School—whether in undergrad, grad school, or pursuing doctoral studies—can bring along great amounts of stress. While stress appears in all of our lives, we each react and cope differently. It has many impacts on our mental and physical health but understanding how stress affects our voice is not as widespread—even for a speech-language pathology graduate student, like myself.

Subtle Differences in My Voice

Throughout the last year or so, I began noticing changes in my voice. I first noticed it in my singing. I’ve always sang, but I was experiencing vocal fatigue after just one song during my car karaoke sessions. My range felt impacted, and I couldn’t access my upper register as freely. After a while, I started keeping an eye out for other voice changes. My breathing felt off, vocal fry was much more prevalent, and I couldn’t sustain notes as long as I used to.

When I attended the Fall Voice Conference in Dallas last October, I was excited to attend a seminar on laryngeal massage since I didn’t have much experience with it. To start the session, the presenters instructed everyone in the room to feel for their larynx. I ended up having someone palpate for me because I was having difficulty finding it myself. Their reaction validated everything I’d been feeling and telling people over the past year . . . I was VERY tense, with an extremely elevated larynx. I couldn’t even focus for the remainder of the session because of the news.

Being Stressed Had Me So . . . Stressed!

Once I got back to campus, I spoke with my current voice disorders professor about my concerns. After a preliminary oral mech exam and voice eval, she pointed out some of her initial observations:

• Shallow breathing
• Tension in my shoulders and neck
• Hard glottal attacks
• Vocal fry
• Hypernasality
• Deviated uvula
• Reduced elevation of my velum

I was already aware of and actively working on some of these symptoms. Others were new that I hadn’t yet noticed. We began by actively relaxing and dropping my shoulders, followed by sustained phonation. I didn’t get too far (literally—I only got through one trial) before I put my head between my legs and tears started flowing down my face. I could not relax—physically nor mentally. I knew I couldn’t. I’d always been wound tight. In fact, I was diagnosed with General Anxiety Disorder (GAD) in 2018, soon after beginning graduate school.

Looking Back

As a child, I recall my mother always telling me to unclench my toes when I wore sandals. I had a long bout of trichotillomania (“hair-pulling disorder”) which lasted from the age of 10 through some of my college years. My husband still catches me clenching my fists when I’m in a resting state. My shoulders are usually tense and elevated. I guess you could say I’m an inherently stressed-out person, predisposed to a certain level of stress due to my anxiety . . . never mind the added stress of being a grad student and my desire to be involved in everything under the sun.

Despite knowing my history, GAD diagnosis, and the effects of stress and tension on the voice, it took me over a year to realize these factors may be contributing to the changes in my voice!

Finding My Voice

This entire experience confirmed for me that the effects of mental and emotional health do, indeed, have implications on the voice and should most definitely be considered during treatment. It’s inspired me to complete a directed study on the effects of mindfulness practices. I’ve also made a vow to prioritize myself and my mental health this year. I was hoping to visit a local voice center before the stress of finals and graduation, but due to the current public health circumstances I’ve had to make-do at home. Fortunately, I’ve been able to take time to relax and focus on myself—attempting to reduce my overall emotional and physical stress, being mindful of my emotions and my body, and intentionally doing vocal warm-ups and semi occluded vocal tract exercises.

If you’d like to learn more on this topic, Emory Voice Center recently collected data for a study looking at the effects of mindfulness and meditation on the voice. I look forward to seeing their results and encourage you to follow them if you’re interested in the outcome. I challenge all of you to prioritize your mental health and take care of your voice. It needs to be heard, so take care of it!