Let’s talk about the throat and its ability to respond to childhood trauma!
This is the summary version of the episode for conceptual takers. For the full research details check the links below or patreon!
And either way please note that there’s a brand-new option!
For the EXTRA fuckin geeks… this week there’s another version with results, limitations, and extended methods included. Also linked below. Maybe we do this forever, maybe not. But you want to talk research? Ohhhh, we’ll fucking talk research.
And we’ll do so, today, as we explore the paper I told you to hold out for:
Investigating Past Trauma in Laryngoresponders Versus Non- Laryngoresponders: Piloting New Methods in an Exploratory Study
*Diana Rose Becker, †Brett Welch, ‡Elisa Monti, §Harmony Sullivan, and †Leah B. Helou, *
Journal of Voice
2022
Let’s begin with the introduction.
We know by now, hopefully, if you’ve been here for more than a few minutes, that the body responds to stress in undiagnosable and debilitating ways. What we might not know is stress counts as anything that offsets balance mentally, physically, and emotionally – and the three are related. A single dose of stress can be significant, but regularly or chronically repeated stress RESPONSES establish a basis for lasting diseases, dysfunctions, and pathologies. We make a point to say stress RESPONSES, because the original stress doesn’t have to be present – the brain or body may continue to react as though it is. Common provokers are early childhood traumas, depression, and anxiety; common outcomes include digestive disorders like IBS.
We know that stress, trauma, abuse, and mistreatment lead to somatic impairments – potentially with significant delay. What we don’t know is why some biological systems are affected instead of others, and why this is seen variably between individuals.
One area of trauma-inspired disfunction is thought to be the throat; specifically, the larynx, which takes care of speaking and swallowing. Muscle tension dysphonia (as we’ve heard before) is anecdotally connected to stress load and has the outcome of losing the ability to speak. It’s characterized by excessive, abnormal tension in the muscles around the larynx (voice box). It causes the vocal cords to overexert and work inefficiently, resulting in a strained, hoarse, or weak voice, vocal fatigue, and throat pain or tightness.
Though the link between imbalance and voice loss (or any other functional disorder) isn’t currently understood, there’s some common wisdom that somatic ailments are somehow symbolic or “awfully coincidental” presentations of prior experience. For instance, not being able to stand up for oneself could manifest in back issues, or, in this case, not being able to speak for self-protection during a stressful event could lead to later voice impairment. Psychosomatic illness could be metaphorical or directly representative of traumatic events.
Another theory is that the most at-risk part of the body will accept the dysfunction caused by the stress. If the voice or throat is already compromised, it could acquire the burden of the trauma.
And lastly, there is the possibility that particular personality plus situational factors simply causes some people to experience voice and throat responses while others do not.
In light of these unknowns and observations, researchers began referring to those affected as “larynoresponders” – individuals who, for unknown reasons, experience distress alongside changes in the throat, causing voice or sensational disorders. Some folks report pain or vocal alterations during or after upset; others do not. What is the difference between the two?
The diverse nature of the stress experience is probably part of it. Stress, itself, isn’t a determinedly negative thing, though it is marked by tension and it comes with change. Some stressful events are positive, like new jobs, marriage, having children. Others are traumatic – meaning they cause a degree of pain, suffering, and functional compromise. Major life events, social changes, disasters and accidents are some examples of long-lasting stressors that alter thought, emotional, and living patterns. Even after the events conclude, the imbalance they caused can live in the body, like long-term echoes. This is confusing to medical science due to the individual nature of physical disorders. In terms of laryngoresponders, the connection between past trauma and vocal defect seems clear for some, but it hasn’t been well investigated or documented.
For these authors, this throaty response is the focus. By identifying those affected in the population, they say, somatic disorders could be more efficiently studied. Rather than sending those afflicted to voice pathologists, they might visit psychotherapists. And rather than studying myriad somatic ailments in general populations hoping for clear connections between dissimilar biological systems, throat responders might be separated from, say, those who are gut or headache impaired by stress.
These points are the motivations behind this study, where childhood trauma and neglect were compared against biological stress responses of the present. The purpose was to improve identification of throat responders, understand differences in the traumatic histories between laryngoresponders vs nonlaryngoresponders, and better understand how communication of prior trauma may be implicated in vocal dysfunction. In other words, if disclosure and support weren’t available, could this contribute to later vocal box impairment?
And how did they begin to address these questions?
METHODS
Here’s the thing. The authors didn’t have tools to do this investigation. So, they made some.
First, the Physical Report Form (PRF). This was a “show me where trauma has touched you” tool using a genderless mannequin split into six planes where participants marked the areas most affected by pain. They were given paper copies of the diagram and used colored pencils for expression of these responses.
Secondly, the Ideal Internal and External Communication Question tool was developed to qualify the “ideal” communication circumstances post-trauma. In other words, did the individual receive compassion and support? Were they able to disclose safely? Previous tools we’ve heard about (the Childhood Trauma Questionnaire, for instance) do not include questions about this post-traumatic experience, which the authors note, may explain differences in long-term stress responses. Since they are examining the effects of trauma on the throat, unwelcome, stressful, or punitive communication about childhood trauma is of utmost concern. Thus, they developed this unique questionnaire (the Ideal Internal and External Communication Questionnaire) known as the IECQ for short.
The IECQ specifically examines how individuals communicated with themselves post-trauma. If they addressed their experience compassionately and emotionally to themselves. And it also explores communicating outwardly about the events – how were their words received? These questions were answered via a simple scale, where participants marked how ideal each experience was along a 100mm line. For later data analysis, this scale was broken into categories of low, medium, and high idealness.
Participants were cisgender women from 19 to 65 years old who responded to flyers in the Pittsburgh area. This demographic reflects the population most likely to have voice disorders, per vocal pathology clinics. A number of health conditions ruled out some participants for the study – anything easily diagnosable like asthma, respiratory disorder, pregnancy that could affect the throat was reason for exclusion from the study to maintain the focus on unclear somatic disorders.
This research was conducted in a University laboratory space where they completed questionnaires and were given the option to opt-out of the study when the trauma-related probes began.
In addition to the tools already discussed, they answered the Childhood Trauma Questionnaire Short Form, which was further used to create a score of Adverse Childhood Experiences. They also responded to the Trauma History Questionnaire and Dissociative Experiences Scale.
This is where we talk about results for the super nerds. And they’re fascinating – really go beyond the intention of the study and give you some extra things to think about, if you’re into that sort of thing.
For instance, let me share, as a self-validated asshole, this line, with everyone:
The following regions had more participant responses than the vulnerable system of interest (ie, the larynx): abdomen and digestive system (83%), back neck (72%), shoulder (69%), chest and respiratory (69%), and the head (59%).
4/5 participants reported what? Abdominal responses to trauma. Trauma affects and weakens the guts. Contributing, perhaps, to vocalization and walking gait issues that we’ve been speaking about.
Anyways, for the rest of the most impactful results, check those links below.
Nerds, stay tuned and here we go, bravely, into the findings details!
Otherwise, let’s continue with our:
DISCUSSION
From this and other studies, as we’ve briefly covered here, the throat with it’s vocal capabilities might be vulnerable to stress load and/or associated trauma for some. These authors intended to find out why some traumas might have this effect, and why some individuals might have this particular biological response.
While it’s more common for other areas to be afflicted by stress and phantom stress responses, including the abdomen, chest, neck, back, shoulders, heart, lungs, and head – reactions that we commonly accept as signals of anxiety or strain – about one in five participants of this study identified that the larynx, not the back of the neck, could be afflicted by stress in a consistent manner (not a one-off or uncommon experience that might only be coincidentally correlated with a stress event).
Those LRs self-reported nearly three-quarters more experienced and severe trauma than NLRs, and they experienced both more ACEs and more traumatic events in every category. This validates the idea that long-past personal history might cause disorder of the throat and voice.
Most significantly, though, emotional neglect was most commonly indicated by LRs (83% compared to 43% of NLRs). We can never make definitive statements from one single study, and it is possible that emotional neglect could cause personal characteristics such as shyness that explain the vocal difficulties. And yet, it is also possible that with future research the connection between trauma, inability to successfully discuss the trauma, and later physiological disorder of the vocal region could be confirmed.
Based on the lackluster scores in ideal communication after a trauma, it appears that LRs fail to show up for themselves (51% ideal communication) and others fail to show up for them (a similar 45/100 for ideal communication). Whereas NLRs experienced far more supportive communication (roughly 75% for both self- and other-communication experiences). The authors’ findings implicate childhood emotional neglect as a causative factor that could decrease easeful or effective communication down the road and further validate the results as being cohesive with clinical observations.
They say:
For example, it is not uncommon for a patient who presents with a functional voice disorder to disclose that they are sometimes known to limit their verbal communication at a general level, to hold in their verbal acknowledgement of emotional state, or to engage in ostensibly inhibitory behaviors such as breath-holding and laryngeal muscular hyperfunction.
Although this study didn’t include measures of physiological responses in real time, but rather relied on self-reports about previous experiences, the research suggests that post-traumatic behavioral patterns could be established during early childhood neglect and other ACEs which carry through into adulthood, including learning to somatically inhibit communication attempts.
And with that, let’s hit the:
CONCLUSION
Preliminary findings from this study suggest that the oftcited voice-trauma link warrants future investigations with further refined tools. In particular, experiences of emotional abuse and neglect in LR seem worthy of further exploration.
From this research it seems not only logical and anecdotal, but perhaps also statistically validated; trauma affects the ability to communicate. The isolative environment and difficulty explaining distressing emotional events that are common in the traumatic aftermath – or, even worse, dismissal and punishment for disclosure - could teach the body not to allow communication to take place.
One doesn’t have to try hard to imagine that emotional neglect corresponds with an environment of difficult or lacking communication. Something that could be further evidenced by the LRs reported dissatisfaction in how they communicated with themselves after a trauma; we learn how to talk to ourselves based on how others speak to us. This result suggests that in the childhood home, the individual has already been conditioned to avoid self-disclosure, self-comfort, and self-compassion at the time that adverse events take place. They cannot turn to themselves for support, and the same result is obtained if attempting to discuss the happenings with others. This further concretizes the learned behavior of not speaking ideally to themselves. In general, when it comes to care, if we don’t receive it outwardly, we fail to give it to ourselves inwardly, and both experiences support each other to create a sense of correctness. In this way we believe that it’s our lot in life or unique role to be silent, destitute, unexpressed and unheard. Even within ourselves.
This behavioral pattern may stretch all the way into the physical realm; physiologically disabling or diminishing vocal capacity at the point of the larynx.
One might suggest the antidote is to begin ideal self-communication, to break the cycle of silence psychologically and physiologically.
And with that…
Get out of here! I’ll talk to you next week!
Or continue on to the Limitations and future directions of the study in the supergeek version of the episode.
Thank you for being here.
Please don’t stop expressing yourself or stopping yourself from expressing to yourself.
Do mind all the various systems that could be impacted by stress or artifactual stress responses from the past.
And I’ll talk to you, larynx permitting, real soon.