If the eyes are the mirror of the human soul, then the voice is the barometer of human emotion

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Voice of Emotion

The Speech-Language Pathologist’s Role in Managing Stress Related Voice Disorders

If the eyes are the mirror of the human soul, then the voice is the barometer of human emotion. Voice is the melody of speech. It reflects our deepest feelings and intentions, and permits us to glimpse at the state of our emotional lives. We may be unaware of our emotional reactions to stress, but our voices are constantly vigilant. They respond to the stresses and strains of life on a minute-to-minute basis.

For some people, stress can actually cause physical changes in the voice that can lead to damage. About 7% of the adult population are susceptible to the ravages of vocal tension, and may need professional help to recognize what they are doing to hurt their voices. Speech-language pathologists are experts in this form of stress intervention.

John (fictitious name) was an energetic, 35 year old teacher and single father of three young boys. He had experienced chronic hoarseness over a three-month period of time. It appeared to be getting worse. An ear nose and throat doctor diagnosed vocal nodules (i.e. calluses) and recommended a speech-language pathology referral. By the time I saw John, he could not work, had great difficulty in managing his sons’ behaviour at home and was becoming increasingly frustrated and exhausted.

An assessment indicated that John was demonstrating hyper functional voice patterns, characterized by excessive tension in the shoulder and throat muscles, inefficient breathing, abusive vocal habits (e.g. whispering and throat clearing) and abrupt voice initiation patterns that aggravated the vocal dysfunction. Treatment consisted of education about the mechanics of laryngeal function, and instruction and practice on how to achieve a more relaxed and efficient voice. John learned to identify and eliminate abusive voice habits, relax, breath more efficiently and use "easy voicing" patterns to initiate speech. Treatment also included discussion of healthy life style choices (e.g. the importance of eating properly, exercising and handling day to day stressors more effectively).

Susan was referred because of a peculiar, sudden loss of voice. She was a 25-year-old legal student, who began to experience hoarseness with the onset of an upper respiratory infection. The cold resolved after a week, but the voice problem did not. Doctors could find no lesions or damage of any kind on the vocal chords. In fact, Susan had been to several specialists over a two-year period and no one could help her regain her voice. When I met Susan, she spoke in a faint whisper and was in great distress.

Assessment results suggested a conversion aphonia. Susan initially lost her voice on the anniversary date of her twin sister’s death. Her sister had been killed suddenly in a car crash two years prior.

Conversion voice disorders, like other conversion disorders, can result from severe stress. An individual develops the voice disorder as an avoidance reaction to counteract the trauma that they are having difficulty facing. The disorder permits the individual to avoid awareness of emotional pain, and is completely subconscious. In Susan’s case, the voice problem delayed and distracted her from facing the pain associated with losing her twin sister.

In treatment, Susan was able to regain her voice quickly. Initially, this was through non-speech activities that prevented the triggering of old avoidance behaviours. Using a calm and supportive approach, Susan could phonate again after two sessions, and went on to pursue counseling services with a psychologist. Follow up counseling helped Susan to explore many unspoken issues, and is often indicated after speech-language therapy for a conversion voice disorder.

Both of these examples demonstrate how effective the voice is at helping us hear the stress that accompanies our hurried life styles. Like barometers that measure changes in atmospheric pressure and signal foreboding weather conditions, the human voice can be a signal for increasing pressure levels in life and a signal for danger up ahead.

Speech-language pathologists can be important allies in the battle against stress induced voice disorders. Services are available through local hospitals, schools, treatment centers, university speech and language training programs and private clinics such as London Speech and Language Centre.

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London Speech and Language Centre
1589 Fanshawe Park Road East
London ON N5X 3Z9

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