Acceptance and commitment coaching for music performance anxiety in adolescent singers.

Introduction: Most of the anxiety disorders, particularly social anxiety, seem to develop either during childhood or adolescence. Adolescent singers who experience physical, mental and emotional changes along with voice change are particularly prone to the development of MPA. However, adolescence also seems to be an opportune time to instil healthy behaviours in singing students as they are more likely to remember these coping strategies, owing to the release of dopamine and the 'reminiscence bump'. As this period of a singer's life is wrought with inevitable anxiety development, the additional aim of the study was to develop a coaching framework which can be used by singing teachers in their practice. Mindset training for adolescents seems crucial to help them continue singing through puberty so they do not drop out of singing lessons or choir during voice change and identity development. Methods: The study aimed to determine if Acceptance and Commitment coaching could be used with adolescent singers with MPA and to record and analyse rich qualitative data in the form of semi-structured participant interviews and questionnaires. Results: When their perception of MPA symptoms and physiological and psychological arousal before a performance changed, their behaviour and reactions changed accordingly. The change took place over a period of time, which was characterised by discoveries about themselves, confusion in understanding new concepts and letting go of old habits. Interestingly, by the end of the coaching sessions, their preoccupation with pleasing the audience and appearing perfect on stage was replaced by a new-found delight in pursuing values and goals related to their singing. Along with this came the acceptance of themselves and others as individuals with the potential for growth and change and the capacity to learn from mistakes. Discussion: This study marks the first investigation into the effectiveness of using of ACC as an intervention for MPA in adolescent singers undergoing puberty by a singing teacher. The results are promising and suggest that ACC is an effective MPA intervention for adolescent singers to cope with inevitable development-related anxieties and keep them engaged in the activity of singing during their pubertal years.

Female Classical Singers Apply Different Resonatory Strategies Than Male: Insights from an MRI-Based Analysis.

INTRODUCTION: The morphology of the vocal tract plays a crucial role in singing. Adjustments of the lower part of the vocal tract are essential for voice quality and timbre. Structured investigations of this region are challenging due to the small extent of the morphological modifications. MATERIAL AND METHODS: This study analyzed the morphology of the endolaryngeal tube and parts of the surrounding hypopharynx for the sustained vowels /a/, /e/, /i/, //, and // by 11 female singer subjects who were at the beginning of their academic singing studies. As in a previous study with male subjects, analysis was based on two phonatory conditions: a natural, speech-like phonation and a singing phonation, like in classical singing. By means of 3D image processing from magnetic resonance imaging, multiple measures were derived. The data were statistically analyzed using linear mixed effects models and ANOVA. RESULTS: The female singers enlarged the ratio of the endolaryngeal tube to the adjacent hypopharynx for singing. DISCUSSION: In contrast to the findings of the male singers in a previous study, the ratios of the laryngeal volumes to the neighboring hypopharynx increased while singing. The female singer subjects of the present study increased those ratios, mediated by an over-proportional enlargement of the endolaryngeal tube. Existing acoustic differences to male singers are thus given a morphological basis. CONCLUSION: The study gives insight into the characteristic adjustments of the vocal tract of female classical singers. The resonatory strategies for females in classical singing differ from those found in males.

Preliminary Findings of Vocal Fold Vibratory Characteristics of Singers Analyzed by Laryngeal High-Speed Videoendoscopy.

OBJECTIVES: This study investigates the vocal fold vibratory dynamics of singers, which are postulated to differ from those of normal speakers due to the singers' regular vocal training. The measurement of vocal fold vibration involved the utilization of laryngeal high-speed videoendoscopy (LHSV) and subsequent LHSV-based analysis. The focus of the present study is to characterize and compare the LHSV-based measures derived from the glottal area waveform (GAW), namely fundamental frequency (F0GAW), glottal perturbation (jitterGAW and shimmerGAW), open quotient (OQGAW), and Nyquist plots, between singers and normal speakers across genders. METHODS: Participants comprised 13 singers from a local cultural and heritage academy and 56 normal speakers from a local university, all were evaluated to have normal voices. Each participant underwent LHSV procedures to capture images of vocal fold vibration, which were subsequently analyzed to generate the LHSV-based measures. RESULTS: Male singers exhibited lower F0GAW, jitterGAW, shimmerGAW, and OQGAW than female singers. When compared to normal speakers, male singers demonstrated higher F0GAW, and lower jitterGAW and shimmerGAW. No difference in OQGAW was found between male singers and normal speakers. Female singers exhibited lower jitterGAW compared to normal speakers, but no differences were observed in shimmerGAW and OQGAW. The results of Nyquist plots indicated no gender-related associations between types of rim width and among singers. However, for rim pattern, male singers were associated with a higher percentage of clustered rim, suggesting more regular vocal fold vibration, compared to female singers and normal male speakers. CONCLUSIONS: Singers, particularly male singers, demonstrate distinct and potentially superior vocal fold vibrations compared to normal speakers, likely attributed to their regular vocal training, resulting in refined vocal fold configurations even during speaking. Despite the limited sample of singers, the study offers valuable insights into the vocal fold vibratory behaviors in singers analyzed using LHSV.

A Comparison of the Dysphonia Severity Index and Singing Voice Handicap Index Between Trained and Untrained Male Iranian Traditional Singers.

OBJECTIVES: This study aimed to compare trained and untrained Iranian traditional singers on the Dysphonia Severity Index (DSI) and the Singing Voice Handicap Index. The second objective was to examine the relationship between the DSI and Persian version of the Singing Voice Handicap Index (P-SVHI) scores in each group of trained and untrained Iranian traditional singers. STUDY DESIGN: This study is a comparative cross-sectional study. METHODS: This study included 17 trained male Iranian traditional singers who were compared with 17 untrained ones who were matched in terms of age. The P-SVHI was completed by trained and untrained Iranian traditional singers. Measures of jitter, lowest intensity, highest phonational frequency, and maximum phonation time (MPT) were obtained from each participant. The DSI scores were calculated using these values. RESULTS: Trained male traditional singers had an average age of 33.76 ± 7.45 years, 3.24 ± 1.85 hours of daily practice, 5.24 ± 3.78 years of training, 3.06 ± 2.65 no. of professional performances, and untrained singers had an average age of 32.76 ± 12.92 years, 1.53 ± 1.17 hours of daily practice, and 0.88 ± 1.65 no. of professional performances. Trained singers had lower P-SVHI scores and sub-scores, longer MPT, higher F0 high, lower jitter, and lower I low, resulting in higher DSI values (P < 0.05). There was no significant correlation between P-SVHI scores and DSI values in each group of trained and untrained Iranian traditional singers (P > 0.05). CONCLUSIONS: The results of this study show that the vocal abilities of professional vocalists are enhanced through voice training (higher DSI scores in trained singers vs untrained ones). Voice training can also help to lessen the perception of a handicap related to the singing voice. Hence, it may be necessary to consider alternative norms for the DSI and P-SVHI when administering them to patients who have undergone guided vocal training, such as voice/singing lessons. The current research indicates that the perception of singing voice handicap and DSI values are two distinct characteristics that do not have a significant correlation.

Population characteristics and self-assessment of speaking and singing voice in Polish contemporary commercial music singers-an exploratory, cross-sectional study.

Background: The domination of the Contemporary Commercial Music (CCM) industry in music markets has led to a significant increase in the number of CCM performers. Performing in a wide variety of singing styles involves exposing CCM singers to specific risk factors potentially leading to voice problems. This, in turn, necessitates the consideration of this particular group of voice users in the Occupational Health framework. The aim of the present research was threefold. First, it sought to profile the group of Polish CCM singers. Second, it was designed to explore the prevalence of self-reported voice problems and voice quality in this population, in both speech and singing. Third, it aimed to explore the relationships between voice problems and lifetime singing involvement, occupational voice use, smoking, alcohol consumption, vocal training, and microphone use, as potential voice risk factors. Materials and methods: The study was conducted in Poland from January 2020 to April 2023. An online survey included socio-demographic information, singing involvement characteristics, and singers' voice self-assessment. The prevalence of voice problems was assessed by the Polish versions of the Vocal Tract Discomfort Scale (VTDS) and the Singing Voice Handicap Index (SVHI). Also, a self-reported dysphonia symptoms protocol was applied. The perceived overall voice quality was assessed by a Visual Analogue Scale (VAS) of 100 mm. Results: 412 singers, 310 women and 102 men, completed the survey. Nearly half of the studied population declared lifetime singing experience over 10 years with an average daily singing time of 1 or 2 h. 283 participants received vocal training. For 11.4% of respondents, singing was the primary income source, and 42% defined their career goals as voice-related. The median scores of the VTDS were 11.00 (0-44) and 12.00 (0-40) for the Frequency and Severity subscales, respectively. The median SVHI score of 33 (0-139) was significantly higher than the normative values determined in a systematic review and meta-analysis (2018). Strong positive correlations were observed between SVHI and both VTD subscales: Frequency (r = 0.632, p < 0.001) and Severity (r = 0.611, p < 0.001). The relationships between most of the other variables studied were weak or negligible. Conclusion: The examined CCM singers exhibited substantial diversity with regard to musical genre preferences, aspirations pertaining to singing endeavors, career affiliations, and source of income. Singing voice assessment revealed a greater degree of voice problems in the examined cohort than so far reported in the literature, based on the SVH and VTDS.

Vocal Pedagogues Training Dysphonic Voices: Treatment Seeking Approaches and Practices.

OBJECTIVE: This study examined the practices of current professional voice teachers' management of voice disorders. TYPE OF STUDY: Survey. METHODS: An online survey was developed and made available to vocal educators who had membership in organizations within the field of voice. Respondents rated their comfort with management of voice disorders, criteria for accepting a dysphonic student, and their approach within the multidisciplinary environment. RESULTS: Of 786 responses from professional vocal educators, 48% had worked with a vocalist recovering from dysphonia, vocal surgery, or a vocal pathology. Two-thirds reported management of nodules, polyps, or cysts. The majority of respondents working with injured voices had advanced degrees in vocal performance, but few had cross-training as an speech-language pathologist. Pedagogues focused on breathing strategies while speech-language pathologist pedagogues focused on resonance and reduction of phonotrauma. Pedagogues sought information on voice science and medicine from scholarly journals, attending conferences, and medical professionals. CONCLUSIONS: Vocal pedagogues were interested members of the interdisciplinary team with a desire to seek knowledge beyond their initial career training, even though additional continuing education or licensure is not mandated for vocal educators. Findings show a need for vocal degree programs to include anatomy and physiology and multidisciplinary management of voice disorders.

When Art Meets Medicine: Use of Flexible Laryngoscopy in Development of Singers' Voices-A Scoping Review.

AIM: To describe what is known from scientific literature on the use of laryngoscopy to enhance singing pedagogy and foster improvements in vocal development. DESIGN: The scoping review methodological framework by Arksey and O'Malley was used. REVIEW METHODS: A systematic search was conducted and peer-reviewed scientific papers were screened through the Rayyan software. Data were extracted and synthesized thematically as narrative text. DATA SOURCES: Searches were carried out on January 2023 in the Web of Science, MEDLINE, PsychINFO, ERIC, Scopus, Google Scholar, Embase and Academic Search Elite databases using relevant keywords to capture evidence, limited to peer-reviewed scientific papers in Nordic or English language. RESULTS: A total of 1413 studies were screened and assessed for eligibility. Two studies met the inclusion criteria reporting results on the use of laryngoscope in development of singers' voices. Different designs were applied and the charted data characteristics varied. Two populations were explored; one cohort of trained professional female musical theater singers and one cohort of students (both sexes) recruited from a music school. Results from examinations with laryngoscopy regarding vowel quality, register quality, anterior-posterior compression scores, and maximum phonation time are presented. None of the retrieved studies aimed to apply laryngoscopy to enhance singing pedagogy. CONCLUSION: Use of laryngoscopy to enable the singer to directly see their song instrument in order to foster improvements in vocal development, have been subject to little exploration. Only two studies were retrieved in our systematic search, none aimed to study potential pedagogical aspects of applying laryngoscopy. These findings support further investigation of the users', especially singers' and voice teachers' perspective, to guide and inform best practice for use of laryngoscopy as a pedagogical tool in a song development context.

Analysis of the relationship between emotion intensity and electrophysiology parameters during a voice examination of opera singers.

OBJECTIVES: Emotions and stress affect voice production. There are only a few reports in the literature on how changes in the autonomic nervous system affect voice production. The aim of this study was to examine emotions and measure stress reactions during a voice examination procedure, particularly changes in the muscles surrounding the larynx. MATERIAL AND METHODS: The study material included 50 healthy volunteers (26 voice workers - opera singers, 24 control subjects), all without vocal complaints. All subjects had good voice quality in a perceptual assessment. The research procedure consisted of 4 parts: an ear, nose, and throat (ENT)­phoniatric examination, surface electromyography, recording physiological indicators (heart rate and skin resistance) using a wearable wristband, and a psychological profile based on questionnaires. RESULTS: The results of the study demonstrated that there was a relationship between positive and negative emotions and stress reactions related to the voice examination procedure, as well as to the tone of the vocal tract muscles. There were significant correlations between measures describing the intensity of experienced emotions and vocal tract muscle maximum amplitude of the cricothyroid (CT) and sternocleidomastoid (SCM) muscles during phonation and non-phonation tasks. Subjects experiencing eustress (favorable stress response) had increased amplitude of submandibular and CT at rest and phonation. Subjects with high levels of negative emotions, revealed positive correlations with SCMmax during the glissando. The perception of positive and negative emotions caused different responses not only in the vocal tract but also in the vegetative system. Correlations were found between emotions and physiological parameters, most markedly in heart rate variability. A higher incidence of extreme emotions was observed in the professional group. CONCLUSIONS: The activity of the vocal tract muscles depends on the type and intensity of the emotions and stress reactions. The perception of positive and negative emotions causes different responses in the vegetative system and the vocal tract. Int J Occup Med Environ Health. 2024;37(1):84-97.

Associations of Postural Activities and Knowledge for Voice with Breathing Issues and Voice-Physical-Disorders Among Lyric Singers.

OBJECTIVES/HYPOTHESIS: The purpose of this research was to study the associations of postural activities and knowledge of the voice of opera singers, recognized in the literature for the specificity of their posture. Additionally, the link between vocal pathologies and body pains on one hand, and posture control on the other hand was investigated. METHODS: A questionnaire including 90 questions was distributed to singers in France and overseas during 6 months. Ninety-eight opera singers participated in the survey. Data were analyzed using Excel and Stata software. RESULTS: The results showed that the singers who paid more attention to posture, postural work while singing, had knowledge of anatomy and postural role in singing voice, healthy lifestyle, and good body habits, had less vocal discomfort and pathologies, a better vocal preservation, and used more costo-abdominal breathing. On the other hand, knowledge of postural role and postural work was linked with pain and vocal fatigue. Furthermore, a preventive need was revealed concerning the providing of knowledge and skills to singers, but also to singing teachers, speech therapists, and stage workers. CONCLUSION: Our study shows that benefits were found in the voice quality of opera singers with anatomical and postural knowledge and who work on posture as part of their vocal work compared to others. Postural work and knowledge increase attention to body pain and vocal fatigue. These results can inform health care providers, opera singers, and their teachers and performers of the benefits of posture on operatic voice quality. Accordingly, this study sparks new ideas for postural work and therapy in lyric voice.

Immediate effects of the semi-occluded bubble mask technique using VocalFeel® device as vocal warm-up in singers.

OBJECTIVE: The present study aims at investigating the immediate effects of the Semi-Occluded Bubble Mask Technique (SOBM) performed with the device VocalFeel® as a vocal warm-up in a group of professional singers. STUDY DESIGN: A randomized controlled study was carried out. METHODS: Forty-four vocally healthy professional singers were randomly divided into two groups on recruitment: an experimental group and a control group. The same vocal warm-up exercise was performed by the experimental group with the SOMB technique and by the control group without semi-occlusion. Self assessments, acoustic analysis and aerodynamic analysis of Peak Nasal Inspiratory Flows (PNIF) and Peak Oral Inspiratory Flows (POIF) were performed. RESULTS: Significant improvements after the SOBM technique were detected in the experimental group concerning some acoustic parameters (Jitt%; Shimm%) and aerodynamic measures (PNIF and POIF). No significant improvements after the warm-up exercise were observed in the control group. Significant differences between the experimental and the control group were found for ΔJitt%, ΔShimm%, ΔNHR, ΔPOIF and self assessments. CONCLUSIONS: The results of the present study support the efficacy of a vocal warm-up performed with the SOBM technique using VocalFeel® device in terms of acoustic quality, aerodynamic measures and perceived phonatory comfort in professional singers.