Can Trauma Affect Your Voice? An Interview with Elisa Monti, PhD — Mindsplain
By: Michael C. Kinsey
Tags: PTSD, Trauma, Voice, Vocal Disorder, Trauma And Voice

Elisa Monti, PhD Bio

Elisa Monti is a voice-specialized experimental psychologist. She received her doctorate from The New School for Social Research. Her concentration is the relationship between psychological trauma and measures of voice. Her mission is to contribute to further understanding of the relationship between trauma and voice.

Elisa is a collaborator of the Helou Laboratory at the University of Pittsburgh and is affiliated with New York Speech Pathology. Elisa is now completing Level III Montello Method for Performance Wellness Certification and is certified in Vocal Psychotherapy (trained by Dr. Diane Austin). Elisa is the founder of the Voice and Trauma Research and Connection Group.

Dr. Monti’s Career Path

Q: Tell me a little about where you are now in your career and the path you’ve taken to get here.

Thank you for a question that helps me look back and reflect on what my path has been. My purpose in life is to contribute to the understanding of the relationship between psychological trauma and the voice. This “field” is not yet established and research still needs to go a long way. I have therefore founded voiceandtrauma.com, a platform for conversations among experts on this topic.

Currently, I call myself a researcher and a Performance Wellness therapist. The path to get here was certainly marked by educational steps, such as getting my PhD in experimental psychology and my certification in the Montello Method for Performance Wellness as well as my certification in Vocal Psychotherapy. I am passionate about research as it is the part that helps pose questions in a certain way and at least strive for some objectivity in my quest for answers about the links between traumatic experiences and voice.

My work as a Performance Wellness therapist helps me get closer to the inner world of individuals and it has been very humbling for me. My clients are generally creative individuals who deal with various kinds of emotional blocks, performance anxiety and trauma.

So, I would say that currently I am divided between research, client works, and connecting with others who share my same interest in the trauma-voice relationship.

What is Trauma?

Q: Trauma is a term thrown around a lot these days. How do you conceptualize trauma? What are the hallmarks? What are the common misconceptions you observe others having?

I think conceptualizations and terminology for trauma have been changing throughout the years. Trauma can be described as a particularly emotionally distressing event that happens to a person with potentially long-term effects on one’s wellbeing. Perhaps the most up-to-date conceptualization of trauma is that trauma is not necessarily the event itself, but trauma is how the nervous system responds to the event.

I think the hallmarks of trauma are several, but at the core is a change in one’s ability to deal with everyday situations in the same way that one used to before the trauma. Connecting with others may have become difficult, sounds may have become unbearable, falling asleep may be a challenge. One might see themselves and their world differently than they did before.

I believe that a big misconception is what “counts” as trauma and the frequency of trauma occurrence. If we think about childhood trauma specifically, survivors of abuse and neglect worldwide are at least 1 in 5, but if you ask individuals outside of the field to take a guess, they will probably tell you it’s 1 in 100 or something along those lines.

Also, I think people often focus on what they believe is “bad enough” to be considered trauma. Again, if one’s system reacts exhibiting post-traumatic reactivity, the person has suffered trauma. Importantly, on an ethical level, I think we cannot tell anyone that what they considered traumatizing is not.

Discovering the Connection Between Trauma and Voice

Q: How did you first become aware of the possible connection between trauma and the voice?

I initially became very fascinated with the connections between one’s past and the voice a very long time ago, when I was in musical theater school, specifically at the American Musical and Dramatic Academy.

I remember watching peers sing songs beautifully and flawlessly until they were in a particularly triggering situation, a personal rough patch or difficulties with specific professors around whom they felt insecure or vulnerable. Suddenly their voices were unable to do what they would normally do.

I remember being stunned by those instances, especially because no one seemed interested in discussing these potential connections. The “fix” was always technical, there was never an acknowledgment of the emotional mechanisms underlying elements in a voice changing suddenly.

How Trauma Affects the Voice

Q: How do you understand the connection between trauma and voice? What is the pathway through which trauma influences voice?

This is my favorite question as it is the question that my passion revolves around! The connection between trauma and voice is widely discussed, but not yet researched enough. There are probably several pathways that we still have to investigate.

One possible connection can exist in how trauma impacts physiology and therefore potentially the physiological systems of the vocal apparatus. The voice is incredibly complex, and because saying what we need to say comes so naturally, we often take this complexity for granted.

When we speak, several steps occur, beginning with respiration, then to phonation (vocal folds vibrating) to resonation (oral tract cavities change shape when we speak) to articulation (e.g. lips moving).

Also, the brain is involved in all of these mechanisms at various levels. One could argue that any of these elements could be physiologically indirectly influenced by trauma which can then impact the voice.

The investigative works needs to uncover all of these layers.

“Voice” as a Metaphor

Q: “Voice” is an interesting topic because it is a discrete, observable, physiological entity and it’s also used abstractly as a synonym for someone’s unique perspective. Voice is a literary term and a colloquial term referring to the distinctive way people express themselves. What are your thoughts on trauma and its potential to impact voice in the more abstract sense?

I love the numerous aspects of voice as well!

Generally, research approaches the voice in its acoustic, physiological or perceptual form.

I do certainly agree that the voice is a symbol of the “metaphorical” voice that we attribute to someone’s truth, perspective, self-expression. I think trauma can absolutely impact the voice in this more abstract sense, as sometimes trauma can make one feel afraid to say what they need to say, feel vulnerable in taking up space, or hesitant to be seen and heard.

Some scholars have actually argued that the abstract metaphorical meaning of voice is one of the pathways that can affect the actual voice. I think this is an interesting line of inquiry that can be further explored.

For example, there are case studies in speech language pathology discussing voice loss after the loss of loved one, or developing unexplained vocal tension when tension arises in a marriage. Also, cases have been reported of people who sound “strangled” when they are holding in guilt or an unbearable secret.

I personally find it very fascinating when people’s voices change when they talk about themselves as opposed to when they talk about someone else, such as suddenly sounding very high pitched and soft.

I think that the abstract, more metaphorical definition of “voice” and the actual voice often go hand in hand in mysterious ways that inform us about both.

Trauma and Voice: Now and the Future

Q: What are some of the most compelling findings on the link between trauma and the voice? Where do you see your research heading going forward?

I would say there are different findings, some have to do with vocal pathology and some have to do with “normal” voices.

There is a substantial body of literature on what we call ‘psychogenic voice disorders’ which are voices that become pathological as a result of psychological events — including trauma — in the absence of laryngeal pathology.

The links between trauma and non-pathological voices remain largely unexplored. An important article to know about is the paper that came out in 2019 by Marmar and colleagues about speech indices in the voices of veterans with posttraumatic stress disorder and without.

I have conducted a few preliminary studies myself where I have primarily explored the links between self-reported childhood trauma and interpersonal violence with acoustic measures of voice. Some are out there, and some are in the making.

Research is necessary to create a sense of direction that is currently lacking in the field.

Importantly, though not of empirical nature, the work by Dr. Diane Austin, the founder of Vocal Psychotherapy, needs to be kept in mind. Dr. Austin works a lot with the voice in trauma survivors and has written several case studies that can inspire both research and clinical work.

Supporting Dr. Monti’s Work

Q: How can people support you and/or your research?

The best way to support us is to visit our website voiceandtrauma.com and spread the word about our mission and our events!

Thank you.

Further Reading

Austin, D. (2009). The theory and practice of vocal psychotherapy: Songs of the self. Jessica Kingsley Publishers.

Baker, J. (2017). Psychosocial Perspectives on the Management of Voice Disorders: Implications for Patients and Clients, Options and Strategies for Clinicians. Compton Publishing.

Becker, D. R. (2019). Vocal Manifestations of Reported Past Trauma (Doctoral dissertation, University of Pittsburgh).

Marmar, C. R., Brown, A. D., Qian, M., Laska, E., Siegel, C., Li, M., … & Knoth, B. (2019). Speech‐based markers for posttraumatic stress disorder in US veterans. Depression and anxiety, 36(7), 607–616.

Monti, E., D’Andrea W., Freed, S., Kidd, D., Feuer, S., Carroll, L., Castano E. Does Self-Reported Childhood Trauma Relate to Vocal Acoustic Measures? Preliminary Findings at Trauma Recall. J Nonverbal Behav (In Press).

Monti, E., & Sidtis, D. V. L. (2018). Can childhood trauma impact the adult voice through the brain?. Journal of Interdisciplinary Voice Studies, 3(1), 45–59.

Monti, E., Kidd, D. C., Carroll, L. M., & Castano, E. (2017). What’s in a singer’s voice: The effect of attachment, emotions and trauma. Logopedics Phoniatrics Vocology, 42(2), 62–72.

Porges, S. W., & Dana, D. A. (2018). Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies (Norton Series on Interpersonal Neurobiology). WW Norton & Company.

Rosen, D. C., Sataloff, J. B., & Sataloff, R. T. (2020). Psychology of voice disorders. Plural Publishing.

Scherer, S., Stratou, G., Gratch, J., & Morency, L. P. (2013, August). Investigating voice quality as a speaker-independent indicator of depression and PTSD. In Interspeech (pp. 847–851).

Van der Kolk, B. (2000). Posttraumatic stress disorder and the nature of trauma. Dialogues in clinical neuroscience, 2(1), 7.