Properties (16)

Id 112ca1f0-a946-4e0c-b1d5-d67d608d1e45

Year 2023

Abstract Clinical observations of hundreds of patients who exhibited decreased tolerance to sound showed that many of them could not be diagnosed as having hyperacusis when negative reactions to a sound depend only on its physical characteristics. In the majority of these patients, the physical characteristics of bothersome sounds were secondary, and patients were able to tolerate other sounds with levels higher than sounds bothersome for them. The dominant feature determining the presence and strength of negative reactions are specific to a given patient's patterns and meaning of bothersome sounds. Moreover, negative reactions frequently depend on the situation in which the offensive sound is presented or by whom it is produced. Importantly, physiological and emotional reactions to bothersome sounds are very similar (even identical) for both hyperacusis and misophonia, so reactions cannot be used to diagnose and differentiate them. To label this non-reported phenomenon, we coined the term misophonia in 2001. Incorporating clinical observations into the framework of knowledge of brain functions allowed us to propose a neurophysiological model for misophonia. The observation that the physical characterization of misophonic trigger was secondary and frequently irrelevant suggested that the auditory pathways are working in identical manner in people with as in without misophonia. Descriptions of negative reactions indicated that the limbic and sympathetic parts of the autonomic nervous systems are involved but without manifestations of general malfunction of these systems. Patients with misophonia could not control internal emotional reactions (even when fully realizing that these reactions are disproportionate to benign sounds evoking them) suggesting that subconscious, conditioned reflexes linking the auditory system with other systems in the brain are the core mechanisms of misophonia. Consequently, the strength of functional connections between various systems in the brain plays a dominant role in misophonia, and the functional properties of the individual systems may be perfectly within the norms. Based on the postulated model, we proposed a treatment for misophonia, focused on the extinction of conditioned reflexes linking the auditory system with other systems in the brain. Treatment consists of specific counseling and sound therapy. It has been used for over 20 years with a published success rate of 83%.

Cssclasses

purpleRed

Aliases

The neurophysiological approach to misophonia
(Jastreboff & Jastreboff, 2023)

Key Terms

decreased sound tolerance (DST)
phonophobia

Import Date 04-20-2024

Dissertation Source Tags

#Misophonia
DST
clinical
Neurophysiological models
treatment
lit review

Quick Cites 2

Dv Limitations N/A

Dv Initial Source My Dissertation MOC

Dv Status #status/reviewed

Dv Relevance • a good lit review on the history of Misophonia research from the perspective of the Jasterboffs, with an emphasis on the neurophysiology of the topic. • make a point about the dominate feature of a trigger being the meaning it has for the individual Misophonic • provides some proposed mechanistic models of misophonia vs those proposed for hyperacusis • provides an interesting explanation for why some things are more likely to be triggers as a result of complex conditioning • provides examples of clinical observations dispositive of the dx criteria from Schröder 2013 • discuses Misophonia in the context of the neurophysiological model of DST • discusses the Jastreboffs proposed method of Misophonia treatment. primarily counseling + sound therapy • criticizes the Swedo definition of Misophonia for not being specific enough to distinguish Misophonia from hyperacusis. ([page 6](zotero://open-pdf/library/items/ZJG3VMTE?page=6&annotation=3V94EHLG))

Dv Future Directions N/A

Checked For Zettle Notes true

Zotero Note Link Generated true

The neurophysiological approach to misophonia: Theory and treatment

Status:: #status/reviewed

Metadata

Item Type: #journalArticle
Authors: Pawel J. Jastreboff, Margaret M. Jastreboff,
Date Added: February 22, 2024
URL: https://www.frontiersin.org/articles/10.3389/fnins.2023.895574/full
DOI: 10.3389/fnins.2023.895574
Cite Key: jastreboffNeurophysiologicalApproachMisophonia2023
Tags: #Misophonia, #Neurology, #literature-review, #treatment, #audiology, #hyperacusis, #autonomic-nervous-system, #definitions, #limbic-system, #subconscious-conditioned-reflexes, #tinnitus, #Hyperacusis, #decreased-sound-tolerance

Article Review Table: (Jastreboff & Jastreboff, 2023)


Background/Purpose	Background- Purpose- • describe the origin and supporting data leading to the concept/definition of Misophonia • summarize the key observations accumulated over the three decades the authors have been treating people with decreased sound tolerance (DST), and how these observations support the idea that Misophonia is a different condition. • clarify misconceptions and controversies that have arisen surrounding Misophonia • justify the a potential model for Misophonia that is the result of combining clinical observations with basic neuroscience knowledge. (page 2)
Participants/samples	N/A
Measures	N/A
Procedures	lit review + first hand clinical experience
Results	N/A
Discussion/Limits	Conclusion- • a major takeaway from existing lit is that Misophonia reflects overly strong autonomic and limbic system reactions, stemming from hyper functional connectivity between auditory, limbic, and autonomic systems in response to specific trigger sounds. though the resposnes are not a function of the sounds themselves, but rather the result of ones interpretation /experience with the sounds. (page 7) Limitations-
Relevance::	• a good lit review on the history of Misophonia research from the perspective of the Jasterboffs, with an emphasis on the neurophysiology of the topic. • make a point about the dominate feature of a trigger being the meaning it has for the individual Misophonic • provides some proposed mechanistic models of misophonia vs those proposed for hyperacusis • provides an interesting explanation for why some things are more likely to be triggers as a result of complex conditioning • provides examples of clinical observations dispositive of the dx criteria from Schröder 2013 • discuses Misophonia in the context of the neurophysiological model of DST • discusses the Jastreboffs proposed method of Misophonia treatment. primarily counseling + sound therapy • criticizes the Swedo definition of Misophonia for not being specific enough to distinguish Misophonia from hyperacusis. (page 6)

Notes

key terms and concepts:

decreased sound tolerance (DST)- a class of auditory issues defined by abnormally negative reactions to sounds. this is an overarching term for a class of issues that includes things like Phonophobia and hyperacusis. (page 2)
phonophobia- an persistent and abnormal fear of sound. in the context of Misophonia , it could be considered a form of Misophonia where the dominate response is fear. (page 6)

my engagement notes

my questions

my comments

Bookmarks

bookmark for talking about the history of Misophonia (page 2)
bookmark for talking about Ménière’s disease. used to illustrate the potential problems that can arise when foundations of a research field are based on a faulty etiology (page 5)
bookmark for talking about the logic behind the neurophysiological model of Misophonia and hyperacusis (page 6)
bookmark talking abut proposed treatments for both Misophonia and hyperacusis based on the model in the paper. (page 8)
bookmark for future directions (page 11)

reading notes

the lack of a consensus dx criteria means it is hard if not impossible to combine research results across studies because they end up using different rules for Misophonia status. (page 5)
a lot of Misophonia research is contaminated by the fact they fail to account for hyperacusis. this is a problem because despite the similar ( almost identical) reactions from both conditions, hyperacusis treatment is not effective for Misophonia
- this similarity runs the risk of confusing Misophonia results as actually hyperacusis results. (page 5)
The authors argue that the similarity in symptoms between Misophonia and hyperacusis, makes it such that one should completely exclude people with hyperacusis from Misophonia research (page 5)
major diff between Misophonia and hyperacusis is that hyperacusis symptoms are the same for any stim, it is dependent on volume. in contrast, Misophonia is mainly about the stim source and identification, and loudness if secondary if relevant at all.. for instance, a Misophonic may react strongly to a trigger but fail to react to another, louder sound. (page 6)
the authors criticizes the Swedo definition of Misophonia for not being specific enough to distinguish Misophonia from hyperacusis. (page 6)
a big idea about Misophonia triggers is that the dominate feature of a trigger is its meaning to an individual Misophonic. this idea makes the topic more complex then a simple single stimulus, involving a complex interaction of of other dimensions ( ex: the environment, history with trigger, etc.) (page 6)

authors describe an idea that the complex conditioned stimuli in Misophonia explains a few oddities in Misophonia.

- specifically:
   - why some classes of sounds are more likely to be triggers
   - why different people ( most commonly close family) cause more interested resposnes then others
   - the reduced resposnes to triggers that are not identified/misidentified. (page 7)

authors clinical experience working with Misophonics is dispositive of some of the dx criteria from Schroder 2013

specifically:
   - triggers are not all orofacial sounds or human sounds
   - anger is not always a symptom
   - aggressive outbursts are uncommon
   - most Misophonics thing trigger are rude and their reactions justified.
   - avoidance and discomfort are the primary responses
   - resposnes can be mild, and can mimic those seen in tinnitus or hyperacusis
the authors then go on to criticize the Schröder model for not being very specific or selective , noting its tendency to lump in other unrelated issues ( ex: hyperacusis) and just generally claiming that the Schröder model is unhelpful;. (page 9)

models for hyperacusis vs Misophonia

image-7-x309-y548.pngFIGURE 2 Proposed mechanisms of misophonia. The thick red arrow in the red oval marks the functional linking of the subconscious part of the auditory system with the limbic and autonomic nervous systems, postulated to be responsible for misophonia. All systems in the brain could be working within the norm. Other symbols are described in Figure 1. page 7556x484

zettlekasten

Jastreboff 2023 contradicting Schroder 2013 dx criteria

Jastreboff 2023 idea that the complex conditioned stimuli in Misophonia explains a few oddities in Misophonia

Jastreboff 2023 on the difference between Misophonia and hyperacusis

Jastreboff 2023 criticism of the Swedo definition of Misophonia due to lack of hyperacusis specificity