A false dichotomy
Brains implement emotion, attention, and inhibition; psychology describes patterns you can measure and treat. Misophonia research maps autonomic surges and selective trigger networks without requiring patients to pick a team.1
Listening effort and cognitive load frameworks remind us that when attention is captured by a trigger, everything else pays a tax: conversation, work, parenting.2
Semantic control and selection processes matter when triggers generalize or when family members feel like they must “walk on eggshells.”13
Clinical takeaway
Treat what maintains suffering: avoidance, conflict, shame, sleep loss, and comorbid anxiety, using individualized hierarchies, regulation skills, and careful exposure where appropriate.3
When hearing loss overlaps, sensory and cognitive scores need interpretation together; training design should engage linguistic systems, not only detection.4
For patients
You are not “just dramatic.” Mechanisms are real and learnable. Progress is often incremental. Predictability at dinner beats a miracle cure narrative.23
