Laryngeal manual therapy: a preliminary study to examine its treatment effects in the management of muscle tension dysphonia. Randomized controlled trial of vocal function exercises on muscle tension dysphonia in Vietnamese female teachers. Manual circumlaryngeal therapy for functional dysphonia: an evaluation of short- and long-term treatment outcomes. Evaluating the effectiveness and efficiency of voice therapy using transnasal flexible laryngoscopy: a randomized controlled trial. Intensive voice treatment in Parkinson disease: laryngostroboscopic findings. The Influence of Voice Volume, Pitch, and Speech Rate on Progressive Relaxation Training: Application of Methods from Speech Pathology and Audiology Therapeutic Interactive Voice Response for chronic pain reduction and relapse prevention An evaluation of a behavioural treatment approach to hearing impairment. Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial Behavioural hearing tactics: a controlled trial of a short treatment programme. Differentiation of adductor-type spasmodic dysphonia from muscle tension dysphonia by spectral analysis Cognitive behavioural therapy group work with voice hearers. Part 2. Use of portable digital media players increases patient motivation and practice in voice therapy. Efficacy of a behaviorally based voice therapy protocol for vocal nodules. Efficacy of the Accent Method of Voice Therapy The International Society for Traumatic Stress Studies New Guidelines for the Prevention and Treatment of Posttraumatic Stress Disorder: Methodology and Development Process. An evaluation of behavioral treatments for Tourette syndrome.
The objectives of this study were to determine appropriate acoustic and outcome measures for the evaluation of a method of laryngeal manual therapy ( LMT ) used in the treatment of patients with muscle tension dysphonia ( MTD ) . The effects of this technique were also investigated . The study was based on the hypotheses that the vertical position of the larynx in the vocal tract would lower , that the quality of the voice would normalize , and that a reduction in any vocal tract discomfort ( VTD ) would occur after LMT . This was a small , prospect i ve , repeated measures pilot study in which each member of the research team was " blinded " to all other stages of the study and during which all data were anonymized until the final stage of data analysis . Ten subjects presenting with MTD completed outcome measures and provided audiorecordings immediately before , immediately after , and 1 week after LMT . The Kay CSL 4150 was used for signal acquisition and for some acoustic measurements . Spectrographic evaluation was accomplished with Praat . A new perceptual , self-rating scale , the VTD scale , and a new proforma for use by the clinician for palpatory evaluation , were developed for the study . Relative average perturbation during connected speech was significantly reduced after LMT , indicating a reduction in abnormal vocal function . The severity and frequency of VTD was shown to have reduced after LMT . This pilot study showed positive evidence for LMT as a method of therapy in the treatment of hyperfunctional voice disorders . Its effects were shown to be measurable with both acoustical analysis and the VTD scale OBJECTIVE This study evaluated the treatment effects of vocal function exercises on muscle tension dysphonia ( MTD ) in tonal language speakers . DESIGN Single-blinded , r and omized , controlled , clinical trial . METHODS Forty female primary school teachers from Northern Vietnam , diagnosed with MTD , were r and omly allocated into a treatment group ( n = 22 ) , which used a full vocal exercise protocol ( FE ) ( modified for use with Vietnamese speakers ) , and a control group ( n = 18 ) which was treated with a partial vocal exercise protocol ( PE ) . The treatment duration was 4 weeks for both groups . MAIN OUTCOME MEASURES Acoustic and perceptual data were used as primary outcome measures . Acoustic parameters included frequency and amplitude perturbation , harmonics-to-noise ratio ( HNR ) , mean fundamental frequency of the broken and rising tones , and parameters representing pitch movement in the rising tone . Perceptual analyses were performed on pre- and posttreatment sample s of the sustained /a/ sound using anchor vocal sample s. Self-report data , collected via a posttreatment question naire , comprised the secondary outcome measure . RESULTS Significant changes in perturbation , HNR , and perceptual data were observed in the FE group but not in the PE group . The FE group showed increased size and speed of pitch change . Participants from both groups showed positive changes in some tonal parameters after treatment . However , the magnitude of change and the number of participants with positive changes were larger in the FE group . CONCLUSION The data showed that vocal function exercises may be a cost-effective treatment for MTD Manual circumlaryngeal therapy ( manual laryngeal musculoskeletal tension reduction ) was used to treat 25 consecutive functional dysphonia patients . Pre- and post-treatment audio recordings of connected speech and sustained vowel sample s were su bmi tted to auditory-perceptual and acoustical analysis to assess the immediate and long-term effects of a single treatment session . To complement audio recordings , subjects were interviewed in follow-up regarding the stability of treatment effects . Pre- and post-treatment comparisons demonstrated significant voice improvements . No significant differences were observed between post-treatment measures , suggesting that vocal gains were maintained . Interviews revealed 68 % of subjects reported occasional partial recurrences , typically less than 4 days in duration , which resolved spontaneously . These results replicate and extend previous research suggesting the utility of manual circumlaryngeal therapy for functional voice disorders Transnasal flexible laryngoscopy ( TFL ) is an examination of laryngeal anatomy and physiology using continuous light . TFL is being used increasingly by voice pathologists in treatment but with little scientific evidence to support it . The purpose of this study was to evaluate the effectiveness and efficiency of TFL as a therapeutic tool . The study used a prospect i ve r and omized controlled trial . Fifty dysphonic subjects were recruited and r and omly assigned to either a traditional treatment group or a TFL-assisted treatment group . The effectiveness of voice therapy in both treatment groups was measured with a package of voice outcome measures . Subjects in both treatment groups demonstrated statistically significant improvements after voice therapy ( perceptual auditory rating of voice quality measurement p < 0.01 ; instrumental electroglottographic measurement p < 0.01 ; patient question naire measurement p < 0.01 ) . The time taken to complete treatment in both groups was recorded . The average ( median ) time taken to complete voice therapy in the TFL-assisted treatment group was 2 hours less than in the traditional treatment group ( p < 0.01 ) . Voice therapy with TFL  as a therapy tool was effective and more efficient than traditional voice therapy As part of ongoing research to investigate and document the efficacy of intensive voice therapy to improve functional communication in patients with idiopathic Parkinson disease , 45 patients were enrolled in a controlled , r and omized , prospect i ve study . Pre- to posttreatment comparisons are presented here on 22 of those patients who underwent laryngeal imaging examination . Of the 22 patients , 13 patients received intensive therapy aim ed at increasing vocal and respiratory effort ( VR ) , whereas nine received intensive therapy aim ed at increasing respiratory effort ( R ) only . All patients had a pretreatment evaluation that included two ( but sometimes only one ) voice recordings and an  otolaryngologic examination with  laryngostroboscopy .  At the completion of 4 weeks of therapy ( 16 sessions ) , two voice recordings were made , and laryngostroboscopy was again performed . The pre- and posttherapy videolaryngostroboscopy tapes were then r and omized and rated by four judges . Raters ' findings were then compared with vocal intensity measured before and after therapy . The VR therapy group showed improvements on laryngostroboscopic variables : less glottal incompetence and no significant change in supraglottal hyperfunction after therapy . No differences were observed in the R-only group . The mean intensity increase in the VR therapy group was 12.5 dB , compared with a decrease of 1.9 dB in the R-only group . These findings suggest that in patients with Parkinson disease , intensive therapy focusing on phonatory effort improves adduction of the vocal folds as assessed by laryngostroboscopy . Differences in laryngeal function in these patients observed with fiberoptic laryngoscopy and rigid telescopic laryngoscopy are discussed Vocal characteristics of therapists , including voice volume , pitch and timbre of speech , and rate of speech have been hypothesized to facilitate the therapeutic process , particularly during procedures like progressive relaxation training ( PRT ) . Very little empirical work , however , has examined the relation between vocal characteristics and treatment process or outcome . The purpose of this study was to examine the role of vocal characteristics during a single session of PRT applying technological innovations devised for speech pathology and audiology setting s for evaluating therapist 's vocal characteristics . Forty-eight high anxious young adult women were r and omly assigned to one of four conditions for training : PRT with the recommended therapist voice ( RV ) that decreased in tone , volume , and rate across the session , PRT with conversational therapist voice during the session ( CV ) , a credible treatment control called systematic self-relaxation ( SR ) , or no treatment control ( NT ) . All subjects participated in a single PRT session during which heart rate , EMG , self-report measures of tension ( SRT ) and anxiety , and treatment credibility ratings were obtained . Results revealed significant reductions in SRT , self-reported anxiety , and heart rate for participants in all groups . Only the RV group displayed significant reductions in EMG when compared with the other three groups . Participants in the RV group also rated the therapist 's voice as “ more facilitating ” of relaxation when compared to the CV group . These results suggest that methods employed for evaluating the quality of vocal characteristics in speech and audiology clinics may be useful for evaluating the quality of therapist 's voice when conducting PRT & NA ; We developed Therapeutic Interactive Voice Response ( TIVR ) as an automated , telephone‐based tool for maintenance enhancement following group cognitive – behavioral therapy ( CBT ) for chronic pain . TIVR has four components : a daily self‐monitoring question naire , a didactic review of coping skills , pre‐recorded behavioral rehearsals of coping skills , and monthly personalized feedback messages from the CBT therapist based on a review of the patient ’s daily reports . The first three components are pre‐recorded and all four can be accessed remotely by patients via touch‐tone telephone on dem and . Following 11 weeks of group CBT , 51 subjects with chronic musculoskeletal pain were r and omized to one of two study groups . Twenty‐six subjects participated in 4 months of TIVR , while a control group of 25 subjects received st and ard care only . The TIVR group showed maximum improvement over baseline at the 8‐month follow‐up for seven of the eight outcome measures ; improvement was found to be significant for all outcomes ( p ⩽ .001 ) . Between‐group analysis of covariance ( ANCOVA ) revealed significantly greater improvement for the experimental group at both 4‐ and 8‐month follow‐ups for most of the outcomes . Results demonstrate that TIVR can be used to decrease pain , improve coping and decrease likelihood of relapse into pain behavior . Preliminary analysis of medication usage suggests that the superior outcome of the TIVR group was unlikely to be a consequence of differential medication use Twenty-four elderly hearing impaired Ss participated in an experimental treatment study and received either behavioural group treatment or served as untreated controls . The treatment package included applied relaxation , video self-modelling , exposure , information and various coping skills . Assessment s ( pre-post ) were conducted using a structured video-interview measuring coping behaviour . In order to evoke behavioural compensation small acoustic provocations were included in the interview . The edited videos were then rated blindly by two trained observers . Pre-post assessment s also included daily registered hearing problems on visual analogue scales and a question naire . Finally , a one month follow-up blind telephone interview was conducted . Results showed significant beneficial effects in favour of the treatment package and support the implementation of a behavioural approach in audiological rehabilitation research Group Person-Based Cognitive Therapy ( PBCT ) integrates cognitive therapy and mindfulness to target distinct sources of distress in psychosis . The present study presents data from the first r and omised controlled trial investigating group PBCT in people distressed by hearing voices . One-hundred and eight participants were r and omised to receive either group PBCT and Treatment As Usual ( TAU ) or TAU only . While there was no significant effect on the primary outcome , a measure of general psychological distress , results showed significant between-group post-intervention benefits in voice-related distress , perceived controllability of voices and recovery . Participants in the PBCT group reported significantly lower post-treatment levels of depression , with this effect maintained at six-month follow-up . Findings suggest PBCT delivered over 12 weeks effectively impacts key dimensions of the voice hearing experience , supports meaningful behaviour change , and has lasting effects on mood Nineteen elderly hearing impaired subjects participated in an experimental treatment study and received either behavioural hearing tactics or served as untreated controls . Treatment was supplied in the form of a self-help treatment manual supplied with telephone contacts during 4 consecutive weeks . The treatment manual included applied relaxation , communication strategies training , advice to relatives , information , and coping skills . Assessment s ( pre-post ) were conducted in a structured interview measuring coping behaviour . In order to evoke behavioural compensation small acoustic provocations were included in the interview . Pre-post assessment s also included question naires , daily registered hearing problems , and hours of daily hearing aid use . Results showed significant beneficial effects in favour of the treatment in terms of self-assessed problems and behaviour change Objectives To determine the utility of spectral analysis in the differentiation of adductor-type spasmodic dysphonia ( AdSD ) from muscle tension dysphonia ( MTD ) . Study Design Prospect i ve blinded study . Methods Forty-seven sample s of AdSD-connected speech spectrograms from 27 subjects and 17 sample s of MTD-connected speech spectrograms from 15 subjects were selected from clinical charts and de-identified . These spectrograms were review ed independently and blindly by two speech language pathologists experienced in spectrography . The speech language pathologists design ated the spectrogram as consistent with AdSD and MTD , and these design ations were compared with actual clinical diagnoses . Results The ability to differentiate AdSD from MTD with spectral analysis was 94 % for rater # 1 and 98 % for rater # 2 . No MTD subjects were incorrectly diagnosed as having SD ( 100 % specificity ) . Conclusions This study suggests that experienced speech language pathologists can distinguish AdSD from MTD with a high degree of sensitivity and specificity based on spectral analysis . Spectral analysis is especially useful in cases where perceptual analysis and clinical evaluation alone are insufficient This is the second of two papers that present a small , r and omized control trial of cognitive behavioural therapy ( CBT ) within a group setting for the treatment of  auditory hallucinations .  In the previous paper , a method was described for an eight-session CBT group .  Assessment s were undertaken measuring control , power , frequency , and symptoms of distress and anxiety on commencement and on completion of the group . This second paper details the experience of the group and reports on the outcomes of the assessment measures . The study concludes that group CBT was helpful in the treatment of auditory hallucinations OBJECTIVES /HYPOTHESES There are many documented barriers to successful adherence to voice therapy . However , methods for facilitating adherence are not well understood . The purpose of this study was to determine if patient adherence and motivation for practice could be improved by providing patients with practice support between sessions using mobile treatment videos . METHODS Thirteen voice therapy participants were provided with portable media players containing videos of voice exercises exemplified by their therapists and themselves . A r and omized crossover design of two conditions was used : ( 1 ) st and ard of care voice therapy where participants were provided with written homework descriptions ; and ( 2 ) video-enhanced voice therapy where participants received a portable digital media player with clinician and self-videos . The duration of each condition was 1 week . Self-report measures of practice frequency and aspects of motivation were obtained at the end of each session . RESULTS Practice of voice exercises was significantly greater in the video-enhanced voice therapy condition than in the st and ard of care " written " condition ( P<0.05 ) . Three aspects of participant motivation for practice -overall commitment to practice , importance of practice , and confidence in the ability to practice were also significantly greater after video-enhanced condition than after st and ard of care condition . CONCLUSION These results support the use of video examples and portable digital media players in voice therapy for individuals who are comfortable using such technology The aim of this study was to assess the effects on vocal function of voice therapy for vocal nodules . Perceptual and physiological progressive changes were examined during a strictly structured , behaviorally based voice therapy protocol in which 11 women with vocal nodules participated . R and omized audio recordings from pretherapy and from each of the therapy approaches ( vocal hygiene , respiration , direct facilitation , carryover ) were used for perceptual evaluations . Six speech- language pathologists rated ten voice quality parameters . Two evaluation procedures were performed and compared . Interlistener reliability was sufficiently high in both tests . Significant effects of therapy were found for decreased overall dysphonia , press , instability , gratings , roughness , vocal fry , and " scrape . " Nonsignificant group effects were found for breathiness , aphonic instances , and lack of sonority . No significant parameter changes occurred between baseline assessment and the completion of the initial ( vocal hygiene ) phase of therapy . Significant changes were found following the direct facilitation and respiration phases of therapy . Videostroboscopic evaluations made by two laryngologists showed that in no case were the nodules completely resolved . However , the nodules had decreased in size and edema was reduced after therapy for all clients , but one . Combined results suggest : ( 1 ) Alterations in vocal function were reflected in perceptual parameters , and ( 2 ) the voice therapy had a positive effect on voice quality , vocal status , and vocal function for the majority of the vocal nodule clients There is an increasing need for studies of efficacy of behavior readjustment therapy procedures in human communicative disorders . Legal , social , scientific and professional considerations point up the need for more careful documentation of the effects of treatment techniques used by phoniatricians and speech- language pathologists . This study is conducted in order to evaluate the efficacy of the accent method of voice therapy ( AM ) . The AM is one of the holistic approaches for behavior readjustment voice therapy . It tackles collectively and simultaneously the various parameters of voice such as pitch , loudness and timbre . The results of intervention utilizing the AM in this clinical trial are assessed in a relatively controlled setup . Patients with voice problems result ing from various etiologic vocal pathologies are distributed r and omly into two groups . Group 1 ( G1 ) is given the full aspect of the AM , that is , voice hygiene advice plus the accent exercises to correct the faulty vocal technique ( habit ) . Group 2 ( G2 ) receives only voice hygiene advice . The AM is administered in individual sessions 20 min each , twice a week , while the voice hygiene advice counseling is given once a week . The assessment of the vocal pathology is done following a diagnostic protocol utilizing subjective as well as quasi- objective measures of evaluation . The initial assessment presents the baseline ( pretest ) data for both groups . The follow-up evaluations are done at mid intervention ( mid-test ) , that is , 10 sessions for G1 and 5 sessions for G2 , and at the termination of intervention/therapy ( post-test ) . The difference in improvement between G1 and G2 at the end of the observation was generally significant in favor of G1 . There were significant improvements in G1 in certain items specific for the various etiologic categories . The improvement from pretest to mid-test to post-test values followed a linear tendency . The significance of the results is discussed and the conclusions are outlined and criticized Over the last two decades , treatment guidelines have become major aids in the delivery of evidence -based care and improvement of clinical outcomes . The International Society for Traumatic Stress Studies ( ISTSS ) produced the first guidelines for the prevention and treatment of posttraumatic stress disorder ( PTSD ) in 2000 and published its latest recommendations , along with position papers on complex PTSD ( CPTSD ) , in November 2018 . A rigorous methodology was developed and followed ; scoping questions were posed , systematic review s were undertaken , and 361 r and omized controlled trials were included according to the a priori agreed inclusion criteria . In total , 208 meta-analyses were conducted and used to generate 125 recommendations ( 101 for adults and 24 for children and adolescents ) for specific prevention and treatment interventions , using an agreed definition of clinical importance and recommendation setting algorithm . There were eight strong , eight st and ard , five low effect , 26 emerging evidence , and 78 insufficient evidence to recommend recommendations . The inclusion of separate scoping questions on treatments for complex presentations of PTSD was considered but decided against due to definitional issues and the virtual absence of studies specifically design ed to clearly answer possible scoping questions in this area . Narrative review s were undertaken and position papers prepared ( one for adults and one for children and adolescents ) to consider the current issues around CPTSD and make recommendations to facilitate further research . This paper describes the methodology and results of the ISTSS Guideline process and considers the interpretation and implementation of the recommendations The present study evaluated the effectiveness of self-monitoring , relaxation training and habit reversal in the treatment of 6 Tourette Syndrome ( TS ) subjects with multiple motor and vocal tics .  A counterbalanced design was employed and tic frequencies were measured in the clinic setting using videotapes taken through a one-way mirror . Tics were reduced by an average of 55 % with habit reversal , 44 % with self-monitoring , and 32 % with relaxation training and each behavioral procedure was the most effective treatment for at least one subject . All three treatment approaches may have some utility in the behavioral treatment of TS
Specific " active ingredients " for therapeutic change were not identified .
PURPOSE A systematic review of behavioural intervention for the treatment of adults with muscle tension voice disorders ( MTVD ) .