Imagine a tingling sensation, starting at the top of the scalp and traveling down your spine, inducing a state of relaxation and deep breathing [1]. You feel an increased desire to sleep. Your phone supplies the source of this peace: a video of a woman speaking softly, barely above a whisper. She is reading an excerpt from a book, tapping lightly on the pages as she does so. You are entranced by the graceful sweeping motions of her hands while she taps, feeling as though she is brushing all of your worries aside. This unusual experience has been termed ASMR, meaning Autonomous Sensory Meridian Response, characterized by this relaxing, pleasant, and tingly sensation originating in the body’s meridian (center) during exposure to specific audio and/or visual somatosensory stimuli [2]. There are many different “triggers” commonly known to induce ASMR, including tapping, whispers, and even aesthetic visuals [3].

While the term coined in 2010 implied something scientific, little was understood about the phenomenon at the time. The only certainty was that some people who, aware of their sensitivity to particular sounds, developed an ASMR community using online media forums such as YouTube to create videos for relaxation and sleep [4]. The community has since grown, with some so-called “ASMRtists” enjoying millions of subscribers on their YouTube channels. With increased social media attention, there is an increased interest in understanding the scientific basis of this phenomenon: what characterizes ASMR, and what prompts its physiological and psychological effects? How is ASMR related to other phenomena or conditions? Is there any merit for ASMR to be used in a clinical setting? These are among some of the questions of special interest to those researching the phenomenon and seeking to understand its neurological basis [1, 2].

Characteristics of ASMR

Several studies have found that, during exposure to ASMR, subjects experienced increased ‘flow’, a state of heightened focus on the provided stimuli and distorted perception of the passage of time [1]. Flow is not specific to ASMR, with another common example being a state of altered consciousness during athletic performances, almost as if the athlete is in their own world [1]. A person can experience a flow state while doing anything that sufficiently captures their attention, including playing video games, painting, or even working [5].

In addition to the joys received from simple repetitive sounds, many ASMRtists perform roleplay based on various professions, characters, or other fictitious situations. For example, during physician roleplays the “doctor” performs various tasks such as measuring the viewer’s heart rate, performing eye tests, or even preparing the viewer for surgery. It is thought that observing the completion of tasks performed by others in a similar state of flow induces an equivalent “flow” response, potentially resulting in the ASMR experience. Although the mechanism is not entirely understood, this type of attentive acting may facilitate the increased flow-like state [1].

Researchers also believe that another driving force to experience ASMR is its facilitation of increased social connection [3]. One study found individuals sensitive to ASMR reporting higher empathy levels. The finding suggests the ASMR experience may be related to social interaction because empathy stems from the recognition and concern for the emotions of others [6]. Further, many viewers report increased feelings of nostalgia, especially when the video imitates real-life personal attention, because the artificial attention reminds them of positive social experiences they may have had in the past [7]. For example, one commenter on a doctor roleplay produced by GentleWhispering ASMR compared the video to the feeling of “coming home again” [8]. The social nature of ASMR differs from real-world social interaction in that the viewer has no risk of criticism, nor are they expected to provide anything for the interaction [7]. This may help remove some common fears associated with social interaction while retaining the benefits. Participants in an exploratory study of ASMR frequently referred to a seemingly paradoxical relationship between intimacy and privacy while watching ASMR videos. Intimacy is facilitated by the ASMRtist through eye contact and proximity to the camera, while privacy is maintained because the experience is a one-way interaction [7]. Overall, ASMR seems to create an environment of both comfort and nonjudgmental social presence.

Considering the implications of the experience of ASMR, the phenomenon may be used for therapeutic benefits. Research into personality traits associated with those who use ASMR has shown increased neuroticism and introversion but less conscientiousness and agreeableness [9]. Those struggling with various mental health issues may thus gravitate towards ASMR in an attempt to reduce symptoms such as insomnia, loneliness, and anxiety [10]. One study evaluated anxiety and psychological cravings from abstaining drug addicts exposed to ASMR over a period of twelve weeks, finding an overall reduction in both associated symptoms. The researchers utilized Stroop testing, which evaluates one's ability to selectively focus on one stimulus over another, and measured decreased focus on drug-related stimuli from the participants. It was therefore posited that ASMR mediates decreased attention towards the psychological cravings associated with drug withdrawal [10]. Watching or listening to ASMR has also been found to decrease heart rate to a similar degree observed in mindfulness exercises [3]. Indeed, ASMR may facilitate increased mindfulness, as it encourages calm reflection [1]. ASMR has also been shown to boost mood and provide short-term relief from depression, but further research is necessary to establish a more concrete understanding of potential long-term therapeutic applications [2].

ASMR has often been compared to related experiences and conditions such as misophonia, synesthesia, and musical frisson. To investigate underlying mechanisms and potential utilizations of the ASMR experience, it is beneficial to highlight the commonalities and distinctions present among these phenomena. Misophonia is a condition in which characteristic sounds invoke anger or disgust [11]. Chewing, snoring, and breathing are common sounds triggering this negative emotional response, although the specific stimuli vary between individuals, a characteristic similar to that of ASMR. Additionally, the overlap of individuals who experience both ASMR and misophonia suggests a potential correlation in generalized auditory sensitivity rather than specifically pleasant stimuli. e.Although the two phenomena share sensitivity to auditory stimuli, misophonia seems to be the inverse of ASMR, eliciting negative emotions rather than positive. Likewise, current research has not uncovered more than a correlational relationship between ASMR and misophonia, and further research is needed to understand the connection [11].

Synesthesia defines experiences in which one sensory input, seeing a number for example, induces a separate sensory input, such as a specific color [12]. While synesthesia tends to combine non-tactile senses, ASMR seems to blend either the visual or auditory senses with the tactile. A major difference between the two, however, is that synesthesia seems to remain highly constant throughout one’s life, with one study finding specific stimuli induced the same sensations 90% of the time [13]. However, individuals with sensitivity to ASMR do not always respond the same way to a certain sound, and the blending of senses is a more emotional phenomenon.

The tingles of ASMR have also been often compared to the sensation felt during musical frisson, a phenomenon which occurs when listening to music induces a shiver-like sensation down the spine [14]. One difference between the two, however, is found with the relative activity within the medial prefrontal cortex (mPFC), a brain region associated with the regulation of emotions and socialization, where one study found activity increased during ASMR but decreased during frisson [14]. Researchers wanting to specifically investigate the roles of ASMR and music in relaxation as opposed to the sensation of tingles used fMRI to measure brain activity while also asking participants to complete questionnaires about their comfort levels after listening to either ASMR recordings or music [15]. Interestingly, although relaxation did not differ significantly depending on whether the subject listened to ASMR or music, listening to ASMR did correspond to enhanced brain activity in the mPFC, supporting the previous finding. The mPFC also contributes to the regulation of dopamine, a neurotransmitter integral in the pathways regulating reward and excitement. Enhanced feelings of reward could be partially responsible for the relaxation observed while listening to ASMR. However, the lack of a clear distinction between the reported relaxation when listening to ASMR versus music prevents the conclusion that greater activation of the mPFC leads to increased relaxation. A possible explanation for these results could be that mPFC activation is closer related to the induction of tingles than it is to relaxation. Future studies should include measurement of tingles in addition to relaxation [15].

Investigating the Neural Basis of ASMR

In one study investigating the neural mechanisms associated with ASMR, functional magnetic resonance imaging (fMRI) was performed on participants experiencing ASMR-associated tingles [14]. An fMRI functions to measure the relative level of blood flow in specific regions of the brain, which may indicate increased activity (or function) by the need for greater oxygen uptake [16]. Notable findings from this study showed heightened activation of the nucleus accumbens, a brain area involved in reward and motivation [17]; the dorsal anterior cingulate cortex (dACC), which plays a role in learning and decision-making [18]; and the insula, which is associated with self-awareness and the processing of pain and other sensations [14, 19]. Interestingly, participants seemed to feel a sensation of touch whenever the ASMRtist mimicked physical contact. In general, the brain region with greater activity shown on fMRI corresponded to the area of the body “receiving” the touch, but in some cases the stimulation was less discriminatory. For example, a pretend touch to the face sometimes elicited activation of the region responsible for processing of somatosensory information in the foot. Activation of regions known to modulate feelings of reward and sensory processing may help provide a neurological basis for the association between ASMR and tingles [14].

Electroencephalograms (EEGs), which measure electrical activity of the brain in the form of ‘brainwaves’, have also been used to investigate the neural foundation of ASMR, specifically related to the sensation of tingles. One such study found enhancement of low-frequency brain waves (alpha waves) and inhibition of high-frequency waves (beta and gamma waves) during ASMR [20]. Alpha wave activity corresponds both to relaxation during rest and to enhanced cognitive attention on a specific task through a reduction in distracting stimuli [20]. Beta wave activity is associated with arousal and cognitive activity [21], so if ASMR decreases arousal, it seems convincing that beta wave activity would also decrease. However, other studies have found that beta activity actually increases during ASMR [2, 6]. One study measured a significant increase in beta wave activity whenever the participants experienced tingles, lending additional support to the idea of tingles being attributable to altered brain activity [6]. If ASMR really does increase arousal while simultaneously maintaining a state of relaxation, it differs largely from other tools used to induce relaxation and/or sleep, which tend to avoid arousing the subject.

Although ASMR is traditionally characterized by somatosensation, primarily “tingles”, perhaps the greatest psychological impact of ASMR is the induction of relaxation [7]. Research has suggested that relaxation involves the default mode network (DMN), a region of the brain that combines new external stimuli with established internal information, creating a constantly adapting system [22]. Utilizing fMRI to measure the functional connectivity between different brain regions in the DMN during ASMR, researchers observed an increased connectivity in parts of the gyrus and thalamus, which are associated with a state of rest, providing evidence for the facilitation of relaxation and sleepiness during ASMR [23, 24].

An additional fMRI study of various brain networks upheld similar findings, showing regions primarily associated with motor function to have a reduction in activity, while regions corresponding to the somatosensory cortex (processes touch, detects position) experienced increased activity in individuals who experience ASMR [25]. In finding this, researchers examined beyond just the DMN and into other neural networks, such as the salience, sensorimotor, visual, and central executive networks. The salience network is responsible for the prioritization of stimuli, processing what is worthy of our focus. The sensorimotor network (SMN) integrates sensory information and includes various parts of the motor cortex. The central executive network plays a major role in attention, the regulation of emotions, and working memory. Their findings display that, overall, functional connectivity with respect to the five networks as a whole was lower in individuals who did versus did not experience ASMR, suggesting less interaction occurs between them. However, upon isolation, a few key regions within the greater five networks were observed to actually exhibit increased connectivity in people who exhibited an ASMR. Notably, there was a positive association between activation of the SMN and of the orbital gyrus, a region participating in pathways involving sensory and social reward. This finding provides further insight into a potential mechanism behind the sensation of tingles. Also notable was the greater connectivity within regions of the midcingulate cortex, a region known to coordinate motor and emotional responses. An enhanced tie between motor function and emotions could describe the sensitivity of those who experience ASMR to possess greater emotional and physiological response to external triggers. A third example of increased connectivity found was between the CEN and the part of the temporal lobe responsible for speech processing. This finding is significant because it could be related to the experience of ASMR in response to whispering or soft speaking. Overall, although those who experience ASMR had a general reduction in functional activity in the five networks analyzed, ASMR seems to involve enhanced activation of regions associated with relaxation and stimuli processing [25].

Limitations and Doubts

Despite the increasing acceptance of ASMR as a valid phenomenon and potential therapeutic device, doubts remain about the underlying neural mechanisms of ASMR and its practical applications. Much of the existing research has used small sample sizes and often relies on subjective information. Studies performed using fMRIs also potentially reduce the authenticity of the ASMR experience because they take place in an unnatural setting and involve loud noises, both of which could interrupt the focus needed for ASMR [14].

There are also concerns about the legitimacy of ASMR as actually facilitating a relaxing experience. Some people have proposed that any physiological or psychological benefits are attributed to the placebo effect [26]. One study tested this belief by observing whether or not participants reported experiencing ASMR while listening to a provided clip. Some participants were given videos actually meant to induce ASMR, while others were given an instructional, non-ASMR-inducing video that was meant to act as the placebo. Those new to ASMR reported experiencing ASMR even during instructional videos not designed for ASMR, while those more familiar with the experience were only “triggered” by intentional stimuli. These results suggest new ASMR listeners receive benefits from the expectation rather than the induction of pleasure, but that the phenomenon itself plays more of a role after repeated use [26].

There are some widespread misconceptions regarding ASMR as well. Many people unfamiliar with the experience believe it to be sexual in nature [3]. While this misunderstanding could result from the extensive personal attention of many ASMR videos, research has maintained that the arousal associated with ASMR is non-sexual [3]. That said, some ASMRtists do use their platforms in sexually provocative ways, and it is important to recognize that ASMR encompasses a wide variety of triggers that appeal to different people.

Future Research

As recognition of ASMR is relatively recent, much remains unknown regarding the experience. Some future directions might include further distinguishing ASMR from similar experiences such as musical frisson, misophonia, and synesthesia to develop a better understanding of its distinct neural mechanisms. Emphasis should also be placed on understanding the potential for clinical applications. Early studies have suggested ASMR’s effects may be comparable to those of mindfulness meditations for certain mental health issues, but the extent of these benefits has yet to be discovered. It is also worth researching why some people are more sensitive to the phenomenon than others, as there are large variations in those who experience ASMR, making generalization difficult. Some experience the physiological sensation of tingles, some only experience relaxation, and some are actually repulsed to some degree by ASMR. Furthermore, individuals respond in different ways to different ASMR stimuli. One person may experience ASMR when listening to whispering, while another might find whispering uncomfortable and instead find tapping sounds facilitative of the experience. Regardless of any given person’s response to stimuli associated with ASMR, research into its scientific basis suggests ASMR is a distinct phenomenon deserving continued attention.

Now, imagine you are approaching the end of the video of the ASMRtist quietly reading you a book. The book was a review of ASMR, meant to inform both those who are sensitive to ASMR and those with limited knowledge about the phenomenon. As the woman continued to read you gradually became more and more entranced in the content, and as the video fades out you realize ten minutes has passed in what felt like no more than one. You decide to succumb to the desire to sleep as your eyes struggle to stay open. As you drift into slumber you start to ponder the future of ASMR. You wonder if ASMR will eventually become viable in therapeutic practice, perhaps even developing into its own treatment for certain mental health disorders. One thing is for sure, ASMR is and will continue to be a fixture in the modern world.

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