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This study used ecological momentary assessment to quantify relationships between voice outcomes and psychological variables. It combined group-level dynamic time-series analysis and group/individual causal modeling to determine key factors driving voice handicap. Adults (N=32) completed repeated daily assessments over 10 days.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ecological-momentary-assessment-of-voice-psychological-factors-group-individual-mechanisms/446149/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ecological-momentary-assessment-of-voice-psychological-factors-group-individual-mechanisms/446149.png","ImageObject",300,407,{"name":92,"@type":93},"Quinn Holloway","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What methods were used to connect voice outcomes with psychological factors over time?","Question",{"text":112,"@type":113},"The study used ecological momentary assessment with group-level dynamic time-series analysis via dynamic structural equation modeling and causal modeling using the Greedy Fast Causal Inference algorithm for group and individual levels.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What did the group-level time-series results show about perceived control and distress?",{"text":117,"@type":113},"Neither perceived control nor distress predicted subsequent timepoint voice handicap scores in group-level time-series analyses.",{"name":119,"@type":110,"acceptedAnswer":120},"How did individual-level causal findings differ from group-level results?",{"text":121,"@type":113},"Individual-level analyses identified multiple causal factors for voice handicap, including perceived control and negative affect, while group-level causal modeling found anxiety as causal but perceived control as not causal at the group level.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},446149,1791234971,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},2336474466712,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","The Laryngoscope  \nORIGINAL REPORT  OPEN ACCESS   \nEcological Momentary Assessment of Voice & Psychological Factors: Group & Individual Mechanisms  \nStephanie Misono1  | Viann N. Nguyen-Feng2 | Xiaofan Lei3 | Erin Feddema4 | Anika Tella5 | Ali Stockness5 | Patricia A. Frazier6 | Erich Kummerfeld7 | Kelvin O. Lim8  \n1Department of Otolaryngology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA | 2Department of Psychology, University of Minnesota Duluth, Duluth, MN, USA | 3Magnit, Maple Grove, MN, USA | 4Boston Scientific, Minneapolis, MN, USA | 5Department of Otolaryngology, University of Minnesota Twin Cities, Minneapolis, MN, USA | 6Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA | 7Institute for Health Informatics, University of Minnesota Twin Cities, Minneapolis, MN, USA | 8Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA  \nCorrespondence: Stephanie Misono ([smisono@umn.edu](smisono@umn.edu))  \nReceived: 24 April 2025 | Revised: 11 July 2025 | Accepted: 5 August 2025  \nFunding: The study was supported by funding from the National Institutes of Health (K23DC016335, KL2TR000113, UL1TR002494), American College of Surgeons, the Triological Society, and the Clinical Scientist Development Award. The funders had no role in the design and conduct of the study, and the content does not represent the views of the funding organizations.  \nKeywords: causal modeling | ecological momentary assessment | psychology | voice  \nABSTRACT  \nObjectives: Cross-sectional associations between voice and psychological factors are known, but changes over time offer opportunities to refine our understanding of their interactions and consider customized treatment options. Study objectives were to measure relationships between voice and psychological factors using ecological momentary assessment and applying (1) grouplevel time series analysis and (2) group and (3) individual causal modeling to identify key psychological factors relevant for voice outcomes.  \nMethods: Adults (N = 32) with primary muscle tension dysphonia completed multiple assessments daily for 10 days. Measures included items from the Voice Handicap Index-10, voice-adapted perceived present control scale, items from NIH PROMIS and the NIH Toolkit to assess distress, and the Positive and Negative Affect Scale. Group-level time series analysis was conducted using dynamic structural equation modeling; causal analysis utilized the Greedy Fast Causal Inference algorithm.  \nResults: In group-level time series analyses, neither perceived control nor distress predicted subsequent timepoint voice handicap scores. In group-level causal modeling, anxiety was causal for voice handicap, but perceived control was not. Individual-level analyses identified various causal factors for voice handicap including perceived control and negative affect, and to a lesser extent, serenity, anxiety, somatic arousal, and stress.  \nConclusions: Group-level analyses may obscure important heterogeneity that is identifiable using individual-level causal analyses. For example, perceived control was not identified as predictive or causal for voice handicap at the group level; but was a salient causal factor for voice handicap in some individuals. Causal modeling using intensive longitudinal datasets offers a potential avenue for individualized treatment approaches.  \nLevel of Evidence: 4.  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2025 The Author(s) . The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.  \n324 The Laryngoscope, 2026; 136:324–331  \n[https://doi.org/10.1002/lary.70049](https://doi.org/10.1002/lary.70049)  \n1 | Introduction  \nA growing body of literature ","cbCaiefz3GELDrBi","https://ap.wps.com/l/cbCaiefz3GELDrBi","pdf",617327,"English","# Introduction\n# Methods\n## Participants and procedures\n## Measures\n## Statistical analysis\n# Results\n# Discussion\n# Conclusions","[{\"question\":\"What methods were used to connect voice outcomes with psychological factors over time?\",\"answer\":\"The study used ecological momentary assessment with group-level dynamic time-series analysis via dynamic structural equation modeling and causal modeling using the Greedy Fast Causal Inference algorithm for group and individual levels.\"},{\"question\":\"What did the group-level time-series results show about perceived control and distress?\",\"answer\":\"Neither perceived control nor distress predicted subsequent timepoint voice handicap scores in group-level time-series analyses.\"},{\"question\":\"How did individual-level causal findings differ from group-level results?\",\"answer\":\"Individual-level analyses identified multiple causal factors for voice handicap, including perceived control and negative affect, while group-level causal modeling found anxiety as causal but perceived control as not causal at the group level.\"}]","Ecological Momentary Assessment of Voice & Psychological Factors: Group & Individual Mechanisms | PDF",1790714306]