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 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. 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 […]
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). 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.  A memory trace is a way to theoretically describe the physical representation of a memory in the brain
Misophonia can be scary, confusing and upsetting for the people around us. I get a steady stream of emails from people each month asking: “What can I do? How can I help?” There is an army of mums, dads, brothers, sisters, partners and best friends who want to understand and be there and help, but don’t know where to start. The problem is, with little guidance or professional help on offer, we’re all desperately trying to feel our way around a disorder about which very little is known and let’s face it, it’s hard. The good news is, if you’re close to someone with misophonia there are things you can do to help. But before we get started a quick public service announcement… If you’re the parent, sibling, lover or friend of someone who has misophonia, thank you. The fact that you’re reading this article shows, beyond measure, that you care. Thank you for being there and for wanting to understand and wanting to help. It might feel like we don’t appreciate you (especially when we’re flashing a dagger-like glares at you across the kitchen table when you accidentally bang your fork) but we do. Ok, let’s get back to business. Here are 6 actionable things you can do to help: Understand that it’s not your fault – The fear-flight-fight response that your loved one feels every time they hear certain sounds is just a part of their brain (the amygdala) misinterpreting that sound as a danger signal. If you happen to have made the ‘trigger’ sound then you might be in their line of fire, but you’re not the cause of the disorder, it’s not your fault. Any upset or tantrum that ensues isn’t really directed at you as person, even if it might feel exactly like that! Try to avoid being confrontational – Most (reputable) studies indicate that misophonia is a neurological condition. In other words it isn’t ‘learnt’ and won’t just go away or lessen over time. Saying that “you just need to get over it” or to “stop overreacting” is a bit like screaming at a blind person: “START SEEING!”. They can’t help it and it will only make things worse and cause the situation to escalate. Getting frustrated is totally understandable but will raise tensions and leave both of you feeling hurt or upset. Remember, your loved one likes this disorder even less than you and would do anything to make it stop. The physiological reaction caused by a trigger sound won’t go away, but over time they will find ways to cope. Don’t let misophonia dictate how you live your life – It’s bad enough we have it, you shouldn’t have to suffer as well! Try to be considerate and mindful, but don’t feel like you have to tread on eggshells whenever you’re around that person. I know this is hard, particularly for mums and dads (no one wants to see their child in pain) but if you’re constantly tip-toeing around each other you’ll both be stressed and on edge all the time and it can make things worse. It’s important that your loved one is able to find coping mechanisms and support that works for them in different environments. Remain calm and level during an episode – Misophonia causes high stress levels in your loved one’s body (causing cortisone and adrenaline to race around their system) during an episode. The best way to help them calm down and reset is to try to be patient and understanding. You don’t have to endorse their behaviour (particularly if they’re being aggressive) but let them know you’re there for them and that you don’t think they’re ‘stupid’ or ‘weird’. Try to speak softly and calmly and without judgement until the moment has passed. Give them space but let them know that you’re there if they need you – Sometimes they may experience a total sensory overload and will just need to get out of the room. It might seem like they’re being rude or childish but they’re probably doing this as much for you as they are for themselves. Moving away from the situation gives them time to reset and prevents them from lashing out and saying something they don’t mean and might later regret. In calm moments, if it seems appropriate, try talking to them about how misophonia makes them feel. You’ll get a much better understanding of the disorder and they’ll feel supported and less alienated. Allow them to use tools and devices to help mask sounds in difficult situations – Putting on some background music or even having the TV on during mealtimes can work wonders, others find white noise can help. Adding another layer of sound in the background often helps to dull the intensity of a misophonic reaction. Sometimes that’s not enough and as any misophone will tell you, the humble set of earphones is always a close ally! If you’re a parent, let your son or daughter use earphones or headphones in their room when they’re trying to concentrate. That’s it. I hope you found some of these helpful. Even if you’re able to act on just one of these points, it really could help to alleviate the stress and anxiety that misophonia can cause. With the right management and encouragement, people with misophonia can develop and hone coping mechanisms that enable them to live a wonderful and fulfilling life. By Tom from AllergictoSound.com, originally published on our Winter 2016 Magazine
Lately I’ve felt pretty guilty. For three years I lived on my own, in a city 6 hours from home. People did not expect to see me. I had a group of friends and a life in the city. I saw them when it suited me. Most of them were amazingly understanding and I feel like I had built a network of people that were understanding. Then, money led to me moving back home. It’s never nice to feel like the rug has been pulled out from under you. That’s not what this is about. Now that I’m ‘home’ friends and family are flabbergasted when they learn I’ve been around for months. Very few of them have seen me. I am not intentionally avoiding friends and family. However, as I think harder on it, maybe I am. You see, my misophonia has gotten so bad that the mere thought of explaining the situation to more people, risking triggers, and having the inevitable “first trigger conversation” is too much. It may seem irrational, but the idea of being triggered affects me so greatly that I simply avoid confrontation altogether. The idea of a relative showing up even weeks from now brings me so much distress that I become anxious and irate. Because of my misophonia I am now nocturnal. I rarely go outside except for the wee morning hours before most people have even woken. I do this not because I dislike people, but because triggers are so life-altering, so volatile, that avoidance at all costs has become my new way of life. Still, there are people I love and miss. Unfortunately, seeing them is a lot of effort. It is wrought with fear of yelling at them, of feeling hurt by their actions (despite them not knowing they did it) and the inevitable tarnishing of relationships that comes from great strain. I’ll admit to throwing back a few drinks whenever I have to face crowds. It’s the only way I can even stomach the idea of being around a crowd larger than 3. Yes, 3. That’s how isolating misophonia is. I turn down shopping days, and I turn down casual chats. I’m not trying to be cruel and I certainly don’t want to be isolated. The thing about misophonia is that it cannot be controlled. As many here know, we don’t have a cure yet. Even using a sensory diet and regime cannot alleviate all of the symptoms from being triggered. Pain, anger, frustration. The emotional trauma after-wards is just as bad. I’d reckon I live in a constant cycle of fight/flight vs fear of fight/flight. Everything I do goes back to the disorder. Every decision. I know when my neighbours are outside – I know when objects are shaking in the wind. I know when lawn mowers are going off. I know everything because each time it happens, I’m faced with devastating consequences. There is no “get over it” for misophonia. Sensory information is cumulative and each time I’m triggered I feel it chipping away at me. While I can’t avoid people forever, it is sometimes my only option. I do not want to get angry or be bitter. I do not want to ruin my relationships by constantly snapping at people for moving their fingers, making noises with their mouths, or shaking their feet. But, when I’m faced with these triggers – I feel as though I have been shot. My head hurts. My body shakes. I feel hurt, literally. My muscles tense. My back aches. My heart races and my mind goes numb. All I feel is the pain and emotional frustration. As it continues, the anger builds. If I stay too long, I enter either meltdown or shutdown. Meltdowns are tantrums – a complete intense irrational state where I want to lie on the floor and pound my fists. I’ve done it. Shutdowns are when your entire body just stops. Seeing becomes too hard. Breathing feels like a chore. Imagine a panic attack that has been put on steroids. Everything becomes loud and quiet all at once. Unfortunately, once I enter shutdown if the noises continue, I come to. I then feel this entire reaction again and again on a loop. Later, it replays in my memory. Every noise. Every movement. I am trapped in this disorder. So, I stay away. I hide and I flee. I spend my nights mostly alone and I spend my days trying to sleep as much as possible. The farthest I go is the grocery store. Even that simple trip feels like it takes all of my energy. Simple activities leave me fatigued. My sensory system is the equivalent of spending all night and day at a rave party hungover. I feel assaulted. Constantly. I miss my friends and family but 10 seconds of a trigger can set me off for hours. Then I remember they do it. Once I remember they have triggered me, it sticks. I think about it. I worry that it will happen again. I’m not avoiding you, but my misophonia is. I don’t want to be angry. I don’t want to be hurt. But this disorder does exist. My amygdala unfortunately cannot tell what is a threat and what is a friend. As I fight for a cure I stay huddled in the night. But, I promise you, I still love you. I’m just going to have to do it from afar for now.
The cerebral cortex plays a key role in memory, attention, perceptual awareness, thought, language and consciousness. It is divided into four main regions or lobes, which cover both hemispheres: the frontal lobe (involved in conscious thought and higher mental functions such as decision-making, particularly in that part of the frontal lobe known as the prefrontal cortex, and plays an important part in processing short-term memories and retaining longer term memories which are not task-based); the parietal lobe (involved in integrating sensory information from the various senses, and in the manipulation of objects in determining spatial sense and navigation); the temporal lobe (involved with the senses of smell and sound, the processing of semantics in both speech and vision, including the processing of complex stimuli like faces and scenes, and plays a key role in the formation of long-term memory); and the occipital lobe (mainly involved with the sense of sight). The Limbic System and Basal Ganglia Picture from How Stuff Works (http://people.howstuffworks.com/ swearing.htm/printable) The medial temporal lobe (the inner part of the temporal lobe, near the divide between the left and right hemispheres) in particular is thought to be involved in declarative and episodic memory. Deep inside the medial temporal lobe is the region of the brain known as the limbic system, which includes the hippocampus, the amygdala, the cingulate gyrus, the thalamus, the hypothalamus, the epithalamus, the mammillary body and other organs, many of which are of particular relevance to the processing of memory. The hippocampus, for example, is essential for memory function, particularly the transference from short- to long-term memory and control of spatial memory and behaviour. The hippocampus is one of the few areas of the brain capable actually growing new neurons, although this ability is impaired by stress-related glucocorticoids. The amygdala also performs a primary role in the processing and memory of emotional reactions and social and sexual behaviour, as well as regulating the sense of smell. Taken from: http://www.human-memory.net/brain_parts.html So peripherally attached to the major areas of the auditory cortex that are interpreting sound is the amygdala and the hippocampus!
Many people have wondered, is misophonia neurological? Classifications of disorders are usually based upon their underlying causes. Thus, if a disorder is caused by a neurological problem, we would say it is a “neurological” disorder. However, in modern times it has become increasingly difficult to categorize disorders in this way because disorders overlap, and causality is often unknown. This, of course, adds to the confusion. Neuroscientist Joseph E. LeDoux has been studying the implications of auditory over-responsivity in the part of the brain called the amygdala. The amygdala plays an important role in the body’s fight/flight/freeze processes. It is because of the nature of the amygdala and the limbic system that misophonia is most-likely neurological in origin. 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. The perception of memory offers reasonable theories as to why cognitive therapies such as CBT have shown little progress for misophonia, and have been said to make the disorder worse. Dr. LeDoux is working on whether or not memory reconsolidation therapy can have an impact on persons with misophonia. This research is particularly interesting because it is widely innovative in regard to approaches for misophonia. Edelstein, Brang, Rouw, and Ramachandran (2013) found some similarities between Synesthesia and Misophonia. Edelstein et al. proposed that misophonia “displays similarities” to synesthesia. Edelstein et al. used both self-report (qualitative interviews) and physiologic measures (Skin Conductance Response, or SCR) to characterize aversive reactivity in Misophonia: “The underlying neurological cause of this condition may be similar to that of synesthesia in terms of enhanced connectivity between relevant brain regions. In short, a pathological distortion of connections between the auditory cortex and limbic structures could cause a form of sound-emotion synesthesia.” (Edelstein et al., 2013). The authors note that limitations of the study include small sample size, a lack of screening for psychiatric or psychological problems (no measures of mental health disorders were included), and that SCR measures autonomic arousal, but does not describe the nature of the emotion associated with that autonomic arousal. As you may have noted, the synesthesia research is applicable to Misophonia as it directly addresses the aberrant brain connectivity that the Jastreboff’s originally conceived of. While synesthesia research does not directly translate into treatment, it can certainly further our understanding of the disorder and therefore inform treatment. There are a few more synesthesia research studies underway and it will be interesting to find out results.
UPCOMING MISOPHONIA STUDY: Currently the Duke Sensory Processing and Emotion Regulation program is collaborating with Dr. Sukhbinder Kumar (Newcastle University) and Mercede Erfanian (University of Maastricht) through the International Misophonia Research Network to better understand misophonic trigger sounds. “ I have wanted to do this study for 15 years” says Dr. Jennifer Jo Brout of IMRN. “We always look to the sufferers and study what is wrong with them but we never think to deconstruct the sounds to find out why these triggers line up so closely…Why do all of us have aversive reactivity to the so many of the same sounds?” The researchers all feel that with more knowledge about the sounds the disorder will be better characterized and the potential for treatment will be more easily and more efficiently formulated. Dr. Stephen W. Porges (Indiana University Bloomington) has already done a pilot study in association with IMRN but the research needs to be further expanded to really shed light on this issue. The researchers are currently donating their time to begin this study and hope to find resources, which will allow for more of the misophonia researchers to contribute. Misophonia Research is ever-evolving. While there are currently only a small number of academic articles published, this is growing rapidly. Misophonia International supports the International Misophonia Research Network (IMRN). The IMRN was formed to facilitate cross disciplinary research in misophonia and conditions related to auditory over-responsivity. Founded by Jennifer Brout, PsyD, the IMRN aims to connect sufferers and researchers to accurate and current information related to the disorder. The Sensation and Emotion network by Dr. Jennifer Jo Brout has been at the forefront of sensory advocacy and misophonia research for the past two decades. In-fact, Dr. Brout was an advocate for misophonia before the name even existed! Disappointed by her own experiences with the state of the field when seeking help for her own child, Dr. has dedicated herself to advocating for the establishment of better mental health research practice, improved diagnosis, and innovative clinical practice for the past 18 years. Her focus has been on the relationship between auditory over-responsivity and psychological functioning. Dr. Brout continues to, bring together multi-disciplinary teams of highly esteemed academic researchers and clinicians in order to share resources, eventually culminating in research papers, academic conferences, and innovative treatment. Currently we are involved in the following studies on sensory disorders. Below that, we will list studies that we are interested in. Our Programs & Studies New York University LeDoux Lab The goal of this research is to explore how the processing of auditory stimuli in the brain can go awry (leading some people to have aversive reactions to stimuli that most people consider innocuous). To gain a better understanding of how these averse reactions are controlled by the brain, we are building on our research over the past 30 years. We have shown that the brain region called the amygdala is key to such responses. One area of the amygdala , the lateral nucleus, is involved in receiving sensory inputs and another, the central nucleus, controls the expression of responses. Over-reactivity to auditory stimuli could be due to a hypersensitive lateral amygdala or an over-reactive central amygdala. We will study animals that show exaggerated responses to auditory stimuli and will record activity in the lateral or central nucleus to try to determine whether the problem is due to hyper-sensitivity or hyper-reactivity. Duke University Sensory Processing and Emotion Regulation The Sensory Processing and Emotion Regulation Program is the longest standing research program involved with The International Misophonia Research Network. Founded by Jennifer Jo Brout in 2008 and led by Dr. Zach Rosenthal, research conducted within this program investigates the relationship between auditory over-responsivity/misophonia, emotions, cognition and behavior. Previous studies from this program have examined the effects of meclizine on pre-pulse inhibition (Levin et al., 2014) and the relationship between sensory over-responsivity and emotions in adult psychopathology (Rosenthal et al., 2011; Rosenthal et al., in press). In addition to research, we are dedicated to developing, evaluating, and establishing best practices for providers working with patients who report having misophonia. The approach we are developing is multi-disciplinary and is done in tandem with patients and their families. The self-help component to this approach is a practical combination of proactive coping skills designed to help individuals identify aversive stimuli, and learn different ways to help calm the physiological and emotional over-arousal associated with that stimuli. The program also seeks to help individuals reevaluate and change ways of thinking about aversive stimuli that may act to acerbate. The program teaches how to help calm the physiological and emotional responses to these aversive stimuli. Updates about this program will be posted periodically. Current Studies Sensory Processing and Mental Health Study Some people respond to sensory cues in their daily environments differently than others. Problem with processing sensory information (e.g., getting angry when hearing certain sounds) can be associated with various behavioral health problems. This study was funded by the Wallace Research Foundation and is no longer active. The study examines the relationship between self-reported responses to sensory cues (during childhood and adulthood) and various mental health problems. Generalization of Emotion Regulation This is a study about the ways in which people cope with emotional distress in their lives. We will be looking at ways to understand how to help people calm down easier after they become emotionally distressed. We are interested in how to do this both inside the clinic and also outside in the real world. Investigating Antihistamine Treatment to Reduce Sensory Over-responsiveness Histamine, in addition to being a chemical that controls nasal and stomach acid secretions and itch responses also serves as a transmitter between neurons in the brain. We have found that brain histamine systems play important roles in sensory responsivity. In preclinical studies we have shown that a certain type of antihistamine treatment can help reverse sensory gating impairments. In an initial clinical study with people who have difficulty modulating their sensory responsiveness, antihistamine treatment improved sensory screening without producing sedation. This initial study was in people with general sensory over-responsiveness. The Polyvagal Theory – Stephen Porges Polyvagal Theory makes predictions based on acoustic properties. The Polyvagal Theory proposes that subjective responses to sounds are initially (before associative learning) based on two features of the acoustic signal: pitch and […]
Breakthrough Misophonia Study by Dr. Sukhbinder Kumar provides strong evidence that Misophonia is a ‘real disorder’. Jennifer Jo Brout, PsyD and Michael Mannino, PhD candidate Dr. Sukhbinder Kumar, and his team from the Institute of Neuroscience at Newcastle University and the Wellcome Centre for NeuroImaging at University College London (UCL) published a groundbreaking Misophonia study, which recently appeared in Current Biology. What makes this study “ground-breaking?” In an interview with Dr. Kumar, he explains the study and what it might mean for people with Misophonia. Dr. Kumar states that his team is specifically using Magnetic Resonance Imaging (MRI). Kumar’s team found identifiable differences in the brains of misophonic individuals. The study reveals numerous important findings. First, there is a notable difference in the connectivity in the frontal lobe between the cerebral hemispheres in people with Misophonia. The difference appears to be due to higher myelination in the ventromedial pre-frontal cortex (vmPFC). The vmPFC sits almost right above the eye-socket, the bottom middle towards the front of the brain. It is involved in processing and regulation of emotions like fear and empathy, and decision making. “The higher myelination in this area of the brain in Misophonia subjects suggests abnormal connectivity” The myelin sheath cells surround the connecting axons of neurons, allowing for, and increasing electrical conductivity between brain cells. Without this, cells could not communicate properly. Also, the ventromedial prefrontal cortex is central to understanding Misophonia because it is part of a complicated network of connections between numerous other areas of the brain. It receives sensory information, processes that information, and influences the functioning of many other brain areas including those involved in memory, olfaction and perhaps of great importance, the amygdala (where fight/flight is mediated and where salience, or importance, is assigned to incoming sensory stimuli). Dr. Lorenzo Díaz-Mataix (LeDoux Lab, NYU) comments: “In the study we are conducting, we explore individual different responses in rodents induced by acoustic stimuli, [which they associate with threat]. The auditory threat then triggers neural activity in the amygdala; behavioral responses (freezing), autonomic activity (increases in heart rate, blood pressure), and the release of stress hormones. These neural, behavioral, autonomic, and endocrine responses vary across individuals, with some rats consistently responding strongly and others weakly to the same stimulus. This work relates to the Kumar study since the insula connects directly with the amygdala. We believe that our experiments, under controlled laboratory conditions will complement and add to our understanding of brain circuits that underlie symptoms related to threat processing in psychiatric conditions, including Misophonia.” The study also revealed that a major area involved in the brain’s ability to pick out what it thinks are “salient”, or important, stimuli (the anterior insular cortex, or AIC) showed greater activation for Misophonia subjects responding to trigger sounds. The AIC is involved in processing emotions and integrating sensory stimuli (such as sounds) from both the outside world and from within the body. article continues after advertisement Here, “salient” means picking out or paying attention to something that stands out from its neighbors, like off-color in the case of vision, or in this case, an off-sound. Importantly, this area also showed abnormal “functional” connectivity to other brain regions highly involved in processing emotions, including the amygdala, the vmPFC, and the posteromedial cortex (PMC), also involved in emotional regulation. Dr. Kumar hypothesizes that the difficulty in processing sensory information in these brain networks leads to a “mismatch between how a person perceives their physical state and what their physical state really is”. This refers to an often overlooked sense “interoception”, which allows us to accurately perceive our body states. As an example, Dr. Kumar explained that “a person may feel as though they have a dry mouth, yet objectively, their mouth is not dry”. Dr. Kumar is very interested in this finding and is continuing research on how this relates to Misophonia. Please be sure to specify “Sukhbinder Kumar Misophonia Study” when donating. The take home message here is that due to this aberrant connectivity, those with Misophonia misinterpret the common misophonic trigger sounds in a way that causes their bodies to respond as though they are under threat. The amygdala is the part of all this that takes all this “mis” information, and then tells the body, ‘let’s do something about this‘. Dr. Kumar hopes that this study will help lead to treatment. Treatment possibilities include learning ways to self-regulate (or bring down the nervous system arousal). We also spoke about the potential of memory re-consolidation therapy. Memory re-consolidation therapy would involve changing the physiological response to the trigger sound. This was developed in the Joseph LeDoux lab at NYU and has been successfully trialed in rodents, and is currently being trialed successfully in human beings for Post Traumatic Stress Disorder and phobias. Dr. Joseph LeDoux comments: This seems like an important and well-conducted study by a research team from a leading functional imaging center published in a top-tier journal implicating the insula cortex in auditory responsivity in Misophonia. As the study shows, the insula is well situated to play a role in processing sounds as threats given that it receives auditory inputs and is also connected with the amygdala and medial cortical areas. I was surprised that the anterior insula was found to be acoustically responsive in this study since most the posterior insula is usually found to be the sensory (including auditory) responsive region. Regardless, this seems to be an important advance in linking symptoms in Misophonia to the brain. Dr. Kumar adds that this study validates misophonia is it’s own disorder. It cannot be classified within any psychiatric or specific neurological disorder. When asked if he thought misophonia should be classified as neurological or psychiatric, Dr. Kumar explained that the lines between psychiatric and neurological are blurred. “Many psychiatric disorders are neurologically driven”, and this differentiation may be irrelevant.” For more information on Dr. Kumar and related studies http://ttp://misophonia-research.com/misophonia-advisory-board/ For more information on misophonia https://www.misophoniainternational.com/what-is-misophonia/
On behalf of the International Misophonia Research Network (IMRN), Misophonia International promotes these following researchers, and hopes that you will too. Through your generous donations these programs will be able to further move-along and facilitate research that is influenced by our challenging, lesser-known disorder. When we work together and back researchers we are taking the initiative to hold our futures in our own hands. It’s exciting to be able to control our own research and be able to choose to seek answers. Duke University The Sensory Processing and Emotion Regulation Program is the longest standing research program involved with The International Misophonia Research Network. Founded by Jennifer Jo Brout in 2008 and led by Dr. Zach Rosenthal‚ research conducted within this program investigates the relationship between auditory over-responsivity/misophonia‚ emotions‚ cognition and behavior. NYU LeDoux Lab The goal of this research is to explore how the processing of auditory stimuli in the brain can go awry (leading some people to have aversive reactions to stimuli that most people consider innocuous). To gain a better understanding of how these averse reactions are controlled by the brain‚ we are building on our research over the past 30 years. We have shown that the brain region called the amygdala is key to such responses. One area of the amygdala ‚ the lateral nucleus‚ is involved in receiving sensory inputs and another‚ the central nucleus‚ controls the expression of responses. Over-reactivity to auditory stimuli could be due to a hypersensitive lateral amygdala or an over-reactive central amygdala. Stephen Porges (The Polyvagal Theory) Be sure to select “Kinsey Institute Research Fund” from the drop down list Polyvagal Theory makes predictions based on acoustic properties. The Polyvagal Theory proposes that subjective responses to sounds are initially (before associative learning) based on two features of the acoustic signal: pitch and variation in pitch. The theory articulates that for mammals there is a frequency band of perceptual advantage in which social communication occurs. It is within this frequency band that acoustic “safety” cues are conveyed. Dr. Sukhbinder Kumar (Newcastle University) Dr. Sukhbinder Kumar and colleagues from the Institute of Neuroscience at New Castle University published a groundbreaking misophonia study in Current Biology (February‚2017). The research team measured three sets of sounds that were presented to both misophonics and to controls while they were in an MRI scanner. Sounds included typical misophonia “trigger sounds”‚ typically unpleasant sounds‚ as well as neutral sounds. Measurements of brain activity and autonomic responses (heart rate and galvanic skin response) were recorded in the MRI scanner Want to help on a larger scale? Why not start a local fundraiser! Here’s a comprehensive list of fun and interesting ideas.
Living with a disorder that doesn’t have a cure is unimaginable. At times I have been called overly-passionate when it comes to Misophonia and the advocacy surrounding it. I have been accused of being too dedicated and even told that I should back down and let things go slower. I can’t do that. When I say I can’t, I’m not doing so in the stubborn kind of way. Misophonia has taken away from me more than I care to admit. Due to this disorder I have been saddled with an unfortunate situation. I’ll be honest, I’m fighting back tears as I write this. My eyes are wet with the grief that comes with realizing the impact that this disorder has had on my life. This week should (and would have been) the start of my fourth year of university. I should be spending my time with my classmates. I should be going out to parties, laughing, and enjoying the last year of my bachelor’s program. Instead, I wait to start online classes next month. The school that I dreamt about as a depressed and anxious teenager was taken from me. It became a symbol and a beacon – it was everything I wanted when I finally recovered. As an overly-anxious 19 year old I took a leap, and I finally crawled out of depression’s grasp to jump into my future. That first year of university was amazing. Unfortunately the second year was wrought with a problem that hit me full force. What was small inconvenience before was now un-imaginable. I couldn’t stop seeing a leg shaking. Whistling brought me to tears. Classrooms became hell. I am grieving. I have faced many losses, and many deaths. This has hit me just as hard as any of them. Misophonia terrifies me. Past the amygdala and the fight/flight/freeze response I am petrified. Like the impact of a basilisk I feel my nerves pause. I feel my heart skip beats. Why? Because if this disorder continues to get worse I am not sure what else I will lose. How will I travel the world like I’ve always planned? Will I ever sit in a café in France? Or, will I ever dance in the streets of Latin America? If I have a say I will… This is why I’m fighting so hard. Because I have to. I need a cure because I know that my quality of life is hanging in the balance. We need to help with research because that is the way to find a cure. I don’t think I’m able to stop fighting. If I stop fighting for a cure than I have stopped fighting for my future. I’m not ready to do that.