Reducing negative emotions and anxiety using a mental health approach

About the authors:

hudockDaniel Hudock, Ph.D., Certificate of Clinical Competence of Speech-Language Pathology (CCC-SLP), is an Assistant Professor at Idaho State University in Pocatello, Idaho, USA. As a person who stutters himself, he is very passionate about fluency disorders and helping those with fluency disorders. He currently serves on the International Cluttering Association and International Stuttering Association website committees, is the Northwestern Regional Chapter Coordinator for the National Stuttering Association in the United States, and is a Chapter Leader for the NSA’s Southeastern Idaho Chapters. He is a regular presenter at conferences and has several publications. His research interests are exploring: the communicative process during the observation of normal and disordered speech using eye-tracking, biobehavioral and neurophysiological measures, stuttering inhibition during the perception of second speech signals, EEG temporal and spectral components for sensory and motor involvement and integration during speech perception and production, and forming effective collaborations between Speech-Language Pathologists and Mental Health Counselors for the treatment of people who stutter. He is also Director of the Northwest Center for Fluency Disorders, which hosts a two-week summer intensive clinic. For more information about research, clinical, or support opportunities please visit http://www.northwestfluency.org/.
oconnorNora A. O’Connor is a licensed clinical social worker and a person who stutters living in Los Angeles, California.  Nora has been involved locally and nationally with stuttering self help organizations for over 15 years. She is featured in two stuttering documentaries, Spit It Out (2004) and Right Here, Right Now (PBS, 2000).  She is an adviser to StutterTalk and author of the chapter Substance Abuse and Stuttering in the book Stuttering: Inspiring Stories and Professional Wisdom.  Nora is a graduate of the Successful Stuttering Management Program at Eastern Washington University, and has returned to the SSMP frequently to provide her experience and expertise.  Nora facilitates counseling groups, in her private practice, for kids, teens and adults who stutter.  She is committed to treating the emotional response to stuttering.  Nora earned her Master’s in Social Work from San Francisco State University.  She holds additional training in addiction studies, trauma interventions, motivational engagement and walk & talk therapy.  You can learn more about her practice at  www.center4betterliving.com

Author Notes – Both authors were equal contributors on this work

Correspondence concerning this presentation may be addressed to either author:

Daniel Hudock, Ph.D., Department of Communication Sciences and Disorders, Division of Health Sciences, Idaho State University, 921 South 8th Ave, Mail Stop 8116, Pocatello, ID 83209-8116, USA. Phone: (011) 208-282-4403; Fax: (011) 208-282-4571; E-mail: Hudock@isu.edu, website: http://www.northwestfluency.org/

Nora A. O’Connor, LCSW, California Center for Better Living, 566 S. San Vicente, Suite 102, Los Angeles, CA 90048-4622, USA.  Phone: (011) 310-736-8623; E-Mail: NOConnorLCSW@gmail.com,  website: www.center4betterliving.com

Reducing negative emotions and anxiety associated with stuttering by a cumulative trauma-based mental health approach

Stuttering has historically been defined by Speech-Language Pathologists, researchers, and lay people by overt speech disruptions, however more recently a shift has occurred to describe stuttering in a more multidimensional sense. By describing stuttering not only as a speech disorder, but rather as a multidimensional syndrome that impacts individuals’ anxiety, emotions, socialization, and other personality domains, we gain a clearer understanding of how to approach more effective treatments. The purpose of this paper is to present a new perspective to conceptualize and treat the person impacted by the stuttering syndrome. To illustrate why we are categorizing stuttering using a cumulative trauma-based mental health perspective, the authors will first describe some of our personal traumatic experiences then discuss how the emotions and anxiety associated with those instances compound over time. We will then briefly describe recent literature relating to anxiety and multidimensional models of stuttering treatment. Lastly we will discuss the reduction of negative emotions and anxiety through trauma treatment methods.

Personal Experience of Dan Hudock

I am a faculty member in a Department of Communication Sciences and Disorders (Speech Pathology); as such we introduce ourselves to the Graduate Students during the graduate student orientation each year. Being a person who stutters, introductions are not high on my list of favorite things to do. However, it is part of the job, so I use these and other situations as challenges rather than avoiding them. In the past two years when I have introduced myself at orientation, at least some of the new graduate students in Speech Pathology have laughed, thinking that I was faking and joking. After they realize that I was not joking, and that I actually do stutter, the wide-eyed bright jovial faces turn into blushes of red embarrassment with dreadfully avoided gaze. In talking with some of those who did not realize until after the fact that the stuttering was real, they reported thinking it was a joke and being embarrassed when they “found out.”

These and other challenging experiences occur quite routinely for those of us who stutter. Previously, I would have considered this situation to be a traumatic experience that I might have dwelled on throughout the rest of the day, or for several days / weeks. From several days to moments before the introductions my anxiety would have increased and the trauma would have escalated with my anxiety. I would have anticipated and been fearful of the student’s reactions. Then after the fact I would dwell on my failures during the event. I would think that I should have used my techniques more efficiently and effectively, and that I was the one to blame for students reactions.  Experiencing anxiety and dwelling on such traumatic events are quite common to the clients who stutter that I’ve seen, as is feelings of shame, guilt, and perceived self-failures. For example not “using my speech techniques right or to the extent that I should have” and then choosing to isolate myself to manage the emotional response. Constant rumination of traumatic speaking situations is one factor that compounds the disorder into a syndrome. As clients and professionals, we are seldom taught how to manage our negative emotions and anxiety during those moments, which is clinically necessary since the anxiety during the moment of stuttering has on several occasions been described as similar to drowning.  Negative emotions and anxiety greatly reduce our ability to effectively manage our stuttering and not to be in the present moment.

Personal Experience of Nora O’Connor

I am a licensed clinical social worker in Los Angeles, California. I am also a person who stutters. As a child, I feared speaking in class and would commonly count off how many kids ahead of me had read to determine what paragraph would be mine. My palms would sweat; hands trembling; heart beat accelerated, chest pains, and felt dizzy. By the time it was my turn to read I was not only dealing with stuttering but also symptoms of a panic attack. The traumatic event would come to pass and I would head out to the restroom to gather myself. I would play the scenario over and over in my mind. This situation, and many others, started the beginning of cumulative trauma that would be stored in my brain and body for years to come.

My stuttering took a devastating turn in High School as the crushing weight of my emotional response to my stuttering swiftly became out of control. I clearly was no longer dealing with dysfluencies; I was now dealing with my emotional response to stuttering and other people’s bewildered response to my stuttering. I needed to learn coping skills to manage what had now become a stuttering syndrome.

Many years would come to pass of internal and external negative responses to my stuttering before I gained insight of coping skills to manage emotions and anxiety.  I had been experiencing years of recurrent, involuntary and intrusive distressing memories of previous traumatic speaking events; persistent efforts to avoid distressing memories or external reminders of traumatic speaking events; and a persistent negative emotional state. During this time I was also studying to be a social worker. I was learning strategies to manage emotions and anxiety, but it really wasn’t until I was practicing in the mental health field that I fully understood the impact of cumulative trauma. I began applying the skills I was learning as a clinician to treat my own emotional response to stuttering. I also saw how well my clients, dealing with substance abuse and trauma, responded to interventions such as mindfulness, resourcing and grounding, which will be further discussed later.  I was motivated to see how people who stutter would respond to these practices.

Literature Review

As a profession, we have described the emotional / social impacts and components of stuttering for almost a century! Charles Van Riper (1971) stated “Stuttering is more than a riddle. It is at least a complicated, multidimensional jigsaw puzzle, with many pieces still missing. It is also a personal, social, and scientific problem whose equation has not yet been stated completely, and a problem with many unknowns.” (p. 1). During the middle of the 20th century it was even thought that anxiety caused stuttering (Hudock & Altieri, 2013). We now know that anxiety does not cause stuttering, but most certainly exacerbates stuttering (Craig, 2014). PWS have increased rates and rankings of anxiety and perceive anxiety differently from their fluent counterparts (Craig & Tran, 2014; Iverach & Rapee, 2013; Lieshout, et al., 2014). Models of stuttering have reflected this multidimensional view of stuttering for decades; Demands and Capacities (Starkweather, 1987), Dynamic Multifactorial (Smith & Kelly, 1997) among many others. More recently researchers are now applying these theoretical models clinically (CALMS – Healey, 2012; Packman and Attanasio 3-factor causal model – Packman, 2012).

The role of anxiety as a modulating factor of stuttering is a powerful one that should be treated in conjunction with other associated domains (Iverach & Rapee, 2013). One such way that anxiety is being treated in stuttering is through the use of mindfulness practices (Beilby, et al., 2012; Boyle, 2011). Anxiety related to the moment of stuttering has been very often described as the sensation of drowning (Sliverman, 1996), so by training PWS to not avoid or judge the anxiety they feel and rather allow themselves be present and mindful of the effect anxiety has on them, it can allow us to maintain control over our functioning during those moments.

Introducing New Skills

We encourage the incorporation of mindfulness into treatment for people who stutter.  Mindfulness will allow a person who stutters to pay attention to thoughts and feelings without judging them or feeling that there is a “right” or “wrong” way to think or feel. This practice can alleviate the extreme harshness that causes suffering for some people who stutter, as well as learning to live in the present moment. In addition to the practice of mindfulness, we will now discuss grounding and resourcing.

Grounding is a set of strategies to detach from emotional pain, (i.e. racing thoughts, negative talk, worries, anger, sadness). Mental, physical, and soothing grounding skills are a healthy distraction to emotional pain that work by focusing outward on the external world, rather than inward toward the self. Grounding is also the relationship between a person and the earth. When we are grounded we have a sense of self in relationship, and not stuck in the past or the future (Najavitis, 2002).

A couple examples of physical grounding are when standing in front of an audience we may take a moment to wiggle our toes or touch a smooth rock that can be carried in your pocket. These behaviors allow us to reconnect to the physical world through the sensation of touch. A mental grounding exercise would be to look around the room and silently name colors and objects. A soothing grounding technique would be to think of your favorites (i.e. colors, animals, food, TV shows, and books) (Najavitis, 2002).

Resourcing means using positive memories and good things in your life to bring you back to a positive emotional state or into your resiliency zone (Miller-Kraus and Leitch, 2010). The resiliency zone is the place where you’re able to manage distress and intense emotions. People who stutter often are bumped out of their resiliency zone when ruminating about a past speaking experience or when negatively impacted by a listener’s response. When this happens one can learn how to connect with positive memories that bring calming sensations. To recognize the sensations in the body you “track” yourself or do a “body scan.” The hope is that, with practice, it will take a shorter and shorter time span for a person to regain emotional control and be present in the moment.

For example, “Mike” often becomes affected emotionally with increased anxiety when he is anticipating a speaking situation. He becomes flooded with bad memories of previous speaking situations. Mike learns to recognize or track when his stomach begins to tighten, and his mind begins to race. Mike knows that his secondary stuttering or emotional response to stuttering is going to increase if he does not get himself back into his resiliency zone. At this point, Mike chooses a “resource” to bring calmness. Mike’s resource is a positive memory of sitting at a basketball game with two close friends. He recalls the players on the court and the conversations with his friends. He remembers the familiar sounds and sights. He smells the popcorn in the air. Mike begins to focus on calming sensations in his body. He then notices his two feet connected to the earth, and how his body is supported in the chair. Mike picks up a glass of water and is soothed by the cool liquid. He has successfully returned to his resiliency zone and is more prepared for the speaking situation ahead. Mike doesn’t feel out of control with emotions and anxiety. He will most likely have to pull up his “resource” at another time during the same situation.

Conclusion

In 1971 Charles Van Riper stated that stuttering is a problem with many unknowns. Van Riper would be pleased to know that the stuttering syndrome is being further explored. Given the increased anxiety due to cumulative trauma, treatments for individuals who stutter need to include mental health approaches. We have discussed our personal and professional experiences that demonstrate the need for stuttering to be treated more broadly. Many professionals are utilizing mindfulness in their practice. We presented the importance of learning techniques to reduce negative emotions and anxiety resulting from years of traumatic speaking experiences.  Grounding and resourcing are skills that can provide a person who stutters with more stability in their life.

References

Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012). Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. Journal of Fluency Disorders37(4), 289-299.

Boyle, M. P. (2011). Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. Journal of Fluency Disorders36(2), 122-129.

Craig, A. (2014). Major controversies in Fluency Disorders: Clarifying the relationship between anxiety and stuttering. Journal of fluency disorders40, 1-3.

Craig, A., & Tran, Y. (2014). Trait and social anxiety in adults with chronic stuttering: Conclusions following meta-analysis. Journal of Fluency Disorders, 40, 35-43.

Healey, C. (2012). The Cognitive Affective, Linguistic, Motor and Social (CALMS) Assessment for School-Age Children who Stutter. Lincoln, NB

Hudock, D., & Altieri, N., (2013). Foundations to theories and perspectives on stuttering from a historical perspective of societal influences: Part II. Proceedings of the International Stuttering Association

Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 40, 69-82.

Lieshout, P. V., Ben-David, B., Lipski, M., & Namasivayam, A. (2014). The impact of threat and cognitive stress on speech motor control in people who stutter. Journal of Fluency Disorders, 40, 93-109.

Miller-Karas, E., & Leitch, L. (2010).  The Eight Skills of TRM.  Trauma Resiliency Model Workbook (pgs. 49-68), Claremont, CA.

Najavatis, Lisa (2002).  Detaching from Emotional Pain (Grounding). In H. T. Blane and T. R. Kosten (Eds), Seeking Safety: A Treatment for PTSD and Substance Abuse (First Edition, p. 130-135) New York, NY, The Guilford Press.

Packman, A. (2012). Theory and therapy in stuttering: A complex relationship. Journal of Fluency Disorders37(4), 225-233.

Silverman, F. H. (1996). Stuttering and Other Fluency Disorders. Allyn and Bacon.

Smith, A & Kelly, E. (1997). Stuttering: A dynamic, multifactorial model. In R. Curlee and G. Siegel (eds). Nature and treatment of stuttering: New directions (pp.204-217). Boston: Allyn & Bacon.

Starkweather, C. W. (1987). Fluency and stuttering. Englewood Cliffs, NJ: Prentice-Hall.

Van Riper, C. (1971). The Nature of Stuttering (Vol. 3). Englewood Cliffs, NJ: Prentice-Hall.

 

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Comments

Reducing negative emotions and anxiety using a mental health approach — 108 Comments

  1. How do you distinguish between grounding activities and secondaries? It feels like both of your examples could easily be interpreted as secondaries (how is fingering a physical talisman different than any objectless tapping/twitching/rubbing/picking?) or become, through use, perverted into them (picking at your pockets, scanning-the-horizon eye-rolling, e.g.).

    I’m honestly of the opinion that secondaries, if inoffensive to the user and to the audience (starting every sentence with profanity or by hocking a loogie may be a bit much, for example) aren’t bad. They’re more something to be aware of and require that you be aware of their effect on your overall presence and presentation. However, I do realize that many dictatorial or perfection-obsessed therapists consider them the ultimate evil…

    • Thanks for reading the article, Ann. Grounding skills are designed to “anchor” you to the present and to reality. Personally, secondaries are what I do to avoid reality.

      A skilled mental health clinician would be able to guide you to identify what grounding skills would work best for you. You would both be mindful if a skill is developing into a “secondary.” Maybe having a smooth rock to touch in your pocket would not be an effective skill for you. There are many ways to ground.

      Some of my skills are: listening to music, mindful breathing, taking a walk, thinking of happy thoughts. Prior to giving a presentation I will look around the room and silently name the colors and objects. Sometimes soothing grounding works better, other times it’s physical or mental grounding.

      If you wouldnt mind sharing, what skills do you use now to manage negative emotions or worrying?

      Thanks again for your post.

      • The discussion of the differences between grounding skills and secondaries was interesting to read about. Ann’s question really helped promote understanding that grounding skills are different from secondaries because of the responses that followed from Nora and Dan. It is good for individuals to realize that grounding skills are unique to each person who stutters. I myself do not stutter, and use some of these same skills during public speaking to help calm my nerves and become more fluent.

    • I agree with everything Nora mentioned as well, also thank you for reading the article. As with Nora, I use them personally and in clinical settings to reduce avoidances behaviors. Although we try to make distinctions, as you point, there are many grey areas. Secondaries occur to varying degrees and interoperation can alter the presence or absence of such behaviors. For example, what one may think is a pronounce avoidance behaviors (e.g., using the word um before words or sentences) might not be described as an avoidance behavior to the individual, but if the frequency with which it occurs becomes more pronounced (used before every word) it might be classified in such a way. I often use my hands and gestures when I talk. I know it helps me become more fluent, but I think I do it as a communication strategy, to engage my listener.

  2. Thank you both for sharing your stories and for describing “mindfulness,” “resourcing,” and “grounding” and how it can help the person who stutters, or anyone for that matter who has experienced accumulative negative experiences. From your paper, I ascertained that “grounding” provides a reminder to be in the moment and is quite different from secondary behaviors, which are negative in nature because they require physical tension, e.g. excessive eye blinks; resourcing means remembering happier moments and letting go of the tension associated with stuttering. Is this a correct interpretation? I do have a couple of questions for you. Are there programs that offer training in these techniques for speech-language pathologists and are these techniques supported by evidence-based research specifically for use with individuals who stutter?

    Thank you so much,

    Debbie W.

    • Debbie – Thank you so much for taking the time to read the article and post a comment. I am very happy to be exploring this topic with the stuttering community.

      You did a great job of summarizing the concepts. I love it! A little bit of a clarification on Grounding. Grounding is a set of strategies for healthy detachment from emotional pain, anxiety or worrying. Grounding can also be called “centering,” “looking outward,” or “distraction.” As you detach from the worrying by using a grounding skill – then you’re more prepared to come back into the present moment and deal with the present moment. Sometimes a person may need to “ground” for 10 minutes, others for much longer or shorter. The ultimate goal is yes – to return to the present moment with reduced symptoms of anxiety so you can proceed effectively (in speech or decision making or taking an exam or whatever else!)

      To answer your questions:
      1) As far as I know there are not training programs to teach SLPs these skills. Most recently I taught the skills to undergraduate students at the Successful Stuttering Management Program at Eastern Washington University. The concepts were very well received (by the students and .
      2) As of now, there has not been research done on the effectiveness of these skills for people who stutter

      The skills themselves are evidenced based practices. I have treated people with anxiety and mood disorders and substance related disorders who have all responded very well to this treatment. I look forward to actually doing a study with people who stutter. I also look forward to teaching SLPs these skills to use in their practice. As a licensed clinician, my desire is to work collaboratively with SLPs to provide PWS with the best possible treatment.

      A book I would recommend you to read is Waking the Tiger: Healing Trauma by Peter Levine. He has spent over 35 years studying stress and trauma. You will learn more about grounding, resourcing, the body’s response to trauma, somatic experiencing.

      Please stay in contact, Debbie. I am treating PWS in my private practice and plan to expand the practice to teaching, lectures, workshops, etc. (for both PWS and SLPs). Check back to my website (there’s nothing currently posted, but there will be. 🙂
      http://www.center4betterliving.com

      All the best, Nora

    • Debbie,

      Great questions a summaries. Being in academia, I’m not aware of many CSD programs that train students on such practices, however there are a few that I’m aware of (with research to support the practice for students and clients). Please see “Boyle, (2011) Mindfulness training in stuttering therapy: a tutorial for speech-language pathologists” and “Beilby, Byrnes and Yaruss, (2012) Acceptance and Commitment Therapy for adults who stutter: psychosocial adjustment and speech fluency” for review. Additionally, I know that Scott Palasik at the University of Akron does student training and clinical application of these procedures and a collaborator of mine at Syracuse University is planning on starting trainings with CSD students there. Lastly, there was an ASHA panel last year that had 5 academic faculty presenters who train students in mindfulness and use these clinically.

      Lastly, I’m an Assistant Professor at Idaho State University in Pocatello, ID and we offer student training courses at the Division of Health Sciences Level on this and I have guest lecturers on this topic in my graduate course on Fluency Disorders. I also use this practice clinically, and recently finished collecting data from our Northwest Center for Fluency Disorders Interprofessional Intensive Stuttering Clinic that will be presented as a poster at the ASHA convention in November, and submitted for publication shortly after.

      Hope to see you at ASHA so we can talk about this in person.
      Dan

  3. Hello,
    First and foremost, I want to thank you for sharing your life experiences and knowledge with me and everyone. My name is Bree Anne and I currently attend Chapman University and am studying communicative disorders. I have not yet had a great deal of course work related to fluency, however, it has always been of great interest to me. I am especially interested in the psychological aspects that are so closely associated with it and the lasting effects it may leave on the individual. Some of the situations described I feel any child could relate to and then compounding those typical difficult situations with having to worry about fluency disturbances seems unfathomable. The strategies discussed in your paper, in my opinion, would seem to be extremely beneficial to all PWS. I could see this being especially beneficial to very young children who may just be starting to feel or recognize the emotional components associated with their stuttering. Have either of you worked closely with small children and seen how they respond to these strategies? And if so at around what age, in your opinion, are children most compelled to implement these strategies? Are these strategies primarily used as a means to ease the emotional/ mental sequel associated with stuttering or are they more often used to increase fluency, or for both?
    Very insightful and extremely useful information, thank you so much for sharing.

    Regards,
    Bree Anne

    • Hi, Bree. I’m so glad you are right down the freeway from me. If you’re not already – please come out to the NSA Regional Conference this weekend in Anaheim, California. I will be talking about grounding and resourcing during a workshop on Sunday morning. I will be at the conference all day on Saturday as well.

      To answer your questions:
      I started counseling groups for children and teens who stutter this past summer in Los Angeles, Ca. The youngest child I worked with was a 9 year old girl. During the 5 week session – she showed increase awareness of the sensations in her body that indicate nervousness or anxiety (i.e. tightness in stomach, etc.), which appeared to help her use grounding skills earlier. I taught her grounding skills to use in the classroom or any other time she felt her anxiety move from a 1 to a 10 (scale).

      In my professional opinion, I feel that most children (not just PWS) would benefit from learning these skills. Thinking back on my own experience as a child who stutters – probably by the 2nd or 3rd grade I would have started to need these skills.

      The skills can help to manage or reduce the negative thoughts and worrying associated with stuttering. From my personal experience – this also can carry over to better management of my stutter (that would increase fluency). Othertimes, when using these skills, I just feel more at ease as a communicator – no matter the level of fluency / stuttering.

      Keep in touch. I’m sure our paths will cross.

      Nora

      • Bree Anne,

        Thanks for reading the article. Great questions! In collaboration with a SLP / Counselor we offered a school-age day camp this past summer where we used some of these strategies with children as young as five. I wasn’t sure how well mindfulness strategies were going to work, but they worked surprisingly well. Toward the beginning of the camp we had the clients make artwork of their stuttering and how it made them feel. At the end we had a similar activity. The expression of anxiety, which was very pronounced to start was dramatically reduced and reframed to be more positive after the clinic. Additionally, one five-year old girl was able to tell us about how she was felling stress and butterflies and that she needed to wiggle her toes so she could use her strategies. I was amazed at the abilities of this little girl, and the others as well.

        Cheers,
        Dan

  4. Great paper! Thank you for the practical applications regarding mindfulness work and stuttering therapy. People often report experiencing out of body feelings when stuttering- by focusing on staying present, they are in a better position to collect helpful data about what is going on around them and in their own minds and bodies. I also recommend meditation as a way to develop mindfulness, and remind people not to get discouraged when they “slip” or say they “can’t meditate.” These skills take a long time to develop.

    • Thank you, Heather. It was so good to talk with you about some of these concepts this past summer at the Friends Conference. I’m so happy to know that you are using a lot of CBT and mindfulness skills at American Institute for Stuttering.

      Mindfulness, Grounding and Resourcing do take practice (and patience). At the same time grounding skills are also very basic and simple. I have taught these skills to severely impaired psychiatric clients and was able to see immediate results. Of course with more practice we will see better results.

      Thanks, Heather. You’re the best!

      Nora

    • Great points Heather, I couldn’t agree anymore. As with most things we have to practice to become proficient. Hope to see you at ASHA this year!

  5. Daniel and Nora, first off, I want to thank you for being willing to open up your hearts to others and share your personal experiences with such honesty. I really enjoyed reading through this article and I gleaned a lot of insight from it. This is a very new subject for me (as I recently began to pursue my degree in Speech and Language Pathology), so being able to read through this article gave me a better understanding of the emotional struggles that accompany a stutter. I think that it is so important for people to be aware of these psychological affects that stuttering can cause someone, especially in regards to therapy. I believe that it helps the therapy to be more effective and to become an actual part of a person’s daily life, as opposed to just in the therapy session. After reading through the article, my question for you is, are there clinical therapy methods that incorporate these 3 concepts “mindfulness”, “grounding”, and “resourcing”? Or are these relatively new ideas that will become more popular as professionals become more aware in their understanding of the emotional aspects involved in stuttering? Also, as a person is learning to incorporate these new skills, is it almost like training their mind to think differently about the affects of their stutter (maybe it differs from person to person)? Do you think that this mindset will be the primary way of thinking for PWS in the upcoming generations?
    I am looking forward to reading through some of the resources you’ve listed to learn more. Thank you again!

    -Lynlee

    • Good questions, Lynlee! Thank you so much for taking the time to read the paper and respond. Dan and I feel really good with how the paper turned out.

      I’m happy that we helped you to see some of the emotional struggles that accompany stuttering (and that can begin for some at a very early age.)

      To answer your questions
      1) These are evidenced based practices. Either stand alone treatment or incorporated with other interventions. A good book to read is Waking the Tiger: Healing Trauma by Peter Levine. He has spent over 35 years studying stress and trauma. You will learn more about grounding, resourcing, the body’s response to trauma, somatic experiencing.

      Also, download the ap “iChill” It’s free and will outline in even more detail the concepts I discussed. The author (Elaine Miller-Karas also has an audio component on the ap. She has a great voice to listen to.)

      These skills are well known and used in the mental health community. As a mental health professional I became very curious at how effective these skills would be for people who stutter.

      2) My hope is that they will begin to catch on in the Communicative Disorder programs / SLP community. It can only expand a SLPs toolbox, and will be of great use to PWS.

      3) Yes – as a PWS is learning these skills they are training themselves to respond to anxiety, worrying and negative thoughts in a different and more effective way. Many PWS talk about the feeling of drowning with worry and negative thoughts. I want PWS to learn coping skills that are accessible, not too complicated and they can see immediate results.

      4) Good question! I don’t know if these skills or way of thinking will be the primary way of thinking for PWS in future generations. As a stutterer and a mental health professional – I sure hope that treating the emotional response to stuttering starts now, and is researched for years to come.

      Take a look over at another ISAD paper.
      Connecting to Others: The Role of Mental Health Professionals in the Stuttering Community

      This is a daily forum. Let’s keep the mental health dialogue going all month! 🙂

      http://isad.isastutter.org/isad-2014/papers-presented-by/therapy-research-and-other-fun-things/connecting-to-others-the-role-of-mental-health-professionals-in-the-stuttering-community/

      Keep in touch.
      All the best, Nora

  6. Thank you Daniel and Nora! To me, as a parent of a young adult who stutters, it is so hopeful to see mental health be considered a significant contributor to the syndrome. Now what we need is for all of this to be adjusted to be developmentally appropriate for children. Then we need professionals well-trained in this field – both mental health and fluency issues. If I had to do it over again, I would be looking for a mental health professional with deep knowledge of fluency issues to work with my child over a speech therapist. The big questions to me are
    –How can we minimize the cumulative trauma in a child’s life?
    –What are some developmentally-appropriate ways to keep our children grounded and mindful (as I do believe that’s how they start out).
    –How can we convince parents who just want this to go away (like I was) that this focus is (IMO) far more important to a child’s well-being than attempting to minimize or eliminate the stuttering moments. Thoughts? Thanks again – brilliant!!

    • Dori,

      Thanks for reading! Also thanks for your blog posts, it always offers such nice insight and guidance. I think it is really helping the stuttering community.

      The difficult part is many mental health professionals don’t undergo any training on communication disorders, nor do they specialize in that area. To the best of my knowledge, our Northwest Center for Fluency Disorders Interprofessional Intensive Stuttering Clinic is the first to exist, providing interprofessional education to mental health professionals on communication disorders and stuttering then offering collaborative Speech-Language Pathologists and Mental Health Professionals in the treatment of PWS. Hopefully this idea will catch on, so we can start treating clients and their families in more holistic (soon to be stronger evidence-based practices).

      As for the question, I totally agree with Nora’s reply.

      Best,
      Dan

      • Makes my day to know you value my blog postings – thank you! It does seem that the pendulum is swinging to a more holistic approach. I came up with an analogy this morning over breakfast (I feel a blog-post coming on): “Going to a speech therapist exclusively to treat stuttering is like going to a dermatologist exclusively to treat skin cancer.” I think it needs a little work…but there’s something there…

  7. Thank you for such great comments and questions. I’m so glad that a parent of child who stutters is reading this article. You’re the best!

    I could not agree further how happy I am to be involved with introducing mental health as a significant contributor. I’ve been thinking that since the stuttering community has tried so hard to educate people that stuttering is not a “mental health problem” that it’s going to take even more educating to learn have people who stutter and SLPs to look at the “emotional response to stuttering” and the treatment needed.

    I am happy to say that I am now treating PWS in my private practice. I look forward to working in collaboration with SLPs to provide comprehensive treatment.

    To answer your big questions. 🙂
    1) How can we minimize the cumulative trauma in a child’s life? I would say that the first way of minimizing it is to acknowledging that stuttering can be a traumatic event. As professionals gain that understanding then the proper interventions can be used to provide the PWS with tools and skills to manage or prepare for speaking events better, and even to have the language to talk about it. My understanding didn’t start coming together until I was sitting in a Somatic Experiencing PTSD three day training.

    2) What are some developmentally-appropriate ways to keep our children grounded and mindful (as I do believe that’s how they start out).
    Good question. I treated a 9 year old who stuttered and she loved the basketball player Kobe Bryant – so we talked about how he would deal with being over excited or anxious prior to and playing ball. I had her imagine what grounding skills that Kobe would use. This exercise helped to normalize using mindful and grounding skills. A lot of “noticing” and ” describing” exercises are good places to begin from a young age. The more aware a child is about what’s happening inside and around them – they have a better chance to ground themselves. For example, sitting at a park and for a minute asking the child to name everything they see around them. Ask them to describe the smells and any sensations they notice when touching the grass. Then eventually moving to their body. Asking what do you notice when you get mad. Does your chest tighten or your heart race? What do you notice when you take slow breaths. These awareness skills would then continue to build as normal way of living in the world.

    3) How can we convince parents who just want this to go away (like I was) that this focus is (IMO) far more important to a child’s well-being than attempting to minimize or eliminate the stuttering moments. Thoughts?
    Such a good and powerful questions. I think about my parents and of course they wanted my stutter to go away. I’m also convinced that they just wanted me to be happy. If they had more awareness of the need to treat my emotions and worrying – they would have done so. I feel the best approach is education … with education comes understanding. But – who will educate the parents? It would have to be the SLPs. We need to first continue to get SLPs to understand the importance of referring a student to counseling when they recognize the emotional response to stuttering has become beyond their scope of practice to treat.

    Thanks again for your great comments and questions. Stay in touch. I plan to post more information on this topic to my website, so check back. http://www.center4betterliving.com

    How old is your child?
    He or she has a great parent!

    Nora

    • Hi Nora – thank you for your thoughtful response! I’ve come to believe that in most cases mental health is not only a significant contributor, but the primary contributor to the aspects of stuttering behavior that have the most negative impact on long-term well-being. Please keep up the great work in this direction!

      I have not heard of Somatic Experience PTSD – I will check out your website. If you’ve read my book (borrow it from Dan – also available on Amazon and as an e-book), you’ll know that we came to the conclusion that the therapy itself (focused on lessening and/or eliminating speech errors) was contributing significantly to the trauma our son was experiencing, causing him to become increasingly silent and withdrawn. I am on a mission to educate parents and speech therapists to keep this from happening to other children.

      I love your examples of how to keep our children grounded – I know there’s some good stuff out there ( “The Most Unique Anxiety Relief Workbook for Your Child in the Universe” by Renee Jain.) and I hope to find more. Can I have your permission to re-post your guidance on my Voice Unearthed Facebook page? These are great ideas for all children!

      I wrote the book I wish I could have read before starting this journey with our son. I’ve heard from many speech therapists who loan theirs out to parents prior to starting therapy – and I am so honored that this is happening.

      I spent six years researching this field and I know that there have been contentious discussions around the idea that a person who stutters can benefit from a mental health professional. There also has been a reluctance on the part of many speech therapists to collaborate with or refer to a mental health professional. In a perfect world, they will work together – and thank you for helping us move towards that perfect world.

      BTW, my son is 18, in college majoring in astro-physics, belongs to four different clubs, has an adorable girlfriend, and does not let his stutter (which can still be severe) stop him. I’m certain that this would not have been the outcome if we had continued focusing primarily on speech tools rather than switching to a full-on effort to get him talking and re-engaged in his world. He’s a great kid. Please do keep in touch…
      Best,
      Dori

  8. Hello,
    Thank you for sharing not only your knowledge and experience, but also your personal stories. I appreciated the outline of this article that allowed me to get to know your personal stories before learning about current literature and practices. My name is Danielle and I’m currently a student at Chapman University enrolled in a post baccaluareate program for communication disorders. My background is in social work and I spent 5 years working in child protection services before coming to the field of speech pathology. I believe as speech pathologist it is important that we understand the emotional and psychological impact any speech disorder has on our clients. I find this to be especially true for PWS. Until we understand all that is going on, we are unable provide the most effective treatment and support.
    I had a couple questions regarding this article that could further help me in my own practice. First of all, I had a question regarding the concept of mindfulness. I think it’s easy for people to become accustom to a certain way of thinking without fully understanding why we may think that way or the impact it may have on others. What is one way we can teach mindfulness or help people understand and incorporate it into their lives? I can see this being helpful in my own life.
    My second question is do you find “resourcing,” “grounding,” or “mindfulness” the most common practice among PWS? Does it very person to person?
    Thank you so much for sharing this article. I look forward to reading more of the articles on this site.
    Danielle

    • Danielle,

      Thanks for reading and for your insightful questions. Nora would be better to answer your first question, so I’ll stick to the second one.

      There’s not much data on who / how many are using which strategies, but from indirect evidence of information in the literature and textbooks, no. It is an exciting time to be using these practices, because it does appear that the paradigm in the field is shifting, but it is still in the early stages of that shift.

      Interestingly, after our recent interprofessional clinic we had several news paper articles and television news appearances that were reposted by the National Stuttering Association and other bloggers. Some of the comments to those posts indicated that several PWS had reached out to mental health professionals on their own and reported that was the only way they found success in therapy. Long story short, it might be happening more than we know by people seeking it out themselves, but we don’t have any data on how often it occurs.

      Best,
      Dan

  9. I enjoyed reading your article. I am currently working as a special education teacher and I am attending graduate school to become a speech language pathologist. So many of the topics I am currently studying are not black and white and I fully I agree, stuttering is multi-dimensional! I believe many of the practices you are experimenting with are great tools. They are tools for PWS but also great tools for any population suffering from anxiety including my young special needs students who range in age from 5-8 and unfortunately with current trends in education for many teachers who are also suffering from anxiety. At what age do you being teaching these strategies? When do you see the strategies becoming automatic in your clients? Do you also provide training for the teachers and families of the people who stutter?
    Thank you
    Allegra Greeley

    • Allegra,
      Thank you for taking the time to read article and comment.

      To answer your questions
      1) I treated a 9 year girl who stuttered this last summer. She responded well to learning grounding and resourcing. For your kids a lot of “noticing” and ” describing” exercises are good places to begin from a young age. The more aware a child is about what’s happening inside and around them – they have a better chance to ground themselves. For example, sitting at a park and for a minute asking the child to name everything they see around them. Ask them to describe the smells and any sensations they notice when touching the grass. Then eventually moving to their body. Asking what do you notice when you get mad. Does your chest tighten or your heart race? What do you notice when you take slow breaths. These awareness skills would then continue to build as normal way of living in the world.
      2) when do the skills become automatic. Good question. This would depend upon the length of time in treatment learning skills and how clinician assists clients to take practice into everyday situations. It also would depend upon a persons willingness to use the skills !
      3) I provided a workshop on his topic at the NSA REGIONAL conference in Anaheim, California a few weeks ago. The SLPs, families and PWS responded well to the workshop. I look forward to doing more of this work.

      Take care. Keep in touch.
      Nora

      http://Www.center4betterliving.com

    • Allegra,

      Thanks for reading the article, I’m glad that you enjoyed it. At a school-age day camp I put on at ISU, we treated kids as young as 5 with some mindfulness based procedures, in addition to other approaches and they seemed to respond well. Toward the beginning of the clinic one child used crayons to draw her stuttering and drew several scary zombie looking creatures with the words fear, terror, afraid, in them. At the end of the clinic she mentioned that she was able to calm herself by looking around the room and counting, or remembering a happy memory. So the level of introspective reflection or grounding procedures may change, but it seems beneficial to do with kids as young as five (for short periods of time). Additionally, one of the meditation groups that I attend sometimes has older children attend with their parents and in conversations, they’ve mentioned how beneficial it was for them as kids (about the same age as previously mentioned).

      Your second question is a very good and difficult one. After having speech therapy for 22+ years and being an academic and clinician with several years of very specific training, it is still not an automatic process for me and some times are easier than others. For example, just the other day I was ordering food through a drive through and sensed an increase in anxiety as I was stuttering, which I was able to pause, modulate the anxiety and effectively use my modification techniques in a very short period of time. However other times, especially face to face interactions, some times I am effective at it, while others I am not. I guess what I am trying to say is I don’t think it will ever be a truly automated process, but as with anything it is something that can become refined with practice and we can become much more efficient at it.

      Great third question as well. I always include family and teachers in the therapy process. Sometimes I will have parents pseudostutter with their children and strangers to help open lines of discussion. I also typically have my school-age kids do classroom presentations that I help with, but I think the point you are getting at is education and practice for mindfulness procedures. I try to educate parents and teaching on the fear / anxiety related to stuttering and use Silverman’s (along with many others) description of the anxiety associated with stuttering being like drowning, but don’t believe that I have ever taught family members or educators mindfulness practices. That is likely something that would be very beneficial. Good point!

      Cheers,
      Dan

  10. Hello,

    This article was helpful for me as a future speech language pathologist and on a personal level. I am pursuing my Master’s degree at UW-Stevens Point and am currently in a fluency disorders class. When I first started learning about stuttering I immediately wondered about the anxiety component of it, because many of the secondary symptoms sound much like social anxiety. After reading this article it is easy to see how experiencing stuttering everyday could lead to anxiety, avoidance and other mental health issues.

    I am learning that to treat stuttering you have to treat the person as a whole. Incorporating mindfulness is a great idea to help a person who stutters overcome the negative thoughts and panic.

    As a person who suffers from severe anxiety, I thank you for writing this article because it is a good reminder to work on improving mental health in order to improve overall wellness.

    Have you seen any genetic studies showing a higher percentage of people who stutter also have a predisposition to anxiety disorders? I think it would be interesting to know if there is a relationship, because stuttering seems to evoke anxiety to different degrees in every person.

    Thank you,
    Katie Kozulla

    • Katie,

      Thank you for taking the time to read article and comment. All the best as you pursue your Masters.

      To answer your question: I’m not aware of any research studies correlating anxiety and people who stutter. It would be helpful information to create evidenced based treatment. In the meantime, SLPs will need to talk with their clients about their level of worrying or anxiety. When needed a referral to a mental health specialist should be made.

      Thank you for sharing your experience too. Keep taking care of you. I will do the same. 🙂

      Keep in touch.
      Nora

      http://www.center4betterliving.com

    • Katie,

      Thanks for reading and best of luck throughout your program of study. Two good articles discussing anxiety and stuttering are Iverach, et al., 2011 and Manning & Gayle-Beck, 2013. If you go to PubMed and search those you will find the articles. There has recently been much more evidence coming out about anxiety and stuttering, none that I can think of on genetics and predisposition to anxiety in PWS, but that is part of our field that is quite complicated (not that others aren’t!).

      Best,
      Dan

  11. These strategies are helpful to anyone dealing with anxiety, whether related to those who stutter, have a mental illness, or just get nervous here and there. Thank you for the tips. I can definitely use them myself. I have a question about family involvement in counseling for children and adolescents who stutter. With my experience with different kinds of therapies, I’ve noticed that parents and family members can be involved in the process. How can family members get involved with the counseling process for children and adolescents who stutter? If the PWS receives counseling to learn these strategies, are there strategies or skills that the therapist can teach family members who want to join the journey?

    • Good questions, Jennarose. I’m glad you read the article.

      Family Involvement is very important in speech therapy and mental health counseling. When appropriate a family session could be conducted to learn grounding and resourcing skills all together. Parents and guardians may need counseling to receive support dealing with a child who has differences.

      Take care.
      All the best.
      Nora

  12. Hello,

    I am currently a graduate student studying to become a Speech Language Pathologist (I will graduate in May 2015). My question for you is as follows: Do you think that SLPs would benefit from some level of course work in counseling as part of undergraduate/graduate education? I often feel that we take on the role of counselor from time to time, and I feel somewhat unprepared as a result. What kind of “counseling skills” do you feel are most important for SLPs to acquire as clinicians? Thank you for the article!

    • Hi, Melinda,

      I definitely believe that SLPs would benefit from courses in counseling while in school and have counseling requirements for CEUs.

      I’d encourage you to learn about Cognitive Behavior Therapy and mindfulness skills.

      My co-writer, Dan, could speak to this matter as well.

      Keep in touch. Feel free to contact directly.
      Nora

      http://www.center4betterliving.com

    • Melinda,

      Best of luck with your program of study and thanks for reading / commenting! I definitely think that SLP students should have a course specific to counseling as opposed to having it integrated into other courses, especially disorder-based courses. Some programs are starting to implement this at various levels or as trainings, Idaho State University where I work for example, but to the best of my knowledge not as a stand alone class. As SLPs we do still need to maintain that distinction that one class would not solely prepare us to counsel our clients, as most master’s programs in counseling are three year programs with many additional requirements for certification. Gaining the foundations to reflexion of feelings, and improving client functioning holistically are needed.

      Best,
      Dan

  13. Dear Daniel and Nora,
    Woody Starkweather expressed the idea that there are many paths out of the thicket of stuttering. Mindfulness might well be one of them. However, it was only useful to me to get me to the starting point of where I got in touch with my feelings. After that I used the Cognitive Behavior Therapy (CBT) model (especially as advocated by Rational Emotive Behavior Therapy (REBT)) that my feelings did not exist in vacuum but were the product of my classically and operantly conditioned conscious and preconscious beliefs as well as classically conditioned fear residing in my limbic system–especially amygdala. In short my C-consequent feelings & stuttering were the product of A-activating event and what was stored in my brain (beliefs & fear reaction in amygdala). Activating Event x Beliefs (and conditioned fear response) -> feelings of stuttering anxiety culminating in stuttering.

    This is not so much different from Joseph Sheehan and the much maligned Wendell Johnson and all their followers. The psychologist-my mentor- Albert Ellis formulated his Rational Emotive Behavior Therapy (REBT) using some of the General Semantics of Wendell Johnson. In turn, Ellis helped me to formulate an psychological approach to stuttering which culminated in my book “From Stuttering to Fluency: Manage Your Emotions and Live More Fully”.

    This is the first book demonstrating how to use evidence-based Cognitive Behavior Therapy and selected stuttering modification techniques to gain an attitude of stuttering and self-acceptance to reduce stuttering blocks and struggling speech to lead to operational fluency. And, of course, live life to the fullest without shame, guilt, and anxiety.

    Yes, indeed mindfulness and awareness of what is happening in the moment is an important first step…but why not go all the way and parse the healthy negative emotions that lead to freer speech from those that are unhealthy and cause more anxiety, avoidance and self-downing? Then play detective to unearth unhelpful negative beliefs such as demand for perfect speech, awfulizing about stuttering, using discomfort fear to avoid forward moving speech, and self-downing because one stutters? Once the irrationalities are discovered they can be challenged by rational thinking as described in my book. The outcome of this therapy can be seen on my website http://www.stutteringpsychotherapy.com There are also a number of blogs about various aspects of stuttering.

    In conclusion, yes I subscribe to mindfulness as a good first step to forward moving speech, self-acceptance, stuttering-acceptance, and risk-taking behavior leading to a full life.

    • Gunars,

      Thanks for all the great comments and suggestions. I look forward to reading your website. I appreciate your multi layered understanding of the stuttering syndrome hat Dan and I wrote about.

      This article addressed cumulative trauma in people who stutter. I went beyond mindfulness to discuss trauma based interventions, such as grounding and resourcing. It’s my belief that a person needs to get familiar with what’s happening in their body to allow lasting change to happen.

      Mindfulness is a style of living that can lead someone to a life free of suffering.

      Cognitive behavioral therapy, as well as Dialectical Behavior Therapy are also needed approaches to treat the emotional response to stuttering, and address the thought, feeling, action process.

      All the best,
      Nora

  14. Great paper. Thank you to both of you for sharing your journey and for providing practical approaches that persons who stutter, or anyone for that matter, can use to lessen anxiety and regulate emotional responses to (the fear of) stuttering.
    Nora – I particularly enjoyed reading this after attending your workshop this past weekend in Anaheim, and hearing you speak about grounding and resourcing. It was helpful to now put both together. I have heard of both of these techniques before and used a combination of both when working as a counselor with youth for many years.
    It was a helpful reminder for me to realize that I do a lot of this now anyway – personally and with a great psychotherapist I work with who has helped me with life issues and stuttering.

    Again, thank you both for the great contribution.

    -Pam

    • Pam, thank you so much for your comments. I appreciate you taking the time to read article. I’m happy that you attended my workshop at the NSA Regional conference in Anaheim, Ca. I look forward to providing more workshops and trainings on is subject matter.

      Take care !
      Nora

  15. Great paper! This relates with the thesis I am doing with regard to the impacts of counseling on people with aphasia who have experienced depression. I am doing a survey among counselors, psychologists, social workers, etc. on whether they have ever provided counseling to a person with aphasia, or a spouse of a person with aphasia, and generally, what they know about aphasia; if they’ve had any training or gone to any workshops etc. Having a personal connection to depression, I couldn’t imagine having a communication disorder on top of that. This is what drives my passion to find out how better to help all of those with communication disorders stay mentally and emotionally healthy and in what ways I can help. I hope to present my thesis at ASHA within the next two years (fingers crossed)!

    Do either of you have any advice for me? And also, is there any research on depression in people who stutter that you know of? Also, Nora, from a clinical social worker’s perspective, in what ways would you suggest trying to help those with aphasia? I know, it might not be that similar to working with people who stutter, but I am curious about your take on this topic.
    Thank you!!
    Chandler Barnes

    • Hi, Chandler,
      All the best with your thesis project. I’d love to follow what you are doing.

      As far as I know there are not research on depression with PWS. My co-author may be able to speak more meaningfully to this.

      From what understand there are different diagnosis of aphasia. I would recommend exploring different ways to familiar communication. Possibly through Art and Music therapy. Doing Somatic Experiencing would most likely be beneficial.

      All the best,
      Nora.

    • Chandler,

      Thanks for reading the paper and for your comment. Also good luck with your studies and thesis! Sounds like a timely and good idea for a thesis. My advice is submit a presentation proposal. ASHA typically accepts a very high percentage of submissions, especially as posters, so go for it! I typically have most of my students submit their thesis for presentations. Additionally, you could submit the thesis for a poster presentation at your state convention prior to ASHA (to get some practice). State conventions and ASHA tend to be very supportive of student research.

      There is currently one assessment for people with aphasia with a subtest that quantifies functional impact. This is an area of study that has received far to little attention. Individuals with communication disorders often experience functional impact in similar ways (this could also be said for individuals with anxiety, depression and other alignments as well). I’m in the early stages of developing an assessment measure functional impact for people with communication disorders, which will hopefully shed some light on the topic and allow for greater understanding of the treatment needs in this area.

      As for your question about depression and stuttering, I would recommend reading Gunn et al., 2014; Manning & Gayle-Beck, 2013. Additionally, Iverach et al.,’s 2011 publication on the UTBAS provides a section on depression that lists other associated articles that you could track down.

      Best,
      Dan

  16. Daniel and Nora,

    Thank you for such an insightful paper. I am currently a graduate student of Speech Language Pathology and I am taking a course on stuttering. I find your paper very insightful because individuals do not see the psychological aspect with stuttering. People do not see that stuttering not only causes difficulties with communication, but it also causes anxiety and an excessive amount of stress. My question to you is: how do you think graduate students can bring awareness to stuttering and how it is a multidimensional syndrome?
    Thank you for all your efforts!
    Safa

    • Hi, Safa,
      I’m so glad to hear that you are interested in raising awareness about stuttering with graduate students.

      I’d recommend your peers to read OUT WITH IT by Katherine Preston. Contacting a local National Stuttering Association chapter, and attend a meeting. You could also invite a person who stutters to talk to the Fluency class. There’s also many stuttering videos that could be watched.

      All the best.
      Keep in touch.
      Nora

      http://www.center4betterliving.com

    • Safa,

      Nora had some great recommendations! I would also say as a first step having the graduate student pseudostutter to strangers will give them more insight into stuttering, and therefore can be better equipped to serve as advocates.

      Best,
      Dan

  17. Thanks for sharing this with us. I would like to know if you believe that these techniques, wiggling your toes or rubbing a smooth rock, does not give the communicator the opportunity to conjure a negative communicative memory. I know when I am giving a presentation, it ply takes one memory to place me in a state of anxiousness. I was also wondering if you have looked at why we as communicators can focus on our many “successes”, but it may only take one memory of an unsuccessful experience to slip in and send us into an unconfident state.
    Thanks
    Ben James

    • Ben,

      Thanks for your comments. The techniques are learned to be able to reduce anxiety or manage negative emotions, so it would seem that his would make for a better or different commendation experience.

      You can teach yourself how to increase positive thoughts and reduce negative thoughts. Cognitive Behavioral Therapy is extremely helpful to learn how to do this.

      All the best,
      Nora

  18. Thank you for publishing this presentation. I thoroughly enjoyed reading your insights and information. I am pursuing my Master’s degree in Speech-Language Pathology and I intend to take the information that I learned here along with me throughout my education and practice. There is always more to the disorder than what meets the eye. It is like the tip of the iceberg analogy. Anxiety may not always been seen in a person who stutters, but that does not mean it is not there. This presentation is a great contribution and acknowledgement to the multidimensional syndrome of stuttering.

    Renee

    • Renee,
      Thank you for your comments. Congratulations for pursuing a Masters Degree.

      Stay connected to the stuttering community

      All the best,
      Nora

  19. Hi Nora and Daniel,
    I am currently a graduate SLP student graduating in May and feel some what unprepared to counsel clients/families. I feel it would be of great service to our clients if our coursework included more counseling training. Is there any advice or resources you could recommend that would help me become more prepared to counsel clients and their families?

    Thank you!
    Lauren

    • Lauren,

      Thanks for your response! I appreciate that you want to learn more about counseling skills. I’m going to go out on a limb and say – take a counseling class. Look for one that will teach cognitive behavior skills. Or maybe even just a one day workshop, and look for others as you go through your career.

      Also, start collaborating with LCSWs in your area. Have a few colleagues who work in the mental health field to bounce ideas off of –

      Stay connected to groups like Friends, the National Association of Young people who stutter. You can build a good professional network through this organization. And the NSA as well.

      All the best,
      Nora

    • Lauren,

      First of all congrats! More SLP programs need to integrate counseling education and training into their curriculums. Along with what Nora mentioned, form collaborations. Wherever you are going to be working, there is likely an opportunity to collaborate with a mental health professional. Reach out and educate the professional about the negative impact that communication disorders can have on clients and how they can help in the treatment process. I frame it like this, because mental health professionals are very often not trained on anything having to do with communication disorders, so as with us, they need to undergo training. For example, one of the clients from our recent interprofessional intensive stuttering clinic sought out a counselor upon their return home. The counselor’s lack of knowledge about stuttering lead them to recommending having the client repeatedly tap their head on one side while stuttering, to lateralize hemispheric brain activity! Scary, so we as SLPs need to be an educator and advocate not only to our clients and their environment (families, teachers, friends, spouses etc), but also to other professionals! Most professionals would likely welcome such an opportunity.

      Best,
      Dan

  20. Thank you for the article. It really reinforces how important it is to treat the person as a whole not just the stutter. Do you feel most clients appreciate that approach? Do any clients feel addressing the negative emotions and anxiety are outside of a speech pathologist’s scope of practice?

    • Lynn,
      Good questions !
      I would assess that most people appreciate being looked at as a whole person not just their disorder.
      Often a persons depressed mood or anxiety would be outside the scope of practice for an SLP to treat.

      Thanks for your comments.
      All the best,
      Nora

    • Qualitative and quantitative research has consistently shown that clients report increased success, rapport with their clinicians, value of therapy, etc from SLPs who take a more holistic approach targeting emotional, social and anxiety factors. Similarly, research consistently reports that clients report less favorable experiences, less success, increased negative impacts from therapies and clinicians who primarily target overt fluency as a goal. Anecdotally, after our recent interprofessional intensive stuttering clinic many clients reported having more success with this type of approach as compared to any other that they’ve received. We’re currently analyzing the data and are hoping to submit it for publication within the year. When the National Stuttering Association posted some of the news paper articles written about our clinic, several responses mimicked the data that I just presented. Many people mentioned that they saw SLPs and Mental Health Professionals (MHPs), which was the only successful treatment that they had experienced.

      Your second question is a very important one, there are components of cognitive, emotional, and social features that is within our scope of practice to ethically treat, however as you indicate, SLPs are not specifically trained on theories or application of treating a client’s mental health. So it is a very fine line and one that should not be tampered with, due to the potential negative impacts on the client, which is why we recommend taking an interprofessional collaborative care approach to treatment. By including a social worker / counselor, etc in the treatment each professional can stay within their scope of practice and ethically treat the client to the best of their ability and training.

      Best,
      Dan

  21. Thank you for your article, it was really interesting. I am a second year graduate student studying Speech Language Pathology. I was wondering if the grounding techniques you discussed our appropriate for most PWS? As a future SLP, how do you best address the mental health issues that can be associated with stuttering and best help clients to feel less anxious and more comfortable? Thank you for taking the time to answer my questions.

    Bekah

    • Hi, Bekah,

      Congratulations for entering your second year of graduate school. It’s a good sign that you are reading the ISAD articles.

      If a PWS is having challenges with increase worry and anxiousness when speaking or if they are dealing with overwhelming negative emotions they most likely will benefit from grounding and resourcing skills.

      I would encourage you to build a network of professionals that include mental health professionals. Often times a person mental state would be better treated by a LCSW or MFT. I recommend that an SLP and a mental health professional collaborate in the treatment. It would be helpful for you to become familiar with cognitive behavioral therapy and mindfulness practices.

      All the best,
      Nora

      • Thank you for taking the time to reply to my comment. I will take your advice to heart and love the idea of working collaboratively with other professionals.

  22. I really enjoyed reading this article. Thank you so much for sharing your experiences. I am currently a graduate student studying SLP, and I loved reading about these alternative approaches to anxiety from stuttering. I am wondering if there is a certain age this should be started at? Can it be put into effect with anyone at any age? I feel as though there are so many people who could benefit from a healthier way to deal with anxiety from stuttering and I am curious to know who would be good candidates. I am also wondering if through your studies you have found that the anxiety from talking aloud has interfered with a child’s schooling? I feel as though many children take so much time thinking about talking and how fluent they will be that they are missing what other kids or teachers are saying. Thanks!!

    • Hi, Emily,

      Thank you for your comments.

      I would assess that children today (whether they stutter or not) can benefit from learning ways to reduce worrying or anxiety or racing thoughts. I enjoy seeing young children learning yoga. Our kids today have so much happening in their lives they will need to be taught ways to cope better.

      From my personal experience as a person who stuttered I was challenge with so much anxiety in speaking situations that often couldn’t hear what others were saying. Instead of trying talk fluently a child needs to learn that stuttering is ok and how to cope with worrying.

      All the best in your schooling.
      Please stay connected to the stuttering community.

      Nora

  23. Thank you for sharing! This is an excellent article. I am curious about the age ranges for using these techniques. Is this something that can be done at an early age? The anxiety that comes along with stuttering can be so severe I am wondering if these ideas can be started at an early age to hopefully relieve some of the tension that continues with age. I am also wondering if you believe that severe anxiety that comes from speaking aloud interferes with schooling. A child spends so much time worrying about speaking aloud or doing a presentation, are they often missing what the other kids are saying? Thanks!

  24. Daniel and Nora,

    I am a speech pathology graduate student at Illinois State University. I was truly touched by your paper and love reading papers that bring me closer to understanding what a PWS goes through throughout their lives. Many clinicians avoid the aspect of counseling because they simply think it is out of our realm. But we know, that counseling is a major key to success for PWS. Stuttering is a part of someone and I believe that in order to reduce negative emotions one needs to take that in and embrace the feelings so that their true identity may be seen. I love your two approaches when situations of anxiety occur. Making sure the person never looses sight of reality and can always feel connected to the present can make such a big impact.
    Have you ever read the book, Counseling in Speech-Language Pathology and Audiology by Anthony DiLollo and Robert A. Neimeyer? This book has taught me some of the greatest lessons in not just counseling but life in general. Like what you guys bring up in your approaches they teach us that all communication disorders may come with these narratives or traumatic experiences that have shaped people’s lives. A PWS may have become so attached to their stuttering and all the negative emotions that come with it and this turns into their dominant voice. The non-dominant voice is the one that rarely ever pops up or one they hardly ever get to see and that would be their fluent voice. This book teaches us ways to help people to come into touch with their non-dominant self and to create narratives to get them to understand that somewhere a different side of them is waiting to be seen. It teaches how to relate positive emotions to the non-dominant self and to let go of the one that has been controlling their lives. If you haven’t you should read it, it goes hand in hand with everything you guys have reported.
    More and more each day I think of counseling in the back of my head because in order for successful therapy and better quality of life for these patients, starting with mindfulness and just listening and helping these people with coping strategies for anxiety could make the world of difference. Many clinicians think of counseling as what psychologist do and while that may hold some truth there are little things we can be doing in our treatments that go hand in hand with success.
    Thank you again for sharing your stories and the stuttering community is lucky to have two people like you on their team. While most clinicians do not have stutter it is clinicians like you that can give insight to the world PWS live in

    • Thank you so much for your kind and informative comments. I am happy that you are pursuing a masters degree in speech path. Your clients will benefit from your wisdom and expertise.

      Keep in touch.

      Nora

  25. Nora and Dan,
    I just want to say Thanks for taking the time to write this paper. The subject is, in my opinion, of vital importance in the management lf stuttering. My personal experience is that Mindfulness, being and remaining in the moment of stuttering, and learning to change my thoughts about stuttering and about myself, are practices that work. It does not necessarily replace classical therapies dealing with speech techniques, but augments, and even enables those therapies to work. Other authors on ISAD make similar remarks, and it’s enlightening.

    Thanks a lot,
    Hanan

  26. Hi Dan and Nora,
    A light bulb went off in my head when I read your paper.
    On a very personal level I intimately understood the idea of anxiety and feelings of drowning related to trauma as well as using mindfulness and grounding techniques. My anxiety is not related to stuttering. I stumbled upon the practice of yoga as a response to my anxiety and found that many of its principles helped me relieve anxiety and learn how to be present. But I had to teach myself (and I’m still learning).
    As a Comm Disorders grad student I have taken an interest in the field of fluency disorders (among a couple other areas). Even though I am not a PWS and do not have a close connection with anyone who stutters, I have felt drawn to this population. Perhaps there is an empathetic connection on the mental health/anxiety/trauma level.
    My lightbulb was – “This is the kind of therapy I want to do!” So any resources (and I’ve noted the ones you mentioned in previous comments) you have please send my way! I wish I was attending ASHA this year. It’s the first one in 4 years that I’m missing. However, Nora I am in OC not too far from you. I would love to hear more about how you deliver services utilizing these techniques. My email is sfloerke@csu.fullerton.edu
    Thank you for writing this paper and sharing!

    • Stephanie,

      Thank you for sharing your thoughts. I love when the light bulbs start going off. :).

      Please mark April 25th on your calendar. The organization Friends for young people who stutter will be hosting a one day conference at Chapman University in Orange, California. This will be a great way for you to meet some leaders in the field, as well as interact with PWS and their families.

      If you find yourself in Los Angeles – let me know and we can have coffee !
      All the best.
      Nora

      http://www.center4betterliving.com

      • Thanks for responding Nora! I will plan to be at Chapman for that conference! I have a lot of friends in the grad program there actually. I will let you know if I find myself in L.A.!

  27. Dan and Nori,

    The idea of bridging fluency treatment and mental health treatment is compelling and exciting. Mindfulness and grounding techniques are becoming increasingly important in my own life, and I can understand how these techniques could improve daily life experiences for PWS. Thank you for writing this article and thank you for sharing your personal experiences. Good luck to you both.
    Kate Mortensen

    • Hi, Kate,

      Thank you for taking the time to read and comment on the article. I appreciate you !!! I am very excited about bringing this work together to provide the best possible treatment to people who stutter and their loved ones.

      Personally, these techniques have changed my life (and not just with stuttering !).

      Take care. Keep in touch.

      Nora

      http://www.center4betterliving.com

  28. Thanks for the great information! As a graduate student in speech-language pathology, this article was a great reminder of the importance of helping future clients with their emotions as well as their communicative issues. My question is how can a speech pathologist incorporate mindfulness techniques into their therapy sessions and also when would treating the anxiety surrounding stuttering become more of a mental health professional’s job rather than an SLPs?

    Thank you,
    Melanie

    • Hi, Melanie,
      All the best to you in graduate school. We need you!

      As a professional, one should now when they are beyond their scope of practice. I always listen to my gut and bounce questions off of colleagues. I encourage SLPs to build a working relationship with local LCSWs so a referral can be seamless and effective. I would also encourage an SLP to take a workshop on mindfulness.

      All the best,
      Nora.

    • Melanie,

      Great question. As Nora mentioned knowing your ethical scope of practice is very important, as people treating outside of their scope has often resulted in failures in therapy and negative perceptions of therapy by clients and clinicians. The medical field and academic training in America is and, in the recent past, has been emphasizing interprofessional education and practice. That being said, talking to mental health professionals who are specifically trained in treating anxiety, depressions, confidence etc are the best practice strategies. However, it is very likely that a mental health professional may have not received any training on communication disorders, therefore it is you (future and current) job to educate them on the impacts felt by our clients. All of that being said, treating subtle associated anxiety factors related to stuttering (and other communication disorders) are within our scope of practice as SLPs. If this is something that you have not received training on, or feel uncomfortable with refer and collaborate! There are many components of anxiety and mental health that are completely outside of our scope of practice; in most every case I refer and or collaborate.

      Best of luck with your studies,
      Dan

  29. Great article! Thanks for sharing your experiences and knowledge! I am a graduate student studying speech-language pathology. I have always been interested in mental health, so connecting stuttering to mental health is intriguing and it makes total sense! When using the techniques mentioned above, should an SLP and a social worker/other mental health care worker work together in the same session? Since an SLP would need to have experience with counseling and take some counseling classes, would this be a good idea? Also, since so many people who stutter feel the affects of anxiety, would you recommend these techniques be incorporated into every day practice or should it be something that is greatly discussed with the client and/or their families?
    Thanks so much!
    Meghan

    • Meghan,
      Great questions. If a person who stutters experiences a high level of anxiety they should be referred to a MH professional for evaluation. The SLP and MH professional would work in collaboration to provide the best possible treatment to the PWS, and their family if needed. Coping skills learned should be used daily and eventually will become a way of living.

      All the best.
      Nora

    • Meghan,

      Truly great questions. I agree with all that Nora mentioned. Additionally, there are many forms and styles of collaboration, from practical standpoints to reimbursements. As Idaho State University, where I work, we just put on our first interprofessional intensive stuttering clinic, that had counseling graduate students and our own CSD graduate students working in unison with their clients. So starting out each clinician was in each session, which had great benefits reported by the clients and clinicians. However, some counseling sessions got pretty deep, so the SLP student felt uncomfortable and removed themselves. For some of the clients both clinicians were present during each session, for other clients, either because their or the clinician preferences therapy was more individualized and cross-over occurred during generalization or group therapy activities. To the best of my knowledge our clinic is the first to take such a collaborative approach, however I have seen posts from PWS that have attended SLP and MH services separately and noted much benefit. While working together professionals begin to understand their roles and responsibilities and can support each other by passing off between themselves during therapy. Due to scheduling and daily life, this might not occur regularly so having the professionals communicate and treat individually might be a viable option if they can’t get together.

      There are many studies demonstrating that including family / spouses etc in the treatment process is a best practice strategy and should be done. Given the amount of time clients spend with us compared to their family it only makes sense to have other supports in place for generalized success. I think Nora hit the nail on the head with using it daily to make it become a way of living. Mindfulness practices that are used every day, even for short periods of time, will have more effect than ones that are used intermittently. This same can be said for other techniques and procedures from SLPs.

      Best,
      Dan

  30. I think that this is a really interesting perspective. In your conclusion, you mentioned treating stuttering more broadly and I wonder if you think that it would be beneficial for a person who stutters that is also experiencing a lot of anxiety to work with a psychologist or another therapist. I realize that the trick is the therapist having a true understanding of stuttering but where do you feel like the related mental health components go beyond the scope of the SLP? Also, out of curiosity, have you looked into yoga or meditation as having any kind of similar benefits?

    Thanks,
    Jocelyn

    • Thanks for your comments. As a professional, one should now when they are beyond their scope of practice. I always listen to my gut and bounce questions off of colleagues. I encourage SLPs to build a worming relationship with local LCSWs so a referral can be seamless and effective. I would also encourage an SLP to take a workshop on mindfulness.

      Personally, my yoga practice has helped me as a person who stutters.

      All the best,
      Nora.

    • Jocelyn,

      As Nora mentioned knowing your ethical scope of practice is very important, as people treating outside of their scope has often resulted in failures in therapy and negative perceptions of therapy by clients and clinicians. The medical field and academic training in America is and, in the recent past, has been emphasizing interprofessional education and practice. That being said, talking to mental health professionals who are specifically trained in treating anxiety, depressions, confidence etc are the best practice strategies. However, it is very likely that a mental health professional may have not received any training on communication disorders, therefore it is you (future and current) job to educate them on the impacts felt by our clients. All of that being said, treating subtle associated anxiety factors related to stuttering (and other communication disorders) are within our scope of practice as SLPs. If this is something that you have not received training on, or feel uncomfortable with refer and collaborate! There are many components of anxiety and mental health that are completely outside of our scope of practice; in most every case I refer and or collaborate.

      Meditation is one form of mindfulness which can be quite helpful for people who stutter. Not sure about yoga, but it could likely have benefits of helping the individual remain in the present moment, allowing them to mediate their anxiety so they can more effectively manage their communication.

      Best,
      Dan

  31. Hi Dan and Nora-

    Thank you for this paper, and for sharing your insights about this topic in such a personal way. I appreciated your point of view about how the trauma of stuttering, which I have thought of through the years. I think not only of the thousands of times I have stuttered through the years, but also the anticipation and all the other thoughts that are associated with stuttering.

    Years ago when I first joined Toastmasters, I was stuttering severely in my early brief talks at my club. In preparing to give my first formal speech, I arrived early. I walked around the meeting room, breathing deeply and steadily. I stood at the lectern about pictured myself comfortably speaking to the club and dat where thecch prepared spI

  32. Hi Dan and Nora-

    Thank you for writing this personal and thoughtful paper. I have long thought about the trauma of stuttering; not only in the act of speaking but also in the anticipation and word switching and all else that is involved.

    I appreciated the examples you provided about the methods of dealing with stuttering which have little to do with speech.

    I have my own experience in feeling grounded. Years ago, when I first joined Toastmasters, I was stuttering severely in my early, brief talks at my club. To begin to change this, I wanted to feel comfortable at the lectern, no matter how fluent or not my speech was.

    I arrived early at the meeting where I was to give my first formal speech. I walked around the room, breathing slowly and steadily. I stood in back of the room and pictured myself speaking in a relaxed manner. And I want to the lectern and calmly looked around the room.

    All of which helped me in the process of approaching speaking situations in new ways and becoming a better communicator.

    Jeff

    • Thank you for sharing your experience, Jeff. I enjoyed hearing the techniques you used prior to getting to the lectern. These are needed skills that any communicator needs, especially people who stutter.

      All the best.
      Nora

    • Great example and practice Jeff. Glad that you had success in the speech and life from using such approaches!

      Dan

  33. If a client who experiences panic attacks tries the above strategies without success, when would it be appropriate to refer to a mental health professional (e.g., to acquire anti-anxiety medication to manage the panic attacks)? Would it be the frequency of panic attacks that warrants the referral or some other indicator? Thank you!

    • Phillip,
      Thanks for comments. A mental health professional should be teaching the above mentioned skills, especially if the PWS is experiencing high levels of anxiety. If you are receiving speech therapy then he SLP should be working within their scope of practice and make appropriate outside referrals as needed. You would want all providers to be communicating with each other. A medication evaluation may be called for.

      All the best.
      Nora OConnor
      Los Angeles, CA

  34. Dan and Nora,

    Your personal stories of struggle with stuttering are what drew me in to your article, but then I was very interested to read what you had to say about grounding and mindfulness. I agree with what others have said about children benefiting from these techniques, as well as adults. I am not a person who stutters, but I can only imagine that being a child who stutters has got to be one of the most painful experiences for someone growing up, since peers in childhood can so often be insensitive and cruel, not knowing how to respond properly and sensitively to a peer who stutters. I am studying to be an SLP and I would love to be able to teach anyone, including a child, how to empower themselves with the techniques you suggest. These techniques and ideas remind me very much of yoga and/or meditation, and I’m wondering if a consistent and regular yoga and/or meditation practice might help people who stutter, if not with their stutter itself, at least with their anxiety and self-confidence.

    Erica

    • Thanks for your interest, Erica.

      Personally, I have highly benefited from a regular yoga practice these past years. It’s not a matter of my stuttering reducing it’s about being grounded and living in the moment and aware of my body. Living life one pose to the next, one and off the mat !! 🙂

      Take care
      Nora OConnor
      Los Angeles, CA

  35. Dan and Nora,
    Thank you so much for sharing. It is refreshing to hear people researching and finding the connection between anxiety and those who stutter! I am a graduate student student speech pathology and I had a few questions! Which technique have you two found most useful? Does one seem to prevail or do you take this as a case by case basis? Also, do you recommend SLP’s take their time to learn and take counseling classes so we can be a bigger help during this process? I think a partnership between these two professions is crucial. Thank you so much for your time.

    Melissa

    • Melissa,

      All the best in your studies. We need you in the field.

      I agree – a working relationship between SLPs and LCSWs needs to be established. To bounce ideas off of, to educate each other – so an appropriate referral is made.

      I recommend a SLP take a mindfulness workshop and learn basic cognitive behavioral therapy skills.

      I have definitely prevailed by using mentioned skills. I strongly believe that most people who stutter would as well.

      Take dare. Keep in touch.
      Nora OConnor
      Los Angeles, CA

    • Melissa,

      Great questions and thanks for reading the paper. I typically use refocusing grounding strategies, then support that with positive reframes. For overt stuttering, I have been taught a wide array, so I switch between several. For clients, I typically present two to three initial options and ask what they think sounds and feels the most natural and which would they be willing to use outside of therapy. From there, given success I may recommend including supplementary ones (light contacts etc) if needed. I definitely think an SLP learning counseling strategies would be beneficial not only for their clients who stutter, but for many clients with communication disorders (and themselves)!

      Cheers,
      Dan

  36. Dan and Nora,
    Thank you for sharing your personal experiences in relation to the anxiety associated with stuttering. I am not a person who stutters, however, I do struggle with very similar patterns of anxiety. I can imagine that anxiety has a huge impact on fluency, in addition making it more difficult to remember and practice your techniques. It seems to me that it is easy to get stuck in a vicious cycle with anxiety and stuttering, and from my experience, this is not an easy cycle to break. After briefly experimenting with the techniques of “grounding” and “resourcing” when stuck in my own cycle of anxiety, I found them to be helpful in reducing the anxious thinking patterns. I feel that if I can incorporate these strategies into therapy with my future clients who stutter, they will have an easier time controlling the anxiety and be less worried about their speech.

    -Victoria

  37. I enjoyed your article! I love the idea of mindfulness and grounding being incorporated into stuttering treatment. I could imagine that mindfulness would be a great tool in the personal, covert, inner reactions that a PWS may experience after a stuttering event. It may also help alleviate some future anxiety by helping the client with the cumulative trauma. Thank you for your article!

    • Leslie – as a person who stutter and a psychotherapist I am very excited to move this agenda forward. I want to see a comprehensive approach to treating stuttering. I want to see SLPs reach to mental health professionals and creating working relationships so when referrals happen they are appreciate referrals.

      Stay in touch. My website will have ongoing updates on treating the emotional response to stuttering.

      All the best.
      Nora

      http://www.center4betterliving.com

  38. Thank you so much for sharing your own personal stories and for this educational and interesting article! I believe that mindfulness is a great tool for SLPs to be able to reference to for many different clients who are experiencing anxiety and a great tool for the client to have to reference to in their time of need, especially for individuals who stutter. I was wondering if there was a particular skill, whether it be mindfulness, grounding, etc., that you really feel works for you and you have found to work well with others? I also was wondering if you would recommend teaching all of these new skills, over a certain amount of time, to client’s for them to refer to or if these should be taught according to client’s preference only?
    Thank you for your time and wonderful article!
    M. Alexander

    • Hello. Thank you for reading article.

      Mindfulness becomes a way of life and not so much skills to be used only as needed. A mindfulness practice takes daily commitment, and the results can be life changing.

      A client will benefit from becoming aware of their body’s response to challenging speaking situations. A mental health health professional can teach a PWS how to utilize grounding and resourcing to live more easily and peacefully with their stutter.

      A SLP should be reaching out to mental health professionals in their local area and develop working relationships.

      Personally I have practiced mindfulness for several years and have incorporated grounding and resources into my daily life. Mindfulness is a lifestyle for me. I have seen great success for myself.

      All the best. Keep in touch.

      Nora OConnor
      Los Angeles, Ca

      http://www.center4betterliving.com

    • Thanks for reading the article and for the questions. I agree with what Nora mentioned. I use a variety of mindfulness procedures and may utilize different ones depending on the situation. As with typical SLP procedures, we don’t want to overwhelm the clients with an assortment of procedures and targets of focus. Many of these take years to perfect, so taking time and training these practices over the course of therapy is likely a good approach.

      Best,
      Dan

  39. Thank you for sharing your article and your experiences. I have a loved one who suffers from great anxiety and their thought process sounded incredibly similar to your quote: “Constant rumination of traumatic speaking situations is one factor that compounds the disorder into a syndrome,” as they constantly over think until it drives them to exhaustion and depression. Knowing that people who stutter may attempt to go through that alone on a daily basis is worrying, and I hope to help as I pursue a career in speech pathology (in grad school currently). As a future SLP what advice would you have for future SLPs on how to deal with this high anxiety? Is there a certain point when you would suggest referring to a mental health professional?
    Thanks,
    Bethany

    • Bethany,

      Thanks for reading and commenting. As you know being a loved one of someone who stutters, it is a very difficult thing to deal with. I think, most if not all of us as humans can benefit from talking about our problems with someone trained to listen to them. So in my opinion, it wouldn’t hurt to refer or collaborate just to assess and see. Although not a frequent occurrence, SLPs should undergo training on counseling procedures in the realm of SLP. It would likely be quite beneficial for all types of clients and for the professional themselves. Collaborations are great ideas, or doing continuing education on those concepts. There are likely even some introductory classes offered on such topics.

      Hope this helps,
      Dan

  40. Nora and Dan,

    What a great article. As a stutterer and mental health professional I use mindfulness, resourcing, and grounding on a daily basis.

    My first experience was actually with my SLP, Mrs. Berman. We worked together on a weekly basis from 7th to 12th grade. In our sessions we worked together to create resourcing options and grounding techniques. I didn’t get it at first, but I felt better. I felt understood, cared for, and was better able to deal with my day to day events.

    As an adult I started working with a skilled psychotherapist. Together we began to unravel the level of negative thoughts that I had associated with my stutter. This process took close to two years of work. During this time I felt extremely vulnerable. To manage this I used mindfulness, resourcing and grounding. It assisted my healing process and helped keep me grounded and stable as I worked through the process.

    In my own work as a mental health professional I use these techniques often. I find that my clients respond in a very positive manner. They take what they want from it in their own pace. It’s like creating a toolbox.

    Lastly, as a stutterer, keeping grounded, mindful, and developing resources helps me be okay with me – day to day.

    Peace

    Elizabeth Kapstein

    • Elizabeth,

      Thanks for reading and for your comments. Wow, very cool, I didn’t know that SLPs were utilizing these procedures. Sounds like you had some very beneficial experiences in therapy. Thank you so much for commenting about your experiences! Great to hear. Nora is in the early stages of building a speciality in treating individuals who stutter from a social work perspective. I believe that she and others, Michael Sugarman etc, are trying to gain a more recognized presence of the benefits. It sounds like you could offer valuable input in this area.

      Cheers,
      Dan

  41. Thank you both for this informative presentation! I find the idea of using methods like mindfulness in stuttering therapy extremely interesting. As someone who does not stutter but who has an anxiety disorder and has experienced the benefits of mindfulness as a method for anxiety management, it is exciting to think that I could potentially incorporate this technique into my future practice as an SLP, as this is something I had never considered.This really does show the need for more collaboration between mental health counselors and SLP.It is important work that you are doing!

    I am currently a graduate student enrolled in a fluency course, and we recently had a very interesting discussion about an SLPs scope of practice and when it may be necessary to refer a client to a mental health counselor. Do you have any suggestions about if or when an SLP should make a referral?

    All the best,

    Jamie Cronce

    • Jamie,

      Thanks for reading the paper and commenting. Also, good luck with your studies! Many of these procedures could likely be readily applied to various individuals with communication disorders, not only stuttering.

      Knowing your ethical scope of practice is very important, as people treating outside of their scope has often resulted in failures in therapy and negative perceptions of therapy by clients and clinicians. The medical field and academic training in America is and, in the recent past, has been emphasizing interprofessional education and practice. That being said, talking to mental health professionals who are specifically trained in treating anxiety, depressions, confidence etc are the best practice strategies. However, it is very likely that a mental health professional may have not received any training on communication disorders, therefore it is you (future and current) job to educate them on the impacts felt by our clients. All of that being said, treating subtle associated anxiety factors related to stuttering (and other communication disorders) are within our scope of practice as SLPs. If this is something that you have not received training on, or feel uncomfortable with refer and collaborate! There are many components of anxiety and mental health that are completely outside of our scope of practice; in most every case I refer and or collaborate.

      Hope this helps,
      Dan

  42. Hello Dan and Nora,

    Thank you for sharing your view on incorporating mindfulness, grounding, and resourcing. As a current graduate student in a fluency disorders class our discussions on stuttering often seem to come back around to the topic of anxiety. I look forward to the continuing advances in research on these treatments as they become increasingly accepted and implemented into work within the stuttering population.
    In class we have discussed the lack of awareness children who stutter sometimes have to their disfluencies, and how children may not develop negative emotional reactions to their stutter until they have traumatic experiences in school or elsewhere. We have learned that with young children it can be a good first step in therapy to teach them awareness of their disfluencies. This sounds a lot like mindfulness, as we would teach them to be aware of their disfluencies in absence of labeling them ‘right’ or ‘wrong’. This leads me to wonder if it would be beneficial to teach grounding or resourcing to young children as well? Particularly in young children who either have no negative reaction to their stuttering yet or have a very mild negative reaction, in your opinions would there be a way to teach the skills based in grounding and/or resourcing to potentially prevent future anxiety from forming?

    Thanks,
    Morgan