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Dr. Jennifer Brout

Dr. Jennifer Brout

Jennifer Jo Brout is a New York State Certified School Psychologist, a Connecticut Professional Licensed Counselor, and she also holds a Doctorate in School/Clinical-Child Psychology. She graduated from New York University, Columbia University, and Ferkauf School of Psychology (at Albert Einstein School of Medicine) respectively. She is also the mother of adult triplets, and is a Misophonia sufferer herself. Disappointed by her own experiences with the state of the field when seeking help for her own child in 1999, Dr. Brout began efforts to establish better research practice, improved diagnosis, and innovative clinical practice related to Misophonia (under the name “auditory over-resposivity). Dr. Brout has been at the forefront of research in this area for over 18 years, having established the Sensation and Emotion Network (SENetwork) in 2007, along with Sensory Processing and Emotion Regulation Program at Duke University in 2008.

Introducing the Duke Center for Misophonia and Emotion Regulation
ResearchResearch Interview

Introducing the Duke Center for Misophonia and Emotion Regulation

written by Dr. Jennifer Brout

Hi there, Dr. Rosenthal! I am thrilled to hear that the Duke Center for Misophonia and Emotion Regulation is officially established. Would you tell me a little bit about how the center is set up?

Hi, Jen! Happy to. The Center is set up to advance research, education, and clinical services for adults with Misophonia. An anonymous and generous family that wants to do help rapidly accelerate knowledge about misophonia recently funded us. It is an incredible honor. And we have a lot of work to do!

The Center includes a post-doctoral researcher, three doctoral students, several faculty researchers, an administrative and regulatory lead, and a growing number of undergraduate research assistants. These staff members are involved in all aspects of our center, and each contributes unique expertise to the work we do.

Would you tell me about the overall goals of the Center in terms of research?

Sure. We want the science we do to have an impact on people who are suffering. Aligned with the Milken Institute report on Misophonia, our first goal is to study the phenotype of Misophonia. This means that we will be doing studies that carefully examine correlates and possible causes of Misophonia in order to better understand what it is, what it isn’t, and where we should then be looking for the most effective treatments.

Our first study is designed to develop and validate a measure that has strong psychometric properties and can be used by researchers to study Misophonia. Our second study will use structured psychiatric diagnostic interviews, a laboratory study, and a prospective study using mobile phones to investigate Misophonia and related difficulties with emotion regulation. And, most recently, our Center researcher Dr. Andrada Neacsiu was funded by the REAM Foundation to use neuroimaging and neuromodulation techniques in an effort to look for candidate neural targets for treatment in Misophonia. We also have begun early collaborative work with colleagues to explore possible genetic underpinnings of Misophonia, and are actively building other collaborations with really smart and motivated scientists.

I understand that the Center is multidisciplinary in nature. Would you describe the various kinds of researchers involved, and how each field may contribute to a better understanding of this disorder?

We think that Misophonia is inherently a multi-disciplinary problem. It involves how we hear things, how our brains process information, what we do with that information, and the emotions we experience. As a result, it needs to be both studied and treated using a multi-disciplinary approach.

We are clinical psychologists, and so we have our own natural biases and blind spots. We tend to focus on emotions and how people manage the experience of strong emotions. Given this emphasis, we are intentional in setting up the Center in a way that enables research, education, and clinical services with disciplines outside clinical psychology. For example, we have collaborators in areas such as auditory and cognitive neuroscience, translational genetic epidemiology, neuropsychology, and audiology. Each field brings unique and important perspectives that collectively should yield better insights than any one field alone.

What kind of treatment will you be offering?

We encourage a multi-disciplinary approach to evaluation that leads to a person-centered treatment plan that is both flexibly tailored and grounded in clinical science. Some people who come into the Center for evaluation will receive treatment recommendations that do not include any psychological services. Others will receive a plan that involves the use of evidence-based approaches for co-occurring psychiatric problems, designed to address Misophonia.

We are psychologists, so we will be offering psychological services. We use a process-based approach using cognitive and behavioral approaches with empirical support for intervening on Transdiagnostic problems—things like attentional hypervigilance, emotional reactivity, cognitive biases, interpersonal difficulties, and unhelpful behaviors.

Will there also be a variety of clinicians available to see individuals with misophonia? Please explain how these different therapists may be of help.

We are currently offering evaluations for misophonia that include treatment recommendations. As I mentioned, these recommendations may involve a range of providers, including psychologists, neurologists, and audiologists. As psychologists, we offer evidence-based treatment designed to help individuals cope with the experience of strong emotions.

These skills can help people in a lot of ways! For example, if someone hears a trigger sound and gets angry, they might be tempted to yell at the person making the sound. Sometimes this behavior will get the other person to stop making the sound, and sometimes it won’t. Yelling at someone also might cause an argument. In this situation, we would help someone learn skills to ask for what they want in an effective way.

All the skills we teach have research indicating they are helpful to people. It’s our job as psychologists to make sure we tailor the skills to each patient, given their context and goals. Additionally, some of our research will focus on treatment and how we can develop existing treatments for Misophonia. Individuals will be able to receive treatment as part of these studies.

Please tell us a little bit about the history of the Center and how it has changed, and what further objectives you have for the Center over the next three years?

Well, as you know, we were launched as a program in the late 2000s with the intention of studying sensory processing and emotion regulation. We published several studies and, over time, tightened the focus to be more specifically on Misophonia. In the next three years, we plan to make progress in all three domains of our Center’s mission: education, clinical services, and research.

We are starting our education initiatives by hosting quarterly webinars on topics of interest to the Misophonia community, including updates from recent research studies. Our clinical services are currently focused on evaluation and treatment recommendations. As we learn more about Misophonia, we plan to expand our clinical services to include treatments designed specifically for Misophonia.

And our research is currently focused on understanding what Misophonia really is. This research is multidisciplinary in nature and involves examining whether any psychological problems, like depression and anxiety, frequently co-occur with misophonia, as well as examining the neurological mechanisms that underlie the condition. Additionally, we are excited to start treatment studies! Using the knowledge we have so far, we are going to start by adapting existing evidence-based treatments to Misophonia in order to help individuals cope with the symptoms.

Is there a particular age group that is appropriate for the Center?

We are able to provide clinical services for adults only. We work with our colleagues at Duke to provide care for children outside the Center, and we hope to raise funds and interest in the future to bring a child psychologist into the Center team.

What about parents?

Parents can be involved in certain research studies and can receive an evaluation and recommendations on ways to manage their emotions, communication, thoughts, and behaviors related to the stress of parenting children with Misophonia.

How can an individual reach the Center?

The best way to contact our center is to email psychcmer@dm.duke.edu. We check this email address daily and respond as quickly as we can! Or, see our website: http://www.misophonia.duke.edu.

What about the Duke Quarterly Research updates?

To sign up for our workshop updates, see MIsophonia Education Duke Quarterly Research Updates

Thank you so much, Zach! This is so exciting for the misophonia community!

November 13, 2019 0 comment
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What is Sensory Over-Responsivity (SPD-SOR)?
ResearchSPD

What is Sensory Over-Responsivity (SPD-SOR)?

written by Dr. Jennifer Brout

Sensory processing involves the reception of and automatic neurobiological responding to stimuli from the outside environment (Brown, Tollefson, Dunn, Cromwell & Fillion, 2001). The proposition that we learn through our senses has been widely accepted within the fields of mental health and child development for over half a century. For example, Piaget (1958) described how the infants’ coordination of sensorimotor actions forms the foundation of cognitive development as they become internalized, and symbolically represented in memory.

With the advent of more sophisticated technologies in neuroscience, the various ways that sensory stimuli are processed in the brain were elucidated in the late 1970’s-1980’s (LeDoux, personal communication, 2016). Joseph E. LeDoux, for example was one of the early pioneers of affective neuroscience, and demonstrated in rodent models that sensory stimuli is the forerunner to emotional responding (Almada, Periera Jr. & Carrara-Augustonborg, 2013). In 1990, LeDoux made this connection overtly clear in the title of his paper “Information flow from sensation to emotion: Plasticity in the neural computation of stimulus value.”
The senses, then, are connected to complex and incalculable neural processes, including perception, learning, memory, motor coordination and emotion regulation (Brown et al., 2001; Kandel, Schwartz, & Jessell, 2000; Shepherd, 1994). In addition, over the past 20 years, sensory processing problems related to the tactile, auditory, visual, gustatory, olfactory, proprioceptive, and vestibular systems have been associated with various problems related to daily living. These problems include motor planning, visual and auditory discrimination as well as the processing and reacting to sensory stimuli in a graded manner (Bundy & Murray, 2002; Greenspan & Porges, 1984; Kandel et al., 2000; Reeves, 2001; Schaaf & Anzalone, 2001; Wiener, Long, DeGangi, & Battaile, 1996; Williamson & Anzalone, 2001). Early estimates of the prevalence of sensory processing problems in Kindergarten children were 5% (Ahn, Miller, Milberger, & McIntosh, 2004). In contrast, estimates of atypical sensory processing in children with developmental disabilities were between 40-88% (Adrien et al., 1993; Dahlgren & Gillberg, 1989; Kientz & Dunn, 1997; Ornitz, Guthrie, & Farley, 1977; Talay-Ongan & Wood, 2000).

Sensory Over Responsivity (SPD-SOR)

The inability to respond to sensory stimuli in a graded manner refers to individuals who may over-respond, under-respond or crave more sensory stimulation than others. Sensory Over Responsivity, or SOR, describes children who react adversely to sensory stimuli that others find neutral or even pleasant. (Ahn, et al., 2004). Prevalence estimates of children who are over responsive to sensory stimuli (SPD-SOR) are estimated to be 16% in children 7-11 years old (Ben-Sasson, Carter & Briggs-Gowan, 2009).

In a ground breaking study McIntosh, Miller, Shyu, & Hagerman (1999) used electrodermal activity and vagal tone as dependent measures. The researchers found that children with SPD-SOR demonstrated a greater sympathetic response (i.e., freeze, fight or flight response) to stimuli, as well as a weaker parasympathetic response (i.e., the system referred to as “rest and digest”; McCorry, 2007). SPD-SOR children demonstrated responses to stimuli that were larger in amplitude, more frequent, and/or of longer duration compared to typical peers. In addition, they demonstrated specific difficulties in habituation, manifesting difficulties returning to baseline arousal compared to typical peers (McIntosh et al., 1999; Schaff & Anzalone, 2001). Notably, later research comparing sensory over responsive children with Autistic Spectrum Disorder (ASD) children revealed that while ASD children were more likely to under-respond to sensory stimuli than children with SPD, over-reactivity within both groups were similar. (Tavassoli et al., 2017). Finally, a more recent neuroimaging study revealed strong evidence for specific brain differences in children with SPD, adding more validity to the diagnosis. In this study boys with SPD were found to have decreased white matter connectivity, particularly in the parietal regions of the brain (Owen et al., 2013).

SOR, Auditory Gating and Misophonia

Research supports a decreased ability to auditory gate in children with SPD. In other words, children with SPD are less able to detect changes in the frequency and the loudness of auditory tones presented sequentially (compared to typically developing control children; Davies et al., 2009, 2010; Davies & Gavin, 2007; Gavin et al., 2011). It is interesting to note that parallel to this research Jastreboff and Jastreboff (2001) termed the newly proposed disorder Misophonia.

Misophonia is a newly termed disorder (Jastreboff & Jastreboff, 2001) that shares a phenotype similar to auditory over-responsivity (SOR specific to the auditory sense) and is particularly relevant to auditory gating. Although the research on this disorder is in its infancy, Misophonia is considered a neurophysiological condition characterized by heightened physiological responsivity and a high level of emotional reactivity resulting from intolerance to specific auditory, and sometimes visual, stimuli (Jastreboff & Jastreboff, 2001; Jastreboff & Jastreboff, 2014; Moller, 2011; Edelstein, et al., 2013). Originally described by Jastreboff and Jastreboff (2001), individuals with Misophonia demonstrate increased sympathetic nervous system arousal, accompanied by emotional distress in response to specific pattern-based sounds, irrespective of decibel level (Kumar et al., 2017; Schröder, Vulink & Denys, 2013). Examples of these sounds include other people chewing, throat clearing, slurping, finger tapping, foot shuffling, keyboard tapping, and pen clicking (Edelstein et al., 2013; Rouw & Erfanian, 2017). Additionally, some sufferers have reported experiencing visual triggers, such as leg-shaking, mouth movements, chest movements, etc. (Edelstein et al., 2013; Schröder et al., 2013). Preliminary experimental studies have noted hyper-myelination between the parts of the brain that process auditory stimuli and parts of the brain that process emotion (as well as detecting salience of stimuli; Kumar et al., 2017).

To date there have been no studies directly comparing Misophonia with SOR. Nor have there been studies exploring whether earlier and more generalized auditory over responsivity is a risk factor for the specific sounds in Misophonia. However, because of the overlaps between Misophonia and SOR, exploration of how self-regulatory skills develop in Misophonia is warranted as part of a larger discussion of SOR, and self-regulation.

Excerpt from:
Brout, J., Ahn, R, & Appelbaum, M. (2018). Sensory Over Responsivity,
Attachment, and Self-Regulation: Considerations of the Specific Impact of Auditory Stimuli. Reframed: The Journal of Self-Reg, 2, 4-13.
December 3, 2018 0 comment
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Interview on Misophonia With Audiologist, Melanie Herzfeld
Research

Interview on Misophonia With Audiologist, Melanie Herzfeld

written by Dr. Jennifer Brout

Melanie Herzfeld misophonia

Audiologist Melanie Herzfeld, interviewed by Dr. Jennifer Jo Brout. Melanie Herzfeld, Au.D., provides complete audiological assessments for all ages, including Tinnitus Evaluations and treatments, Auditory Processing Disorder Tests, Hearing Aid dispensing.

Q: How did you become an audiologist? What drew you to this field?

A:  My father was a physician. My mother didn’t believe in education for girls. There were people in my family who were hard of hearing.

I skipped my senior year of high school and started college after 11th grade. I was only 16 and immature. I had to pick a major, which meant I had to spend a day going from department to department, meeting with each chair. I wore a mini-skirt.

The English chair was the first person I met. She was frumpy, obese, wearing a blue serge dress with bread crumbs down the front. I couldn’t look her in the face.

The Sciences chair had body odor. The mathematics department would not allow mini-skirts or slacks and required a computer lab that had to be taken in another bldg. In those days, a computer lab would mean learning how to punch cards.

At the end of the day, I was a speech and hearing major. The chair was the only person I met that day to whom I had no objections.

 

Q: How did you get started?

A:  I was teaching and I needed an M.A. I got a fellowship to Long Island colleges, but I was required to quit my job at a school for handicapped boys. In spite of my fellowship, I couldn’t make ends meet, so I had to withdraw from graduate school.

But if I studied audiology, I was allowed to work part time. That made graduate school affordable for me.

 

Q: What does an audiologist do?

A: Most of audiology practice is test heavy: working with the hard of hearing to find the right hearing aide, adjust it, and continue to monitor it to be sure it works correctly. A few practitioners , like me, work with patients who have tinnitus or misophonia. We are not typical.

 

Q: How did you become involved with misophonics?

A: I was part of a private practice, and I always had patients who asked about the Jastreboffs. We were offered an opportunity to be trained in misophonia treatment. Of the group in the practice, only 3 or 4 of us were interested. In the end, there was only me.

 

Q: How do you work with tinnitus sufferers?

A: Tinnitus sufferers often hear a constant high-frequency background sound, like a “sh-sh.” I use a program called normonics, a form of music therapy that uses slow music timed to the rhythm of the patient’s heartbeat. I use it to retrain the patient’s brain not to pay attention to the background sound.

Patients still hear the “sh-sh,” but are not bothered by it. I find a way to neutralize the sound. That is what an audiologist like me does: neutralize sounds.

 

Q: How do you treat misophonics?

A:  Like people with tinnitus, misophonics want to hear certain specific sounds differently. What I do is work to put the sounds that set them off in a different context, neutralize the stimulus. Behavioral therapy talks about white, pink, brown noise. The name of a noise corresponds to its energy. For instance, brown noise is lower frequency. I try to change the color of the noise that bothers them. Some people can’t listen to campfires or popcorn popping, someone eating chips.

I begin by making sure the patient’s auditory mechanisms, like the hair cells inside the ears, are intact and not damaged. Then I start using guided imagery: I walk the patient along a beach or through the woods while they hear the triggering sound. Again, I try to take the sounds out of their usual context, like a specific person, place, or thing.

I also send them to Dr. Jennifer Brout, whose work on the psychological level complements what I do with the patient.

April 30, 2018 0 comment
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What Can I Do If My Teenager Has Misophonia?
CopingParents

What Can I Do If My Teenager Has Misophonia?

written by Dr. Jennifer Brout

When we think of teenagers we often focus on hormonal, physiological and emotional changes. However, we often neglect to focus on how cognitive abilities, or thinking, changes. By adolescence, individuals are typically able to utilize abstract reasoning. However, this doesn’t happen for all teens at the same time.

During the “tween” years, individuals begin to make logical predictions about the future (“what if?” questions). Then, as they grow into the later teen years, individuals move into hypothetical and deductive reasoning, which enables them to be able to plan and organize with more efficiency. However, there is a lot of variability in this stage and the parts of the brain that mediate these functions are not fully developed until age 23.

In addition, physical growth, hormonal changes, and emotional development overlap. However, they do not necessarily move forward in sync with one another. The disparity between the physical, emotional and cognitive development can be confusing for many adolescents. However, this can be even more difficult for those with misophonia. Therefore, it helps to base your expectations of your teenager according to these differing developmental processes.

For example, despite the development of more sophisticated reasoning, self-regulation (independently calming one’s body and mind) is often an area of difficulty for teens. This is why we often refer to our teenagers as “moody” and “unpredictable”. However, the ability to self-regulate is significantly compromised in misophonia, making the teenage years possibly more “stormy”. In addition, as socialization becomes more important, your adolescent is likely to face conflict between wanting to be with friends and wanting to avoid triggers. Finally,  your adolescent may fearstigma associated with misophonia.

So, what can you do to help your teenager cope with these issues?

It may seem very challenging. However, you can help your teenager learn how to mediate relationships with friends within the context of misophonia. Here are some ideas:

  • Reassure your teen that not all social events must be attended.
  • It’s okay to skip ones that might be particularly uncomfortable, or to stay home and rest if a break is needed.
  • In addition, you can help by suggesting alternative activities for your teenager (especially ones that are regulating, such as exercise, yoga, sports, dance, etc.).
  • The more rested and regulated your teenager is, the easier it will be to cope with triggers.
  • Help your adolescent understand that missing a particular event today will likely make tomorrow a better day.

Finally, as many of us know, family conflict often arises from the stressors of the adolescent years. Teenagers usually experience conflicts related to separating from family/parents as they move toward their peers. This conflict can be exacerbated for teenagers with misophonia, since they may be more reliant on their parents’ help. For many parents, it is difficult to parse out “typical teenage behavior” and behavior related to misophonia. Here are some tips that may help:

  • Ask your teenager as calmly as you can about any behavior with which you are concerned
  • This will encourage self-awareness.
  • Try to make this a discussion to help figure these issues out, rather than making assumptions and engaging in conflict.
  • Seek a mental health provider who can help if you and your family if you feel that you are faced with problems that seem insurmountable.
  • Although the number of doctors and mental health clinicians is smaller than we would like, many are willing to learn about misophonia.
  • Ask your doctor or therapist to consult with another professional who understands misophonia, and/or give them reliable information (provided at the end).
  • Suggest to your counselor or therapist to take a course on misophonia. All clinicians are required to take continuing education credits and many are happy to take an online misophonia course. A link for a course is provided below.

Adolescence is difficult for the individual, and it is equally as daunting for parents. Misophonia can certainly make this already “stormy” time worse for everyone. However, helping your teenager make some adjustments within daily routines and in regard to social events can go a long way. Demonstrating understanding and patience when your adolescent is behaving in ways that concern you is not necessarily “indulgent”. Teens with misophonia often need their parents’ guidance and support for a bit longer than others.

For a comprehensive literature review to give your doctor: https://www.misophoniainternational.com/academic-article-misophonia-research/(link is external)

If your doctor or therapist would like a course on misophonia https://www.sensationandemotionnetwork.com/ceus-for-clinicians.html

April 24, 2018 0 comment
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A note from Dr. Brout on the Misophonia Criminal Minds Episode
Awareness

A note from Dr. Brout on the Misophonia Criminal Minds Episode

written by Dr. Jennifer Brout

Criminal Minds Episode referencing Misophonia: They got their info from the Slate article. We can’t blame the show writers. We should blame the faulty research and some, but not all, of the people who were interviewed for that article. I have been arguing with certain researchers about this not being a psychiatric disorder for years. I have been trying to tell everyone in the community that we cannot send out Memes all over the place about wanting to kill people. We know we don’t mean it. However, what do you think other people think? I knew this was going to happen. We should blame anyone and everyone who has tastelessly and naïvely said things about this disorder that aren’t true.

We should blame the people who have co-opted the Internet so that hardly any of the right information gets through.We should blame every practitioner that refers to this as an anger disorder. I truly believe that the work that some of us in the community have done has changed the picture a lot. Certainly we’ve really tried. It’s a shame the criminal minds writers didn’t use a different article, one that was well written. However, we, the community are the people who gave that slate article the number of views that it got. So when you Google Misophonia you get nonsense. If the community really wants to fix this problem, it can be fixed. However if nobody cares to fix what is intrinsically wrong with how this disorder is presenting on the Internet than petitioning an entertainment outlet is useless. For anyone who is interested in wanting to change the face of this disorder even further, and I say further because five years ago it was sound rage and now it’s known that it is related to related to fight flight and is neurologically based.

Without pointing fingers, I’m going to point two fingers, the UK site has a test for Misophonia. It’s the level test as you all know. The test directly equates level 10, I believe, with performing violent acts. I asked whomever runs that site years ago to get that test off. However, he chose not to do so. Even worse, that test is being used by psychologists and audiologists.

If we as a community want to take hold of this disorder, we can. We have researchers, really great ones, ready to go. We need to change the face of this disorder because it is been corrupted by corrupt people, and by some well-meaning people who unfortunately don’t know what they don’t know.We should blame webMD, MedicineNet and all of the “medical“ outlets for writing Information based on, nonsense. We should be calling them. Every good researcher that we have will back us up. It is we who have not done what we need to do. As I have always said there is no “they” out there. They are us. Excuse my rant. I will be writing something that is not is not a rant for my psychology today blog. I hope you will all help getting it around. I’m hoping to interview a writer. We shall see.

April 24, 2018 0 comment
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