diverging future directions for Misophonia based on the importance of depending on the top down or bottom up nature of of Misophonic responses

One of the motivations of a 2022 study was to disentangle the nature of the Misophonic responses as either being a top down or bottom up process. the authors discuss potential lines of treatment focus based on these possible observations. they hold that if the evidence supports role of acoustic cues as important, solutions should modify acoustic properties of triggers. is top down properties turn out to be the driver, interventions should disrupt the associative link with each trigger. (Savard et al., 2022)

Characterizing real time course of Misophonic responses

In a 2026 study, Shan attempted to characterize real-time emotional responses to misophonia triggers in naturalistic settings and examine their temporal dynamics and individual variability, by having 40 adults with misophonia complete smartphone surveys five times daily for 10 days, rating 16 negative emotions during both trigger and no-trigger periods. They found that triggers elicited significant elevations in negative emotions (particularly irritability and anger, with large effect sizes), most emotions returned to baseline within 31-60 minutes, but substantial individual variability existed in both reactivity magnitude and recovery speed, with greater reactivity associated with higher baseline negative affect, misophonia severity, and co-occurring psychopathology. From this they concluded that misophonia involves phasic context-dependent emotional reactivity centered on anger rather than chronic distress or primarily fear-based responses, and that treatment should move beyond one-size-fits-all fear-based approaches toward personalized, process-based interventions targeting individual emotional patterns, anger regulation, and distress tolerance. (Shan et al., 2026)

Hansen 2024 implications for social cognition in Misophonia

In a 2024 study, Hansen reported that exposure to aversive sounds is associated with impairments in social and cognitive judgments, particularly in individuals with misophonia. The findings showed that misophonic aversion extends beyond oral triggers to include non-oral sounds, and that explicit identification of a sound modulates perceived discomfort across the general population, with these effects being amplified in misophonia. Misophonia was also linked to generalized performance deficits on basic tasks such as gender judgment, suggesting broader cognitive interference. Importantly, trait and likeability judgments were selectively influenced by explicit source memory for the sounds in misophonia, indicating that social evaluations are shaped by conscious sound–source appraisal. Overall, the results suggest that when misophonic individuals experience sustained discomfort, their social and cognitive judgments are reliably disrupted.(Hansen et al., 2024)

central role of anger and disgust in Misophonia

In a 2022 study, Dibb and Golding conducted a longitudinal study looking at which negative emotions (anger, disgust, or anxiety) are most strongly associated with misophonia. they found that Anger and disgust emerged as the primary emotions associated with misophonia, with both predicting misophonic responses over time even after controlling for depression. Disgust specifically predicted stronger emotional responses to triggers and greater perceived impact on participation in life at follow-up, while anger predicted longer recovery times and stronger physiological responses. Both anger and disgust predicted overall misophonia severity scores longitudinally, whereas anxiety did not predict any misophonic responses over time, indicating that anger and disgust are more central to the misophonic experience than anxiety (Dibb & Golding, 2022). Also note that This directly contradicts (Jager et al., 2020) finding of no association between disgust and misophonia

observation of person focused specificity of trigger responses

it has been observed the Misophonia response can be enhanced when the trigger source are specific people (ex - parents). this suggests a role of top down cognitive processing in Misophonia.
(Savard et al., 2022, Edelstein et al., 2013)

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

In their 2023 review of misophonia, the Jastreboffs argue that misophonia reflects complex conditioned stimuli in which triggers encompass not only acoustic features but also contextual and interpersonal associations. This model explains why certain sound classes, such as eating or breathing, are common triggers due to their social and emotional salience. It also accounts for stronger reactions to sounds produced by specific individuals, often close family members, because personal history becomes embedded in the conditioned response. Moreover, variability in reactions based on source identification supports this framework: if acoustic properties alone determined the response, intensity would remain constant, but the observed modulation indicates activation of a broader conditioned network (Jastreboff & Jastreboff, 2023).

Savard 2022 findings in support of top down processes in Misophonia

In a 2022 study examining subjective aversiveness ratings and sound-source identification across trigger and non-trigger sounds at varying signal-to-noise ratios, Savard and colleagues found that, on trials where triggers were correctly identified, individuals with higher misophonia severity reported the strongest aversive responses. This pattern was also observed for generally unpleasant sounds but was more pronounced for trigger sounds, supporting the interpretation that misophonia is driven primarily by top-down evaluative processes rather than bottom-up sensory differences.(Savard et al., 2022)

Savard 2022 findings arguing against bottom up processes in Misophonia

• In a 2022 study examining subjective aversiveness ratings and sound-source identification across trigger and non-trigger sounds at varying signal-to-noise ratios, Savard and colleagues found that individuals with high versus low misophonia, as assessed with the MisoQuest, did not differ in their ability to detect trigger sounds. This suggests that misophonia is unlikely to reflect a purely bottom-up sensory processing abnormality (Savard et al., 2022)
  • this also contradicts past research suggesting differences in low level auditory processing in Misophonics (Schröder et al., 2014)

Misophonia and co-occurring sound tolerance disorders linked to multimodal sensory over- and under-responsiveness, pointing to processing differences beyond the auditory system.

In a 2026 study, Meral Çetinkaya and colleagues investigated whether decreased sound tolerance disorders (hyperacusis, misophonia, and phonophobia) are associated with broader sensory processing differences in normally hearing adults without neurological disorders. They assessed 315 participants using pure-tone audiometry and two self-report measures: the Decreased Sound Tolerance Scale–Screening (DSTS-S) and the Adult Sensory Processing Scale (ASPS), and analyzed correlations and logistic regression models. They found that misophonia, and especially co-occurring (dual and triple) decreased sound tolerance, were associated with elevated sensory over responsiveness and under responsiveness across multiple non-auditory domains, whereas pure hyperacusis and phonophobia showed more limited patterns. From this they concluded that decreased sound tolerance may involve multimodal sensory processing difficulties beyond the auditory system, particularly when multiple DST types co-occur (Meral Çetinkaya et al., 2026).

non-trigger stimuli reveals fundamental cortical processing differences independent of emotional reactivity

Karupaiah et al. (2025) deliberately used a non-trigger speech stimulus (/da/) confirmed to be aversive to none of their misophonic participants, finding that earlier P1-N1-P2 latencies, reduced N1 amplitudes, and atypical scalp topographies nonetheless emerged in the misophonia group relative to controls. The authors interpret this as evidence that misophonia involves fundamental alterations in auditory cortical processing that are not contingent on emotional reactivity to trigger sounds, suggesting a generalized difference in how the auditory system operates rather than a stimulus-specific response. Whether these differences are predisposing to misophonia or acquired through repeated emotional exposure to triggers remains an open question (Karupaiah et al., 2025).

temporarily modulated sounds tend to stand out from background noise and grab peoples attention

• one acoustic property that tends to grab peoples attention is modulation. sound signals that are modulated tend to stand out from background noise, and some modulation rates are known to produce a “rough” sensation and are associated with greater perceptions of pleasantness/unpleasantness in some naturalistic sounds.
  • such sounds are also thought to be processed through bottom-up mechanisms
  • this has some implications for misophonia., as Misophonia triggers tend to share this feature (i.e. the modulation of chewing, modulation of leg swigging (leg position?) etc.)
  • (Savard et al., 2022)

finding of increased general sound reactivity for Misophonics

in a 2023 study where participants rated the aversiveness of different human/animal sounds while alternating contextual conditions ( no context, correct context, false context), it was found that Misophonics related all stim more aversive and arousing and with less self reported feelings of dominance then controls (Siepsiak et al., 2023).

strong link between physiological and affective dimensions of Misophonia

In a 2026 study, Woolley aimed to qualitatively characterize negative cognitions during and after misophonia triggers by analyzing interview responses from 60 treatment-seeking adults. they found that many of the self reported thoughts during and immediately after trigger exposure acted to appraise the emotional responses they were suffering, suggesting a tight link between the physiological and affective dimensions of Misophonia (Woolley et al., 2026a page 10)

commentary on the nature of Misophonic triggers as generally aversive

in their 2024 paper, Simner Author highlights that has been coming up more and more in recent years, the fact that a lot of Misophonia triggers are slightly disturbing even to people without Misophonia. Because of this there’s an inherent difficulty in separating the Misophonic effect from just general aversiveness. (Simner et al., 2024 )

Savard 2022 findings against generalized sound sensitivity in Misophonia

In a 2022 study examining subjective aversiveness ratings and sound-source identification across trigger and non-trigger sounds at varying signal-to-noise ratios, Savard and colleagues found that, on trials where triggers were correctly identified, individuals with higher misophonia severity reported the strongest aversive responses. Although this pattern was also present for generally unpleasant sounds, it was markedly stronger for trigger sounds, suggesting that misophonic reactivity is trigger-specific rather than a reflection of generalized sound sensitivity. (Savard et al., 2022)

Misophonia's executive deficits may stem from the cognitive load of managing responses rather than underlying dysfunction, echoing chronic-pain research on resource depletion.

in there 2025 literature review, Savard and Coffey discuses how when considering the relationship between abnormal executive functioning and Misophonia and important thing to consider is what causes what. while it is easy to assume that abnormal executive functions are the root of the issue, it could be the inverse. it is possible that executive functions are normal in Misophonia, but the added cognitive load from mitigating Misophonia responses could be taking cognitive resources that in turn cause the impaired cognitive functions. this is similar to an idea in pain research that those with chronic pain use more cognitive resources for self regulation and attention then healthy people. (Savard & Coffey., 2025)

Misophonia involves higher order cognitive process more then simple sensory system issues

in their 2025 literature review, Savard et all note that research showing the behavioral and cognitive differences between Misophonics and controls suggests that it is not simply an issue of the peripheral sensory system. rather it is a complex issue linked to higher cognitive processes such as perceptual decision making, attentional control, response inhibition, and perceptual alertness. (Savard & Coffey., 2025)

findings suggest that Misophonia mechanisms are not specific to triggers

In a 2026 study, Black et al. investigated the relationships between misophonia severity and affective flexibility, cognitive flexibility, and rumination, employing the Memory and Affective Flexibility Task (MAFT), a novel neurocognitive paradigm that embeds affective task-switching demands within an N-back working memory structure using emotionally valenced images, alongside a battery of self-report measures in a sample of 140 adults. Reduced switch accuracy on the MAFT was observed in response to emotionally valenced images unrelated to auditory triggers, indicating that affective switching difficulties in misophonia generalize beyond the misophonic trigger context. Cognitive inflexibility as measured by the DFlex was broadly associated with misophonia severity across multiple subscales, extending the pattern into trait-level, context-general rigidity. All three rumination subtypes (perseverative thinking, brooding, anger rumination) predicted misophonia severity above and beyond anxiety, depression, and hyperacusis, and these ruminative tendencies were measured as general cognitive styles rather than misophonia-specific ones. Taken together, the data support the view that misophonia involves a broader cognitive-affective profile of rigidity and perseverative responding, not simply a conditioned reaction to a specific class of stimuli (Black et al., 2026).

Misophonia severity linked to greater emotional switch costs, attributed jointly to reconfiguration difficulty and task-set inertia rather than either alone.

Black et al. (2026) examined affective switching costs in misophonia through the lens of two complementary theories of task-switching, finding that individuals with higher misophonia severity showed reduced accuracy on emotionally valenced switch trials. Task-Set Reconfiguration theory suggests these costs reflect impaired top-down cognitive control during the reconfiguration of a new emotional task set, consistent with documented cognitive control deficits in misophonia when confronted with triggers. Task-Set Inertia theory alternatively frames the costs as residual activation from prior task sets interfering with the transition to an emotional task, suggesting misophonic individuals may be especially susceptible to carryover interference during affective switching. The authors treat these accounts as mutually inclusive rather than competing, arguing that both reconfiguration difficulty and inertia-driven interference likely jointly contribute to the elevated emotion switch costs observed in this population (Black et al., 2026).

Elevated autonomic arousal and salience-network engagement in misophonia suggest sustained vigilance that lowers the aversiveness threshold and lets sensory input override cognitive control.

In a 2024 paper, Murphy discussed the role of vigilance in misophonia, noting that prior findings of elevated galvanic skin response, heart rate, and muscle tension to trigger sounds suggest heightened autonomic arousal. Such sustained vigilance may disrupt working memory and daily functioning, and anticipatory alertness to potential triggers may contribute to increased sensitivity and mood disturbance. Neuroimaging studies further indicate altered engagement of the salience network, implying a lowered threshold for stimuli to be perceived as aversive. Behaviorally, this heightened vigilance may allow sensory input to override cognitive control, as observed in Stroop task interference effects. (Murphy et al., 2024)

results showing impaired cognitive control in Misophonics

a 2020 paper found that The study found that individuals who report stronger emotional and behavioral reactions to misophonia trigger sounds exhibit significantly worse cognitive control, as indicated by a larger Stroop effect, but only when exposed to misophonia-related sounds, not universally unpleasant ones. The Stroop task requires participants to name the ink color of a word while inhibiting the automatic tendency to read the word, with greater interference reflecting poorer cognitive control. This effect was independent of general personality traits like neuroticism. Additionally, both misophonia sensitivity and emotional reactivity were associated with slower cognitive processing and increased anxiety during exposure to aversive sounds, with emotional reactivity also predicting higher baseline anxiety. These findings suggest that misophonia is linked to functional depletion of cognitive control in symptom-provocation contexts, especially for individuals with strong emotional responses to trigger sounds. (Daniels et al., 2020)

Response Bias Favoring Accuracy Over Speed (Perfectionism / Behavioral Inflexibility Framing)

A stop-signal task study found that individuals with misophonia exhibited a response bias favoring accuracy over speed, accompanied by elevated psychopathology scores and neural patterns suggesting excessive cognitive control and self-monitoring. The authors interpreted this pattern as consistent with traits such as perfectionism and compulsivity, rather than impulsivity, aligning misophonia with behavioral styles characterized by rigid rule adherence and intolerance of mistakes. (Eijsker et al., 2019)

Misophonic youth showed heightened attentional sensitivity (greater d', scaling with trigger count), consistent with hypervigilance and hyperarousal.

In a 2024 study, Murphy investigated attentional processing in youth with misophonia using an Immediate Memory Task adapted from the continuous performance task to assess discriminability and response bias. The authors predicted that the ex-Gaussian tau component of reaction time and heightened response sensitivity with a more liberal bias would characterize misophonia, reflecting hypervigilance. Results showed greater discriminability (d’) in the misophonia group compared to an anxiety group, a positive association between number of triggers and d’, and a moderate effect of age on d’, with no group differences in overall accuracy or reaction time. These findings support the idea that misophonia in youth is associated with heightened attentional sensitivity and hyperarousal, potentially reflecting developmental differences in executive attention. (Murphy et al., 2024)

Body

Misophonia severity linked to greater emotional switch costs, attributed jointly to reconfiguration difficulty and task-set inertia rather than either alone.

Black et al. (2026) examined affective switching costs in misophonia through the lens of two complementary theories of task-switching, finding that individuals with higher misophonia severity showed reduced accuracy on emotionally valenced switch trials. Task-Set Reconfiguration theory suggests these costs reflect impaired top-down cognitive control during the reconfiguration of a new emotional task set, consistent with documented cognitive control deficits in misophonia when confronted with triggers. Task-Set Inertia theory alternatively frames the costs as residual activation from prior task sets interfering with the transition to an emotional task, suggesting misophonic individuals may be especially susceptible to carryover interference during affective switching. The authors treat these accounts as mutually inclusive rather than competing, arguing that both reconfiguration difficulty and inertia-driven interference likely jointly contribute to the elevated emotion switch costs observed in this population (Black et al., 2026).

Prior null flexibility findings in misophonia may stem from emotionally neutral tasks; the affect-laden MAFT was designed to surface deficits that neutral tasks like the WCST and Stroop miss.

in a 2026 study, Black et al. identify five non-exclusive explanations for prior null or inconsistent task-based flexibility findings in misophonia: definitional inconsistency across studies, methodological and reporting biases, context-specificity of deficits to trigger stimuli, poor correspondence between self-report and neuropsychological task measures, and use of emotionally neutral stimuli insufficient to recruit affective switching processes. The Stroop-trigger specificity finding from (Daniels et al., 2020) and the null WCST result from (Abramovitch et al., 2023) are both consistent with the view that general-purpose neutral flexibility tasks miss the affective dimension central to misophonic reactivity. The MAFT was selected specifically to address the emotionally neutral-task limitation by embedding switching demands within affectively valenced material, with the hypothesis that this context is necessary to surface flexibility impairments (Black et al., 2026).

audiological evidence of trigger specific impairments to selective attention in Misophonia

In a 2018 study, Silva examined whether misophonia is associated with selective attention impairment specific to trigger sounds by comparing dichotic sentence identification (DSI) test performance across three conditions (conventional, white noise, chewing sound distractor) in misophonic (n = 10), tinnitus (n = 10), and asymptomatic (n = 20) normal-hearing participants. They found that the misophonia group performed more poorly than both control groups only on the DSI + chewing condition, with no group differences on the conventional DSI or DSI + white noise conditions. From this they concluded that selective attention may be specifically impaired in misophonic individuals when exposed to sounds that function as triggers, consistent with clinical reports of sound-specific attentional disruption in this population (Silva & Sanchez, 2019).

Hansen 2024 finds evidence of split attention cost and broader task interference in Misophonia when exposed to aversive sounds

In a 2024 study examining how misophonia trigger sounds affect cognitive and social judgments, Hansen found that individuals with misophonia reported higher discomfort ratings for both oral and non-oral sounds, particularly when the sounds were correctly identified, with the strongest effects for oral triggers. The misophonia group also showed slower response times on a basic gender judgment task across sound categories, including an unexpected slowing on no-sound trials, which the authors suggest may reflect cautious waiting to ensure that no sound was present. Faces paired with highly discomforting sounds were rated as less likeable by the misophonia group when the associated sound was correctly remembered, whereas failures of sound source memory were associated with average, nonsignificant differences in likeability, highlighting a cognitive appraisal component of misophonia. Face memory was generally worse for faces paired with high-discomfort and oral sounds compared to control or silence conditions, but this impairment was not specific to the misophonia group. Together, the results point to a split-attention cost and broader task interference in misophonia during exposure to aversive sounds, suggesting everyday burdens for multitasking and social evaluation, along with an unusual trend in which faces paired with low-discomfort sounds were rated as more likeable than novel faces (Hansen et al., 2024)

a 2024 study suggests 3 explanations for the lack of observed memory differences to different sound categories in Misophonia

in there 2024 study looking into the effect of Misophonia triggers on cognitive and social judgments , Hansen found worse memory for faces paired with oral sounds compared to control sounds or silence, but this effect was not dependent on Misophonia status. Hansen suggest three possible explanations for this 1) despite self reported task difficulties when exposed to triggers, Misophonics perform just as well as controls ( less likely explanation). 2) there are different subsets of Misophonia that impact cognitive performance in different ways that wash out when averaged together. 3) task designs were not sufficient to show the Misophonia effect ( i.e. task was not powerful enough to detect the small effect size) (Hansen 2024).

Abramovich 2023 discussion of hot vs cold cognition studies in Misophonia

in a 2023 study , Abramovich et al discusses the topic of hot vs cold cognition in Misophonia research

Hot cognition

• author references (Daniels et al., 2020) as an example of a “hot” cognitive functioning study, where they found impaired stroop task performance in the presence of triggers. this source is another one the prelims reading list and the citation statement is verified (page 2)
• author cites (Silva & Sanchez, 2019) as showing impaired performance on dichotic listing tasks for Misophonics when exposed to triggers. this article was already in our database but had no existing notes. cursory review of abstract verifies the citation statement (page 2)

cold cognition

• the author cites two papers as examples of “cold” cognitive functioning in Misophonia, that being task’s without the presence of triggers, and neither found any misophonia status effects. suggesting that Trigger exposure is required for impairments to cognitive tasks.
  • (Simner et al., 2021) was cited as showing no change/difference in performance on visual attention on embedded figures. this citation was not in our database, and i did not add it because it did not seem interesting, but a quick review of the abstract verifies this citation statement.
  • (Eijsker et al., 2019) was cited as showing no difference on a stop signal task in Misophonics when given without triggers. this source was another one on our reading list and the citation statement is verified (page 2)

Siepsiak et al. (2025): Misophonia linked to enhanced (not impaired) cold cognition, a potential differentiator limited by cross-disorder variability.

in there 2025 study, Siepsiak et al looked at  “cold cognitive processes” like inhibitory control, selective/divided attention, and verbal/abstract reasoning in kids with and without Misophonia using standard assessments. they found that Misophonics had better divided attention and inhibitory control suggesting that Misophonia may be linked to enhanced inhibitory control rather then impaired cognitive functioning. the authors briefly mention the idea of using this lack of cognitive impairment/ specific enhancements as a way to differentiate Misophonia from other conditions, but note challenges stemming from the variability of cognitive impairments seen in many psychiatric disorders. (Siepsiak et al., 2025)

Abramovich 2023 findings on cold cognition in Misophonia

In a 2023 study, Abramovitch et al. conducted the first comprehensive neuropsychological assessment of misophonia under “cold” cognitive conditions (i.e., without trigger exposure) to examine its cognitive, clinical, and functional correlates. Despite administering a broad test battery, they found no significant group differences in executive function, working memory, attention, or non-verbal memory. The only deficits observed in the misophonia group were modest impairments in verbal memory retrieval—specifically on CVLT short-delay recall and semantic fluency tasks. The authors concluded that misophonia is not associated with global cognitive impairment but may involve subtle verbal memory deficits and elevated emotional impulsivity (Abramovitch et al., 2023).

trigger impact on speech in noise discrimination

In a 2025 study, Özdeş evaluated the speech perception performance in noise of individuals with misophonia and investigated the effects of triggering sound number and symptom severity by administering the Hearing in Noise Test under two scenarios (speech-shaped noise alone and speech-shaped noise combined with a buzzing fly trigger) to 40 adults with misophonia and 40 matched controls. They found that the presence of a triggering sound significantly impaired speech perception in noise in the misophonia group compared to controls, with no between-group difference in the standard noise-only condition. Additionally, higher misophonia severity and greater number of triggers were associated with worse performance. From this they concluded that misophonia adversely affects speech perception in noise, particularly when triggering sounds are present, and that the condition influences neurophysiological functioning beyond emotional or psychological responses, with implications for understanding communication difficulties and developing therapeutic interventions (Özdeş & Yılmaz, 2025)

it is possible that vigilance and expectations could impact the task based results of studies on Misophonics

in their 2025 literature review, Savard et all note that Misophonics who expect to get triggered when going into  study might start with a higher baseline arousal then those who don't,. This could impact the ability of the subjects to focus on cognitive tasks and affect baseline physiological measurements in ways not accounted for by experimental designs (Savard & Coffey, 2025)

evidence for Misophonia’s cognitive nature from results on the impact of context on emotional processing

in their 2025 literature review, Savard et all note that research suggests that the emotional reactions to sounds are significantly influenced by the cognitive context, rather then simply the result of the acoustic properties of the sound. for misophonia, this fact also gives strong evidence for it being based on a cognitive process rather then a simple sensory issue. (Savard & Coffey, 2025)

Context-Dependent Reactions Require Personalized Treatment Approaches

In a 2024 study, Woolley attempted to characterize the onset, symptom progression, triggers, and psychiatric comorbidities in treatment-seeking adults with misophonia by conducting structured clinical interviews (Duke Misophonia Interview and DIAMOND) and administering self-report questionnaires to 60 adults meeting clinical criteria for misophonia. They found that Context matters for 97% of participants, with triggers from known people (85%), internal factors like stress or fatigue (80%), and quiet environments (70%) most exacerbating. Only 3% reported context-irrelevant reactions, highlighting the specificity of misophonic distress and distinguishing it from conditions like hyperacusis. Internal states significantly influence symptom intensity, consistent with patterns in other psychopathology. Personalized, flexible interventions should address unique triggers, contextual factors, and individual clinical histories, potentially incorporating multidisciplinary approaches combining cognitive-behavioral strategies with audiological interventions and environmental accommodations (Woolley et al., 2024).

Müfreze 2024 findings about the impact of believed sound source on Misophonic responses

In a 2024 experiment, Müfreze tested whether perceived source influences misophonic distress by manipulating whether trigger sounds were labeled as coming from a relative or someone else. Participants rated discomfort to (1) a sound bank recording labeled as a relative, (2) a relative’s voice labeled as someone else, and (3) a relative’s voice labeled as the relative. Sounds labeled as coming from a relative elicited significantly greater distress regardless of their true acoustic origin, and there was no difference between the two “relative-labeled” conditions. The authors concluded that contextual source attribution, rather than acoustic properties, primarily drives subjective disturbance in human-made misophonic triggers. (Müfreze et al., 2024)

Berger 2024 discussing the potential therapeutic implications of incorporating social cognitive aspects of Misophonia

In their 2024 literature review on misophonia and the role of social cognition, Berger outlines several therapeutic implications of adopting a social cognitive framework. One key implication is the need to examine whether neurobiological and physiological responses to trigger sounds change when the context in which those sounds are perceived is altered. Re-framing a trigger sound within a different interpretive context may reduce the severity of misophonic reactions, and training individuals to actively re-frame triggers could therefore serve as a viable treatment strategy. Supporting this idea, research in non-misophonia participants has shown that stress responses to unpleasant sounds such as nails on a blackboard are reduced when the sounds are presented as contemporary music. Interventions that emphasize contextual reinterpretation rather than the acoustic properties of the sound itself may also extend to misokinesia, the visual analogue of misophonia, and preliminary evidence for the effectiveness of cognitive behavioral therapy suggests that context plays a central role in shaping aversive responses (Berger et al., 2024) .

disgust response to bodily fluids may develop to protect against contamination, and disproportionally intense responses may be modulated by contextual meaning placed on the sounds

Vitoratou describes an interesting idea surrounding the formation of negative responses to bodily sounds. they described the work of Trevor J.Cox who proposes that aversion to bodily sounds developed as mechanism to protect against the contaminates/pathogens that can be found in such fluids. particularly in relation to the aerosolized spit particles that can be formed when chewing with ones mouth open. at the same time, cox claims that such responses are more extreme then would be necessary to avoid contamination, suggesting an modulatory role of meaning/context applied to the behaviors (i.e being rude) in heightening the reactions. (vitoratou et al., 2021)

Kazazis 2024 discussion of the impact of systemic mis-identification of sound sources

in a 2024 paper looking at the impact spectral and temporal modification of trigger and neutrals sounds impacts aversiveness, the authors discuss an interesting explanation there observed large variance in ratings of unmodified stimuli. they attribute this variability to systemic misidentification of the stimuli by the subjects. the authors give the example of subjects possibly mislabeling one stimulus as “chewing” when the experimenters labeled it as “slurping”. (Kazazis et al., 2024)

• it would be wise to address concerns like this in future methods, such as how I am looking at trends in response IDs in the MisoCog2 project project

Spectral modification and source misidentification each reduced trigger aversiveness (most so in combination), pointing to spectral cues and source recognition as central to misophonia.

in a 2024 paper looking at the impact spectral and temporal modification of trigger and neutrals sounds impacts aversiveness, the authors found that spectral modification significantly reduced aversiveness of trigger sounds compared to temporally modified and unmodified sounds. additionally, when subjects mis-identified a sound source (indicated by trial level probes presenting possible source labels), aversiveness also decreased, with this effect most pronounced with the spectrally modified sounds ( i.e. correct sim identification had the biggest impact on the spectrally modified sounds). from this the authors concluded that spectral information and source identification both paly a major role in Misophonia. (Kazazis et al., 2024)

example of congruent vs incongruent audiovisual stimuli effect in Misophonia

in a 2023 study where participants rated the aversiveness of different human/animal sounds while alternating contextual conditions ( no context, correct context, false context), it was found that congruent congruent animal eating sounds/visuals and incongruent human eating sounds/visuals associated with reduced self reported misophonia responses (Siepsiak et al., 2023)

Jastreboff 2023 on the difference between Misophonia and hyperacusis

The major diff between Misophonia and hyperacusis is that in 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. (Jastreboff & Jastreboff, 2023)

Samermit 2022 findings on alternative source videos in Misophonia

in a 2022 study, Samermit sought to establish a database of sound swapped videos to act as Misophonia stimuli in research. specifically, they sought to validate audio-video parings that leveraged acoustic ambiguity in some sounds to manipulate the individuals ability to identify sound sources in videos. this was done by pairing trigger source sounds with plausible alternative visuals, and having participants review all the videos and give individualized aversiveness ratings. the authors found significant reductions in Misophonic resposnes when the audio was paired with a pleasant visual, validating the stimulus set and demonstrating the top down aspect of the Misophonic response. (Samermit et al., 2022)

finding on how degrading a trigger sound impacts the misophonia response

Heller and Smith., 2022 examined the role of source identification in the emotional responses, having subjects exposed to sounds of various emotional categories ( trigger, neutral, unpleasant, pleasant). they manipulated the indefinability of these sounds, evidenced by increased misidentification, by degrading the signal via envelope vocoding. this resulted in a change in subjects reported pleasantness of the sound based on it's misidentification, with more pleasant misidentifications being associated with more pleasant valance ratings and vice versa.

observed top down influence in Misophonia triggers suggests interventions targeted at breaking trigger associative links

A 2022 study looked at the specificity of Misophonic responses, using a signal to noise paradigm. on trials where the source of sounds were identified, Misophonic participants reported greater aversiveness then controls, with a similar but weaker trend for generally aversive sounds. from this the authors suggest that interventions  might benefit from focus on braking the associative links with specific trigger sounds. (Savard et al., 2022)

Spectral modification and source misidentification each reduced trigger aversiveness (most so in combination), pointing to spectral cues and source recognition as central to misophonia.

in a 2024 paper looking at the impact spectral and temporal modification of trigger and neutrals sounds impacts aversiveness, the authors found that spectral modification significantly reduced aversiveness of trigger sounds compared to temporally modified and unmodified sounds. additionally, when subjects mis-identified a sound source (indicated by trial level probes presenting possible source labels), aversiveness also decreased, with this effect most pronounced with the spectrally modified sounds ( i.e. correct sim identification had the biggest impact on the spectrally modified sounds). from this the authors concluded that spectral information and source identification both paly a major role in Misophonia. (Kazazis et al., 2024)

Spectral modification cut trigger aversiveness while temporal changes did not, implicating spectral cues averaged over ~250 ms in misophonic triggers.

in a 2024 paper looking at the impact spectral and temporal modification of trigger and neutrals sounds impacts aversiveness, the authors found that spectral modification significantly reduced aversiveness of trigger sounds compared to temporally modified and unmodified sounds. this finding, taken with the lack of effect of temporal modification of 25-ms within 250ms radius on aversiveness, the authors suggest that spectral information averaged over 250ms is important for triggers in Misophonia. (Kazazis et al., 2024)

• Note that I do not fully think I understand this logic