Coping Strategies in Teachers With Vocal Complaint

*,†Fabiana Zambon, *Felipe Moreti, and *Mara Behlau, *yS~ao Paulo, Brazil

Summary: Objectives. To understand the coping strategies used by teachers with vocal complaints, compare the
differences between those who seek and those who do not seek voice therapy, and investigate the relationships among
coping and voice perceptual analysis, coping and signs and symptoms of voice, and coping and participation restrictions
and limitations in vocal activities.
Study Design. Cross-sectional nonrandomized prospective study with control group.
Methods. Ninety female teachers participated in the study, of similar ages, divided into three groups: group 1 (G1)
comprised 30 teachers with vocal complaints who sought voice therapy, group 2 (G2) comprised 30 teachers with vocal
complaints who never sought voice therapy, and group 3 (G3) comprised 30 teachers without vocal complaints. The
following analysis were conducted: identification and characterization questionnaire, addressing personal and occupa-
tional description, recording speech material for voice perceptual analysis, Voice Signs and Symptoms Questionnaire,
Voice Activity and Participation Profile (VAPP), and Voice Disability Coping Questionnaire (VDCQ)—Brazilian
Version.
Results. In relation to the voice perceptual analysis, there was statistically significant difference between the groups
with vocal complaint (G1 + G2), which had showed voices with mild-to-moderate deviation, and the group without
vocal complaint (G1), which showed voices within the normal variability of voice quality (mean for G1 ¼ 49.9,
G2 ¼ 43.7, and G3 ¼ 32.3, P < 0.001). G1 had higher mean of voice signs and symptoms (G1 ¼ 8.6, G2 ¼ 6.6, and
G3 ¼ 2.0, P < 0.001) and higher scores in almost all dimensions of VAPP (P < 0.001), except for the aspects effect
on job and effect on social communication. Individuals with vocal complaints who looked for voice therapy (G1) tended
to use more problem-focused strategies and had higher scores in VDCQ (G1 ¼ 45.4, G2 ¼ 38.5, and G3 ¼ 9.5,
P < 0.001). The aspects that were correlated with VDCQ in the three groups were degree of vocal deviation, VAPP total
score, VAPP partial scores of self-perceived severity of voice problem, effect on daily communication, effect on
emotion, and participation restriction for G1; VAPP total score and partial score of effect on daily communication
for G2; and all VAPP scores for G3. No correlation was found between voice signs and symptoms and coping.
Conclusion. Teachers with vocal complaints who looked for voice therapy use more coping strategies. Moreover,
they present a tendency to use more problem-focused coping strategies. Voice symptoms prompt the teachers into
seeking treatment; however, they are not correlated with the coping itself. In general, the higher the perception of lim-
itation and restriction of participating in vocal activities, the greater the use of coping strategies.
Key Words: Voice–Dysphonia–Teachers–Questionnaires–Voice Symptoms.

INTRODUCTION instance finding out information about the problem or

Coping refers to the cognitive and behavioral manners that in- searching for medical help.2,7–10 Deary et al11 observed that pa-
dividuals use to cope with stress caused by a specific situation. tients with dysphonia tend to use more emotional coping
These manners include thoughts or actions. The type of coping strategies.
can be related to the individual’s personality and can be modi- There are many aspects that play a role in the way an individ-
fied according to different moments of a stressful situation.1–9 ual copes with a stressful situation, such as individual factors,
Coping strategies can be generically categorized into personality (flexibility, stubbornness, and proactivity) as well
emotional and cognitive strategies.2,9 Individuals who deal as psychological, personal (age and sex), functional, physical,
with a problem using emotional strategies tend to use tools environmental, and cultural issues.7,12,13 The way in which an
that help control or alleviate emotions, that is, they use individual copes with a disease may influence treatment
affectional functions to deal with stress. On the other hand, outcomes.7 In addition, the use of a specific strategy may be
the cognitive strategies are ways to deal with problems adequate at a certain stage of the disease and inadequate at
looking for solutions that change the source of stress, by for another. This is an important factor that clinicians should be
aware of.8
A teacher’s main work instrument is their voice, thus, it is
Accepted for publication November 15, 2013.
Presentations in Congress: The Voice Foundation’s 41st Annual Symposium: Care of the
very likely that a vocal deviation can produce a negative
Professional Voice; May 30 - June 3, 2012; Philadelphia, Pennsylvania; and 20th Brazilian impact on their professional performance. Frequently, these
Speech-Language Pathology and Audiology Congress; October 31 - November 3, 2012;
Brası́lia, Distrito Federal, Brazil.
professionals teach under inadequate conditions, for long
From the *Department of Speech-Language Pathology and Audiology, Universi- periods, for a large number of students, under harmful envi-
dade Federal de S~ao Paulo – UNIFESP, S~ao Paulo, Brazil; and the ySao Paulo Teachers
Union – Sindicato dos Professores de S~ao Paulo – SINPRO/SP, S~ao Paulo, Brazil.
ronmental settings, and without previous voice and communi-
Address correspondence and reprint requests to Fabiana Zambon, Sao Paulo Teachers cation training. These factors result in teachers having a high
Union – Sindicato dos Professores de S~ao Paulo – SINPRO/SP, Rua Borges Lagoa, 208,
Vila Clementino, S~ao Paulo 04038-000, Brazil. E-mail: fabianazambon@hotmail.com
prevalence of vocal signs and symptoms (mean of 3.7 signs
Journal of Voice, Vol. 28, No. 3, pp. 341-348 and symptoms for Brazilian teachers and 4.3 for American
0892-1997/$36.00
Ó 2014 The Voice Foundation
teachers) and vocal deviation (57% for American teachers
http://dx.doi.org/10.1016/j.jvoice.2013.11.008 and 63% for Brazilian teachers). There are approximately
342 Journal of Voice, Vol. 28, No. 3, 2014

3.87 new cases of voice deviation per year for every 1000
TABLE 1.
teachers.14–22 Frequency of Vocal Complaints in Teachers who Had
Researches show that the use of inadaptative strategies can Sought (G1) and Had Never Sought (G2) for Voice
contribute to the development of a voice problem in teachers Therapy
and that the professional that treats/trains these individuals
G1 G2
should recognize and address these strategies during his/her
clinical/educational intervention.10,23,24 Based on this Vocal Complaints N (%) N (%)
perspective, it seems reasonable to have coping strategies Vocal quality deviation 15 (50.0) 25 (83.3)
addressed during the training of teachers-to-be.25,26 However, Vocal fatigue and effort 8 (26.7) 2 (6.7)
studies that investigate the relationship between voice Breathiness — —
disorders and coping strategies are scarce and little is known Lack of pitch control 1 (3.3) —
about how much the type of coping plays a role in the search Lack of loudness control 1 (3.3) 3 (10.0)
for medical help. In addition, little is also known about which Discomfort speaking 5 (16.7) 3 (10.0)
strategies teachers with vocal complaints use and whether Notes: Vocal quality and other complaints. G1 3 G2: P ¼ 0.006.
coping can be affected by the presence of vocal signs and
symptoms and by the way these individuals perceive the
limitation and the restriction imposed by the voice problem.
The purpose of the present study was to understand coping Participants answered a questionnaire for gathering per-
strategies used by the teachers with vocal complaint, compare sonal and work-related demographic information. They also
the differences between those who seek and do not seek for completed the following procedures: recording of connected
treatment, and check the relationship between coping and speech sample for perceptual analysis of vocal deviation,
perceptual analysis, vocal signs and symptoms, and participa- list of 14 vocal signs and symptoms,17 Voice Activity and
tion restriction and vocal activities limitation. Participation Profile (VAPP)28 and the Voice Disability Coping
Questionnaire (VDCQ).7
METHODS For the perceptual analysis of the vocal deviation, the sub-
This research was approved by the Institutional Review Board jects were asked to count the numbers from 1 to 10 in habitual
(protocol number 0789/10). A total of 90 primary, middle, and pitch and loudness. Voice samples were analyzed by a Speech
high school teachers, with age ranging from 21 to 61 years Pathologist specializing in voice (80% of reliability), using a
participated in the study. A previous statistical analysis esti- 100-mm visual-analog scale. Voices were considered within
mated that groups around 30 subjects would be enough to the normal range of variability when they had a mean rate lower
deal with the research question. Then, subjects were subse- than 35.5 mm, mild-to-moderate deviation when the mean rate
quently recruited reaching the designed number. Teachers was between 35.5 and 50.5 mm, moderate deviation when the
were distributed into three groups: group 1 (G1) comprising mean rate was between 50.6 and 90.5 mm, and severe deviation
30 female teachers, age ranging from 23 to 49 years and when the mean rate was higher than 90.5 mm29
mean of 26.2 (standard deviation [SD] ¼ 7.5), with vocal The current absence and presence of 14 signs and symp-
complaint, and that had sought for voice therapy in a Vocal toms17 (hoarseness, vocal alteration or fatigue after a short
Health Program; group 2 (G2) comprising 30 female teachers, time of use, trouble singing or speaking softly, difficulty projec-
age ranging from 21 to 51 years and mean of 35.1 (SD ¼ 7.9), ting the voice, difficulty singing in high pitch, discomfort or
with vocal complaint, and that had never sought for voice ther- effort to speak, monotone voice, dry throat, sore throat, diffi-
apy; and finally group 3 (G3) comprising 30 female teachers, culty swallowing, acid and/or bitter mouth taste, and vocal
age ranging from 23 to 66 years and 37.2 (SD ¼ 9.8), without tremor or instability) were investigated.
vocal complaint. The teachers from groups 2 and 3 were as- The impact of the voice disorder on the individual’s life was
sessed by the researchers during visits to private schools in assessed by means of the VAPP30 translated and adapted to the
different areas of S~ao Paulo city. Later, vocal complaints Brazilian Portuguese as Perfil de Participaç~ao e Atividades Vo-
were listed, analyzed, and grouped according to the following cais.28 The VAPP has 28 items distributed into five dimensions:
list: vocal quality deviation, vocal fatigue and effort, breathi- Self-perceived severity of voice problem and effects on job,
ness, lack of pitch control, lack of loudness control, and daily communication, social communication, and emotion.
discomfort speaking27 (Table 1). A chi-square test was used This instrument provides an activity limitation score and a
to check the difference between groups G1 and G2 regarding participation restriction score.
the presence of complaints; nonetheless, due to the small num- Coping was assessed by means of the Voice Disability
ber of all complaints, except for vocal quality, they were pooled Coping Questionnaire (VDCQ)7 translated and adapted to Bra-
and compared under two options: vocal quality and other com- zilian Portuguese, entitled Estrategias de Enfrentamento na
plaints. Participants from G2 presented with more complaints Disfonia.9 The VDCQ has 27 items, 10 categorized as
related to vocal quality when compared with G1 (Table 1). problem-focused strategies (items 2, 4, 7, 8, 11, 13, 14, 24,
Exclusion criteria were use of medications for psychiatric 25, and 26) and 17 items as emotion-focused strategies (items
disorders during the time of the research, being off work or un- 1, 3, 5, 6, 9, 10, 12, 15, 16, 17, 18, 19, 20, 21, 22, 23, and
employed, and history of previous voice therapy. 27). Its total score varies from zero to 135. Zero indicates no
Fabiana Zambon, et al Coping Strategies in Teachers With Vocal Complaint 343

TABLE 2.
Mean, SD, Number, and Frequency of Perceptual Analysis of Vocal Deviation in Millimeters, for G1, G2, and G3
Degree of Vocal Deviation

Normal Range Mild-to-Moderate Moderate Severe

Group Mean SD N (%) N (%) N (%) N (%)
G1 49.9 19.4 6 (20.0) 11 (36.7) 12 (40.0) 1 (3.3)
G2 43.7 14.9 8 (26.7) 13 (43.3) 9 (30.0) —
G3 32.3 11.1 19 (63.3) 9 (30.0) 2 (6.7) —
Notes: Chi-square (P  0.05). G1 3 G2 3 G3: P ¼ 0.002; (G1 + G2) 3 G3: P < 0.001; and G1 3 G2: P ¼ 0.554.
G1, teachers with vocal complaint and who had sought for voice therapy; G2, teachers with vocal complaint and who had never sought for voice therapy; G3,
teachers without vocal complaint.

use of strategies at all and 135 indicates use of all the strategies Regarding the assessment of coping with the VDCQ, G1 pre-
assessed by the instrument. sented a mean score of 45.4, G2 a mean score of 38.5, and G3 a
Statistical analysis compared the three groups (G1 3 G2 3 G3). mean score of 9.5 (Table 5).
The groups with vocal complaint were compared with the group When analyzing all the items of the VDCQ, four strategies
without vocal complaint (G1 + G2 3 G3) and the group that were reported more by G1 (item 2: ‘‘I try to avoid situations
looked for treatment compared with the group that did not look where my voice problem would become evident’’; item 4: ‘‘I
for treatment (G1 3 G2). The following tests were performed: try to find as much information as possible about my voice
chi-square, analysis of variance, and Pearson correlation (Minitab problem’’; item 5: ‘‘I find it easier to cope with my voice prob-
software, 16.1; Minitab, Inc, State College, PA). Significance level: lem by expressing my feelings outwardly’’; and item 13: ‘‘I find
5%. it easier to cope with my voice problem if I ask the doctor ques-
tions about it’’). Whereas only one item was reported more by
G2, which was the item 22: ‘‘I ignore my voice problem by
RESULTS
looking at only the good things in life’’ (Table 6).
Teachers with vocal complaint (G1 + G2) presented with mild-
The variables that presented correlation with the VDCQ were
to-moderate degree of voice deviation and teachers without
for G1, the overall voice deviation, the VAPP total score, and
vocal complaint presented with voices within the normal range
partial scores of self-perceived severity of voice problem, effect
of variability (Table 2).
on daily communication, effect on emotion, and participation
Teachers with vocal complaint that looked for treatment (G1)
restriction; for G2, only the VAPP total score and the partial
presented with a mean of 8.6 voice signs and symptoms; those
scores of effect on daily communication; and finally for G3,
who presented with vocal complaint and did not look for treat-
all the dimensions of the VAPP. None of the groups presented
ment (G2) had a mean of 6.6 voice signs and symptoms; and
a correlation between voice signs and symptoms with coping
those without vocal complaint (G3) had a mean of 2 vocal signs
(Table 7).
and symptoms (Table 3).
The results of the VAPP showed that G1 presented the high-
est scores when compared with G2 and G3 for almost all its di- DISCUSSION
mensions, with the exception of effects on job and effects on Coping is the cognitive and behavioral way that individuals deal
social communication. The latter were higher for the group with the stress caused by a specific situation. The coping pro-
with vocal complaint (G1 + G2). The G3 had the lowest scores cess can be done by means of thoughts and actions and it can
in all dimensions of the questionnaire (Table 4). be changed according to the different stages of the same stress-
ful situation.2–7 Coping strategies can be generally classified
into emotional and cognitive strategies.1,2,9 Understanding
TABLE 3. how a teacher copes with the stress caused by a voice
Mean, SD, Minimum, and Maximum Values of Voice problem and how coping correlates with voice deviation,
Signs and Symptoms for G1, G2, and G3
vocal signs and symptoms, and self-perception of the voice
Group Mean SD Minimum Maximum P Value problem can be important strategies to help the teacher assim-
G1 8.6 3.4 2.0 14.0 ilate and adopt information about voice care.7–10,23,25,26,31
G2 6.6 3.2 0.0 7.0 <0.001 However, little is known about how this coping process takes
G3 2.0 2.0 0.0 7.0 place in teachers’ lives.
Notes: Analysis of variance (P  0.05). The present research analyzed coping strategies of a popula-
G1, teachers with vocal complaint and who had sought for voice therapy; tion of teachers, who were distributed into three groups: with
G2, teachers with vocal complaint and who had never sought for voice
vocal complaint that looked for voice treatment (G1), with
therapy; G3, teachers without vocal complaint.
vocal complaint that did not look for voice treatment (G2),
344 Journal of Voice, Vol. 28, No. 3, 2014

TABLE 4.
Mean, SD, Minimum, and Maximum Values of VAAP Scores for G1, G2, and G3
G1 G2 G3 P Value P Value P Value
VAPP Mean SD Mean SD Mean SD G1 3 G2 3 G3 (G1 + G2) 3 G3 G1 3 G2
Total score 88.9 53.5 47.0 35.0 16.6 26.3 <0.001 <0.001 0.001
Severity of voice problem 6.1 2.3 4.8 2.6 1.1 1.5 <0.001 <0.001 0.011
Effects on
Job 12.9 8.7 9.2 8.0 2.5 4.2 <0.001 <0.001 0.086
Daily communication 37.2 25.1 17.0 16.6 7.9 14.8 <0.001 <0.001 <0.001
Social communication 8.1 8.5 4.3 6.3 1.3 2.1 <0.001 0.001 0.052
Emotion 24.9 19.6 11.1 10.9 3.6 6.5 <0.001 <0.001 0.001
ALS 32.4 19.5 19.5 13.0 7.6 12.1 <0.001 <0.001 0.004
PRS 27.0 20.5 12.0 13.5 4.0 7.7 <0.001 <0.001 0.001
Notes: Chi-square (P  0.05).
ALS, activity limitation score; PRS, participation restriction score; VAPP, Voice Activity and Participation Profile; G1, teachers with vocal complaint and who had
sought for voice therapy; G2, teachers with vocal complaint and who had never sought for voice therapy; G3, teachers without vocal complaint.

and without vocal complaint (G3). This categorization was in their vocal activities plays a great role in their search for
designed to facilitate the understanding of how coping with a treatment and is less correlated with the vocal deviation itself.33
voice problem can influence the search for treatment and The mean of voice symptoms (Table 3) differentiated the
whether there is a specific pattern of coping that differentiates three groups. This can be a factor that affected the search for
teachers who look for treatment from the ones who do not voice treatment because it was higher for G2. Data related to
look for treatment. The majority of the teachers with voice dis- group G2 (mean of 6.6 voice signs and symptoms) and G3
orders usually keep up with their teaching activity regularly. (mean of 2 voice signs and symptoms) were similar to that
Many times they seek help when they had already developed found in the literature. The literature shows a mean of 6.28
vocal signs and symptoms or even a long-term voice disorder, voice signs and symptoms for individuals with vocal complaint
which can aggravate the problem and have a negative impact and a mean of 1.27 voice signs and symptoms for the general
on their job activities.17,22,32 To better understand the factors population without vocal complaint.9 Researches that studied
that influence coping, we investigated its correlation with the teachers in general, independently of the presence of vocal
degree of vocal deviation, vocal signs and symptoms, and VAPP. complaint, found a mean of 3.7 voice symptoms for Brazilians
Teachers with vocal complaint (G1 + G2) presented voices and 4.3 for Americans.17,22 These data indicate that teachers
with a mild-to-moderate degree of deviation and the ones have indeed voice signs and symptoms; nevertheless, the
without vocal complaint presented voices within the normal mean of voice signs and symptoms increases as the teachers
range of variability (Table 2). It was observed that the teachers’ present with a voice complaint and increases even more for
vocal complaint regarding vocal quality was coherent with the those who seek for treatment. It can be noted that teachers in
degree of voice deviation; yet, it did not influence their decision general search for medical/speech pathology help when the
to seek treatment. Probably, the lack of information and percep- number of symptoms is high. This means that many times
tion that teachers have regarding their own voice influences they need treatment rather than only a preventive action.32,34
their behavior in taking too long to seek for specialized treat- Table 4 shows that only the limitation of daily activities and
ment. In addition, their perception of a limitation or restriction effect on emotion led the teachers to search for voice treat-
ment.35 Probably, teachers notice a vocal deviation, but they
do not really identify its impact on their vocal activities.33
TABLE 5. Results show that coping influenced the search for voice
Mean, SD, Minimum, and Maximum of VDCQ Scores for treatment by the teachers (Table 5); however, they present
G1, G2, and G3 much smaller scores than the ones found in the literature. The
Group Mean SD Minimum Maximum P Value mean coping score shown in the literature is 51.86 for the gen-
eral population and 50.3 for individuals with spasmodic
G1 45.4 19.93 9.0 96.0
G2 38.5 20.64 0.0 89.0 <0.001
dysphonia and muscle tension dysphonia.9,36 This diversion
G3 9.5 13.86 0.0 51.0 suggests that teachers use fewer strategies to cope with a
voice problem than vocally healthy people and individuals
Notes: Analysis of variance (P  0.05).
VDCQ, Voice Disability Coping Questionnaire; G1, teachers with vocal with dysphonia. Even the teachers who sought for treatment
complaint and who had sought for voice therapy; G2, teachers with vocal present much lower scores than the ones found in the
complaint and who had never sought for voice therapy; G3, teachers literature.9,36 Perhaps these professionals assume that being
without vocal complaint.
hoarse is part of their teaching activity, which gives them the
Fabiana Zambon, et al Coping Strategies in Teachers With Vocal Complaint 345

TABLE 6.
Number and Frequency of VDCQ Items for G1, G2, and G3
Group 1 Group 2 Group 3 P Value P Value
Item n (%) n (%) n (%) G1 + G2 3 G3 G1 3 G2
1. It helps me to cope with my voice 22 (73.3) 19 (63.3) 9 (30.0) 0.001 0.405
problem if other people are
sympathetic
2. I try to avoid situations where my 26 (86.7) 17 (56.7) 10 (33.3) <0.001 0.010
voice problem would become evident
3. I find myself wishing that I never had a 25 (83.3) 22 (73.3) 8 (26.7) <0.001 0.347
voice problem
4. I try to find as much information as 28 (93.3) 20 (66.7) 6 (20.0) <0.001 0.010
possible about my voice problem
5. I find it easier to cope with my voice 26 (86.7) 18 (60.0) 8 (26.7) <0.001 0.020
problem by expressing my feelings
outwardly
6. I find it easier to cope with my voice 18 (60.0) 17 (56.7) 5 (16.7) <0.001 0.793
problem by telling myself not to think
about it
7. I find talking with friends and family 20 (66.7) 21 (70.0) 6 (20.0) <0.001 0.781
about my voice problem helpful
8. I find it easier to cope with my voice 27 (90.0) 25 (83.3) 8 (26.7) <0.001 0.706
problem by finding out as much about
it as I can
9. I keep any worries I may have about 19 (63.3) 15 (50.0) 5 (16.7) <0.001 0.297
my voice problem to myself
10. I take the view that there is little I can 10 (33.3) 14 (46.7) 3 (10.0) 0.003 0.292
do about my voice problem
11. I find it easier to live with my voice 19 (63.3) 19 (63.3) 5 (16.7) <0.001 -
problem, if I do not use my voice
12. Having a voice problem has helped 16 (53.3) 17 (56.7) 7 (23.3) 0.004 0.795
me to find some important truth
about my life
13. I find it easier to cope with my voice 28 (93.3) 19 (63.3) 4 (13.3) <0.001 0.005
problem if I ask the doctor questions
about it
14. I find it easier to cope with my voice 8 (26.7) 9 (30.0) 2 (6.7) 0.018 0.774
problem by avoiding being with
people in general
15. I find it easier to cope with my voice 21 (70.0) 22 (73.3) 5 (16.7) <0.001 0.774
problem by wishing that it would go
away or somehow be over with
16. I find it easier to cope with my voice 12 (40.0) 9 (30.0) 5 (16.7) 0.070 0.417
problem by joking about it
17. I cope better with my voice problems 7 (23.3) 7 (23.3) 2 (6.7) 0.051 -
by trying to accept it, since nothing
can be done
18. I find religion and praying to God 10 (33.3) 10 (33.3) 5 (16.7) 0.096 -
help me cope with my voice problem
19. I keep my frustrations to myself, so 15 (50.0) 10 (33.3) 2 (6.7) 0.001 0.190
few of my friends know I am frustrated
20. I try to convince myself that my voice 17 (56.7) 17 (56.7) 1 (3.3) <0.001 -
problem is not really that disabling
21. Having a voice problem has helped 9 (30.0) 5 (16.7) 2 (6.7) 0.051 0.222
me develop into a better person
22. I ignore my voice problem by 9 (30.0) 18 (60.0) 5 (16.7) 0.008 0.020
looking at only the good things in life
(Continued )
346 Journal of Voice, Vol. 28, No. 3, 2014

TABLE 6.
(Continued )
Group 1 Group 2 Group 3 P Value P Value
Item n (%) n (%) n (%) G1 + G2 3 G3 G1 3 G2
23. When my voice gets bad, I find 8 (26.7) 7 (23.3) 3 (10.0) 0.094 0.766
myself taking it out on others
around me
24. Resting my voice at times, helps me 25 (83.3) 22 (73.3) 11 (36.7) <0.001 0.347
cope with my voice problem
25. I ask people to help me with those 18 (60.0) 19 (63.3) 2 (6.7) <0.001 0.791
things I cannot manage because of
my voice
26. I try to become involved in as many 3 (10.0) 5 (16.7) 1 (3.3) 0.136 0.448
physical activities as possible to take
my mind off my voice problem
27. I find easier to cope with my voice 7 (23.3) 14 (46.7) 6 (20.0) 0.143 0.058
problem when I compare myself with
other people who have worse health
problems
Notes: Chi-square (P  0.05). G1, teachers with vocal complaint and who had sought for voice therapy; G2, teachers with vocal complaint and who had never
sought for voice therapy; G3, teachers without vocal complaint.

impression that there is little that can be done to change this it easier to cope with my voice problem if I ask the doctor ques-
situation. tions about it’’). Only one of these four strategies was emotion-
When analyzing all the answers of the VDCQ (Table 6), focused (item 5: ‘‘I find it easier to cope with my voice problem
it was observed that the groups with vocal complaint reported by expressing my feelings outwardly’’). These results indicate
using a greater number of strategies (G1 + G2 3 G3). Neverthe- that teachers who sought for intervention tended to use strate-
less, when G1 was compared with G2, G1 reported four strate- gies to either remediate or alleviate their voice deviation.8,9
gies more frequently, three of which were problem-focused On the other hand, the group with vocal complaint that did
(item 2: ‘‘I try to avoid situations where my voice problem not look for treatment (G2) reported using more than G1 only
would become evident’’; item 4: ‘‘I try to find as much informa- one strategy, an emotion-focused strategy (item 22: ‘‘I ignore
tion as possible about my voice problem’’; and item 13: ‘‘I find my voice problem by looking at only the good things in

TABLE 7.
Correlations Between VDCQ Scores and Voice Signs and Symptoms, Overall Voice Deviation, and VAPP Scores for G1, G2,
and G3
G1 G2 G3

VDCQ Correlations Coefficient P Value Coefficient P Value Coefficient P Value

Overall voice deviation 0.430 0.018 0.166 0.380 0.094 0.622
Voice signs and symptoms 0.009 0.960 0.226 0.231 0.198 0.294
VAPP
Total score 0.534 0.002 0.417 0.022 0.700 <0.001
Severity of voice problem 0.363 0.049 0.071 0.709 0.459 0.011
Effects on
Job 0.275 0.141 0.283 0.130 0.515 0.003
Daily communication 0.562 0.001 0.431 0.018 0.647 <0.001
Social communication 0.278 0.137 0.249 0.184 0.669 <0.001
Emotion 0.467 0.009 0.344 0.063 0.654 <0.001
ALS 0.243 0.196 0.351 0.057 0.707 <0.001
PRS 0.343 <0.001 0.292 0.118 0.613 <0.001
Notes: Pearson correlation (P  0.05). 0.7 or more: strong correlation; 0.3 to 0.7: moderate correlation; and 0 to 0.3: weak correlation.
ALS, activity limitation score; PRS, participation restriction score; VAPP, Voice Activity and Participation Profile; VDCQ, Voice Disability Coping Questionnaire;
G1, teachers with vocal complaint and who had sought for voice therapy; G2, teachers with vocal complaint and who had never sought for voice therapy; G3,
teachers without vocal complaint.
Fabiana Zambon, et al Coping Strategies in Teachers With Vocal Complaint 347

life’’). This may have contributed for these teachers to not look 2. Lazarus RS, Folkman S, eds. Stress, Appraisal and Coping. New York, NY:
for treatment, although they had vocal complaint. Literature Springer Publishing Company; 1984.
3. Folkman S. Personal control and stress and coping process: a theoretical
findings reveal that teachers and individuals with voice problem
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