This study aims to explore the feasibility of incorporating regular guided meditations via immersive virtual reality (IVR) at the start of voice therapy sessions to facilitate better learning and retention of treatment. The study will involve 30 participants, and use the TRIPP application with the Meta Quest 2 virtual reality headset, known for its immersive meditation experiences designed to calm or focus the user. The objective is to investigate the immediate effects of meditation/mindfulness in IVR on vocal production, with the goal of improving self-regulation, attentional focus, and reducing vocal hyperfunction. IVR has been utilized in mental health settings and exposure therapy for various conditions, but its application in voice therapy, particularly for anxiety reduction through fully immersive meditation, remains unexplored. The study seeks to determine whether IVR can enhance therapy outcomes by improving engagement, attention, and vocal control in individuals undergoing voice therapy, potentially maximizing treatment gains. Through this research, the aim is to assess the efficacy of IVR in enhancing voice therapy interventions and addressing the unique challenges posed by stress and anxiety in voice users.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
All patients will receive a course of voice therapy as normal.
Meditation at the start of each session. (each session is 30 minutes)
TRIPP application in the Meta Quest 2 Virtual Reality Headset.
Mount Sinai Downtown Union Square
New York, New York, United States
Maximum Phonation Time (MPT)
MPT will be used to assess participants' maximum phonation time. The speech evaluator instructs the patient to take a comfortable breath and then produce the sound /a/ for as long as possible. The task is performed twice, and the maximum duration of the two measurements is used.
Time frame: at each therapy session (approximately 1 week apart over 4 weeks)
Noise-to-Harmonic Ratio (NHR)
NHR is a parameter in MDVP that represents ratio of non-harmonic and harmonic waves in a certain sound wave period. NHR describes the quality of the amount of noise in the sound. Inadequate closure of the vocal cords and periodic vibrations of the vocal cords cause excessive air flow as it passes through the vocal cords, causing turbulence and noise. Normal and periodic sound signals will have a small NHR, while dysphonia sound signals will have a large NHR value.
Time frame: Pre-intervention (within 1 week before first session) and post-intervention (within 1 week after final session
Cepstral Peak Prominence (CPPS)
Cepstral Peak Prominence (CPPS) is an indicator of voice quality. It is measured in decibels. An increase in CPPS value indicates an improvement in voice symptoms.
Time frame: Pre-intervention (within 1 week before first session) and post-intervention (within 1 week after final session
Acoustic Vocal Quality Index (AVQI)
The acoustic voice quality index (AVQI) is a multiparametric score to quantify vocal quality. It is based on a weighted combination of 6 voice parameters: smoothed cepstral peak prominence (CPPS), harmonics-to-noise ratio (HNR), shimmer local (SL), shimmer local dB (SLdB), general slope of the spectrum (slope) and tilt of the regression line through the spectrum (tilt). The formula is constructed as 9.072 - 0.245 × CPPs - 0.161 × HNR - 0.470 × SL + 6.158 × SLdB - 0.071 × Slope - 0.170 × Tilt and ranges from 0 to 10. A lower score correlates with a better vocal quality.
Time frame: Pre-intervention (within 1 week before first session) and post-intervention (within 1 week after final session
Voice Handicap Index
The Voice Handicap Index (VHI) is a validated 10-item questionnaire measuring the impact of voice challenges on quality of life (QOL). Scores range from 0 to 40, with higher scores indicating greater perceived voice handicap and negative impact on daily functioning.
Time frame: Pre-intervention (within 1 week before first session) and post-intervention (within 1 week after final session
State Trait Anxiety Inventory Y-1 (STAI-1), long form
The State Anxiety Inventory (STAI Y-1) long form assess the severity of current state of anxiety in the moment, with a minimum score of 40 and max of 80, where scores \>37 indicates moderate-severe state anxiety. Higher score indicates more severity of anxiety
Time frame: Pre-intervention (within 1 week before first session) and post-intervention (within 1 week after final session
State Trait Anxiety Inventory Y-1 (STAY Y-1), short form
The State Anxiety Inventory-Short Form (STAI Y-1) assesses severity of current state of anxiety in the moment to determine immediate effects of meditation. Scores range from 20-40. Higher score indicates more severity of anxiety.
Time frame: Immediately pre- and immediately post-meditation in each therapy session, over approximately 4 weeks
State Trait Anxiety Inventory Y-2 (STAI Y-2), long form
The State Trait Anxiety Inventory (STAI Y-2) assesses severity of anxiety relative to how the patient "generally" feels. Scores range 40-80, with scores \>37 indicating moderate-severe trait anxiety. Higher score indicates more severity of anxiety.
Time frame: Pre-intervention (within 1 week before first session) and post-intervention (within 1 week after final session
Vocal Fatigue Index
The Vocal Fatigue Index (VFI) is a validated questionnaire designed to measure three distinct dimensions of vocal fatigue and voice disorders. It evaluates scores across three subscales: Fatigue and Avoidance (Part 1): Scores range from 0 to 44, with scores ≥24 indicating severity. Physical Discomfort (Part 2): Scores range from 0 to 20, with scores ≥7 indicating severity. Improvement with Rest (Part 3): Scores range from 0 to 12, with scores ≤7 indicating severity. Higher scores on Parts 1 and 2, and lower scores on Part 3, indicate greater voice disorder severity. The VFI is intended to be used for the score of each subscale individually and is not validated to measure severity based on the composite score. However, the maximum total score across all three subscales is 79.
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Time frame: Pre-intervention (within 1 week before first session) and post-intervention (within 1 week after final session
CAPE-V, Consensus on Auditory-Perceptual Evaluation of Voice
A subjective auditory-perceptual evaluation to judge the severity of dysphonia from the standpoint of expert clinician raters (at least 2 for each sample, not including the treating clinician). Scale of severity overall from 0-100. Higher score indicates more severity of symptoms.
Time frame: Pre-intervention (within 1 week before first session) and post-intervention (within 1 week after final session
Heart rate measured in beats per minute
Heart rate (HR) is measured in beats per minute (bpm) using a standard hospital-provided pulse oximeter to assess cardiovascular function.
Time frame: Immediately pre- and immediately post-meditation in each therapy session, over approximately 4 weeks