained, the association between the particular harmful stimulus and the high autonomic arousal is diminished. Using variations of memory re-consolidation based interventions, other researchers have used this for phobias and PTSD.
For misophonia sufferers, this approach may result in the development of new associations between trigger sounds and reduced fight/flight activation in the autonomic nervous system. In order to translate this research into those with misophonia, we propose to conduct a clinical trial at Duke University, in consultation with the LeDoux Lab.
[1] A memory trace is a way to theoretically describe the physical representation of a memory in the brain
Want To Support This Program? Donate Now.
Almost every article about the origin of misophonia begins like this: “Misophonia, which means ‘hatred of sound” was termed by Jastreboff and Jastreboff in 2001.”
After this cursory mention of the Jastreboff’s and their role in naming misophonia, academic authors often jump to their own interpretations about the disorder. This leaves readers wondering why these two esteemed doctors at Emory University thought to conceive of a new disorder in the first place.
In order to comprehend a newly proposed disorder, it is important to understand its history. If we don’t, members of the medical community often regard these disorders as “unreal” because descriptions of them have been haphazardly built out of ambiguous bits of information that ultimately don’t add up to anything grounded in theory. I like to call this process the “dominos of disbelief”. Misophonia is a very real condition that has unfortunately fallen victim to this phenomenon. In order to help put together the puzzle pieces of misophonia, let’s talk about the conception of the disorder, and the doctors who named it.
While working in their audiology clinic, the Jastreboff’s (who happened to be married) observed that some people reacted to sounds, such as chewing, pencil tapping, keyboard typing, and coughing, with high levels of irritability, sometimes to the extent of rage, or disorientation. This group of patients responded to “repetitive” and “pattern based noises.”
Unlike their patients with hyperacusis (a disorder in which individuals feel pain in response to loud sounds), individuals with misophonia appeared to respond to “repetitive” and pattern-based sounds with autonomic arousal. That is, upon presentation of such stimuli, patients reported rising stress levels (such as elevated heart beat, muscle tension and sweating) along with strong negative emotions. This was different from what the Jastreboffs had seen with regard to other forms of “decreased sound tolerance” such as tinnitus (ringing in one or both ears), hyperacusis, and phonophobia (fear of sound often secondary to hyperacusis).
Due to the high cost of research the Jastreboffs did not study their misophonia theory, but ventured to begin treatment at their clinic based on methods previously used for tinnitus and hyperacusis. Since then a small body of academic literature coupled with a great deal of popular press has emerged replete with consistent misunderstandings about the Jastreboff’s original concepts. Lets begin to set the record straight.
Although the Jastreboff’s suggested that misophonia involves negative associations between auditory, cognitive and emotional areas of the brain, they did not view misophonia as a “psychiatric disorder” and certainly not any specific one such as Obsessive Compulsive Disorder (personal communication, 2015). Similarly, the Jastreboff’s ideas about misophonia treatment were based on neuroplasticity (the brains ability to reorganize itself based on making new associations). This treatment has its roots in their tinnitus and hyperacusis retraining therapy. It is not simply “exposure therapy” as it is often described. Unfortunately, both research and treatment has followed some of these misconceptions.
Taking this step back, how should we conceptualize misophonia? I think a judicious way to describe the disorder is as one in which auditory stimuli provokes a neurophysiological response with accompanying negative, emotions, cognitions and behavior. Misophonia should not be referred to as a psychiatric disorder.
How should therapists treat misophonia? Therapists and doctors must be very clear that treatments are all experimental at this point and that efficacy studies will hopefully ensue. Therapists can also help sufferers cope by consulting and communicating with other clinicians across disciplines, and taking the initiative to utilize individualized strategies for each client.
Most of all, therapists and doctors can help by taking the time to learn about this easily misunderstand disorder, and sharing this knowledge with misophonia sufferers. As a psychologist who has misophonia (and who has raised a child with the disorder) I know this: In the case of misophonia knowledge may not be “power” but it can help take some of the “power” out of the disorder.
Originally posted on PsychToday
For more information about misophonia research misophonia-research.com
Is there a relationship between Misophonia and Auditory Processing Disorder?
Studies on misophonia have compared the newly termed disorder to Obsessive Compulsive and Related Disorders, synesthesia, anger management problems, disorders related to impulse control, and hyperacusis to name a few. However, nobody has studied, or mentioned in the literature, the potential overlap of Auditory Processing Disorder and Misophonia.
Back in the 1990’s when I focused on the auditory component of Sensory Over-Responsivity, or SOR, I recall asking the same question.[1] Why wasn’t anyone interested in researching the commonalities between APD and Auditory over-responsivity?
I have a long history of bringing together scientists and clinicians in order to work across-disciplines. I’ve had conferences and have developed networks for this very purpose. By the 1990’s occupational therapists, developmental pediatricians and speech/language therapists formed cross-disciplinary groups most especially related to disorders such as SPD, autism, ADHD and more. Neuroscientists, psychologists and psychiatrists were well on their way to forming working alliances both in regard to research and clinical innovation for disorders such as anxiety, phobias and even with regard to general stress.
Even the Dalai Lama and neuroscientists were sharing ideas at conferences about the benefits of meditation.
Sixteen years into the new millennium we finally see research in misophonia accelerating after it was termed in 2001 by Pawel and Margaret Jastreboff. However, the small body of misophonia research focuses more on that which is psychiatric. It’s easy to say that this is due to a lack of cross-disciplinary research. Yet, even amongst audiology research I cannot find one study that considers a connection between ADP and Misophonia. Lets compare APD and Misophonia for a moment:
“There is no clearly agreed-upon definition of APD. However, Auditory Processing Disorder (APD) is a neurological defect that affects how the brain processes spoken language. This makes it difficult for the individual to process verbal instructions or even to filter out background noises” (NCAPD)
There is no clear agreement regarding the definition of Misophonia. However, the consensus is that Misophonia is considered a neurological/auditory disorder in which the brain misinterprets auditory stimuli. Auditory stimuli are often pattern based, repetitive and may or may not emanate from other people.
Individuals with Auditory Processing Disorder can often have the same types of behavioral problems as individuals with ADD.
Individuals with Misophonia often have difficulty paying attention and/or experience autonomic nervous system arousal when exposed to certain sounds.
“There are four components to APD. These include difficulty with auditory discrimination(the ability to distinguish between different sounds), Figure-to-Ground Discrimination (the i ability to differentiate important sounds from background noise), Auditory Memory (which includes the ability to remember things we hear, in both the short-term and the long-term), and Auditory Sequencing ( the ability to understand and recall the order of sounds).” (Miller, nd)
Individuals with APD do not typically report the autonomic nervous system arousal (or the fight/flight reaction associated with anger and rage) in association with sounds in Misophonia. However, there are theoretical overlaps particularly within the area of “Figure-to-Ground Discrimination”.
Most of the trigger sounds reported by individuals with Misophonia are sounds that would not be noticed by other people. Successful figure-to-ground discrimination is sometimes referred to as the “cocktail party effect”. One automatically processes auditory stimuli so that important information is attended to, while the rest is “filtered” to the background. Typical trigger noises, such as chewing, coughing, pencil tapping, could easily be viewed as noises that many people filter to the “background” in favor of speech, or something else relatively salient. This is a process that should be effortless and automatic.
We don’t have a valid or reliable test for misophonia yet. However, audiologists do have reliable and valid tests for APD. Studying if people with misophonia have this component of APD may help to better inform understanding of the underlying mechanisms of Misophonia, which would also help develop treatment. This potential connection may also help to classify different types of Misophonia, which would also help delineate possible therapies, or different therapeutic strategies. Finally, since ADP is often diagnosed in children it would be prudent to look for this as a possible risk factor in developing Misophonia.
[1] SOR is a subtype of Sensory Processing Disorder in which individuals react with autonomic nervous system arousal in one or more sensory modalities)
LeDoux Lab Findings (January 2017)
One of the working theories related to mechanisms underlying misophonia is that auditory stimuli may be misinterpreted by the brain as dangerous, or threatening. As such, the brain responds as it would if it were actually in danger. When we are in danger, our freeze/fight/flight system[i] is set off. When this happens, our autonomic (involuntary nervous system) is activated, or aroused.
When our involuntary nervous system is aroused physiological and other hormonal changes occur (e.g. blood is redistributed throughout our bodies, the heart rate raises, etc. ) to enable us to “flee” from the apparent danger or “fight” if we must.
This is a system that all mammals have that has been conserved by evolution.[ii] The feelings we have as a result of the fight/flight system being activated are associated with “wanting to get away from the offending stimuli (sound, or visual), or irritation, anger or rage. In other words, the irritation, anger and rage that we feel when faced with sounds that are noxious likely manifest from the physiologic fight/flight response. It is difficult to separate our physiological feelings from our emotions, which is why looking at the areas of the brain that react to sound and other stimuli is important.
The fight/flight response is mediated by a part of the brain called the amygdala. At the LeDoux lab at NYU Joseph LeDoux and his colleagues have been studying the amygdala for decades. They have done groundbreaking work in this part of the brain that mediates fight/flight, and is also involved in neural processes related to memory related to fear.
The amygdala is also involved with memory. In terms of misophonia, regardless of whether or not one is born with the disorder individuals make memories in which the body’s fight/flight response is associated with particular sounds. In addition, some of us may be born with a higher arousal system, or may simply be more sensitive to auditory stimuli. Therefore, some of us may be more vulnerable to forming these memories.
Once these memories are formed, they are similar to trauma memories (yet they are not like trauma memories as there is no associated traumatic event). However, prior research suggests that auditory stimuli (or misophonic sounds) will automatically activate the autonomic nervous system and fight/flight, leaving people with misophonia feeling angry or trapped by sounds or other stimuli for no apparent reason.
In an analysis of the auditory stimuli that are most noxious to people with misophonia, I noted that repetitious stimuli is a common characteristic.
Normally, in order to test how these memory associations are made, the rodent sample used is tested in a typical learning paradigm. That is, the rodent is “taught” to associate a sound with an unpleasant stimulus. Then the situation is reversed, and the rodent eventually unlearns this response (or extinguishes).
Dr. LeDoux has been working on the ability to reverse these associated memories for many years. He has done so in the realm of “basic science”. Basic neuroscience strives to look at specific brain processes that may then inform typical and atypical populations and therefore numerous disorders.
Because typical exposure therapy and therapies that have relied upon re-associating stimuli with events or other stimuli generally do not show results that are long lasting for disorders such as PTSD, or even phobias, LeDoux has looked for other ways in the brain to change the association between the automatically activated threat response once it has been associated with a particular stimuli. This is a process called memory re-consolidation.
Believe it or not, each time we retrieve a memory from our long term memory system it alters
Joseph E. LeDoux
slightly. This is something LeDoux’s lab discovered early in the millennium. This is contrary to prior ideas about memory in which scientists thought that once a memory was formed it was stable and always retrieved as the exact same memory.
Using memory reconsolidating LeDoux and colleagues have already proven that the automatic physiological response to a stimuli (or a memory in regard to sound in misophonia) can be changed in simple ways. Whereas most behavior therapists rely on exposure to aversive stimuli in order to desensitize people to trauma (in this case a noise, pattern of sound, or repeating noise) or to relearn an association between a sound and a particular person, etc. they are often unable to obtain results, and if they do obtain results, they don’t last. This is because of memory.
However, in LeDoux’s lab this problem with memory was solved many years ago using subconscious ways to change the way memory was reconsolidated. I believe, and have since I first learned of this work, that this is a therapy that is most promising for misophonia.
Lorenzo Diaz-Mataix
In our study at NYU at the LeDoux Lab, Dr. LeDoux and Dr. Lorenzo Díaz-Mataix are studying two parts of the amygdala in order to see where the problem may arise in regard to auditory over-responsivity, or misophonia.
The lateral amygdala is the part of the brain structure where the auditory (or other sensory information) comes in and the central amygdala is the part where signals are sent that send the message “go or no go” for fight flight. One of the roles of central amygdala is to mediate valence (positive or negative assignment) to sensory information.
Although the brain works in an interconnected and highly complicated manner, and there are other candidate brain regions for misophonia. Since, we know that autonomic (involuntary) nervous system arousal is involved in the disorder, we know that the amygdala is certainly a region we should be looking at.
In this study Dr. Díaz-Mataix separated out rodents by the level of their over-responsivity to repetitive stimuli. The rodents naturally fell into groups of extreme high responders, high responders, typical responders and low-responders. That means, that even in rodents there seems to be a range from extreme sensitivity to low sensitivity to repetitive auditory stimuli (just as there seems to be with people). People with misophonia would be like the extreme over-responder rodents.
Results show that extreme-responders are least likely to “un-learn” the association between noxious stimuli and the physiological response (or fight/flight). However, this is a scientific experiment helps supports:
- This the misophonia symptoms are truly due to physiological phenomena (i.e. if you can see it rodents who don’t “think” as we do, then we have more evidence that this is not a “psychological problem”
- If “extreme-responders” are similar to those of us with misophonia and are unable to “unlearn” an associated response between stimuli and an event ,than simple exposure therapy is highly unlikely to work
- Given this information, memory reconsolidation, which is working for people with phobias in new trials, may be a promising remediation for misophonia symptoms
The illustration below is a poster from a neuroscience conference that demonstrates the first part of our study. The IMRN hopes to continue to support this work if more funding becomes available. We would very much like to see memory reconsolidation therapy for misophonia trialed.
Diaz-MataixLeDoux_ACNP2016_Poster_LAST
(Please download poster as it is rather large, and will not fit on web page).
[i] The physiologic response we often refer to as fight/flight follows a particular sequence that includes freezing (which comes first). However, we often freeze so quickly that it is unnoticeable to the human eye and/or we are not conscious of our self in this modality.
[ii] LeDoux (2015) Anxious: Using the Brain to Understand and Treat Fear and Anxiety. Penguin Random House. New York.
Newer Posts