Properties (9)
- purpleRed
- (Dozier, 2015)
Treating the Initial Physical Reflex of Misophonia With the Neural Repatterning Technique: A Counterconditioning Procedure
Status:: #status/Bare-bones-review
Metadata
- Item Type: #journalArticle
- Authors: Thomas H. Dozier
- Date: 2015-10-16
- Date Added: 2020-01-15
- URL: http://psyct.psychopen.eu/article/view/138
- DOI: 10.5964/psyct.v8i2.138
- Cite key: dozierTreatingInitialPhysical2015
- Topics: primary Resources
- Tags: #Misophonia, #Article-review, #added-to-Misophonia-data-base, #Fully-reviewd, #noted, #reviewed, #to-be-annotated, #tags-need-to-be-checked, #zotero, #literature-notes, #reference
- PDF Attachments
Abstract
Misophonia is a condition in which a person has an acute emotional response of anger or disgust to a commonly occurring innocuous auditory or visual stimulus referred to as a trigger. This case details the effective treatment of misophonia in a young woman that included a counterconditioning treatment called the Neural Repatterning Technique (NRT), which combines a continuous positive stimulus and a reduced intensity, intermittent trigger. The treatment was delivered via the Misophonia Trigger Tamer smartphone app and all treatments were conducted independently by the patient. In this patient, the trigger elicited a physical reflex of contraction of the flexor digitorum profundus, which caused her to clench her fist. To enhance the effect of the NRT treatment, Progressive Muscle Relaxation was incorporated to increase her ability to deliberately relax the affected muscle during treatment. During NRT treatment sessions, the patient experienced a weak physical reflex to the reduced trigger stimulus but no emotional response. Her emotional response of misophonia was not treated, but when the physical reflex extinguished, the emotional response also extinguished. This case indicates that the misophonic response includes a Pavlovian-conditioned physical reflex. It is proposed that the trigger elicited the physical reflex and the physical reflex then elicited the conditioned emotional response that is characteristic of misophonia. Because of the conditioned reflex nature of misophonia, it is proposed that a more appropriate name for this disorder would be Conditioned Aversive Reflex Disorder.
other Files
Related
Zotero links
Article Review table
| Background/Purpose | Background- 1. there is little verified treatment data on Misophonia. 2. study details a case of successful treatment of 21-year-old female using counterconditioning treatment called the “Neural Repatterning Technique” (NRT), which combines a continuous positive stimulus and a reduced intensity, intermittent trigger, delivered via a phone app. • Misophonia involves intense emotional responses to common, non-threatening stimuli. • Prior views emphasized emotional reactivity but neglected physical reflexes. • Evidence supports the involvement of physiological arousal and muscle reflexes in response to triggers. • Misophonia has no formal classification in DSM-5 or ICD-10, and its prevalence estimates vary. Purpose- • case study of treatment of a Misophonic using a counter conditioning approach to treat the muscle reflex to specific triggers • Good source for history ,some descriptive factors, and description of and reasoning behind nontraditional treatment strategies - To test the effectiveness of NRT in treating a young woman's physical misophonic reflex. - To explore whether reducing the physical reflex alone can extinguish the associated emotional response. - To evaluate a self-administered treatment using a smartphone app. - To propose reconceptualizing misophonia as a conditioned reflex disorder. |
| Participants/samples | A 21-year-old female misophonic • Single participant: "Miley," a 21-year-old Caucasian female college student. • No comorbid psychiatric diagnoses reported initially. • No psychotropic medication use; high motivation for self-help. • Assessed via online forms and remote sessions using VSee video conferencing. |
| Measures | Self-report of intensity of symptoms. • Misophonia Assessment Questionnaire (MAQ) – Evaluates distress and life impact; initial score: 49 (severe). • Misophonia Activation Scale (MAS-1) – Rates emotional distress intensity. • Misophonia Physical Sensation (MPS) – Captures physical reactions to triggers. • Misophonia Trigger Severity (MTS) – Specific response intensity to identified triggers. • Misophonia Coping Responses (MCR) – Catalogs behavioral responses to triggers. • Misophonia Emotional Response (MER) – Tracks frequency and intensity of emotional reactions. |
| Procedures | Treatment case study Subject preformed PMR twice a day for 7 days on her own time while also having semi regular therapy sessions. Subject had a total of 9 PMR sessions ( equivalent of 7 hours) over the course of the study. • Stimuli: Personalized recordings of auditory triggers (e.g., spoon-on-bowl, chewing sounds). • Positive stimuli: Calming music selected by the participant. • Delivered via Misophonia Trigger Tamer app—automated control over stimulus intensity and timing. • PMR and Applied Relaxation taught and practiced to improve muscle control over the reflex (hand clenching). • NRT involved daily 30-minute sessions over 3 weeks, paired with ongoing PMR practice. |
| Results | Reactions to simulated triggers disappeared, and reactions to real life triggers diminished significantly. • MAQ scores decreased from 49 (severe) to 13 post-treatment, then to 7 at 6 months. • Emotional and physical responses to treated triggers significantly declined (e.g., spoon-on-bowl score dropped from 8 to 0). • Untreated triggers still evoked responses, though slightly attenuated (e.g., yawning). • Reflex response extinction led to emotional response extinction, supporting the conditioned reflex model. • A small resurgence of symptoms was noted at 12-month follow-up (MAQ: 12), possibly due to generalized anxiety disorder diagnosis. |
| Discussion/Limits | Conclusion- • Misophonia may be best understood as a conditioned reflex disorder, where emotional responses are secondary to physical reflexes. • NRT, especially when paired with PMR, appears effective in reducing misophonic responses, even in self-administered formats. • Identifying and targeting the physical reflex may be key to treatment efficacy. |
| Limitations:: | • Reliance on self-reports, non-conventional treatment method, being a case study means that results cannot be generalized. • Single-case study design limits generalizability. • Self-report measures introduce potential bias. • The specific physical reflex (hand clenching) was relatively easy to relax, which may not generalize to all muscle groups. • No formal diagnostic assessment for comorbid conditions at intake. |
| Future Directions:: | • Larger controlled studies needed to validate the reflex-based model. • Development of refined, validated assessment tools. • Investigations into long-term maintenance, spontaneous recovery, and context sensitivity of extinction. • Explore broader applicability to more complex or less consciously controllable physical reflexes. |
| Relevance:: | • case study of treatment of a Misophonic using a counter conditioning approach to treat the muscle reflex to specific triggers • Good source for history ,some descriptive factors, and description of and reasoning behind nontraditional treatment strategies |
key terms
-
Misophonia – A condition characterized by extreme emotional reactions (e.g., anger, disgust) to specific innocuous auditory or visual stimuli known as triggers.
-
Neural Repatterning Technique (NRT) – A counterconditioning treatment method pairing a reduced-intensity trigger with a continuous positive stimulus to extinguish physical reflexes associated with misophonia.
-
Pavlovian conditioning – A form of learning in which a neutral stimulus becomes associated with a reflex response through pairing with a conditioned or unconditioned response.
-
Conditioned Aversive Reflex Disorder – A proposed alternate name for misophonia, emphasizing the conditioned physical reflex at the core of the disorder.
-
Progressive Muscle Relaxation (PMR) – A technique involving the systematic tensing and relaxing of muscle groups to increase voluntary muscle control and reduce anxiety.
-
Applied Relaxation – An advanced technique of PMR where relaxation is achieved without prior tensing and ultimately applied globally and instantly in response to stimuli.
Misc notes
Misophonic Reflex Identification
-
Therapist-guided trigger exposure in a relaxed state was critical for isolating the specific reflex (flexor digitorum profundus activation).
-
Patients often misidentify general emotional arousal as the initial reflex; careful elicitation is crucial.
Treatment Implications
-
Counterconditioning should be tailored with low-level triggers and progressive exposure.
-
Misophonia should not be treated solely as a behavioral or emotional problem; targeting the reflex is essential.
-
NRT may augment CBT or audiological interventions effectively.
Self-Treatment Viability
-
High-functioning, tech-literate patients may successfully use automated apps with minimal clinical oversight.
-
Success depends on training, motivation, and accurate stimulus calibration.
Reflex vs. Emotion
-
Extinction of physical reflex preceded extinction of emotional reaction.
-
Context specificity observed: real-life triggers persisted after recorded-trigger extinction, consistent with classical conditioning principles.
Nomenclature Reconsideration
- Authors advocate renaming misophonia to "Conditioned Aversive Reflex Disorder" to better reflect its core pathology.