Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


48th Annual Convention; Boston, MA; 2022

Event Details

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Symposium #17
Theory and Intervention for Misophonia: A Conditioned Aversive Respondent Behavior
Saturday, May 28, 2022
10:00 AM–10:50 AM
Meeting Level 1; Room 104A
Area: CBM; Domain: Translational
Chair: Thomas H. Dozier (Misophonia Institute; Misophonia Treatment Institute)
Discussant: Emily Thomas Johnson (Behavior Attention and Developmental Disabilities Consultants, LLC)
CE Instructor: Thomas H. Dozier, M.S.

Misophonia is an understudied but relatively common learned respondent behavior condition, the impact of which ranges from annoying to debilitating. Misophonia is known as a condition where commonly occurring innocuous stimuli (e.g. chewing sound, specific voice) elicit anger and accompanying physiological responses which function as motivating operations for overt aggression, escape, and avoidance. Although there are many common misophonic stimuli, each person has a unique set of trigger stimuli. Misophonia has similarities with general sensory sensitivity which is common with autism, but is distinctly different. Misophonia was first identified and named by audiologists and has been considered a hearing disorder. Recently misophonia has come to be viewed as an anger disorder and the focus of psychologists and neuroscientists, however our research indicates the core of misophonia is a Pavlovian conditioned muscle reflex, so it may be more appropriate to view misophonia as a conditioned behavioral disorder. Once a misophonic respondent behavior develops, it generally strengthens with repeated exposure to the trigger stimulus and persists indefinitely unless there is an intervention to reduce the respondent behavior. One intervention that has been effective for misophonia is counterconditioning of trigger stimuli by paring a continuous positive stimulus with an intermittent trigger.

Instruction Level: Advanced
Keyword(s): ABA Intervention, aggression, counterconditioning, misophonia
Target Audience:


Learning Objectives: At the conclusion of the presentation, participants will be able to: 1. Identify the core reflex of the misophonia response chain. 2. Identify the neurological learning process that creates and maintains the core reflex of misophonia response chain. 3. Identify one treatment method that can change the misophonic response when used in an intervention. 4. Distinguish between general sensory sensitivity, common to ASD, and misophonia.
The Composition of Misophonia: A Conditioned Respondent Behavior
(Basic Research)
THOMAS H. DOZIER (Misophonia Institute; Misophonia Treatment Institute)
Abstract: Misophonia is a recently identified condition in which an individual has an immediate acute emotional response (e.g., anger, disgust, anxiety) when exposed to specific commonly occurring stimuli. We conducted two basic research studies that indicate the core component of misophonia is a Pavlovian conditioned muscle reflex. Following the muscle reflex, misophonia includes an intense conditioned emotional response, which is the hallmark feature of misophonia. An fMRI neurological imaging research study results will be presented which indicates the emotional response develops through experiential learning of emotions. Unconditioned physiological responses are elicited by the distress of the reflex and emotional response and have been validate with skin conductance measurements. Conditioned operant behavior develops around these core responses which often include avoidance, escape, and sometimes aggression. The “learned” nature of misophonia is also supported by age of onset data, and case data which support that counterconditioning the learned physical reflex results in a reduction in the emotional response and overall severity ratings of misophonia.

Counterconditioning Intervention for Misophonic Triggered Aggressive Behavior of a Student With Autism

(Service Delivery)
MOLLY LUTZ (Pediatric Therapeutic Services)

Misophonia is a disorder in which specific innocuous stimuli trigger negative emotional and physiological responses. Reactions can range from annoyance to fight-or-flight. Commonly occurring triggers are oral and nasal sounds, but can be any stimulus. This study reports a successful intervention of a male high school student diagnosed with the primary educational classification of intellectual disability, a secondary classification of autism spectrum disorder, and speech and language impairment. Prior to intervention, the student was frequently triggered by vocal stimuli of one student, and he was continually removed from class due to aggressive and perseverative episodes towards that student. Pre-intervention rate of perseverative behavior was 12.3 times per hour. The intervention consisted of 10-30 minute counterconditioning sessions in a public education setting for three recorded trigger stimuli. Counterconditioning was accomplished by pairing continuous preferred stimuli (e.g., video or music) while the trigger played intermittently using the Misophonia Trigger Tamer app on an iPad. Staff observed overt behavior which indicated physiological responses after the trigger played and increased or decreased volume to maintain a minimal response. The intervention successfully reduced the misophonic respondent behavior, and the aggressive behavior extinguished. Preliminary post intervention rate of perseverative behavior is 0 times per hour.




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Modifed by Eddie Soh