Immediate Effects of Mindfulness Meditation on the Voice
正念冥想对声音的即时影响

$^{IIDiana Rose Becker,}^{TSandeep Shelly,}^{†}$ Dio Kavalieratos, $^{[}$ Carissa Maira, and $^{[l, ‡}$ Amanda I. Gillespie, $^{[} † † ‡$ Atlanta, Geogia
$^{IIDiana Rose Becker,}^{TSandeep Shelly,}^{†}$ Dio Kavalieratos， $^{[}$ Carissa Maira， $^{[l, ‡}$ Amanda I. Gillespie， $^{[} † † ‡$ 乔治亚州亚特兰大

Abstract摘要

Summary: Objectives. The benefits of mindfulness meditation are well documented. This study evaluated the immediate effects of mindfulness meditation (MM) on the voice and voice user. Study design. Prospective experimental study. Methods. Participants: 19 vocally healthy (VH) individuals, and 26 individuals with common voice disorders (CVD; benign lesions and hyperfunctional muscle tension) deemed stimulable for voice therapy. Exclusionary criteria: prior training or regular meditation practice. Participants recorded speech samples before and after a 11.5minute prerecorded session of MM. Primary outcomes: phonatory aerodynamics and participants’ self-reported experience of voice. Secondary outcomes: self-reported anxiety, vocal acoustics, speech breathing patterns, and auditory-perceptual outcomes. Baseline self-reported measures of voice (Voice Handicap Index-10 - VHI-10), breathing (Dyspnea Index - DI), stress (Perceived Stress Scale - PSS), and trait mindfulness (Cognitive and Mindfulness Scale - Revised, CAMS-R, Five Facet Mindfulness Questionnaire - FFMQ) were compared between groups. Results. At baseline, CVD had significantly higher VHI-10 ( $P < 0.001$ ) and DI ( $P = 0.0014$ ), and lower trait mindfulness (CAMS-R, $P = 0.02$ ). No difference between groups for PSS or FFMQ. Changes postMM: decreased CPP for all-voiced sentences for VH ( $P = 0.003$ ), decreased mean SPL ( $P = 0.012$ ) on sustained vowel for VH, increased mean phonatory airflow during sustained vowel for CVD ( $P = 0.012$ ). VH demonstrated a decrease in CPP on the all-voice sentence, and CVD demonstrated an increase, resulting in a significant between group difference ( $P = 0.013$ ). Participants reported improvements in voice, emotional and physical states. State anxiety decreased for both groups ( $=< 0.001$ ). No other objective outcomes reached significance. Conclusions. After a brief MM, participants experienced improvement in physical, emotional, and cognitive states, and in their perceptions of their voice. Results indicate that a brief, single session of MM may be beneficial for some, but not sufficient to override habitual voice and speech patterns. Given the benefits of MM, future work should evaluate MM in a standard voice therapy protocol.
摘要：目的。正念冥想的益处已有充分文献记载。本研究评估了正念冥想（MM）对声音及声音使用者的即时影响。研究设计。前瞻性实验研究。方法。参与者：19 名声音健康（VH）个体，26 名被认为适合语音治疗的常见声音障碍（CVD；良性病变和功能性肌肉紧张）个体。排除标准：先前接受过训练或有定期冥想习惯。参与者在进行 11.5 分钟预录制的正念冥想课程前后录制语音样本。主要结果：发声气动学指标及参与者自我报告的声音体验。次要结果：自我报告的焦虑、声音声学特征、言语呼吸模式及听觉感知结果。基线时自我报告的声音（声音障碍指数-10，VHI-10）、呼吸（呼吸困难指数，DI）、压力（感知压力量表，PSS）及特质正念（认知与正念量表-修订版，CAMS-R，五因素正念问卷，FFMQ）在各组间进行了比较。结果。基线时，CVD 组的 VHI-10（ $P < 0.001$ ）和 DI（ $P = 0.0014$ ）显著较高，特质正念（CAMS-R， $P = 0.02$ ）较低。两组在 PSS 或 FFMQ 上无差异。MM 后变化：VH 组所有发声句子的 CPP 下降（ $P = 0.003$ ），VH 组持续元音的平均 SPL 下降（ $P = 0.012$ ），CVD 组持续元音的平均发声气流增加（ $P = 0.012$ ）。VH 组在所有发声句子的 CPP 下降，而 CVD 组则上升，导致两组间存在显著差异（ $P = 0.013$ ）。参与者报告声音、情绪和身体状态有所改善。两组的状态焦虑均下降（ $=< 0.001$ ）。其他客观指标无显著变化。结论：经过简短的正念冥想，参与者在身体、情绪和认知状态以及对自己声音的感知上均有所改善。结果表明，简短的单次正念冥想对部分人有益，但不足以改变习惯性的声音和言语模式。鉴于正念冥想的益处，未来研究应评估其在标准语音治疗方案中的应用。

Key Words: Meditation-Mindfulness-Voice therapy-Muscle Tension Dysphonia.
关键词：冥想-正念-语音治疗-肌肉紧张性发声障碍。

INTRODUCTION引言

Interest in complementary and alternative medicine (CAM) practices is growing. In recent years, the voice community has seen advocacy and encouragement for use of CAM included in scientific voice conference lectures and panels,

^{1}

articles,

^{2, 3}

and more readily accessible social media accounts. Mindfulness meditation (MM) is one such practice. A seemingly low-risk alternative medicine option, MM is proposed as beneficial to the voice and vocalist, and may be reasonable to integrate into traditional voice therapy or voice training practices.

^{2, 4}

While myriad positive effects of MM are well-documented, less is known about exactly how, or whether, such practices directly benefit the voice.
对补充和替代医学（CAM）实践的兴趣正在增长。近年来，声音领域在科学声音会议的讲座和小组讨论中，

^{1}

文章，

^{2, 3}

以及更易获取的社交媒体账号中，均见到了对 CAM 使用的倡导和鼓励。正念冥想（MM）就是这样一种实践。作为一种看似低风险的替代医学选项，MM 被认为对声音和歌手有益，且可能合理地整合到传统的声音治疗或声音训练实践中。

^{2, 4}

虽然 MM 的众多积极效果已有充分记录，但关于此类实践如何或是否直接有益于声音的具体机制知之甚少。

The Centers for Disease Control and Prevention reported that the percentage of adults who practice meditation the United States rose from

4.1 %

in 2012 to

14.2 %

in 2017.

^{5}

Per a 2022 review of 104 RCTs evaluating the use of meditation
美国疾病控制与预防中心报告称，2012 年至 2017 年间，美国成年人练习冥想的比例从

4.1 %

上升至

14.2 %

。

^{5}

根据 2022 年对 104 项随机对照试验（RCT）评估冥想使用的综述

in clinical practice, nearly

50 % (n = 51)

utilized mindfulnessbased meditation practices.

^{6}

Originating in Buddhism,

^{7}

mindfulness meditation (MM) may be used in secular practice or as complement to religious ideology. MM is most simply described as a means of intentionally bringing nonjudgmental attention and awareness into the present moment.

^{8 - 10}

It has been shown to facilitate a reduction of distress and anxiety,

^{8, 11 - 13}

benefit autonomic nervous system function and heart rate variability,

^{14}

and decrease in resting systolic blood pressure, cardiac output and heart rate.

^{15 - 17}

在临床实践中，近

50 % (n = 51)

采用了基于正念的冥想练习。

^{6}

正念冥想（MM）起源于佛教，

^{7}

可用于世俗实践或作为宗教理念的补充。MM 最简单的描述是有意地将非评判性的注意力和觉察带入当下时刻。

^{8 - 10}

研究表明，它有助于减轻痛苦和焦虑，

^{8, 11 - 13}

改善自主神经系统功能和心率变异性，

^{14}

并降低静息收缩压、心输出量和心率。

^{15 - 17}

When used in conjunction with existing treatment protocol, patients with osteosarcoma and breast cancer who receive training in MM are reported to experience more positive treatment outcomes than patients not practicing MM.

^{18, 19}

Across clinical populations,

^{20}

MM has been shown to facilitate a decrease in both acute

^{21 - 23}

and chronic pain,

^{24, 25}

distress tolerance,

^{26}

reduce perceived stress,

^{27}

improve quality-of-life scores,

^{24}

and reduce depression.

^{28}

Effects have been seen across a wide variety of populations

^{29}

including patients with cancer,

^{18, 19, 30, 31}

fibromyalgia,

^{32}

and tinnitus,

^{33}

adults who stutter,

^{34, 35}

patients experiencing long-term effects of COVID-19,

^{36}

and those recovering postseptorhinoplasty.

^{23}

Of interest to the voice and upper-airway disordered population, mindfulness training has been observed to reduce dyspneic symptoms in patients with COPD, and improve quality of life in patients suffering with GERD.

^{37}

当与现有治疗方案结合使用时，接受正念冥想（MM）训练的骨肉瘤和乳腺癌患者据报道比未进行正念冥想的患者获得了更积极的治疗效果。

^{18, 19}

在临床人群中，

^{20}

正念冥想已被证明有助于减轻急性

^{21 - 23}

和慢性疼痛，

^{24, 25}

提高痛苦耐受度，

^{26}

降低感知压力，

^{27}

改善生活质量评分，

^{24}

并减少抑郁。

^{28}

这些效果已在多种人群中观察到，

^{29}

包括癌症患者，

^{18, 19, 30, 31}

纤维肌痛患者，

^{32}

耳鸣患者，

^{33}

口吃成人，

^{34, 35}

经历新冠长期影响的患者，

^{36}

以及鼻整形术后恢复者。

^{23}

对于声音和上呼吸道疾病人群而言，正念训练被观察到能减轻慢性阻塞性肺疾病（COPD）患者的呼吸困难症状，并改善患有胃食管反流病（GERD）患者的生活质量。

^{37}

Existing of research has evaluated the effects of mindfulness practices after long-term training programs such as the 8-week, highly protocolized Mindfulness Based Stress Reduction.

^{8}

However, a decrease in symptom severity has also been observed after a much shorter period of meditation. For example, patients with lung cancer, asthma, and COPD demonstrated reduced dyspnea symptoms after only 20-minutes of mindfulness practice,

^{38}

and a reduction in cough reflex sensitivity was observed in healthy participants after only 11.5 -minutes of MM.

^{39}

现有研究评估了正念练习在长期训练项目（如为期 8 周的高度规范化的正念减压课程）后的效果。

^{8}

然而，在更短时间的冥想后也观察到了症状严重程度的减轻。例如，肺癌、哮喘和慢性阻塞性肺病（COPD）患者在仅仅 20 分钟的正念练习后表现出呼吸困难症状的减轻，

^{38}

健康参与者在仅 11.5 分钟的正念冥想后也观察到了咳嗽反射敏感性的降低。

^{39}

The purpose of this study was to evaluate the effects of a single, 11.5-minute session of MM on the voice. The primary hypothesis was that compared to performance on premeditation speech tasks, when performing identical speech tasks postmeditation, changes in voice production would reflect an increase in mean phonatory airflow. The secondary hypothesis was that participants would report improvements in how they experience their body and voice while performing tasks postmeditation. Additionally, it was expected that there would be an improvement in voice quality postmeditation, as judged by listener’s perceptual ratings.
本研究的目的是评估一次 11.5 分钟的正念冥想对声音的影响。主要假设是，与冥想前的语音任务表现相比，冥想后执行相同语音任务时，声音产生的变化将反映出平均发声气流的增加。次要假设是参与者在冥想后执行任务时，会报告其身体和声音体验的改善。此外，预计冥想后声音质量会有所提升，这将通过听者的感知评分来判断。

MATERIALS & METHODS材料与方法

Experimental design实验设计

This study was a prospective non-randomized investigation of the effects of MM on vocally healthy (VH) individuals and adults with a common voice disorder (CVD) conducted at the Emory Voice Center in Atlanta, GA. The Emory University Institutional Review Board approved the protocol (IRB00114520).
本研究是一项前瞻性非随机调查，旨在研究正念冥想（MM）对声音健康（VH）个体及患有常见声音障碍（CVD）成人的影响，研究地点为佐治亚州亚特兰大的埃默里语音中心。埃默里大学机构审查委员会批准了该方案（IRB00114520）。

Participants参与者

Inclusion criteria in the Vocally Healthy (VH) group included no current voice complaints, deemed vocally normal by a voice-specialized SLP, VHI

< 11 .^{40}

Inclusion criteria for the Common Voice Disordered (CVD) group were as follows; diagnoses as determined by a multidisciplinary team of a laryngologist and voice-specialized speech-language pathologist (SLP), determination of eligibility for voice therapy due to stimulability as judged by a SLP,

^{41}

and VHI-10 >

11 .^{40}

声带健康组（VH）的纳入标准包括无当前声音投诉，经声音专业语言治疗师（SLP）评定为声音正常，VHI 为

< 11 .^{40}

。常见声音障碍组（CVD）的纳入标准如下：由多学科团队中的喉科医生和声音专业语言治疗师（SLP）诊断确定，SLP 评估具备声音治疗的适应性（通过刺激反应判断），以及 VHI-10 >

11 .^{40}

All participants were non-smoking individuals aged 18 years or older. Each participant self-identified as male or female. No participants had a history of other serious chronic medical conditions that may affect voice. Hearing and vision were adequate for all tasks as determined by patient self-report. Exclusionary criteria were as follows: a history of voice therapy or voice surgery, and prior training in,

^{42}

or formal practice of MM. Recruitment for the VH cohort occurred via flyers posted throughout the Emory ENT clinics and by word-of-mouth recruitment of interested family members and friends of Emory Voice Center patients. Recruitment of individuals for CVD occurred immediately after the diagnosis and evaluation of a current voice compliant, and prior to initiation of voice therapy.
所有参与者均为 18 岁及以上的非吸烟者。每位参与者自我认定为男性或女性。所有参与者均无可能影响声音的其他严重慢性疾病史。根据患者自述，听力和视力均足以完成所有任务。排除标准如下：有声音治疗或声音手术史，曾接受过

^{42}

培训或正式练习正念冥想（MM）。VH 组的招募通过在埃默里耳鼻喉科诊所张贴传单以及通过埃默里声音中心患者的家属和朋友的口碑招募进行。CVD 组的招募则在当前声音问题的诊断和评估后、声音治疗开始前立即进行。

Participants received $20 Amazon gift card as compensation for participation in the study.
参与者因参与本研究获得 20 美元亚马逊礼品卡作为补偿。

Procedures程序

All experimental procedures occurred in a private, soundtreated room at the Emory Voice Center located within Emory University Hospital’s midtown campus. For baseline comparison between groups, participants completed the Voice Handicap Index-10 (VHI-10) and the Dyspnea Index (DI).

^{43}

The VHI-10 is a frequently used, validated tool which measures the degree to which one’s voice changes impact their life. The DI measures the degree of an individual’s symptoms of upper airway dyspnea. For both measures, a higher score corresponds to a greater degree of symptom severity. To assess baseline anxiety and mindfulness, patients completed the following three questionnaires: the Perceived Stress Scale (PSS),

^{44, 45}

a validated and reliable 10-item questionnaire measuring the degree to which an individual feels their life is stressful, the State and Trait Anxiety Index (STAI),

^{46}

a two-part questionnaire which measures both state anxiety (momentary or temporary response to a condition) and trait anxiety (a typically more stable predisposition to anxiety). Finally, participants completed the Five Facet Mindfulness Questionnaire (FFMQ),

^{47}

a 39question survey which includes questions from five mindfulness measures and addresses the five primary facets of mindfulness; observing, describing, acting with awareness, nonjudging of inner experience, and non-reactivity to inner experience.

^{47}

Mindfulness, as a trait or disposition, is an indicator of a tendency to experience a mindful state.

^{9}

For the PSS, STAI, and FFMQ, a higher score indicate a greater degree of stress severity, anxiety, or mindfulness, respectively.
所有实验程序均在埃默里大学医院市中心校区内的埃默里语音中心一间私密的隔音室内进行。为了进行组间基线比较，参与者完成了语音障碍指数-10（VHI-10）和呼吸困难指数（DI）。

^{43}

VHI-10 是一种常用且经过验证的工具，用于测量语音变化对个人生活的影响程度。DI 则测量个体上呼吸道呼吸困难症状的严重程度。两项测量中，分数越高表示症状越严重。为了评估基线焦虑和正念，患者完成了以下三份问卷：感知压力量表（PSS），

^{44, 45}

一份经过验证且可靠的 10 项问卷，用于测量个体感受到生活压力的程度；状态-特质焦虑量表（STAI），

^{46}

一份分为两部分的问卷，分别测量状态焦虑（对某一情况的瞬时或暂时反应）和特质焦虑（通常较为稳定的焦虑倾向）。最后，参与者完成了五因素正念问卷（FFMQ），

^{47}

这是一份包含 39 个问题的调查，涵盖了五个正念测量维度，涉及正念的五个主要方面：观察、描述、有意识的行动、对内在体验的不评判以及对内在体验的非反应性。

^{47}

正念作为一种特质或倾向，是体验正念状态的倾向指标。

^{9}

对于 PSS、STAI 和 FFMQ，得分越高分别表示压力严重程度、焦虑或正念程度越高。

To evaluate speech breathing patterns, respiratory kinematic data was recorded during performance of all speech tasks using respiratory inductance plethysmography. Participants were fitted with respiratory transducer belts placed over the rib cage and abdomen (Ambulatory Monitoring, Ardsley, NY). Belts include a wire coil which stretches in length to reflect the change in circumference of either the rib cage and abdomen across inspiration and expiration.

^{48}

Calibration of the belts was performed for each participant by asking each participant to perform a series of three “maximum” breaths. The point of maximum excursion or greatest circumference was determined and used to indicate the greatest point of expansion for inhalation or

100 % max

capacity. The most minimal circumference was determined used to indicate the greatest point of exhalation or 0% of max capacity. All movement within these parameters are viewed as a percentage of maximum capacity. Data were converted using the AD Instruments PowerLab data acquisition system (Boulder, Colorado).
为了评估言语呼吸模式，在执行所有言语任务时使用呼吸感应体积描记法记录呼吸运动学数据。参与者佩戴了放置在胸廓和腹部的呼吸传感带（Ambulatory Monitoring，纽约阿兹利）。传感带内含有一根线圈，长度会随着吸气和呼气时胸廓和腹部周长的变化而伸缩。

^{48}

对每位参与者进行了传感带校准，方法是让每位参与者进行三次“最大”呼吸。确定最大扩张点或最大周长，并用以表示吸气的最大扩张点或

100 % max

容量。确定最小周长，用以表示呼气的最大点或最大容量的 0%。所有在这些参数范围内的运动均视为最大容量的百分比。数据通过 AD Instruments PowerLab 数据采集系统（科罗拉多州博尔德）进行转换。

A premeditation speech sample was recorded within the Analysis of Dysphonia in Speech and Voice (ADSV) software in the Computerized Speech Laboratory (CSL) (KayPENTAX, Montvale, NJ). A head-set microphone was
在计算机语音实验室（CSL）（KayPENTAX，Montvale，NJ）中的语音和声音失调分析（ADSV）软件内录制了冥想前的语音样本。头戴式麦克风
placed at a

45^{\circ}

angle from their mouth (Sure WBH54 Beta headset microphone),

^{49, 50}

and speech samples consisted of reading the six sentences from the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V)

^{51}

at a comfortable pitch and loudness. Recordings used for aerodynamic analysis were captured via the Phonatory Aerodynamic System (PAS) 6600 (Pentax Medical, Inc., Montvale, NJ), a lowpass filtered system with a sampling rate of 22,050 samples/s. Participants recited the first four sentences of The Rainbow Passage,

^{52 - 54}

and three repetitions of sustained vowel /a:/, held for 3-5 seconds, all at a comfortable pitch and loudness.

^{50}

An accompanying microphone attached to the pneumotach at a calibrated distance of 15 cm from the mouth recorded additional acoustic variables.

^{55}

放置在距离嘴部

45^{\circ}

角度的位置（Sure WBH54 Beta 头戴式麦克风），

^{49, 50}

语音样本包括以舒适的音高和响度朗读共识听觉感知语音评估（CAPE-V）中的六个句子。

^{51}

用于气动分析的录音通过发声气动系统（PAS）6600（Pentax Medical, Inc., Montvale, NJ）采集，该系统为低通滤波系统，采样率为 22,050 样本/秒。参与者朗诵《彩虹段落》的前四个句子，

^{52 - 54}

并三次重复持续发音元音/a:/，持续 3-5 秒，均以舒适的音高和响度进行。

^{50}

附加麦克风连接在气流计上，距离嘴部校准为 15 厘米，记录额外的声学变量。

^{55}

Participants were then fitted with over-the-ear headphones (Koss SB49, Koss Corporation, Milwauke, WI) for listening to the 11.5 minute prerecorded guided meditation.

^{56}

A meditation produced by the company “Headspace”

^{56}

was chosen based on the nature of its content, as well as being freely available online. The video’s visual stimulus consists of a simple, neutral geometric image that slowly changes to mark time. The speaker’s voice, with an Australian accent, cues listeners through paced breathing and body awareness exercises. Examples of the speaker’s prompts include asking the participant to bring “the mind into the body, starting to become more aware of physical senses”. The speaker guides the listener’s attention to scan their body from head to toe, noticing any areas of discomfort or ease, noticing the sound and feel of the breath on inhalation and exhalation, noticing the weight and feel of the body, etc
参与者随后佩戴了头戴式耳机（Koss SB49，Koss Corporation，密尔沃基，WI），聆听时长为 11.5 分钟的预录引导冥想。

^{56}

选择了由“Headspace”公司制作的冥想

^{56}

，基于其内容性质以及可在网上免费获取。视频的视觉刺激由一个简单、中性的几何图形组成，缓慢变化以标记时间。讲者带有澳大利亚口音，通过有节奏的呼吸和身体觉察练习引导听众。讲者的提示示例包括要求参与者将“心灵带入身体，开始更加意识到身体感官”。讲者引导听众的注意力从头到脚扫描身体，注意任何不适或舒适的区域，注意吸气和呼气时呼吸的声音和感觉，注意身体的重量和感觉等。

Postmeditation tasks included a repetition of speech tasks as previously described, and completion of the state portion of the STAI,

^{46}

used to assess for any changes in anxiety immediately postmeditation.

^{57, 58}

Finally, participants were asked to provide free-written response to the following question “What difference, if any, did you experience during the speech tasks as a result of the mindfulness practice?”
冥想后任务包括重复之前描述的语音任务，以及完成 STAI 的状态部分，

^{46}

用于评估冥想后即时的焦虑变化。

^{57, 58}

最后，要求参与者对以下问题进行自由书写回答：“在语音任务中，由于正念练习，您体验到了什么不同（如果有的话）？”

All data were collected and stored in the Emory University supported research electronic data capture system (REDCap).
所有数据均收集并存储在埃默里大学支持的电子数据采集系统（REDCap）中。

OUTCOMES结果

The two primary outcomes of interest were the change in mean airflow during phonation, and participants’ response to a question regarding changes they may have experienced while recording a repeat voice sample postMM. A change in mean phonatory airflow for the Rainbow Passage

^{52 - 54}

and sustained vowel task was calculated from preMM to postMM. Though individual differences exist, particularly in patients with MTD, an increase in mean phonatory airflow during connected speech is a desired aim of numerous voice therapies that target the improved coordination of respiration and phonation.

^{41, 59 - 61}

两个主要关注的结果是发声时平均气流的变化，以及参与者对重复录制语音样本后可能经历变化的回答。计算了彩虹段落

^{52 - 54}

和持续元音任务的平均发声气流从冥想前到冥想后的变化。尽管存在个体差异，特别是在肌张力性发声障碍（MTD）患者中，增加连贯语音中的平均发声气流是许多针对改善呼吸与发声协调的语音治疗的目标。

^{41, 59 - 61}

Participants responded to the free-response question “What difference, if any, did you experience during the
参与者回答了开放式问题“您在……期间体验到了什么差异（如果有的话）？”
speech tasks as a result of the mindfulness practice?” using text in REDCap. Two coders (two blinded, voice-specialized Speech-Language Pathologists) read and coded the content of each response to determine similarities across participants’ experiences. Two authors (DRB and AIG) conducted inductive thematic analysis, identifying themes from coding of respondents’ observations of their voice postMM. Findings were summarized, and examples were chosen as representative of each theme for future discussion and presentation.
使用 REDCap 中的文本回答“正念练习是否对语音任务产生了影响？”两名编码员（两位盲法、专注于语音的言语语言病理学家）阅读并编码每个回答的内容，以确定参与者体验之间的相似性。两位作者（DRB 和 AIG）进行了归纳主题分析，从对受访者正念冥想后语音观察的编码中识别主题。研究结果被总结，并选择了代表每个主题的示例以供未来讨论和展示。

Secondary outcomes include state anxiety as assessed via the State and Trait Anxiety Index (STAI),

^{46, 62}

additional aerodynamic and acoustic measures, respiratory kinematics, and auditory perceptual outcomes. Each was assessed immediately prior to and immediately following 11.5-minute MM.
次要结果包括通过状态-特质焦虑量表（STAI）评估的状态焦虑，

^{46, 62}

项额外的气动和声学测量，呼吸运动学以及听觉感知结果。每项均在 11.5 分钟正念冥想（MM）前后立即进行评估。

Participants’ self-reported state anxiety was measured due to the known interaction between an individuals’ acute stress and emotional state and their vocal quality.

^{63 - 67}

Additional aerodynamic analyses included mean number of breaths, and duration of the reading of The Rainbow Passage.

^{68}

Acoustic analyses

^{59}

included mean fundamental frequency and its standard deviation, Cepstral Spectral Index of Dysphonia (CSID),

^{69}

Cepstral Peak Prominence and its standard deviation, and mean vocal intensity.
由于个体的急性压力和情绪状态与其声音质量之间存在已知的相互作用，参与者的自我报告状态焦虑被测量。

^{63 - 67}

额外的气动分析包括平均呼吸次数和《彩虹段落》的朗读时长。

^{68}

声学分析

^{59}

包括平均基频及其标准差、声谱倒谱失声指数（CSID），

^{69}

倒谱峰值显著性及其标准差，以及平均声音强度。

Respiratory kinematic measures were used to assess for any changes in breathing patterns during speech tasks as a result of MM. Respiratory transducer belts measure the anterior-posterior changes in chest wall dimension. The chest wall - including the abdomen and the rib cage - contains within it all of the structures of the lower airway.

^{70}

The abdomen and the rib cage may move in conjunction as well as independent of each other. Measuring the anteriorposterior changes in chest wall dimensions provides information on the contributions of the abdomen and the rib cage independently to the volume displacement of the entire system. In general, during voicing, the rib cage and abdominal diameters decrease, with the abdomen demonstrating a more significant reduction than the rib cage.

^{70}

However, laryngeal status influences respiratory kinematic patterns during speech, and vice versa. Studies have shown that initiating phonation at high lung volumes results in increased vocal intensity and fundamental frequency, and perceptual evaluations of “normal” vocal quality.

^{71 - 73}

Phonation initiated at low lung volumes resulted in the opposite effects of decreased intensity and frequency, and decreased voice onset time.

^{71}

Initiating phonation at low lung volumes has been observed as a characteristic of the speech breathing behaviors of individuals with voice disorders, such as muscle tension dysphonia.

^{74}

After identifying the participants’ maximum and minimum rib cage and chest circumference, their point of maximum capacity (

100 %

) capacity was identified. All movement of the rib cage and abdomen during speech tasks and at rest were interpreted as a percentage of their maximum capacity.
呼吸运动学测量用于评估正念冥想（MM）对言语任务中呼吸模式的任何变化。呼吸传感带测量胸壁前后方向的尺寸变化。胸壁——包括腹部和肋骨笼——内部包含所有下气道结构。

^{70}

腹部和肋骨笼可以协同运动，也可以相互独立运动。测量胸壁前后方向的尺寸变化可以提供腹部和肋骨笼对整个系统体积位移的独立贡献的信息。一般来说，在发声过程中，肋骨笼和腹部直径都会减小，其中腹部的减小幅度比肋骨笼更显著。

^{70}

然而，喉部状态会影响言语中的呼吸运动学模式，反之亦然。研究表明，在高肺容量下开始发声会导致声强和基频的增加，以及“正常”声质的感知评估。

^{71 - 73}

在低肺容量下启动发声会导致相反的效果，即强度和频率降低，声音起始时间缩短。

^{71}

在低肺容量下启动发声被观察为声音障碍个体（如肌张力性发声障碍）言语呼吸行为的一个特征。

^{74}

在确定参与者的最大和最小肋骨及胸围后，确定了他们的最大容量点（

100 %

）。言语任务和静息时肋骨及腹部的所有运动均被解释为其最大容量的百分比。

Auditory-perceptual analysis consisted of comparison of overall voice severity as judged by the CAPE-V score assigned by three blinded voice-specialized speech-language
听觉感知分析包括由三位盲法的声音专业言语语言病理学家根据 CAPE-V 评分对整体声音严重程度的比较。
pathologists.

^{75}

Raters listened to participants’ readings of the CAPE-V sentences, which were de-identified and randomized by speaker and time recorded (whether pre or postmeditation).

^{75}

Raters listened using headsets and maintained a consistent volume and setting throughout the listening exercise.

^{75}

评分者聆听参与者朗读 CAPE-V 句子，这些句子已去标识并按说话者及录音时间（冥想前或冥想后）随机排序。

^{75}

评分者使用耳机聆听，并在整个聆听过程中保持音量和设置的一致性。

Statistical analysis统计分析

Statistical analyses were conducted using SAS 9.4 software (SAS, Cary, NC). Univariate analysis was performed to check normality of the data and the skewed data was log transformed. Student’s two sample

t I

-test and paired

t

-test was utilized to evaluate between and within group differences for cases and controls, respectively. The two-sample

t

test for variables with prepost measures used gained score (Post-Pre) as the outcome variable. A correlation matrix was used to evaluate agreement between raters for the audi-tory-perceptual ratings.
统计分析使用 SAS 9.4 软件（SAS，Cary，NC）进行。对数据进行单变量分析以检验正态性，对偏态数据进行了对数转换。采用学生两样本

t I

检验和配对

t

检验分别评估病例组和对照组之间及组内差异。对于具有前后测量的变量，使用两样本

t

检验，采用得分变化（后测-前测）作为结果变量。采用相关矩阵评估听觉感知评分者之间的一致性。

RESULTS结果

Participant recruitment and demographics
参与者招募及人口统计学特征

Nineteen vocally healthy (VH) participants and 26 participants with a common voice disorder (CVD) were recruited. The mean age of participants was 35.5 years old (

SD = 11.4

; age range

= 19 - 59

) in the VH group, and 46 years old (SD 14.11; age range

= 25 - 80

) in the CVD group. Recruitment was halted in March 2020 due to the COVID-19 pandemic limiting in-person clinical and research operations. Of the CVD participants, 20(77%) were diagnosed with primary muscle tension dysphonia, and six (

23 %

) were diagnosed with a benign vocal fold lesions (Table 1).
共招募了 19 名声音健康（VH）参与者和 26 名患有常见声音障碍（CVD）的参与者。VH 组参与者的平均年龄为 35.5 岁（

SD = 11.4

；年龄范围

= 19 - 59

），CVD 组为 46 岁（标准差 14.11；年龄范围

= 25 - 80

）。由于 COVID-19 疫情限制了现场临床和研究操作，招募于 2020 年 3 月停止。在 CVD 参与者中，20 人（77%）被诊断为原发性肌张力性发声障碍，6 人（

23 %

）被诊断为良性声带病变（见表 1）。

Primary outcomes主要结果

Mean Phonatory Airflow Neither group demonstrated a significant change in mean phonatory airflow during connected
平均发声气流两组在连贯发声过程中均未表现出平均发声气流的显著变化

TABLE 1.表 1.
Participant Demographics
参与者人口统计信息

	VH ( $N = 19$ )VH（ $N = 19$ ）	CVD ( $N = 26$ )CVD（ $N = 26$ ）
Age - Mean (SD) 年龄 - 平均值（标准差）	35.30 (11.41)	46.04 (15.11)
Sex, $N$ (%)性别， $N$ （%）
Male男性	5 (26.32%)	4 (15.38%)
Female女性	14 (73.68%)	22 (84.62%)
Race, $N$ (%)种族， $N$ （%）
Asian亚洲人	3 (15.79%)	4 (15.38%)
Black or African American 黑人或非裔美国人	4 (21.05%)	9 (34.62%)
White白人	10 (52.63%)	9 (34.62%)
More than one race 多种族	0 (0.0%)	3 (11.54%)
Unknown未知	2 (10.53%)	1 (3.85%)
Diagnosis, $N$ (%)诊断， $N$ （%）
Vocal Fold Lesions +/MTD 声带病变 +/MTD	NA	6 (23.07%)
Primary MTD原发性 MTD		20 (76.92%)

speech (The Rainbow Passage) from pre to postMM (Table 2). The CVD group had a statistically significant increase in mean phonatory airflow for repeated, sustained vowel (

P < 0.05

) (Table 2). Mean phonatory airflow increased in nine of 26 (

35 %

) CVD. Of these participants, three had a therapeutic improvement (from below normal to within normal limits). Additionally, no significant difference between group change (Table 3).
语音（彩虹段落）从冥想前到冥想后（表 2）。CVD 组在重复的持续元音（

P < 0.05

）的平均发声气流量上有统计学显著增加（表 2）。26 名 CVD 中有 9 名（

35 %

）的平均发声气流量增加。在这些参与者中，三人有治疗性改善（从低于正常到正常范围内）。此外，组间变化无显著差异（表 3）。

Qualitative analysis of participant perception of the voice
参与者对声音感知的定性分析

In response to the question “What difference, if any, did you experience during the speech tasks as a result of the mindfulness practice?” three themes were identified: (1) reduction of emotional stress, (2) improvement in the sound or feel of the voice and breath, (3) change in physical state (increased relaxation, reduced tension, calmness).
针对“在进行正念练习后，你在语音任务中体验到了哪些变化（如果有的话）？”这一问题，识别出三个主题：（1）情绪压力的减轻，（2）声音或呼吸的改善，（3）身体状态的变化（放松增加、紧张减少、平静）。

Theme 1: Participants experienced a reduction in stress levels. This theme encompasses all responses referencing an improvement in mental or emotional state. When not cited in reference to a specific reduction of physical tension, mentions of “relaxation” and “calmness” were included. Select participant response include feeling “calmer, less agitated and stressed,” “my overall mood felt calmer,” “(my) mind felt more relaxed,” “felt a bit more settle(d),” and “more calm, relaxed, at ease post meditation. More steady and grounded. . .” Several participants also cited experiencing a reduction of anxiety or quick thoughts; “I felt my thoughts slow down,” “I feel good and worry free, also boost (of) confidence.”
主题一：参与者感受到压力水平的降低。该主题涵盖所有提及心理或情绪状态改善的回答。当未特别指身体紧张的减轻时，提及“放松”和“平静”的内容也被纳入其中。部分参与者的回答包括感到“更平静，不那么激动和紧张”，“整体情绪更平稳”，“（我的）思绪更放松”，“感觉稍微安定了一些”，以及“冥想后更平静、放松、自在。更加稳定和扎实……”。还有几位参与者提到焦虑或思绪快速流动的减少；“我感觉思绪放慢了”，“我感觉良好且无忧无虑，自信心也提升了”。

Theme 2: Participants experienced an improvement in the sound or feel of the voice and breath. Responses range from a general acknowledgement of change or improvement (“I do feel a difference in my voice”, “I felt only a slight change in my voice quality after the meditation”) to more specific.
主题二：参与者体验到声音或呼吸的改善。反应从对变化或改善的一般认可（“我确实感觉到我的声音有变化”，“冥想后我只感觉到声音质量有轻微变化”）到更具体的描述。

Participants who noted a change in the sound of their voice postmeditation referenced a voice that was “not as crackly”, “fading away”, or that it “broke’ a lot less the second time around”. More specifically, there was a mention of “less vocal fry” and “my “ahs” started to sound on my voice and in my resonance”. Among those who noted a change in the feel of their voice postmeditation, there were several mentions of the voice being “easier to speak”, “more relaxed” or more “comfortable”. Select responses from participants also mentioned feeling “more in control of breathing and tone of voice”, “I feel my voice opening up a bit”, and “I felt like it was a little easier to speak and I didn’t have to use as much force to push words out.”
注意到冥想后声音变化的参与者提到声音“不那么沙哑”、“逐渐消失”，或者“第二次时声音断裂少了很多”。更具体地，有人提到“减少了声带摩擦音”和“我的‘啊’声开始在我的声音和共鸣中显现出来”。在那些注意到冥想后声音感觉变化的参与者中，有几人提到声音“更容易说话”、“更放松”或更“舒适”。部分参与者还提到感觉“更能控制呼吸和声音的音调”，“我感觉我的声音有点打开了”，以及“我觉得说话更轻松了，不需要用那么大的力气去发声”。

Because of the relationship between phonation and respiration, responses involving changes in the feel of breathing or breathing patterns were also included. Responses included changes in ease or tension; “…less tension with prephonatory breathing, and easier breathing in general”, “I felt it was easier to put breath in and strength behind my words”, “. . . I also felt easy on [sic] catching my breath”, “I felt it became easier to focus on my breath over time”, "I felt some mild change in my breathing, feeling slightly more
由于发声与呼吸之间的关系，涉及呼吸感觉或呼吸模式变化的反应也被包括在内。反应包括轻松度或紧张度的变化；“…发声前呼吸时紧张感减少，整体呼吸更轻松”，“我觉得吸气更容易，话语更有力”，“……我也觉得更容易喘息”，“我觉得随着时间推移，专注于呼吸变得更容易”，“我感觉呼吸有些轻微变化，感觉稍微更

TABLE 2.表 2.
VH and CVD Participants, Primary Outcome - Mean Phonatory Airflow
VH 和 CVD 参与者，主要结果——平均发声气流

Variable变量	Vocally Healthy声音健康			Common Voice Disorder常见语音障碍
Variable变量	Pre-Meditation M (SD)冥想前平均值（标准差）	Post-Meditation M (SD)冥想后平均值（标准差）	$p$	Pre-Meditation M (SD)冥想前平均值 (标准差)	Post-Meditation M (SD)冥想后平均值 (标准差)	$p$
Rainbow Passage Mean Phonatory Airflow (l/s) 彩虹段平均发声气流量 (升/秒)	104.74 (50.15)	103.68 (47.87)	0.858	140.77 (91.69)	139.62 (67.97)	0.904
Sustained Vowel Mean Phonatory Airflow (l/s) 持续元音平均发声气流量 (升/秒)	113.07 (56.1)	122.28 (62.07)	0.230	148.21 (107.58)	175.77 (123.42)	0.012

TABLE 3.表 3.
Change score - Mean Phonatory Airflow
变化分数 - 平均发声气流

	Vocally Healthy声音健康	Common Voice Disorder常见语音障碍	$P$
	Mean Change, Pre- to Postmeditation 平均变化，冥想前后	Mean Change, Pre- to Postmeditation 平均变化，冥想前后	$P$
Rainbow passage - Mean phonatory airflow (l/s) 彩虹段落 - 平均发声气流量（升/秒）	-1.05	-1.15	0.99
Sustained vowel - Mean phonatory airflow (l/s) 持续元音 - 平均发声气流量（升/秒）	9.21	27.56	0.185

at ease". Others reported changes in breathing patterns or coordination; “I was focusing a little more on taking breaths in natural places rather than saying a whole sentence in one breath”, or “I . . .was using less breath overall after the meditation, including with my voice. . .”.
“放松”。其他人报告了呼吸模式或协调性的变化；“我开始更多地关注在自然的地方吸气，而不是一口气说完整句话”，或者“我……在冥想后整体用气量减少了，包括说话时的用气……”。

Finally, participant response of feeling “less tension in my neck and throat” was included in this theme. Some participants specifically mentioned not experiencing an improvement in the sound or feel of the voice and breath.
最后，参与者感受到“颈部和喉咙的紧张感减轻”也被归入此主题。一些参与者特别提到没有感受到声音或呼吸的改善。

Theme 3: Participants experienced a change in physical state (increased physical relaxation, reduced tension, physical calmness). The most frequently mentioned experience was that of the body feeling more “relaxed”. This was often generally stated (“my body was more relaxed…” or “I could feel my body relax”) or used to describe a specific site of relaxation, ie"physically, my usual tense spots (neck,
主题三：参与者体验到身体状态的变化（身体放松增加，紧张感减少，身体平静）。最常提到的体验是身体感觉更加“放松”。这通常是笼统地表达（“我的身体更放松了……”或“我能感觉到身体放松了”），也用来描述特定的放松部位，即“身体上，我平时紧张的部位（颈部，
shoulder, brow) felt much more relaxed", “. . . I have TMJ (Temporomandibular Joint dysfunction) but after my meditation my jaw felt more relaxed”. Most frequently mentioned was a feeling of relaxation in the shoulders. Participants also mentioned feeling more “comfortable” or experiencing “less overall tension in my body”.
肩膀、眉毛）感觉更加放松”，“……我有颞下颌关节功能障碍（TMJ），但冥想后我的下巴感觉更放松”。最常提到的是肩膀的放松感。参与者还提到感觉更“舒适”或“身体整体紧张感减少”。

Secondary outcome(s)次要结果

State Anxiety (STAI) A statistically significant decrease in state anxiety (improvement) was observed between baseline and postmeditation voice for both the VH (

M = - 10.74, P <

0.001 ) and CVD (

M = - 11.23, P < 0.001

) groups (Table 4). There was no statistically significant difference in change of state anxiety between groups (

P = 0.634

) (Table 5).
状态焦虑（STAI）在基线和冥想后声音之间，VH 组（

M = - 10.74, P <

0.001）和 CVD 组（

M = - 11.23, P < 0.001

）的状态焦虑均有统计学显著下降（改善）（表 4）。两组之间状态焦虑变化无统计学显著差异（

P = 0.634

）（表 5）。

TABLE 4.表 4。
VH AND CVD - STAI State Anxiety
VH 和 CVD - STAI 状态焦虑

Variable变量	Vocally Healthy声音健康			Common Voice Disorder常见声音障碍
Variable变量	Pre-Meditation M (SD)冥想前平均值 (标准差)	Post-Meditation M (SD)冥想后平均值 (标准差)	$p$	Pre-Meditation M (SD)冥想前平均值 (标准差)	Post-Meditation M (SD)冥想后平均值 (标准差)	$p$
STAI -state anxietySTAI -状态焦虑	37.53 (9.66)	26.79 (5.27)	<0.001	39.15 (12.24)	27.92 (9.56)	<0.001

TABLE 5.表 5。
Change Score - STAI
变化分数 - STAI

	VH	CVD	Between group $P$ 组间 $P$
	Mean Change, Pre to Post Meditation 冥想前后平均变化	Mean Change, Pre to Post Meditation 冥想前后平均变化	Between group $P$ 组间 $P$
STAI - State Anxiety STAI - 状态焦虑	-10.74	-11.23	0.634

Secondary aerodynamic and acoustic outcomes The VH group demonstrated statistically significant decrease in Mean SPL during the sustained vowel task (

M = - 1.552, P

= 0.012

) and CPP during the CAPE-V sentence “we were away a year ago” (

M = - 0.663, P = 0.003

) (Table 6). There was a statistically significant difference (

P = 0.013

) between group change in CPP on the CAPE-V sentence “we were away a year ago” with VH demonstrating a decrease in CPP (M = -0.663) and CVD demonstrating an increase (

M = 0.215

) (Table 7). No other changes in acoustic or aerodynamic variables from pre to postmeditation were statistically significant either within groups, or between groups.
次要气动和声学结果 VH 组在持续元音任务中显示出平均声压级（Mean SPL）的统计学显著下降（

M = - 1.552, P

= 0.012

），以及在 CAPE-V 句子“we were away a year ago”中的共振峰峰值（CPP）显著下降（

M = - 0.663, P = 0.003

）（表 6）。在 CAPE-V 句子“we were away a year ago”中，CPP 的组间变化存在统计学显著差异（

P = 0.013

），VH 组表现为 CPP 下降（M = -0.663），而 CVD 组表现为 CPP 上升（

M = 0.215

）（表 7）。在冥想前后，其他声学或气动变量在组内或组间均无统计学显著变化。

Speech breathing, Respiratory Kinematics Student’s

t -

test did not show any between or within group changes in ribcage or abdominal excursion during speech tasks prepost MM (Table 8).
言语呼吸，呼吸运动学学生 t 检验未显示 MM 前后言语任务中肋骨或腹部运动范围在组间或组内有任何变化（表 8）。

Auditory-perceptual analysis
听觉感知分析

A strong correlation (

83 %

) was found between the raters. On an average, the overall severity score for the voices was higher (25.36) post meditation in comparison to premeditation (23.88), however, the values were not statistically significant (

P = 0.651

).
评审者之间发现了较强的相关性（

83 %

）。平均而言，冥想后的声音总体严重程度评分较高（25.36），相比冥想前（23.88），但这些数值在统计学上无显著性差异（

P = 0.651

）。

Baseline group data - surveys
基线组数据 - 调查问卷

At baseline, CVD had a significantly greater mean VHI-10 (17.8 vs. 2.3) and DI (12.9 vs. 3.9) than VH (Table 9). CVD had a significantly lower mean CAMS-R ( 31.2 vs . 36.3) than VH. The mean scores for STAI trat anxiety, STAI state anxiety at baseline, and PSS were comparable for both group (Table 9).
在基线时，CVD 的平均 VHI-10 显著高于 VH（17.8 比 2.3），DI 也显著高于 VH（12.9 比 3.9）（表 9）。CVD 的平均 CAMS-R 显著低于 VH（31.2 比 36.3）。两组在基线时的 STAI 特质焦虑、STAI 状态焦虑和 PSS 的平均分数相当（表 9）。

DISCUSSION & FUTURE DIRECTIONS
讨论与未来方向

This study is the first known to investigate the immediate effects of a 11.5-minute period of MM on the voice and voice user. While results did not support each of our hypotheses, they confirmed that in addition to experiencing an improvement in emotional, cognitive, and physical states, novice meditators experienced an improvement in the sound and feel of their own voice postMM.
本研究是首个已知的研究，探讨了 11.5 分钟正念冥想（MM）对声音及声音使用者的即时影响。虽然结果未能支持我们所有的假设，但证实了除了情绪、认知和身体状态的改善外，初学冥想者在冥想后也体验到了自己声音的音质和感觉的改善。

Minimal support was found for our primary hypothesis that there would be an increase in mean phonatory airflow postMM. This was hypothesized due to the well documented changes in breathing patterns and heart rate postMM reported in the literature for long-term meditators or following a course of MBSR. Our results indicate that subtle changes in breathing may occur after a single session
对我们主要假设的支持有限，即冥想后平均发声气流会增加。该假设基于文献中长期冥想者或完成正念减压课程（MBSR）后呼吸模式和心率变化的充分记录。我们的结果表明，单次冥想后可能会出现细微的呼吸变化。

TABLE 6.表 6。
VH and CVD Participants, Secondary Aerodynamic and Acoustic Outcomes
VH 和 CVD 参与者，次要气动和声学结果

Variable变量	Vocally Healthy声音健康			Common Voice Disorder常见语音障碍
Variable变量	Pre-Meditation M (SD)冥想前 M（标准差）	Post-Meditation M (SD)冥想后 M（标准差）	$p$	Pre-Meditation M (SD)冥想前 M（标准差）	Post-Meditation M (SD)冥想后 M（标准差）	$p$
The Rainbow Passage彩虹段落
Mean SPL平均声压级	77.81 (1.61)	77.33 (1.76)	0.058	79.4 (2.69)	79.18 (3.0)	0.361
Mean F0平均基频	169.68 (39.09)	167.96 (38.77)	0.082	176.88 (32.69)	175.71 (32.09)	0.343
Sustained Vowel持续元音
Mean SPL平均声压级	83.98 (4.05)	82.42 (3.96)	0.012	85.06 (5.98)	85.11 (5.45)	0.938
Mean pitch - F0 平均音高 - F0	191.72 (52.13)	183.09 (46.57)	0.031	186.43 (41.86)	188.29 (39.6)	0.605
CPP	12.74 (2.22)	12.7 (2.26)	0.910	11.65 (3.29)	11.35 (3.17)	0.346
CPP F0	189.26 (55.72)	185.11 (47.34)	0.535	186.43 (41.12)	181.25 (40.13)	0.263
CSID	2.98 (14.93)	2.65 (13.81)	0.729	11.12 (19.51)	11.82 (19.36)	0.794
Cape-V "We were away a year ago" Cape-V “我们一年前离开了”
CPP	8.22(1.18)	7.55 (1.09)	0.003	6.63 (1.84)	6.84 (1.61)	0.403
CPP F0	178.53 (40.69)	178.36 (35.19)	0.962	182.04 (32.41)	179.59 (33.0)	0.311
CSID	8.12 (9.77)	2.65 (13.81)	0.794	16.93 (17.74)	17.36 (15.5)	0.837

TABLE 7.表 7.
Change Score - Acoustics and Aerodynamics
变化得分 - 声学和气动学

Vocally Healthy声音健康

Common Voice Disorder常见语音障碍

Mean Change, Pre- to Post- meditation
冥想前后平均变化

Between Group P组间 P 值

The Rainbow Passage彩虹段落

Mean SPL平均声压级

-0.474

0.463

-0.221 持续元音

-0.221

Sustained Vowel

Mean SPL平均声压级

-1.552

0.07

Mean Pitch - F0
平均基频 - F0

0.049

-8.634

0.055

1.956

CPP

-0.04

0.557

-0.307

-4.143

0.894

CSID

-5.174

-0.959

0.673

0.699

Cape-V "We were away a year ago"
Cape-V “我们一年前离开了”

CPP

-0.663

0.215

0.013

CPP F0

-0.173

0.5843

-2.450

CSID

3.785

0.257

0.432

MM, however no measurable group change reached significance.
然而，MM 组没有达到显著的可测量群体变化。

Qualitative report of some patients’ experience of changes in their breathing patterns may warrant further individual analysis. As is currently understood, large variability of aerodynamic measures can be expected in participants with MTD. This expected variability could obscure individual changes in performance postMM.

^{76}

In future studies, analyses performed while controlling for either self-reported objective experience (“I did feel a change in my breathing” or “I did not feel a change in my breath”), or for
一些患者对其呼吸模式变化的定性报告可能值得进一步的个体分析。根据目前的理解，患有 MTD 的参与者的气动测量值可能存在较大变异性。这种预期的变异性可能会掩盖 MM 后个体表现的变化。

^{76}

在未来的研究中，可以在控制自我报告的客观体验（“我确实感觉到呼吸有变化”或“我没有感觉到呼吸有变化”）的情况下进行分析，或者控制...
participants’ degree of trait mindfulness might assist in identifying the profiles of those patients within our voice disordered population who would most benefit from this practice.
参与者的特质正念程度可能有助于识别我们声音障碍人群中最能从此练习中受益的患者类型。

During the sustained vowel task, VH demonstrated a decrease in mean SPL and CVD demonstrated an increase in mean phonatory airflow. For connected speech tasks, only one objective change was observed in the VH group postMM; a decrease of CPP during the all-voiced CAPE-V sentence “we were away a year ago”. A change in CPP typically indicates a reduction in strain or an increase of airflow
在持续元音任务中，声音障碍组（VH）表现出平均声压级（SPL）的下降，声带功能障碍组（CVD）表现出平均发声气流的增加。对于连贯语音任务，声音障碍组在正念冥想后（postMM）仅观察到一项客观变化；在全发声的 CAPE-V 句子“we were away a year ago”中，CPP 下降。CPP 的变化通常表示紧张度的降低或气流的增加。

TABLE 8.表 8.
VH and CVD Participants, Speech Breathing
声音障碍组（VH）和声带功能障碍组（CVD）参与者，语音呼吸情况

Variable变量	Vocally Healthy声音健康			Common Voice Disorder常见声音障碍
Variable变量	Pre-Meditation $M$ (SD)冥想前 $M$ (标准差)	Post-Meditation M (SD)冥想后 M（标准差）	$p$	Pre-Meditation M (SD)冥想前 M（标准差）	Post-Meditation M (SD)冥想后 M（标准差）	$p$
Ribcage excursion (% of maximum excursion) 肋骨活动幅度（最大活动幅度的百分比）
Acoustics声学	65.48 (34.98)	65.5 (24.3)	0.537	54.14 (16.11)	57.41 (19.05)	0.299
Rainbow Passage彩虹段落	69.28 (46.54)	73.52 (50.38)	0.475	52.83 (20.2)	52.88 (20.37)	0.986
Normal Breathing正常呼吸	54.43 (22.09)	53.88 (20.26)	0.857	52.97 (16.39)	51.27 (16.73)	0.415
Abdominal excursion (% of maximum excursion) 腹部运动（最大运动的百分比）
Acoustics声学	63.41 (20.86)	64.97 (20.21)	0.792	69.88 (28.79)	72.46 (28.25)	0.376
Rainbow Passage彩虹段落	67.57 (27.16)	70.06 (26.25)	0.599	75.27 (34.49)	74.63 (28.97)	0.862
Normal Breathing正常呼吸	64.83 (22.88)	70.75 (29.76)	0.266	73.31 (26.94)	74.34 (39.39)	0.617

TABLE 9.表 9。
Baseline Data Between Group Comparison
组间基线数据比较

	VH M (SD)VH 平均值（标准差）	CVD M (SD)CVD 平均值（标准差）	$P$
VHI-10	2.26 (2.72)	17.77 (10.02)	<0.001
DI	3.95 (4.90)	12.88 (10.6)	0.0014
STAI Trait AnxietySTAI 特质焦虑	41.47 (9.31)	42.58 (13.19)	0.757
STAI State Anxiety (Baseline) STAI 状态焦虑（基线）	37.53 (9.66)	39.15 (12.24)	0.6336
PSS	17.84 (14.99)	19.38 (16.26)	0.4713
CAMS-R	36.26 (33.37)	31.19 (27.98)	0.02
FFMQ	135.3	128.1	0.2617

as initially hypothesized, however aerodynamic measures were not captured for this task and cannot be confirmed. A change in CPP is most frequently thought to be related to overall severity of voice quality on CAPE-

V^{77}

, but this was not corroborated by perceptual observations. While the number of significant objective observations are not overwhelming, it’s possible that the greater number of changes for VH vs. CVD participants is an indication that this group - by definition of being more vocally healthy - is more susceptible to maintain or generalizing any change in voice use. One explanation for greater changes observed during sustained vowel is that this task draws on fewer of our learned, behavioral speech habits. As we know from voice therapy, it can be easier to change voice quality at the sound level than in connected speech without scaffolding and direct instruction. This may indicate that the suggestions for, or use of an indirect technique such as MM, is much more appropriate for vocally healthy individuals who are more flexible in their voice use patterns.
正如最初假设的那样，然而该任务未采集气动学指标，因此无法确认。CPP 的变化通常被认为与 CAPE-

V^{77}

上声音质量的整体严重程度相关，但这一点未被感知观察所证实。虽然显著的客观观察数量并不多，但 VH 组相比 CVD 组观察到更多变化，可能表明该组——按定义更具声音健康性——更容易维持或推广任何声音使用的变化。持续元音任务中观察到更多变化的一个解释是，该任务较少依赖我们习得的行为性语言习惯。正如我们从语音治疗中所知，在没有支架和直接指导的情况下，在声音层面改变声音质量比在连贯语音中更容易。这可能表明，建议使用或采用间接技术如正念冥想（MM）更适合声音健康、声音使用模式更灵活的个体。

A vast majority of existing research using MM is designed with a more long-term protocol in mind. Considering the typical length of voice therapy,

^{78}

there are a variety of ways in which MM could be implemented in clinical practice. MM might be incorporated into standard voice therapy in a number of ways; not limited to, but including providing time for patients to practice MM prior to each session, or encouraging daily MM practice as an element of their home practice protocol.
绝大多数现有使用正念冥想（MM）的研究都是以更长期的方案为设计考虑。考虑到语音治疗的典型时长，

^{78}

MM 可以通过多种方式在临床实践中实施。MM 可能以多种方式融入标准语音治疗中，包括但不限于在每次治疗前为患者提供练习 MM 的时间，或鼓励将每日 MM 练习作为家庭练习方案的一部分。

Limited adherence to voice therapy is well established as a problem, both intersession adherence to practice

^{79, 80}

and session attendance.

^{81, 82}

It has been posited that some internal characteristic exists that differentiates voice therapy graduates from dropouts,

^{83}

and trait mindfulness has potential to be that characteristic. Trait mindfulness, mediated by motivation, is directly correlated with self-efficacy.

^{84}

Low trait mindfulness may result in reduced awareness of nuances in voice production and as a result, low self-efficacy for production and identification of target voice (“I can’t tell whether I’m doing it right; you tell me.” “When I’m with you I can make that voice, but at home, I don’t know how.”). In an initial evaluation, patients with low trait mindfulness may present with limited stimulability to
有限的语音治疗依从性已被广泛认为是一个问题，包括会话间的练习依从性

^{79, 80}

和会话出席率

^{81, 82}

。有人提出，存在某种内在特质将语音治疗完成者与中途退出者区分开来

^{83}

，而特质正念有可能成为这种特质。特质正念通过动机的中介，与自我效能感直接相关

^{84}

。低特质正念可能导致对语音产生细微差别的意识降低，进而导致对目标语音的产生和识别自我效能感低下（“我无法判断自己是否做对了；你告诉我。”“当我和你在一起时，我能发出那个声音，但在家里，我不知道怎么做。”）。在初次评估中，低特质正念的患者可能表现出对
negative practice of habitual voice and reduced awareness of real-time changes produced with trial therapy techniques. Future research should investigate trait mindfulness and the effect of long-term MM on successful completion of voice therapy.
习惯性语音的负面练习刺激性有限，以及对试验性治疗技术所产生的实时变化的意识降低。未来的研究应探讨特质正念及长期正念冥想对成功完成语音治疗的影响。

LIMITATIONS局限性

Several limitations to this study exist. In addition to those listed above, recruitment to this study was cut short by the COVID-19 pandemic, resulting in reduced sample size, and potentially limiting the ability to generalize our results. Finally, qualitative analysis of participants’ free-response answers is limited by our inability to probe for further clarification or elaboration.
本研究存在若干局限性。除上述列出的限制外，本研究的招募因 COVID-19 疫情而提前终止，导致样本量减少，可能限制了结果的普适性。最后，对参与者自由回答的定性分析受限于我们无法进一步探询以获得更详细的澄清或阐述。

CONCLUSION结论

Results of this study indicate that a single 11.5 -minute session of MM may be beneficial for some patients, but alone, it is not sufficient to override habitual voice and speech patterns. This study affirms that the physical, cognitive, and emotional benefits known to benefit the patient and nonpatient populations are, as expected, seen in novice meditators performing voice tasks. To advertise that meditation or mindfulness practices will benefit vocal physiology in any objective way requires further exploration. However, given the stated positive experiences and the anecdotal interest of the community, is worth of further investigation.
本研究结果表明，单次 11.5 分钟的正念冥想（MM）对部分患者可能有益，但单凭一次冥想不足以改变习惯性的声音和语言模式。本研究确认，已知对患者及非患者群体有益的身体、认知和情绪方面的益处，正如预期，在初学冥想者执行语音任务时也能观察到。若要宣称冥想或正念练习能以任何客观方式改善声带生理功能，还需进一步探究。然而，鉴于参与者所述的积极体验及社区的轶事兴趣，值得进行更深入的研究。

DECLARATION OF INTERESTS
利益声明

None无

Acknowledgments致谢

The authors wish to thank Grace Cutchen, CCC-SLP, Brian Petty, CCC-SLP, and Nathaniel Sundholm, CCC-SLP, for their help as voice-specialized SLPs who provided perceptual ratings and coded qualitative data.
作者感谢 Grace Cutchen, CCC-SLP，Brian Petty, CCC-SLP，以及 Nathaniel Sundholm, CCC-SLP，作为声音专业的语言治疗师，他们提供了感知评分并编码了定性数据。

SUPPLEMENTARY DATA补充数据

Supplementary data related to this article can be found online at doi:10.1016/j.jvoice.2022.10.022.
与本文相关的补充数据可在线查阅，网址为 doi:10.1016/j.jvoice.2022.10.022。

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Accepted for publication October 24, 2022.
2022 年 10 月 24 日接受发表。
From the $9 E m o r y$ Healthcare, Department of Otolaryngology, Atlanta, Geogia; $†$ Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Geogia; and the $‡$ Department of Otolaryngology, Emory University School of Medicine, Atlanta, Geogia.
来自 $9 E m o r y$ 医疗保健，耳鼻喉科，佐治亚州亚特兰大； $†$ 姑息医学部，家庭与预防医学系，埃默里大学医学院，佐治亚州亚特兰大；以及 $‡$ 耳鼻喉科，埃默里大学医学院，佐治亚州亚特兰大。
Address correspondence and reprint requests to Diana Rose Becker, 550 Peachtree Street NE The Emory Voice Center, Atlanta, GA, 30308. E-mail: Diana. Becker@emoryhealthcare.org
通讯及重印请求请寄至 Diana Rose Becker，地址：550 Peachtree Street NE，The Emory Voice Center，亚特兰大，GA，30308。电子邮件：Diana.Becker@emoryhealthcare.org

Journal of Voice, Vol. 39, No. 3, pp. 718-727
《声音杂志》，第 39 卷，第 3 期，第 718-727 页
0892-1997
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
© 2022 声音基金会。由爱思唯尔公司出版。版权所有。
https://doi.org/10.1016/j.jvoice.2022.10.022
Abbreviations: CPP, cerebral perfusion pressure;CSID, Congenital sucrose-isomaltase deficiency
缩略语：CPP，脑灌注压；CSID，先天性蔗糖-异麦芽糖酶缺乏症

Immediate Effects of Mindfulness Meditation on the Voice 正念冥想对声音的即时影响