Autonomic responses to trigger sounds persist despite attentional redirection in misophonia

Misophonia is a disorder characterized by exaggerated emotional responses and heightened autonomic arousal triggered by specific sounds. Despite evidence that higher-level cognitive processes contribute to misophonia, it remains uncertain whether they can be used to modulate misophonic responses to trigger sounds. Based on the observation that individuals with misophonia often report listening to music as a coping mechanism, we investigated how directing attention to music could modulate physiological responses of individuals with misophonia in the presence of trigger sounds. Participants with and without misophonia completed a task in which they selectively attended to music in one ear while sounds (trigger, unpleasant, or neutral) played in the other. Measures that capture autonomic nervous system state (i.e., pupil size, skin conductance response, and heart rate) were continuously recorded. Physiological reactions (skin and pupil responses) in misophonics were consistent with a higher arousal than in controls specifically for trigger sounds in silence. This heightened arousal to triggers persisted in the dual-stream conditions regardless of attentional focus, suggesting that music-directed attention did not meaningfully attenuate trigger responses in either group. Subjective ratings were roughly consistent with physiological measures, revealing greater mental demand and frustration in misophonics, and for aversive sounds (with no obvious interaction with attention). Overall, these data demonstrate the expected physiological and subjective responses experienced by misophonics when exposed to triggers, but suggest that attentional redirection towards music is insufficient to modulate it once trigger recognition has occurred.