Psychology of Voice Disorders

Miriam van Mersbergen, Ph.D., CCC-SLP
Assistant Professor
University of Memphis
Editorial Board, Journal of Voice

Introduction

The term psychology is the marriage of two Greek words: psyche; meaning breath, life, soul, and logia; meaning speech, word, reason1.  Although the translation into Standard English refers to the science of the mind and behavior, the literal translation of breath and speech, is undeniably compelling in voice science.  The relationship between the voice and the person is so deep that often it can be hard to disentangle, presenting challenges to investigators.  How can we truly separate voice from the self and study it with the appropriate scientific controls?  I am happy to report that this challenge has been met by artists, clinicians, and scientists alike and this collection will present some of the research that falls under the broad heading of Voice and Psychology. 

The scope of psychology is broad, covering perception, cognition, attention, emotion (affect), intelligence, phenomenology, motivation (conation), brain functioning, and personality2.  It studies individuals, interpersonal relationships, families, workplace interactions, population trends, and media influences2.  Psychology researches individuals of all ages, from neonates to the aged and all groups in between. The various fields study normal and disordered processes, methods of assessment, and treatment for the myriad problems of the mind.  Psychology employs a wealth of investigative methods from biology, chemistry, neuroscience, statistics, mathematical modeling, linguistics, political science, economics, education, and religion, to name a few4.  This collection will present research from many of these various methodological perspectives.  Subsequently, on the surface the compilation of articles presented here might appear to lack cohesion.  However, as reflective of the broadness of the entire field of psychology, the articles presented here all fall under the cross-section of this discipline and voice science.

The compilation of articles in this collection begin at the journal’s inception. Since its first publication in 1987, the Journal of Voice has experienced an increase in the number and variety of articles submitted under this topic area.  Graph 1 shows the steady increase in publications per year in voice and psychology and we look forward to seeing more in this area. To be considered for entry into this collection, research employed psychological methods, discussed psychological constructs, investigated voice in those with psychopathologies, and described psychological entities that can be observed in voicing.  However, there are some areas of voice and psychology that are so broad they required their own collection.  One such collection is the development and tracking of well-being and quality of life in those with voice impairment, edited by Dr. Heather Bonilha and Ms. Maude Desjardins.  The methods employed to develop and measure these psychological constructs fall under the broad heading of psychometric scaling and construct measurement.  The other addresses the link between voice and identity, specifically gender identity, which is edited by Dr. Karen Kost.  Although a few articles in this collection will address voice and identity, the topic of gender identity will be found in its own collection.  There are many additional collections that intersect with the topics included in this collection and specific mention of them follows.

There were 164 articles addressing the following broad categories:  Functional, Behavioral, or Non-organic Dysphonia, Emotion, Psychosocial Factors, Learning, Psychopathologies, Autonomic Nervous System Activation, Compliance, Cognition, Personality, and Voice and Identity.  Two additional categories arose during the review that bear mentioning.  The general topic of Paradoxical Vocal Fold Movement occasionally addresses possible psychological mechanisms involved in the development of this disorder.  Although PVFM and related disorders do involve psychological components, the jury is still out on the predominant underlying mechanisms.  Indeed, the current research in this area has helped broaden its lens to include physiological mechanisms that contribute to this disorder5.   Additionally, some of the topics addressing children and families fall under the scope of psychology.  Of these articles, a few also fell under another category and so were included under those.  We look forward to more research into how voice intersects with developmental psychology and family interactions in the future.

An inventory of all 164 articles are included in this chapter and organized within each broad topic area.  However, a smaller subset of articles was chosen for this collection based on their coverage of the topic or their contribution of additional information.  Some articles fell under two or more categories and are appropriately marked as belonging to another category.  Articles are organized chronologically to give the reader perspective on how the field had progressed over the past forty years.  Following is a brief overview of what is included.

Functional, Behavioral, or Non-organic Dysphonia

By far, the largest number of contributions to this collection come from the investigations into the broad, heterogenous diagnosis of Functional Dysphonia.  If the saying “a well-loved child has many names” is true, then this voice impairment it certainly well-loved!  In the articles listed below some of the names for this class of disorders include: Functional Voice Disorders, Primary Muscle Tension Dysphonia, Muscle Misuse Voice Disorders, Muscle Tension Dysphonia, Psychogenic Dysphonia, Nonorganic Dysphonia, Functional Voice Problems, Psychogenic Spasmodic Dysphonia, Mutational Falsetto, Psychogenic Voice Disorders, Functional Ventricular Fold Phonation, and Hyperfunctional Voice Disorders. The many names for this disorder belie the central theme that these disorders are motivated by psychological interference more than biological interference.  Indeed, the community of artists, clinicians, and scientists have not reached a consensus on what we are truly talking about when an individual presents with no other clinical sign than maladaptive phonatory behaviors.  Although this area contains the largest number of articles in this area, more research is required to truly parse out the contributions of various psychological factors to phonatory behavior. 

There were 46 articles that mentioned functional dysphonia as a separate diagnosis.  Four subcategories arose from the original category.  Clinical Presentation included a total of 13 articles (see table 1), with 8 republished in this section.  There were 6 articles primarily addressing Assessment, 5 of which are included here.  Treatment, the next category, included a total of 15 articles, 10 were reprinted.  Finally, a category addressing how Functional Dysphonia may differ in Special Populations included 14 articles, with 7 occurring in this collection.  

Subheading

Article

Included in Collection

Included in another section

Clinical Presentation

Baker_1998_Psychogenic dysphonia Peeling back the layers

X

 

 

Andrade, Heur, Hockstein, Castro, Spiegel, Sataloff_2000_The frequency of hard glottal attacks in patients with muscle tension dysphonia, unilateral benign masses and bilateral benign masses.

X

 

 

Angsuwarangsee & Morrison_2002_Extrinsic muscular tension in patients with voice disorders.

X

 

 

Behrman, Dahl, Abrahamson, Schutte_2003_Anterior-Posterior and medial compression of the supraglottis signs of nonorganic dysphonia or normal postures,

 

 

 

Stager, Neubert, Miller, Regnell, Bielemowicz_2003_Incidence of supraglottic activity in males and females a preliminary report.

 

 

 

Altman, Atkinson, Lazarus_2004_Current and Emerging concepts in muscle tension dysphonia: a 30-month review.

X

 

 

Awaan & Roy_2004_Acoustic Prediction of Voice Type in Women with Functional Dysphonia

X

 

 

Roy & Hendarto_2005_Revisiting the Pitch Controversy Changes in Speaking Fundamental Frequency (SFF) After Management of Functional Dysphonia.

 

 

 

Izadi & Salehi_2013_Comparison Between Palpatory Findings of the Hyoid Position and Their Acoustic Videostroboscopic, and Perceptual Attributes in Patients with Muscle Tension Dysphonia.

X

 

 

Sinkiewicz, Jaracz, Machiewicz-Nartowicz, Wishirska-Woznica, Wojnowski, Bielecka, Krasny, Kaminska, & Borkowska_2013_Affective Temperament in Women with Functional Aphonia.

 

X

 

Liang, Yang, Mei, Cai, Guan, Shang, Wang, Gong, Huang, Peng, Zheng_2014_The Vocal Aerodynamic Change in Female Patients with Muscular Tension Dysphonia After Voice Training.

 

 

 

Kryshtopava, Van Lierde, Meerschman, D'Haeseleer, Vandemaele, Vingerhoets, Claeys_2017_Brain Activity During Phonation in Women with Muscle Tension Dysphonia: An fMR Study.

X

 

 

Whitling, Lyberg-Ahlander, Rydell_2017_Long-Time Voice Accumulation During Work, Leisure, and a Vocal Loading Task in Groups with Different Levels of Functional Voice Problems.

X

 

Assessment

Aaronson_1990_Importance of the psychosocial interview in the diagnosis and treatment of "functional" voice disorders.

 

X

 

Morrison_1997_Pattern recognition in muscle misuse voice disorders: How I do it.

X

 

 

Zheng, Zhang, Su, Gong, Yuan, Ding, Rao_2012_Laryngeal Aerodynamic Analysis in Assisting with the Diagnosis of Muscle Tension Dysphonia.

X

 

 

van Houtte, Claeys, D'haeseleer, Wuyts, van Lierde_2013_An examination of surface EMG for the assessment of muscle tension dysphonia.

X

 

 

Andrea, Dias, Andrea, Figueira_2017_Functional Voice Disorders: The Importance of the Psychologist in Clinical Voice Assessment.

X

 

 

Khoddami, Talebian, Izadi, Ansari_2017_Validity and reliability of surface electromyography in the assessment of primary muscle tension dysphonia.

X

 

Treatment

Roy & Leeper_1993_Effects of the manual laryngeal musculoskeletal tension reduction technique as a treatment for functional voice disorders: Perceptual and acoustic measures.

 

 

 

Roy, Bless, Heisey, & Ford_1997_Manual circumlaryngeal therapy for functional dysphonia: An evaluation of short- and long-term treatment outcomes.

X

 

 

Andersson & Schalen_1998_Etiology and treatment of psychogenic voice disorder: Results of a follow-up study of thirty patients.

 

 

 

Carding, Horsley, Docherty_1999_A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia.

 

 

 

vander Linde, De ley, Clement, de Bolt, van Cauwenberge_2004_Outcome of laryngeal manual therapy in four Dutch adults with persistent moderate-to-severe vocal hyperfunction a pilot study.

X

 

 

van Lierde, Claeys, De Bolt, van Cauwenberge_2007_Longterm outcome of hyperfunctional voice disorders based on a multiparameter approach.

 

 

 

Mathieson, Hirani, Epstein, Baken, Wood, Rubin_2009_Laryngeal Manual Therapy: A Preliminary Study to Examine its Treatment Effects in the Management of Muscle Tension Dysphonia.

X

 

 

van Lierde, DeBodt, Dhaeseleer, Wuyts, Claeys_2010_The Treatment of Muscle Tension Dysphonia: A Comparison of Two Treatment Techniques by Means of an Objective Multiparameter Approach.

X

 

 

Friedrich, Kiesler, Gugatschka_2010_Treatment of Functional Ventricular Fold Phonation by Temporary Suture Lateralization.

 

 

 

Van Houtte, Van Lierde, Claeys_2011_Pathophysiology and Treatment of Muscle Tension Dysphonia A Review of the Current Knowledge

X

 

 

Stepp, Heaton, Braden, Jette, Staeman-Cohen, Hilman_2011_Comparison of Neck Tension Palpation Rating Systems with Surface Electromyographic and Acoustic Measures in Vocal Hyperfunction.

X

 

 

Wenke, Stable, Walton, Coman, Lawire, ONiel, Theodoros, Cardell_2014_Is More Intensive Better for Functional Dysphonias?

X

 

 

Khoddami, Ansari, Jalaie_2015_Review on Laryngeal Palpation Methods in Muscle Tension Dysphonia Validity and Reliability Issues.

X

 

 

Jafari, Saehi, Izad, Moghadam, Ebadi, Dabirmoghadam, Faham, Shahbazi_2017_Vocal Function Exercises for Muscle Tension Dysphonia: Auditory-Perceptual Evaluation and Self-Assessment Rating.

X

 

 

Kolbrunner & Seifert_2017_Encouragment to increase the use of psychosocial skills in the diagnosis and therapy of patients with functional dysphonia.

X

 

Special Populations

 

 

 

General

Sapir_1995_Psychogenic spasmodic dysphonia: A case study with expert opinions.

 

 

 

vander Linde, De ley, Clement, de Bolt, van Cauwenberge_2004_Outcome of laryngeal manual therapy in four Dutch adults with persistent moderate-to-severe vocal hyperfunction a pilot study.

 

X

 

Nguyen, Kenny, Tran, Livesey_2009_Muscle Tension Dysphonia in Vietnamese Female Teachers.

X

 

 

NGuyun & Kenny_2009_Effects of Muscle Tension Dysphonia on Tone Phonation Acoustic and Perceptual Studies in Vietnamese Female Teachers.

 

 

 

Ngyuyen & Kenny_2009_Impact of Muscle Tension Dysphonia on Tonal Pitch Target Implementation in Vietnamese Female Teachers.

 

 

Mutational Falsetto

Woodson & Murray_1994_Botulinum toxin in the treatment of recalcitrant mutational dysphonia.

X

 

 

Lim, Lim, Choi, Kim, Kim, Choi_2007_Clinical characteristics and voice analysis of patients with mutational falsetto clinical significance of diplophonia and closed quotients.

 

 

 

Nakamura, Tskahara, Watanabe, Komazawa, Suzuki_2013_Type 3 Thyroplasty for Patients with Mutational Dysphonia.

X

 

 

Gokdogan, Gokogan, Tutar, Aydil, Yilmaz_2016_Speech Range Profile (SRP) Findings Before and After Mutational Falsetto (Puberphonia).

X

 

 

Balasubramaniam & N_2017_Voice Mutation during Adolescence in Mangalore, India Implications for the Assessment and Management of Mutational Voice Disorders.

 

 

Singers

Rubin & Greenberg_2002_Psychogenic Voice Disorders in Performers: A Psychodynamic Model.

X

 

 

Goffi-Fynn & Carroll_2013_Collaboration and Conquest MTD as Viewed by Voice Teacher (Singing Voice Specialist) and Speech-Language Pathologist.

X

 

 

Liang, Yang, Mei, Cai, Guan, Shang, Wang, Gong, Huang, Peng, Zheng_2014_The Vocal Aerodynamic Change in Female Patients with Muscular Tension Dysphonia After Voice Training.

X

 

 

Sielska-Badurek, Osuch_Wojcikiewicz, Sobol, Kazanecka, Rzepakowska, Niemczk_2017_Combined Functional Voice Therapy in Singers with Muscle Tension Dysphonia in Singing.

 

 

 

Emotion

The field of emotion science recognizes vocal expression as one of two means by which individuals transmit their internal state to the outside world (facial expression being the other method.)6 Thus, it is no surprise that there is a growing interest in voice and emotion.  Included in this collection is a basic science review of how emotional vocalizations differ by Dr. Ewe Jurgens. There were 19 articles directly addressing voice and emotion with 13 contributing to this collection (see table 2).

Article

Included in Collection

Included in another section

Scherer_1995_Expression of emotion in voice and music.

X

 

Siegwart & Scherer_1995_Acoustic concomitants of emotional expression in operatic singing: The case of lucia in Ardi gli incense.

 

 

Davis, Zhang, Winkworth, Bandler_1996_Neural control of vocalization Respiratory and emotional influences.

 

 

Murray & Rosen_2000_Phonotrauma associated with crying.

X

 

Roy, Ryker, & Bless_2000_Vocal violence in actors: An investigation into its acoustic consequences and the effects of hygienic laryngeal release training.

X

 

Scheidner, Hammerschmidt, Jurgens, Zwirner_2002_Acoustic Analyses of Developmental Changes and Emotional Expression in the Preverbal Vocalizations of Infants.

X

 

Schneider, Hammerschmidt, Jurgens, Zwirner_2006_Vocal Expression of Emotions in Normally Hearing and Hearing-impaired Infants.

X

 

Hammerschmidt & Jurgens_2007_Acoustic correlated of affective prosody.

X

 

Jurgens_2009_The Neural Control of Vocalization in Mammals: A Review.

X

 

Pettersen & Bjorkey_2009_Consequences of Emotional Stimulus on Breathing for Singing.

X

 

Waarama, Laukkanen, Airas, Alku_2009_Perception of Emotional Valences and Activity Levels from Vowel Segments of Continuous Speech.

X

 

Wermke & Robb_2010_Fundamental Frequency of Neonatal Crying Does Body Size Matter

X

 

Szameitat, Darwin, Szameitat, Wilgruber, Alter_2011_Formant Characteristics of Human Laughter.

X

 

Rodero_2011_Intonation and Emotion Influence of Pitch Levels and Contour Type on Creating Emotions.

 

 

Guzman, Dowdall, Rubin, Maki, Levin, Mayerhoff, Jackson-Menaldi_2012_Influence of emotional expression, loudness, and gender on the acoustic parameters of vibrato in classical singers.

 

 

Guzman, Correa, Munoz, Mayerhoff_2013_Influence on Spectral Energy Distribution of Emotional Expression.

 

 

Baker, Oates, Leeson, Woodford, Bond_2014_Patterns of Emotional Expression and Responses to Health and Illness in Women With Functional Voice Disorders (MTVD) and a Comparison Group.

X

 

Belyk & Brown_2014_The Acoustic Correlates of Valence Depend on Emotion Family.

X

 

Dromey, Holmes, Hopkin, Tanner_2015_The Effects of Emotional Expression on Vibrato.

 

 

 

Psychosocial Factors

Sixteen articles mentioned the cross section of voice disorders and well-being, quality of life, coping, locus of control, sociodemographic, and other psychosocial factors.  Eleven were included in this collection and present the reader with information on ways to incorporate psychosocial information in assessment, treatment and epidemiological study (see table 3). 

Article

Included in Collection

Included in another section

Aaronson_1990_Importance of the psychosocial interview in the diagnosis and treatment of "functional" voice disorders.

X

 

Gates_1992_Coping with dysphonia.

X

 

Kiese-Himmel & Kruse_1995_Sociodemographic variables of a German sample of patients with contact granuloma.

 

 

Kooijman, Graamans, de Jong_2007_Psychosocial Impact of the Teacher's Voice Throughout the Career.

X

 

Baylor, Yorkston, Eadie, Maronian_2007_The Psychosocial Consequences of BOTOX Injections for Spasmodic Dysphonia A Qualitative Study of Patients' Experiences.

 

 

*Kooijman, Graamans, de Jong_2007_Psychosocial Impact of the Teacher's Voice Throughout the Career

X

 

Bouwers & Rikkers_2009_A Retrospective Study Concerning the Psychosocial Impact of Voice Disorders Voice Handicap Index Change in Patients with Benign Voice.

X

 

Epstein, Hirani, Stygall, Newman_2009_How do Individuals Cope with Voice Disorders Introducing the Voice Disability Coping Questionnaire.

 

 

Haselden, Powell, Drinnan, Carding_2009_Comparing Health Locus of Control in Patients with Spasmodic Dysphonia, Functional Dysphonia and Nonlaryngeal Dystonia.

X

 

Yui, Ho, Ma, Verdolini Abbott, Branski, Rishardson, Li_2011_Possible Cross-Cultural Differences in the Perception of Impact of Voice Disorders.

X

 

Etter, Stemple, Howell_2013_Defining the Lived Experience of Older Adults with Voice Disorders.

 

 

Abeida, Liesa, Varela, Campayo, Gormedino, Garcia_2013_Study of the Influence of Psychological factors in the Etiology of Vocal Nodules in Women.

X

 

Kirsh, van Leer, Phero, Xie, Khosla_2013_Factors Associated with Singers' Perceptions of Choral Singing Well-Being.

X

 

Misono, Peterson, Meredith, Banks, Bandyopadhyay, Yueh, Frazier_2014_Psychosocial Distress in Patients Presenting with Voice Concerns.

 

 

Zambon, Moreti, Behlau_2014_Coping Strategies in Teachers with Vocal Complaint.

X

 

*Misono, Meredith, Peterson, Frazier_2016_New Perspective on Psychosocial Distress in Patients with Dysphonia The Moderating Role of Perceived Control

X

 

 

Learning

Fifteen articles addressed learning, learning techniques, and learning style; ten of which are included in this collection.  Learning is a broad construct and spans various motor learning principals, faciliatory techniques such as biofeedback, and preferences in learning in the studio and the clinic. Indeed, two separate collections address various voice therapy treatments (edited by Drs. Mara Behlau and Linda Carroll) and pedagogical techniques (edited by Drs. David Meyer and Brenda Smith) that employ many of these principals. Please refer to table 4 for the articles that touch on these topics.

Article

Included in Collection

Included in another section

Bastian_1987_Laryngeal Image Biofeedback for Voice Disorder Patients.

X

 

Ferrand_1995_Effects of Practice with and without knowledge of results on jitter and shimmer levels in normally speaking women.

X

 

Andrews, Shrivastav, Yamaguchi_2000_The role of cognitive cueing in eliciting vocal variability.

 

 

Stienhauer & Grayhack_2000_The role of knowledge of results in performance and learning of a voice motor task.

X

 

Bohnenkamp, Andrews, Shrivisankar, Summers_2002_Changes in Children's Voices: The Effect of Cognitive Cues.

X

 

Van Leidre, Claeys, deBboldt, vanCcauwenberge_2003_Outcome of laryngeal and velopharyngeal biofeedback treatment in children and young adults: A pilot study.

 

 

Howard, Bereten, Welch, Himonedes, DeCosta, Williams, howard_2007_Are real-time displays of benefit in the singing studio an exploratory study?

X

 

Herbst, Howard, Schlomicher-Thier_2009_Unsing electroglottographic real-time feedback to control posterior glottal adduction during phonation.

X

 

Wong, Amy Y.-H. Wong, Estella P.-M. Ma, Edwin M.-L. Yiu_2010_Effects of Practice Variability on Learning of Relaxed Phonation in Vocally Hyperfunctional Speakers.

X

 

Schneider-Stickler, Knell, Aichstill, Jocher_2011_Biofeedback on voice use in call center agents in order to prevent occupational voice disorders.

 

 

Ma, Yiu, Yiu_2013_The Effects of Self-Controlled Feedback on Learning of a "Relaxed Phonation Task."

X

 

Schalling, Gustafsson, Ternstrom, Wilen, Sodersten_2013_Effects of Tactile Biofeedback by a Portable Voice Accumulator on Voice Sound Level in Speakers with Parkinson's Disease.

 

 

Carroll & Tan_2015_Aerodynamic Measures and Biofeedback as Management in Persistent Paradoxical Vocal Fold Motion and Reverse Phonation.

X

 

Bottalic, Graetzer, Hunter_2016_Effect of Training and Level of External Auditory Feedback on the Singing Voice Volume and Quality.

X

 

Gustafsson, Ternstrom, Sodersten, Schalling_2016_Motor-Learning-Based Adjustment of Ambulatory Feedback on Vocal Loudness for Patients with Parkinson's Disease.

 

 

 

Psychopathologies

At times the primary problem of an individual with a voice problem is a diagnosed psychopathology that interferes with voice functioning or voice improvement. Other times the voice problem can the provoke a latent psychopathology to develop.  Either way, the relationship between psychopathology and vocal pathology has been established in the included articles.  This section includes articles that focus on specific psychopathologies such as Attention Deficit Hyperactivity Disorder, Anxiety, Depression, and Bulimia.  Although debated in some circles7, Premenstrual Syndrome (as defined by the Diagnostic Statistical Manual) can also be a confounding factor in dysphonia as mentioned in some articles. There were 14 total articles in this section and 8 were included for this collection (see table 5).

Subheading

Article

Included in Collection

Included in another section

General

da Rocha & Souza_2013_Voice Handicap Index Associated with Common Mental Disorders in Elementary School Teachers.

 

 

 

da Rocha, Behlau, Souza_2015_Behavioral Dysphonia and Depression in Elementary School Teachers.

X

 

 

Marinho, Medeiros, Gama, Teixeira_2017_Fear of Public Speaking Perception of College Students and Correlates.

X

 

ADHD

Hamdam, Deeb, Sibai, Rameh, Rifai, Fayyad_2009_Vocal Characteristics in Children With Attention Deficit Hyperactivity Disorder.

X

 

 

Garcia_Real, Diaz_Roman, Garcia-Marinz, Vieiro-Iglasias_2013_Clinical and Acoustic Vocal Profile in Children With Attention Deficit Hyperactivity Disorder.

X

 

 

Terea & Diaz-Roman_2016_Vocal Hyperfunction in Parents of Children With Attention Deficit Hyperactivity Disorder,

 

 

 

Barona-Lleo & Fernandez_2016_Hyperfunctional Voice Disorder in Children With Attention Deficit Hyperactivity Disorder (ADHD): A Phenotypic Characteristic.

X

 

Anxiety

Merritt, Richards, Davis_2001_Performance Anxiety Loss of the Spoken Edge.

X

 

 

Dietrich, Verdolini Abbot, Gartner-Schmidt, Rosen_2008_The frequency of perceived stress, anxiety and depression in patients with common pathologies affecting voice.

X

 

 

Martinez, Cassoll_2015_Measurement of Voice Quality, Anxiety and Depression Symptoms After Speech Therapy.

X

 

Bulimia

Morrison & Morris_1990_Dysphonia and Bulimia vomiting Laryngeal Injury.

 

 

 

Rothstein_1998_Reflux and vocal disorders in singers with bulimia.

 

 

PMS

Davis & Davis_1993_The effects of premenstrual syndrome (PMS) on the female singer.

 

 

 

Chae, Choi, Kang, Choi, Jin_2001_Clinical analysis of Voice Change as a parameter of premenstrual Syndrome.

 

 

 

Autonomic Nervous System Activation

Because emotion and emotional experience is inextricably linked to autonomic functioning8 and because the Vagus nerve is a primary nerve in autonomic regulation9 it is no surprise that autonomic functioning plays a role in the voice and psychology research. Stress and autonomic arousal do influence voicing within individuals and the 12 articles in the bibliography speak to this nascent area of research.  Seven of these articles are included here (table 6).

Article

Included in Collection

Included in another section

Mendoza & Carballo_1998_Acoustic analysis of induced vocal stress by means of cognitive workload tasks.

X

 

Mendoza & Carballo_1999_Vocal tremor and psychological stress.

 

 

Demmink-Geertman & Dejonckere_2002_Nonorganic Habitual Dysphonia and Autonomic Dysfunction.

X

 

Baker_2003_Psychogenic voice disorders and traumatic stress experience a discussion paper with two case reports.

 

 

Schneider, Enne, Cecon, Deindorfer-Radner, Wittels, Bigenzahn, Johannes_2005_Effects of Vocal Constitution and Autonomic Stress-Related Reactivity on Vocal Endurance in Female Student Teachers.

 

 

Kwong & Yiu_2010_A preliminary study of the effect of acupuncture on emotional stress in female dsyphonic speakers.

 

 

Giddens, Barron, Bryd-Craven, Clark, Winter_2013_Vocal Indices of Stress: A Review.

X

 

Holmquisst, Santtila, Lindstrom, Sala, Simberg_2013_The Association between Possible Stress Markers and Vocal Symptoms.

X

 

Larrouy_Maestri & Morsomme_2013_The Effects of Stress on Singing Voice Accuracy.

 

 

Tse, Wong, Whitehill, Ma, Masters_2014_Analogy Instruction and Speech Performance Under Psychological Stress.

X

 

MacPhearson, Abur, Stepp_2017_Acoustic Measures of Voice and Physiologic Measures of Autonomic Arousal during Speech as a Function of Cognitive Load.

X

 

van Mersbergen Lyons, Riegler, 2017_Vocal Responses in Heighted States of Arousal.

X

 

 

Compliance

The success of voice patients in their journey to health and well-being largely depends on the therapeutic alliance and the clinician’s ability to foster compliance. The ten articles addressing these concepts speak to the importance of understanding the factors involved in compliance.  Seven of these articles are included in this collection (table 7).

Article

Included in Collection

Included in another section

Sapir_1993_Vocal attrition in voice students: Survey findings.

X

 

Schmidt & Andrews_1993_Consistency in clinicians' and clients' behavior in voice therapy: An exploratory study.

X

 

van Leer, Hapner, Connor_2008_Transtheoretical Model of Health Behavior Change Applied to Voice Therapy.

X

 

Portone, Johns, Hapner_2008_A review of patient adherence to the recommendation for voice therapy.

 

 

Gilman, Merati, Klein, Hapner, Johns_2009_Performer's attitudes toward seeking health care for voice issues understanding the barriers.

 

 

Hapner, Portone-Maira, Johns_2009_A study of voice therapy dropout.

X

 

van Leer, Connor_2010_Patient Perceptions of Voice Therapy Adherence.

X

 

Portone-Maira, Wise, Johns, Hapner_2011_Differences in Temporal Variables Between Voice Therapy Completers and Dropouts.

X

 

de Almeida, Santos, Bassi, Teixeira, Gamma_2013_Relationship between Adherence to Speech Therapy in Patients With Dysphonia and Quality of Life.

X

 

Rinsky-Halivni, Klebanov, Lerman, Paltiel_2017_Adherence to Voice Therapy Recommendations Is Associated with Preserved Employment Fitness Among Teachers with Work-Related Dysphonia.

 

 

 

Cognition

Voice is used in language expression and is dependent upon the cognitive systems that support it.  The primary role cognition has on voicing is a relatively new direction in the field of voice science.  However, there are six exciting articles into how our attention, memory, and language influence voicing that are included in this collection (table 8).

Article

Included in Collection

Included in another section

Fozo & Watson 1998 Task complexity effect on vocal reaction time in aged speakers

X

 

Bohnenkamp, Andrews, Shrivisankar, Summers_2002_Changes in Children's Voices: The Effect of Cognitive Cues.

 

X

Dodd 2004 Is There an Effect of Dysphonic Teachers' Voices on Children's Processing of Spoken Language?

X

 

Vinney & Turkstra 2013. The Role of Self-Regulation in Voice Therapy.

X

 

Vinney, van Mersbergen, Connor, Turkstro-2016. Vocal Control ls it Susceptible to the Negative Effects of Self-Regulatory Depletion?

X

 

Almeida & Behlau-2017. Relations Between Self-Regulation Behavior and Vocal Symptoms

X

 

 

Personality

Our temperament, which is our proclivity to experience emotion and express emotion, our cognitive abilities, and our perceptual capabilities all make up what we know as personality 10.  Because the voice expresses our emotion, participates in language expression, and relies on our sensations for feedback, it is little wonder that our personalities may influence our voices.  The six articles in this collection describe how personality may influence the development of a voice problem and its subsequent therapy (table 9).

Article

Included in Collection

Included in another section

Andrews & Schmidt_1995_Congruence in personality between clinician and client: Relationship to ratings of voice treatment.

X

 

Hugh-Munier, Scherer, Lehmann, Scherer_1997_Coping strategies, personality, and voice quality in patients with vocal fold nodules and polyps.

X

 

Roy, McGory, Tasko, Bless, Heisey, &Ford_1997_Psychological correlates of functional dysphonia: An investigation using the Minnesota Multiphasic Personality Inventory.

X

 

Roy, Bless, Heisey_2000_Personality and voice disorders: A multitrait-multidisorder analysis.

X

 

Sinkiewicz, Jaracz, Machiewicz-Nartowicz, Wishirska-Woznica, Wojnowski, Bielecka, Krasny, Kaminska, & Borkowska_2013_Affective Temperament in Women with Functional Aphonia.

X

 

Bastian & Thomas_2016_Do Talkativeness and Vocal Loudness Correlate with Laryngeal Pathology: A Study of the Vocal Overdoer Underdoer Continuum.

X

 

 

Voice and identity                                                              

The relationship between voice and personality can be bidirectional. If personality influences our voice, our voice can influence how we see ourselves and define our personal stories.  This relationship is investigated intensely in the Journal of Voice. As mentioned earlier, the vocal identity of individuals within a given gender has its own collection.  In addition to gender identity, general vocal identity occurred in five articles, four of which are included in this collection (table 10).

Article

Included in Collection

Included in another section

Amir & Levine Yundof_2013_Listeners' Attitude Toward People with Dysphonia.

X

 

Andrew & Schmidt_1997_Gender presentation: Perceptual and acoustical analyses of voice.

 

 

Gama, Camargo, Santos, Rusilo_2015_Discriminant capacity of Acoustic, Perceptual, and Vocal Self: The Effects of Vocal Demands.

X

 

Haskell_1987_Vocal Self-Perception: The Other Side of the Equation.

X

 

Sandmann, Zehnhoff Dinnesen, Schmist, Rosslau, Lang-Roth, Bermer, Knief, Marular, Vauth,  Dauster_2013­_Differences Between Self-Assessment and External Rating of Voice.

X

 

 

Children and the Elderly

Finally, this collection includes two additional articles about the attitudes toward children with voice problems (table 11).  Although the topic of children is not exclusively, or even predominantly psychological, it bears mentioning that this special population may experience voice problems differently given their biological, developmental, and social differences. Please refer to Dr. Rita Patel’s edited collection devoted to children for a more complete discussion of pediatric voice.  Additionally, specific articles addressing psychological concepts in the elderly bear mentioning.  Although much is known about quality of life and handicap in the elderly presented as seen in the collection edited by Drs. Edie Hapner and Michael Johns, how other psychological constructs differ in the aging population awaits further discovery. Two articles of the seven pertaining to children are included in this collection (table .)

Article

Included in Collection

Included in another section

Bohnenkamp, Andrews, Shrivisankar, Summers_2002_Changes in Children's Voices: The Effect of Cognitive Cues.

 

X

Dodd_2004_ Is there an Effect of Dysphonic Teachers' Voices on Children's Processing of Spoken Language?

 

X

Nienkerk-Springer, McAllister, Sundberg_2004_Effects of Family Therapy on Children's Voices.

 

 

Connor, Cohen, Theis, Thibeault, Heatly, Bless_2007_Attitudes of Children with Dysphonia.

X

 

Roy, Holt, Redmond, Muntz_2007_Behavioral Characteristics of Children with Vocal Fold Nodules.

X

 

Wermke & Robb_ 2010_ Fundamental Frequency of Neonatal Crying Does Body Size Matter

 

x

Kolbrunner, Seifert_2013_Functional Hoarseness in Children Short-Term Play Therapy with Family Dynamic Counseling as Therapy of Choice.

 

 

 

Conclusion

I hope that you enjoy this collection as much as I have.  In researching this topic, it struck me how tightly linked our psychological processes are with our voice; from higher cortical processes such as language and cognition, to bodily processes observed through our autonomic system.  It seems to me, if one were to look for a good place to investigate the mind-body connection, the neck is great place to start.

Enjoy!

 

References

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  4. Psychology is a “Hub Science". Association for Psychological Science Observer (September 2007).
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  6. Scherer, K. R., Johnstone, T. & Klasmeyer, G. (2003). Vocal expression of emotion. In R. J. Davidson, K. R. Scherer, H. Goldsmith (Eds.). Handbook of the Affective Sciences (pp. 433–456). New York and Oxford: Oxford University Press.
  7. Romans, S.E., Kreindler, D., Asllani, E., Einstein, G., Laredo, S., Levitt, A., Morgan, K., Petrovic, M., Toner, B., & Stewart, D.E. (2013) Mood and the menstrual cycle. Psychotherapy and Psychosomatics 82: 53-60.
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  9. Langley, J.N. (1921). The Autonomic Nervous System Part 1. Cambridge: W. Heffer.
  10. Derryberry, D., & Rothbart, M. K. (1984). Emotion, attention, and temperament. In C. E. Izard, J. Kagan, & R. B. Zajonc (Eds.), Emotions, cognitions, and behavior. New York: Cambridge University Press. (excerpt: pp. 132-153).
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