Delivery of Conversation Training Therapy (CTT) in the Group Therapy Environment

Objective: Conversation Training Therapy (CTT) is a recently-developed voice therapy approach in which connected speech is trained from the start, foregoing a traditional hierarchical therapy model. CTT sessions are inherently conversation-based, but still limited to practice with a therapist. This feasibility study investigated the effect of group CTT sessions on voice outcomes, as well as patients’ self-reported self-efficacy toward carryover of techniques outside the session, and self-reported carryover.

Methods/Design: Patients with benign lesions or muscle tension dysphonia (MTD) were recruited and screened via routine evaluations at Emory Voice Center. An SLP evaluation and VHI-10 served as baseline data. Consenting participants engaged in four sessions of group teletherapy. Each week, participants completed the VHI-10 and reported their generalization of skills the prior week. After each session, they completed a self-efficacy questionnaire about their upcoming practice. Following four sessions, participants completed questionnaires regarding their perception of the treatment and group. Three blinded SLPs completed CAPE-V ratings on pre and post recordings.

Results: Eight total participants (two groups of three, and one group of two) completed therapy. Mean VHI-10 decreased significantly (from 22.25 to 10) with therapy, and mean VHI-10 at follow-up was below the clinical limit for a voice disorder. Patient-reported generalization of skills increased with therapy, and mean reported generalization was 55% by session 4. Individuals reported increased confidence, importance, and commitment toward generalizing skills. They reported 70% voice improvement on average, and unanimously reported therapy “helped” them and “definitely caused voice change.” The two “most useful” reported aspects of therapy were techniques to increase awareness and carryover to real-life conversation. Patient perception of the group dynamic was overwhelmingly positive. Patients unanimously endorsed future use of group therapy at Emory Voice Center.

Conclusions: Group CTT maintains the individual CTT model while incorporating group support and more realistic conversation practice with peers. These may improve buy-in toward therapy and carryover of skills. Group therapy reduces out-of-pocket patient costs and improves clinician productivity. Cons include difficulties in scheduling and attendance management, and the added documentation time required for multiple patients. Further studies may support the feasibility of this model.

Raquel M. Tripp, M.S., CCC-SLP, NYU Voice Center, New York, NY

Sandeep Shelly, MPH, Emory Voice Center, Atlanta, GA

Amanda Gillespie, PhD, Director of Speech Pathology, Emory Voice Center, Atlanta, GA