Symposia
Obsessive Compulsive and Related Disorders
Andrada D. Neacsiu, Ph.D.
Assistant Professor
Duke University Medical Center
Durham, North Carolina
Kevin LaBar, PhD
Professor
Duke University
Durham, NC
M. Zachary Rosenthal, PhD
Associate Professor
Duke University
Durham, North Carolina
Noreen Bukhari-Parlakturk, MD, PhD
Assistant Professor
Duke University
Durham, North Carolina
Background: Misophonia, the inability to tolerate certain aversive repetitive and common sounds, is gaining rapid recognition as a debilitating condition that is in need of novel interventions.
Methods: In an ongoing study, clinical and misophonic adults were exposed to personalized misophonic, aversive, and neutral sounds and were asked to either listen or downregulate arousal while undergoing an MRI. For each participant, we extracted two personalized neural targets related to the experience and regulation of misophonic distress. In a subsequent experimental session, participants listened to or downregulated sounds and receiving either sham or active repetitive transcranial magnetic stimulation (rTMS) over each of the targets. We applied high frequency (HF)-rTMS over the dorsolateral prefrontal cortex (dlPFC; 39 5s trains, 10-Hz, 15s ITI, 120% rMT) and low frequency (LF)-rTMS over the medial PFC (mPFC; 1 Hz, 1s ITI, 90% rMT). Participants were blinded to active/sham conditions.
Results: Preliminary analyses in misophonic adults, showed robust activation within the bilateral anterior insular cortex (AIC) when hearing misophonic versus aversive sounds. When comparing downregulation versus hearing misophonic sounds, there was significantly higher activation in the dlPFC, mPFC, and temporo-parietal junction, and significant de-activation in the left insula. The majority of this activity was not present when downregulating aversive, non-misophonic sounds. Preliminary analyses also show that across the experiment active rTMS significantly reduced distress (ddlPFC = 0.47, dmPFC = 0.31) and heart rate reactivity (dmPFC = .32, ddlPFC= .24) when compared to sham. These findings suggest that both types of rTMS have a calming effect during distressing experiences.
Pairwise comparisons show that both HF-rTMS (dsuds = .59; dmaxHR = .47) and LF-rTMS (dsuds = .47; dmaxHR = .48) significantly decreased distress to triggers when compared to sham (ps < .05). During down-regulation of misophonic distress, only HF-rTMS significantly decreased SUDS beyond sham (ddlPFC = .55). Therefore, both types of rTMS show benefits, with the dlPFC having additional advantage during downregulation. Pre-post comparisons of misophonia scores indicated a significant drop in maladaptive coping (p = .016) in the misophonia group.
Conclusion: These findings highlight that neurostimulation has a calming effect and can aid regulation during misophonic distress. Our results could have direct implications for the development of novel misophonia interventions.