General voice relaxation techniques and speech therapy may play an adjunct role in the treatment of spasmodic dysphonia. These include reducing one's vocal effort, loudness, intonation, and rate of utterance while increasing pause time between phrases. These techniques can only be reinforced and adapted if they do not intrude on the vocal naturalness. Some people with spasmodic dysphonia suggest the use of a voice amplifier for the phone or that of a self-contained microphone used in conjunction with any FM radio. Understanding what causes your voice to be better or worse is an important step in managing symptoms of SD. Susan Shulman, M.S., CCC-SL/A surveyed individuals with SD attending NSDA conference in Dallas, TX, regarding what affect voice quality and the following results were presented: Related Questions What often helps make voice quality better? Vocal exercise (humming, speaking slowly, reciting nursery rhymes) Volume control (talking softly or loudly) Feeling relaxed Breathing deeper breaths, exhaling before speaking, not holding onto the breath Environmental control (talking one-on-one, not being interrupted) Using voice early in the morning Sensory gestures (neck muscle massage, covering eyes, pinching nose) Physical exercise Mental aspects ("not thinking about it", keeping a good attitude) Miscellaneous (physical rest, vocal rest, warm liquids, laughing) What often makes voice quality worse? Stress (being tense, being in a hurry) Speaking on the telephone Speaking in a loud or large space Trying to talk over noise Lack of sleep Negative thinking Miscellaneous (overuse, weather changes, having a cold) By educating yourself with information, you have taken the first step in dealing with spasmodic dysphonia. SD and its emotional offshoots affect every aspect of a person's life - how we think, the way we act, and how we cope. Stress is an inevitable part of life, and although it clearly does not cause spasmodic dysphonia, it can aggravate symptoms. Stress-reduction programs such as relaxation techniques, meditation, and journal writing may be beneficial . Sometimes depression can be a byproduct of SD. It, too, can aggravate symptoms and make them worse, but often, treating depression can result in an improvement of SD. It is important to remember that depression is a disease; it is treatable and not a reflection of one's self. Your increased understanding of your condition and your active role in the decision-making process will be of major importance in the total treatment program of SD.