The Misophonic Response Chain

We can expand our graph for the misophonia reaction a bit more. The next figure shows the extreme emotional response and the accompanying physiological response (stress response) as two adjoining boxes. Anytime you are feeling emotions, the emotions consist of two parts. One part is what is going on in your head – what you perceive as the feeling, along with thoughts about it. The other part is what is happening in your body. There are automatic responses for emotions. If you are angry, you will have tense muscles and increased heart rate. If you are happy, you will have more relaxed muscles and positive sensations in your body (we will use this to our advantage later). The last box, labeled Coping Behaviors, comprises the things you do after you are triggered. This includes things that will reduce the trigger, such as putting your hands over your ears, mimicking the trigger noise, ordering the offending person to stop, or running away from the trigger. We will talk more about changing our behavior in each of these boxes later. For now, we just want to recognize that they exist as different components of your misophonic response to triggers.

What is happening when you are triggered? It is not as simple as it seems to someone suffering with misophonia. Misophonia is really a twostep process.

  • Step 1: You hear or see a trigger. You perceive a trigger and you have an intrusive, physical reflex. This is an aversive, unpleasant, unwanted physical reflex.
  • Step 2: You feel the sensation of the physical reflex and instantly feel irritation or disgust. This is an emotional reflex response. The physical sensation triggers your extreme emotions.
  • Step 3: The extreme emotions cause a stress response. This includes general physiological (bodily) responses associated with emotional arousal including pressure in chest, head, and whole body; clenched/tightened muscles; sweaty palms; difficulty breathing; and increased blood pressure and heart rate.
  • Step 4: You act outwardly in a way that works for you by stopping the trigger, getting away from the trigger, or other behaviors that is your way to dealing with a highly distressing and aversive situation.

From my work with clients, I find that the way their physical reflex responds to treatment and to different strength of triggers is very consistent with the research on reflexes. This reflex is an acquired aversive physical reflex. An acquired reflex is also called a conditioned reflex or a Pavlovian reflex,23 which we shall discuss in the next chapter.