Misophonia Guide for Doctors and Clinicians - Jennifer Jo Brout, Psy.D. International Misophonia Research Network
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INTERNATIONAL MISOPHONIA RESEARCH NETWORK
Misophonia Guide for Doctors
and Clinicians
Jennifer Jo Brout, Psy.D.
International Misophonia Research Network
1JENNIFER JO BROUT, PSY.D.
What is Misophonia? is involved in the processing and regulation of
emotions like fear and empathy as well as in
Individuals with Misophonia experience decision making (Kumar et al., 2017).
heightened autonomic nervous system arousal
accompanied by negative emotional reactivity Studies addressing the specific mechanisms
in response to specific, pattern-based sounds. underlying Misophonia are not conclusive.
The intensity of both neurophysiological and However, processes related to both the
emotional responding varies from mild to central and peripheral nervous systems such
severe across individuals, as well as differing as pre-attentive processing of stimuli and
environments. Misophonia was termed by salience detection, as well as the integration of
Jastreboff and Jastreboff (2001) as they perceptual salience with atypical awareness of
differentiated it from hyperacusis (a disorder internal body states emerge as important (Brout
in which individuals perceive sounds as louder et al., 2018).
than they are. Sometimes individuals with
Misophonia also have hyperacusis, but not Finally, age of onset is unknown, and preliminary
always. The Jastreboffs (2001) proposed that studies suggest that both children and adults
Misophonia was primarily an auditory-based have Misophonia. Misophonia may overlap with
disorder which also involves brain areas that other developmental, medical and psychiatric
process sympathetic nervous system arousal disorders, and may also present without co-
and emotional valence.Currently, there is occurring diagnoses. Common co-occurring
some disagreement within the literature as disorders are hyperacusis (Jastreboff &
to how the disorder should be classified. Jastreboff, 2001), Autism Spectrum Disorder
However, there seems to be a consensus that (Brout et al., 2018; Danesh & Kaf, 2012),
a multi-disciplinary approach to research and Sensory Processing Disorder (Brout et al.,
treatment is most appropriate. 2018; Cavanna & Seri, 2015), and Obsessive-
Compulsive Disorder (Webber, Johnson, &
Storch, 2014). Anxiety appears to mediate
Misophonia symptoms, and may also co-occur
Misophonia Research as a disorder (Brout et al., 2018).
Research specific to Misophonia is in its
infancy. Most studies involve case reports, or
are limited by small samples without control 2018 Literature Review
groups. In addition, these studies rely on self-
report measures that are not yet validated. Please read the entire Literature Review here:
However, studies using physiological measures https://www.frontiersin.org/articles/10.3389/
(e.g. skin conductance, heart rate) consistently fnins.2018.00036/full
demonstrate sympathetic nervous system See references at end.
arousal in response to auditory (and sometimes
visual) stimuli, verifying subjective reporting
(Edelstein, Brang, Rouw, & Ramachandran,
2013; Kumar et al., 2017). International Misophonia Re-
Brain imaging and neural network modeling search Network (IMRN)
reveal a notable difference in connectivity in the Dr. Jennifer Jo Brout established The
frontal lobe between the cerebral hemispheres International Misophonia Research Network
in people with Misophonia. The difference (IMRN) in order to facilitate cross-disciplinary
appears to be due to higher myelination in the Misophonia research. Disappointed by her
ventromedial prefrontal cortex (vmPFC), which own experiences with the state of the field
2INTERNATIONAL MISOPHONIA RESEARCH NETWORK
when seeking help for her own child in 1999, Dr. body and return to homeostasis), Cognitive
Brout began efforts to establish better research and Emotional (altering thoughts and emotions
practice, improved diagnosis, and innovative surrounding Misophonia), and Behavioral
clinical practice related to individuals with (developing new behavioral patterns of
difficulties processing sensory information (with responding).
a particular focus on auditory over-responsivity).
Dr. Brout established the Sensation and Emotion
Network (SENetwork) in 2007 and founded the
Sensory Processing and Emotion Regulation Misophonia Provider Network
Program at Duke University in 2008 (with funds Providers interested in helping Misophonia
from her family foundation). The Sensory patients in their areas can be listed on the
Processing and Emotion Regulation Program was Misophonia Provider Network. A short class is
renamed the Misophonia and Emotion Regulation offered to providers for listing on the network.
program in 2015. The Misophonia Provider Network was formed
along with the International Misophonia Research
The International Misophonia Research Network
Network (IMRN) in order to connect individuals
advisory board features professionals from many
to a cross-disciplinary network of researchers
disciplines, and the advisory board can be found
and professionals. Our provider network does
here: www.Misophonia-research.com/advisory-
not allow providers to simply list with us. Rather,
board
we try to ensure that the providers associated
with our Network understand Misophonia from an
interdisciplinary perspective and have a working
Misophonia Treatment knowledge of the scope of Misophonia research
and clinical practice standards.
While there is no official treatment for Misophonia,
a multidisciplinary approach can be used to help Dr. Jennifer Jo Brout formed the IMRN in order
patients cope with Misophonia. Coping skills are to facilitate cross-disciplinary research in
an important part of managing Misophonia. Misophonia and conditions related to auditory
over-responsivity. The IMRN connects sufferers
Coping skills are beneficial for Misophonia and researchers to accurate and current
patients, because they help patients to: information related to the disorder. The IMRN
• Reduce the intensity and duration of reactivity supports science that informs treatment and
when triggered better practice standards for Misophonia. The
IMRN does not accept donations and instead
• Ease the anxiety and emotional distress related facilitates research through crowd sourcing and
to Misophonia other funding strategies. You can find the provider
network at www.Misophoniaproviders.com .
• Help sufferers to understand the disorder
• Improve academic, occupational, or social
functioning
• Reduce family tensions related to Misophonia
• Allow sufferers and their families to advocate for
themselves while at work and in school
Coping skills are Psychoeducational
(understanding Misophonia, the nervous system,
and the brain), Physiological (how to calm the
3JENNIFER JO BROUT, PSY.D. References and Selected Papers Brout, J.J., Edelstein, M., Erfanian, M., Mannino, M., Miller, L.J., Rouw, R. Rosenthal, M.Z. (2018) Investigating Misophonia: A review of the empirical literature, clinical implications, and a research agenda. Frontiers of Neuroscience, 12(36). doi:10.3389/fnins.2018.00036 Cavanna, A. E., & Seri, S. (2015). Misophonia: current perspectives. Neuropsychiatric Disease and Treatment, 11, 2117–2123. doi:10.2147/NDT.S81438. Danesh, A. A., & Kaf, W. A. (2012). DPOAEs and contralateral acoustic stimulation and their link to sound hypersensitivity in children with autism. International Journal of Audiology, 51, 345-352. doi:10. 3109/14992027.2011.626202 Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. S. (2013). Misophonia: physiological investigations and case descriptions. Frontiers of Human Neuroscience, 11(296). doi:10.3389/ fnhum.2013.00296. Gavin, W. J., Dotseth, A., Roush, K. K., Smith, C. A., Spain, H. D., & Davies, P. L. (2011). Electroencephalography in children with and without sensory processing disorders during auditory perception. American Journal of Occupational Therapy, 65(4), 370-377. doi:10.5014/ ajot.2011.002055. Jastreboff, M. M., & Jastreboff, P. J. (2001). Components of decreased sound tolerance: hyperacusis, Misophonia, phonophobia. ITHS News Letter, 2, 5–7. Jastreboff, M. M., & Jastreboff, P. J. (2002). Decreased sound tolerance and tinnitus retraining therapy (TRT). Aust. NZ J. Audiol., 24, 74–84. doi:10.1375/audi.24.2.74.31105. Jastreboff, P. J., & Jastreboff, M. M. (2014). “Treatments for decreased sound tolerance (hyperacusis and Misophonia),” in Seminars in Hearing, 35(2). New York, NY: Thieme Medical Publishers. Kumar, S., Hancock, O. T., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., Griffiths, T.D. (2017). The brain basis for Misophonia. Current Biology, 27(4), 527-533. doi:10.1016/j. cub.2016.12.048 Meltzer, J., & Herzfeld, M. (2014). “Tinnitus, hyperacusis, and Misophonia toolbox,” in Seminars in Hearing, 35. New York, NY: Thieme Medical Publishers. Rouw, R., & Erfanian, M. (2017). A large-scale study of Misophonia. Journal of Clinical Psychology, 74(3), 453-479. doi:10.1002/jclp.22500. [Epub ahead of print]. Schröder, A., van Diepen, R., Mazaheri, A., Petropoulos-Petalas, D., de Amesti, V. Vulink, N., & Denys, D. (2014). Diminished n1 auditory evoked potentials to oddball stimuli in Misophonia patients. Frontiers in Behavorial Neuroscience, 8(123). doi:10.3389/fnbeh.2014.00123. Webber, T. A., Johnson, P. L., & Storch, E. A. (2014). Pediatric Misophonia with comorbid obsessive– compulsive spectrum disorders. General Hospital Psychiatry, 36(2), 231 e1. doi:10.1016/j. genhosppsych.2013.10.018. 4
INTERNATIONAL MISOPHONIA RESEARCH NETWORK
Further Reading
Baguley, D. M., & McFerran, D. J. (2011). “Hyperacusis and disorders of loudness perception,” in
Textbook of Tinnitus. A. R. Møller, B. Langguth, D. DeRidder, & T. Kleinjung (Eds.) New York, NY:
Springer.
Davies, P. L., & Gavin, W. J. (2007). Validating the diagnosis of sensory processing disorders using
EEG technology. American Journal of Occupational Therapy, 61, 176–189. doi:10.5014/ajot.61.2.176.
LeDoux, J. (2015). Anxious: Using the Brain to Understand and Treat Fear and Anxiety. New York,
NY: Penguin.
Neal, M., & Cavanna, A. E. (2013). Selective sound sensitivity syndrome (Misophonia) in a patient
with Tourette syndrome. Journal of Neuropsychiatry and Clinical Neurosciences, 25(1), E01–E01.
doi:10.1176/appi.neuropsych.11100235.
Perry, W., Minassian, A., Lopez, B., Maron, L., & Lincoln, A. (2007). Sensorimotor gating deficits in
adults with autism. Biological Psychiatry, 61(4), 482–486. doi:10.1016/j.biopsych.2005.09.025.
Rosenthal, M. Z., Neacsiu, A. D., & Geiger, P. J. (2016). Emotional reactivity to personally-relevant
and standardized sounds in borderline personality disorder. Cognitive Therapy and Research, 40(3),
314–327. doi:10.1007/s10608015-9736-y.
5JENNIFER JO BROUT, PSY.D. Misophonia Links and Resources http://www.Misophonia-research.com/ International Misophonia Research Network. http://www.Misophoniainternational.com/ Misophonia International. http://www.psychologytoday.com/blog/noises Blog by Dr. Brout on Misophonia research and coping. https://www.amazon.com/Exploring-Misophonia-Shaylynn-Hayes/dp/1544279280 Exploring Misophonia (2017) by Shaylynn Hayes, edited by Dr. Brout. An anthology on Misophonia, incorporating interviews with sufferers and professionals. https://www.allergictosound.com Allergic to Sound, a Misophonia advocacy and community site based in the UK. http://dukescience.org/content/Misophonia Misophonia and Emotional Regulation Program at Duke University co-founded by Dr. Brout. Other Resources https://self-reg.ca The MEHRIT Center, an educational organization, established by Dr. Stuart Shanker to work towards a vision of calm, alert children, youths, and adults flourishing in physically and emotionally nurturing environments. https://www.spdstar.org SPD Star Institute, for comprehensive information on Sensory Processing Disorders http://differentbrains.com Different Brains, a not-for-profit organization dedicated to promoting the understanding and acceptance of the basic variations in the human brain known as neurodiversity http://a2aalliance.org The Adversity 2 Advocacy Alliance, a nonprofit organization dedicated to promoting and fostering the power of turning personal challenges into service to others with similar challenges. 6
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