Properties (14)
Id 8c19c142-b1e9-490a-a6b6-1ac92841a4fc
Year 2026
Abstract
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  • (Savard et al., 2026)
Import Date 11-08-2026
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Dv Authors Marie-Anick Savard, Mary Brooks, Emily B.J. Coffey, Mickael L.D. Deroche,
Dv Status #status/reviewed
Dv Limitations • Standardized trigger set may not reflect each individual's main or strongest triggers, and standardized music may be a less effective competing cue than participant-selected music; findings may not generalize to most salient triggers or personally meaningful distractions. • Same-modality auditory distraction may have imposed intramodal competition, limiting effectiveness of attentional redirection. • Ceiling-level task performance makes it difficult to disentangle the cognitive cost of processing triggers from attentional-task demands. • Cardiac outcome was PPG-derived HR rather than HRV or a direct sympathetic/parasympathetic measure; cannot determine whether either autonomic branch was selectively engaged.
Dv Future Directions • Combine standardized with participant-specific stimuli for ecological validity. • Cross-modal (tactile or visual) distraction tasks; more demanding tasks (e.g., reduced signal-to-noise ratio). • Individual differences in symptomatology in relation to autonomic and attentional responses; responses in real-world contexts. • Integrate subjective, behavioural, physiological, and neural measures. • Interventions targeting recognition and appraisal of triggers rather than attentional redirection alone. • Neuroimaging: whether trigger salience arises from abnormal network interactions resisting top-down modulation; whether misophonic workload reflects salience network, cognitive control systems, or both; stage at which triggers acquire disproportionate affective impact.
Dv Relevance • Authors propose that abnormalities in arousal rather than valence are the key differentiator for the misophonia response (Savard et al., 2026). • found a trigger specific effect on autonomic arousal as measured by skin conductance responses and pupillary responses exposed to Misophonic triggers for a group of Misophonics compared to controls (Savard et al., 2026) • Results are dispositive of an affect-focused nature of misophonia response (Savard et al., 2026) • Authors claim that results suggest that the misophonia response forms independently of attention. They go on to propose that any sort of attentional capture related to trigger sounds is a property of the acoustics itself rather than the underlying cognitive interpretation (Savard et al., 2026) • Gives an Argument for increased cognitive load and trigger exposure despite lack of impact on behavioral outcomes (Savard et al., 2026). • gives an argument for the critical role of intervention timing in the ability to modulate the misophonia response (Savard et al., 2026).

Autonomic responses to trigger sounds persist despite attentional redirection in misophonia

Status:: #status/reviewed

Metadata

Abstract
Background/Purpose Background-
• Misophonic responses are not driven only by acoustics; the same sound is less aversive when attributed to another source or when not identifiable, so interpretation of sound source and meaning matters.
• Trigger sounds capture attention involuntarily and impair cognitive performance, particularly with higher misophonia sensitivity.
• Endogenous attention may offer a way to regulate responses by directing focus away from triggers.
• Individuals with misophonia report masking and distraction coping strategies (DMQ) and show stronger emotional responses to music, making music a possible candidate for attentional redirection.
• Triggers may act as auditory stressors, so redirecting attention away from them may raise cognitive workload.
• Pain research shows attention to auditory stimuli reduces pain perception even under high cognitive load.
• SCR consistently shows heightened reactivity in misophonia; pupil dilation reflects both emotional arousal and cognitive effort; heart rate findings are mixed.
• Gap: unknown whether physiological responses in misophonia can be modulated through volitional attentional strategies such as attending to an alternative sound source.



Purpose-
• Investigate how endogenously directing attention to music or simultaneously presented trigger sounds affects physiological responses in misophonics vs age-matched controls.
• Examine whether selectively attending to music in a dual-stream paradigm affects autonomic arousal (skin conductance, pupil size, heart rate) to aversive sounds.
• Assess whether attention-based strategies are cognitively feasible or carry a cognitive workload cost.
Participants/samples • N = 60 neurologically healthy adults: 30 misophonic (25 female; mean age 23.4), 30 age- and sex-matched controls (24 female; mean age 22.2).
• Recruited from Concordia University undergraduates and Montréal community.
• Inclusion: normal hearing; typical anxiety (Beck Anxiety Inventory); no ADHD or ASD diagnosis.
• Misophonic group: "Yes" to any of first 15 DMQ items and MisoQuest severity matching "Most-Misophonic" group of Savard et al. (2022); confirmed sensitivity to study trigger types via first three DMQ items.
• Controls: no reported trigger sounds on DMQ.
• Exclusions: five from CPT-AX analysis (task misunderstanding); four from Selective Attention behavioural analyses (file-saving issue), retained for physiology.
Measures
• Duke Misophonia Questionnaire (DMQ) – self-report; Symptom Severity and Coping composites.
• MisoQuest – misophonia screening; used as continuous severity measure.
• Beck Anxiety Inventory – anxiety screening.
• Montreal Music History Questionnaire – demographics, languages, music experience/training.
• NASA-TLX – cognitive workload after each block; mental demand, effort, performance, frustration (physical and temporal demand omitted).
• Pure-tone audiometry – hearing screen.
• Auditory continuous performance test (CPT-AX) – sustained attention; hits, omissions, false alarms.
• Bell detection accuracy – check on compliance with attentional instructions.
• Skin conductance (Shimmer3 GSR+) – phasic driver from continuous decomposition analysis (Ledalab), z-scored.
• Pupil size (Pupil Labs Pupil Core, right eye) – preprocessed in PuPl, z-scored.
• Heart rate – PPG-derived from earlobe clip; computed over block-level windows; HRV not analysed.
Procedures • Screening questionnaires at recruitment; in-lab session: questionnaires, audiometry, CPT-AX, physiological fitting, Selective Attention task.
• Stimuli: neutral, unpleasant, and trigger sounds (coughing, sniffing, eating, packet rustling, cutlery) from Savard et al. (2022), a subset of Kumar et al. (2017); unfamiliar piano excerpts, each sound paired with a fixed excerpt; brief cowbell target.
• Trial: silent baseline, piano-only, then sound added in opposite ear; on-screen arrow indicated ear to attend; bell embedded in final portion; yes/no report of bell in attended ear.
• Experimental conditions: attend-to-sounds (Sounds-with-Music) and attend-to-music (Music-with-Sounds), each crossed with three sound types.
• Control conditions: Sound-Only (each sound type without competing input) and Music-Only.
• Blocks of five same-condition trials; full block set completed twice in randomized order; ear of presentation counterbalanced across halves; NASA-TLX after each block; luminance fixed to prevent light-driven pupil changes.
• Analysis: ANOVAs for bell detection and NASA-TLX; linear mixed-effects models (random intercepts for subject and presentation order) for physiology, fit separately for Sound-Only, Music-Only, and dual-stream conditions.
Results Behavioural
• No group differences in sustained attention (CPT-AX).
• Bell detection near ceiling; unpleasant sounds lowered detection relative to neutral and trigger sounds in dual-stream conditions only; no group or attention-condition effects.
• Workload higher for unpleasant than neutral and trigger sounds (dual-stream and in silence) and for sounds than music alone; misophonics reported higher workload than controls in dual-stream conditions only, regardless of sound type or attention condition.

Physiological – sounds in silence
• SCR: misophonics greater for trigger than neutral and unpleasant sounds; no sound-type differences in controls.
• Pupil: misophonics larger for trigger and unpleasant vs neutral sounds; no differences in controls.
• HR: lower for unpleasant vs neutral sounds across groups; no group effect or interaction.
• No group differences in any measure for Music-Only.

Physiological – dual-stream
• SCR: Group × Sound Type interaction without significant pairwise contrasts in either group; no attention-condition effect.
• Pupil: trigger > neutral in both groups and both attention conditions (three-way Group × Attention × Sound Type interaction); attending to music reduced the unpleasant-sound response in misophonics (no longer differing from neutral) but elevated it in controls.
• HR: lower for unpleasant vs neutral and trigger sounds across groups and attention conditions; no group or attention effects.
Discussion/Limits Conclusion-

• Trigger-specific arousal: In silence, SCR and pupil responses showed heightened autonomic arousal specific to trigger sounds and only in misophonics, demonstrating selectivity of the misophonic response; some pupil effects may also reflect cognitive demands.
• Attention does not attenuate trigger responses: Directing attention to music did not substantially reduce trigger-related reactivity, suggesting the misophonic response unfolds relatively independently of attentional focus and resists top-down modulation once sound recognition has occurred; this resistance may reflect the high salience and processing priority of trigger sounds rather than impaired attentional capacity.
• Pupil effects in dual-stream reflect processing demands: Elevated trigger pupil responses in both groups during dual-stream conditions are unlikely to be purely affective and more likely reflect added demands of same-modality competition plus arousal; the attention-grabbing capacity may be a property of trigger sounds rather than a misophonia-specific mechanism.
• Unpleasant sounds and attention: Controls may have been more broadly disrupted by aversive sounds when attending elsewhere (cognitive load more likely than arousal, given SCR); misophonics appeared able to ignore unpleasant sounds, possibly reflecting an attentional advantage in the absence of triggers from long-term coping.
• Greater effort without performance deficit: Misophonics had intact sustained attention but reported higher workload in dual-stream conditions with equal performance, interpreted as greater perceived effort to maintain performance; misophonia may involve recruiting additional cognitive resources to manage competing input and trigger responses.
• Heart rate as an insensitive marker: HR deceleration to unpleasant sounds is consistent with orienting responses; for triggers, orienting-related deceleration and action-readiness acceleration may co-occur and cancel out; PPG-derived HR cannot determine which autonomic branch was engaged.
• Arousal as the defining dimension: Unpleasant sounds may have been aversive enough to drive orienting but not arousing enough to engage sympathetic responses; arousal rather than negative valence may define the misophonic response.
• Clinical implication: Attention-based interventions may provide little relief because they act after trigger recognition; interventions targeting how sounds are identified and appraised (e.g., Mahzouni et al., 2024) may be more effective, offered as a hypothesis for future research.
Limitations:: • Standardized trigger set may not reflect each individual's main or strongest triggers, and standardized music may be a less effective competing cue than participant-selected music; findings may not generalize to most salient triggers or personally meaningful distractions.
• Same-modality auditory distraction may have imposed intramodal competition, limiting effectiveness of attentional redirection.
• Ceiling-level task performance makes it difficult to disentangle the cognitive cost of processing triggers from attentional-task demands.
• Cardiac outcome was PPG-derived HR rather than HRV or a direct sympathetic/parasympathetic measure; cannot determine whether either autonomic branch was selectively engaged.
Future Directions:: • Combine standardized with participant-specific stimuli for ecological validity.
• Cross-modal (tactile or visual) distraction tasks; more demanding tasks (e.g., reduced signal-to-noise ratio).
• Individual differences in symptomatology in relation to autonomic and attentional responses; responses in real-world contexts.
• Integrate subjective, behavioural, physiological, and neural measures.
• Interventions targeting recognition and appraisal of triggers rather than attentional redirection alone.
• Neuroimaging: whether trigger salience arises from abnormal network interactions resisting top-down modulation; whether misophonic workload reflects salience network, cognitive control systems, or both; stage at which triggers acquire disproportionate affective impact.
Relevance:: • Authors propose that abnormalities in arousal rather than valence are the key differentiator for the misophonia response (Savard et al., 2026).
• found a trigger specific effect on autonomic arousal as measured by skin conductance responses and pupillary responses exposed to Misophonic triggers for a group of Misophonics compared to controls (Savard et al., 2026)
• Results are dispositive of an affect-focused nature of misophonia response (Savard et al., 2026)
• Authors claim that results suggest that the misophonia response forms independently of attention.
They go on to propose that any sort of attentional capture related to trigger sounds is a property of the acoustics itself rather than the underlying cognitive interpretation (Savard et al., 2026)
• Gives an Argument for increased cognitive load and trigger exposure despite lack of impact on behavioral outcomes (Savard et al., 2026).
• gives an argument for the critical role of intervention timing in the ability to modulate the misophonia response (Savard et al., 2026).

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contextual statement

In a 2026 study, Savard attempted to determine whether directing attention to music modulates autonomic responses to trigger sounds by having misophonic and age- and sex-matched control adults attend to piano music in one ear while neutral, unpleasant, or trigger sounds played in the other, measuring skin conductance, pupil size, PPG-derived heart rate, and NASA-TLX workload.

summary statement

In a 2026 study, Savard investigated whether attentional redirection toward music modulates physiological responses to misophonic trigger sounds by recording skin conductance, pupil size, and heart rate while misophonic and control adults selectively attended to music or sounds in a dual-stream task. They found trigger-specific heightened skin and pupil responses in misophonics in silence that persisted regardless of attentional focus, alongside greater subjective workload than controls in dual-stream conditions without a performance deficit. From this they concluded that trigger processing resists top-down attentional modulation once recognition has occurred, and that interventions targeting how trigger sounds are identified and appraised may be more effective than attention-based strategies.

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