Consider the case of John, an individual I met at several misophonia conferences.29 Now a middle-aged adult with misophonia, John recalled developing his first trigger. He shared a bedroom with his brother. John suffered from anxiety as a child. One night, he was unable to sleep. His brother had allergies and his breathing produced an audible nasal sound. After hours of hearing his brother breathe, John went to the couch and slept. From that night on, he was triggered whenever he heard his brother breathe. This type of experience, where one stimulus (sound) starts to cause a reflex response, is called Pavlovian or classical conditioning. The nasal breathing sound became associated with the physiological response30 from the distress John experienced. For John, the physical response was tightening his shoulders. There may also be an association of the sound and the emotional distress experienced from anxiety, inability to sleep, and annoyance aroused by hearing the breathing sound. When he heard the sound later, it elicited the conditioned physical and/or emotional response. It seems that it is more the physical reflex response than the emotional response that becomes associated with the trigger (nasal breathing), and then the emotions follow.