Misophonia Studies With Dr. Prashanth Prabhu
Going into detail about some of the most interesting misophonia studies.
Updated May 6, 2026 | Reviewed by Monica Vilhauer Ph.D.
This post is Part 2 of a two-part series. Find Part 1 here .
In part two of this series of interviews with Dr. Prabhu, we discuss his recent studies on misophonia in more detail.
Jennifer Brout: Would you tell us about your research regarding Central Auditory Processing Disorder (CAPD) findings and misophonia? What does it indicate that individuals with misophonia demonstrated reduced scores on dichotic consonant-vowel (DCV) and pitch pattern tests (PPT)? How does this indicate possible poor auditory cortical processing?
Prashanth Prabhu : In our study , we assessed auditory processing abilities in individuals with misophonia using the dichotic consonant-vowel (DCV), pitch pattern test (PPT), and masking level difference (MLD) tests. We found that individuals with misophonia had reduced scores on DCV and PPT, which suggests difficulty in binaural integration and temporal ordering. DCV reflects cortical-level binaural integration and PPT reflects cortical-level temporal processing, so reduced performance points toward inefficient auditory cortical processing rather than a simple hearing loss problem. We hypothesize that people with misophonia may become hyperfocused activating their attention network, and this heightened emotional and attentional load may interfere with normal sound processing, which could explain why they perform more poorly on tasks that require selective auditory attention and cortical processing.
JB: In another study you and colleagues found that people with misophonia had reduced brain responses to novel auditory stimuli. Would you explain what this may mean in terms of misophonia? Would you also explain what you mean by “early auditory processing?”
PP: In our study, we found that individuals with misophonia showed earlier auditory late latency responses and reduced N1 amplitude even for a non-trigger speech sound, which suggests that their brain may process sound differently even before the sound is consciously evaluated as pleasant or unpleasant. This may mean that in misophonia, the auditory cortex is more reactive or differently organized at an early stage of sound processing, and this altered response may contribute to the strong reactions these individuals later show to trigger sounds. When I say “early auditory processing,” I mean the first stage of cortical sound processing, where the brain detects, registers, and begins to analyze an incoming sound. In this article, the P1-N1-P2 complex reflects that early stage, and the reduced N1 amplitude with altered scalp distribution suggests that sound is being processed in an atypical way from the beginning itself in individuals with misophonia.
JB: In your findings, you report that individuals with misophonia demonstrate more difficulty with emotion regulation than those with hyperacusis. Why might this be true? Do you think it reflects the involvement of different brain areas? If so, please elaborate.
PP: I think this is likely because misophonia is not just a sound tolerance problem; it appears to involve stronger affective, behavioral, and salience-related responses to specific triggers, which makes emotion regulation more important to the condition. Misophonia is typically triggered by specific, often pattern-based sounds and is associated with intense irritation, anger , anxiety , avoidance, and attempts to control the trigger situation, whereas hyperacusis is described more as a generalized intolerance to sound loudness. That difference matters because a condition driven by trigger-specific emotional reactions is more likely to affect the systems involved in regulating distress, impulse control, and behavioral responses than a condition primarily characterized by abnormal loudness perception.
I do think these findings are consistent with the involvement of somewhat different brain networks, although our emotion regulation study itself was based on questionnaires and therefore does not directly prove neural differences. The interpretation becomes stronger when viewed alongside neurophysiological and neuroimaging findings from other studies showing that misophonia involves the auditory cortex together with regions involved in salience detection and emotion regulation, especially the anterior insula, anterior cingulate cortex, amygdala, hippocampus, vmPFC, and superior temporal regions.
JB: Also, is it possible that people with hyperacusis are better able to regulate emotions for other reasons? For example, it is a more accepted disorder, and individuals may feel higher validation. Or might there be better treatment for hyperacusis? Or is it possible that the sounds that are prevalent in hyperacusis are less correlated with sounds emanating from other people?
PP: I think those are all reasonable possibilities, but I would frame them as hypotheses rather than firm conclusions because our study did not directly test validation, treatment access, or the social meaning of triggers. One possibility is that hyperacusis has a clearer audiological framework, whereas misophonia is still less widely recognized, which may affect how understood and supported individuals feel. Another is that misophonia is often triggered by specific, context-dependent, human-generated sounds, so the reaction may be more socially and emotionally loaded than the broader loudness intolerance seen in hyperacusis. It is also possible that differences in clinical validation or treatment pathways contribute, but based on our data, the safest interpretation is that emotion regulation appears to be more central to misophonia than to hyperacusis.
JB: As we conclude the interview, would you explain what you mean by "sensory?" This is often confusing to people, and it would help if you would clarify.
PP: By “sensory,” I mean that the problem begins with sound input, but it is not limited to the ear; it also involves how the nervous system processes, filters, and reacts to that sound. In simple terms, the “earlier brain centers” relate to early auditory relay and sensory gating, while the “higher brain centers” involve cortical, limbic, and salience networks that give the sound emotional meaning and drive the behavioral response. So, misophonia can be called sensory-based, but the distress likely reflects an interaction between auditory processing and higher-order emotional systems rather than a purely peripheral hearing problem.
JB: Thank you for sharing your knowledge with us Dr. Prabhu! I am sure I speak for everyone in the misophonia community when I say that we eagerly await more of your work!
Adline, P. D., Venkateswaran Nisha, K., Prabhu, P., & Uppunda, A. K. (2025). Assessment of working memory abilities in normal hearing individuals with and without misophonia. Quarterly Journal of Experimental Psychology . https://doi.org/10.1177/17470218251322718
Aryal, S., & Prabhu, P. (2023). Auditory brainstem functioning in individuals with misophonia. Journal of Otology , 18(3), 139–145. https://doi.org/10.1016/j.joto.2023.05.006
Aryal, S., & Prabhu, P. (2024). Auditory cortical functioning in individuals with misophonia: An electrophysiological investigation. European Archives of Oto-Rhino-Laryngology , 281, 2259–2273. https://doi.org/10.1007/s00405-023-08318-w
Suraj Urs, B. R., Nisha, K. V., Mohamad, A., & Prabhu, P. (2025). Distortion-product otoacoustic emission input-output characteristics of misophonic ears with normal hearing. Hearing Research . https://doi.org/10.1016/j.heares.2025.109435
Patro, C., Wasko, E., Prabhu, P., & Srinivasan, N. K. (2025). Investigating neurophysiological, perceptual, and cognitive mechanisms in misophonia. Biology , 14(3), 238. https://doi.org/10.3390/biology14030238
Aryal, S., & Prabhu, P. (2023). Awareness and perspectives of audiologists on assessment and management of misophonia in India. Journal of Otology , 18(2), 104–110. https://doi.org/10.1016/j.joto.2023.02.003
Aryal, S., & Prabhu, P. (2022). Understanding misophonia from an audiological perspective: A systematic review. European Archives of Oto-Rhino-Laryngology . https://doi.org/10.1007/s00405-022-07774-0
Share this post Facebook Bluesky Linkedin Email
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy
Jennifer Brout, Psy.D. , who suffers from misophonia, helped found the Sensory Processing and Emotion Regulation Program at Duke University.
Get the help you need from a therapist near you–a FREE service from Psychology Today.
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.