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Personality and coping with stress in patients suffering from functional dysphonia

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Abstract

The examination covers the personality of 20 functional dysphonics, 14 individuals suffering from organic voice disorders and a group of 20 control persons when exposed to stress and its working up. In examining the group of functional dysphonics a significant positive self-assessment regarding their personality with a clear tendency to restraint has become clear. In comparison with the control persons an intensified anxiety state in situations causing stress is the result. Thus the influence of life events has been shown to have an important effect on the etiopathogenesis of functional dysphonia.
... Surprisingly, there had only been five published studies using a comparative group design up until 1998 (Andersson & Schalen, 1998;Friedl, Friedrich, & Egger, 1990;Friedl, Friedrich, Egger, & Fitzek, 1993;House & Andrews, 1988;McHugh-Munier, Scherer, Lehmann, & Scherer, 1997), with one further study exploring this complex area published in the last year (Baker et al., 2006;Baker & Lane, in press). ...
... The anecdotal data from the early case reports suggests that women with FVD use a repressive coping style, especially in relation to negative emotions such as anger and fear. The meagre empirical data however are contradictory, indicating that women with FVD are inclined to report an anxious coping style, which means they are able to acknowledge their anxiety rather than repress it (Baker et al., 2006;Baker & Lane, in press;Friedl et al., 1990) whereas others report an emotion focussed coping style which shows a preference for controlling emotional reactions and implying processes such as repression or suppression of emotional reactions (McHugh-Munier et al., 1997). ...
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The primary objective of this discussion paper is to review the available evidence for the role of psychogenic and psychosocial factors in the development of functional voice disorders (FVD). Current theoretical models linking these factors to the aetiology of FVD and to vocal hyperfunction are then considered. Since there is a paucity of solid empirical evidence to date, general patterns of evidence derived from single case reports and case series are examined first, followed by those empirical studies using more sophisticated methodologies. The discussion is structured around a framework that includes the following psychosocial areas of enquiry: demographic profiles of individuals with FVD; stressful incidents preceding onset; personality traits; coping styles and psychiatric disorder. Current evidence and associated theoretical models suggest that cognitive, affective, neurophysiological and behavioural aspects culminate in the development of these complex voice disorders. The implications of these findings are discussed with respect to clinical practice and clinical training, with suggestions for future scientific research.
... Despite speculation about similar links between stressor-induced autonomic reactivity and musculoskeletal function in MTD, thus far data on this relation have been negative. No significant differences were found during acute laboratory-induced stress, not further defined, on skin conductance across patients with MTD, patients with organic voice disorders, and healthy controls (Freidl, Friedrich, & Egger, 1990) or on heart rate across participants with MTD, those with social anxiety, and healthy controls during emotional mental imagery (van Mersbergen et al., 2008). ...
... Despite the lack of group effects in autonomic measures in the foregoing studies, other studies have found significantly greater scores on various self-report measures of psychophysiological functioning in patients with MTD compared with control groups. Findings included greater perceived anxiety during stressor exposure (Freidl et al., 1990) or greater perceived vocal effort during mental imagery of an aversive speech condition (van Mersbergen et al., 2008) in this group. Patients with MTD also reported significantly more psychosomatic symptoms in general based on psychometric measures compared with healthy controls (Geertman & Dejonckere, 2002; Goldman, Hargrave, Hillman, Holmberg, & Gress, 1996; Millar, Deary, Wilson, & MacKenzie, 1999). ...
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Purpose: The purpose of the study was to determine whether persons who responded with high stressor-induced extralaryngeal muscle activity in a stress reactivity protocol differed from those with low muscle activity on measures of emotional and autonomic cardiovascular reactivity and personality. Method: Thirty-six vocally healthy women (18-35 years) were assigned to high and low extralaryngeal groups based on submental (SM) and infrahyoid (IH) surface electromyography (sEMG) recordings obtained during a stress reactivity protocol (high vs. low sEMGSM and sEMGIH, n = 18 per subgroup; Dietrich & Verdolini Abbott, 2012). Measures included assessments of basic fear and fear of public speaking, rumination, systolic blood pressure (SBP), and personality. Results: The high sEMGIH group reported significantly greater basic fear across experimental phases than did the low sEMGIH group (p = .036). However, the high sEMGSM and sEMGIH versus low sEMGSM and sEMGIH groups did not differ on fear of public speaking, rumination, or SBP across phases. Both high sEMGSM and sEMGIH groups were characterized by significantly lower scores on Extraversion (p < .001). Conclusion: In combination with the authors' previous findings (Dietrich & Verdolini Abbott, 2012), the present findings provided robust evidence that low Extraversion was linked to stressor-induced changes in extralaryngeal functioning and that perceived fear played a contributing role.
... Surprisingly, there had only been five published studies using a comparative group design up until 1998 (Andersson & Schalen, 1998;Friedl, Friedrich, & Egger, 1990;Friedl, Friedrich, Egger, & Fitzek, 1993;House & Andrews, 1988;McHugh-Munier, Scherer, Lehmann, & Scherer, 1997), with one further study exploring this complex area published in the last year (Baker et al., 2006;Baker & Lane, in press). ...
... The anecdotal data from the early case reports suggests that women with FVD use a repressive coping style, especially in relation to negative emotions such as anger and fear. The meagre empirical data however are contradictory, indicating that women with FVD are inclined to report an anxious coping style, which means they are able to acknowledge their anxiety rather than repress it (Baker et al., 2006;Baker & Lane, in press;Friedl et al., 1990) whereas others report an emotion focussed coping style which shows a preference for controlling emotional reactions and implying processes such as repression or suppression of emotional reactions (McHugh-Munier et al., 1997). ...
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In the lead article, Hersh (2010) draws attention to the significant phase of ending therapy for clients and in particular, for their therapists. Hersh highlights three main tensions that underpin this process: real versus ideal endings, making and breaking of the therapeutic relationship, and balancing of respect for client autonomy over considerations of caseload and resources. In this paper, I offer a commentary on the first two of these issues by drawing upon my experience as a speech-language pathologist/family therapist specializing in voice, and as an academic fostering the development of student clinicians. This is then linked to parallel discussions in the recent psychoanalytic and psychotherapy literature. I support Hersh's premise that the implicit processes and emotions associated with this final phase of therapy need to be made more explicit and suggest that this is more likely to occur when clinicians acknowledge that they too experience rewards and losses in the therapeutic relationship. I challenge the notion that any therapeutic relationship once established is ever entirely broken.
... Despite their methodological differences/inadequacies , these studies have identified a trend toward elevated levels of (a) anxiety, (b) somatic complaints , and (c) introversion in the FD population. Patients have been described as socially anxious, nonassertive, and with a tendency toward restraint (Friedl et al., 1990; Gerritsma, 1991). These researchers have not attempted to explicitly integrate their findings into a coherent theory of personality as a contributing factor for FD. ...
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It has been argued that personality, emotions, and psychological problems contribute to or are primary causes of voice disorders and that voice disorders in turn create psychological problems and personality effects. This article (a) briefly reviews the literature surrounding the role of psychological and personality processes in individuals with functional dysphonia (FD), vocal nodules (VN), and spasmodic dysphonia (SD); (b) provides an overview of recent concepts in personality and trait structure; and (c) summarizes the fundamental tenets of a theoretical synthesis proposed by Roy and Bless (2000) to explain the disposi-tional bases of FD and VN. This theory links FD and VN to the signal sensitivities and behavioral response biases of neurotic introverts and neurotic extraverts, respectively. In a companion article, the merits of the Roy and Bless theory are evaluated.
... Despite their methodological differences/inadequacies , these studies have identified a trend toward elevated levels of (a) anxiety, (b) somatic complaints , and (c) introversion in the FD population. Patients have been described as socially anxious, nonassertive, and with a tendency toward restraint (Friedl et al., 1990; Gerritsma, 1991). These researchers have not attempted to explicitly integrate their findings into a coherent theory of personality as a contributing factor for FD. ...
Article
It has been argued that personality, emotions, and psychological problems contribute to or are primary causes of voice disorders and that voice disorders in turn create psychological problems and personality effects. This article (a) briefly reviews the literature surrounding the role of psychological and personality processes in individuals with functional dysphonia (FD), vocal nodules (VN), and spasmodic dysphonia (SD); (b) provides an overview of recent concepts in personality and trait structure; and (c) summarizes the fundamental tenets of a theoretical synthesis proposed by Roy and Bless (2000) to explain the disposi-tional bases of FD and VN. This theory links FD and VN to the signal sensitivities and behavioral response biases of neurotic introverts and neurotic extraverts, respectively. In a companion article, the merits of the Roy and Bless theory are evaluated.
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Purpose Laboratory stressors have been shown to impact the activity of the intrinsic laryngeal muscles (ILMs), which may be part of the final causal pathway in some stress-induced voice disorders. Previous research suggests that personality traits such as stress reaction might increase one's susceptibility to these problems. Also, the autonomic nervous system response is implicated in the pathogenesis of voice disorders putatively involving ILM hyperfunction. The purpose of this study was to investigate personality and autonomic nervous system predictors of ILM responses to stressor exposure. Method Thirty-seven physically and vocally healthy female adults completed a personality questionnaire and were subjected to a speech preparation task intended to induce stress. Fine wire electromyography of the ILMs was performed so that the activity of these muscles could be measured prior to and during the stressor. Participants' trait stress reaction was measured as a personality-based predictive variable, as was respiratory-corrected respiratory sinus arrhythmia, a putative measure of vagal outflow to the heart. Results The personality measure trait stress reaction uniquely predicted thyroarytenoid, trapezius, and tibialis activity, whereas respiratory sinus arrhythmia uniquely predicted the activity of all muscles studied. Differences were observed in the autonomic predictor variable as a function of whether or not effects of respiration were accounted for in the variable's calculation. Conclusions This study explores the potential mediating roles of personality and autonomic function in ILM activity during a stressor. Both variables have value in predicting ILM activity during stressor exposure.
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The etiopathogenesis of functional dysphonia is complex; it is not sufficient to look solely at vocal behavior aspects. The predisposing basis for functional dysphonia can lie in the constitution of an individual, his/her professional speaking and speech behavior and/or may be personality-based. (Prolonged) psychosocial stress, vocal overstressing, unfavorable speaking habits, infection of the upper respiratory tract, inflammatory processes in the larynx, emotional life events and COSO events are considered as possible triggers. The interaction of predisposed and causal factors is unknown. Stress, overall fatigue, anxiety, depression and/or certain personality traits (which complicate or hamper coping) are considered as perpetuating factors. In any case, overlaps between voice symptoms and reactive psychic as well as social problems have to be kept in mind (e. g. the burden of suffering, depressive processing, speaking anxiety, socially withdrawal). Because the association of multiple psychosocial factors with functional dysphonia is not distinct - such are always existent in organ medically unexplained symptoms - functional dysphonia has to be diagnostically differentiated. For the purpose of the article, a psycho-diagnostic path following the ICD-10 chapter V along general lines is presented. Until now, it is unknown which psychosocial factors discriminate a psychogenic dysphonia from muscle tension dysphonia. © Georg Thieme Verlag KG Stuttgart · New York.
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Stress reaction provokes changes in the body involving cardiovascular alterations, autonomic reactions, neuroendocrine and immunologic as well as psychoneuroimmunologic changes. Both the primary and secondary effect of stress reaction may be of consequence for vocal function. The purpose of this questionnaire study was to determine the effect of stress symptoms on the occurrence of vocal symptoms. The study also aimed at investigating whether a possible effect was different for men and women. A total number of 1728 participants completed a questionnaire concerning speech, language, and voice. Six vocal symptoms and four possible stress symptoms were included in the questionnaire. There was a significant association between stress symptoms and the occurrence of vocal symptoms. The occurrence of muscle tension or a lump in the throat was significant regarding all the four possible stress symptoms. There were also significant results concerning gender difference. All vocal symptoms and two of four stress symptoms were more common among women. Physical changes caused by the stress reaction may result in vocal symptoms as those presented in the study. Both vocal symptoms and stress symptoms were more common among women. Stress should preferably be acknowledged as a risk factor containing and possibly entailing a number of physiological, psychological, and behavioral symptoms affecting the voice negatively.
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