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Misophonia Research and Treatment: Statement from The Misophonia and Emotion Program, Duke University Medical Center

Jennifer Jo Brout, Psy.D. & M. Zachary Rosenthal, Ph.D.

About the program: The Misophonia and Emotion Regulation Program is the longest standing research program involved with The International Misophonia Research Network. Founded by Jennifer Jo Brout in 2008, and led by Dr. Rosenthal, research conducted within this program investigates the relationship between auditory over-responsivity/Misophonia and emotions, cognition and behavior.

Previous studies from this program have examined the effects of meclizine on pre-pulse inhibition (Levin et al., 2014) and the relationship between sensory over-responsivity and emotions in adult psychopathology (Rosenthal et al., 2011; Rosenthal et al., 2016). Research funded by the Wallace Research Foundation has helped us begin to explore the relationships among sensory processing impairments and difficulties such as misophonia with emotional functioning in adults.

In addition to research, we are dedicated to developing, evaluating, and establishing best practices for providers working with people who report having Misophonia. The approach we are developing is multi-disciplinary and is done in tandem with patients and their families. The self-help component to this approach is a practical combination of proactive coping skills designed to help individuals identify aversive stimuli, and learn different ways to help calm the physiological and emotional over-arousal associated with that stimuli. The program also seeks to help individuals re-evaluate and change ways of thinking about aversive stimuli that may inadvertently exacerbate, rather than help calm, the physiological and emotional responses. Updates about this program will be posted periodically.

As those involved at the forefront of research on this topic, we would like to make the following statements about Misophonia.

Misophonia research is in its infancy

There are less than 25 studies that directly evaluate Misophonia.
Much of the existing research has not interpreted individual findings on Misophonia to important and related basic and applied research across disciplines. As such, we believe a more comprehensive approach to the study of Misophonia is needed that includes researchers, methods, and measures used across fields (e.g., occupational therapy, audiology, neurology, psychiatry, psychology, cognitive neuroscience, neurobiology). A multi-disciplinary approach to research on Misophonia has the promise to offer insights about the causes and treatments for this condition.

There is no evidence-based behavioral or device-based treatment for Misophonia

There are no single specific behavioral or device-based treatments that have been rigorously tested scientifically across multiple studies and shown to efficaciously treat Misophonia. At this point, there only are early small scale uncontrolled and pilot controlled clinical studies. In addition, there are unstudied approaches used by clinicians. Without being subjected to research, it is not possible to know whether unstudied treatments can be expected to help. And, at the same time, it is possible that there are interventions which may be helpful that have yet to be studied scientifically. This presents a conundrum for patients and family members seeking care. We don't have clear research to inform which interventions might help, much less for whom, why, and how. And patients need help, every day, as misophonia and related problems cause significant distress and impairment.

Accordingly, as consumers of treatment services, patients seeking services for Misophonia are encouraged to ask treatment providers to disclose (a) which interventions will be used to help treat Misophonia, (b) the rationale for such approaches in light of available scientific evidence, and (c) any potential risks a particular treatment may pose.

There is no FDA approved medication for Misophonia

There is no scientific evidence that any specific medication treats Misophonia. However, doctors are able to prescribe medications “off label,” which means that they can suggest you try medications developed for other problems that they believe may help reduce difficulties related to Misophonia. If a doctor prescribes medications for Misophonia, we believe it is appropriate that patients be aware that such medications are experimental. In such circumstances, we suggest patients ask their doctor to disclose (a) the clear rationale for the use of such medications and (b) any possible side effects and risks.

Although there are no evidence-based treatments for Misophonia, if you are seeking treatment we suggest you receive an evaluation using a multi-disciplinary approach

There is no single specific evidence-based pharmacological, device-based, or behavioral treatment for Misophonia. However, if you are seeking help for problems related to Misophonia we suggest you receive an evaluation using a multi-disciplinary approach. This would include evaluations from licensed providers who can begin by assessing underlying biological impairments (e.g., neurologists) and behavioral problems (e.g., psychologists, occupational therapists). Following assessment, these professionals can work together to provide a multi-disciplinary and personalized treatment approach.

For more information about Misophonia, or questions about our programs please see Misophonia-research.com or contact Dr. Brout at Jbrout@gmail.com

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