Etiology, Composition, Development and Maintenance of Misophonia: A Conditioned Aversive Reflex Disorder

Status:: #status/reviewed

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• Item Type: #journalArticle
• Authors: Thomas H. Dozier
• Date: 2015-04-30
• Date Added: 2020-01-15
• URL: http://psyct.psychopen.eu/article/view/132
• DOI: 10.5964/psyct.v8i1.132
• Cite key: dozierEtiologyCompositionDevelopment2015
• Topics: primary Resources
• Tags: #Article-review, #Misophonia, #added-to-Misophonia-data-base, #to-be-annotated, #Fully-reviewd, #noted, #reviewed, #tags-need-to-be-checked, #zotero, #literature-notes, #reference
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Abstract

Misophonia is a recently identified condition in which an individual has an acute reaction of hatred or disgust to a specific commonly occurring sound. We propose that misophonia is a form of conditioned behavior that develops as a physical reflex through Pavlovian conditioning. Although misophonia is generally considered to be a one-step reaction, in which the sound elicits rage or disgust, as well as typical autonomic responses associated with these emotions, we propose that misophonia is a two-step reaction, in which the sound elicits an aversive conditioned physical reflex, and the aversive conditioned physical reflex elicits hatred or disgust. We also propose that the emotional response to trigger stimuli creates a Pavlovian conditioning paradigm that maintains or strengthens the misophonic physical reflex. Finally, we propose that new misophonic trigger stimuli are developed through the pairing of a neutral stimulus with a misophonic trigger stimulus. We suggest that a better name for misophonia is Conditioned Aversive Reflex Disorder (CARD) since it focuses attention on the reflexive nature of this condition and incorporates multiple stimuli modalities. A counterconditioning treatment for misophonia is presented with brief case descriptions which demonstrate the conditioned reflex nature of this disorder.

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Article Review-  (Dozier, 2015a)

Article Review table

| Background/Purpose | Use of case studies to show the following hypotheses:
1. Misophonia develops as a Pavlovian-conditioned physical and/or emotional reflex.
2. Misophonia is often comprised of a physical muscle reflex that is elicited by the trigger stimulus and an emotional response that is elicited by the sensation of the physical muscle movement
3. The misophonic response to trigger stimuli is maintained (or strengthened) due to the physical reflex increasing in intensity during the conditioning episodes associated with each Stimulus presentation.
4. Additional trigger stimuli can develop by being paired with previously conditioned trigger stimuli and the reflex response they produce.
|
| Participants/samples | Case study’s/literature review |
| Measures | Case study’s/literature review |
| Procedures | Case study’s/literature review |
| Results | Found support for all stated hypothesis. |
| Discussion/Limits | Reliance on 10 case studies ( of one person per study) limits generalizability. The author is a private practitioner, with a “doing business as” entity of the Misophonia Treatment Institute (MTI), in which he serves as director. The MTI also trains other practitioners in techniques of misophonia treatment. The author is the developer of the Misophonia Trigger Tamer, Visual Trigger Tamer, and Misophonia Reflex Finder apps, which are patent pending. |
| Relevance | 1: great source for description of treatment method using an app using counterconditioning
2: provides unique perspective on how the condition starts, develops, and is maintained by means of being a conditioned response/conditioned physical reflex.
3: unique perspective that the neurology is normal.
4: gives a reasonable argument that the condition should be called “ conditioned Aversive Reflex Disorder” (CARD) is a more accurate name for the condition based off assumption that it is a conditioned physical reflex.  
5: shows the importance of/how to identify aversive physical reactions.
6: describes how popular understanding of the paring processes in classical conditioning might be wrong.
7: describes how any repetitive stimuli can become triggering when exposure occurs during a misophonic response ( which can last for seconds to minutes). In this sense, a repetitive stimulus gets paired with the Misophonic reaction (elicited by something else), and thus becomes triggering.
8: describes spontaneous recovery                                         

Misc Notes

summary of Jastreboff and Jastreboff (2014)- "Jastreboff and Jastreboff (2014) stated that the misophonic trigger stimulus is part of a complex conditioned stimulus that includes the context and other factors. Although this was based on professional judgment, rather than a finding of an experimental study, they have treated individuals with misophonia for over a decade. They reported that of the 184 patients treated for misophonia, 83% showed significant improvement in their condition. Their treatment used several protocols designed to produce active extinction of the misophonic reflex. The success of their treatment method provides support for the hypothesis that misophonia is a Pavlovian-conditioned reflex."

Summary of Pavlovian Conditioning (classical Conditioning ) in the context of Misophonia- "The basic theory of Pavlovian conditioning is that pairing a neutral stimulus (NS) with an unconditioned stimulus (US) establishes an association that results in the NS becoming a conditioned stimulus (CS) and producing a conditioned response (CR) similar to the unconditioned response (UR) elicited by the US. With misophonia, it is often difficult to identify an unconditioned (or conditioned) stimulus that was initially paired with the misophonic trigger stimulus (NS)."