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