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M11 A preliminary biopsychosocial model of Vocal Cord Dysfunction (VCD)
  1. CC Maskell1,
  2. N Pargeter1,
  3. J Fellows1,
  4. A Mansur1,
  5. R Howard2
  1. 1Birmingham Heartlands Hospital, Birmingham, UK
  2. 2University of Birmingham, Birmingham, UK

Abstract

Introduction Vocal cord dysfunction (VCD) can have a significant impact on breathing ability and quality of life.1 Psychological factors can contribute to the onset and maintenance of the condition.2 Little has been written about the patient experience of VCD; therefore this study sought to understand what it is like to live with the condition and develop a preliminary model of VCD.

Methods Six adults diagnosed with VCD were interviewed and full transcripts of each interview were analysed via Interpretive Phenomenological Analysis.3 Six themes were generated reflecting the experiences of living with VCD. Next, the relationships between the themes were explored diagrammatically for each participant. Key phenomena or processes were fed into a summary cross-case diagram, which hypothesised how common aspects of the VCD experience may affect quality of life.

Results It is theorised that three key elements are interacting to influence quality of life: (1) bodily sensations, such as throat tightening, wheeze and cough can feed into a cycle of panic that exacerbates symptoms; (2) unpleasant or traumatic memories can lead to hyper-vigilance for symptoms, worry and social withdrawal; (3) enabling patients to understand, prepare and cope with the physical and mental aspects of VCD can reduce the impact of VCD on quality of life. Furthermore, environmental factors, such as the general lack of knowledge about the condition, can exacerbate negative experiences of VCD.

Conclusions We posit a biopsychosocial model of VCD which requires multidisciplinary treatment. In addition to speech and language therapy for throat-based symptoms, psychological interventions should be considered to address both thoughts about VCD and unpleasant memories. There is also an urgent need to improve and disseminate knowledge of the condition generally amongst medical professionals.

References 1 Mansur AH. Vocal cord dysfunction. In: Palange P, Simonds AK, eds. European respiratory society handbook: Respiratory medicine. 2nd edn. Sheffield, England: European Respiratory Society, 2013: 274–279

2 Morris MJ, Oleszewski RT, Sterner JB, Allan PF. Vocal cord dysfunction related to combat deployment. Mil Med. 2013;178(11):1208–12

3 Willig C. Introducing qualitative research in psychology. Buckingham: Open University Press, 2009

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