The human voice is extremely flexible and adjustments of quality, frequency, and intensity serve to signal various moods, emotions, and intentions. These modifications occur automatically in daily life, but can also be implemented in a developed, controlled, and consciously applied way, in spoken and sung artistic expression. The vocal output depends on a series of anatomical, physiological, and neurological factors, however, there is a crucial participation of the emotional component that impacts the vocal output.

Self-regulation or self-control is the result of the active process of self-awareness so that the individual is conscious of how he or she uses his or her voice in various interaction situations.  Self-regulation is essential to control inappropriate voice use practices and depends on the executive functions of the brain, particularly the prefrontal cortex, which plays an essential role in planning complex cognitive behaviors, decision-making, personality expression, and moderating social behavior. The behavior inhibition system, which ends its development around the age of 24-28, is crucial for the control of human behaviors, which includes vocal behavior.

Vocal behavior can be defined as the set of vocal reactions in response to interpersonal relationships in the environment in which the individual lives. Such vocal reactions can be the result of the individual’s psychological needs, habits, social stimuli, or a combination of these. The vocal behavior may also be a specific emotional manifestation of professional voice users or even constitute a vocal style in certain artists such as singers and actors. Patterns of vocal behaviors are also common in non-artistic professional voice users, such as teachers and preachers. (Behlau, 2018).

Evaluating vocal self-regulation to understand a person’s communicative behavior can help define the risk of a voice problem, characterize possible etiological factors of a voice problem, and also estimate adherence and results of vocal therapy, which includes cognitive-behavioral strategies with specific goals to be achieved. People with vocal symptoms have greater impairment in self-regulation behavior compared to vocally healthy individuals, especially about impulse control.  

Voice therapy requires the patient to be active, to get involved to achieve specific goals, learning new behaviors, modifying vocal habits, and developing new levels of self-regulation. These items are even more essential in individuals who are very responsive to their environment and who find it difficult not to engage in abusive vocal practices, even while undergoing vocal treatment.

There have been advances in understanding the importance of this executive function of vocal control: reduced self-regulation may affect vocal performance (Vinney et al, 2016); a greater number of vocal symptoms is associated with difficulties in vocal self-regulation (Almeida et al, 2017; Correa et al 2022); and, particularly in teachers with vocal symptoms, as the number of common mental disorder symptoms (anxiety and depression) increased, voice self-control decreased (Barbosa et al 2021). In addition, an integrating review on this subject highlighted that despite the small number of articles, self-regulation is an important factor in vocal behavior, and it is necessary to evaluate this aspect in vocal disorders (Barbosa et al 2022).

Self-regulation can be assessed through questionnaires (Almeida, Behlau, 2017; Barbosa et al, 2023) and in cases of clear reduction, specific strategies, such as implementation intention and change of habits (Behlau et al, 2023) must be introduced in voice therapy.  

REFERENCES

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Almeida AA, Behlau M. Cultural adaptation of the short Self-Regulation Questionnaire: suggestions for the speech area. Codas. 2017 Aug 14;29(5):e20160199. Portuguese, English. doi: 10.1590/2317-1782/20172016199. PMID: 28813068.

Barbosa IK, Behlau M, Lima-Silva MF, Almeida LN, Farias H, Almeida AA. Voice Symptoms, Perceived Voice Control, and Common Mental Disorders in Elementary School Teachers. J Voice. 2021 Jan;35(1):158.e1-158.e7. doi: 10.1016/j.jvoice.2019.07.018. Epub 2019 Aug 12. PMID: 31416748.

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Barbosa I, Behlau M, Almeida LN, Ramos N, Lopes L, Almeida AA. Validation of the Brazilian Scale of Perceived Control Over Voice in the Present using Item Response Theory. J Voice. 2023 Mar 1:S0892-1997(23)00028-0. doi: 10.1016/j.jvoice.2023.01.027. Epub ahead of print. PMID: 36868955.

Behlau M. The 2016 G. Paul Moore Lecture: Lessons in Voice Rehabilitation: Journal of Voice and Clinical Practice. J Voice. 2019 Sep;33(5):669-681. doi: 10.1016/j.jvoice.2018.02.020. Epub 2018 Mar 19. PMID: 29567050.

Behlau M, Madazio G, Pacheco C, Vaiano T, Badaró F, Barbara M. Coaching Strategies for Behavioral Voice Therapy and Training. J Voice. 2023 Mar;37(2):295.e1-295.e10. doi: 10.1016/j.jvoice.2020.12.039. Epub 2021 Feb 2. PMID: 33541765.

Correa S, Ribeiro VV, Behlau M. Chilean’s Self-Perception of Their Self-Regulatory Behaviors and Vocal Symptoms. J Voice, 2022 Mar; 36(2):292.e23-292.e28. DOI: https://doi.org/10.1016/j.jvoice.2020.04.036

Vinney LA, Turkstra LS. The role of self-regulation in voice therapy. J Voice. 2013 May;27(3):390.e1-390.e11. doi: 10.1016/j.jvoice.2013.01.003. PMID: 23639733.