VISUA L FEEDBA CK OF VOCAL INTENSITY IN THE TREA TMENT OF HYSTERICAL APHONIA COLIN MACLEOD* and DAVID R. HEMSLEY Psychology Department, Institute of Psychiatry, London Summary--This case report describes the successful though temporary removal of a hysterical aphonic symptom in a 49-year-old male patient by using visual feedback of changes in vocal intensity. Following symptom removal the patient experienced considerable emotional distress due to a number of factors. His aphonia returned and has proven resistant to subsequent intervention. At a l-year follow-up his condition was found to be unchanged. The case is discussed in relation to the common controversy over the wisdom of symptomatic treatment for hysterical reactions, and a practical means of resolving the disagreement is considered. Walton and Black (1959) report one of the earliest behavioural treatments of hysterical aphonia. They had the patient read what they considered to be extremely boring passages of text. If vocal intensity increased she was rewarded with shorter sessions, but if no such increase was shown she was punished with longer sessions. They report a successful increase in volume which was maintained at an 1 l-month follow-up. Subsequent programmes have intro- duced more immediate feedback while main- taining contingent reinforcement for increases in volume. Jackson and Wallace (1974) used a voice operated relay to dispense reinforcer ‘tokens’ immediately a volume increase was detected. Brody, Nelson and Brody (1975) report a study which highlights the importance of the visual feedback component in this kind of approach. For two mildly retarded subjects with ‘functional vocal intensity deficits’ a light was made to come on when a target volume was achieved. Thus they aimed at trying to turn on the light. One subject was given additional reinforcement (tokens) contingent on success, while no additional reinforcement was provided for the other. Nevertheless, both subjects pro- gressed ‘consistently and remarkably’ and reached the same conversational intensity. Indeed the subject who did not receive tokens showed considerably greater generalisation of progress to other situations. This current study investigates the efficacy of providing visual feedback of vocal intensity as the central treatment factor for a 49-year-old male diagnosed as a hysterical aphonic. A goal oriented framework was employed so that the patient always attempted to exceed his current ‘record volume’ which was constantly updated. Further- more, the feedback of vocal intensity was con- tinuous and no external reinforcers were employed. Of course contingent reinforcement is inherent in any goal oriented biofeedback procedure such as this, and it was not the intention to attempt to eliminate reinforcement altogether. Rather, as will be discussed, it was simply thought that this patient would reject an approach employing tangible reinforcement. While results initially proved extremely en- couraging, the events which followed the Requests for reprints should be addressed to: Colin MacLeod, Psychology Department, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, U.K. ‘Now at St. George’s Hospital Medical School, London. 347