An experimental examination of neurostimulation and cognitive restructuring as potential components for Misophonia interventions

• Published in: Journal of affective disorders Vol. 350; pp. 274 - 285
• Main Authors: Neacsiu, Andrada D., Beynel, Lysianne, Gerlus, Nimesha, LaBar, Kevin S., Bukhari-Parlakturk, Noreen, Rosenthal, M. Zachary
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2024
• Subjects: Adult; Cognitive Restructuring; Emotion dysregulation; Emotions - physiology; Hearing Disorders; Humans; Intervention; Misophonia; Neuroscience; Neurostimulation; Prefrontal Cortex - physiology; Psychiatric/Mental Health; Intervention; Misophonia; Neurostimulation; Emotion dysregulation; Neuroscience
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2024.01.120

Misophonia is a disorder of decreased tolerance to certain aversive, repetitive common sounds, or to stimuli associated with these sounds. Two matched groups of adults (29 participants with misophonia and 30 clinical controls with high emotion dysregulation) received inhibitory neurostimulation (1 Hz) over a personalized medial prefrontal cortex (mPFC) target functionally connected to the left insula; excitatory neurostimulation (10 Hz) over a personalized dorsolateral PFC (dlPFC) target; and sham stimulation over either target. Stimulations were applied while participants were either listening or cognitively downregulating emotions associated with personalized aversive, misophonic, or neutral sounds. Subjective units of distress (SUDS) and psychophysiological measurements (e.g., skin conductance response [SCR] and level [SCL]) were collected. Compared to controls, participants with misophonia reported higher distress (∆SUDS = 1.91–1.93, ps < 0.001) when listening to and when downregulating misophonic distress. Both types of neurostimulation reduced distress significantly more than sham, with excitatory rTMS providing the most benefit (Cohen's dSUDS = 0.53; dSCL = 0.14). Excitatory rTMS also enhanced the regulation of emotions associated with misophonic sounds in both groups when measured by SUDS (dcontrol = 1.28; dMisophonia = 0.94), and in the misophonia group alone when measured with SCL (d = 0.20). Both types of neurostimulation were well tolerated. Engaging in cognitive restructuring enhanced with high-frequency neurostimulation led to the lowest misophonic distress, highlighting the best path forward for misophonia interventions. •We examine differences between misophonia and transdiagnostic emotion dysregulation.•We utilized functional imaging to explore differences in emotion response and regulation between groups.•We used a within subject design to compare the benefits of cognitive restructuring and neurostimulation in reducing distress•Cognitive restructuring enhanced with excitatory neurostimulation led to most change in misophonia