Training speech therapists in Cognitive Behavioural Therapy to treat Medically Unexplained Dysphonia: A Trial Platform
Lead Research Organisation:
Newcastle University
Department Name: Inst of Health and Society
Abstract
Medically Unexplained Symptoms (MUS), i.e. physical symptoms in the absence of physical disease, account for up to 30% of medical consultations. For a substantial minority, symptoms develop into chronic and disabling conditions such as Chronic Fatigue Syndrome or Fibromyalgia. Currently the best treatment for these conditions is cognitive behavioural therapy (CBT). However CBT therapists are scarce, so there has been a move to teach CBT skills to other health professionals dealing with these conditions. This forms the background to our project. Our aim is to develop a CBT enhanced treatment package that can be delivered by Speech Therapists to improve the voice and quality of life in patients with Functional Dysphonia, an MUS where people experience unexplained voice loss or hoarseness. Our research brings together Britain‘s leading dysphonia research team with a MUS-specialized CBT therapist. We will initially develop and test the treatment in an study comparing standard voice therapy to CBT enhanced treatment in 62 patients. We will use these findings to design a much larger trial to further test the feasibility of passing on clinically useful CBT skills. A positive finding will have far reaching benefits not only for dysphonia but for the treatment of MUS in general.
Technical Summary
Functional dysphonia is the commonest disorder presenting to voice clinicians in the UK. It affects not only communication, but is also associated with anxiety, depression, poor general health and reduced quality of life. Voice therapy alone improves quality of speech but not these other factors. Our pilot study proved that training a Speech and Language Therapist (SLT) in cognitive behavioural therapy (CBT) skills is feasible within a relatively short timescale and that this seems effective in significantly improving voice and reducing distress. The study was limited by small numbers and baseline between group differences, but our findings support and inform the design of the proposed trial platform.
The overall objectives of the trial platform are: to refine and develop our CBT model of dysphonia; to refine and develop our prototype CBT training package and treatment of dysphonia by SLTs; to conduct a feasibility and exploratory efficacy study of the training and treatment; to use the data from this exploratory study to inform the design and power calculation of a definitive Phase 3 cluster-randomised trial (CRT) of this intervention. Phase 1 of the trial platform will consist of analyzing existing baseline data and collecting new baseline data to develop the CBT model, treatment and training packages. Phase 2 will be an exploratory randomised trial of the Phase 1 materials, where approximately 60 patients will be randomised to either speech therapy alone or speech therapy plus CBT. Both treatments will be manualised and delivered by the same therapist who will have received a brief training in CBT. Data collected at this stage will include the SLTs protocol adherence, the estimation of likely patient recruitment and attrition rates, the assessment of the reliability and responsiveness of a range of both voice and quality of life outcome measures. In Phase 3 the fellow will lead on utilizing the data from phases 1 and 2 to design a definitive cluster-randomised trial, if merited by the results from phase 2.
CBT has grade 1 evidence of its effectiveness in treating medically unexplained symptoms (MUS), but skilled practitioners are scarce. As MUS account for up to 30% of specialised medical referrals, the proposed study would be a substantial contribution to the assessment of the feasibility and effectiveness of targeting this population by providing brief CBT training interventions to non mental health professionals and would develop the fellow as a unique source of expertise in this burdensome area.
The overall objectives of the trial platform are: to refine and develop our CBT model of dysphonia; to refine and develop our prototype CBT training package and treatment of dysphonia by SLTs; to conduct a feasibility and exploratory efficacy study of the training and treatment; to use the data from this exploratory study to inform the design and power calculation of a definitive Phase 3 cluster-randomised trial (CRT) of this intervention. Phase 1 of the trial platform will consist of analyzing existing baseline data and collecting new baseline data to develop the CBT model, treatment and training packages. Phase 2 will be an exploratory randomised trial of the Phase 1 materials, where approximately 60 patients will be randomised to either speech therapy alone or speech therapy plus CBT. Both treatments will be manualised and delivered by the same therapist who will have received a brief training in CBT. Data collected at this stage will include the SLTs protocol adherence, the estimation of likely patient recruitment and attrition rates, the assessment of the reliability and responsiveness of a range of both voice and quality of life outcome measures. In Phase 3 the fellow will lead on utilizing the data from phases 1 and 2 to design a definitive cluster-randomised trial, if merited by the results from phase 2.
CBT has grade 1 evidence of its effectiveness in treating medically unexplained symptoms (MUS), but skilled practitioners are scarce. As MUS account for up to 30% of specialised medical referrals, the proposed study would be a substantial contribution to the assessment of the feasibility and effectiveness of targeting this population by providing brief CBT training interventions to non mental health professionals and would develop the fellow as a unique source of expertise in this burdensome area.
Organisations
- Newcastle University, United Kingdom (Collaboration, Lead Research Organisation)
- Royal Victoria Infirmary (Collaboration)
- University of Edinburgh, United Kingdom (Collaboration)
- Durham University, United Kingdom (Collaboration)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (Collaboration)
- Northumbria University (Collaboration)
- King's College London, United Kingdom (Collaboration)
- Northumbria University, United Kingdom (Fellow)
People |
ORCID iD |
Vincent Deary (Principal Investigator / Fellow) |
Publications

Carding, P & Deary, V
(2013)
International perspectives on voice disorders and research

Chalder T
(2010)
Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: a randomized controlled treatment trial.
in Psychological medicine

Daniilidou P
(2007)
Cognitive behavioral therapy for functional dysphonia: a pilot study.
in The Annals of otology, rhinology, and laryngology

Deary V
(2011)
Reconsidering the role of psychosocial factors in functional dysphonia.
in Current opinion in otolaryngology & head and neck surgery

Deary V
(2007)
The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review.
in Clinical psychology review

Deary V
(2018)
A psychosocial intervention for the management of functional dysphonia: complex intervention development and pilot randomised trial.
in Pilot and feasibility studies

Deary V
(2010)
Personality and perfectionism in chronic fatigue syndrome: a closer look.
in Psychology & health

Deary V
(2008)
A precarious balance: using a self-regulation model to conceptualize and treat chronic fatigue syndrome.
in British journal of health psychology

Moss Morris, R; Deary, V And Castell, B
(2012)
Neurological Rehabilitation, Volume 110 of the Handbook of Clinical Neurology

O'Hara J
(2011)
Relationship between fatigue, perfectionism, and functional dysphonia.
in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
Description | SLT Training |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Influenced training of practitioners or researchers |
Description | Action for M.E. |
Amount | £11,500 (GBP) |
Organisation | Action for M.E. |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 09/2012 |
End | 09/2014 |
Description | NIHR Research for Patient Benefit (RfPB) Programme: |
Amount | £240,000 (GBP) |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 10/2013 |
End | 10/2015 |
Description | NIHR-HTA |
Amount | £980,000 (GBP) |
Organisation | National Institute for Health Research |
Department | Health Technology Assessment Programme (HTA) |
Sector | Public |
Country | United Kingdom |
Start | 05/2011 |
End | 01/2015 |
Description | Public Engagement and Impact Grant |
Amount | £2,850 (GBP) |
Organisation | Higher Education Funding Council for England |
Sector | Public |
Country | United Kingdom |
Start | 02/2012 |
End | 02/2013 |
Description | CBT for Vaso-vagal Syncope (VVS) |
Organisation | Royal Victoria Infirmary |
Country | United Kingdom |
Sector | Hospitals |
PI Contribution | PI on NIHR RfPB fto develop a novel CBT intervention for VVS |
Collaborator Contribution | New partnerships with consultants and psychologists which have lead to further projects |
Impact | NIHR grant application, not successful, but will recycle. |
Start Year | 2010 |
Description | CBT for fear of falling in the elderly |
Organisation | Newcastle University |
Department | Institute of Health and Society |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Designed a protocol for developing and delivering a complex intervention to target fear of falling in elderly population. |
Collaborator Contribution | Access to clinical population. |
Impact | This lead to a successful bid to the NIHR HTA targetted call for proposals in this area. |
Start Year | 2010 |
Description | Chronic Fatigue Syndrome in adolescents |
Organisation | King's College London |
Department | Institute of Psychiatry, Psychology & Neuroscience |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Worked with Professor Trudie Chalder in development and trial of CBT intervention for adolescents with chronic fatigue syndrome |
Collaborator Contribution | Clinical and research colloboration. |
Impact | Published results of trial this year. Also, with same collaborator, have published work on personality factors in development of chronic fatigue syndrome (see publications) |
Description | Development of Fatigue Intervention |
Organisation | Newcastle University |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Co-applicant on an NIHR programme grant to develop fatigue services across various medical conditions. |
Collaborator Contribution | Has lead to access to and work relating to patients with Sjogrens disease which forms part of my PhD students work |
Impact | NIHR Programme Grant submission was not successful but the parners are now working on a sleep study in CFS/ME which has been the subject of a successful Action for ME Grant |
Start Year | 2011 |
Description | Development of Fatigue Intervention |
Organisation | Newcastle upon Tyne Hospitals NHS Foundation Trust |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Co-applicant on an NIHR programme grant to develop fatigue services across various medical conditions. |
Collaborator Contribution | Has lead to access to and work relating to patients with Sjogrens disease which forms part of my PhD students work |
Impact | NIHR Programme Grant submission was not successful but the parners are now working on a sleep study in CFS/ME which has been the subject of a successful Action for ME Grant |
Start Year | 2011 |
Description | Development of a theoretical model of mental health and well-being |
Organisation | Northumbria University |
Department | School of Life Sciences Northumbria |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Co-applicant with input on health psychology aspects of grant to develop methodology to guide complex intervention development in life long well being. |
Collaborator Contribution | Access to clinical populations |
Impact | Submission of an MRC LLHW grant, not successful. |
Start Year | 2010 |
Description | Development of personality theory |
Organisation | University of Edinburgh |
Department | Psychology |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Working with Wendy Johnson to apply insights from Cognitive Behavioural theory and practice to personality theory. |
Collaborator Contribution | ideas |
Impact | So far only one short paper (see publications) , and one commentary piece in European Journal of Personality Volume 22 Issue 5, Pages 385 - 409 but ongoing |
Start Year | 2008 |
Description | Food and Psychosocial Intervention for Head and Neck Cancer Survivors |
Organisation | Durham University |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Development of the psychological part of the intervention protocol |
Collaborator Contribution | Access to new patient groups |
Impact | Submission of an NIHR RfPB grant application which was successful. |
Start Year | 2010 |
Description | Sleep Snorer Intervention Development |
Organisation | Durham University |
Department | School of Applied Social Sciences |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Complex Intervention Development Expertise and CBT skills |
Collaborator Contribution | Qualitative Expertise |
Impact | A patient and public involvement HEIF Grant. |
Start Year | 2012 |
Title | CBT enhanced voice therapy for functional dysphonia. |
Description | A CBT enhanced voice therapy intervention for patients suffering from functional dysphonia. Accompanied by patient treatment manual. |
Type | Therapeutic Intervention - Psychological/Behavioural |
Current Stage Of Development | Small-scale adoption |
Year Development Stage Completed | 2009 |
Development Status | Under active development/distribution |
Clinical Trial? | Yes |
Impact | Has become standard practice for therapist involved in trial, and CBT enhanced voice therapy is now routinely available to clients referred to the Freeman Hospital in Newcastle for functional dysphonia. |
URL | http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=4588 |
Title | Complex Intervention Development Methodology |
Description | The complex intervention development methodology worked out in the course of this research is currently being used in an NIHR HTA Grant to develop interventions for fear of falling in older adults. We have also piloted this methodology in a group of head anmd neck cancer patients. |
Type | Therapeutic Intervention - Psychological/Behavioural |
Current Stage Of Development | Initial development |
Year Development Stage Completed | 2012 |
Development Status | Under active development/distribution |
Clinical Trial? | Yes |
Impact | has illuminated the phenomenon of fear of falling, currently being prepared for publication. |
URL | http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=4588 |
Description | CBT for SLTs workshops |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Health professionals |
Results and Impact | In conjunction with Freeman Hospital Speech Voice and Swallowing Clinic, Newcastle. As a result of the cognitive behavioural model and training package developed as part of research have delivered training workshops to speech and language therapists in region Clear change in practice of speech and language therapists within my purview as evinced by clinical discussions |
Year(s) Of Engagement Activity | 2007,2008,2009,2010,2011,2012 |
Description | Medical Teaching |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | Yes |
Type Of Presentation | Workshop Facilitator |
Geographic Reach | Local |
Primary Audience | Health professionals |
Results and Impact | Lectures to 1st year medical students on a CBT approach to the management of physical symptoms Content of lecture will form part of examined curriculum |
Year(s) Of Engagement Activity | 2009,2010,2011,2012 |
Description | SLT Teaching |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | Yes |
Type Of Presentation | Workshop Facilitator |
Geographic Reach | Local |
Primary Audience | Health professionals |
Results and Impact | Workshops to SLTs on the CBT approach to the management of voiced disorders developed in the research. Now part of core examined curriculum and clinical skills training |
Year(s) Of Engagement Activity | 2009,2010,2011,2012 |
Description | Sage Centre Event |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Organised by the Sage Arts Centre in Newcastle Upon Tyne, a day for the public on Voice and Health in which I presented a lay version of the cognitive behavioural model developed as part of research. Have been asked to contribute to training of Sage staff in future. |
Year(s) Of Engagement Activity | 2009 |