No AccessJournal of Speech, Language, and Hearing ResearchResearch Article1 Dec 2008

Functional Dysphonia During Mental Imagery: Testing the Trait Theory of Voice Disorders

    Purpose

    Previous research has proposed that persons with functional dysphonia (FD) present with temperamental traits that predispose them to their voice disorder. We investigated this theory in a controlled experiment and compared them with social anxiety (SA) and healthy control (HC) groups.

    Method

    Twelve participants with FD, 19 participants with SA, and 23 HC participants were studied before, during, and after mental imagery of positive, neutral, and aversive scripts in a within-subject reversal paradigm with multiple experimental conditions using psychometric, self-report, and psychophysiological measures.

    Results

    In psychometric tests, those with FD demonstrated increased fear in social situations but not increased avoidance. On measures of mood, all groups responded with predicted increases in pleasant mood for positive scripts and unpleasant mood for aversive scripts; on vocal effort ratings, those with FD reported greater effort for all scripts following imagery. Under experimentally controlled conditions, the SA and HC groups demonstrated predicted activation of EMG measures of mood, whereas the FD group demonstrated overall reduced activation of EMG measures.

    Conclusion

    Results may suggest that those with FD respond to emotional stimuli with reduced behavioral expression, compared with SA and HC groups, consistent with the temperamental trait of behavioral constraint.

    References

    • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
    • Aronson, A. E., Peterson, H. W., & Litin, E. M. (1966). Psychiatric symptomatology in functional dysphonia and aphonia.Journal of Speech and Hearing Disorders, 31(2)115–27.
    • Arnold, G. E. (1962). Vocal nodules and polyps: Laryngeal tissue reaction to habitual hyperkinetic dysphonia.Journal of Speech and Hearing Disorders, 27(3)205–217.
    • Bastian, R. W., Keidar, A. K., & Verdolini-Marston, K. (1990). Simple vocal tasks for detecting vocal fold swelling.Journal of Voice, 4(2)172–183.
    • Beck, A. T., & Steer, R. A. (1993). Beck Depression Inventory manual. San Antonio: The Psychological Corporation.
    • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression.Archives of General Psychiatry, 4, 561–571.
    • Behrman, A. (2005). Common practices of voice therapists in the evaluation of patients.Journal of Voice, 19(3)454–469.
    • Betts, G. (1909). Distributions and functions of mental imagery (Columbia Univ. Contr. to Educ. No. 26). Oxford, England: Teachers College, Columbia University. Retrieved October 23, 2008, from the PsycINfo database
    • Borg, Q. A. V. (1982). Psychophysiological bases of perceived exertion.Medical Science Sports and Exercise, 14, 377–381.
    • Bradley, M. M., & Lang, P. J. (1995). Measuring emotion: The Self-Assessment Manikin and the semantic differential.Journal of Behavior Therapy and Experimental Psychiatry, 25, 49–59.
    • Bradley, M., & Lang, P. (2000). Measuring emotion: Behavior, feeling, and physiology.In R. D. Lane, & L. Nadel (Eds.), Cognitive neuroscience of emotion (pp. 242–276). New York: Oxford University Press.
    • Caspi, A., & Roberts, B. W.1999 (Eds.), L. A. Pervin, & O. P. John (Eds.), Handbook of personality: Theory and research (pp. 300–326). New York: Guilford Press.
    • Cook III, E. W., Melamed, B. G., Cuthbert, B. N., McNeil, D. W., & Lang, P. J. (1988). Emotional imagery and the differential diagnosis of anxiety.Journal of Consulting and Clinical Psychology, 56(5)734–740.
    • Cuthbert, B. N. (2002). Social anxiety disorder: Trends and translational research.Biological Psychiatry, 51, 4–10.
    • Demmink-Geertman, L., & Dejonckere, P. H. (2002). Nonorganic habitual dysphonia and autonomic dysfunction.Journal of Voice, 16(4)549–559.
    • Ding, R., Larson, C., Logemann, J., & Rademaker, A. (2002). Surface electromyographic and electroglottographic studies in normal subjects under two swallow conditions: Normal and during the Mendelsohn maneuver.Dysphagia, 17, 1–12.
    • Elias, A., Raven, R., Butcher, P., & Littlejohns, D. (1989). Speech therapy for psychogenic voice disorder: A survey of current practice and training.British Journal of Disorders of Communication, 24(1)61–76.
    • Fridlund, A. J., & Cacioppo, J. T. (1986). Guidelines for human electromyographic research.Psychophysiology, 23, 567–589.
    • Gerritsma, E. J. (1991). An investigation into some personality characteristics of patients with psychogenic aphonia and dysphonia.Folia Phoniatrica, 43(1)13–20.
    • Goldman, S. L., Hargrave, J., Hillman, R. E., Holmberg, E., & Gress, C. (1996). Stress, anxiety, somatic complaints, and voice use in women with vocal nodules: Preliminary findings.American Journal of Speech-Language Pathology, 5, 44–54.
    • Gray, J. A. (1991). The neuropsychology of temperament.In J. Strelau, & A. Angleitner (Eds.), Explorations in temperament: International perspectives on theory and measurement (pp. 105–128). New York: Plenum Press.
    • Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences.Psychophysiology, 39, 281–291.
    • House, A. O., & Andrews, H. B. (1988). Life events and difficulties preceding the onset of FD.Journal of Psychosomatic Research, 32(3)311–319.
    • Jacobson, B., Jacobson, A., Grywalski, C., Silbergleit, A., Jacobson, G., Benniger, M., & Newman, C. (1997). The Voice Handicap Index (VHI): Development and validation.American Journal of Speech-Language Pathology, 6, 66–70.
    • Kaufman, J. A., & Blalock, P. D. (1982). Classification and approach to patients with functional voice disorders.Annals of Otology, Rhinology & Layrngology, 91(4 Pt1), 372–377.
    • Kinzl, J., Biebl, W., & Rauchegger, H. (1988). Functional aphonia: Psychosomatic aspects of diagnosis and therapy.Folia Phoniatrica, 40, 131–137.
    • Lang, P. (1979). Bio-informational theory of emotional imagery.Psychophysiology, 16(6)495–512.
    • Leonard, R., & Kendall, K. (1999). Differentiation of spasmodic and psychogenic dysphonia with phonoscopic evaluation.Laryngoscope, 109(2 Pt1), 295–300.
    • Liebowitz, M. R. (1987). Social phobia.Modern Problems in Pharmacopsychiatry, 22, 141–173.
    • Matas, M. (1991). Psychogenic voice disorders: Literature review and case report.Canadian Journal of Psychiatry, 36, 363–365.
    • McGuigan, F. J., & Dollins, A. B. (1989). Patterns of covert speech behaviors and phonetic coding.Pavlovian Journal of Biological Science, 24(1)19–30.
    • McNeil, D. W., Vrana, S. R., Melamed, B. G., Cuthbert, B. N., & Lang, P. (1993). Emotional imagery in simple and social phobia: Fear versus anxiety.Journal of Abnormal Psychology, 102(2)212–225.
    • Mennin, D. S., Fresco, D. M., Heimberg, R. G., Schneier, F. R., Davies, S. O., & Liebowitz, M. R. (2002). Screening for social anxiety disorder in the clinical setting: Using the Liebowitz Social Anxiety Scale.Anxiety Disorders, 16, 661–73.
    • Milutinovic, Z. (1991). Inflammatory changes as a risk factor in the development of phonneurosis.Folia Phoniatrica, 43(4)177–80.
    • Morrison, M. D., & Rammage, L. A. (1993). Muscle-misuse voice disorders: Description and classification.Acta-Oto-Laryngologica, 113(3)428–434.
    • Patrick, C. F., Curtin, J. J., & Tellegen, A. (2002). Development and validation of a brief form of the Multidimensional Personality Questionnaire.Psychological Assessment, 14(2)150–163.
    • Roy, N. (2003). Functional dysphonia.Current Opinion in Otolaryngology & Head and Neck Surgery, 11, 144–148.
    • Roy, N., & Bless, D. M. (2000). Personality trait and psychological factors in voice pathology: A foundation for future research.Journal of Speech, Language, and Hearing Research, 43(3)737–748.
    • Roy, N., Bless, D. M., & Heisey, D. (2000a). Personality and voice disorders: A superfactor trait analysis.Journal of Speech, Language, and Hearing Research, 43(3)749–768.
    • Roy, N., Bless, D. M., & Heisey, D. (2000b). Personality and voice disorders: A multitrait-multidisorder analysis.Journal of Voice, 14(4)521–548.
    • Roy, N., McGrory, J. J., Tasko, S. M., Bless, D. M., Heisey, D., & Ford, C. N. (1997). Psychological correlates of functional dysphonia: An investigation using the Minnesota Multiphasic Personality Inventory.Journal of Voice, 11(4)443–451.
    • Sama, A., Carding, P. N., Price, S., Kelly, P., & Wilson, J. A. (2001). The clinical features of functional dysphonia.Laryngoscope, 111(3)458–463.
    • Schalen, L., & Andersson, K. (1992). Differential diagnosis and treatment of psychogenic voice disorder.Clinical Otolaryngology and Allied Sciences, 17(3)225–230.
    • Schalen, L., Andersson, K., & Eliasson, I. (1992). Diagnosis of psychogenic dysphonia.Acta-Oto-Laryngologica, 492(Suppl.), 110–112.
    • Schultz, G. M., Varga, M., Jeffires, K., Ludlow, C. L., & Braun, A. R. (2005). Functional neuroanatomy of human vocalization: An H215 O PET study.Cerebral Cortex, 15(12)1835–1847.
    • Sheehan, P. W. (1967). A shortened form of Betts' Questionnaire Upon Mental Imagery.Journal of Clinical Psychology, 23, 380–389.
    • Spielberger, G. D., Gorusch, R. L., Lushene, R., Vagg, P., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory (Form Y, Self-Evaluation Questionnaire). Palo Alto, CA: Consulting Psychologists Press.
    • Stager, S. V., Bielamowicz, S. A., Regnell, J. R., Gupta, A., & Barkmeier, J. M. (2000). Supraglottic activity: Evidence of vocal hyperfunction or laryngeal articulation?.Journal of Speech, Language, and Hearing Research, 43(1)229–238.
    • Tellegen, A., & Waller, N. (in press). Exploring personality through test construction: Development of the Multidimensional Personality Questionnaire. Minneapolis: University of Minnesota Press.
    • Verdolini, K., Rosen, C. A., & Branski, R. C. (2006). American Speech-Language-Hearing Association Special Interest Division 3, Voice and Voice Disorders, Classification manual for voice disorders–I. Mahwah, NJ: Erlbaum.
    • Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety.Journal of Counseling and Clinical Psychology, 4, 448–457.
    • White, A., Ian, J. D., & Wilson, J. A. (1997). Psychiatric disturbances and personality traits in dysphonia patients.European Journal of Disorders of Communication, 32, 307–317.

    Additional Resources