{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:18:59Z","timestamp":1790716739204,"version":"4.1.0"},"reference-count":119,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T00:00:00Z","timestamp":1725926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The first objective of this research project is to compare the occurrence and frequency of symptoms and\/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender\u2010 and age\u2010matched vocally healthy controls, using a case\u2010control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Case\u2010control study: Autonomic (dys)function of patients with FD will be\u00a0compared with gender\u2010 and age\u2010matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient\u2010reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be\u00a0performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase.<\/jats:p><\/jats:sec><jats:sec><jats:title>Expected results<\/jats:title><jats:p>Higher occurrences of symptoms and\/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre\u2010ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self\u2010report of feelings\/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds to the existing knowledge<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The first objective of this study is to investigate the occurrence and frequency of symptoms and\/or disorders related to autonomic dysfunction in patients with FD as compared with a gender\u2010 and age\u2010matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the potential or actual clinical implications of this work?<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence\u2010based practice in the field of voice.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.13111","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T11:29:37Z","timestamp":1725967777000},"page":"2723-2736","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exploring autonomic dysfunction in functional dysphonia: A protocol for a case\u2010control study and a randomized controlled trial"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1147-1708","authenticated-orcid":false,"given":"Iris","family":"Meerschman","sequence":"first","affiliation":[{"name":"Centre for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences Ghent University  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3956-5936","authenticated-orcid":false,"given":"Evelien","family":"D'haeseleer","sequence":"additional","affiliation":[{"name":"Centre for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences Ghent University  Ghent Belgium"},{"name":"Royal Conservatory Brussels, Musical Department  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie\u2010Anne","family":"Vanderhasselt","sequence":"additional","affiliation":[{"name":"Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin Ghent University  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie","family":"Claeys","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Department of Head and Skin Ghent University Hospital  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristl","family":"Vonck","sequence":"additional","affiliation":[{"name":"Department of Neurology, Department of Head and Skin Ghent University  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riet","family":"Vergauwe","sequence":"additional","affiliation":[{"name":"Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin Ghent University  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwen","family":"Van Nuffelen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Rehabilitation Center for Communication Disorders Antwerp University Hospital  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gauthier","family":"Desuter","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Rehabilitation Center for Communication Disorders Antwerp University Hospital  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences &amp; Disorders The University of Utah  Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristiane","family":"Van Lierde","sequence":"additional","affiliation":[{"name":"Centre for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences Ghent University  Ghent Belgium"},{"name":"Faculty of Humanities, Department of Speech\u2013Language Pathology and Audiology University of Pretoria  Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,10]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Clinical voice disorders","author":"Aronson A.E.","year":"1990"},{"key":"e_1_2_9_3_1","first-page":"231","volume-title":"Clinical voice disorders","author":"Aronson A.E.","year":"2009"},{"issue":"6","key":"e_1_2_9_4_1","first-page":"935.e1","article-title":"Immediate effects of mindfulness meditation on the voice","volume":"36","author":"Becker D.R.","year":"2022","journal-title":"Journal of Voice"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2020.12.039"},{"issue":"4","key":"e_1_2_9_6_1","first-page":"292","article-title":"Effectiviteit van hartritmevariabiliteitbiofeedback als aanvulling bij behandeling van depressie en posttraumatische stressstoornis [Efficacy of HRV\u2010biofeedback as additional treatment of depression and PTSD]","volume":"58","author":"Blase K.L.","year":"2016","journal-title":"Tijdschr Psychiatr"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18073329"},{"key":"e_1_2_9_8_1","unstructured":"Boersma W.&Weenink D.(2013)Praat: Doing phonetics by computer. 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