Stuttering Therapy Reviews

Responding to Stress

• Responding to Stress
• Normal Disfluencies Under Stress
• Good Stress, Bad Stress
• Treating Stress in Stutterers
• Personal Construct Therapy: You Always Have Choices

Responding to Stress

Stress was a focus of the Iowa therapies. Parents were trained to reduce stress in their children's lives. Adult stutterers were desensitized to their stuttering to make them tougher in stressful situations. Responses to stress and speech-related fears and anxieties were seen as the same thing, with the same treatment.

Prolonged speech (fluency shaping) stuttering therapy programs generally ignore stress.

In the neurological era, we recognize that stressful situations change our brains' neurochemistry. Dopaminergic disorders, including Tourette's syndrome, obsessive-compulsive disorder (OCD), tics, and stuttering, manifest in stressful situations but not during relaxed situations.

We also now know that responses to stress aren't the same as speech-related fears and anxieties. Preschool stutterers stutter more in stressful situations (their stuttering often starts when they're experiencing unusual stress), but preschoolers don't have speech-related fears and anxieties. Treatments for stress and for speech-related fears and anxieties are different. The latter is covered in the next chapter. This chapter is about learning to handle stress better.

Normal Disfluencies Under Stress

Under stress, people's voices change. They tense their speech-production muscles, increasing vocal pitch. They talk faster. They repeat words or phrases. They add interjections, such as "uh." These are normal disfluencies. A study found that under stress, non-stutterers went from 0% to 4% disfluencies. Stutterers went from 1% to 9%. [1]

The "conventional wisdom" is that stutterers are always nervous or stressed out. Many psychological studies have proven that this isn't true. But stress has an important role in stuttering.

All stutterers can talk fluently. In relaxed, low-stress situations we can say any sound or word fluently.

In other situations we stutter. How many paraplegics do you know who can walk down country lanes, but not on city streets? Or blind persons who can't see certain people, but can clearly see others? OK, that describes young women after I turned 40, but most blind people are blind all the time.

Our brains are capable of producing fluent speech. We have all the speech motor programs necessary to produce any speech sound, fluently.

We also have speech motor programs for producing disfluent sounds. Stutterers have two sets of open-loop speech motor programs. Our brains select (response selection) one or the other set of speech motor programs, depending on environmental cues—where we are or whom we're talking to.

This is like a person who grew up summers in Vermont and winters in Georgia. Such a person would have a set of speech motor programs to speak with a New England accent. And this person would have a set of speech motor programs to speak with a Southern accent. When she's in Vermont, hearing people speak with New England accents, her brain automatically selects the New England accent speech motor programs. In Georgia, her brain selects Southern accent speech motor programs.

You always have choices for handling stressful situations (even if the choices aren't obvious). Some choices trigger your brain to automatically select disfluent speech motor programs. Other choices trigger your brain to select fluent speech motor programs. This chapter will teach you to make choices that automatically select fluent, relaxed speech. You'll feel relaxed and speak confidently even when non-stutterers are stressed out.

Are Responses to Stress Psychological?

According to "conventional wisdom," stuttering is a psychological disorder because stutterers speak fluently in low-stress situations and stutter in high-stress situations.

But many responses to stress are physical. For example, " fight or flight" increases heart rate. Stress is considered to be a factor in the development of physical disorders, such as heart disease and gastrointestinal disorders. Why is stuttering considered to be a psychological disorder, but heart disease is considered to be a physical disorder?

Stuttering Reduces Stress

Systolic blood pressure is an indicator of stress. Stuttering reduced stutterers' blood pressure 10%. [2] In contrast, fluent speech, chewing gum, and sitting quietly each reduced blood pressure about 2%.

You're thinking, "No way. Stuttering doesn't relax me. Stuttering doesn't feel like a massage or a warm bath."

But think about it. Stutterers are, on average, disfluent on 10% of syllables. We say 90% of syllables fluently. But we don't say one hundred syllables fluently, and then finish a conversation with ten disfluencies. Stuttering usually occurs on the first sound of the first word, in a stressful situation. In other words, your stress builds up as you anticipate speaking. You stutter, and this releases stress. You then say several syllables fluently.

You then stutter on another syllable, then say several more syllables fluently. Usually your speech improves over the course of the conversation, and your last few sentences are your most fluent.

If your blood pressure were monitored in such a conversation, it might look like (this is speculative, not based on research).

Your stress increases as you anticipate speaking. You block on the first syllable. This reduces your stress, and you speak fluently. Your stress builds up again, and you stutter again. This reduces your stress, and the cycle repeats until you're speaking fluently at the end of the conversation.

Stuttering Isn't a Good Response to Stress

Stuttering doesn't change the stressful situation. For example, a highway patrol officer pulls you over for speeding. Stuttering won't make the officer think you weren't speeding.

Stuttering might make the situation worse. For example, the highway patrol officer mistakes your stuttering for methamphetamine addiction. He handcuffs you and searches your car. This stresses you more, and you stutter more.

Stuttering and stress are a vicious cycle. Stuttering reduces your stress for a few seconds, but then causes more stress. You get stuck in the cycle, unable to break free.

Another study measured listeners' systolic blood pressure. [3] Listening to stuttering made listeners feel stress. The listeners' increased stress may in turn increase the stutterer's stress. Again, stuttering and stress start a vicious cycle.

This chapter will show you that you have other choices for handling stress, instead of stuttering. These other choices reduce stress, instead of throwing you into an endless cycle.

Distraction

A Ph.D. speech-language pathologist wrote, "Distraction methods can be used to eliminate stuttering temporarily." [4] The scientific term for "distraction" is dual-tasking. For example, psychologists test cognitive impairment by having a subject count series of tones while looking for symbols in a Yellow Pages directory.

If distractions eliminated stuttering, then stutterers would dual-task when we want to talk fluently, perhaps by working a Rubik's cube or playing a pocket video game. Two studies investigated this. In the first study, stutterers stepped on and off a 10-inch platform while reading out loud. In the second study, stutterers manually tracked an irregular line on a rotating drum while speaking. Neither distraction was able to reduce stuttering. [5]

Dual-tasking can make stuttering worse. Every stutterer who has completed a prolonged speech (fluency shaping) therapy program knows that you can focus on what you're saying or on how you're talking, but doing both at the same time is a challenge. In other words, using prolonged speech techniques in a clinical environment is easy, but the distractions of conversations make using fluency shaping skills difficult.

Beliefs and Placebos

Oliver Bloodstein wrote, "if a stutterer were to forget that he was a stutterer, he would have no further difficulty with his speech." [6] Gunars Neiders wrote, "our beliefs about stuttering seem to be one of the main factors in stuttering severity." [7]

These hypotheses have been repeatedly proven wrong—but not in studies set up for that purpose. Instead, studies of medications to treat stuttering are usually placebo-controlled. A placebo is a pill without a medication. The purpose of a placebo is to make study subjects believe that they are getting medication that will treat their disease or disorder. In other words, study subjects are all told that they will receive a medication that might (or might not) reduce their stuttering, but only half the subjects get the medication. The other half get the placebo pills. The latter are perfect subjects for testing the hypothesis that believing you won't stutter will lead you to not stutter.

A study found that placebos did not reduce stuttering. [8] Another study also found that placebos had no effect on stuttering—but the placebos caused terrible side effects! [9] Reported placebo side effects included constipation, sexual dysfunction, dizziness, sweating, and tremors. The placebo produced six times more side effects than the medication in the study.

This raises an interesting question. Placebos are effective treatments for almost every disease and symptom:

Study after study showed that, for virtually any disease, a substantial portion of symptoms—roughly one-third, by most estimates—would improve when patients were given a placebo treatment with no pharmacological activity. Patients simply believed that the treatment would help them, and somehow, it did. [10]

…for a wide range of afflictions, including pain, high blood pressure, asthma and cough, roughly 30 to 40 percent of patients experience relief after taking a placebo…placebos seem to be most reliably effective for afflictions in which stress directly affects the symptoms…pain, asthma and moderate high blood pressure can become worse when the patient is upset…placebos may work in part by lessening the apprehension associated with the disease [because] the immune system falters under stressful conditions. [11]

Stuttering may be the only disorder that placebos have no effect upon! In other words, stuttering isn't affected by belief, and stutterers can't be "psyched" into fluency. In contrast, heart disease, asthma, etc. appear to be physical diseases but are actually in large part psychological (or psychophysiological or psychosomatic). Could stuttering—long believed to be entirely psychological—actually have no psychological component?

Good Stress, Bad Stress

We experience many forms of stress. Some forms of stress reduce stuttering. Other forms of stress increase stuttering.

Stress is defined as

the condition that results when person-environment transactions lead the individual to perceive a discrepancy, whether real or not, between the demands of a situation and the resources of the person's biological, psychological or social systems. [12]

Stress is divided between distress, or stress leading to anxiety or depression; and eustress, or stress that enhances function, such as sports training or challenging work.

Reactivity to stress is also divided into two types. There's an emotional response that appears to be automatic and uncontrollable, and a cognitive response that is conscious and under volitional control. Stress management trains individuals to change emotional responses into cognitive responses, and to become more aware of available resources, thus enabling individuals to choose resources to handle situations while experiencing less stress. [13]

My definition, based on personal construct therapy, is that stress is the absence of choices, and stress management teaches individuals to see that they have choices in every situation.

Adrenaline and Fluency-Enhancing Stress

In World War Two, a severe stutterer regularly spoke fluently for mortar communication during combat. [14]

I was once physically threatened by a person for several hours. I've never been so fluent in my life! My voice was calm and relaxed as I tried to get the person to calm down.

Noradrenaline and adrenaline compete with dopamine for the binding sites on D4 receptors, and when bound, act as agonists. At the same time, through feedback inhibition, norepinephrine inhibits tyrosine hydroxylase, which in turn inhibits the production of dopamine. Because dopamine in the striatal system increases stuttering, and adrenaline blocks dopamine, "fight or flight" situations that increase adrenaline reduce stuttering. [15]

Stutterers report that when the adrenaline wears off, their stuttering increases. [16]

Cognitive Stress

Hearing or seeing several things at once, especially if the events contradict each other (cognitive dissonance), increases stuttering.

For example, I can't stand talking to a person who's watching television. Or a person who's playing guitar, or picks up the phone to make a call while I'm trying to talk to him. I have a cousin who watches TV, plays guitar, and makes telephone calls, all at the same time, when I try to talk to him.

Listeners should give their full attention to stutterers. Turning away to do something else, even if you say, "I'm still listening," will increase the individual's stuttering.

If a listener won't give you his or her full attention, consider whether the conversation matters to you. If not, walk away.

Time Pressure

Time pressure increases stuttering. At the beginning of this chapter I mentioned a study in which stress increased disfluency. [17] The study began with subjects seeing "red" written in red on a computer monitor. They had to say "red." The screens came faster and faster, to increase time pressure.

Next, cognitive stress was added. For example, the word "red" was written in yellow on a computer monitor. The subjects had to say "yellow," not "red."

These results were dramatic. Non-stutterers went from 0% disfluent words, to 2% disfluencies with time pressure, then to 4% with time pressure and cognitive stress.

Stutterers went from 1% stuttered words, to 3% with time pressure, to 9% with time pressure and cognitive stress.

Telling a stutterer to talk faster will have the opposite effect. Instead, tell stutterers to take all the time they need.

Use time pressure to your advantage by limiting what you say. Tell most people to make a five-minute speech and they ramble on for ten minutes, without getting to the point. If you're asked to make a five-minute speech, get to the point in one minute, without the rambling. What you think is one minute will actually take two or three minutes, and then adding in stuttering will make it five minutes. Even when I stuttered severely I had professors compliment my presentations.

Pragmatic Speech

Pragmatic speech is intended to cause another person to do a specific action. This might be telling a co-worker how to send a fax. Don't say, "Let me do it for you."

More stressful is asking someone to do something you want, when you're afraid that the person will say no. For example, asking your boss for a raise, or asking an attractive person out on a date. The listener is relatively powerful, and you're in a position of relative weakness.

To reduce stress, we usually try to make the question look casual. You "just happen" to run into the attractive person at the health club, and you "just happen" to have tickets to a show in your pocket, and you "casually" ask for a date. Or you wait until you've just landed a big sale for the company, and "jokingly" tell your boss that you deserve a raise.

But then you stutter, belying that this "casual" conversation is stressful for you. Your listener recognizes your weak position and, if he or she has an ego problem, enjoys manipulating you. A powerful person with an ego problem manipulating you is a pretty good description of stress.

Instead, use other ways to reduce stress. First, don't make a big effort to set up a "casual"-seeming situation. The more effort you make, the more stress you'll feel that it's "now or never" to get a positive response.

Next, use Winston Churchill's strategy of preparing your points in advance ("I deserve a raise for three reasons…"), anticipating your listener's objections, and preparing responses to those objections.

Then use slow speech to explain each point. Pause between points. Use the pause to check that your breathing and vocal folds are relaxed. You'll sound confident and in control.

Lastly, be willing to walk away. Is it the end of the world if you don't get a date? Visual what you'll do and how you'll feel if the answer is no.

Mirroring Speech Patterns

People tend to mirror each others' speech patterns. A person speaks fast to you, so you talk fast. A listener jumps in before you finish your sentences, so you interrupt her sentences. A person gets angry at you, so you raise your voice and get emotional.

Conscious choice requires slow reactions. In a fast reaction to environmental stimuli, your brain will select the most myelinated (habitual) open-loop motor program. Interrupting people, or responding quickly in a conversation, is a fast reaction.

Instead of mirroring, be an anti-mirror. The faster others speak, the slower you respond. Instead of interrupting, wait for the other person to finish their sentences, then count to three before you start to talk. If a person expresses anger, make your voice quieter, slower, and less emotional. You'll sound in control of the conversation as well as talk more fluently.

Embarrassment and Uncertainty

We fear embarrassment. For example, I'm about to call you Josh, when I think, "Wait, his name is Joel."

This fear is multiplied when we're speaking to more than one person—saying something embarrassing in front of an audience of a thousand people is more embarrassing than in front of one person.

Lack of feedback increases our fears of embarrassment. In other words, when speaking on television we can't observe the reactions of listeners. You could say something stupid and never know it. You try to remember and analyze the last thing you said while you're saying something else.

If you say something embarrassing, make a joke out of it, e.g., "at my advanced age I can't remember names." That's funny whether you're 90 or 19. Acknowledging embarrassment ends embarrassment.

Establishing Status

We communicate status largely via speech. We feel anxiety when status is ambiguous.

For example, you find a large, muscular hoodlum sitting on your car. Do you speak with firm authority, ordering the hoodlum off your car? Do choose a friendly, buddy-buddy tone of equality? Do you meekly ask if the hoodlum could let you have your car back? Or do you thank the hoodlum for watching your car and hand him $5?

Stuttering doesn't necessarily communicate low status. Embarrassment and anxiety about stuttering communicates low status. Calmly stuttering, while looking the hoodlum in the eye, establishes that you're not afraid to stutter and you're not afraid of the hoodlum.

Moral Stress

Whether you tell the truth or lie, you can use stuttering to make listeners believe that you're telling the truth. Interrogations start with "baseline" questions such as your name. Do some voluntary stuttering and get into some good disfluencies on your name.

In a stressful situation, imagine yourself hooked up to a lie detector machine. Start the conversation with a topic unrelated to the big issue. Do some voluntary stuttering. Imagine making the lie detector needle swing into the red.

Then change the topic to the main issue, pause, relax your breathing and your vocal folds, and slowly and fluently tell your story—truthfully or otherwise. A lie detector machine will indicate that you're telling the truth. A human listener will do the same.

Treating Stress in Stutterers

Everyone is nervous about some speaking situations. Public speaking is humanity's most common fear, greater than the fear of death. Few women have the courage to introduce themselves to a man and ask for a date. Ordering in a French restaurant is scarier than ordering at McDonald's.

Increase Your Resources

If a stressful situation demands more resources than you have, increase your resources. But first rent the video Predator, starring Arnold Schwarzenegger and Jesse Ventura. Settle down with a bowl of popcorn to watch the governor of California and the governor of Minnesota discuss school funding and property tax reform.

Just joking. Back in 1987, Schwarzenegger and Ventura were action movie heroes. In Predator the men are dropped into a jungle with dozens of enemy soldiers, and one nasty alien. But they arrive with a whole lot of resources, such as an M-134 7.62mm mini-gun and an M-79 grenade launcher.

Now write down a list of speaking tasks that you don't do, that non-stutterers don't think twice about doing. Let's say that you're afraid to leave voicemails on answering machines. Write down all the speech therapy tools you can use in this situation. Imagine yourself as Schwarzenegger and Ventura making a list of weapons to bring. But instead of arming yourself with a mini-gun and a grenade launcher, your weapons for voicemail could include:

1. Practicing your message before you call.
2. Fluency skills, such as slow speech with stretched vowels, relaxing your breathing, or relaxing your vocal folds.
3. Using a DAF/FAF anti-stuttering device.
4. A hierarchy of stress, beginning with calling your own answering machine, then calling your speech-language pathologist's answering machine, then calling a friend's answering machine, then calling a business's answering machine (e.g., calling restaurants before they open asking if they have banquet facilities), and finally calling that attractive person's voicemail.

Don't stop listing your arsenal until you look at the list and laugh at how you'll blow away that poor little voicemail. Then think of one more weapon to add to your list. You're ready when you're confident that you won't stutter.

Let's say that your message is, "You're the most wonderful person I've ever met. I can't wait to see you again." Using all of your fluency weapons, pick up the phone and call your own answering machine. Then check your messages. Pretty good, huh?

Now call yourself again. This time, reduce or throw away one of your weapons. If you used one-second stretched syllables on the first call, call yourself using half-second stretch. Then go to quarter-second "slow normal" speech.

If you used an anti-stuttering device on the first call, don't use the device for your next call.

If you practiced the message on the first call, say something spontaneous on your next call.

Step by step, throw away your weapons, until you can call your own voicemail fluently, without effort or fear.

Choose one stuttering treatment from the Iowa era, perhaps voluntary stuttering; one treatment from the prolonged speech (fluency shaping) era, e.g., relaxed vocal folds; and one treatment from the neurological era, e.g., an altered auditory feedback (AAF) device. Don't select all your fluency skills from one era.

Make a Stress Hierarchy

Now take a step up the stress hierarchy. Call your speech-language pathologist and leave a message. (If you're not in speech therapy, call a nice friend or kindly relative.) Begin with your full arsenal of fluency weapons, then call back, using fewer fluency weapons. Then work your way up your stress hierarchy. If you feel any twinge of fear on a call, take a step back until you feel confident again.

Approaching feared speaking situations can be like fighting a grizzly bear armed only with a pocket knife. Scary speaking situations combine to look like a ten-foot-tall bear. Speech therapy programs typically give you only one weapon.

Divide your general fear of speaking into specific fears. The giant bear becomes many small bears. Now create a stress hierarchy, with a small bear on one end, and a bunny rabbit on the other end. And instead of having one weapon, you now have a variety of fluency skills.

Now you're armed like Arnold Schwarzenegger, you're hunting bunny rabbits, and you're in a pet shop the day before Easter. Armed to the teeth with speech therapy skills, there's no possibility of stuttering in your feared situation. Heck, it isn't even a feared situation anymore!

Further Reducing Fears and Anxieties

When you run out of stressful situations, make a list of speaking situations that scare non-stutterers. Remember when I said that your speech can be better than non-stutterers? When you're ready, move on to these areas:

• Go up to strangers at parties. Say that your speech therapist wants you to talk to strangers and ask if you can talk to this person. If you have an anti-stuttering device, ask if it's OK to use it. No one is going to say no. I met one of my ex-girlfriends this way.
• Join Toastmasters International to learn public speaking.
• Sign up for a beginning acting class at a university or community theater. Acting classes are the most fun you've had since sixth grade.
• Put together some funny stories and perform stand-up comedy on amateur night at a nightclub.
• Sign up for voice lessons. Amaze people by singing at social occasions.
• Learn a foreign language. Talk to cab drivers in their native tongues.

Reduce Your Listener's Stress

Stuttering is a rare disorder. Many people have never met a stutterer. Some listeners think that they did something to make you stutter. Other listeners wish there were something they could do to help you. Tell them that you stutter. If they have any questions about stuttering, they'll ask you.

Tell a joke about stuttering. Or put stuttering on your business card, perhaps describing you as chapter leader of your local stuttering support group.

Tell listeners that you're using speech therapy skills, and explain what those skills are (e.g., voluntary stuttering, slow speaking rate). Ask the listener to remind you when you miss a target, e.g., increase your speaking rate.

Lastly, if you use an altered auditory feedback (AAF) device, show it to your listener and ask if she minds if you use it. Listeners invariably ask questions about the devices. In contrast, listeners rarely ask questions about speech therapy, e.g., vocal fold relaxation isn't of great interest to the general population. But everyone wants to know how anti-stuttering devices work. Suggest that the listener try on the device, and adjust it to make the listener stutter (by maximizing the delay, or moving the pitch shift up and down). When I do this, other people come over to see what's making their friend trip over his or her words. They give me positive feedback about my stuttering, laugh at their own failure to talk, and experience for a few minutes what it feels like to stutter.

Increasing or Decreasing Stress in Therapy

Stuttering therapy typically begins with a stutterer learning closed-loop speech motor control in a low-stress environment, e.g., chatting with the speech-language pathologist, or alone practicing word lists.

The stutterer gradually moves from closed-loop speech motor control to open-loop speech motor control. When he achieves fluent open-loop speech motor control, the speech-language pathologist takes him to a shopping mall for "transfer" practice. Then they're finished with speech therapy and he's on his own.

The result is open-loop fluent speech in low-stress environments, and relapse to open-loop stuttering in high-stress environments. The relapse shakes the stutterer's self-confidence. Or the stress de-myelinates (weakens) fluent speech motor programs. A single high-stress, disfluent experience might destroy weeks of low-stress practice.

The stutterer then gets into a vicious cycle of stress and relapse leading to more stress and more relapse.

A better plan would be to train a stutterer to recognize stressful situations, and consciously switch to closed-loop speech motor control (i.e., very slow speech, HYPERELINK in high-stress environments.

For example, I used to meet strangers and say, "My speech-language pathologist wants me to talk to strangers. May I talk to you?" I would then use slow closed-loop speech motor control. After we had a friendly conversation going and my fears and anxieties diminished, I'd use the "slow-normal" speaking rate that mixes open- and closed-loop speech motor control.

With traditional therapy the stutterer switches between stuttering and fluent speech, as situations change between high-stress and low-stress. Instead, I switched between closed-loop and open-loop speech motor control, as stress changed. The result was that I constantly myelinated (strengthened) the fluent speech motor programs in my brain.14

Personal Construct Therapy: You Always Have Choices

No one needs to be completely hemmed in by circumstances; no one needs to be the victim of his biography. [18]

— George Kelly,The Psychology of Personal Constructs (1955)

In every situation, you always have a choice of how to react. This insight is the basis of personal construct therapy (PCT). The goal of PCT is to develop awareness of your choices in every situation. The antithesis is to react the same way to all stressful situations.

If you make the same speech choices in high-stress situations, no amount of practice in a low-stress speech clinic will change your speech. For example, if you always substitute words "when the going gets tough," you're not going to use gentle onsets in a difficult situations, even after practicing 5,000 gentle onsets in the speech clinic.

To develop awareness of your choices, describe a situation in which you stuttered. Imagine different ways you could have responded to the situation.

Role-play the scene with your speech-language pathologist or in your stuttering support group. When someone sees a choice that hasn't been played, switch roles, for that person to play the new choice. For example, the situation is answering the telephone at work. One person pretends to be a caller, and the other pretends to be the employee answering at Pasquale's Pizza. The employee uses slow speech. But another choice might be to switch to voiced consonants, i.e., answering the phone Basdahllee's Bizza. You should be able to think of a half-dozen other possibilities. Role play each choice and see what feels best.

Verbal Aikido

Aikido is a Japanese martial art. Combatants focus not on punching or kicking opponents, but rather on using the opponent's own energy to gain control of the opponent or to throw the opponent away from you. [19]

Verbal aikido is the art of not arguing, but instead agreeing with someone who is verbally attacking you. You help the assailant attack you, until—surprise—he realizes that he's just been made to look like a fool.

For example, a middle-aged, overweight woman owned a chain of women-only health clubs. Middle-aged, overweight women could work out in these health clubs without feeling intimidated by young male bodybuilders.

A "shock jock" radio host invited the health club owner onto his show. He described her physical appearance, then asked why anyone would want to work out at a health club owned by a fat, ugly old lady.

She responded that overweight, middle-aged ladies have to exercise too, and that the "shock jock" was a perfect example of the men she didn't want to have to be around when she exercised.

The example of the parents responding to their teenagers' four-letter words is another example of verbal aikido.

Use verbal aikido to turn around the stress. For example, a highway patrol officer pulls you over for speeding. Instead of trying to hide your stuttering, you make a joke: "I stutter, so I'm not going to try to talk you out of giving me a ticket."

Changing Self-Descriptions

Many stutterers improve their speech, yet continue to believe that their speech is worse than non-stutterers. Graduates of fluency shaping therapy programs sometimes have beautiful, clear speech that is easier and more pleasant to listen to than non-stutterers' speech. Yet they continue to believe that they can't do certain things, such as public speaking. [20]

In contrast, stutterers who improve their speech attitudes have better speech a year after completing therapy, as compared to stutterers who maintain poor attitudes. [21]

Write a description of yourself now, and who you expect to be in five years. What items are opposite in the two descriptions? E.g., now you're now single, but in five years you hope to be married.

Write a description of yourself as a stutterer, and then who you'd be if you didn't stutter. E.g., assertive vs. shy, or popular vs. lonely. These descriptions are your personal constructs.

Work on changing your personal constructs. Again, imagine specific situations for each personal construct. For example, if you wrote that you'd be assertive instead of shy, describe a recent situation in which you weren't assertive. Now role-play the scene with your speech-language pathologist or your support group. Imagine different ways to react in the situation and switch roles.

"Who Would I Be If I Didn't Stutter?"

This is a favorite conversation topic at stuttering support groups. People initially say, "I'd be more successful at work" or "I'd be more assertive with my husband and family." They first think their lives would be better without stuttering.

After fifteen minutes, people start saying, "If I didn't stutter, I'd be less compassionate," or "I would never have developed my musical talent." People realize that they chose a career in a "helping profession" (e.g., nursing or teaching), or they developed non-verbal skills, such as athletics or painting, because they stutter. They realize positive aspects of stuttering. They see that stuttering can be a gift.

In contrast, a stutterer completed a speech therapy program, but refused to speak fluently. He said that his co-workers had listened to his stuttering for 20 years. He asked, "What would they think if I came to work speaking fluently?"

Another stutterer was earning $25,000/year as a computer programmer. His supervisor left, and the company wanted to promote the stutterer. He would receive a salary of $55,000/year. The management position required talking to clients on the telephone. The company offered to pay for speech therapy and an anti-stuttering device. The stutterer refused the promotion, saying that he didn't want to talk to anyone. The company instead hired a less-qualified manager from outside the company.

For these stutterers, the psychological issues surrounding stuttering are more disabling than their disfluencies.

Change Your Lifestyle

As your improve your fluency, ask your supervisor for tasks that require talking. Participate in social activities that involve talking.

Training a new motor skill requires about three million repetitions. To say three million words, you must talk at least four hours a day for at least six months.

Take an acting class. Take singing lessons. You'll have fun, and meet new people. You'll get over your speech-related fears.

You'll find some things other people can easily do that you can't, but you'll also find things you can easily do that other people can't. For example, I took a public speaking course. I was able to project my voice, when other students are afraid to raise their voices. I was able to switch emotions (anger, sadness) easily and convincingly, when other students couldn't. On the other hand, there were simple presentations where you couldn't understand a word I said.

Volunteer to read to blind or elderly individuals. Volunteer at a hospital directing visitors where to go. Volunteer with your public radio station answering pledge week calls.

Or moonlight at a job that requires talking. Find a job that requires being charming and friendly.

Join social clubs that requires talking. Put Toastmasters at the top of your list. Members give a series of ten speeches, usually one speech per month. The speeches are four to ten minutes long. Each of the ten speeches teaches you a new skill, such as using gestures and body language, or being persuasive on a controversial topic. Judges always point out things you did well—and award lots of ribbons—as well as ways you can improve. You'll find that even if you stutter severely, you're better than non-stutterers at some aspects of public speaking.

The National Stuttering Association has its own public speaking training program, which is quite different from Toastmasters. Ask for the "Speaking Circles" video.

References

[1] Caruso, A., et al. (1994). Adults Who Stutter: Responses to Cognitive Stress. Journal of Speech and Hearing Research, 37, 746-754.

[2] Perkins, W., & Dabul, B. (1973). The Effects of Stuttering on Systolic Blood Pressure. Journal of Speech and Hearing Research, 16:4

[3] Schwartz, Martin. Personal correspondence.

[4] Kuehn, Donald (1994). Official correspondence from the National Institute of Deafness and Communication Disorders (NIDCD).

[5] Bloodstein, Oliver (1995) A Handbook On Stuttering, 5th edition, San Diego: Singular Press.

[6] Bloodstein, Oliver (1996) Stuttering as an Anticipatory Struggle Reaction. In R. F. Curlee & G. M. Siegel, Nature and Treatment of Stuttering: New Directions. Boston: Allyn&Bacon.

[7] Neiders, Gunars. Stutt-x e-mail correspondence, December 18, 1997.

[8] Prins, D., Madelkorn, T., Cerf, A. (1980). Principal and Differential Effects of Haloperidol and Placebo Treatments Upon Speech Disfluencies in Stutterers. Journal of Speech and Hearing Research, 23, 614-629, September 1980.

[9] Stager, Ludlow, Gordon, Cotelingam, & Rapoport. (1995). Fluency Changes in Persons Who Stutter Following a Double Blind Trial of Clomipramine and Desipramine. Journal of Speech and Hearing Research, June 1995.

[10] Goleman, Daniel, and Joel Gurin. Mind/Body Medicine, Consumer Reports Books, 1993.

[11] Brown, Walter A. The Placebo Effect. Scientific American, January 1998, 90-96.

[12] "Stress (medicine)," Wikipedia, accessed 2008 May 25, http://en.wikipedia.org/wiki/Stress_%28medicine%29

[13] "Stress management," Wikipedia, accessed 2008 May 25 http://en.wikipedia.org/wiki/Stress_management

[14] Bloodstein, Oliver (1995) A Handbook On Stuttering, 5th edition, San Diego: Singular Press.

[15] Newman-Tancredi, Adrian. Noradrenaline and adrenaline are high affinity agonists at dopamine D4 receptors. European Journal of Pharmacology 319 (1997) 379-383. 101511,274@compuserve@com. Valerie Audinot-Bouchez, Alain Gobert, Mark J. Millan, Department of Psychopharmacology, Institut de Recherches, 125 Chemin de Ronde, 78290 Croissy-sur-Seine (Paris), France.

[16] Bloodstein, Oliver (1995) A Handbook On Stuttering, 5th edition, San Diego: Singular Press.

[17] Caruso, A., et al. Adults Who Stutter: Responses to Cognitive Stress. Journal of Speech and Hearing Research, 37, 746-754, August 1994.

[18] Kelly, George. The Psychology Of Personal Constructs, (Routledge, 1955, ISBN 0415037980).

[19] Clausen, Kjartan. The Aikido FAQ. March 8, 2002 http://www.aikidofaq.com/

[20] Andrews, G., Cutler, J. Stuttering Therapy: The relation between changes in symptom level and attitudes. Journal of Speech and Hearing Disorders, 39, 312-319, 1974.

[21] Guitar, B. & Bass, C. (1978). Stuttering therapy: The relation between attitude change and long-term outcome. Journal of Speech and Hearing Disorders, 43, 392-400.