Hey, Girlfriends. It's me, Carole Fisher, back with another season of the global number one podcast, The Girlfriends. Last time, we investigated the murder of Gail Katz. This time, we're uncovering the identity of the woman who was buried in Gail's grave for a decade before she disappeared. Join me and the rest of the club as we tell her story. Listen to season 2 of The Girlfriends, our Lost Sister on the iHeartRadio app, Apple podcast, or wherever you get your podcast.

Get emotional with me, Radhi De Vluukia, in my new podcast, A Really Good Cry. We're going to be talking with some of my best friends. I didn't know we were going to go there on this. People that I admire. When we say, Listen to your body, really tune in to what's going on. Authors of books that have changed my life. Now you're talking about sympathy, which is different than empathy. Never forget, it's okay to cry as long as you make it a really good one. Listen to A Really Good Cry with Radhi De Vluukia on the iHeartRadio app. Apple Podcasts or wherever you get your podcasts.

Hey, everybody. We are coming to a town ostensibly near you, so punitively see us.

That's right. May 29th, we'll be in Boston, really Medford, Massachusetts. The next night, we're going to go down to Washington, DC, and then scooch back up to New York City at town hall on May 31st.

Yeah. If you're one of those people who likes to plan way far in advance, then you can go ahead and get tickets for our shows in August. We're going to start out where, Chuck?

We're going to be in Chicago, August Minneapolis, August eighth, then Indianapolis for the very first time on August ninth, and then we're going to wrap it up in Durham, North Carolina, and right here in Atlanta on September fifth and September seventh.

Yeah. You can get all the info you need and all the ticket links you need by going to stuffyoushouldknow. Com and hitting that tour button, or you can also go to linktree/sysklive. We'll see you guys this year. Welcome to stuffyoushouldknow, a production of iHeartRadio.

Hey, and welcome to the podcast.

I'm Josh, and there's Chuck and Jerry's here, too. It's the trio, the Tom and Jerry and Jerry of podcasting.

Okay, I like that.

Well, no. How about Tom and Jerry and Jerry's little nephew who's always getting in trouble, but he's super cute? Was that a character? Yeah.

I'm not sure if I remember that.

He was a little gray kid in diapers. Very, very cute. Even Tom wanted to take care of him sometimes.

It feels like so many shows and cartoons felt the need to bring on a little cute addition every now and then, whether it was cousin Oliver.

I was going to say him.

On the braided bunch or Godzuki.

Who?

Godzilla and Godzuki.

Mm-mm.

Yeah, it was a little cute baby Godzilla.

Oh, that's great. Way to go, Godzilla. You really slip one past the goalie.

Or whoever this one. Who's this one? What's his name? The nephew?

I don't know. Jerry. That's why I said Tom and Jerry and Jerry.

I got you.

There's also, Don't Forget Captain Caveman and Son.

Yeah.

Pretty straightforward stuff. But that's not at all what we're talking about, Chuck. Let's just get serious here. Let's get down to brass tacks. Let's get down to the facts, in other words, as our Cogni friends say. We're talking about misophonia. There was an O in there somewhere, but my voice hitched. Misophonia. It's possible I just accidentally set some people off because when I said it that second time, I articulated it clearly, the O. And vocal articulation or speech articulation, where you're really pronouncing a phoneme, can trigger misophonia, which we should say means hatred of sound, and is essentially a outraged nervous reaction to sounds that the average person doesn't even notice.

Yeah, and we'll get into all of this stuff here with misophonia. But it seems to be more like, generally more like, sounds people make. You often hear about chewing food or lip smacking or chewing just body sounds that people make, yauning sometimes.

Yeah, particularly orophacial, the stuff you do with your mouth and stuff. Yeah, like sniffing. Yeah, or nose.

That's typically it. I mean, there's a range of stuff, but I thought maybe we could chat very briefly just about sounds that you hate, if you have any triggering sounds at all.

Trigger is probably a strong word because I don't fly into I don't necessarily feel disgust. The closest would be someone using a leaf blower. I just think those are the worst people on the planet.

I forgot about that, your long-running feud with the-I can't stand them, Chuck.the blowers. I know. I'm with you. I have a couple of things, but similarly to you, similarly... Here we go. It's like a noise thing, like an ambulance crossing close by. I plug my ears like a five-year-old. I can't take it.

How about these new ambulance sirens that are like,.

Have you heard those? I don't know if I've heard those.

They're bonkers.

But if I'm on a street and there's a rush of emergency Agency Services, I have to plug my ears. When I'm using an airplane toilet, I have to plug my ears for that succubus flush sound. Cannot hear it. But those, I think, are just like loud noises, which, as we'll see, isn't the same as misophonia. The closest I can come with misophonia as far as an emotional thing that really feels like it's connected to my brain is hearing two kinds of music at the same time. When Ruby was growing up, it's a big thing when we'd be playing music and she would come into the room with some dumb kid toy that plays music. It makes me crazy and angry very It's clear it's not just like, Oh, that annoys me. It's like a real thing.

You're like, I'm trying to listen to Pavement.

Yeah, but it triggers me in such a way that I'm like, Oh, I think I understand that neuroconnective annoyance, which is not the same. It's just like, I don't like that sound.

So Umi has misophonia. She's never been clinically diagnosed, but she very much has it. Oh, yeah, for sure. It's like the orophacial stuff, like chewing, that stuff.

You're just now telling me that.

I know. It's just fun to sit back and observe when you guys are all in the same room together. Right. I would say maybe middling misophonia. Okay. She can control it. But I think if she's having a bad enough day or she's stressed or something like that, and it's triggered, she'd be more likely to be like, Can you chew any louder? Something like that, right? But normally, she can just chill and deal with it. But now that I've done the research, I'm like, Man, I feel for her more than I ever had before as far as that stuff is concerned. It's not like this is news to me. I knew she had misophonia. I understand I understand it. But just the degree that it affects people, she just plays it really cool. Knowing now that what's going on inside of her while she's playing it cool makes me never want to eat around her again, just out of support.

Yeah. Well, A, that's sweet. B, playing it cool is the Yumi way. That doesn't surprise me. C, you mentioned her, if she's already anxious or something about something else. As we'll see, there are comorbidities that can definitely make it worse. I imagine just being in an anxious state, like with anything else, something annoying could push you over the edge.

Exactly. You're already right there. And yes, it's an emotional reaction, a profound emotional reaction. And you said something else, too, that I think is worth really digging into for a second. You don't like ambulances. Nobody likes the sound of ambulance. The ambulance siren is designed to annoy you, to basically get you out of the way to catch your attention, but not in a good way. They don't want you standing around jamming out to the siren or something, right? So that makes sense. Someone chewing, the sound of someone chewing doesn't send the average person into a state of anger or in severe cases, rage, where you're yelling at the other person because they're chewing like a normal person. That's really where misophonia begins, where just a sound that wouldn't really upset anybody else really affects you.

Yeah, absolutely. We heard from the reason... I mean, we're getting to it late, but when we did our ASMR episode, we heard from a lot of people with misophonia that were like, Hey, a lot of this episode triggered me, and it's a real thing. I think we might have even poked fun at it a little bit, and we're even smacking sounds and things because we were oblivious at the time to what a real thing it is. We're doing this to make up for that in a way, and we're not going to give examples of sounds because we do know that it's a serious thing. It's not something to be made fun of or laughed at, it's to be taken seriously. That is part of the history of misophonia and continuing history as clinicians basically being like, I don't know what this is, but you learn to deal with it if you don't like the way your husband choose.

Yeah, let's talk about history. One of the reasons why people who finally go in to get diagnosed and treated for misophonia, one of the reasons they run into that thing, their doctor might tell them, just wear earplugs or get a hold of yourself or something like that. Or their psychologist might be like, You clearly have other issues. This is just some symptom of it. Misophonia is a very new thing. It has no clinical definition anywhere. Apparently, there was a committee that got together as recently as, I think, 2014, '15, '16? Very recently.

I don't 2022 was when the expert committee got together for- No.

Okay.

Yeah.

So during COVID, that's how recent this was. They're like, Well, we have time now. Exactly. They're like, I guess we'll get around to it. But they finally said, Okay, This is a thing. This is what this thing consists of, and this is how we think maybe you could conceivably treat it. It's that new. It was only back in 2001 that it was first described. 2001, the 21st It's like a brand new disorder.

Yeah, in 2001, that was when a couple that is going to figure pretty heavily in this one because they were the OGs, Powell and Margaret Jasterboff. They were from Poland, the married couple. They were professors of Otolaryngology.

Yeah.

Jeez, I had it right. It sounds funny. That's an ENT study, basically. They were here at Emory, I guess, in Atlanta, and Powell was studying tinnitus, TRT, specifically, tinnitus retraining therapy. Margaret, she was studying cancer research, but was like, I'm also involved in this tinnitus thing, and We're both going all in. It's 2001 on... What did they call the grouping?

Oh, here it is. Oversensitive hearing?

Well, decreased sound tolerance conditions, DST conditions, which at the time included hyperacusis, phonophobia with a B, and then mesophonia with an N.

Yeah, that's a lot of info.

It is a lot of info.

And by the way, I can just hear you saying, I had a bout of tinnitus while I was getting a tattoo. I'm going with tinnitus. All right. I'm also going with Pavel because they're from Poland, so I think his name's Pauvre.

Oh, is it W-A-I think so. Yeah, you're probably right.

I think they actually spell vodka with a W over there. It's just off the wall.

What a time to be alive. Right.

At first they were saying, okay, there's all these things that are lumped together. Like you said, the DSTs, decrease sound tolerance, and they can present in different ways. Hyperacusis is definitely its own thing. They think that maybe something happened to your ear, you damaged it. There's a facial muscle that controls it, that controls how much your ear intensifies or amplifies the sound. If that muscle is damaged, that sound is going to just come raging through your brain. If you hear somebody typing on a keyboard, you might have to crawl under your desk and want to die.

Because it seems like really loud, though, not annoying. Exactly. I mean, I'm sure it's annoying, but it's the decible level is the issue.

Yeah, it seems to produce more of a physical reaction than just an emotional reaction. If it is an emotional reaction, it seems to be more suffering than rage. Phonophobia, they were like, Okay, that's a separate thing, too, for now. And that is a fear of loud sounds. And the reason that it's a phobia is because you're afraid of loud sounds that can't actually hurt you, like the sound of traffic or the sound of emergency services. Yeah, an ambulance or something like that.

Or a toilet in a plane.

So if you felt fear while you were plugging your ears and maybe even ran away, you would probably have phonophobia.

No, it doesn't reach those levels. It's It bothers me, and I'm not afraid to look like a five-year-old in public. Okay.

Man, I want to see that so bad.

I'm surprised. No, surely I've done that in front of you. Maybe not.

I have not seen it. I would definitely remember that.

I know one thing. We've never been in an airplane bathroom together.

You know what I'm going to... That's true. You know what I'm going to do is next time we're on tour and we're hanging out backstage, I'm going to start a fire and sit around and wait for the show. That's a great idea. Okay, and then there's Misophonia, too, which is the topic of this episode.

Yeah, and I think they went on studying that stuff for about a dozen years. Then in 2014 is when they said, and this is a couple, the Jasterboffs?

Yeah?

Jasterboff. Or it's probably Jasterboff.

Pawel Jasterboff is what I'm going with.

That sounds so much better than Pawel Jasterboff.Jasterboff.Jasterboff. Anyway, they got together in 2014 and said, Dear, I think we should reorganize this stuff. Margaret said, Don't call me Deer. We're in a professional environment.

Also, could you chew any louder?

Could you chew any louder? They said, Let's just reorganize our taxonomy here. I believe what they did was they tucked the phonophobia under mesophonia and basically said there's pretty much two things, hyperacusis or mesophonia with phonophobia underneath Yeah, you touched on the distinction between them, too.

Hyperacusis is some mechanical issue, they think. It's not in the brain. It's just like the sound itself is being delivered to your brain way louder than it is to other people for some reason. But with misophonie and phonophobia, the research seems to strongly suggest that not only does it have a neurobiological, a brain basis, it also may even have a genetic basis as well. They're starting to figure out. So it is definitely something going on with your neurology. And again, just in 2022, they finally created a diagnostic definition of misophonia. So we have no idea what actually causes misophonie. Misophonia. But the studies that are out are pretty interesting, and they seem to point to something that I'll point it out when we get to it, but I think it's the smoking gun. It's the reason for misophonia, if you ask me.

Oh, well, that sounds like a fun cliffhanger.

Oh, I agree.

All right. Well, you know what they say, if you introduce a smoking gun in act one, you have to fire it in act three.

That's right.

We'll be back right after this commercial break.

Learning stuff from Joshua and Charles.

Stuff you should know.

Hey, Girlfriends, it's me, Carole Fisher. I'm so excited to tell you about the brand new series of The Girlfriends. In season one, we told you about the murder of Gail Katz at the hands of my ex-boyfriend, Bob. At one point, a woman's torso washed up on Staten Island and was misidentified as Gail. She spent nine years in Gail's grave, and then she just disappeared. It's almost like it's become this moral obligation to find her. And that's what we're going to do. Find this missing girlfriend and tell her story. With the help of some of your favorite girlfriends from season one, like my producer, Anna. Oh, my God. My friend Dr. Mindy Shapiro. Hi, it's Dr Shapiro, and I'd like to speak with the Deputy Medical Examiner. And of course, Gail's sister, Elaine Katz.

Having no closure. It kills you.

Join us as we try to solve a 35-year-old cold case. It's not going to be easy, but it's going to be one hell of a ride. What?

I can't believe this.

Listen to season two of the Girlfriends, Our Lost Sister on the iHeartRadio app, Apple podcast, or wherever you get your podcast.

Get emotional with me, Radhi Deblukia, in my new podcast, A Really Good Cry. We're going to talk about and go through all the things that are sometimes difficult to process alone. We're going to go over how to regulate your emotions, diving deep into holistic personal development, and just building your mindset to have a happier, healthier life. We're going to be talking with some of my best friends. I didn't know we were going to go there. I'm here. There are a lot of people that I admire. When we say, Listen to your body, really tune in to what's going on. Authors are books that have changed my life. Now you're talking about sympathy, which is different than empathy, right? Basically, I have conversations that can help us get through this crazy thing we call life. I already believe in myself.

I already see myself. And so when people give me an opportunity, I'm just like, oh, great, you see me too.

We'll laugh together, we'll cry together, and find a way through all of our emotions. Never forget, it's okay to cry cry, as long as you make it a really good one. Listen to A Really Good Cry with Radhe DiVlucia on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

Hey, I'm Rachel Martin. You probably know how interview podcasts with famous people usually go, right? There's a host, a guest, and a light Q&A. On NPR's new podcast, Wild Card, we have ripped up the typical script. It's part existential deep dive and part game show. I ask actors, artists, and comedians to play a game using a special deck of cards to ask some of life's biggest questions. Listen to NPR's Wild Card on the iHeartRadio app or wherever you get your podcast.

All right, so we're back talking Misophonia. One thing we should mention is as the Yastraboths... They are in there. What is going on with me. The Yastraboths were doing their work. It started to become just a more known thing on the internet. In 2011, there was a New York Times article by Joyce Cohen that got it out there in a more public way. The growth of internet forums and Reddit and stuff like that. All of a sudden people are getting online in the 2010s and saying, Hey, wait a minute. I've been living this my whole life. No one's ever taken me seriously. That can be one of the great things the internet is bringing people together for a common ailment that had not previously been taken seriously.

Yeah, for sure. That Joyce Cohen, New York Times article from 2011, by the way, is called When a Chomp or a Slurp is a Trigger for Outrage. And like you said, it really helped a lot of people, right? So flash forward to 2022, we've got the diagnostic definition of it. And what they figured out is that when you have a a bout of misophonia, when you're triggered, the sound triggers you, not only do you have an emotional reaction, typically it's anger, anxiety, disgust. And again, this is a pronounced emotional reaction. It's not like you're just a little annoyed. You're disgusted. Olivia helped us with this, and she turned up, I think, on a Reddit board that if you heard the sound of somebody clipping their toenails, you'd be so disgusted that you would not be able to drink coffee even 20 minutes later.

It's just stuff like that. I don't like that one.

That's discussed, but I think the the classic emotion is rage or anger, usually associated with it. In addition to the emotional component, there's also a physical component, too. It's been documented, these things happen to your body when you're suffering about a misophonia.

Yeah, and they smack of... Sorry, I don't even know if these words trigger like chom and smack.

Yeah, probably.

I didn't mean to say that, but it mirrors anxiety. It mirrors anxiety. Your blood pressure might go up, you might start sweating, you might get tightness in the chest, goosebumps, I think it's at heart rate. It's not necessarily... It depends on the person as to whether or not there's a single trigger that affects you or whether you have a lot of them. It's not always the same in everybody. There's also behavior responses. Like you said, if maybe Yumi was having a particularly bad day, she might be glaring at you from across the dinner table, and you're like, Stop with the fork in your mouth. You're like, What?

I got a chunk of spaghetti hanging out of the side of my mouth.

Now you know what. Yes.

I knew what before, but again, I just did not... I hadn't done the research. I hadn't been around it long enough. I'd never met anybody with it before. So, yes, I was Gosh, man, I guess I wasn't a very good husband for a little while there.

No, you were fine. You just didn't know. We're all better people now than we were when we got together.

That's true. I like to think that, too, Chuck.

But it can lead to, like you said, ragey episodes. It's pretty rare, but it can lead to actual violence, suicidal feelings, self-harm. I think they've documented that that's almost always isolated to cases where people have some other mental condition that is comorbid with, it may be a last straw thing. But it's, again, just more than an annoyance. I think that's probably the name of this episode.

I think you're right. You hit upon it. There's also some other things that studies have turned up. They found that people with misophonia don't respond to loud noises any different, typically, than other people. Somebody with misophonia probably wouldn't respond with a misophonia response to those ambulance sirens, right? It's more, usually, softer, probably wet or something like that sounds. I'm sorry, I'm really trying not to, but it would make sense why the ASMR episode set so many people off because it's exactly those soft sounds, chewing. That's why if somebody's like, Can you chew any louder? You're like, I'm not doing anything unusual, but you're making a soft sound, and that is what they hone in on. So there's no difference between someone with misophonia and someone without it as far as loud sounds go. It's where the softer sounds are. And then other sounds that upset most people. Again, this ambulance siren, siren, well, is still very deep. I'm going to go back to it again. But also a baby crying or something like that. Who wants to hear that? Nobody. And that includes people with misophonia, but that doesn't necessarily trigger rage in or misophonia.

Yeah. In cases of babies crying, even if you don't have misophonia, a lot of times that is coupled with lack of sleep from new parents, and it can get pretty severe. I mean, we were lucky with the sleep situation, but I've heard horror stories of new parents who are getting three hours of sleep a night, and a colicky baby. It's terrible. I feel so much empathy for those situations. But Back to Misophonia. I guess I was just empathizing for a minute. If we're going to talk about how many people have this, the Jastrabos did, I guess, just a round guess of 3.2% in 2014. But they based that on people who came in seeking treatment that also usually had tinnitus. Obviously, we've said this before about lots of things. You can't really base a number like that on people who seek help because so many people don't, especially when it's something like this that's underdiagnosed and treated.

Right. Other people who've studied it are saying, No, it's more like 20% of the entire population, which is a lot of people who have misophonia. They also think that women are overrepresented among people with misophonia as much as 83% people with misophonia might be women. Then there's one other very important thing that we need to point out. People with misophonia do not have better or more acute hearing than anybody else. That's not the problem. That's not it. It's a difference in the way their brain is connected is what it seems like.

Yeah. Well, that's a good set up for getting into the brain. Thank you.

I've been doing this for years now.

If you're wondering if they ever stuck somebody into a wonder machine and smack some Oatmeal in their ears, then the answer is yes, of course they have. They have done experiments. But as we'll see, there haven't been a ton of them because it is so new and probably underfunded. But they did put people in an fMRI machine, the WNDYR machine, and they found that the interior insular cortex, the AIC, which, and this makes total sense, it helps integrate sensory data from organs and stuff like that. But it's also associated with the parts of the brain that are responsible for emotion, fear, long-term memory, and stuff like that.

Yes. This is where I think the smoking gun is, the AIC.

Act 2, we're a little early.

Because I haven't fired it yet.

Okay.

I'm about to, though. The anterior insular cortex is also a major component of what's called the Salience Network, which is the the region or the network of your brain that takes stimuli from the environment, like you said, even down to your internal organs, and sorts through all of it and says, not important, not important, not important. Oh, that's important, and amplifies it up the chain, and it keeps getting amplified and passing through more and more filters until it becomes the brain's awareness or attention becomes focused on it. That salience network is like, that's important. We need to let the brain's consciousness in on this thing. And now all of a sudden, you're paying attention to that stimulus. What they think, what I think in particular, is that there's a hyper activity and/or hyper connectivity within the AIC that takes things that other people are able to filter out and turns them into a sound that can trigger you emotionally. And it's because your salience network is basically supercharged.

That would actually back up what they did with the studies with the MRI scans, not the fMRI, correct?

Yeah, where they turned up the medial frontal cortex.

Yeah, well, what they found was what you just said, the medial frontal cortices. If you have mesophonia, they have more myelin, which we've talked about before. It's a fatty substance that insulates the nerve cells, but they're saying the excess of myelin backs up the idea of that hyper connectivity with the anterior insular cortex.

Boom. The gun has just been fired and is now smoking bright red, white, and blue smoke.

Yeah, it's a Nerf gun, of course, people.

Yeah, for sure. There's one other thing that seems to be a bit of a boon doggle in misophonie or research, and that is that there's a theory or I guess a school of thought that it's actually triggered by overactive mirror neurons in somebody.

Oh, our old friends.

And in particular, the motor cortex that has to do, again, with orophacial movements, that those mirror neurons are hyperactive, and that when you see somebody or hear somebody chewing, it triggers those mirror neurons, and it creates a reaction, a response in you that you can't control because your mirror neurons have taken over. That seems to be untrue.

Okay. Well, Even so, we did an episode about mirror neurons many, many, many years ago that it's still super interesting to me. And just the quickest summation is the idea of mirror neurons. Or like, when you see someone in a football game on TV, break their leg in a painful way, and you literally feel that in your own leg.

Yeah.

I mean, that's the dumb down version, but that's what we're talking about.

No, I mean, that's a great example. When I watch sports, I find myself leaning. If the guy's trying to avoid a tackle, I'll turn as well. It doesn't help the guy at all, but I can't stop myself. I've noticed it because I'll be on the treadmill watching basketball or something, and all of a sudden, I'm off balance a little bit because I'm moving along with the guy who's doing the layup.

I've seen people do that when they're gaming, first-person games.

That's the exact same thing, I think, yeah.

Moving their body around in weird ways. It's pretty interesting if you train a camera on somebody gaming. Yeah. You did mention genetics. It may have a genetic component. I think they did just an analysis on what's called a GWAS, a genome-wide association study, about just rage-related mesophonia. They found that it does cluster with PTSD, anxiety, and depression, which indicates it could have a genetic component, right? Yes.

Which makes sense for sure. I didn't see the gene that they targeted it to, but- I didn't either. It does seem to be related genetically. There's a researcher from Oxford named Jane Gregory, who also suffers from mesophonia. She depositss that misophonia could be like a relic, like an evolutionary relic from back when it was advantageous for a group to have a few people who responded to sound way more than other people because they essentially served as alarms for the rest of the group. All right. That makes sense. I mean, this is the place that we're at in misophonia research. You can just toss stuff out like that and be like, Yeah, probably.

Yeah. It's also can be comorbid with mesokinesia, and that is when you have a mesophonia-like response to someone's fidgety motions. Yeah. I think someone clicking a pen can be a misophonie a trigger, but that's also a fidgety thing. That makes sense, I think. Yeah.

If you want to empathize with people who have mesophonia and mesokinesia, go on to Reddit. Actually, any condition that could be debilitating, go on to Reddit and look at the Reddit board for that condition, and your heart will just go out to people. I looked at the Misokinesia Reddit board, and just the first few posts, the language they use, like want to die, can't live like this. They're not talking about self-harmed. They're saying this is just bonkers out of control. And they're talking about being in class and everyone just bouncing their knee, and they They're just so overwhelmed by that and unable to not pay attention to it that they just feel like they're losing their minds in just the worst way. It's really awful. And I'm not overstating the way that they describe it at all. Oh, I'm sure. One One thing I did notice, though, on the Misokinesia board is one poster said, or sorry, one OP said that they counteracted the experience by, I guess, mirror wondering what the person was doing. So if somebody's bouncing their knee, they use their hand to just keep time with the person's knee, and it somehow counteracted or short-circuited the mesokinesia in them right then.

Well, they said the same thing with mesophonia is that sometimes people will make that sound themselves to counteract it, and that can help.

Yes. So if you're ever clicking a pen and your coworker stands up and just shouts, Click, click, click, click, they probably are having a misophonic episode right then.

Yeah, for sure.

You should stop clicking your pen.

It can affect, obviously, the workplace in negative ways, but it can also affect your relationships and your family. It has has been described as contagious in a way, because if you're, let's say, in a close relationship, maybe married to somebody or coupled up with someone or living with someone with misophonia, you might become very attuned to their trigger sounds. It's not the same as having misophonia, but it is contagious in a way in that all of a sudden, if you then were just really on the lookout for the sound of people chewing their food because of being married to Yumi, obviously, it's not as bad for you, but it can get into your brain and take over in a way.

Yeah, and I don't think it's like it could trigger misophonie in somebody else. I don't buy that. What I think is, is you've just become hypervigilant on behalf of your spouse because you care about them. So you could conceivably get angry at somebody daring to chew around them because you know what it's doing to them. That's what I take that as.

No, no, no, absolutely. But I think that they say it can be worse with people that are close to than out in a restaurant with a random stranger. You might get more bothered by your family members or your coupled person.

Yes. If you have misophonia, usually it's the people who are closest to you that can set you off the easiest.

With your spaghetti hanging in your mouth.

I've not figured out exactly why. My guess would be that they know that you know what they're going through and you're still doing it. Maybe you seem very thoughtless or careless. You're still eating? Yeah, right then. That would be That would be my guess. But there's a huge component of this that I think really supports that Salience Network hypothesis of mine.

Let's hear it.

And that is that the sounds seem to have also a personal emotional component to them. Like the Yastroboffs, their theory is that the limbic system is very much involved, which would explain why emotions there. So if you combine the limbic system with the Salience network, the emotions you're feeling are personal. It feels personal to you, hence why you would feel something like outrage or profound disgust or something like that. You feel like you're being personally attacked right then.

Oh, yeah, that makes sense.

Yeah. Like your brain has told you this is a very, very important stimulus, and you need to respond to it in kind. That's the salience hypothesis.

I like it. Can we call it the Josh Clarke Salience Hypothesis?

I've been hoping you would say that all episode.

The J C-S-H? It almost spells Josh.

It does. Can we rework that? Sure. Yeah. Can you turn that C into an O?

Well, sure.

Can you turn my last C into a N-O?

I wasn't sure if you knew what you were saying, so I was just giving you a backdoor.

No, I knew it. Josh O'Clarke. I just did it for you.

Hey, you may have been at one point. You never know. All right, so let's take a break now, and we'll come back and talk about what you probably think is coming, which are myriad forms of CBT behavioral therapies right after this.

Learning stuff from Joshua and Charles.

Stuff you should know.

Hey, Girlfriends, it's me, Carole Fisher. I'm so excited to tell you about the brand new series of The Girlfriends. In season one, we told you about the murder of Gail Katz at the hands of my ex-boyfriend, Bob. At one point, a woman's torso washed up on Staten Island and was misidentified as Gail. She spent nine years in Gail's grave, and then she just disappeared. It's almost like it's become this moral obligation to find her. And that's what we're going to do. Find this missing girlfriend and tell her story. With the help of some of your favorite girlfriends from Season 1, like my producer, Anna. Oh, my God. My friend Dr. Mindy Shapiro.

Hi, it's Dr Shapiro, and I'd like to speak with the Deputy Medical Examiner.

And of course, Gail's sister, Elaine Katz.

Having no closure, it kills you.

Join us as we try to solve a 35-year-old cold case. It's not going to be easy, but it's going to be one hell of a ride.

What? I can't believe this.

Listen to Season 2 of The Girlfriends, Our Lost Sister on the iHeartRadio Apple podcast, or wherever you get your podcast.

Get emotional with me, Radhi Deblukia, in my new podcast, A Really Good Cry. We're going to talk about and go through all the things that are sometimes difficult to process alone. We're going to go over how to regulate your emotions, diving deep into holistic personal development, and just building your mindset to have a happier, healthier life. We're going to be talking with some of my best friends. I didn't know we were going to go there on this. I'm not going to go there. I'm not going to go there. People that I admire. When we say, Listen to your body, really tune in to what's going on. Authors are books that have changed my life. Now you're talking about sympathy, which is different than empathy. Basically, I have conversations that can help us get through this crazy thing we call life. I already believe in myself.

I already see myself. And so when people give me an opportunity, I'm just like, oh, great, you see me, too.

We'll laugh together, we'll cry together, and find a way through all of our emotions. Never forget, it's okay to cry as long as you make it a really good one. Listen to a A Really Good Cry with Radhi DiVlucia on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

Hey, I'm Rachel Martin. You probably know how interview podcasts with famous people usually go, right? There's a host, a guest, and a light Q&A. On NPR's new podcast, Wild Card, we have ripped up the typical script. It's part existential deep dive and part game show. I ask actors, artists, and comedians to play a game using a special deck of cards to ask some of life's biggest questions. Listen to NPR's Wild Card on the iHeartRadio app or wherever you get your podcast.

So one of the saddest things about misophonia and misokinesia, aside from the fact that people suffer from it, is that the treatment landscape is so hit or miss. There's so little widespread information out there among clinicians that you very well might go to see an ENT, or a psychologist, or a psychiatrist, or even a neurologist that's particularly uninformed who might basically say, This is your problem? Where are earplugs? Just relax, go do mindfulness or something like that. And some of that stuff can help. But if that's all you're being met with, that's no treatment whatsoever. So fortunately, there are people who have really started to study how to treat it. And one of the things that they've discovered is that good old cognitive behavioral therapy, CBT, seems to work for it, at least as far as any decent study has shown. It It certainly has some effect compared to control groups.

Yeah, there was a trial in 2020, a randomized clinical trial that found that there was significant improvement in 37% of the group that completed CBT versus zero % for the control group, and that a year later, those 37 % seem to be holding, which is great.

Yeah, that's what they call statistically significant.

I would say so. We also should mention, as we're going through these various treatments, there are good people doing a lot of great work, but there are also... Just be wary. There are also people online that are just lining up to take your money to help you with this that may be quacky.

Yes. If somebody has earplugs that the description almost makes seem magical, you should steer clear of that. Or if somebody says this supplement or this crystal or this tarot deck is going to help you, it's not. So just don't. Go seek out a neurologist, a neuropsychologist or neuropsychiatrist, I should say, and they should be able to help you. Do research yourself and say, Hey, I I want CBT, or I want to try something called unified protocol, which is called transdiagnostic therapy, meaning that you can use it for all sorts of different things that stir up strong emotions. Basically, like CBT, it gives you tools to identify what triggers your emotional reactions, what you feel like when you're having that emotional reaction, how to deal when you're having that emotional reaction, and then also, if you're lucky, how to distance yourself from the emotional reaction and the trigger that causes it.

Yeah, I think there are lots of... I feel like all of these are just a reskinned version of the same thing, which are those therapies: identifying mindfulness, recognizing behaviors, learning one thing called cognitive flexibility, like retraining your brain. The one that's a little different, I think, is the Tinnitus Retraining Therapy, the TRT they've been using for misophonia. It seems like with some pretty good results. It's basically sound therapy where you have a wearable device that plays a very low level white noise or pink noise, whatever your noise of whatever color noise you prefer, I guess. But just below the volume threshold of that trigger sound, and the Jastrowoff say 80% of the patients that have tried that have had pretty good success.

Yeah. The key is you want to gradually increase the volume of that trigger sound against the background of that pink noise, so that you're Basically, it's a type of exposure therapy, which is very controversial with misophonia.

Yeah, for sure.

A lot of people say, Do not try exposure therapy. That does not work. Actually, it makes it worse because what you're doing is enraging yourself, and all you're doing is strengthening that neural pathway that triggers that rage in the first place. So it's not only not helpful, it's actually counterproductive. Other people say, No, you can do certain types of exposure therapy, like the Yastrabat's TRT with the pink noise. But if you do start to have an emotional response, stop. Anybody who has any understanding as a health care provider of misophonia will tell you that if you have an emotional response to misophonia while you're undergoing treatment, stop the treatment. Get away from the sound. That's like best practices. If somebody's trying to force you to just hang in there through it during exposure therapy, you're being treated by a quack, and you need to find somebody else to help you because they don't understand misophonia.

Yeah. This one I don't fully understand. This is Jane Gregory again from Oxford. She has worked on a situation where, or I guess a therapy, where she tries to create a different association with that sound. She did this, in one case at least, by riding one of those like an amusement park, like Disney World, I guess, like a dizzy ride, like a spinning teacup ride, a while listening to, what was it in this case?

Her husband slurping tea.

Yeah, it was Josh eating spaghetti, which makes sense in a way, but then wouldn't that just make you dizzy? Wouldn't you want to choose something that's not also awful?

I think that what she was after- Or does she just love those rides? She must love those rides. Also, I think she was after making the whole thing silly. When she heard her husband slurp tea, she would think about spinning around in a tea cup, and that might disarm her rage or something like that.Okay.

I guess I hear that.That's what I think it is. I guess I hear that, and I'm like, Those are the worst rides because it just makes me sick to my stomach. No, I'm totally with you. Maybe the... Yeah, I get it.

But yeah, so that is a weird weird example, but what the basis of that therapy is, is that you're listening to the trigger sound while also doing something else or learning to associate it with something else that's not that horrible emotional reaction.

Yeah, okay. Well, I don't know if that makes sense.

Then also, Chuck, there's self-treatment for misophonia that people have discovered along the way, like wearing noise canceling headphones, wearing headphones where you're listening to pink noise or some noise, or music, just putting a barrier between you and any sound that might trigger you. Then there's other techniques, too, but they're very sad, not eating with your family because You are probably going to get triggered, and it's sad, but that's a really effective intervention for Misophonia.

Yeah, there's a woman named Shalyn Hayes-Raymond, who is a co founder of Misophonia International, and her whole jam is self-advocacy. It's okay to tell your family that, Hey, can you try and avoid these triggering sounds? Can you be aware of what I'm going through? Can you understand if I have to leave the room during a big family meal?

Can you go scan the subreddit on Misophonia? Yeah, but to advocate for yourself also, and things like noise canceling headphones, like you mentioned, or just getting out of there, like you said, leaving the room, because from what I've seen, it calms down pretty quickly.

If you can remove yourself from the sound, you don't stay in that state for hours, generally, from what I've seen. Is that right?

Yes. It can pass fairly quickly.

So that's the good news.

Yeah. Then also the good news is that there are smart people who have begun to study this, in addition to the Yastraboths, who are making some headway. So hopefully, there will be some verifiable cure or treatment for it in the not-too-distant future.

Yeah. I mean, if we're talking about a thing that's just been seriously looked at in the last 20 years, You'd imagine there'll be a lot of headway made. I think just getting an episode out here for people that maybe have been poking fun at someone in their life, not taking it as seriously, hopefully this will help that.

Yeah, we're the Joyce Coens of podcasting. Did you get that?

I did. I mean, that was... I don't know. I'm sorry. I thought you were talking about the self-advocate. Who's Joyce Coen?

She's the woman who wrote the 2011 New York Times article that told everybody who is suffering from misophonia that that was a real thing.

It was the other person. I got it. I thought you were saying Joyce Brothers.

Who won on... What was that show? Quiz?

Quiz That was the Network stars?

No, it was quiz show. Remember, she won big time on a game show, and you had to pick what topic you wanted to be deeply quizzed on, and she chose boxing and just wiped the floor with her opponent.Oh, wow.Yeah. That was on our game show episode. Really? I don't remember that. For some reason, that always stuck out to me. Joyce Brothers in Boxing, it's cognitive dissonance that just stuck with me.

Yeah, totally.

You got anything else on Misophonia?

No.

Well, our heart goes out to all of you there listening to us who have Misophonia. We hope we didn't trigger you. We hope we've never triggered you. And sorry again about that time with the ASMR. And since I said that, it's time for Listener Mail.

I'm I'm going to call this is very interesting, Irish Famine Connection. Hey, guys, listen every day on my drive to work in rural Ireland. Luckily, an episode is just right linked for my 40-mile trip. On the Selects episode, this is about an old one from Famines in 2017, you did a nice job describing the nature of the Irish famine. But rather than bemoan the terrible response of the British rulers, I wanted to celebrate the amazing gesture of the Choctaw Nation of Native Americans, who upon hearing of the plight of the Irish people during the famine, gathered up $170 at the time, which was fairly significant money, to send over for help. This incredible act of generosity came from people who had only recently themselves suffered terribly during the infamous Trail of Tears, showing the true nature of them as a people. This kindness had never been forgotten, has never been forgotten, and thankfully, now that Ireland is a country of significant wealth, we've been able to give back. There has been a spectacular monument erected in honor of the Choctaw Irish Connection, and also a university scholarship program, and that's a program with two Ms and an E.

In Cork, where members of the Choctaw Nation can avail of a fully paid B BED or master's degree, I guess BED as an undergrad, and living expenses paid also. Wow. This is something I teach my students in geography classes on migration at a high school level, as I think it is so important to recognize the... And that's recognize within S. The incredible human acts that take place in these terrible moments really enjoy the variety of things you cover. And thanks for looking beyond the potato in Irish history. And that is from Bob Grace in Count County Carlo.

That's awesome. Thanks a lot, Bob.

Super cool.

Yeah, that's wonderful. I had no idea about the scholarship, did you? I feel like we mentioned that in another episode. I don't remember which one. Maybe Trail of Tears. Oh, really? I don't remember because it does sound familiar, but I definitely don't remember the college scholarship thing. So way to go, Bob.

Well, you know me, I've forgotten anyway, so I'm happy to relearn it.

It's awesome. I wish I were you. You could just watch movies over and over again.

I'm like a That guy, Momento.

Yeah, guy, pierce.

If you want to get in touch with us like Bob Grace did with a great story, we want to hear it.

You can send it off via email to stuffpodcast@iheartradio. Com.

Stuff You Should Know is a production of iHeartRadio.

For more podcasts, My Heart Radio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

Hey, Girlfriends. It's me, Carole Fisher, back with another season of the global number one podcast, The Girlfriends. Last time, we investigated the murder of Gail Katz. This time, we're uncovering the identity of the woman who was buried in Gail's grave for a decade before she disappeared. Join me and the rest of the club as we tell her story. Listen to season 2 of The Girlfriends, Our Lost Sister on the iHeartRadio app, Apple podcast or wherever you get your podcast.

Get emotional with me, Radhi De Vluukia, in my new podcast, A Really Good Cry. We're going to be talking with some of my best friends. I didn't know we were going to go there on this. People that I admire. When we say, Listen to your body, really tune in to what's going on. Authors of books that have changed my life. Now you're talking about sympathy, which is different than empathy. Never forget, it's okay to cry as long as you make it a really good one. Listen to a really good cry with Radhi DiVlucia on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

Hey, I'm Rachel Martin. You probably know how interview podcasts with famous people usually go, right? There's a host, a guest, and a light Q&A. On NPR's new podcast, Wild Card, we have ripped up the typical script. It's part existential deep dive and part game show. I ask actors, artists, and comedians to play a game using a special deck of cards to ask some of life's biggest questions. Listen to NPR's Wild Card on the iHeartRadio app or wherever you get your podcast.