Stress – worries – trauma – upsets – anxiety, these are all words we use to describe a huge range of emotions we will feel at times throughout our lives. Humans are good at dealing with difficulties, we have a well-adjusted sympathetic nervous system to adapt our minds and bodies to cope with a crisis. We are less able to manage with ongoing stressors, repeated upsets and situations that trigger memories of these.

What is going on in our bodies?

In a high-stress situation we will go into what is known as a fight-flight-freeze response. If we are going through a longer-term challenge, which may be at a lower level of immediate danger, but is nonetheless affecting us, our nervous system will be in a state of ongoing alert. We will be subconsciously preparing for some sort of fight-flight-freeze, so our bodies will be holding or guarding in anticipation. This system of nerves is also linked to specific responses in the body; if you are nervous, you may experience:

• Increased muscle holding/guarding responses
• Increased heart and breathing rates, a sense of being ‘on alert’
• Shaky knees or hands
• Dryness in the mouth or throat

If the worries go on for longer, you may get used to them and not notice these responses. However, your body will still be coping and may go on to develop these symptoms:

• Gut responses: (e.g. acid reflux and irritable bowel syndrome)
• Skin irritations: (e.g. eczema / psoriasis)
• Back, neck or other muscle discomfort (including laryngeal ache or discomfort)
• Breathing challenges: (e.g. breath holding or over-breathing panic responses)

Emotions are experienced in our bodies as well as our minds – so what’s the link with the larynx?

Your desire to communicate, and your need to call out or cry, are strongly linked to your emotional state. The nerves supplying your larynx are part of the same system that responds to your sympathetic nervous response. This link is important so you can signal to people around you what you are feeling. If you are experiencing voice-related symptoms that don’t have an obvious cause, these symptoms are real but may not necessarily be related to infection, physical abnormality or disease, and many of them can directly affect your voice. If your voice loss or discomfort is primarily from emotional distress it can be called a ‘psychogenic’ or ‘functional’ voice disorder. While most people with functional dysphonia are aware they are stressed, others may not have made the connection, in which case the diagnosis may come as a surprise. You may even have been told that there is nothing wrong with your larynx, and yet you are still experiencing vocal difficulties.

Who should I go to for help?

Ear Nose and Throat (ENT) surgeon: you need to check that there is nothing that is physically causing your voice problem, this will be from a referral through your GP to an ENT or Joint Voice Clinic. Your GP can also diagnose and treat any other contributing medical conditions.

Specialist Voice Rehabilitation: Working with an expert rehabilitation specialist who is trained and qualified in coaching or counselling skills. This may be a Speech and Language Therapist or a Singing Voice Rehabilitation Specialist. They can help the patient uncover the underlying emotional causes of the voice problem and link these to the timeline of voice issues. They can also improve or resolve the voice problem using specialist voice therapy techniques, which, in turn, can reduce the emotional load.

Counselling/Psychotherapy: Sometimes the emotional aspects need professional help from a Counsellor, Psychologist or Psychotherapist. There are many different psychological approaches available. This may be available on the NHS through your GP, or by contacting the ‘Improving Access to Psychological Therapies’ (IAPT) scheme. Private therapists can be found via the British Association of Counselling and Psychotherapy (BACP).

Manual Therapy/Laryngeal Massage: Muscle tension in and around the larynx can sometimes be difficult to resolve with voice therapy alone. In these cases, laryngeal massage/ manipulation can be useful. Some SLTs and Singing Voice Rehabilitation specialists are trained in these techniques, or they can be carried out by a Physiotherapist, Osteopath or Massage Therapist who specialises in voice disorders.

Medication: Very occasionally psychogenic voice disorders fail to respond to speech therapy alone. There may be associated depression or some other psychological disorder that would respond better to medication. In this case, your GP will either help you find the most suitable medication or will refer you on to a psychiatrist for further assessment and help.

If your voice disorder is stress related it can be really helpful to work out the links between your emotional life and your voice. The voice issue is often just your body’s way of letting you know there is a problem you need to attend to. As you think back over what may have been contributing to the situation, you can begin to make links with past events, situations, or things that have been said to you. It helps to work out the story, understand the subconscious patterns at the root of it all and then you are more able to move on. The more we can learn about the mind/body interaction the better we understand how the mind can affect our health.