Functional Dysphonia: Compared with Healthy Controls. âvocal effort for all scripts. âEMG activity for all scripts except positive. âheart rate postive > aversive.
Functional Dysphonia During Mental Imagery: Exploring the Sources of Anxiety Miriam R. van Mersbergen, Christopher J. Patrick, Edward M. Bernat, & Stephen D. Benning University of Minnesota, Twin Cities
Introduction Psychometric Measures
Functional Dyphonia
(Arnold, 1962; Aronson et al., 1966; Gerritsma, 1991; Roy et al., 2000a, 2000b)
MPQ PEM MPQ NEM BDI STAI LSAS social fear LSAS social avoidance Voice Handicap Index
Methods
Valence
N = 12
Social Anxiety
N = 23
Measures:
N = 19
4.5
4.0
Group
3.5
FD
3.0 nonverbal
Self-Report
Personality
•Vocal Effort •SAM Valence •SAM Arousal
•MPQ •BDI •LSAS •STAI •VHI •QMI
SA speech
2.0
nonverbal
SA speech
1.0
.8 .6 .4
Group FD
-.2
nonverbal
neutral
HC SA speech
l
ng sa ro u
ati
nonverbal
od
tio n xa 20s
Light gold shading = physiological data taken here Script in maroon = eyes closed auditory prompt from ear phones Script in gold = eyes open visual prompt from screen
tone = cue to open eyes tone = cue to close eyes
neutral
.8 .6 .4 .2 -.0
Group
-.2
FD
-.4
HC
-.6
nonverbal
neutral
Script Type
Heart Rate 6
FD
3
2
aversive
neutral
SA positive
SA speech
.2
0.0
Group FD
-.2
HC
SA speech
-.4
2.0
neutral
1.0
neutral
SA positive
Functional Dysphonia:
neutral
1.0
Group
0.0
FD
-.5
HC
-1.0
SA
aversive
neutral
positve
Script Type
FD HC SA speech
Submental Complex
Thyrohyoid .8
.6
.4
.2
Group 0.0
FD HC
-.2
neutral
Script Type
SA speech
.6 .4 .2 -.0
Group FD
-.4
HC SA
-.6
aversive
neutral
Script Type
6
Demonstrate normal self-report of affect & arousal fir affective scripts Demonstrate expected autonomic activity for affective scripts Demonstrate reduced behavioral activity in muscles of communication in muscled of facial expression Cause of dysphonia due to behavioral constraint ?
positive
1.2 1.0 .8 .6 .4 .2
Group
0.0
FD
-.2 -.4
aversive
neutral
HC SA positive
Script Type
5 4
Social Anxiety
Demonstrate exaggerated facial expressive activity Demonstrate expected autonomic activity for affective scripts Demonstrate affective modulation of muscles of communication
3 2
References
Group
1
FD
0
HC SA
-1
neutral
novel findings in italics
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.
positive
Thyrohyoid
Script Type
.8
-.2
Heart Rate
aversive
1.0
Conclusions
HC aversive
novel findings in italics self-report finding in gold physio findings in maroon
Script Type
1.5
.5
vocal effort for all scripts EMG activity for all scripts except positive heart rate postive > aversive speech > nonverbal
FD
.5
positive
2.0
Group
nonverbal
HC SA
2.5
2
neutral
2.5
Group
Zygomaticus
3
nonverbal
FD
1.5
Script Type
4
-1
Group
3.0
3.0
Script Type
0
3.5
aversive
Compared with Healthy Controls
2.0
Corrugator
.4
nonverbal
4.0
aversive mood for all scripts vocal effort for all scripts EMG activity for all scripts heart rate aversive > postive speech > nonverbal
Functional Dysphonia:
Affective Condition
.6
5
1
Compared with Healthy Controls
2.5
4.5
Script Type
.8
Script Type
Submental Complex Mean submental activity from baseline (mV)
~ 20s
Re la
al
eff
t, m
ep or o
,a
rt o R
Al ou
Se vo lf c -R
din g Re a ~10s
Group
HC
SA speech
.5
Mean thyrohyoid activity from baseline (mV)
.2
0.0
d
ry ag e Im tal Me n 20s
4
Zygomatticus
1.0
4 scripts
on
tone ton e
FD
5
Script Type
1.2
Speech
4 scripts 4 scripts 4 scripts 4 scripts
tat i rip Sc
Group
Corrugator
NEUTRAL
Social Anxiety:
3.0
5.0
6
HC
Mean zygomaticus activity from baseline (mV)
Nonverbal Communication
en re s tP
ne
neutral
corrugator for aversive scrips zygomaticus for positive scripts submental & thyrohyoid for communication scripts heart rate for affective and communication scripts
Vocal Effort
5.5
Physiological Data Communication Condition
Procedures:
~ 50s
1.5
Script Type
Script Type
tone
2.0
HC
Mean heart rate activity from baseline (bpm)
between participants
eli
FD
Script Type
Mean corrugator activity from baseline (mV)
VALENCE
within participants
Positive Aversive
COMMUNCATION
prevalidated recorded auditorily presented counterbalanced
Ba s
Group
3.0
2.5
During-Mood-Induction
Stimuli/Scripts: 20 scripts
neutral
7
5.0
4.0
Arousal
Valence
3.0
HC
Physiological •Heart Rate •EMG - corrgator •EMG - zygomaticus •EMG - submental complex •EMG - thyrohyoid
10s
Mean SAM Arousal Score
Healthy Control
Mean SAM Valence Score
Functional Dsyphonia
5.5
5.0
Participants:
Vocal Effort
Arousal
Mean Borg CR-10 Score
Post-Mood-Induction
Physiological Data
Affective Condition
Communication Condition
Mean zygomaticus activity from baseline (mV)
Self-Rating Data
aversive & arousal for aversive scripts postive & arousal for positive scripts vocal effort for aversive scripts
1- nominal finding
Mean Borg CR-10 Score
Determine nature of anxiety in Functional Dysphonia by employing mental imagery and psychophysiological measures
Mean thyrohyoid activity from baseline (mV)
(Cook et al., 1988; Mc Neil et al., 1993; Cuthbert, et al., 2003)
-----------------------------
------------ ----
Mean SAM Arousal Score
During mental imagery physiological reactions differ depending on type of anxiety
Social Anxiety
Mean heart rate activity from baseline (bpm)
Anxiety:
Heathy Control
1
Mean SAM Valence Score
anxiety measured with psychometric inventories nature and cause of anxiety remains unknown
Paradigm Validation: Self-Report Ratings
Pre-Mood-Induction
Mean corrugator activity from baseline (mV)
Voice disorder with no organic cause but marked muscle tension in voicing Anxiety strongly implicated as a cause
Results
Mean submental activity from baseline (mV)
Functional Dysphonia:
Purpose of Study:
Summary
Now at the University of California San Francisco
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.
.8
Cook III, E. W., Melamed, B. G., Cuthbert, B. N., Mc Neil, D. W., & Lang, P. J. (1988). Emotional imagery and the differential diagnosis of anxiety. Journal of Consulting and Clinical Psychology .6
56(5), 734-740. Cuthbert, B. N., Lang, P. J., Strauss, C., Drobes, D., Patrick, C. J., & Bradley, M. M. (2003). The psychophysiology of anxiety disorder: Fear memory imagery. Psychophysiology 40, 407-422.
.4
Gerritsma, E. J. (1991). An investigation into some personality characteristics of patients with psychogenic aphonia and dysphonia. Folia Phoniatrica 43(1), 13-20.
.2
Group 0.0
FD HC
-.2
aversive
neutral
Script Type
SA positive
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. 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), 749-68. Roy, N., Bless, D. M., & Heisey, D. (2000b). Personality and voice disorders: a multitrait-multidisorder analysis. Journal of Voice 14(4), 521-48.
