The Proximity Prediction Hypothesis: How predictive coding of CT-touch explains Autonomous Sensory Meridian Response and its therapeutic applications

Autonomous Sensory Meridian Response (ASMR) is a pleasant tingling sensation felt across the scalp and neck, widely reported to reduce anxiety and improve sleep. The Proximity Prediction Hypothesis (PPH) is the first comprehensive predictive coding model explaining ASMR's underlying neural mechanism. PPH posits that near-field acoustic cues from common ASMR triggers (e.g., brushing sounds, whispered speech) engage the audio-tactile Peripersonal Space Network, generating a top-down prediction of gentle C-tactile (CT) touch on CT fibre-rich skin of the scalp and neck. This prediction suppresses locus coeruleus (LC) arousal and increases vagal output, offering a mechanistic explanation for the phenomenon's therapeutic benefits. In a subjective-experience survey (<i>N</i> = 64), ASMR-labelled trials were rated significantly more pleasant but only slightly more arousing than controls. Pleasantness predicted both the presence and intensity of tingles, supporting PPH's core claim that hedonic value, rather than sympathetic activation, drives the graded somatosensory response. PPH situates ASMR within the Neurovisceral Integration framework, predicting measurable Central Nervous System-Autonomic Nervous System (CNS-ANS) markers (beta-band desynchronisation in the posterior insula and proportional increases in high-frequency heart rate variability with tingle intensity). It further predicts reduced LC activity during ASMR, stronger effects in individuals with high interoceptive prediction error (e.g., anxiety, autism), and attenuation of tingles when spatial proximity cues are removed. By integrating auditory proximity, CT-touch anticipation, and autonomic regulation into a single predictive-coding account, PPH provides a unified, testable framework for explaining ASMR, offering a blueprint for translating this sensory phenomenon into targeted, evidence-based interventions for anxiety and sleep disorders.