Appendix 6: Misophonia Emotional Response Survey.
[a] Misophonia Treatment Institute, Livermore, CA, USA.
Misophonia is a condition in which a person has an acute emotional response of anger or disgust to a commonly occurring innocuous auditory or visual stimulus referred to as a trigger. This case details the effective treatment of misophonia in a young woman that included a counterconditioning treatment called the Neural Repatterning Technique (NRT), which combines a continuous positive stimulus and a reduced intensity, intermittent trigger. The treatment was delivered via the Misophonia Trigger Tamer smartphone app and all treatments were conducted independently by the patient. In this patient, the trigger elicited a physical reflex of contraction of the flexor digitorum profundus, which caused her to clench her fist. To enhance the effect of the NRT treatment, Progressive Muscle Relaxation was incorporated to increase her ability to deliberately relax the affected muscle during treatment. During NRT treatment sessions, the patient experienced a weak physical reflex to the reduced trigger stimulus but no emotional response. Her emotional response of misophonia was not treated, but when the physical reflex extinguished, the emotional response also extinguished. This case indicates that the misophonic response includes a Pavlovian-conditioned physical reflex. It is proposed that the trigger elicited the physical reflex and the physical reflex then elicited the conditioned emotional response that is characteristic of misophonia. Because of the conditioned reflex nature of misophonia, it is proposed that a more appropriate name for this disorder would be Conditioned Aversive Reflex Disorder.
Received: 2015-03-24. Accepted: 2015-07-15. Published (VoR): 2015-10-16.
Misophonia is a recently identified disorder in humans which is characterized by an extreme emotional response of anger or disgust to commonly occurring, innocuous auditory or visual stimuli (Edelstein, Brang, Rouw, & Ramachandran, 2013; Jastreboff & Jastreboff, 2002, 2014; Schröder, Vulink, & Denys, 2013; Wu, Lewin, Murphy, & Storch, 2014). The condition was first identified in 1997 by audiologist Marsha Johnson, which she named Selective Sound Sensitivity Syndrome (4S; Bernstein, Angell, & Dehle, 2013). The name misophonia, which means "hatred of sound" was proposed by Jastreboff and Jastreboff (2002). The name misophonia refers to the emotions evoked by the trigger stimulus rather than a general hatred of sound.
Misophonia is a unique and discrete disorder that cannot be classified in the DSM-5 or IDC-10 (Schröder et al., 2013). With misophonia, specific auditory or visual stimuli trigger a response of irritation or disgust, which immediately escalates to anger (Schröder et al., 2013). Auditory triggers can be almost any repeating sound, but those commonly reported are eating sounds (e.g. lip smacking, chewing), nasal sounds (e.g. sniffing, breathing, snoring), and repetitive sounds (e.g. typing, pen clicking; Edelstein et al., 2013; Jastreboff & Jastreboff, 2014; Schröder et al., 2013; Wu et al., 2014). Visual trigger stimuli of repetitive movements (e.g. hair twirling, leg shaking) and movements associated with auditory triggers (e.g. jaw movement) are also reported (Jastreboff & Jastreboff, 2014; Wu et al., 2014).
Emotions commonly reported in response to trigger stimuli are anger and disgust (Edelstein et al., 2013; Johnson et al., 2013; Schröder et al., 2013; Wu et al., 2014). Schröder et al. (2013) noted that anxiety was specifically not a response to trigger stimuli of the participants in their study, but participants reported actively avoiding exposure to trigger stimuli. Other researchers have reported anxiety as a common emotion of individuals with misophonia (Edelstein et al., 2013; Johnson et al., 2013; Wu et al., 2014). Although this seems to be a discrepancy, the anxiety of misophonic individuals could have been associated with avoidance behaviors, and so referred to as avoidance by Schröder et al. (2013).
The physiologic response accompanying strong emotions was measured to validate self-reports of emotional responses to trigger stimuli (Edelstein et al., 2013). Skin conductance was shown to begin increasing 2 seconds after onset of trigger stimuli and continue increasing for the duration of a 15s trigger. Participants in this study also reported general physiologic responses associated with emotional arousal including pressure in chest, head, and whole body; clenched/tightened muscles; sweaty palms; difficulty breathing; and increased blood pressure and heart rate.
Although the prevalence of misophonia in the general population is unknown, it was estimated at 3.2% based on comorbidity with other auditory conditions (Jastreboff & Jastreboff, 2014). Another study utilizing undergraduate psychology students reported 20% of participants had clinically significant misophonia (Wu et al., 2014). Misophonia can develop at any age, with a mean age of onset in childhood (Schröder et al., 2013). Once misophonia develops, it seemingly persists over the lifespan of the individual and often worsens with time (Schröder et al., 2013). The impact on the individual can vary from mild to debilitating and can cause severe problems in family, social, and professional life (Dozier, 2015b; Edelstein et al., 2013). Although misophonia is a chronic condition, it can vary due to other factors. Patients have reported that the severity of their misophonia is affected by their momentary feeling of well-being (Wu et al., 2014).
Research on the etiology and nature of misophonia is limited by the lack of an animal model (Jastreboff & Jastreboff, 2014). Studies to date have focused on the stimulus-emotion relationship and physiological responses accompanying strong emotions (Edelstein et al., 2013; Schröder et al., 2013; Wu et al., 2014). The etiology and nature of misophonia has been ascribed to physiological abnormalities in the brain (Møller, 2011), general hyper-reactivity similar to sensory processing disorder (Schröder et al., 2013), and classical conditioning (Dozier, 2015b; Jastreboff & Jastreboff, 2014; Schröder et al., 2013). Most discussions of misophonia refer to the condition as an emotional response to trigger stimuli, with accompanying fight-or-flight responses, including both physiological arousal and behavioral activation as shown in Figure 1 (Bernstein et al., 2013; Edelstein et al., 2013; Jastreboff & Jastreboff, 2002, 2014; Schröder et al., 2013; Wu et al., 2014).
Popular view of the misophonic response.
Dozier (2015a, 2015b) identified a discrete muscle reflex in response to trigger stimuli, which occurred independently of the emotional response when the trigger stimuli were sufficiently weak (see Figure 2). Dozier proposed that the emotional response may be elicited by the sensation from the physical reflex, because of the observed direct relationship between the decrease of the physical reflex in treatment and the decrease of the emotional response in real-life (see Figure 3).
Initial skeletal reflex response to a misophonic trigger stimulus. The trigger stimulus directly elicits a skeletal muscle contraction.
Misophonia emotional response is elicited by the physical reflex.
As shown in Figures 1, 2, and 3, the trigger stimulus elicits a response. Such a stimulus-response pair is known as a reflex. A Pavlovian conditioned reflex is generally viewed as being learned through a temporal pairing of a neutral stimulus (NS), which becomes the conditioned stimulus (CS), and an unconditioned stimulus (US), such that the CS becomes associated with the US and elicits a response similar to the unconditioned response (UR) elicited by the US (Lattal, 2012). It has been demonstrated that the critical pairing for conditioning to occur is the NS/CS with the UR (Donahoe & Vegas, 2004), rather than that of the NS/CS and the US. When a stimulus occurs 0 to 2 seconds prior to a skeletal reflex response, Pavlovian conditioning can occur (Furedy & Riley, 1987, p. 7), and that stimulus can then elicit a conditioned response.
There have been no controlled studies on the treatment of misophonia, but there are several published case studies and summaries of patient outcomes. The most established method of treating misophonia is to add noise to the patient's environment, which reduces the misophonic response to auditory triggers (Jastreboff & Jastreboff, 2014; Johnson, 2014). This is generally accomplished with a behind-the-ear sound generator that resembles a small hearing aid. Additionally, this treatment has incorporated protocols to promote active extinction of the misophonic response (Jastreboff & Jastreboff, 2014) or cognitive behavioral therapy to manage misophonia as a chronic condition (Johnson, 2014). Both methods have reported a high level of positive patient outcomes, but details on attrition, statistical significance, and effect size have not been reported.
A case study of cognitive behavioral therapy (CBT) to treat misophonia in a young woman reported remediation of impaired social functioning at end of treatment and at 4-months posttreatment, although the woman still found the trigger stimuli unpleasant (Bernstein et al., 2013). Another CBT case study reported successful reduction in maladaptive behavior associated with trigger stimuli in two adolescents (McGuire, Wu, & Storch, 2015), but no follow-up data was provided. A third case study reported using a counterconditioning treatment called the Neural Repatterning Technique (NRT) in a middle-aged woman by individually counterconditioning three auditory triggers and a visual trigger (Dozier, 2015a). This treatment paired a continuous positive stimulus with an intermittent, reduced-intensity trigger stimulus which resulted in a progressive decline in the strength of her physical reflex to the trigger stimulus (see Figure 2). The patient reported a decline in her emotional responses to real-life trigger stimuli which accompanied the decline in her physical reflex during treatment (see Figure 3). The patient reported a large reduction in the severity of her misophonia at the end of treatment, and at 4- and 10-months posttreatment.
At the 2013 Misophonia Association Conference, a member of the patient panel reported virtually eliminating his misophonic emotional response by relaxing all of his muscles continually during a trigger situation (Martz, 2013). Discussion with the author revealed that this individual developed proficiency in progressive muscle relaxation (PMR) as a treatment for his general anxiety as a teenager, and for many years he relaxed his muscles immediately after triggers to suppress his emotional response.
Progressive Muscle Relaxation (PMR) is practiced by systematically tensing and relaxing 15 to 20 skeletal muscle groups (Borkovec & Sides, 1979). It has been demonstrated that individuals who practice PMR develop increased control of skeletal muscles, including a reduction in muscle tension during stressful events (Borkovec & Sides, 1979; Lehrer, Woolfolk, Rooney, McCann, & Carrington, 1983; O'Bannon, Richard, & Runcie, 1987). Daily PMR has been shown to be a benefit in treating anxiety disorders and improving well-being (Borkovec & Sides, 1979; Conrad & Roth, 2007; Dehghan-Nayeri & Adib-Hajbaghery, 2011; O'Bannon, Richard, & Runcie, 1987; Öst, 1987, 1988a).
Applied Relaxation is an enhancement to PMR that incorporates PMR as the initial relaxation training (Conrad & Roth, 2007; Öst, 1987, 1988b). The second phase of training includes relaxing each muscle group sequentially without first tensing it. The final phase develops the skill of relaxing all muscles simultaneously. Applied relaxation is the technique which was ascribed as an effective management technique for misophonia by one misophonic individual (Martz, 2013).
There is little absolute certainty about misophonia due to the sparse research on the condition, except the finding that typically innocuous auditory and visual stimuli evoke extreme, involuntary emotional responses in the misophonic individual (see Figure 1). Misophonia is a chronic condition that generally maintains or strengthens, so it is unlikely that the condition will abate without intervention. Of fundamental interest to this case is the view of misophonia as a conditioned reflex response and therefore subject to change through experience, as reported by two misophonia treatment providers (Dozier, 2015a; Jastreboff & Jastreboff, 2014). The physical reflex response of misophonia, as shown in Figures 2 and 3, identifies a characteristic that is germane to this case. The course of treatment was informed by the research on muscle relaxation which indicates that the daily practice of PMR provides broad wellness benefits in addition to developing improved muscle control.
Miley (pseudonym) was a 21-year-old, single Caucasian woman. She attended university during the school year, but had just moved home for the summer. Her mother was divorced and lived alone. Miley reported having a generally positive relationship with her mother, except for the issue of misophonic triggers by her mother, which made living together difficult. Miley was not taking psychotropic medications. She presented for treatment by VSee video-chat and was well-groomed, articulate, and outgoing, with an overall positive attitude toward life which was reflected in her bright smile and cheerful demeanor. (VSee is a medical-grade internet video chat service that meets the confidentiality requirements for treatment of patients).
Miley contacted the author by email seeking treatment for misophonia after she had self-diagnosed her condition based on internet research. She was far from the treatment facility, so assessment and treatment were provided by VSee. Although her misophonia caused extreme emotions and was a major problem for her at university, she requested help with the misophonic triggers from her mother, which specifically were sounds of chewing and scraping of utensils on dishes. She reported extreme emotions of anger and rage in response to being triggered by her mother, which prevented them from eating together.
Miley reported that her misophonia began at about age 6 or 7, but her first concrete instance of a severe response to a trigger was at age 9. Her first triggers were her mother's yawning and gum chewing, and a classmate yawning. She reported that her childhood seemed fairly normal to her. She viewed herself as overweight at age 6 and tried to diet at age 8. Her parents divorced when she was 8, but she didn't feel overly affected by this or other life events. She reported that she was a sensitive child, who responded to her mother's emotions and that her mother was often stressed. Miley reported that she had never been diagnosed with depression, anxiety, or other mental conditions, and that she did not have any such tendencies.
All assessment forms were downloaded from misophoniatreatment.com and submitted by email, including an informed consent. The questionnaires included the Misophonia Assessment Questionnaire (MAQ) and the Misophonia Coping Responses (MCR) surveys by audiologist Marsha Johnson, which she has used in her practice for over a decade. The MAQ contains 21 questions on time spent with various negative thoughts and feelings about misophonia. The rating scale is 0 to 3, with 3 being "almost all the time" and 0 being "none of the time" so the sum score can range from 0 to 63. Johnson (2014) used the sum MAQ score to rate patient misophonia severity as mild (1-21), moderate (22-42), or severe (43-63). Other questionnaires included the Misophonia Activation Scale (MAS-1) from misophonia-UK.org, Misophonia Physical Sensation scale (MPS) and Misophonia Trigger Severity scale (MTS) by audiologist Natan Bauman, and the Misophonia Emotional Response (MER) survey by the author. See Appendices 1-6 for the specific content of the assessments and patient responses. Presently there are no validated misophonia assessment instruments.
The written assessment was based solely on the self-report of the client. Her responses supported her self-diagnosis of misophonia. Miley's responses on the MAQ showed that she had a high level of preoccupation with misophonia, answering 16 of the 21 questions with "a good deal" or "almost all of the time," and the other 5 with "a little of the time." Her sum score was 49 at intake, which rated her misophonia as "severe." Miley's initial rating for her emotional distress to triggers was 9 on the MAS-1, and her physical sensation was 7 on the MPS. Her rating was 8 on the MTS, which is a combination of emotional and physical response severity (see Table 1).
aValues are sum scores. bValues are maxima. cMultiple ratings indicate response variability. dMode = 1. eMode = 3. fMode = 0.
On the MCR survey Miley reported that she usually responded to triggers with mild responses that indicated she was annoyed or upset, or by turning away or covering her eyes, putting on headphones, moving away from the sound, and leaving the room either immediately or after attempting to tolerate the sound. She reported often engaging in more aggressive responses, in that she would sternly ask the triggering individual to stop making the sound, verbally snap at the person making the sound, or use physical violence on the person making the sound. Her individual responses are shown in Appendix 2.
Miley's emotional responses to triggers were extreme. All of her responses on the MCR were "almost all the time" except for nonaggressive feelings such as wishing she were deaf, not wanting to offend, or feeling hopeless. She also rated herself low on feeling offended by the person making the sound and feeling disgust. Her individual responses are shown in Appendix 6.
Miley's responses on the assessments indicated that she was suffering from misophonia. To confirm this diagnosis, the therapist tested for an immediate physical reflex response to a single instance of a trigger stimulus (see Figure 2 and Figure 3). The therapist asked Miley to close her eyes and relax while he used a spoon and a bowl to make a trigger sound. The therapist's first trigger sounds were intentionally too soft and short to trigger the patient. The therapist then increased the volume and duration of the sound until Miley reported that she was triggered. She reported that she felt the response in her hands and forearms as if to make a fist, which indicated that the muscle that contracted was probably the flexor digitorum profundus in her forearms.
Misophonia is characterized as an involuntary response to a trigger stimulus. A counterconditioning treatment (i.e., NRT treatment) was reported as being effective in the treatment of specific trigger stimuli for a middle-aged woman (Dozier, 2015a) whose misophonic responses consisted of a physical reflex response to the trigger stimuli and an emotional response. It was posited that the physical reflex response mediated the emotional response, as shown in Figure 3 (Dozier, 2015b). The NRT treatment described by Dozier (2015a) focused on eliminating the physical reflex response without addressing the emotional response. In that case, reducing or eliminating the physical response reduced or eliminated the emotional response in real-life settings. The counterconditioning treatment was delivered in a weekly session with the therapist and with custom audio recordings for daily, independent sessions by the patient. A treatment app (Misophonia Trigger Tamer) was developed by the author for smartphones to automate the delivery of the NRT treatment. The app delivered a continuous positive auditory stimulus (music) and intermittently delivered the trigger stimulus. The app provided control for volume, duration, and rate of the trigger stimulus, which allowed the patient real-time control of the treatment. The app also had the capability for the patient to record and edit custom trigger stimuli, and use their choice of music for the positive stimulus. Delivery of the positive stimulus with the app is optional. The positive stimulus could also be provided by another activity such as a taking a walk or viewing photographs.
Misophonia is reported to persist and often worsen with time (Schröder et al., 2013). Therefore, if misophonia includes a conditioned physical reflex response to the trigger, there must be a mechanism that allows Pavlovian conditioning to occur, such that the trigger-response reflex is maintained or strengthened. Dozier (2015b) posited that the pairing of the trigger stimulus and an increased intensity response can occur when the individual receives repeated triggers. Firstly, muscle tension may increase if the muscle affected by the trigger is not relaxed before the subsequent trigger stimulus, especially when the trigger stimuli occur at high rate. Secondly, a heightened state of anger and distress is experienced with misophonic triggers, and this generally increases muscle tension, which could also contribute to the maintenance of the conditioned reflex. To achieve the opposite effect, an individual would need to relax the affected muscle and remain calm while experiencing repeated trigger stimuli.
As previously discussed, Progressive Muscle Relaxation (PMR) has been demonstrated to increase deliberate control of relaxing a specific muscle; therefore, engaging in PMR for sufficient time to develop muscle control prior to the counterconditioning treatment may enhance the treatment effect. Relaxing muscles in response to triggers, as is taught in Applied Relaxation, might also reduce the emotional upheaval of a trigger situation, as previously discussed (Martz, 2013). Because of the broad benefits of daily deep relaxation, including reduction in anxiety, the author viewed PMR as a practice with the potential to enhance the therapeutic effect of treatment either directly or indirectly.
The treatment design for this case was essentially an automated version of the NRT treatment presented in Dozier (2015a) with the addition of Progressive Muscle Relaxation to develop muscle control and Applied Relaxation during treatment and when exposed to real-life trigger stimuli.
The initial session included the assessment and a discussion on misophonia including ways to manage the condition. The topics covered were 1) the reflexive nature of misophonia; 2) how to reduce triggers by adding noise to the environment; 3) the importance of not enduring triggers; 4) an explanation of the NRT treatment; 5) selecting a the first trigger to address in treatment; 6) selecting the positive stimulus for treatment; 7) verification that Miley had the capability to set up her smartphone for treatment; and 8) a discussion of Progressive Muscle Relaxation. Miley was instructed to download the Misophonia Trigger Tamer app from iTunes or Google Play, learn to use it with the tutorial videos, set up the playlist and trigger in the app, and practice PMR twice a day.
Miley committed to performing the PMR exercise twice a day for the next week using online training video and guided audio downloads. She also committed to conducting four to six NRT 30-minute treatment sessions per week. All NRT treatments were to be carried out independently using the Misophonia Trigger Tamer app. All sessions with the therapist were to be conducted by VSee, which is a Health Insurance Portability and Accountability Act (HIPAA) compliant video-chat service.
Miley performed PMR twice each day for the 7 days before the second therapist session. At this session, she reported that relaxing her hands had reduced her emotional response when she was triggered in public, but that adding noise to her environment had not been effective in reducing her misophonic physical and emotional responses at home. During the previous week she recorded a spoon-on-bowl trigger and edited it, so that the trigger sound began immediately at the start of the file. She also set up a playlist in the Misophonia Trigger Tamer with a mixture of calming and happy songs to use as the positive counterconditioning stimulus. The session with the therapist included discussion about how to set the app parameters for the NRT treatment and a 5-minute sample NRT treatment to insure Miley knew how to conduct the treatment and that the parameters were properly set. She was instructed to increase the volume and duration of the trigger to maintain a low physical response of approximately 1 on a 0 to 5 scale, where 0 was no reflex response and 5 was a real-world trigger response. Miley was instructed to complete the 30-minute NRT treatment session she started with the therapist, and to perform a 30-minute treatment each day. The therapist recommended that she keep her hands relaxed during treatment sessions and wiggle her fingers when triggered in real life.
At the third session with the therapist, Miley reported that she had performed PMR every day and the NRT treatment on 3 days. She stopped after the third treatment because she no longer triggered to the recorded stimulus. She was instructed to use 2 other trigger recordings of the spoon-on-bowl sound and start a variety of chewing-sound triggers once she did not respond to the spoon-on-bowl triggers. She was instructed to continue daily PMR, relax her hands when triggered in real life, and continue with daily NRT treatments.
At the fourth therapist session, which was 2 weeks later, Miley reported that she had performed PMR most days. She happily announced that her responses to the spoon-on-bowl and chewing triggers were gone for her recorded sounds, but still small in real life. At this point, Miley chose to terminate treatment. She had conducted the 5, 30-minute NRT treatment sessions and 4 shorter sessions. The total time was equivalent to 7 half-hour NRT sessions. The Misophonia Trigger Tamer app history log is shown in Table 2. There are 9 entries, indicating that Miley heard a total of 368 spoon-on-bowl triggers and 178 chewing triggers. The duration of the triggers was 0.9s for the spoon-on-bowl triggers and 1.3s for chewing triggers. The inter-stimulus interval was 21 seconds.
The therapist followed up with Miley by email a month after she returned to university. She reported that her misophonia was still a significant problem, especially for yawning, which was both a visual and auditory trigger. She wrote that her response to yawning the previous semester was a 9 or 10, but this semester the worst she had experienced was a 5 and it was usually about a 3. (This verbal report did not reference any specific misophonia assessment scale).
Miley completed the assessment forms and returned them by email for a 6-month posttreatment assessment (see Table 1). Her MAQ sum score had declined to 7, and three of those points were her response to the item, "My sound issues do not seem to have a known cause." (See Appendix 1 for specific responses). The large reduction in her MAQ sum score is illustrated in Figure 4. Her responses on the MCR survey indicated that she had a greatly reduced overt behavioral response to triggers. Her predominant responses to triggers were to "hear a known trigger sound . . . and feel no physical sensation" and "calmly move away from the sound." (See Appendix 2). She also reported greatly reduced emotional responses to triggers. On the intake MER survey, 20 of the 26 responses were "almost all the time." At 6-month follow-up, her highest response was "a good deal of the time" for feeling that she must see the person making the sound. Fourteen responses were "not at all" and 11 responses were "a little of the time." (See Appendix 6). This large decline in the emotional distress to triggers was consistent with the decline in her MAQ sum score. Her MAS-1 score was 4, with a note that 1 was the typical response. Her MPS score was 2, with 0 being a typical response. The MTS score for spoon-on-bowl triggers was 0, and the response for chewing triggers was 0-2. The MTS scores for non-treated triggers was 0 to 3 and 11.
A second follow-up was conducted by email at 12 months posttreatment (see Table 1, Figure 4, and Appendix 1). Miley's misophonia severity had increased as evidenced by the increase in the MAQ sum score to 12 and MAS-1 typical response rating to 3. She also indicated an increase the severity of her response to triggers that had not been addressed in treatment (MTS scores of 0, 1, 8, 11, and 12, indicating that she occasionally experienced rage in response to triggers). However, the triggers specifically addressed in treatment had completely extinguished (MTS score of 0). She also reported that she had been recently diagnosed with generalized anxiety disorder.
Measure of misophonia severity (Misophonia Assessment Questionnaire sum score) over the course of treatment and follow-up.
There were no complicating factors such as difficulty creating appropriate materials for homework sessions as previously reported by Dozier (2015a). The Misophonia Trigger Tamer app allowed Miley to personally adjust the treatment parameters in response to changes in her physical response to the recorded trigger stimulus, so treatment was maintained at the prescribed level. The app also allowed Miley to record real instances of her triggers, edit them, and use them for treatment. The treatment did place a sizeable time demand on Miley. She was very diligent in performing the PMR exercises during the first week, but was sporadic with the NRT treatments, conducting these treatments on only 8 of the 21 days from start to end of treatment. The lack of compliance to the number of NRT treatment session was irrelevant due to her high rate of progress with the treatment. There were few, if any, issues with access or barriers to care in this case. The automation with Misophonia Trigger Tamer app reduced the therapist time to less than half of that required to provide the treatment manually, thereby greatly reducing the cost of treatment. VSee video-chat allowed the treatment to be provided over a long distance, and there were no interruptions to service.
This case includes a replication plus an extension of the treatment of misophonia reported in Dozier (2015a). The replicated issues of treating misophonia include the following: 1) the NRT treatment effectively ameliorated the misophonia in the patient; 2) there was a physical reflex response to the trigger stimulus as shown in Figure 2; 3) the physical reflex occurred independently of the emotional response during treatment; 4) the physical reflex acted like a Pavlovian conditioned reflex in the gradual decline to exposure; and 5) there was a direct relationship between the reduction of the physical reflex and the reduction of the emotional response in real-world experience after treatment, supporting the relationship between the physical reflex and the emotional response shown in Figure 3. This case extended the treatment of Dozier (2015a) by incorporating the Misophonia Trigger Tamer app as an automated delivery mechanism for the NRT treatment, PMR, and Applied Relaxation in the NRT sessions.
Further support that misophonia is a conditioned response comes from the observation of spontaneous recovery by the patient. Spontaneous recovery of conditioned reflexes is a well-documented phenomenon, wherein the reflex decays during an active extinction process and then recovers with time (Lattal, 2012). The Misophonia Trigger Tamer app has precise settings for the volume and duration of the trigger stimulus in treatment. When the parameter values at the end of a treatment were used at the beginning of the next treatment, the response to the trigger was initially stronger than at the end of the previous treatment. This is consistent with spontaneous recovery of a conditioned reflex. Identifying misophonia as a conditioned reflex phenomenon has important implications for management, treatment, and research.
Firstly, with Pavlovian conditioning, a neutral stimulus that occurs temporally with a conditioned stimulus can become a conditioned stimulus. For misophonia, this means that a nontrigger stimulus (e.g., jaw movement) occurring with a trigger stimulus (e.g., chewing sound) can become a new trigger. As noted in Dozier (2015a), a visual trigger will continue to be a trigger, even after the response to the associated auditory stimulus has been extinguished. The implication here is that individuals should be cautious about repeated exposure to trigger stimuli because of the possibility of acquiring new triggers. This is an issue for managing misophonia as a chronic condition and exposure to triggers during treatment. Any treatment that includes exposure to triggers should include techniques that effectively reduce the misophonic response or are devoid of consistent pairing of nontrigger stimuli with trigger stimuli.
Secondly, viewing misophonia as a conditioned reflex rather than the result of a neurological defect has broad treatment implications. There is a large body of research on Pavlovian conditioning that may be applicable to the development and enhancement of treatment procedures (Donahoe & Vegas, 2004; Furedy & Riley, 1987; Lattal, 2012; Mowrer & Klein, 2000; Pavlov, 2003/1927). One simple application is that treatment should include techniques that will reduce a fundamental misophonic reflex rather than solely attempting to reduce the overt coping response of the individual. Jastreboff and Jastreboff (2014) reported achieving meaningful reduction of misophonia severity in patients with a treatment protocol that included in vivo counterconditioning experiences, along with other management techniques.
Thirdly, there is an implication for research to understand misophonia. It has been proposed that misophonia is the result of a defective or malfunctioning structure in the upper brain (Møller, 2011), which is diametrically opposed to the view that misophonia is a Pavlovian conditioning phenomenon. Viewing misophonia as anomalous brain activity will bias the researchers toward looking for the cause of misophonia within the brain, compared to viewing misophonia as an aversive conditioned reflex which is a result of typical brain functioning and environmental experience.
A case study has inherent limitations of generalizability and demonstration of causal factors. A controlled study is needed to demonstrate a causal relationship between the intervention and the reduction of misophonic symptoms. The patient's initial physical misophonic reflex was a hand grasp, which seems easier to willfully control, and so may have facilitated response to treatment. Many individuals have a physical reflex that is more difficult to relax than a hand grasp. Additionally, the dependent measures were self-reports of the patient which is a limitation to the reliability of the data. The subject in this case demonstrated a high level of self-efficacy and motivation by seeking treatment, which could have been a factor for her rapid response to treatment. Furthermore, there was no formal assessment of comorbid conditions which could have an effect on the case.
The forearm muscle contraction Miley experienced in response to triggers appeared to be an important factor in the manifestation of her misophonia. Identifying the specific physical reflex response in the assessment allowed her to increase the focus on that specific muscle in her PMR exercises. Relaxing a hand grasp is a common behavior, so it is likely that Miley's ability to relax this muscle during treatment was not based solely on one week of PMR exercises. Control of the affected muscle seems to have contributed to an enhanced effect of the NRT treatment because she could willfully relax those muscles during treatment and when triggered in real life. Individuals with other muscle reflexes may require much more practice to gain control of the muscle affected by a misophonia trigger and hence receive the benefit of relaxing during NRT treatments.
In both this case and that which was discussed in Dozier (2015a), the NRT treatment was effective in reducing specific triggers, but the reduction of treated triggers did not reduce non-treated triggers. By relaxing her hands in treatment, Miley developed a method of responding to real-life trigger situations that reduced her future misophonic response. This is supported by the decline in her response to triggers from her posttreatment assessment to the start of semester email report, and then the 6-month follow-up assessment at the end of the semester. In this case, Miley developed the ability to relax the affected muscles, and relaxing those muscles in trigger situations was a likely cause for the gradual reduction of her misophonic response for non-treated triggers. However at the 12-month follow-up assessment, she reported an increase in her emotional response to triggers, but she reported that her physical reflex response had remained low. Her increased emotional response to triggers may have been related to her recent diagnosis of generalized anxiety disorder.
This case demonstrated the successful use of the Misophonia Trigger Tamer app to deliver the NRT treatment. All NRT treatment sessions were conducted independently by the patient. Because the app gave the patient full control of the treatment parameters, proper training to use the app was essential. In this case, the patient was an intelligent, technically savvy university student. The training included tutorial videos, help from the therapist in setting the initial parameters for treatment, the guidance of an initial 5 minute NRT treatment, and learning how to adjust the trigger during treatment. The app allowed Miley to vary the intensity of the trigger stimulus within each treatment session to maintain the desired reflex response. Based on the success of the treatment, she did this well, but many patients will likely need more support and guidance.
In this case, the NRT treatment did not eliminate the misophonic response to the trigger. At the end of treatment, Miley had no response to the recorded triggers, but she still had a weak response to the trigger in real life. This is understandable because the treatment setting was a different context than real-life, and conditioned reflexes are context sensitive (Lattal, 2012). It has been demonstrated with animal research that a conditioned reflex which is extinguished in one setting, can still occur in a different setting. The use of recorded vs. live trigger stimuli is a limitation of the NRT treatment. After the NRT treatment, sometimes a misophonic reflex will decline and extinguish in the real-life setting, and sometimes it will maintain at a substantially reduced level (Dozier, 2015a). It is also possible for the misophonic response to strengthen after treatment. If the response in real-life settings is unacceptably strong, then further counterconditioning treatments could be incorporated with a context that is closer to real life, including use of real-life trigger stimuli. In this case, at the 6-month follow-up, Miley reported that she had no trigger response to the spoon-on-bowl sounds, and a weaker trigger response to chewing sounds. It is plausible that she relaxed her hands in trigger situations, and this aided in the continued decline in her misophonic response to the treated triggers. This issue seems important when setting expectations with the patient on the goals of treatment.
This case provides support for the use of the NRT treatment for specific misophonia trigger stimuli. This treatment may be used to reduce triggers from a single source (e.g., one person) or that occur in a single context (e.g., typing at work). Triggers should be treated sequentially, using at least three different recordings of each trigger. The patient responded extraordinarily well in this case. The treatment reported in Dozier (2015a) took over 5 months, and the patient in this study also responded well. An individual who responds more slowly may require a significantly longer treatment. The NRT treatment should enhance other treatments, such as an audiologist-provided behind-the-ear sound generator or CBT therapy, because it reduces the initial physical reflex of misophonia.
This case demonstrated the importance of identifying the initial physical misophonic reflex (see Figure 3) and addressing the reflex in treatment. The therapist should help the patient identify the physical misophonic reflex as part of the assessment, which can often be accomplished by having the patient relax while hearing a single, short, quiet trigger. In this setting, the patient can often identify a specific physical response. Rarely can a misophonic patient accurately identify their initial physical reflex prior to assessment. Typically patients have reported some of the physiological responses that accompany the extreme emotional responses of misophonia as their initial physical reflex. The author has witnessed initial physical reflexes that include virtually every skeletal muscle and many internal responses (e.g., esophagus constriction, stomach constriction, intestine constriction, sexual sensation, nausea, and the urge to urinate). Many individuals have a reflex that affects several muscles (e.g., calves and toes, shoulder and neck, or several muscles in arm).
Incorporating Applied Relaxation into the treatment protocol is highly recommended, with a focus on gaining control of the affected muscle. Prolonged use of Applied Relaxation may be critical to cases in which the treatment effect is slower.
The NRT treatment addresses the physical reflex response of misophonia. The treatment parameters need to be set so that the patient perceives the physical response to the trigger. Some patients have reported a combined emotional and physical response using the Misophonia Trigger Tamer and have responded to treatment. Cases wherein the individual reported only an emotional response to the trigger during treatment have not shown progress.
Some patients reported a pain or sensation in the ear. This can be caused by tensor tympani syndrome which accompanies severe misophonia (Jastreboff & Jastreboff, 2014). This should be considered an accompanying symptom of misophonia and not the initial physical reflex. The settings for the trigger stimulus in NRT treatment need to be high enough to activate the initial physical reflex. Tensor tympani syndrome will likely be eliminated by successfully treating misophonia (Jastreboff & Jastreboff, 2014).
The Misophonia Trigger Tamer app is a means of delivering the NRT treatment for auditory triggers. Visual triggers are common in misophonia and often develop to visual stimuli paired with an auditory trigger. The Visual Trigger Tamer app can be used to provide the NRT treatment for visual triggers. The app uses a video clip for the trigger and allows video, audio, and pictures to be included in the playlist.
The MAQ sum score provides a measure of the distress of an individual due to misophonia. This measure seems to be sensitive to the pervasiveness of trigger stimuli for the individual, as well as the severity of the response to individual triggers. For example, one patient used white noise and open ear headphones as the sole treatment. Her MAQ sum score dropped from 47 to 17 after one assessment and management session because the noise reduced the severity of the misophonic response so she felt no anger. Treatment should include some methods of escape and avoidance of trigger stimuli to have an immediate, meaningful improvement in the distress caused by misophonia. This is likely to aid in the effectiveness of the NRT treatment because the reflex is not continually strengthened through exposure to the trigger and the patient will have an overall improvement in well-being, enabling a positive emotional state for the NRT treatment.
Individuals often seek the help of a psychological therapist for misophonia. In such cases, the therapist should consider all component parts of the misophonic experience. As shown in Figure 5, these parts are the trigger, the physical reflex response, the emotional response including physiological arousal, and overt behavior. The causal interactions shown with horizontal lines are those observed in this case, but it is likely that, in many cases, there are more complex interactions, as shown by the dotted lines. Parents generally seek help because of problems with overt child behavior. CBT or other talk therapy is often requested. Two case studies using CBT for misophonia reported positive outcomes (Bernstein et al., 2013; McGuire et al., 2015). It is recommended that a treatment plan address all component parts. Addressing only the overt behavior with enticing rewards seems contraindicated.
Five distinct components of the misophonic response.
Sensory processing disorder (SPD) or sensory over-responsivity shares similarities of symptomology with misophonia, and it has been suggested that SPD and misophonia are manifestations of a single disorder (Taylor et al., 2014). SPD manifests as over or under-responsiveness to stimulation from touch, taste, smell, vision, hearing, and movement, with tactile and auditory sensitivity being the most common (Reynolds & Lane, 2008; Taylor et al., 2014); and SPD auditory sensitivity is primarily to unexpected and loud noises (Schröder et al., 2013). Misophonia is generally limited to low volume auditory stimuli and visual stimuli associated with the auditory stimuli or repetitive movements. Therefore, SPD and misophonia can be viewed as different, unassociated conditions which may both result in an anger or fight-flight response (Schröder et al., 2013). Furthermore, we view the physical misophonia muscle reflex to trigger stimuli as additional support that SPD and misophonia area distinctively unique and different disorders.
Misophonia is a relatively unknown condition that is a detriment or impediment to the lives of many individuals. Although many think of misophonia as a rare disorder it may afflict hundreds of millions individuals worldwide. There is a great need for fundamental research on misophonia as well as research to validate assessment instruments and establish empirically-validated treatments (Webber & Storch, 2015). Misophonia research seems to be limited by a lack of interested professors and by institutes who have committed research tracks for various neurological and psychological conditions.
In this case, the debilitating effects of misophonia were ameliorated by treating a conditioned muscle reflex response to specific misophonic trigger stimuli and by the patient developing a generalized response of relaxing muscles when triggered. Although the patient experienced misophonia as an extreme emotional responses to specific environmental stimuli, it appears that her condition would be more accurately described as a conditioned skeletal muscle reflex response to specific environmental stimuli which in turn elicited extreme emotional responses. Likewise with the naming of this condition, misophonia focuses on the emotions of this disorder and diverts attention form a core component of the disorder, which is a conditioned aversive reflex. Further research on the components of misophonia is warranted. Aversive stimuli have been shown to evoke fight-or-flight responses in humans (Berkowitz, 1983; Berkowitz, Cochran, & Embree, 1981). These studies found that the aversive stimuli evoked a range of emotions that may not be reflected in overt behavior. Other research identified activation of the limbic system of humans in response to aversive odorants (Zald & Pardo, 1997) and to aversive gustatory stimuli (Zald, Lee, Fluegel, & Pardo, 1998). Such responses seem consistent with those of individuals with misophonia.
Some individuals with misophonia have a weak physical reflex. In these cases, the physical stimulus is too mild to be comparable to aversive stimuli used in research studies; however, the stimulation of the physical reflex may elicit a conditioned emotional reflex. The physical reflex is intrusive, and difficult to not perceive. A person may apply distraction techniques to divert their focus from the trigger stimuli, but the physical stimulation is still perceived and could therefore elicit the conditioned emotional response. For these reasons, a more appropriate name for Misophonia would be Conditioned Aversive Reflex Disorder.
Misophonia is generally viewed as a life-long, debilitating condition, which is disruptive to social and professional life, and becomes progressively worse with time. This case study treatment provides some encouraging results where the typical course of this condition was potentially reversed and apparently abated. It is hoped that the information presented here can supplement other work in developing treatment for misophonia to provide meaningful relief to those suffering from this disorder.
The author did not receive any funding or financial support for the treatment development, treatment delivery, authorship, and/or publication of this article.
The author is a private practitioner, with a "doing business as" entity of the Misophonia Treatment Institute. He is the developer of the Misophonia Trigger Tamer, the Visual Trigger Tamer, and Misophonia Reflex Finder apps, which are patent pending.
Furedy, J. J., & Riley, D. M. (1987). Human Pavlovian autonomic conditioning and the cognitive paradigm. In G. Gavey (Ed.), Cognitive processes and Pavlovian conditioning in humans (pp. 1-25). Chichester, United Kingdom: John Wiley & Sons.
Johnson, M. (2014, February). 50 cases of misophonia using the MMP. Paper presented at the misophonia conference of the Tinnitus Practitioners Association, Atlanta, GA.
Lattal, K. M. (2012). Pavlovian conditioning. In G. J. Madden (Ed.), APA handbook of behavior analysis: Vol. 1. Methods and principles (pp. 283-306). Washington, DC: American Psychological Association Press.
Martz, K. (2013). Patient Panel. Presentation at the annual conference of the Misophonia Association, Portland, OR.
Møller, A. R. (2011). Misophonia, phonophobia, and "exploding head" syndrome. In A. R. Møller, B. Langguth, D. DeRidder, & T. Kleinjung (Eds.), Textbook of tinnitus (pp. 25-27). New York, NY: Springer.
Mowrer, R. R., & Klein, S. B. (Eds.). (2000). Handbook of contemporary learning theories. Howe, United Kingdom: Psychology Press.
The sum of all scores of this assessment is an indicator of the severity of misophonia.
Level 0 I hear a known trigger sound but feel no discomfort.
Level 1 I am aware of the presence of a known trigger person but feel no, or minimal, anticipatory anxiety.
Level 2 Known trigger sounds elicit minimal psychic discomfort, irritation, or annoyance. No symptoms of panic or fight or flight response.
Level 3 I feel increasing levels of psychic discomfort but do not engage in any physical response. I may be hyper-vigilant to audio-visual stimuli.
Level 4 I engage in a minimal physical response – non-confrontational coping behaviors, such as asking the trigger person to stop making the noise, discreetly covering one ear, or by calmly moving away from the noise. No panic or fight or flight symptoms exhibited.
Level 5 I adopt more confrontational coping mechanisms, such as overtly covering my ears, mimicking the trigger person, make repeated sounds, or display overt irritation.
Level 6 I experience substantial psychic discomfort. Symptoms of panic and a fight or flight response begin to engage.
Level 7 I experience substantial psychic discomfort. Increasing use (louder, more frequent) use of confrontational coping mechanisms. I may re-imagine the trigger sound and visual cues over and over again, sometimes for weeks, months or even years after the event.
Level 8 I experience substantial psychic discomfort and some violence thoughts.
Level 9 Panic/rage reaction in full swing. Conscious decision not to use violence on trigger person. Actual flight from vicinity of noise and/or use of physical violence on an inanimate object. Panic, anger or severe irritation may be manifest in my demeanor.
Level 10 Actual use of physical violence on a person or animal (i.e., a household pet). Violence may be inflicted on self (self-harming).
Level 0 I feel no physical sensation.
Level 1 I feel minimal physical sensation and can ignore it.
Level 2 I feel some physical sensation but can often/always ignore it.
Level 3 I feel some physical sensation but have difficulty or cannot ignore it.
Level 4 I feel elevated physical sensation and usually cannot ignore it.
Level 5 Feels elevated physical sensation, definitely cannot ignore it.
Level 6 Feels elevated physical sensation, cannot ignore it and each incidence has an impact on person's life.
Level 7 Feels physical sensation as described above and cannot cope with it.
Level 8 Feels physical sensation which can be best described as emotional pain.
Level 9 Feels physical sensation which can be best described as physical pain.
Level 10 Feels physical sensation which is overpowering and is causing physical pain.
0 I feel no physical sensation.
1 I feel minimal physical sensation.
2 I feel some physical sensation but can ignore it.
3 I feel some physical sensation but cannot ignore it.
4 I feel elevated physical sensation and have difficulty ignoring it.
5 I feel elevated physical sensation and definitely cannot ignore it.
6 I feel elevated physical sensation, cannot ignore it, and have negative emotions.
7 I feel physical sensation as described above, cannot cope with it, and have strong negative emotions.
8 I feel physical sensation which can be best described as emotional pain and causes very strong emotions.
9 I feel physical sensation which can be best described as physical pain and causes extreme emotions.
10 I feel physical sensation which can be best described as severe physical pain and overpowering emotions.
11 I have no physical sensation but immediately get angry at the person making the sound.
12 I have no physical sensation but immediately have rage at the person making the sound.
Thomas Dozier is a Board Certified Behavior Analyst (behavior scientist). He holds a Master of Science in Behavior Analysis and the Family from California State University, Stanislaus. He has researched and developed treatments for misophonia since 2012. He established the Misophonia Treatment Institute (MTI) in 2013 and serves as director. Misophonia Treatment Institute is a "doing business as" entity. Thomas H. Dozier is the sole proprietor of this entity. The goal of MTI is to promote research, development of treatments, and provide information and treatment for individuals with misophonia. In addition to his work on misophonia, Dozier works as a parenting coach to help parents apply behavior analysis to practical family problems.


The new 13th District runs from the urban western end of Guilford County to Iredell County.
Despite an open contest and some history of voters electing Democrats, outside money and support favors the Republican candidate in the new 13th Congressional District.
When Republican state lawmakers were forced by the federal courts to redraw congressional district lines earlier this year, the new 13th was one of the more balanced among 10 designed to favor candidates from their own party.
That doesn't mean it will be anything like a fair fight.
The new 13th District covers two-thirds of Greensboro and 95 percent of High Point, stretching from the urbanized west end of Guilford County through more rural and conservative swaths of Davidson, Davie, Rowan and Iredell counties. The geographical contrast neatly aligns with the partisan breakdown of the contest: Republican Ted Budd, who owns the ProShots shooting range and gun shop outside of Winston-Salem, lives in Davie County, while his Democratic opponent, Bruce Davis, operates a daycare with his wife in High Point. A self-described "outsider," Budd has never before run for office, while Davis served for 10 years on the Guilford County Commission.
John Dinan, a politics professor at Wake Forest University, said the 13th district race "is not on any of the major races-to-watch lists that track races expected to be competitive in November," despite being one of the more evenly balanced districts based on voting patterns for Republican and Democratic candidates in recent elections.
While agreeing that the district leans Republican, Michael Bitzer, who teaches political science at Catawba College, said odds-making in the race is challenged by a number of unique factors this year.
"With it being an open seat, that's usually when you see ability to go one way or another," he said. "Incumbency is a powerful factor. With no incumbent it's going to be the ground game and other influences — primarily the top of the ticket.
Budd, who defeated 16 opponents in the primary to win the Republican nomination, hasn't shied away from his party's standard-bearer.
Despite equivalent attention on North Carolina from the Clinton campaign, including a recent appearance in Greensboro by vice presidential candidate Tim Kaine that drew an enthusiastic crowd, Davis has yet to receive similar exposure from higher profile candidates.
In contrast to Pence's embrace of Trump's stance, Davis has emphasized a compassionate approach to immigration that includes supporting a pathway to citizenship for undocumented residents. He's spoken to a number of people in immigrant communities over the course of the campaign.
While emphasizing that undocumented people with criminal backgrounds must be deported, Davis said he would like to find a way to protect those who come to the United States from Central America seeking asylum from violent gangs.
Davis said he holds out hope that a Democratic wave election similar to the one in 2008 will give him a shot at the 13th Congressional District seat. Voters in the district have favored some Democrats including candidates for secretary of state and superintendent of public instruction in 2012. And they narrowly supported Democrat Kay Hagan in the 2008 US Senate race, but then switched allegiance to her challenger, Republican Thom Tillis, in 2014.
Despite the potential opening, the 13th District race has not attracted attention from Democratic donors outside of North Carolina.
"Right now, it's not going well in fundraising," Davis acknowledged, lamenting that endorsements from the Congressional Black Caucus and NARAL Pro-Choice America haven't translated into donations.
The most recent fundraising totals available from the Federal Election Commission, as of June 30, show Budd dwarfing Davis, $200,636 to $32,910. Budd also benefited from $500,000 in support from the conservative Club for Growth super PAC, mostly in the form of independent expenditures on TV ad buys, during his primary.
Despite being one of the more evenly balanced districts in the state, Dinan said Davis is still likely to have difficulty attracting outside support.
"The district leans Republican to an extent that makes it unlikely that national Democratic groups would target the race for financial support and advertising, especially when there are many other districts around the country that are much more competitive and present more favorable pick-up opportunities," he said.
While Budd has been speaking to the older, whiter audiences that attend Trump rallies, Davis is turning to college campuses in the Piedmont region for support. Much of his campaign staff is drawn from local universities. The campaign's political director and field director both graduated from High Point University last year, while the communications director is a senior at the university, and the campaign's strategy director is a recent UNCG graduate. The campaign held a "turn up the vote" rally at Livingstone College in Salisbury and is planning a similar effort at Bennett College in Greensboro.
Last week, the Davis campaign shifted from building its infrastructure to putting its ground game into effect. A volunteer showed up at the campaign headquarters at 5 p.m. to pick up door hangers before setting out for an hour or so of canvassing.
"I'm gonna knock this out so I can go watch the game," he said, while a campaign coordinator lamented that there weren't more volunteers to join him.
Davis said his campaign has identified areas of strength and weakness and his media team has put together materials to appeal to different constituencies.
Budd isn't conceding anything on his effort to mobilize voters as the campaign moves into its final phase.


text:
Le Rhipidure des Palau (Rhipidura lepida) est une espèce de passereau de la famille des Rhipiduridae.

Distribution
Il est endémique des îles Palaos.

Habitat
Il habite les forêts humides en plaine dans les régions tropicales et subtropicales.

Publication originale
 Hartlaub & Finsch (1868) On a collection of birds from the Pelew Islands. Proceedings of the Zoological Society of London, vol. 1868,  (texte intégral).

Liens externes

Rhipiduridae
Faune endémique des Palaos

redpajama_set_name: RedPajamaWikipedia


From bringing canines to work to having dedicated dog swimming pool days, it's fair to say that Germany takes its Hunde seriously. We dug into the history and spoke to pet owners, to examine why the country really is 'ein Land das Hunde liebt' (a dog loving place).
'Wer mich liebt, der liebt auch meinen Hund', says the German proverb, meaning: whoever loves me, also loves my dog.
Although the phrase is about accepting someone the way they are, it could also take quite a literal meaning in Germany, a country that has more than a soft spot for its canines.
You only have to wander down the street, wherever you are in the country, to see doting dog owners walking their pugs, Labradors, mixed breeds - or whichever four-legged friend has won their heart.
You'll probably even see a fair few happy Hunde with tongues hanging out, racing alongside a bike, while smaller dogs are often tucked securely into little baskets like toddlers on the front of the bicycles.
Figures from 2017 show there are 9.2million dogs in the country, the highest number in Europe, followed by the UK and then Poland.
That isn't surprising given that Germany has more than 82 million people - and, of course, dogs are known in many cultures as being man's best friend - it's not only a German thing.
However, when you look more closely it's clear that hounds are a big part of life in Deutschland.
Pedi Matthies who lives in the Upper Middle Rhine Valley, would describe herself as a serious dog lover - she even founded a business to reflect her passion. The 50-year-old launched Hundenerd, which specializes in dog products like harnesses and provides pet owners with advice, in 2014.
Matthies, who has two dogs, says the country's connection to canines could be connected to one of its residents' favourite pastimes - getting outside and enjoying fresh hair.
"I think the Germans are a little obsessed with their dogs because it gives them the possibility to get in touch with nature and with their emotional side," Matthies told The Local.
"This is something we really need badly especially in these current times."
Matthies says dogs have a "strong social factor in Germany" and are "simply good for the German soul".
Pedi Matthies with Neli and Locke. Photo provided by Pedi Matthies.
Canines take a starring role in German culture, and have done so throughout history.
German writer and playwright Carl Zuckmayer said: "A life without a dog is a mistake", while Frederick the Great of Prussia once said: "the more I see of men, the better I like my dog."
Meanwhile, Otto von Bismarck, the first chancellor of the German empire, was a great lover of dogs and was owner to several Great Danes throughout his life. His dog was known as the 'Reichshund' (dog of the empire).
"Breeds such as the whippet, pug, spitz and poodle became popular in the 18th century," says Matthies.
Owning dogs was becoming more fashionable in German society around this time. The German Shepherd Society was founded in 1899 and experienced a "rapid rise in popularity," says Matthies.
Dogs were also used in both wars and even for "propaganda purposes," says Matthies. It could even be said that the presence of Blondi, Hitler's German shepherd, was a PR move to make the dictator appear more human.
After the war, in 1948, the German Shepherd Society was relaunched and now there are a huge range of dogs across the country used for a variety of reasons, from pets to guide dogs.
Aside from the fun part of owning a dog, the rules involved show that Germany takes the whole business very seriously.
Let's look at the Hundesteuer. When you walk into any Finanzamt (finance office) across the country, you'll spot the sign for dog tax almost immediately. The amount you pay to own a dog depends on where you live.
In Berlin dog owners have to register their pooch with the responsible tax office within a month of getting the animal or after moving to the city. Owners have to pay €120 euros per year for the first dog and €180 euros per year for each additional canine.
In Stuttgart, there are separate taxes for dogs and those deemed dangerous (such as American pitbull terrier), ranging between €35 and €144.
Meanwhile, in Hamburg the tax is around €90 per year for non-dangerous dogs.
"There are also different local laws that you have to be aware of," Matthies says.
In some states you have to take an exam at the vet to prove you're capable of handling a dog.
Dog training is also taken seriously. Matthies say that this tradition "came out of military purposes". Although there are different ways to train canines now, it is still frowned upon if a dog doesn't behave itself.
"There's a lot of serious discussion about that in Germany," says Matthies.
Imagine a world where an animal could accompany you everywhere. To work? No problem. The pub? Absolutely fine.
Well, that's pretty much the case in Germany. Of course, there are some places where your dog might have to wait outside (the supermarket is still dog free) but it's quite acceptable to cart your four-legged friend around with you elsewhere.
"People love to take their dogs everywhere in Germany, in comparison to say, America or the UK," says Matthies.
Filip Jankowski, a chef originally from Poland who lives in Berlin, takes his Italian greyhound called Szczepan (pronounced sheppan) to work every day.
The five-years-old Szczepan can be found tucked into the back room of the bar that Jankowski works in. The 27-year-old is then able to spend time with his pooch during quiet spells in the kitchen and take him out for fresh air.
"Germany is a good place for dogs," says Jankowski. "People treat dogs very well, and the animals are quiet and chilled.
Jankowski adds that he always has lots of offers of help if he needs someone to take care of his dog, a sign that dogs are welcome in society.
A particularly interesting tradition in Germany which sums up the country's deep attachment to canines is dog swimming pool day.
At the end of the outdoor swimming season, usually around mid September, many pools across the country are opened up to the nation's Hunde so they can enjoy a splash around.
Pictures of gloriously happy pooches paddling in pools fill local newspaper pages up and down the country. In some pools, the animals can also be joined in the water by their owners.
Organizers of Trebur outdoor pool in Rüsselsheim am Main said around 500 guests and their dogs came to their Sunday dog day on September 16th, according to the Main-Spitze newspaper.
"The nice thing about Trebur is that the owners can go swimming with their dogs. This is not common in other outdoor pools," said bath manager Elke Sparkuhl.
Dogs are also doted over in the winter: at the an annual Christmas market for dogs in Berlin's Grunewald, vendors sell everything from dog sweaters to edible treats - with a few extra goodies set aside for their owners.
One of Germany's oldest breeds, the dachshund can be long, short or wire-haired and is one of the country's most popular dogs.
Bred for hunting since the Middle Ages, dachshund translates literally as 'badger dog' and their long snouts allow them to burrow into holes to catch small animals.
The founders, Josef Küblbeck and Oliver Storz, themselves owners of two dachshunds, display around 2000 exhibits, from dog-shaped bread to a giant golden statue, in the rooms near the cathedral in the southern German city.
At the opening earlier this year, dog owners flocked to the museum from all over Germany with their pets in tow.
Visitors from all over the world who love the 'Dackel' often sport dachshund-themed clothing and jewellery on their trip to the museum.
The sausage dog can also be found in the back window of many German cars, in the form of the 'Wackeldackel' or nodding dog.
What can the world learn from Germany when it comes to dog care?
Germany's reputation for how it treats its dogs has travelled further afield.
The Tierschutzverein Berlin, the biggest animal shelter in Europe, runs several projects and also campaigns for animal rights. It is currently looking after 260 dogs and 600 cats, according to spokesperson Beate Kaminski.
Kaminski says that Germany is known throughout the world for having a "high standard of care for dogs, and higher than many other countries".
Kaminski points out that there are people who mistreat animals throughout the country otherwise the shelter, and others like it, wouldn't have to exist.
"But there is generally a lot of respect for animals, especially dogs and high regard for animal care in Germany," she says.


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            scope.showCopy = scope.$eval(attrs.allowCopy) && scope.showQuestionNumber;
            scope.showReorder = scope.$eval(attrs.allowReorder) && scope.showQuestionNumber;
            scope.showDelete = scope.$eval(attrs.allowDelete) && scope.showQuestionNumber;

            if (!scope.question.choices) {
                scope.question.choices = ["", "", "", ""];  // Default in 4 empty choices
                scope.question.correctAnswerIndex = 0;
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            scope.ui = {
                showingSettings: false
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            scope.toggleSettings = function () {
                scope.ui.showingSettings = !scope.ui.showingSettings;
                if (scope.ui.showingSettings) {
                    // Emit the settingsOpened event, which notifies all ckEditor instances within the settings
                    // panel to initialize. There's an issue with inline ckeditor that causes it to not initialize
                    // properly in Chrome if the editor is within a hidden container, so we must wait until the
                    // container becomes visible before initializing. Also, add a slight timeout so that opening
                    // the settings panel is visually smooth instead of jumpy.
                    // http://dev.ckeditor.com/ticket/11789
                    //
                    // Note: This also notifies the editQuiz controller to update the min-height of the form.
                    // The intent of this is to prevent the page from jumping when reordering questions. See
                    // longer explanation in editQuiz.js (in the updateFormHeight method).
                    $timeout(function () {
                        scope.$emit('settingsOpened');
                    }, 250);
                } else {
                    $timeout(function () {
                        scope.$emit('settingsClosed');
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                    question: scope.question
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                return function () {
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                        // Large screen - show on the right
                        return "right";
                    } else if ($(window).width() > 1024) {
                        // Medium screen - show on the bottom
                        return "bottom";
                    } else {
                        // Small screen - show on the left
                        return "left";
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                $timeout(function () {
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                if (attrs.form) {
                    scope.form.$setDirty();
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            scope.removeChoice = function (i) {
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                    scope.question.correctAnswerIndex = null;
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                if (attrs.form) {
                    scope.form.$setDirty();
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            scope.addAltAns = function () {
                scope.question.alternativeAnswers.push("");
                $timeout(function () {
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                if (attrs.form) {
                    scope.form.$setDirty();
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            };

            scope.removeAltAns = function (i) {
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redpajama_set_name: RedPajamaGithub


Objective Today, a predominant percentage of vehicles involved in car crashes are exposed to oblique or frontal offset collisions. The aim of this study is to evaluate the 50th percentile male Hybrid III, THOR 99 and THOR Alpha dummies by comparing them with the corresponding kinematics of post mortem human subjects (PMHS) in this type of collision. Methods The PMHS data include results from oblique frontal collision tests. They include sled tests with near-side and far-side belt geometries at 15°, 30° and 45° angles. The test subjects were restrained with a three-point lap-shoulder belt and the ?V was 30 km/h. Results The results from the Hybrid III and THOR 99 tests showed that, in most of the test, the head trajectories were an average of approximately 0.1 m shorter than those from equivalent PMHS. The Hybrid III and THOR 99 far-side belt geometry tests showed that the belt remained in place longer on the shoulder of the Hybrid III than on the THOR 99 and the THOR Alpha. This was probably due to a stiffer lumbar spine in the Hybrid III and to a large groove in the steel of the superior surface of the Hybrid III shoulder structure. The THOR 99 escaped from the shoulder belt about 40 - 50 ms earlier than the THOR Alpha. The results from the THOR Alpha tests show that the head trajectory accorded fairly well with the PMHS data, as long as the shoulder belt did not slip off the shoulder. Although the THOR Alpha shoulder escaped the shoulder belt in the 45° far-side belt geometry, the PMHS did not. This may be due to the THOR Alpha shoulder design, with approximately 0.05 m smaller superior and medial shoulder range-of-motion, in combination with a relatively soft lumbar spine. Conclusions The THOR Alpha provides head trajectories similar to those of the PMHS under these loading conditions, provided the shoulder belt remains in position on the shoulder. When the shoulder belt slipped off the dummy shoulder, the head kinematics was altered. The shoulder range-of-motion may be a contributing factor to the overall kinematics of an occupant in oblique frontal impact situations where the occupant moves in a trajectory at an angle from that of the longitudinal direction of the car.


Gerry Peacock has been around the store since infancy. The last name says it all he does just about anything to help around the store and ensure things are running smoothly. Gerry has officially worked for the company for the last two years.


text:
Thomas Gatzemeier (né le  à Döbeln) est un peintre, sculpteur et écrivain allemand.

Biographie
En 1971, il fait au lycée polytechnique de Döbeln un apprentissage d'affichiste. Il fait son service militaire au sein de la Nationale Volksarmee puis est réformé pour des raisons de santé. Après un bref temps comme assistant d'un tailleur de pierre, il commence en 1975 à étudier la peinture et le dessin à Hochschule für Grafik und Buchkunst Leipzig, où il a comme professeurs Arno Rink et . Comme œuvre pour son diplôme des beaux-arts, il peint un tableau de grande taille représentant un enterrement qu'il intitule Die Hitler kommen und gehen (avec Staline). De 1980 à 1986, Gatzemeier habite à Döbeln et accepte les contrats du gouvernement.

Après que son frère et la femme de celui-ci ont été emprisonnés en 1984 pour des raisons politiques, il demande une autorisation de sortir mais reçoit une interdiction d'exposer. En 1986, il quitte la RDA, s'installe à Karlsruhe comme artiste indépendant. En 2006, il crée un autre atelier à Lepizig.

En 1987, il présente sa première exposition à Karlsruhe. Il est par la suite suivi par d'autres galeries et associations.

En 1989, il crée avec le peintre Paul-Uwe Dietsch le projet "In Spirit of Rubens" à l'Art Cologne.

En 1992 et 1993, il travaille sur le projet de sculptures "17 Plastiken". Ce projet a pour sujet la violence au sens général et s'inspire des meurtres racistes qui viennent d'avoir lieu en Allemagne. Il est présenté dans le palais du Reichstag en 1994.

En 2002, Gatzemeier obtient une commande pour une fresque de  pour l'église Sainte-Marie de Crailsheim.

De 1983 à 2010, Gatzemeier écrit un roman, Der Sekretär, suivi en 2012 par Morgen, morgen wird alles zum guten Ende kommen.

Œuvre
Thomas Gatzemeier est profondément marqué par sa formation à la Hochschule für Grafik und Buchkunst Leipzig qui était resté dans la tradition académique et se concentrait sur la figure humaine. Peu après, ses tableaux vont vers l'art abstrait, les figures humaines se fondent jusqu'à se confondre avec le fond. Aujourd'hui, la figure humaine bénéficie d'un dessin clair, bien académique.

Notes et références

Liens externes

 Site Internet de l'artiste

Peintre allemand du XXe siècle
Peintre allemand du XXIe siècle
Sculpteur allemand du XXe siècle
Sculpteur allemand du XXIe siècle
Écrivain allemand du XXIe siècle
Naissance en décembre 1954
Naissance à Döbeln


text:
Courtesy of Louis Vuitton.
Courtesy of Dior.
Courtesy of David Morris.
Courtesy of Repossi.
High Jewelry 2021: Van Cleef & Arpels, Dior, Louis Vuitton, and More
Recently, jewelry houses have debuted their latest high jewelry collections both in-person in Paris and online. Here, we're sharing details from brands like Van Cleef & Arpels, Dior, Louis Vuitton, and more.
The romance and tragedy in William Shakespeare's Romeo and Juliet played the part of muse in Van Cleef & Arpels's latest collection. Imagery from the city of Verona and the story's iconic scenes were translated into a selection of 100 designs, imagined in richly hued stones that give life to a series of literal and abstracted interpretations of the tale. Pieces that were absolutely magical include the Italian Rose necklace with the ruby pendant; the Balcone clip, dripping with green gemstone ivy, which reveals an image of the lovers in rose gold when turned to the backside; and the clip figurines of the story's main characters, detailed with brilliant stones like rubies, sapphires, garnets, diamonds, and lapis lazuli.
Louis Vuitton's "Stellar Times" took us on a journey into the cosmos for the season's galaxy-inspired high jewelry collection. 90 stunningly intricate designs harnessed the power and beauty of celestial bodies through a selection of bold jewels like diamonds, opals, sapphires, rubies, and emeralds of the most pristine quality. Pieces we're still thinking about include the Planète Bleue cuff with blue and green stones; the Soleils earrings, which capture the fiery heat of the sun in diamonds and yellow sapphires; and the Lune Bleue choker necklace, mimicking the house's iconic checkerboard in a configuration of blue and white stones, surrounding a 15.56 carat Madagascar sapphire.
The chromatic hues and abstracted patterns of tie-dye informed Dior's new "Tie & DIOR" high jewelry designs. Gradations of colored stones reminiscent of tie-dyed ink bleeds painted more than one hundred new pieces, including necklaces, bracelets, asymmetrical earrings, and double rings. Reminding us of the rainbowed, psychedelic imagery of a kaleidoscope, highlights included a pair of earrings with mismatched pearls and other stones in pink, white, and brown; a bracelet in an ombré of blue-to-white; and drop earrings featuring colors across the spectrum.
Entitled "Serti Inversé," Repossi's newest high jewelry debuts built on the house's iconic "Serti sur Vide" collection. Finding beauty through a play on tension, the collection's rings, collars, and bracelets make the wearer appear as though diamonds are suspended in mid-air just above the skin, and cradled in gold. Each has been crafted from white or rose gold and features central pear-shaped diamonds in white or yellow, like a fluid ring shape with tiny pavé stones trailing to and from the central diamond.
David Morris opted for an intimate four-piece collection of one-of-a-kind designs, inspired by the world's most extraordinary gemstones. The collection included pieces like the opal and diamond Aurora ring, the intricate Feather ring in pink and white diamonds, and the Constellation necklace, which offered a delicate combination of shaped diamonds in a style that drapes around the neck in a shape reminiscent of a cluster of stars. The highlight, however, was the jaw-dropping Empress choker. Starting with a special selection of stones held onto by the house for decades for the perfect design, the necklace features over 240 carats of natural pearls set in a lace-like lattice of diamonds, reminiscent of the ornamental Jali screens found in India.
high jewelry 2021
Lifestyle |January 14, 2022
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Brand New: Dior Rings, LV Sneakers, RIMOWA Accessories, and More
Lifestyle |January 7, 2022
Massimo Bottura Moves From Slow Food to Fast Cars with Maserati
Louis Vuitton High Jewelry Reaches New Heights at the MoMA Tower in New York
Lifestyle |December 29, 2021
Amar Lalvani Expands The Standard Locations and Philosophies
Chanel No5 Celebrates a Centennial
Aesop Debuts a Multi-Faceted Fragrance Project with the Artist Davide Quayola
Romeo Hunte Enlivens NYC with Festive Fashion and Holiday Windows
Claire Choisne: Innovating in High Jewelry to Capture the Spectrum of Light

redpajama_set_name: RedPajamaCommonCrawl


text:
Cuban Heels - Work Our Way to Heaven (1981, Virgin)
For a band whose lone marketplace offering was just one measly punk 45 in 1977, Scotland's Johnny and the Self Abusers nevertheless contained members that would spin off into the eventual world renown Simple Minds (Jim Kerr to be specific)...and this band. The Cuban Heels, which entailed the involvement of ex-Abusers Michael McNeil, John Milarky and Tony Donald, had something a bit less lofty and pious in mind than Kerr and his long running offshoots, and all the better for it as evidenced by Work Our Way to Heaven.
The near-spotless first half of the album in question often rocks out like a sturdier XTC - tuneful, smart and dare I say a good couple of years before it's time. "Liberty Park" and "A Matter of Time" are but a couple of inspired standouts. Side two finds the Heels milling about in a couple of different orbits. The hepped up dance rock of "Walk on Water" and "Hard Times" sound downright frivolous by comparison, and "Coming Up for Air" is a strikingly subdued chamber music piece. The title track is loosely similar to some of Public Image Ltd's more structured 'pop' dabblings, and the finale "My Colours Fly" is assertive and lively as anything found on Heaven's better half. It would prove to the Heels sole full length, but roughly half a dozen singles surrounded it. All of these songs collected in one tidy spot would make for a splendid reissue (hint, hint).
01. Liberty Hall
02. Move Up a Grade
03. Where the Days Go
04. A Matter of Time
05. Homes for Heroes
06. The Old School Song
07. Walk on Water
08. Hard Times
09. Coming Up for Air
10. Work Our Way to Heaven
11. My Colours Fly
https://www114.zippyshare.com/v/3FtBEe61/file.html
Sunbirds - No Sun No Shadow (1986 & 1997)
Cuban Heels - Work Our Way to Heaven (1981, Virgin...
The Reivers (Zeitgeist) - KUT Radio, Austin 11/11/...
What are we going to do while we still got the str...
Twilight Idols - Beyond Good and Evil (1986, Twili...
This one is on the house...
Open up your eyes just to check that you're asleep...
The Wishniaks - Catch 33 (1990, Bloodmoney)
The Senses Bureau - Love And Industry ep (1986, E...
Eurogliders - Pink Suit Blue Day (1982)
You'll get hurt if you play with crooks.
The Cripples - What's in a Name ep (1985, Tabb)
The Woodies - Train Wreck ep (1989, Pop)
Life full of chemicals...
Chris Richards and the Subtractions - Peaks and Va...


The weather was perfect as members of the exclusive private members' business club – theProfileClub and their guests enjoyed a champagne reception on the terrace at the House of Commons prior to a delicious 5 course lunch. The lunch was hosted by Sir Graham Brady MP, Chair of the 1922 Committee.
theProfileClub is based in Cheshire and represents 100 key decision makers across both professional services and high-profile brands. The club provides members with a whole range of VIP events and benefits. Following the lunch, Director of theProfileClub, Tony Hallwood hosted a Q and A on a range of topical issues. Guests were then invited into the viewing area to hear a debate. The headline sponsor of the event was Together – Common sense lending.
Later in the afternoon guests were invited to join ProfileClub Directors Tony and Barbara Hallwood for drinks at the St James Hotel and Club in Mayfair, the preferred central London hotel for the members.
The beach comes to Manchester!


text:
Goddard 2 fue un cohete construido por Robert H. Goddard basándose en su Goddard 1.

Para continuar las pruebas con cohetes de combustible líquido, Goddard encontró que su primer modelo era demasiado pequeño para introducir mejoras y refinamientos, por lo que se dedicó a construir un cohete 20 veces más grande. Llevó a cabo el trabajo durante 1926, construyendo además una nueva rampa de lanzamiento, e introduciendo como mejoras e innovaciones reguladores de flujo, inyección múltiple de propulsantes en la cámara de combustión, ignición disparada eléctricamente y medición la presión y del empuje del motor. El cohete no llegó a hacer ningún vuelo.

Véase también
Goddard 1
Goddard 3
Goddard 4
Goddard A
Goddard K
Goddard L
Goddard P-C
Robert Hutchings Goddard

Referencias

Cohetería histórica


text:
When Congress Stops Wars
By William G. Howell and Jon C. Pevehouse
William G. Howell and Jon C. Pevehouse are Associate Professors at the Harris School of Public Policy at the University of Chicago and the authors of While Dangers Gather: Congressional Checks on Presidential War Powers.
Read more by William G. Howell
Read more by Jon C. Pevehouse
Courtesy Reuters
For most of George W. Bush's tenure, political observers have lambasted Congress for failing to fulfill its basic foreign policy obligations. Typical was the recent Foreign Affairs article by Norman Ornstein and Thomas Mann, "When Congress Checks Out," which offered a sweeping indictment of Congress' failure to monitor the president's execution of foreign wars and antiterrorist initiatives. Over the past six years, they concluded, congressional oversight of the White House's foreign and national security policy "has virtually collapsed." Ornstein and Mann's characterization is hardly unique. Numerous constitutional-law scholars, political scientists, bureaucrats, and even members of Congress have, over the years, lamented the lack of legislative constraints on presidential war powers. But the dearth of congressional oversight between 2000 and 2006 is nothing new. Contrary to what many critics believe, terrorist threats, an overly aggressive White House, and an impotent Democratic Party are not the sole explanations for congressional inactivity over the past six years. Good old-fashioned partisan politics has been, and continues to be, at play.
It is often assumed that everyday politics stops at the water's edge and that legislators abandon their partisan identities during times of war in order to become faithful stewards of their constitutional obligations. But this received wisdom is almost always wrong. The illusion of congressional wartime unity misconstrues the nature of legislative oversight and fails to capture the particular conditions under which members of Congress are likely to emerge as meaningful critics of any particular military venture.
The partisan composition of Congress has historically been the decisive factor in determining whether lawmakers will oppose or acquiesce in presidential calls for war. From Harry Truman to Bill Clinton, nearly every U.S. president has learned that members of Congress, and members of the opposition party in particular, are fully capable of interjecting their opinions about proposed and ongoing military ventures. When the opposition party holds a large number of seats or controls one or both chambers of Congress, members routinely challenge the president and step up oversight of
Iraq U.S. Foreign Policy Defense Policy Institutions GW Bush Administration


Shoviv is a software development Company based in India. Following are its privacy policies and terms and conditions.
Every company makes some policies to secure and protect the data and information that users share with them. So, our privacy policies have been made to guide the users how we protect their information.
We collect information from the user only after they agree to share it with us.
The users don't have to unveil their identity if they want to browse the site.
If the user wishes to buy software, then he/she would first have to get them registered with us.
If any user makes any inquiries for anything specific software support, purchase or solution, then they would be required to mention their contact information at our support system.
Any information that the user shares with us will be kept absolutely safe and confidential.
While placing an online order, the users have to log in by inserting their contact details at the support centre.
The personal information given by the users is used to reply the queries of technical support.
By sharing the mailing id, the users get notifications about new launches, modifications in website, promotions, discounts, and so on.
This information is also used when the company organizes any contests or surveys. With the help of the users' contact information, the company sends them notifications.


Rock an edgy look in this faux-leather jacket from Black Rivet; tons of seams and a mock collar create its bold moto vibe. All our Black Rivet brand jackets have an ageless attitude and a slim, modern fit. Runs one size smaller than normal.


The tragedy unfolding in Houston brought back memories of Katrina and Houston's response to the plight of evacuees from Louisiana. It was a massive effort that consumed the city for weeks. The scale of it all would change Houston forever.
What if Charlottesville and the dysfunction in Washington are not aberrations? What happens if the challenges facing society and governance only get more difficult for failing systems to tackle?
In episode 70 Phillip Smyth joins me for a quick look at how the change in U.S. leadership is impacting the balance of sectarian power and our policy toward Iran.
In this episode we discuss bias and how it can impact both the production and consumption of intelligence products.
I'm a huge fan of Warren Ellis, his no-nonsense views on technology, and the way he weaves it all into his work. He is able to sweep away the hype while clearly and creatively envisioning potential outcomes (and, of course, having some dark fun with it).
I've periodically checked in on the Ghost publishing platform as a potential solution over the past couple of years. I wasn't quite ready to make the move in 2015 or 2016 but I recently checked back in on the project and liked what I saw.
Considering Lt. Gen. H.R. McMaster's recent appointment to the position of National Security Advisor, it is prudent to revisit his book Dereliction of Duty.
Andrew Trabulsi, entrepreneur, consultant, and co-editor of Warlords, Inc.: Black Markets, Broken States, and the Rise of the Warlord Entrepreneur, joins me again for a discussion about the inherent challenges in understanding and forecasting technology-driven change.