A special thank you to Dr. Kumar for agreeing to this interview.
How did you become interested in researching Misophonia?
We did not know that much about misophonia until the year 2012, when we published a paper in which we measured brain responses to some of typical aversive sounds (such as chalk on blackboard). This paper got some attention from the press, and I was invited to speak on the BBC about our findings. After the interview, I got many emails asking if I included sounds such as eating and breathing in my study. Initially we were surprised as we thought these sounds are not ‘annoying’, or typically aversive. However, the emails kept coming, and we became intrigued. Professor Tim Griffiths (neurologist) is the leader of our lab, and he invited four misophonia subjects to his clinic and conducted a detailed interview with each of them. We were surprised by the homogeneity of the profile of symptoms described by the participants, and we decided to investigate misophonia further.
What have you found most surprising about Misophonia research?
I have been involved into misophonia research for more than five years now, and have met and spoken with hundreds of sufferers. I find it most surprising, and disappointing at the same time, that misophonia research hardly receives the attention it deserves from the scientific and clinical community. Considering the devastating effects misophonia has on peoples’ lives, more awareness is needed. The situation has improved in the past couple of years, but not enough.
Many aren’t aware how the research process works. How long did your study take?
From conception of the study to its publication, it took roughly 2 years to complete.
Could you summarize what the important findings of your study were? (as briefly/lengthy as you like)
The most important finding of our fMRI study was the hyper activation of a brain structure called anterior insula (AI) specifically in response to trigger sounds in subjects with misophonia. Now the AI is known to be involved in integrating sensations from within the organs of the body, and from the outside world. One interpretation of our data is that the AI triggers atypical responses in the body (which are interpreted as negative). This may lead to unfavorable emotions in response to trigger sounds.
The other important finding was that the AI was strongly connected to a network of brain areas called the default mode network (DMN) in misophonia subjects. The DMN is known to be involved in recalling memories of past experiences. This may suggest that in misophonia, past experiences with trigger sounds have a strong bearing on the current perception and reaction to trigger sounds.
For those that are less familiar with interoception, could you briefly explain what that is?
Interoception refers to the brain’s perception of the internal states of our bodies. Some people have greater interoceptive awareness, and may feel what is happening inside their body more than others. Other people may have less interoceptive awareness, and therefore will be less sensitive to happenings inside the body.
Could you explain the connection between interoception and Misophonia that you found in your last study?
In consideration of the fundamental question of what emotions are, there are different theories. Some theories hold that emotions are simply the perception of internal state of the body, and nothing further. In the light of this definition, emotions and interoception are tightly linked. One can, therefore, argue that those with higher interoception, who are more sensitive to the internal changes in their bodies, may feel emotions more intensely than those who are less sensitive to changes in the internal states of their bodies. Interestingly, anterior insula (which as mentioned above is seen to be hyperactive in misophonics) is the key structure that is known to be involved in interoception. This raises the question: Do subjects with misophonia feel their internal bodies differently or, more generally? Do they have atypical interoception? Our paper suggested that this may be the case. We asked subjects to fill-in a questionnaire which asked questions related to the sensitivity of their internal sensations (e.g. degree of feeling their heart beating, internal tensions). We found that subjects with misophonia scored higher on these questionnaires (compared to controls) pointing to atypical interoception. Further research is needed to test the interception in misophonia and whether the atypical interoception is the cause or consequence of misophonia.
What’s next for your research on Misophonia?
My next experiment on misophonia involves identification and characterization of brain responses that can be measured on the scalp using electroencephalography (EEG) (or magnetoencephalography, MEG). As mentioned above, our previous fMRI study identified brain areas that are involved in mediating the emotional response to trigger sounds. The fMRI, however, has couple of limitations. It is expensive and it is also ‘slow’ (in the sense that it cannot measure moment-by-moment changes, or dynamics, of brain activity). The aim of the present study is determine the dynamics of the brain activity measured via the scalp using EEG. Also, since it is less expensive, EEG may useful as a measure in clinical practice.
How can those interested best help support your research?
The major problem in carrying forward research in misophonia is lack of funding. Misophonia is not officially recognized as a distinct disorder, and therefore funding agencies show little interest. This is where those interested in misophonia can support research. Any financial contribution is extremely helpful in order for us to continue the research.
For those interested in donating, you can learn more here.
Is there anything else you’d like to add/discuss?
Another finding in our study, not mentioned above, is that subjects with misophonia had differences in the structure of their brains in area that are involved in emotional control and regulation. However, seeing these differences does not tell us if they are a result of misophonia, or if they are causal in misophonia. It is, therefore, very important to direct research on structural brain changes in misophonia with consideration to development. In other words, it is important to study children and adolescents with misophonia, as well as adults.
Those interested in reading about Dr. Kumar’s most-recent misophonia study, can read more here.
[btnsx id=”5782″]Want to learn more? Join a Workshop with Dr. Jennifer Brout or Duke CMER at Misophonia Education.