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Study objectives were to measure relationships between voice and psychological factors using ecological momentary assessment and applying (1) group\u2010level time series analysis and (2) group and (3) individual causal modeling to identify key psychological factors relevant for voice outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Adults (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200932) with primary muscle tension dysphonia completed multiple assessments daily for 10\u2009days. Measures included items from the Voice Handicap Index\u201010, voice\u2010adapted perceived present control scale, items from NIH PROMIS and the NIH Toolkit to assess distress, and the Positive and Negative Affect Scale. Group\u2010level time series analysis was conducted using dynamic structural equation modeling; causal analysis utilized the Greedy Fast Causal Inference algorithm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In group\u2010level time series analyses, neither perceived control nor distress predicted subsequent timepoint voice handicap scores. In group\u2010level causal modeling, anxiety was causal for voice handicap, but perceived control was not. Individual\u2010level analyses identified various causal factors for voice handicap including perceived control and negative affect, and to a lesser extent, serenity, anxiety, somatic arousal, and stress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Group\u2010level analyses may obscure important heterogeneity that is identifiable using individual\u2010level causal analyses. For example, perceived control was not identified as predictive or causal for voice handicap at the group level; but was a salient causal factor for voice handicap in some individuals. Causal modeling using intensive longitudinal datasets offers a potential avenue for individualized treatment approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70049","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T08:59:00Z","timestamp":1755248340000},"page":"324-331","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ecological Momentary Assessment of Voice &amp; Psychological Factors: Group &amp; Individual Mechanisms"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9000-6323","authenticated-orcid":false,"given":"Stephanie","family":"Misono","sequence":"first","affiliation":[{"name":"Department of Otolaryngology University of Minnesota Twin Cities  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viann N.","family":"Nguyen\u2010Feng","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Minnesota Duluth  Duluth MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofan","family":"Lei","sequence":"additional","affiliation":[{"name":"Magnit  Maple Grove MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Feddema","sequence":"additional","affiliation":[{"name":"Boston Scientific  Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anika","family":"Tella","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Minnesota Twin Cities  Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Stockness","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Minnesota Twin Cities  Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia A.","family":"Frazier","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Minnesota Twin Cities  Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich","family":"Kummerfeld","sequence":"additional","affiliation":[{"name":"Institute for Health Informatics University of Minnesota Twin Cities  Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelvin O.","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of Minnesota Twin Cities  Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2006.08.007"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2014.02.010"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25819"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537\u2010200409000\u201000009"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2018.08.006"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0029702"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.4956"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000520"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.3.022806.091415"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489419842267"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.7551\/mitpress\/1754.001.0001"},{"key":"e_1_2_8_13_1","first-page":"20","article-title":"Applying Causal Discovery to Intensive Longitudinal Data","volume":"160","author":"Stevenson B. 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