Stuttering Therapy Reviews

Prolonged Speech (Fluency Shaping) Therapy

• Motor Learning and Control
• Speech Motor Control
• Three Stages of Motor Learning
• Prolonged Speech Techniques
• Slow Speech with Stretched Vowels
• Relaxed Breathing
• Phonation
• Articulation
• Improving Cognitive Stage Speech Motor Learning
• Improving Associative Stage Speech Motor Learning
• Automatic, Effortless Fluency
• Reinforcing On-Target Speech
• Zen in the Art of Stuttering

Prolonged speech stuttering therapy, called fluency shaping in the United States and smooth speech in Australia, trains stutterers to speak slowly with relaxed breathing, relaxed vocal folds, and relaxed articulation (lips, jaw, and tongue) muscles.

This article is long but important. Prolonged speech stuttering therapy is where you learn to talk fluently. If you don't master these skills, none of the other treatments—medications, electronic devices, handling stress better, and psychological interventions—will be fully effective. It is the foundation of all other stuttering treatments.

Conversely, you may have tried prolonged speech stuttering therapy and it didn't work for you. For about 70-75% of adult and teenage stutterers prolonged speech stuttering therapy is enough. I was one of the 25-30% of stutterers for whom it wasn't enough. I learned to speak slowly and fluently in a speech clinic but I couldn't transfer this fluency to conversations outside the speech clinic, i.e., as soon as I stepped out the door of the speech clinic my stuttering returned. The second half of this article (beginning at Improving Cognitive Stage Speech Motor Learning) has my own ideas about making fluent speech automatic and effortless, i.e., improving prolonged speech stuttering therapy. And prolonged speech stuttering therapy treats only one factor in stuttering (speech motor overactivity). Other factors contribute to stuttering so I've written articles about technology and medications to treat factors that prolonged speech stuttering therapy doesn't address.

Motor Learning and Control

Motor learning and control is the study of how our brains execute complex muscle movements. Physical therapy and occupational therapy students study motor learning and control. Sports coaches also study motor learning and control. The principles of motor learning and control are usually illustrated with examples from gymnastics, tennis, golf, or other sports.

Closed-Loop Motor Control

A muscle movement takes about 200 milliseconds (one-fifth of a second) to execute:

1. Sensation, or neural transmission from sensory receptors in your eyes, ears, etc., to your brain, takes about 15 milliseconds.
2. Perception, which retrieves long-term memories to organize, classify, and interpret your sensations, takes about 45 milliseconds. Perception changes sensation data into perceived information or meaning.
3. Response selection takes about 75 milliseconds. You use current perception and past experiences to formulate a course or action. For example, in baseball, a batter watches the pitcher and decides whether to swing at a pitch, hit or bunt, hit to left field or right, etc. Psychologists differentiate conscious decisions from unconscious translations, or relating a particular stimulus to a particular response.
4. Response execution of an action plan—a step-by-step sequence of events that make up the planned movement—takes about 15 milliseconds. In these events, motor neurons carry signals from the brain or spinal cord to muscles.

Under closed-loop motor control you use perception to consciously, continuously adjust muscle movements. For example, imagine threading a needle. You look at the needle. You look at the thread. You move the thread towards the needle. You look at the needle again. You look at the thread again. You correct your movement. You do this many times until the thread is through the needle.

Each stimulus-response adjustment takes at least 200 milliseconds (one-fifth of a second). If you make ten adjustments, the task takes at least two seconds.

Closed-loop motor control has two advantages. It enables precise control, and it enables execution of novel movements (activities you've never done before). For example, you could thread a needle on the deck of a rolling ship.

Closed-loop motor control has two disadvantages. It's slow, and it requires your full attention.

Closed-loop motor control is good for learning new skills, or for executing skills you rarely need. But you don't want to use closed-loop motor control for fast-paced, frequently used skills.

Open-Loop Motor Control

200 milliseconds—a split second—may seem fast, but it's too slow for many motor tasks. For example, a gymnast's double-back somersault requires muscle movements lasting only tens of milliseconds.

How is it possible to execute a muscle movement in tens of milliseconds, when the sensation to execution cycle requires about 200 milliseconds? Simple—don't do the sensation, perception, and response selection stages. Just do the response execution. This final stage of muscle movements can be performed in as little as 15 milliseconds. This is called open-loop motor control. Open-loop motor control is the execution of preprogrammed movements, called a motor program, without perceptual feedback.

The colloquial term for this is "muscle memory." For example, gymnasts practice hours each day for years, until their muscles seem to know what to do without the mind getting involved.

After winning the gold medal in gymnastics at the 1984 Olympics, Mary Lou Retton said her coach

Bela [Karolyi] can really teach, I've learned so much from him. Many long hours were spent in the gymnasium…repetition, feedback, repetition, and experimentation. Somehow, after a lot of bumps and bruises, it got easier, as if I could float.

Karolyi added,

Someone should be able to sneak up and drag you out at midnight and push you out on some strange floor, and you should be able to do your entire routine sound asleep in your pajamas. Without a mistake. That's the secret. It's got to be a natural reaction.

Open-loop motor control has two advantages:

1. It's fast. You can execute muscle movements with split-second timing.
2. It requires no attention. Movements under open-loop control are automatic and mentally effortless.

Open-loop motor control has three disadvantages:

1. If your motor program contains errors, you'll execute the errors. You can't stop and adjust a mistake. You may not even be aware that you made a mistake.
2. Developing open-loop control of a motor skill requires long practice—especially for adults. Children learn some motor skills easily, that adults struggle for years to master.
3. Novel or new situations can't be handled. For example, in the 2000 Olympics, officials set the gymnastic vault two inches too low. The officials didn't correct the height until 18 of the 36 women had performed. These 18 athletes performed poorly, eliminating their hopes of winning medals. The American hopeful, Elise Ray, suffered a "devastating fall." [1]

Learning New Motor Skills

Use closed-loop motor control for learning a new motor skill. Then gradually increase your speed until you can perform the motor skill using open-loop motor control.

For example, a tennis or golf coach will have you start with swinging the club or racquet slowly, while she adjusts your knees, elbows, etc. When you've perfected your form, your coach will have you gradually increase the speed and force, while maintaining form. After extensive practice you'll be executing perfect open-loop motor programs. You'll smash the ball hard and fast and accurately without paying attention to your elbows or knees or anything other than the ball.

Speech Motor Control

Normal speech uses open-loop motor control:

• Speech is fast. Phonemes (speech sounds) are typically 20 to 40 milliseconds.
• Speech is complex, requiring coordination of hundreds of muscles to produce sounds.
• Speech is automatic and effortless. Speakers think about what they're saying, not about the muscles they're moving.

Prolonged speech stuttering therapy uses closed-loop speech motor control. You consciously relax your breathing. Then, as you exhale gently, you slowly increase your vocal fold tension, until your vocal folds hum. Then you slowly move your lips, jaw, and tongue to form the sounds of each word. Stuttering is impossible when using closed-loop speech motor control. Stuttering disfluencies are open-loop speech motor programs.

Making stuttering impossible might sound appealing, but

• Closed-loop speech motor control is slow. Closed-loop motor control takes about 200 milliseconds per muscle movement. Open-loop speech sounds are typically in the 20-40 millisecond range. Closed-loop speech motor control slows speech five to ten times, or one or two seconds per syllable.
• Closed-loop speech motor control demands your full attention. You must pay attention to your breathing, vocal folds, and lips, jaw, and tongue. This isn't a problem when reading a list of words, but is difficult to use in conversations.
• Your speech loses prosody (emotional intonation). You sound like a robot with dying batteries.
• A fourth possible problem may be that stutterers learn speech motor skills slower and retain them less than non-stutterers. [2]

Prosody, Parameterization Schemata, and Response Selection

Why closed-loop speech motor control loses prosody is an interesting question.

A study of television talk show guests found that 94% of what viewers remembered was prosody, or what actors call emoting, or what lawyers call affect. [3] Much—or almost all—meaning is communicated by prosody. Schemata theory suggests that you learn certain invariable characteristics of a motor skill, and you learn certain execution rules or parameterization schemata. You then combine the invariable elements with the rules to produce a motor plan.

For example, in a public speaking class I read algebra problems in an angry voice, in a sad voice, and then with the rhythm and emotional intonation of a stand-up comedian. The algebra problems were invariable—I read the same algebra problems each time. I changed the parameterization schemata to communicate different emotional states. Amazingly, the audience laughed at the "punchlines" when I did the stand-up comedy delivery. Even though the "punchlines" were just numbers, I made the audience think that a punchline was coming, and they laughed at the right times. 94% of the joke was the delivery.

Accents are another parameterization schema that conveys meaning. For example, a waitress from Oklahoma asked me if I wanted ah-iss. When I figured out that she was asking about ice, I affirmatively answered yay-iss. I knew the invariable characteristics of "yes," and when I'd learned the rules of an Oklahoma accent—e.g., break monosyllabic words into two syllables—I was able to say a word I'd never heard.

In normal speech, we produce prosody through unconscious response selection of parameterization schemata. Different environmental cues cause us to select different responses. For example, you walk into a church and immediately lower your vocal volume. But if no one else is in the church, you could yell "I hate to wear pants!" while turning somersaults down the aisle. OK, that's one of my eccentric hobbies, but most people wouldn't do that.

Another example is a person who grew up spending summers in Vermont and winters in Georgia. When she's in New England she speaks in a Yankee accent. When she's in the South she switches to a southern accent. Different environmental cues cause her to unconsciously select different parameterization schema to produce each accent.

Like prosody and accents, stuttering is a parameterization schema. A stutterer responds to environmental cues to unconsciously select fluent speech parameters or stuttering speech parameters, which are then combined with invariable characteristics of words to produce fluent or stuttered speech. Thus you can treat stuttering by training stutterers to respond differently to environmental cues (Responding to Stress), or by training stutterers to use fluent speech parameterization schema (this chapter).

Training a stutterer to not feel fear or anxiety when answering the telephone is changing the response selection to an environmental cue (a ringing telephone). In contrast, training a stutterer to speak with relaxed vocal folds changes a speech parameter.

Snake Oil and Charlatans

Closed-loop speech motor control is the "wizard behind the curtain" of many stuttering therapy programs. Switch any stutterer to closed-loop speech motor control and he or she will be completely fluent.

You can switch to closed-loop speech motor control by making any speech process conscious instead of unconscious. For example, focusing on relaxed, slow breathing will switch you into closed-loop speech motor control, with your vocal folds and articulators (lips, jaw, and tongue) following right along. Or you can focus on producing "gentle onsets" with your vocal folds. This will switch your breathing and articulators to closed-loop speech motor control. Or you can focus on "reduced articulatory pressure" and your breathing and vocal folds will follow.

Always these "wizards" claim that their therapies are 100% effective if the stutterer "really tries," that is, if he devotes his full attention to closed-loop speech motor control. If the stutterer instead pays attention to a conversation, switches into open-loop speech motor control, and then stutters, then he wasn't "really trying."

And the closed-loop speech motor control effect has caused speech-language pathologists to hypothesize that stutterers have something wrong with their breathing, or with their vocal folds, or with their articulators, or even that stutterers' brains are slow in some way. That latter theory is like saying that student drivers have slower brains than Indy 500 race car drivers because student drivers are safe at 20 mph but crash when driving at 200 mph. Everyone performs slowly when attentively learning a new motor skill, then their speed improves with practice. For stutterers in speech therapy, the new motor skill is fluent speech.

Some speech clinics tell stutterers that they'll have to speak slowly for the rest of their lives. That's like training a student driver to drive 20 mph, then telling him never to go faster.

Slow Speech Is Not the Goal of Stuttering Therapy

If you learn tennis or golf, you'll use closed-loop motor control when you're learning to swing the club or racquet. As you practice, increasing your speed and force, you'll gradually reinforce open-loop motor programs.

Similarly, you'll use closed-loop speech motor control when working with your speech-language pathologist. She'll train you to move your respiration muscles, vocal folds, and articulators correctly to produce fluent speech. When you've mastered this at a very slow speaking rate, she'll help you to gradually increase your speaking rate, while staying fluent. The goal is fluent, automatic, effortless, normal-sounding and normal-rate speech. Slow speech is not the goal of stuttering therapy.

Severe stutterers usually don't mind learning closed-loop speech motor control. If your stuttered speech is ten to twenty times slower than normal speech, then closed-loop speech motor control, which is typically five to ten times slower than normal speech, will double your speaking rate. Record conversations with and without using closed-loop speech motor control. Count your syllables per second. You may find that closed-loop speech motor control feels slower but is actually faster than your stuttered speech.

But mild stutterers don't like closed-loop speech motor control. They can hide their stuttering by avoidance and substitution (of certain sounds, words, or speaking situations). They can sound fluent at a normal speaking rate. Closed-loop speech motor control would "advertise to the world" that they have a speech disorder. If they're embarrassed to admit that they stutter, they won't want to use closed-loop speech motor control.

Mild stutterers should consider that closed-loop speech motor control enables them to say anything they want. For example, a mild stutterer wants to buy a chess set. He's afraid of s words, so he calls a toy store and asks if they have "one of those games with kings and knights and castles."

The puzzled clerk responds that the store has many games with kings and castles and knights. After five minutes of conversation, the clerk asks, "Do you mean chess sets?" The stutterer says yes. The clerk never knows that the caller is a stutterer, but she thinks that the caller is an idiot. The stutterer wasted five minutes because he wasn't willing to use ten seconds of slow speech.

Or the stutterer drives to the store and looks for a chess set, without calling first. If the store doesn't have chess sets he wastes an hour, to save ten seconds. Saying what you want slowly is faster than saying something else, or not speaking at all.

Americans speak around 165 words per minute. Fast talkers who speak more than 190 words per minute get complaints from listeners unable to understand them. In contrast, Walter Cronkite trained himself to speak 124 words per minute in his newscasts. "Uncle Walter" may have earned his title as "the most trusted man in America" in part because he spoke clearly.

Analogy to Touchtyping

I've never taken a typing class. I type with two fingers, about 45 words per minute. (I'm probably the world's fastest two-fingered typist!)

I tried to learn touchtyping. My speed dropped to less than ten words per minute. Touchtyping not only slowed me down, it required my full concentration. I couldn't think about what I was writing, only about moving my fingers.

I gave up touchtyping within a week. If I'd kept at it, my speed would have increased and eventually surpassed my two-fingered typing speed. I might have been typing 80 words per minute now. The mental effort would have diminished, until touchtyping was automatic and effortless.

Coaches say they'd rather work with a novice who's never played their sport, rather than with an experienced player who uses incorrect techniques. It's easier to learn a new motor skill correctly than it is to correct an incorrect, deeply ingrained motor skill.

Stuttering is difficult to overcome because we learned to talk incorrectly. We have to learn new, fluent speech motor skills, and we have to not use our old, disfluent speech motor skills. We learned these disfluent speech motor skills in childhood, when our brains were growing. Now the disfluent speech motor skills are hardwired into our brains. Making fluent speech automatic and effortless, for a stutterer, demands more time and effort than learning a new sport or vocational skill.

Using DAF to Slow Speaking Rate

Many speech-language pathologists use delayed auditory feedback (DAF) devices to establish fluency using closed-loop speech motor control. With only a little training a DAF device can help a stutterer maintain perfectly paced, steady, mentally effortless, slow closed-loop speech motor control.

The user's speaking rate can adjusted by turning a knob. A typical protocol is to train a stutterer to use closed-loop speech motor control with a 200-millisecond delay and one to two seconds per syllable. The stutterer practices this until he's 100% fluent. That usually takes only one or two therapy sessions. (A study found that without training a 195-millisecond delay reduced stuttering only 85%. [4])

When the stutterer can speak 100% fluently, the speech-language pathologist then has the stutterer use one- or two-second stretched syllables without the DAF device; in increasingly stressful situations (e.g., calling the speech-language pathologist's answering machine); and then with the DAF device adjusted for faster speaking rates. The stutterer must stay on-target with 100% fluency, or go back to using the DAF device at 200 milliseconds and a one- to two-second speaking rate.

Typically, a 100-millisecond DAF delay is used with half-second per syllable stretched speech, a 75-millisecond delay is used with quarter-second per syllable "slow normal" speech, and a 50-millisecond delay is used with a normal speaking rate.

Three Stages of Motor Learning

We learn new muscle movements, or motor skills, in three stages:

1. In the cognitive stage, an instructor demonstrates the motor skill to you.
2. In the associative stage, you learn to perform and refine the motor skill. You perform the movements under closed-loop control.
3. In the autonomous stage, the motor skill becomes automatic. You perform the muscle movements without mental effort, under open-loop control.

For example, imagine yourself learning golf or tennis. You watch the coach hit a few practice balls. Then the coach hands you the club or racket. The coach guides you through a swing, telling you to drop this shoulder or extend that forearm. Soon you can execute the swing perfectly, if you fully concentrate on each movement. You then practice the swing, and your game improves.

A few years later a novice admires your excellent swing and asks you to explain how you do it. "I don't know," you say, "I just do it without thinking about it."

For another example, last summer I tried mountain bike racing. In four races I crashed four times. I then hired a coach. In twelve hours over three weeks, he taught me how to ride down hills, make tight turns, jump my bike over logs, climb hills, plus a few tricks such as picking up a water bottle off the ground.

My coach then said, "You've learned every skill. Now you have to practice a couple hours a day, a couple times a week." I'd completed the associative stage and learned how to do each skill. Now I would have to practice these skills hours a day, several times a week for months to make the skills automatic in the fast, high-stress environment of racing. In other words, I could do any of the skills if I thought about it, but my body didn't automatically execute the moves without conscious mental effort. I decided that mountain bike racing isn't important enough to me to spend thousands of hours practicing skills.

Stuttering therapy follows a similar course. A speech-language pathologist can show you the fluency skills—relaxed, diaphragmatic breathing; vocal fold relaxation (gentle onsets); and relaxed articulation muscles (lips, jaw, and tongue)—in an hour. Teaching you to execute these skills takes a few hours. You can then speak fluently in the speech clinic, when you mentally concentrate on each skill. Almost everyone successfully completes these cognitive and associative stages.

You then have to practice these skills thousands of hours to make them automatic and effortless. Many stutterers fail at this stage. But no one intentionally fails for the reasons I quit mountain bike racing. No one rationally weighs the alternatives and says, "Talking isn't important to me. I'll learn sign language instead, or write notes."

Instead, stutterers fail at the autonomous stage because speech-language pathologists don't train this well. Speech-language pathologists call this transfer. Perhaps your speech-language pathologist takes you to a shopping mall for a few hours. But the autonomous stage requires thousands of hours of conversations, including high-stress conversations. Stutterers habitually avoid such conversations. You may find that the skills you learned in the low-stress speech clinic fail in high-stress conversations. Your therapy progress begins to fail. You revert to old habits and avoidances. Your stuttering returns.

The section Automatic, Effortless Fluency will detail the autonomous stage. The rest of this section is about the cognitive and associative stages.

Prolonged Speech Techniques

Prolonged speech stuttering therapy programs typically begin with slow speech with stretched vowels, then work on relaxed, diaphragmatic breathing, then work on vocal fold awareness and control, and finally work on relaxed articulation (lips, jaw, and tongue).

These techniques are all abnormal. They all produce "weird"-sounding speech. The idea is to go to extremes when practicing (in the speech clinic or at home), and then in "real world" conversations you reduce the techniques so that you sound normal, and speak fluently.

Choosing a Speech-Language Pathologist

Find a speech-language pathologist who specializes in stuttering. More than 100,000 speech-language pathologists are licensed by the American Speech-Language Hearing Association (ASHA). Of these, fewer than 400 are board-certified Fluency Specialists. These specialists are listed on http://www.stutteringspecialists.org/.

The Stuttering Foundation of America also has lists of speech-language pathologists who treat stuttering.

You could also go to a National Stuttering Association local support group and ask for recommendations.

Is Self-Therapy an Option?

You can't learn motor skills out of a book. You can learn the cognitive stage from a book or video. Analogously, many videotapes offer to teach golfers how to improve their swing.

But the associative stage requires feedback. A trained individual must observe you and tell you when your performance is correct, when your performance is incorrect, and what to change to correct your performance.

You can watch my videos demonstrating slow speech with stretched vowels, and lower vocal pitch with relaxed breathing and relaxed vocal folds, at http://www.YouTube.com/CasaFuturaTech. If it helps you, great. If not, make an appointment at a speech clinic.

Slow Speech with Stretched Vowels

Let's start with how not to do slow speech with stretched vowels:

"I" < pause> "am" < pause> "an" < pause> "American."

Saying "I am an American" normally takes about 1.5 seconds (seven syllables at about five syllables per second). By silently pausing two seconds between words, and saying each word normally, the phrase would take about eight seconds. That wouldn't improve your fluency.

Instead, stretch each vowel for a second or two. Also stretch voiced consonants (e.g., /m/, /n/, /r/) a little longer then normal, but not as long as vowels. Articulate voiceless consonants (e.g., /k/) lightly and quickly, just touching your lips or tongue and then moving to the next voiced sound.

Join the syllables together, with no breaks or pauses between words. The result should sound like:

"IIIIIIIIaaaaammaaaaannAAAAAmmeeeeerriiiiiiiikaaaaann"

Be sure that each syllable is held equally. In other words, "American" should take four times longer to say than "I." Don't make "American" the same length as "I."

Should you hold each syllable for one second or for two seconds? Some speech clinics start with one-second stretched syllables, when other speech clinics start with two seconds per syllable. No research has investigated which is more effective. If you're 100% fluent at one second per syllable, that should be slow enough. But if you're not 100% fluent at one second per syllable, use two seconds per syllable. According to motor learning theory, you need to execute slow enough that your form is perfect, but there's no reason to execute slower. Use a stopwatch to check that each syllable is the same length. If you have a DAF device, set the delay to 200 milliseconds. Then hold each syllable until you hear yourself in the headphones. Check your stopwatch and you should see that each syllable is between one and two seconds.

Relaxed Breathing

Place one hand on your stomach. Breathe so that your hand moves out when you inhale, and in when you exhale.

Notice that you're taking many small breaths. Your inhale and exhale times are equal.

This is relaxed or diaphragmatic breathing. This is the way people normally breathe.

Now switch to upper-chest breathing or thoracic breathing. Take a big breath, using your upper chest muscles to expand your lungs. Release the air slowly, while maintaining this upper chest muscle tension to hold air in your lungs as long as possible. When you've released the air, quickly take another breath, filling your lungs as rapidly as possible. Practice switching between thoracic and diaphragmatic breathing.

Thoracic breathing increases our lung capacity. It enables us to maximize our physical exertion. Our " fight or flight" instinct switches us to thoracic breathing. We're then better able to run or fight.

Some individuals hyperventilate or switch to thoracic breathing when experiencing non-physical stress. Stress reduction classes teach students to relax by switching to diaphragmatic breathing.

We also use thoracic breathing when talking. A large breath with a long, slow exhale enable us to speak many words before pausing for another breath.

Well-meaning people who know nothing about stuttering may tell you to "take a deep breath" before talking. But the opposite is better advice. Diaphragmatic breathing is the foundation of many stuttering therapy programs. Taking smaller breaths with your diaphragm can help you relax and talk fluently.

Try it. Your relaxed breathing will relax your entire body. Most importantly, it will relax your vocal folds, and then your lips, jaw, and tongue. Your voice will deepen and sound confident and even "sexy." You'll feel relaxed and confident.

Practice a word list using diaphragmatic breathing. Read a magazine page aloud using diaphragmatic breathing.

You'll soon discover a few problems trying to speak with diaphragmatic breathing. Each breath is small, so you're able to say only a few words on each breath. Inhale time and exhale time are equal, so you have long pauses between short phrases. You're unable to speak loudly.

Like other fluent speech motor skills, speaking with diaphragmatic breathing is abnormal but useful. Include speaking with diaphragmatic breathing in your stuttering therapy practice exercises. Mastering this skill will enable you to speak short phrases fluently in stressful situations. For example, a police officer pulls you over for speeding. You don't need to say much besides, "Yes, officer," and "No, officer."

And as you master speaking with diaphragmatic breathing, you'll develop something in-between thoracic and diaphragmatic breathing. This "in-between" breathing will be more relaxed than thoracic breathing, yet your phrase length and vocal volume will be within the normal range.

Phonation

Your vocal folds are flaps of muscle in your throat. Making your vocal folds vibrate produces sound. This sound then becomes your voice. Vocal fold vibration is called phonation.

Two conditions produce phonation. First, you release air from your lungs. Next, you tension or tighten your vocal folds.

Place your fingers on your throat. Exhale and hum. Your fingers should feel a vibration. This is your vocal folds vibrating.

Stop humming, and feel the vibration stop. Practice switching your phonation on and off.

Now vary your phonation in two ways. Change your volume (hum louder, then quieter). Change your pitch. Hum up and down a musical scale.

How did you do that? You varied your volume of exhalation, i.e., you increased or decreased the air releasing from your lungs by tensing or relaxing your thoracic (upper chest) muscles. More exhalation enabled you to produce more volume.

You also varied your vocal fold tension. Tense vocal folds produce a higher-pitched voice. Relaxed vocal folds produce a deeper or lower-pitched voice.

Tense your vocal folds as hard as you can. You'll block your throat, not allowing any air to escape. If you take a deep breath and then block your throat, your increased lung pressure makes your chest stronger. Like inflating a tire to carry a heavier load, this is effective for lifting a heavy weight. But it's not a good way to talk!

Practice one more aspect of phonation. Take a breath and hold it, tense your vocal folds, then release air. Switch to the other way: take a breath, release a little air, then tense your vocal folds. Note that the former produced a croak. The latter produced a nice hum. This shows that phonation requires timing two muscle movements: exhaling a little air, and then starting to tense your vocal folds.

You now see that three things can go wrong with phonation:

• Releasing too much or too little air (inadequate breath support).
• Overtensing your vocal folds. Under stress, you may try too hard to talk, tense your vocal folds too much, and block off air flow. This results in a silent block
• Mistiming exhalation and vocal fold tension. A goal of stuttering therapy is train the stutterer to consciously breathe, release a little air, gently tense his vocal folds, and then begin to talk. This exercise is called gentle onset or easy onset.

Gentle Onsets with Vowels

To hit a baseball home run, you use all of your arm muscle strength. In contrast, to putt a golf ball a few feet, your arm muscles are more relaxed than tense. Phonation is like putting a golf ball, not hitting a home run.

To use gentle onsets (also called easy onsets), take a relaxed breath with your diaphragm. Release a little air. Say ah as you gradually increase vocal fold tension. Feel your vocal folds begin to vibrate. Increase your vocal fold tension, until you reach normal speaking volume. Gradually reduce vocal fold tension, until you're silent. Time this to take about two seconds. You should be able to do this on one breath, without reaching residual air.

You can buy computer applications that graph your phonation contour. Applications include Dr. Fluency, Speak:Gentle, and the Computer-Aided Fluency Establishment and Trainer (CAFET). Or you can use a sound-recording and -editing application (many such applications are available free). On a computer monitor, your vocal volume should look like this:

Practice fifteen gentle onsets with the fifteen vowel sounds (say the vowel, not the word):

Front Vowels:	long e, as in beet
	short i, as in bit
	long a, as in bait
	short e, as in bet
	short a, as in at
Back Vowels:	long u, as in boot
	short o, as in book
	long o, as in boat
	aw, as in cause
	ah, as in cot
Central Vowels:	ow, as in about
	short u, as in but
Dipthongs:	long i, as in bite
	oy, as in boy
	au, as in bough

Gentle Onsets with Words

Now say "dog," stretched over two seconds, with gentle onset. Begin with a quiet, gentle /d/ sound. Switch to the /aw/ vowel sound and gradually increase vocal volume. After one second, gradually reduce vocal volume. Switch to the /g/ sound, and stop vocal fold vibration.

Voiced and Voiceless Consonants

All vowels use phonation. Some consonants use phonation, i.e., are voiced. Other consonants are produced without phonation, i.e., are voiceless. You can whisper these consonants.

Place your fingers on your throat. Say ah to feel your vocal folds vibrating. Say the following words and decide whether the initial consonant is voice or voiceless:

/h/	hail	/w/	whale
/f/	famous	/v/	vacant
/s/	saber	/z/	zany
/sh/	chenille	/zh/	jeté (a ballet move)
/ch/	chive	/j/	jive
/thr/	throw	/th/	those
/p/	pipeline	/b/	bison
/t/	tie-dye	/d/	diner
/k/	kindness	/g/	guide

The first column was voiceless. The second column was voiced.

Did you notice that these sounds were pairs? /h/ and /w/ have your lips, jaw, and tongue in the same positions. The difference is that your vocal folds vibrate to produce /w/, but don't vibrate to produce /h/.

To say a word with a voiceless consonant, take a breath, let out a little air, shape the consonant with your lips, jaw, and tongue, then switch to the vowel and gently start your vocal fold vibration.

Practice a word list. Keep your fingers on your throat to feel your vocal folds switching on and off as you go from voiced to voiceless sounds. Stretch each word to two seconds.

Because most words contain both voiced and voiceless sounds, we switch our vocal folds on and off many times each second while talking. A core behavior of stuttering is an inability to switch phonation on at the right moments. The timing can be as precise as one one-hundredth (1/100) of a second.

Normal speech is about five syllables per second, or 0.2 seconds per syllable. For this practice you're using two seconds per syllable stretched speech, or ten times slower than a normal speaking rate. Slowing down your speech helps you develop awareness and control of speech elements that are otherwise too fast to notice or control. If you play a sport, such as tennis or golf, your coach might videotape your swing and then replay it back in slow motion. This improves your awareness and control of the motor skill.

Continuous Phonation

Stuttering therapy sometimes teaches techniques that produce fluency, but sound abnormal. For example, speech with diaphragmatic breathing produces fluency, but shortens phrase length and makes you pause between phrases. The immediate goal is to use these techniques to produce fluent speech, and over time reduce the degree of exaggeration, until your speech sounds normal. Another goal is have a "trick" to use in stressful situations, such as speaking to a police officer.

Continuous phonation is such a technique or trick. Recall that consonants come in voiced/voiceless pairs. Simple substitute a voiced consonant whenever you need to say a voiceless consonant.

For example, "Patty" becomes "Baddy." Say each word slowly, with your fingers on your throat to feel your phonation. You'll feel your vocal folds switch on and off for "Patty," but stay on for "Baddy."

If you shorten the consonants and stretch your vowels (producing a slower speaking rate), listeners won't hear the difference between "Patty" and "Baddy."

Gentle Onsets with Multisyllabic Words

Practice using a gentle onset on each syllable. Go loud on each vowel. On the consonants, relax, go quiet, and lightly and quickly articulate the sounds.

For example, on "American," you start with a gentle onset on the initial /uh/. Open your mouth wide at the loudest point in the phonation contour.

Take the /uh/ sound down in volume, while at the same time closing your mouth to articulate the voiced /m/. Bring the /eh/ sound up in volume. Again, open your mouth wide at the loudest point in the phonation contour.

Take the /eh/ sound down in volume, while at the same time reduce your jaw opening (but don't close your lips) to articulate the voiced /r/.

Open your mouth wide again for the /ih/ vowel on the third syllable.

Now you get to the only voiceless sound in "American." Before the /k/ sound, take the down the volume of the /ih/ vowel. Whisper the /k/. If you block, you dropped the /ih/ volume too fast. Try again with a long, slow decline in volume on the /ih/. Articulate the /k/ lightly, for just a moment.

If you still block on the /k/, change it to a voiced /g/. In other words, say "Amerigan."

Use another gentle onset on the final /eh/ vowel. Reduce your volume on the final voiced /n/ consonant.

The result is an abnormal-sounding "sing-song" speech pattern. Your jaw opens and closes noticeably on each syllable. While you won't want to talk like this for the rest of your life, for practice or in stressful situations this technique helps you use gentle onsets, continuous phonation, and a slower speaking rate.

Articulation

The third set of speech muscles (after respiration and phonation) are your articulators: lips, jaw, and tongue. These muscles form your vocal fold humming into sounds and words. If you phonate without moving your lips, jaw, and tongue, all that comes out of your mouth is humming. The goal of this last target is to relax these muscles.

Reduced articulatory pressure is also called "soft targets."

Lightly touch your tongue for the /t/. Lightly close your lips for the /b/. Keep your speech production muscles relaxed for all sounds.

The wrong way is to tense your lips and tongue and jaw too much, and hold this tension too long.

You've learned to stretch and emphasize vowels. Now work on de-emphasizing consonants. If you stretch and emphasize vowels, and de-emphasize consonants, you should be able to speak fluently.

Read another word list aloud. Feel how your lips, jaw, and tongue move to change sounds. Say each word with normal articulation tension. Then say the word again with tense articulation. Then say the word again with relaxed articulation.

Some stuttering therapy programs at this point devote many hours to teaching the stutterer the correct lips, jaw, and tongue position for each of the 40+ sounds of English. This is unnecessary, in my opinion. Stuttering is not an articulation disorder. Stutterers don't, in general, misarticulate sounds (e.g., saying /w/ instead of /v/). Stutterers instead need to learn to relax their lips, jaws, and tongues.

There are exceptions. If your speech-language pathologist diagnoses that you have articulation problems, or if you speak with a foreign accent, do articulation therapy to train you to place your lips, jaw, and tongue in the correct positions.

Biofeedback Technology for Prolonged Speech Stuttering Therapy

Biofeedback is the measurement and display of physiological processes in real time to enable users to develop awareness and control of those physiological processes. When a speech-language pathologist trains a stutterer to use fluent speech motor skills biofeedback can provide knowledge of results (KR) faster and more accurately than the clinician.

Efficacy Studies of Prolonged Speech Stuttering Therapy Programs

Many efficacy studies of prolonged speech stuttering therapy programs have been published in scientific journals.

Improving Cognitive Stage Speech Motor Learning

Advances in the field of motor learning and control could make prolonged speech stuttering therapy more effective. The rest of this article is not standard prolonged speech stuttering therapy, i.e., these are my ideas, not widely practiced techniques and strategies.

In the first or cognitive stage of motor learning, you observe an instructor performing a motor skill that's new to you. But speech-language pathologists may be the wrong people to model fluent speech motor skills. When learning a new motor skill, novices learn best by observing another novice making mistakes, then getting it right.

In contrast, observing a skilled person perform the task flawlessly doesn't do you much good. For example, millions of people watch Michael Jordan play basketball. Few of those people could go out on a basketball court and repeat his moves. The exceptions are people who are already skilled and want to get better, e.g., college basketball players can improve their game by watching the pros.

A stutterer watching a speech-language pathologist model gentle onsets or pull-outs is like Joe Sixpack watching Michael Jordan. The stutterer might learn more if the speech-language pathologist modeled the mistakes her other clients have made, and then showed how to correct those mistakes. Or the speech-language pathologist could show a video of other stutterers making mistakes, and then learning to correct their mistakes.

Improving Associative Stage Speech Motor Learning

In the second or associative stage of motor learning, you learn to perform and refine a new motor skill.

Lower Vocal Pitch

But are there better fluent speech motor skills than the skills taught in fluency shaping stuttering therapy programs?

Speaking at a lower vocal pitch requires relaxing one's vocal folds, and reduces stuttering.REFERENCE Unlike other fluency-enhancing techniques such as a slow speaking rate or gentle onsets, listeners like the sound of a lower vocal pitch. A lower vocal pitch communicates confidence and relaxed authority. Some listeners even say that a lower vocal pitch sounds "sexy." Speaking with a lower vocal pitch makes one feel relaxed and confident. Yet this technique is not a target behavior in fluency shaping stuttering therapy programs.

According to multichannel processing theory, performing two tasks is easier if you integrate the tasks. For example, dancing while playing the saxophone is easier than playing tennis while playing the sax. Using fluency shaping motor skills while paying attention to a conversation should be easier if the motor skills relate to the conversation. If you're trying to communicate that you're relaxed and confident, then using a "slow normal" speaking rate with a lower vocal pitch should be easier than using gentle onsets.

This technique can be trained by using relaxed, diaphragmatic breathing while feeling (with your fingers or your throat) and/or listening to your vocal fold vibrations. Begin by humming or saying "ahhhh." Bring the pitch up, then down, then up again, then down further. Repeat until your feel and hear yourself humming at a very low pitch. Now speak slowly, stretching vowels, while keeping your vocal pitch low.

Notice that your vocal volume drops as you lower your vocal pitch. Don't try to speak loudly with a low vocal pitch, you may damage your vocal folds. A lower vocal volume is usually acceptable unless you're speaking in a noisy environment or to a person with hearing loss.

Frequency-shifted auditory feedback (FAF) devices induce stutterers to change their vocal pitch. [5] Most stutterers lower their vocal pitch when hearing their voices shifted lower in pitch but some stutterers raise their vocal pitch. If you respond by lowering your vocal pitch, an FAF device may help you to speak fluently and sound confident and relaxed.

Automatic, Effortless Fluency

The third or autonomous stage of motor learning moves you from closed-loop motor control to open-loop motor control. In stuttering therapy, the autonomous stage makes fluent speech automatic and effortless.

Autonomous stage motor learning results from:

1. Practicing target muscle movements faster and harder,
2. While making no errors,
3. In stressful situations,
4. With an ideal practice schedule,
5. For about three million repetitions.

For example, you take tennis lessons. Your coach shows you how to grip the racket properly, and swing at the ball. At first you execute this movement slowly, with little force. As your skill improves, you swing faster, and hit the ball harder. Whenever you make a mistake, your coach stops you and makes you begin again, slowly. At first your coach hits you easy balls. Then he hits harder balls to you, making the game stressful. Then you play tennis regularly. Over several years your game improves.

Where Stuttering Therapy Fails

Most stuttering therapy programs do little to train autonomous motor learning:

1. Your speech-language pathologist tells you to make a conscious effort to speak fluently. You're told that if your fluency fails, it's your fault for not concentrating on your speech.
2. All practice is done with relaxed speech-production muscles. You never increase muscle tension.
3. All practice is done at slow speaking rates.
4. All practice is done in the speech clinic, or at home alone. You don't do practice in high-stress situations.

Increasing Force and Speed

Stuttering therapy programs fail to train the autonomous stage of speech motor learning because of a counterintuitive aspect of stuttering. Stuttering is characterized by excessive speech-production muscle activity. The obvious but wrong treatment for stuttering is to reduce speech-production muscle activity, i.e., to speak with relaxed breathing, vocal folds, and articulation muscles.

Speech-language pathologists see that slowing down and using closed-loop speech motor control eliminates stuttering. They reach the obvious but wrong conclusion that stuttering therapy should be done at slow speaking rates.

Fluency shaping therapy begins by training slow, relaxed, fluent speech motor skills. Similarly, golf and tennis instruction begins with slow, relaxed, correct movements. Golf and tennis instructors then have you increase your force and speed. In contrast, speech-language pathologists tell you not to increase your force and speed. It may seem counterintuitive, but after you master slow, relaxed fluent speech, you must increase both the speed and force of your speech, without making errors, to train automatic, effortless fluency.

Increasing Force

The force of your speech is measured by volume. Work on getting loud. But don't shout or yell. Instead, project your voice. Vocal volume is a factor of both exhalation volume and vocal fold tension. Increase your exhalation volume while keeping your vocal folds relatively relaxed. This result is high volume with the intonations of normal conversational speech. Stage actors do this.

Increase your onset speed while maintaining long syllable duration. Pretend that your forearm is a sports car's accelerator. When your fist is up, your vocal volume is quiet. As you push your fist down, your volume increases. When your fist is all the way down, you're at maximum volume. Listeners one hundred feet away should hear you.

Slowly lower your fist to produce a gentle onset. Then slam your fist down fast to go from silence to maximum volume. Then hold that volume while stretching the vowel. Pull your fist up fast to end the word with speed. This is slow speech with maximum effort.

Be careful not to damage your vocal folds. Stop if you feel hoarse or start to lose your voice.

Increasing Speed

Shorten syllable duration from two seconds, to one second, to one-half second, to one-quarter second. Practice this both with relaxed, quiet speech, and with loud, forceful speech.

Using the practice word lists say each word four times:

1. Slow and relaxed (quietly).
2. Slow and projecting your voice (loudly).
3. Relaxed (quietly) with a quick onset.
4. Loudly projecting the word with a hard onset.

Where to Practice Force and Speed

It's hard to practice loud speech in a small room. The ideal place to practice is an empty auditorium. Have your speech-language pathologist sit in the back row. Stand on stage and project your voice to her. She yells, "Can't hear you!" until you reach ideal volume.

Another place to practice is near a building that produces an echo. A third place to practice is on a freeway overpass. Demosthenes, the stutterer who became the greatest orator of ancient Greece, projected his voice over breaking waves at the seashore. Work on projecting your voice over the waves of traffic.

Reinforcing On-Target Speech

Increasing speed and force myelinates or reinforces neural pathways in your brain. A mistake reinforces the wrong neural pathways.

Learning to talk fluently requires talking fluently 100% of the time. That sounds like circular advice, and it is. Reinforcing motor skills is a "virtuous cycle." Using target skills reinforces the skills, making the skills easier to use.

Conversely, stuttering reinforces undesirable speech motor skills (core stuttering behaviors

) and bad communication habits (secondary stuttering behaviors). Stuttering sets up a "vicious cycle" instead of a "virtuous cycle."

Swimming Analogy

I wanted to improve my swimming. At first I could swim only one length of the pool, and then I had to rest. But I got in the pool three times a week. I found that a small flotation device helped me swim five or ten laps. After two months something "clicked" in my brain and I swam half a mile. It was easy, almost effortless. I didn't need the flotation device any more.

Then I moved to a building without a swimming pool, stopped swimming, and now I swim as poorly as I did before that summer.

Similarly, stutterers go to speech therapy three times a week for months. Then suddenly one day they find themselves talking fluently, without effort. If they discontinue speech therapy, this "lucky" fluency disappears and they go back to stuttering.

Stutterers' brains have two sets of speech motor programs. Sometimes our brains pick the fluent speech motor programs. At other times our brains pick the stuttering speech motor programs. This is called response selecton. Speech therapy reinforces the fluent speech motor programs. Eventually this fluent speech becomes habitual. But during "lucky" fluency this habit is precariously balanced. One stressful day, in which you allow yourself to stutter, can reinforce the stuttering motor programs, and your "lucky" fluency is gone.

Speech Buddies

Children learn grammar by listening to other people talking, then speaking, then having their parents correct their grammar. You may not remember this, but after a vacation to the seashore you said, "We went nearly to the beach every day," and your mother corrected you, "No, dear, we went to the beach nearly every day."

Your mom was your speech buddy. You need another speech buddy now, to help you correct your speech when you're disfluent.

Ask your speech-language pathologist to let you organize a practice group with her other clients. Meet once a week to practice fluent speech. Exchange telephone numbers and arrange to call a speech buddy every day.

Here's an idea that'll get you talking fluently. If you have a spare bedroom in your house, call your local university and offer to let a speech-language pathology student live rent-free, in return for reminding you to use fluency shaping skills. If you don't live near a university, call your school district and see if they have a speech-language pathologist who'd go for free rent.

Train your spouse, housemates, and the people you work with to remind you to use fluency skills. If you're a parent with a child in speech therapy, ask your child's speech-language pathologist to train you to correct your child at home (see SLPs vs. Parents vs. Computers).

Bring your spouse or housemates to speech therapy. Ask them to give you a warning sign when you don't use your fluency targets, and offer to pay them $1 whenever you stutter.

My Romantic Disaster of 1996

In eighth grade I had a teacher with a forceful personality. He decided to cure my stuttering. Whenever I stuttered he stopped me, then told me to say it without stuttering. I hadn't had speech therapy and had no idea what to do. His method was as effective as teaching me Chinese by stopping me from speaking English and telling me to speak in Chinese.

Twenty years later I'd completed several speech therapy programs. I'd used electronic anti-stuttering devices for several years. I dated a woman who disliked my stuttering. Whenever I started to block, she'd give me a certain look. I'd stop, relax my breathing and vocal folds, and speak fluently.

After a few days with her I was talking fluently all the time. The relationship crashed and burned shortly after that.

For an individual who hasn't completed a speech therapy program, a person pointing out his stuttering is the worst thing. Such an individual doesn't have any control over his speech. Telling him to talk fluently increases his stress and his stuttering.

But for an individual who has mastered fluent speech skills, pointing out his disfluencies and reminding him to use fluent speech skills will help him. When you're at that stage, find a speech buddy to do this for you.

Start a Virtuous Cycle

Do whatever you need to get into the virtuous cycle. You may have to do things that are difficult or embarrassing—e.g., telling your co-workers that you stutter (hint: they've probably already figured that out!).

Once you're in a virtuous cycle, fluent speech will become easier and easier with less and less effort. The difficult things will become easier, and the embarrassing things won't be embarrassing (or necessary). If you've done it right, you'll only have to do these things for a few days or weeks.

Getting into a virtuous cycle may require:

1. Using closed-loop speech motor control (slow speech).
2. Using an electronic anti-stuttering device.
3. Taking a dopamine-antagonist medication.
4. Talking in uncomfortable situations, e.g., to strangers or to telemarketers.

For a high-testosterone kickstart, try "The Predator Approach".

Practicing Under Stress

Autonomous motor learning requires practicing a new motor skill in stressful situations.

Design a hierarchy of stressful situations. The first might be leaving a message on your speech-language pathologist's answering machine. When you can do that comfortably and fluently, you might talk to telemarketers using closed-loop speech motor control (slow, fluent speech). Then you could join Toastmasters and make a series of increasingly challenging speeches. More about this in the article Responding To Stress.

Practice Scheduling

The United States Postal Service studied workers learning to operate mail-sorting machines (similar to typewriters). All subjects received 60 hours of training. The scheduling varied among four groups.

One group had two two-hour sessions per day, for 15 days. A second group had one two-hour session per day, for 30 days. A third group had two one-hour sessions per day, for 30 days. The fourth group had one one-hour session per day, for 60 days.

The first group (two two-hour sessions per day) learned fastest, but in the long run had the worst performance. The fourth group (one one-hour session per day) took the longest to get "up to speed," but eventually had the best performance.

Surprisingly, the postal workers preferred the two-hour/two-session schedule, even though they had the worst performance. People are impatient. They don't want to spend 60 days learning something, if they think there's a 15-day shortcut.

Extinguishing Old Skills

We could simplistically conclude that you should practice stuttering therapy no more than one hour per day. But there's an essential difference between speech therapy and mail sorting. The postal workers were learning a new motor skill. Stutterers have to learn a new motor skill and extinguish an old motor skill. As noted earlier, coaches often prefer to work with individuals who have never played a sport and haven't learned bad habits, rather than work with experienced athletes and have to break their bad habits.

To extinguish an old motor skill you must stop doing it. Perhaps the ideal stuttering therapy is done one hour per day, and then you take a vow of silence the rest of the day. But that's unrealistic. To burn new fluent neural pathways, and extinguish old stuttering neural pathways, you must use fluent speech every time you talk. You must never stutter. Each disfluency weakens your new fluent neural pathways and strengthens your old stuttering neural pathways.

Extinguishing a maladaptive motor skill isn't the same as "breaking" a bad habit. Maladaptive motor skills enable you to perform a desirable behavior, but not as a well as a better motor skill. For example, touchtyping is better than two-fingered typing, but two-fingered typing also gets the job done. In contrast, picking my nose is an undesirable behavior. I wish that a teacher had taught me to touchtype when I was a child. I don't wish that a teacher had taught me a better way to pick my nose.

Because maladaptive motor skills enable you to perform a desirable behavior, it's hard to unlearn them and replace them with optimal motor skills. Stuttering isn't like picking your nose. Your mother could slap your hand and stop you whenever you pick your nose. If she stopped you every time you stuttered, you wouldn't be able to talk.

Extinguishing a maladaptive motor skill may involve "one step forward, one step back" temporarily. To speak fluently, you may have to speak much slower, or not respond immediately while you focus on your speech motor skills.

Intensive Residential Speech Therapy Programs

Some stutterers go to intensive residential speech therapy programs. These programs typically last three weeks. You're surrounded by speech-language pathologists and other stutterers, and isolated from the real world. For the first two weeks, you use two-second stretch all the time. In the third week, you move to one-second stretch, then half-second, and finally quarter-second slow normal.

Intensive residential speech therapy programs are like the postal workers who did the "short cut" training. In three weeks of intensive therapy you learn to talk fluently. But many stutterers find that long-term results are disappointing.

Your Ideal Practice Schedule

Work with your speech-language pathologist to develop a practice schedule. A severe stutterer may have to spend many hours a day doing "homework."

Don't practice sitting alone in a room reading endless word lists. This isn't going to produce carryover fluency to stressful situations.

A one-hour daily practice could have the following elements:

• After breakfast, twenty minutes of high intensity practice (projection and hard onsets), with practice word lists.
• During the day, a stressful twenty-minute session while using a biofeedback device to keep your vocal folds relaxed. This could be calling strangers for your job.
• After supper, twenty minutes of very slow closed-loop speech motor control conversation. Call another stutterer in your support group. Or call infomercial toll-free numbers.

How Long Does Autonomous Learning Take?

Gymnasts practice daily for about eight years to become proficient.

Motor learning researchers studied the manual (hand) skills of cigar-makers. [6] Beginner cigar-makers worked three times slower than experienced cigar-makers. Becoming fully skilled required making three million cigars.

Three million repetitions were also needed for Japanese pearl handlers to become proficient. The Suzuki method of teaching violin to children requires the production of about 2.5 million notes. Basketball, football, and baseball throws require about a million practice throws.

This suggests that making fluent speech automatic and effortless requires saying about three million syllables. At five syllables per second, talking four hours a day (just your time talking, not combined talking and listening), you could produce three million syllables in six weeks.

If you got a job answering telephone calls, and you did your stuttering therapy skills on every call, and you connected a biofeedback device into your telephone to alert you when you missed a therapy target, and you spent your free time at Toastmasters clubs making speeches or volunteering at a hospital's information desk, fluent speech might become automatic for you in six weeks.

But most stutterers practice between ten minutes and one hour per day. If they were silent the rest of the day, they'd say three million syllables somewhere between six months and three years.

No one has studied whether using undesirable motor skills cancels out on-target practice. In other words, does a half-hour of on-target practice get cancelled out by not using fluency skills the rest of the day? Such a practice schedule might take years to produce automatic fluent speech—or might never work.

Zen in the Art of Stuttering

Zen is the "everyday mind," as was proclaimed by Baso (died 788); this "everyday mind" is no more than "sleeping when tired, eating when hungry." As soon as we reflect, deliberate, and conceptualize, the original unconsciousness is lost and a thought interferes. We no longer eat while eating, we no longer sleep while sleeping. The arrow is off the string but does not fly straight to the target…Calculation which is miscalculation sets in…The archer's confused mind betrays itself in every direction and every field of activity.

— Daisetz T. Suzuki, intro to Zen in the Art of Archery

Stuttering is what you do trying not to stutter again.

— Wendell Johnson

The goal of stuttering therapy is spontaneous fluent speech. The goal of Zen is to do life activities without self-conscious calculating and thinking.

Non-stutterers usually talk without self-conscious calculating and thinking. But sometimes they are self-conscious about their speech. Fear of public speaking is common. And non-stutterers are self-conscious about asking the boss for a raise, or asking someone out on a date, or when discussing an embarrassing subject. Speech-language pathologists call this pragmatics—the mental effort of calculating the listener's reaction to your speech. In the Zen framework, pragmatics is the calculation that is miscalculation.

A goal of stuttering therapy could be to become a "Zen master of speech," just as other Zen masters are archers or swordsmen or calligraphers. To make an analogy to Baso, you sleep when tired, eat when hungry, and talk when you need to communicate. You don't worry about the listener's reaction. You don't fear embarrassment. If the listener doesn't do what you want or expect, you don't get upset.

You also talk fluently—but let's define fluency as if we're learning a foreign language. You need vocabulary to express your thoughts, grammar so your meaning isn't misconstrued, and accent and articulation to be understood. Mild stuttering may be OK, if your listener understands you, and you don't fear or avoid speaking. Van Riper called this "fluent stuttering," and a Zen master might call it "fluency which is not fluency."

Eugen Herrigel and Awa Kenzo

Eugen Herrigel (1884–1955) was a German professor of philosophy, with a special interest in mysticism. From 1924 to 1929 he taught philosophy in Japan, and studied archery with an eccentric archery instructor named Awa Kenzo. Awa taught archery as a mystical religion, called Daishadokyo. Daishadokyo had nothing to do with Zen Buddhism or the traditional Japanese art of archery (kyudo or kyujutsu). [7] In 1936, Herrigel wrote a 20-page essay about his experiences, and then in 1948 expanded the essay into a short book entitled Zen in the Art of Archery. Regardless of whether it accurately portrays Zen Buddhism or traditional Japanese archery, the book has many accurate insights into motor learning and control. For example, a central theme of the book is that a complex and difficult motor skill becomes seemingly mentally and physically effortless after years of practice, and that the motor skill is best performed when your body seems to execute the motor skill without your mind's conscious control. The book is wonderfully written and has been a bestseller for more than fifty years, in many languages.

Master Awa's first lesson was drawing the bow, letting "only your two hands do the work, while your arm and shoulder muscles remain relaxed, as though they looked on impassively."

This step is like stuttering therapy, with the goal of speaking while keeping your speech-production muscles relaxed.

Herrigel couldn't do this first step. He wrote that he'd "start trembling after a few moments, and my breathing became more and more labored." Sounds like stuttering!

He was trying to draw a six-foot bow held above his head, which requires great strength. But somehow the Master did this effortlessly.

…he called out to me to "Relax! Relax!"…the day came when…I lost patience and brought myself to admit that I absolutely could not draw the bow in the manner prescribed.

"You cannot do it," explained the Master, "because you do not breathe right."

Sounds like stuttering therapy! The Master continued,

"Press your breath down gently after breathing in, so that the abdominal wall is tightly stretched, and hold it there for a while. Then breathe out as slowly and evenly as possible, and after a short pause, draw a quick breath of air again—out and in continually, in a rhythm, that will gradually settle itself. If it is done properly, you will feel the shooting becoming easier every day. For through this breathing you will not only discover the source of all spiritual strength but will also cause this source to flow more abundantly, and to pour more easily through your limbs the more relaxed you are."

And as if to prove it, he drew his strong bow and invited me to step behind him and feel his arm muscles. They were indeed quite relaxed, as though they were doing no work at all.

The new way of breathing was practiced, without bow and arrow at first, until it came naturally. The slight feeling of discomfort noticeable in the beginning was quickly overcome. The Master attached so much importance to breathing out as slowly and steadily as possible to the very end, that, for better practice and control, he made us combine it with a humming note.

First relaxed breathing, and now vocal fold vibration!

I cannot think back to those days without recalling, over and over again, how difficult I found it, in the beginning, to get my breathing to work out right…

When, to excuse myself, I once remarked that I was conscientiously making an effort to keep relaxed, he replied: "That's just the trouble, you make an effort to think about it. Concentrate entirely on your breathing, as if you had nothing else to do!"

I've heard speech-language pathologists say the same thing…

It took me considerable time before I succeeded in doing what the Master wanted. But—I succeeded. I learned to lose myself so effortlessly in the breathing that I sometimes had the feeling that I myself was not breathing but—strange as this may sound—being breathed. And even when, in hours of thoughtful reflection, I struggled against this bold idea, I could no longer doubt that the breathing held out all that the Master had promised.

Learning to draw the bow took a year. Perhaps stuttering therapies are unsuccessful because we expect results too quickly. Imagine stuttering therapy starting with a year of breathing exercises!

Then Herrigel learned to loose the arrow. This was even more difficult than drawing the bow. Herrigel kept jerking his hand at the moment of release, which resulted in "visible shaking of my whole body and affected the bow and arrow as well." This caused the arrow to "wobble."

The Master told Herrigel, "Don't think of what you have to do, don't consider how to carry it out! You mustn't open the right hand on purpose."

Herrigel told the Master that after drawing the bow, "unless the shot comes at once I shan't be able to endure the tension…I can't wait any longer."

The Master replied that Herrigel's inability to wait was because, "You do not wait for fulfillment, but brace yourself for failure."

Herrigel spent three years learning to release the arrow. The Master said to release the arrow without tension, like a bamboo leaf holding snow, bending lower and lower until the snow slips off. The bamboo leaf waits without effort until the snow falls off.

In stuttering therapy, the first word of a phrase should be without effort, rolling off your vocal folds like the snow sliding off the bamboo leaf. You shouldn't intend to say the first word, as the archer doesn't open his hand on purpose. The word should say itself, without your planning or calculating or trying.

Herrigel's three years practice releasing the arrow suggests that learning to release the first word of a phrase may also take three years, and be the hardest part of stuttering therapy.

Herrigel was dedicated to his practice, but he couldn't release the arrow smoothly. The Master kept telling Herrigel to become "truly egoless." Herrigel became dejected, and planned to discontinue the archery lessons, concluding that, "all my efforts of the last few years had become meaningless."

Then, one day, after a shot, the Master made a deep bow and broke off the lesson. "Just then 'It' shot!" he cried.

"It" meant that Herrigel had loosed a shot without loosing the shot. "It" had loosed the shot, not Herrigel. The Master could not say anymore what "It" was, just that "It" can only be known through experience.

Only after considerable time did more right shots occasionally come off, which the Master signalized by a deep bow. How it happened that they loosed themselves without my doing anything, how it came about that my tightly closed right hand suddenly flew back wide open, I could not explain then and I cannot explain today…I got to the point of being able to distinguish, on my own, the right shots from the failures. The qualitative difference is so great that it cannot be overlooked once it has been experienced.

In stuttering therapy, the difference between your relaxed, fluent voice and your tense, stuttering voice is as obvious as night and day—after you learn relaxed, fluent speech. Until then it seems impossible.

The Master then began training Herrigel to shoot at a target, adding, "He who has a hundred miles to walk should reckon ninety as half the journey."

The Master refused to teach Herrigel to aim, insisting that the target was not the goal, and the goal cannot be aimed at, and that the goal doesn't have a name, except maybe "enlightenment."

But even though the Master did not aim, all of his shots lodged in the black center of the target, from sixty feet away.

At first Herrigel tried to shoot without caring if the arrows hit the target. But he couldn't do this, and "I confessed to him that I was at the end of my tether."

The Master replied:

You worry yourself unnecessarily. Put the thought of hitting right out of your mind! You can be a Master even if every shot does not hit.

Remember that you can be a Zen master of speech even if you still stutter.

When the Master said he sees "the goal as though I don't see it," Herrigel replied that the Master should then be able to shoot blindfolded. The Master then had Herrigel set up the target in darkness, except for one candle. Herrigel could not see the target at all, but the Master shot two arrows. When Herrigel turned on the lights, he saw that not only had both arrows hit the bulls-eye, but the second arrow had hit the first and splintered it!

Herrigel describes the following months as the hardest yet, of trying to hit the target yet not trying to hit the target. He gradually came to see the value of this training:

It destroyed the last traces of any preoccupation with myself and the fluctuations of my mood.

Finally, the Master had Herrigel shoot in front of spectators, and awarded him a diploma, "inscribed with the degree of mastery." Before Herrigel returned to Europe, the Master added,

I must only warn you of one thing. You have become a different person in the course of these years. For this is what the art of archery means: a profound and far-reaching contest of the archer with himself. Perhaps you have hardly noticed it yet, but you will feel it very strongly when you meet your friends and acquaintances again…You will see with other eyes and measure with other measures.

References

[1] America Wins Olympics, October 2, 2000, http://truthnews.net/culture/2000_10_olympic.html

[2] Namasivayama, A.K., & van Lieshout, P. (2008). Investigating speech motor practice and learning in people who stutter. Journal of Fluency Disorders, 33:1, 32-51.

[3] Arielle Ford's Complete Book Publicity Workshop.

[4] Stager, S., Denman, D., Ludlow, C. (1997). Modifications in Aerodynamic Variables by Persons Who Stutter Under Fluency-Evoking Conditions. Journal of Speech, Language, and Hearing Research, 40, 832-847.

[5] Natke, U., Grosser, J., & Kalveram, K. (2001). Fluency, fundamental frequency, and speech rate under frequency shifted auditory feedback in stuttering and nonstuttering persons. Journal of Fluency Disorders, 26, 227-241.

[6] Kottke, F.J., Halpern, D., Easton, J.K.M., Ozel, A.T., & Burrill, C.A. (1978). The Training of Coordination. Archives of Physical Medicine and Rehabilitation, 59, 567-572.

[7] Yamada Shoji. (2001). The Myth of Zen in the Art of Archery. Japanese Journal of Religious Studies, 28/1-2; http://www.nanzan-u.ac.jp/SHUBUNKEN/ publications/jjrs/pdf/586.pdf