Role of Social-Cognitive Motivational Factors in Achieving Voice Therapy Outcomes

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DESCRIPTION (provided by applicant): Behavioral treatment of voice disorders (i.e. voice therapy) entails daily voice exercises, implementation of improved voice technique in connected speech, and other behavioral changes thought to improve laryngeal health. Thus, voice therapy requires patient participation and motivation for behavior change. For other health interventions that require active participation, such as weight loss and smoking cessation, motivation for behavior change has been partitioned into 3 factors: (1) an individual's commitment to the goals of the behavior change, (2) confidence in ability to achieve the specific, required behaviors (i.e. selfefficacy), and (3) belief in the ability to develop relevant skills. It has been found that these factors influence successful attainment of the desired behaviors. It is reasonable to assume that these social-cognitive motivational variables may play a role in voice therapy as well. However, the relationship of these variables to voice therapy success has not been studied, and it is unclear how a patient's motivation may be therapeutically enhanced. Therefore, the broad aims of this application are: 1) to quantify the relationship between patient motivation and outcome in voice therapy and 2) to determine if motivation-enhancing therapeutic strategies improve motivation for therapy and voice therapy outcomes. Measures of vocal function and motivation will be obtained in 40 voice therapy participants with a diagnosis of vocal nodules, or pre-1 peri-nodular edema at baseline (i.e. prior to voice therapy; Time 1) and completion of voice therapy (Time 2). Twenty of these participants will be randomly assigned to voice therapy without explicit manipulation of patient motivation, while the remaining 20 participants will receive voice therapy with enhanced motivational content. To capture social-cognitive motivational factors, established measures will be used to assess goal commitment and skill attribution, and an original, previously tested measure will be used to assess self-efficacy for voice therapy. Vocal function will be assessed through established measures that capture change in vocal hyperfunction, including perceptual assessment, laryngeal efficiency, voice-related quality of life, and patient-perceived benefit from therapy. The proposed research is significant in filling a gap in knowledge concerning the most effective methods for assessment and enhancement of patient-centered motivational factors in voice therapy. This work has a high likelihood of yielding meaningful findings related to an important clinical issue.