Im All Choked Up How Stress Affects the Voice Box
[Music]
have you ever felt all choked up
have you ever been nervous to present
and your voice starts to tremble
have you ever been on the verge of tears
and felt a lump in your throat
feelings involve physiological changes
in the body
these phrases are physical descriptions
of emotions expressed here in the larynx
otherwise known as the voice box
emotions and stress have a noticeable
effect on our physical performance
when i was a young girl i took ballet
classes and i had a very strict
hungarian ballet teacher named mrs
barron
she used to walk around the classroom
with a stick
and hit my legs to make sure that my leg
was straight and my toe was pointed
we would shift from the bar to our floor
work
and mrs baron would reposition herself
in front of the mirror looking out at
the classroom
with stick in hand
we were instructed to run across the
floor and then leap into a ground detail
it was my turn
i started my runs
and the moment i leapt into the air
the teacher would
bang her stick
and inevitably
i choked
let me back up a little bit and tell you
who i am what i do
and why i find this all so interesting
i’m a medical speech pathologist who
specializes in treating the voice as
well as breathing swallowing and cough
disorders
i have the privilege of working in new
york city with a wide range of
patients the body keeps the score is a
title of a book written by dr bessel van
der kolk
this is what i see on a daily basis with
my patients
unshared pain has to go somewhere
i see the patients who carry their
stress and emotion here
larynx voice box
the voice box or larynx sits in the
front of the throat on top of your
airway with your food tube or esophagus
behind it
okay everyone let’s find your larynx
take your hand
place it gently on the front of your
neck
you should feel your adam’s apple
everybody has one
and now go ahead and swallow
did you feel that moving up and down
that’s your larynx
it moves up and down and out of the way
when we swallow to keep us safe
the vocal folds sit right behind there
you have two of them and they
conveniently make a v for voice
the vocal folds are super tiny
go ahead and look at your your thumbnail
your vocal folds are the approximate
length of your thumbnail
unless of course you’re wearing acrylic
nail tips
fun fact
your vocal folds vibrate 120 to 220
times per second when talking
and up to 1400 times per second for the
highest opera repertoire
your larynx or voice box has three main
functions the first is your vocal folds
come together and they vibrate like this
when we talk
they open when we breathe
and are essentially the gates that let
air in and out of our body
most important the vocal folds come
together
when we cough
this is to protect our airway
you may be surprised to learn that this
is a place in the body where stress is
held
i am not
most are unaware of all that occurs
right here
it’s the crossroads of breathing
eating and communication
think about it breathing it’s what keeps
us alive
eating one of the main things we do when
we get together
and communication
from saying hello
to i love you
and even getting a chance to share
messages that change the world
so how do emotions affect the larynx
well research has shown that emotions in
the larynx are intrinsically related
the vocal tract has rich and a complex
nerve supply making it very sensitive
it receives input from both the central
and the autonomic nervous systems
the limbic system in the brain is the
master of emotions and communicates with
the nerves in the larynx
this helps explain why we are able to
recognize when our loved ones are upset
with us from only subtle changes in
facial expression and tone of voice
emotions and stress cause the body to
tighten that includes muscles of the
neck the shoulders the back the chest
and even the vocal folds
this can have a direct effect on how we
sound
how we breathe
and can even cause
a chronic cough
it’s not easy for people to change these
behaviors on their own
or i wouldn’t have a job
i evaluate and treat patients who have
very real symptoms that negatively
impact their lives
by the time patients come to see me
they’re typically frustrated and
exhausted as they’ve seen multiple
medical professionals searching for the
cause of their problem
the interesting thing is
that these symptoms often occur in
otherwise healthy individuals
so what is the cause
more often than not
it’s stress
what do you think about when you’re
asked about a stressful event
maybe divorce
or death
the stressor does not have to be
negative it can be positive
you can be stressed from having a baby
getting married or moving
a crucial consideration is the timing of
these events
this is because the physical effects of
stress or how it plays out in the body
may not catch up with us for months or
years
the body
keeps
the score
looking back over the past year
especially this year
most people have been a bit stressed
this doesn’t have to occur from one
event like a pandemic
it can be a slow build of pressure
or a general feeling of responsibility
overload
most people are not aware of the
physical and emotional stress that
simply comes from living life
emotional reactions from stress include
anxiety depression
physical reactions things like headache
and pain
these symptoms are often ignored or
attributed to other causes
we humans are great at justifying
symptoms
only when they seem to persist
or cause concern
do we seek help
unfortunately by that time the body has
done a good job
at compensating and creating
dysfunctional patterns affecting voice
and respiration
let’s take a dive into how stress
affects the voice
well there’s the classic stage fright or
how about you get up enough courage
to ask somebody on a date and the moment
you go to open your mouth
nothing comes out
maybe you feel a sore throat but you’re
not sick
or you notice voice changes become
hoarse or tired simply from using your
voice
working with the voice is not only
paying attention to the words that
people say
but listening to the voice
and what i hear in the voice
what’s the quickest way to know how
someone’s feeling
yes you can look them in the eyes
but listen to their voice
if i ask someone how they’re doing and
they respond to me with
i’m okay
we all know they are not okay
we know that under stress the muscles in
and around the voice box and the vocal
folds themselves tighten
if this is prolonged it may cause a
disorder called muscle tension dysphonia
dysphonia simply meaning difficulty with
the voice
it can vary in severity and can cause
disruptions in personal and work life
the effects of muscle tension dysphonia
include fatigue
hoarseness pitch problems loss of range
and pain with use
so how about our breathing
patients come into us reporting
difficulty with breathing and shortness
of breath
this is after they’ve seen a lung
specialist who’s ruled out any other
causes
i’d like to try something
on the count of three
i’d like everybody in the audience to
take a breath in and let it out
one
two three
what i just observed was a collective
wave of bodies rising and falling
i describe a breath like that
as tense
upper body focused
this is not a relaxed breath nor a
breath conducive to voice use
the patients i see suffer from shortness
of breath because they use this tense
upper body breathing pattern to an
extreme
their stress causes a tight voice box
which ultimately makes it difficult to
breathe
so
we talked about voice we talked about
breathing
what about that chronic cough
one of the most interesting groups that
i work with
suffer from chronic persistent cough
or throat clear
this is a cough that’s persisted longer
than eight weeks
and continues despite full medical
workup and treatment
some people have been coughing for
decades
you may know some of them
addition to coughing this group also has
difficulty with their voice and
breathing
their voice boxes have become overly
sensitive reactive or
dramatic
it is normal to cough
if you’re choking please cough
with chronic cough people are coughing
when there is no need
they’re coughing in response to cold air
perfume
and even laughing
i’ve had patients whose cough is so
severe they cough to the point of
vomiting
historically chronic cough has been
treated with medication
these medications have serious side
effects
but i specialize in treating patients
without medication
we work on training people out of their
cough by using alternate strategies
our research has shown about 80 percent
of our patients are improved with
therapy alone
an important part of working with this
group is asking them about what was
happening around the time the cough
started
most people report a significant
emotional or stressful event occurring
around the onset of symptoms one of the
more extreme examples of stress and
emotion affecting the larynx are the
patients who worked at the world trade
center site on 9 11.
there is a large number of this cohort
who experienced severe laryngeal
symptoms that were not present prior to
that day
the emotional trauma is essentially
manifested in the voice box
effective therapy requires treatment of
the body and the mind just at treating
the stress helps relax the larynx
relaxing the larynx helps relieve the
stress
which brings me to all of you
take a moment and think about a
situation where you were upset
emotional
or choked up
a time when your breathing got shallow
or your body got tight
maybe before a job interview
or hearing about a new covet strain
or perhaps
when calling your
mother-in-law
now
hold that thought
i’m going to share with you
a way that you can calm your breathing
relax your throat
and quiet your mind
begin by closing your lips
so they are lightly touching
some people find it more relaxing to
close the eyes
taken a gentle quiet breath through your
nose
not a hard or deep breath just like this
then move right into an exhale through
pursed lips
it’s as if you’re trying to
flicker the flame of a candle
and then move right back into a gentle
inhale through the nose
the exhale should be longer than the
inhale
and they should both be silent
with each exhale think about relaxing
your shoulders your chest your throat
and even your belly let it go
go ahead and give it two or three more
breaths
nice
so
next time your emotions are affecting
your voice box
give this a try
[Applause]
[Music]
you