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Autonomous Sensory Meridian Response: Your Patients Already Know, Do You?

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Autonomous Sensory Meridian Response: Your Patients Already Know, Do You? REVIEW Neha V. Reddy Arya B. Mohabbat, MD, FACP Brown University, Providence, RI Division of General Internal Medicine, Mayo Clinic, Rochester, MN Autonomous sensory meridian response: Your patients already know, do you? ABSTRACT utonomous sensory meridian response A (ASMR) is an atypical sensory-emotional Public interest in autonomous sensory meridian response phenomenon triggered in some people by spe- (ASMR) is growing on digital media platforms. Some cifi c audiovisual stimuli. It is characterized as people can elicit the response by watching videos con- a pleasant, tingling sensation of the head or taining triggering sounds and images. People susceptible neck, and is accompanied by positive feelings, to ASMR’s effects report tingling sensations on the head such as relaxation, a sense of well-being, eu- and neck, as well as feelings of euphoria, relaxation, and phoria, and mood elevation. Common trig- mood elevation. Underlying mechanisms of the phenom- gers include watching someone whispering, enon are not well understood, but physiologic evidence engaging in repetitive rhythmic motions, and corroborates some of the self-reported positive effects. exploring an object.1 Healthcare professionals should be aware of this emerg- Although our understanding of the mecha- ing topic, and the potential for therapeutic applications nisms behind ASMR and its potential clinical should be investigated. implications are in early stages, public inter- est in the phenomenon is growing and people KEY POINTS are actively seeking it out as a type of comple- mentary therapy. As in other complementary ASMR involves pleasurable feelings resulting from audio- therapies such as acupuncture and massage, visual stimuli, such as tapping sounds, watching someone patients may be ahead of the evidence-based brush their hair, or having something explained in detail literature in their interest and use of ASMR. in a whisper. Many use it to help alleviate stress or pain or promote sleep as an alternative to convention- Differences between people capable of the ASMR re- al therapies,1 and they may seek information sponse and controls have been detected in personality from their healthcare professionals about its traits, neural activity, and functional brain connectivity. use. This article describes ASMR and summa- rizes published research investigating its un- ASMR has been anecdotally reported to improve symp- derlying mechanisms and effects. toms of anxiety, depression, insomnia, and chronic pain. ■ POPULARITY OUTSIDE OF Many videos designed to elicit ASMR are freely available THE MEDICAL COMMUNITY on YouTube and other platforms. ASMR has had a presence in Internet cul- ture for nearly a decade. It is becoming more The authors report no relevant fi nancial relationships which, in the context of their contributions, commonly recognized and has recently been could be perceived as a potential confl ict of interest. referenced in conventional media outlets, in- doi:10.3949/ccjm.87a.20005 cluding Good Morning America and the Netfl ix CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 87 • NUMBER 12 DECEMBER 2020 751 Downloaded from www.ccjm.org on October 2, 2021. For personal use only. All other uses require permission. ASMR series Follow This. Despite being relatively un- ceiving color in response to seeing a letter of studied, it has garnered a large following on the alphabet or sensing a taste when hearing a digital platforms such as Reddit and YouTube, specifi c word.5 Unlike ASMR, synesthesia can where ASMR videos are freely available. be regarded as a blending of senses. Frisson, also known as musical or aes- ■ CHARACTERISTICS thetic chills, is the sensation of chills down OF ASMR-CAPABLE PEOPLE the spine when listening to peak emotional Specifi c personality traits have been ascribed moments in music.6 This positive sensation to people who are capable of ASMR. A study resembles those of ASMR. Neuroimaging in evaluating the Big Five Personality Inven- a small sample of ASMR-capable participants tory of 290 ASMR-capable people and 290 (n = 10) found that ASMR and frisson fol- matched controls determined that the capable low similar neurofunctional patterns of acti- cohort scored signifi cantly higher on open- vation in areas of reward and emotion, such ness-to-experience and neuroticism personal- as the nucleus accumbens, dorsal anterior cin- ity scales, and signifi cantly lower on personal- gulate cortex, supplementary motor area, and ity scales of conscientiousness, extraversion, insula.7–9 However, people with ASMR had and agreeableness.2 A positive correlation was increased activation of the medial prefrontal also found between the degree of openness- cortex, an area associated with social cogni- to-experience and neuroticism personality di- tion, social behaviors (eg, grooming), and mensions and intensity of ASMR experiences. self-awareness, while people with frisson had Another study found that ASMR-capa- reduced activation of this area.7–11 ble people scored signifi cantly higher on the mindful attention and awareness scale and the ■ KEY FEATURES ELICIT ASMR curiosity subscale of the Toronto Mindfulness Scale than matched controls,3 suggesting that Although ASMR triggers can be found in daily ASMR-capable people tend to be more mind- life, many people seek online videos designed ful than those who do not experience ASMR. to elicit ASMR, with the most popular amass- Many use ASMR 1 These fi ndings suggest that certain personality ing millions of views. Their focus varies wide- to help alleviate characteristics (and likely other unstudied fac- ly and includes personal attention, grooming, stress or pain tors) may contribute to the ability to experi- spa treatments (eg, massage, aromatherapy, ence the phenomenon. haircut, make-up application), eating, clean- or promote ing, and exploring household objects. Many sleep as ■ WHAT ASMR IS NOT videos feature specifi c trigger sounds, such as whispering, rustling of metallic foil, tapping an alternative ASMR is sometimes confused with other fi ngernails, scratching, crisp sounds, keyboard to conventional sensory-emotional phenomena such as miso- phonia, synesthesia, and frisson. These are typing, chewing, and lip-smacking. A category therapies distinct, although sometimes overlapping, of ASMR videos is dedicated to clinical role- conditions. playing, which may include whispered narra- tion during simulated medical history-taking Misophonia is an aversion to sounds such 12 as chewing, coughing, or loud breathing. and physical examinations. Some simulate While misophonia and ASMR appear to lie an “authentic” experience by using props such on opposite ends of a spectrum,1 a study found as penlights, stethoscopes, ophthalmoscopes, that ASMR-capable people scored higher on and otoscopes. the Misophonia Questionnaire than matched ASMR intensity depends on various char- controls, indicating that they may be more acteristics of the stimuli.13 The most effective likely to have misophonia than the general triggers are about 1 to 5 minutes long, are population.4 viewed in a pleasant environment, contain Synesthesia involves external sensory subject matter that is perceived as realistic, stimuli triggering the internal experience of a and involve diligent exploration of an object. different sensory modality. Commonly expe- Low-pitched audio triggers may be more reli- rienced synesthetic associations include per- able at inducing ASMR than visual stimuli. 752 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 87 • NUMBER 12 DECEMBER 2020 Downloaded from www.ccjm.org on October 2, 2021. For personal use only. All other uses require permission. REDDY AND MOHABBAT ■ NEUROLOGIC BASIS STUDIED ASMR-capable study participants felt sig- Preliminary studies have largely focused on un- nifi cantly more excited (P = .048), more calm derstanding mechanisms by which ASMR elic- (P < .001), less stressed (P < .001), less sad its positive sensations in capable individuals. (P < .001), and more socially connected (P Functional magnetic resonance imaging-based < .001) than non-ASMR participants after investigations suggest that exposure to ASMR watching ASMR media, as measured by the 23 media evokes activation in certain brain areas Multi-Affect Indicator scale. associated with attention, social cognition, and Evidence indicates that ASMR can not sensory processing.7,9,14 One study performed only induce subjective positive emotions but with ASMR-capable participants revealed sig- also objective physiologic responses. It has nifi cant activation of the nucleus accumbens been found to decrease heart rate by an aver- (a reward area).7 A subsequent study compared age of 3.41 beats per minute (P = .028) and ASMR-capable participants with controls but increase skin conductance (commonly used to 24 did not identify this effect.14 The dissimilar re- measure emotional arousal) by an average of 25 sults could be due to differences in study meth- 0.30 microsiemens (P = .017). ods: the former study measured brain activity Although the anecdotal benefi ts of im- during the self-reported tingling sensations and proved pain and mood symptoms are promis- the latter measured brain activity throughout ing, further investigation in clinical and labo- the entire ASMR media viewing session. ratory settings is important before ASMR can Other studies have found that ASMR-ca- be considered a therapeutic option. pable people have signifi cantly less functional connectivity between frontal lobes and senso- ■ PLACEBO EFFECT INVESTIGATED ry-attentional areas compared with
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