About the authors:
|Daniel 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/.|
|Nora 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.
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.
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.
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 Disorders, 37(4), 289-299.
Boyle, M. P. (2011). Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 36(2), 122-129.
Craig, A. (2014). Major controversies in Fluency Disorders: Clarifying the relationship between anxiety and stuttering. Journal of fluency disorders, 40, 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 Disorders, 37(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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