Acceptance and commitment therapy and systematic voice training effects on children voice function recurrence and anxiety

doi:10.5498/wjp.121582

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Publication Name

World Journal of Psychiatry

ISSN

2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Oct 19, 2026; 16(10): 121582
Published online Oct 19, 2026. doi: 10.5498/wjp.121582

Acceptance and commitment therapy and systematic voice training effects on children voice function recurrence and anxiety

Wen He, Dong Li, Li Zhou

Wen He, Department of Otolaryngology, Anhui Provincial Children’s Hospital, Hefei 230000, Anhui Province, China

Dong Li, Department of Otolaryngology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430010, Hubei Province, China

Li Zhou, Department of Otolaryngology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China

Co-first authors: Wen He and Dong Li.

Author contributions: He W and Li D contributed to research design, data collection, data analysis, paper writing, funding application, ethical review, copyright and licensing, and follow-up as co-first authors; Zhou L was responsible for reviewing and editing, communication coordination; all authors have read and approve the final manuscript.

AI contribution statement: We didn’t use AI to write this manuscript. The high AI score likely comes from using translation software (e.g., DeepL) to improve the English. That can accidentally make the text read like AI. All text is human-written.

Institutional review board statement: The research was reviewed and approved by the Medical Ethics Committee of Anhui Provincial Children’s Hospital.

Clinical trial registration statement: This study has not yet been registered with clinical trials.

Informed consent statement: All participants provided informed consent.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: No other data available.

Corresponding author: Li Zhou, Associate Faculty, Department of Otolaryngology, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai 200433, China. 18918253626@163.com

Received: April 24, 2026
Revised: May 26, 2026
Accepted: June 23, 2026
Published online: October 19, 2026
Processing time: 168 Days and 23.6 Hours

Abstract

BACKGROUND

Children with vocal nodules often experience persistent hoarseness and anxiety, creating a vicious cycle that impairs recovery and increases recurrence. Standard voice training lacks psychological intervention. This study hypothesizes that adding acceptance and commitment therapy (ACT) to systematic voice training improves voice function, reduces anxiety, and lowers recurrence.

AIM

To investigate the effect of ACT combined with systematic voice training on children with voice disorders.

METHODS

A randomized controlled trial enrolled 120 children with vocal nodules (6-12 years) at a tertiary hospital, randomized into two groups (n = 60 each). The control group received 8-week systematic voice training; the observation group added ACT. Outcomes included pediatric voice handicap index, vocal fatigue, vocal fold function, anxiety, and 6-month recurrence. Data were analyzed via t-tests and χ² tests.

RESULTS

After the intervention, the observation group showed significantly lower scores in pediatric voice handicap index (28.46 ± 6.15 vs 42.63 ± 7.28), vocal fatigue (2.35 ± 0.82 vs 4.52 ± 1.05), and Scale for Children’s Anxiety Disorders compared to the control group. Furthermore, the improvement in vocal fold vibration symmetry and mucosal wave integrity under videostroboscopy was more pronounced in the observation group (all P < 0.05). During the follow-up period, the recurrence rate of hoarseness in the observation group was 5.00%, significantly lower than the 18.33% in the control group (P < 0.05).

CONCLUSION

Combined intervention improves voice function, alleviates anxiety, and reduces hoarseness recurrence in children with vocal nodules.

Keywords: Acceptance and commitment therapy; Systematic voice training; Voice disorders; Recurrence rate; Anxiety

Core Tip: Combining acceptance and commitment therapy with systematic voice training significantly improves voice function, reduces anxiety, and lowers the recurrence rate of hoarseness in children with vocal fold nodules compared to voice training alone. The integrated approach addresses both physiological and psychological factors, enhancing treatment adherence and long-term outcomes.