Taking ACTion and Committing yourself to your values: Acceptance and Commitment Therapy for People who Stutter

About the Authors

palasikDr. Scott Palasik has been a Certified Speech-Language Pathologist for fifteen years. He’s an Assistant Professor at the University of Akron (UA) where he teaches graduate Fluency Disorders course (on campus and distance learning), Voice Disorders and Cleft Palate, and Support Systems for Families and Individuals with Communication Disorders, along with supervising graduate students in clinical Education. He also is the director of the Mindfulness ACT Somatic Stuttering Lab, and performs research with Acceptance and Commitment Therapy (ACT), unconscious and conscious attitudes about stuttering, and environmental and social effects pertaining to dysphagia. He has presented at many local, regional, state, and national conventions about Mindfulness and ACT. He has been a member of the ACBS (Association of Contextual Behavioral Sciences) for eight years and is the President of the Ohio ACBS Chapter. He is also the co-founder of the UA Campus walk for Suicide Prevention.
hudockDan 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. One aspect of his research interests resides in exploring 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/.
yatesChad M. Yates, Ph.D., Licensed Professional Counselor (LPC), is an assistant professor in the Idaho State University’s Department of Counseling. At ISU Chad teaches group counseling, basic counseling skills, addictions, and assessment and research procedures. Chad’s counseling experience includes working with individuals with substance abuse disorders, batterers and survivors of domestic violence, families, and as a generalist treating many diverse client concerns. Chad has served as the mental health coordinator for the Northwest Center for Fluency Disorders at ISU. He has helped to develop the Acceptance and Commitment Therapy (ACT) manuals and procedures for clients and clinicians at the clinic and supervises the counselors providing ACT.

How often do we live every moment, and every behavior (ACTion) by what we believe? As a person who stutters (PWS), how often do you make sacrifices for your desire to communicate and share with others, because negative thoughts arise related to your stuttering?  Our minds are powerful sources that can influence choices about how we choose to talk. But like Russ Harris (2009) wrote, “Your mind is not your friend-or your enemy…It’s very useful for all sorts of purposes, but if we don’t learn how to handle it effectively, it will hurt us” (p.7).

Acceptance and Commitment Therapy (ACT) is an approach to address basic human suffering. The acronym, ACT, ( pronounced as one word) refers to taking “action” towards one’s values and encouraging movement. This simple word (ACT) can instill a sense of perceived control over negative thoughts and physical behaviors such as making choices of what speaking situations to speak in, what to say, how to talk, who to talk with, and when to engage with others. By moving towards more psychological flexibility, the idea of allowing one’s self to choose thoughts and actions despite the presence of negative thoughts, PWS can find freedom where historically they might have felt held prisoner by their own negative thoughts about themselves and their stuttering.

The ACT model consists of six principles:

  1. Contact with the Present Moment – Being aware of your thoughts before, during, and after speaking situations
  2. Acceptance and Willingness – Being willing to open up and accept any of your stuttering related thoughts and behaviors
  3.  Thought Defusion – Observing your thoughts about stuttering and being able to let them go without judgment
  4. Self as a Context – Seeing yourself as a whole person and understanding that stuttering along with your thoughts related to stuttering are aspects many other characteristics, behaviors, and experiences that make up the whole person
  5. Defining Values – Knowing and defining what matters to you and relating your Values to speaking situations, stuttering moments, and beliefs and attitudes toward yourself
  6. Committed Actions – Creating goals of self-acceptance and overcoming experiential avoidances by speaking in situations and interacting how you want to based on your values

These principles can be worked on in any order, but let’s start with Contact with Present Moment, also referred to as being mindful. Being mindful and present comes in all forms. One of the most common is asking a PWS to participate in guided meditations (focusing on the breath) with a Speech-Language Pathologist (SLP) or Mental Health Professional (MHP), focusing on the breath. When practicing mindful attention to the breath, PWS are learning how to live in the present. Mindfulness is not having a blank mind, in fact it is rare that we do not have thoughts coming and going. Instead, mindfulness is the practice of allowing thoughts to come and go freely without judgment. It can essentially retrain your mind to focus its attention on what is happening now instead of passing judgment on your racing thoughts.

Mindfulness can be a mechanism for PWS to bring awareness to their negative attitudes about stuttering and can also start the process of letting negative thoughts go. Not pushing thoughts away or replacing thoughts, but rather accepting thoughts as words without attaching judgments. Being more mindful and present of thoughts can teach PWS that they don’t have to act on negative thoughts, but that they can simply be willing to see them. This process may help PWS let go of past thoughts like, “I stuttered on the phone last month, and it was awful” along with letting go of worry filled thoughts, “I know when I say my name on the first day of school I will stutter and everyone will laugh.” These might be common thoughts related to the past and future events. So, getting in contact with the present moment allows PWS to live in the NOW.

Acceptance and willingness, the second principle of ACT, can allow a PWS to stand face to face with their feared or negative thoughts about stuttering. Acceptance does not mean you have to say: “I like stuttering.” In ACT, one doesn’t have to like something to accept it as a part of them, but instead acceptance is being willing to walk with stuttering and not let it hold you back from living the life you desire. For example, you may not like the fact that you stutter, but your stuttering is a part of you and has helped make you who they are. You may try to hide the fact that you stutter (e.g., with decreased eye gaze, changing words, or not talking when you want to). So by accepting your stuttering and yourself, you can enhance your identity and confidence. Trying to hide something takes a lot of time and effort, but by accepting stuttering and the thoughts related to it, you can reduce the impact that stuttering may have on you and you can start living your life.  So with ACT, acceptance means to be willing to make contact with negative thoughts in order to examine the thoughts your use to judge stuttering. Just being willing to connect with negative thoughts about stuttering can be one of the first steps toward accepting stuttering and can help decrease negative thoughts and behaviors.

Thought Defusion is the third principle of ACT. This principle can allow a PWS to let go of thoughts, all thoughts, without judging them. PWS can develop a variety of judgmental thoughts that may keep cycling through their minds. Thoughts like: “I will never talk perfectly,” “Stuttering is all I do,” and “I know people laugh at me every time I talk, so why bother talking.” These countless ways PWS create negative attitudes toward stuttering can be held on to and can cause avoidance during speaking (e.g., blocks, interjections, and/or avoidance of speaking entirely). Being able to see thoughts about stuttering as basic words and language, can help let go of negative attitudes built up over years.

With the ability to be present with one’s thoughts, accepting thoughts related to stuttering, and letting go of negative thoughts, a PWS can  step back and obverse themselves and their thoughts as a whole person with many different parts. This is the fourth principle of ACT, Self as Context. One way PWS can practice observing themselves as a context is to describe speaking situations and thoughts associated with an event in the third person, replacing “I” and “me” with your name and “he/she” and “him/her”. So if Dan felt he had a poor speaking experience ordering pizza, and he was practicing self as content language (a narrow observation of self), he might say:

 “I ordered a pizza last night and it was horrible. I was nervous, and was going to hang up, like I always do. When I did go to order I stuttered like crazy and couldn’t get a word out. I’m a professor who teaches speech language pathology, I can’t believe I still talk this way.”

If Dan was practicing self as context (a wide observation of self) he might say the following:

 “Dan called to order a pizza last night. Before ordering he noticed that he had thoughts about the other person hanging up on him. Just before ordering, Dan felt his chest tighten and his face was warm. He thought of hanging up, but he didn’t. When it came time to talk, he observed several stuttering moments. Some were a second long, some shorter. When Dan was finished he was aware of negative thoughts about his speech, and also noticed a sense of accomplishment for ordering the pizza. He looked forward to eating it.”

By describing behaviors and thoughts as a context, from an outside and wide point of view (e.g., “Dan noticed that he had negative thoughts about his speech”), it can allow a PWS to distance themselves from the thoughts and negative emotions attached to them. This allows them to see what happened during a speaking situation with decreased judgmental language. Once a PWS gets used to looking at themselves from a distance, they can move toward using first person language with “I” and “me” (e.g., “I noticed that I had negative thoughts about my speech”).

If asked, “Who are you?” what would you say? Most might list things they do (.e.g,  “I’m a student,” “I’m a dancer”). PWS might say, with some levels of self-judgment, “I stutter.” What’s important about this question is that the things we do, like dancing, being a student, and being a PWS, are parts of us but may not be who we are at the core. The fifth principle of ACT, Defining Values, is a time to discover the parts of us that can dictate the choices we make and how we want to live. Values are chosen by us, and not chosen by anyone else. Some common values that many people hold are, “To be honest to myself and others,” and “To be compassionate to myself and others.” What’s important about defining values is that they involve YOURSELF and OTHERS.  By adding “to myself” when defining values, it creates a commit to one’s self and a practice of living those values in a more conscious (mindful) manner.  Remember, living by our values is a process, which PWS can think about when planning how to interact in speaking situations. It is our values that move us toward accepting ourselves and our role as a communicator in any speaking situation we choose.

The final ACT principle is Committed Actions. A PWS is no different than a person with any other psychological barrier. Growth and commitment to actions is individualized to each PWS. One way to start thinking about committed actions is to develop a series of tiny, medium, and giant goals. For example, if Scott wanted to express a concern to his boss, and was anxious, he might list the following goals:

GIANT GOAL: “I will make a phone call to my boss about a concern I have.

 TINY GOAL “Once today I will think about making a call to my boss about my concerns.”

MEDIUM SIZE GOALS:  “I will write out what I want to say to my boss.” “Twice today I will practice picking up the phone and saying what I want to say to my boss.”

Each PWS is unique, so, tiny, medium, and giant size goals are relative to each person. Another example might include a giant goal of, “Dan will pseudo stutter when presenting to his class.” A tiny goal of, “Dan will pseudo stutter to himself five times today.” And a medium goal of, “Dan will pseudo stutter one time with his friend Chad.” As you see, by starting with a giant goal first you are setting your sights on the wide observation, followed by a tiny goal (seeing the first step), and then medium goals (creating steps along the path and moving toward the giant goal). Like Luoma, Hayes, and Walser wrote, “What matters most is maintaining forward movement and growth, not the amount or the rate of movement” (p. 166).

Acceptance and Commitment Therapy (ACT) can be seen as a way of life, not just a way to do therapy. ACT can help PWS create mental chooses and make decisions for themselves about how, who, what, where, and when they want to communicate with decreased judgments. ACT can allow PWS to be more psychologically flexible with the choices they make and how they live with stuttering. Being accepting and committed to one ’s self as a PWS can lead to the feeling of not needing to push away thoughts, or cling to thoughts. Rather, PWS can be present with their thoughts about stuttering, who they are and want to be. Defining values can help PWS be willing to choose and observe themselves as a whole person and in everyday actions and speaking situations.

Disclosure and Appreciation: Scott and Dan are PWS. Scott, Dan, and Chad would like to thank all of you who read this for being advocates for yourselves and PWS. It was our pleasure and honor to be a part of this wonderful conference.

With compassion and kindness,

Scott, Dan, & Chad

References

Harris, R. (2009). ACT Made simple: An easy-to-read primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

Luoma, Hayes, & Walser (2007). Learning ACT: An Acceptance & Commitment Therapy skills-training manual for therapist. Oakland, CA: New Harbinger.

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Comments

Taking ACTion and Committing yourself to your values: Acceptance and Commitment Therapy for People who Stutter — 32 Comments

  1. I enjoyed reading your article on ACT. The six ACT principles are well explained. However, persistent negative thoughts may become automatized and hard wired in the brain after time, and difficult to dislodge. Have you heard of any guided meditation strategies that can help SLPs get started with this approach ? Or, are you recommending more of a collaborative approach with a meditation master? If so, please advice. Thanks.

    • Dear Lourdes,
      Hi! It is so nice to meet you. And, have you read the other ACT paper at this online conference, it is great! You bring up two great points. Yes, our minds (as humans) is hard wired for negativism. This is called the negativity bias (Rick Hanson, Neuroscientist). As a species we are programed to be negative for survival. So when we move in a different direction it is challenging. As a person who stutters (and have since I was 2 or 3) I know the constant negative thoughts that pop up out of automatically. And, I also have experience and power and practice of coming face to face with those muddy and negative thoughts through meditation and mindfulness practice. Since this paper was limited in space, we couldn’t get into specific practices, however PWS can practice all forms of meditation. One basic forms is called Vipassana (and is the oldest form of meditation). A great book (and it is free online: http://www.urbandharma.org/pdf2/Mindfulness%20in%20Plain%20English%20Book%20Preview.pdf
      by Gunaratana will explain this breathing based meditation, tell you what meditation is (and isn’t) and give you some tools to get started. You can also check out Pema Chodren’s book, “How to Meditate”. Again, these are just a few options that anyone can pick up and learn meditation. You can also do it with an SLP. We do mindfulness and mediation with all of our PWS clients, and have also started doing it with stroke and head injury. So SLPs can lead such guided meditation. Let me also say this, we introduce this to clients, if they don’t want to do it, we don’t do it. We provide options, the client chooses (the foundation of ACT, psychological flexibility).
      Anyway, please ask more questions. If you can’t find Gunaratana’s free PDF book, let me know and I can send it via email.
      Thanks for writing!!!
      With compassion and kindness,
      Scott

  2. Hello Scott, Dan and Chad,

    This is wonderful paper, and extremely important for PWS. I could comment on so much, but suffice it say that the principles you describe are those that enabled me, personally, to get unstuck, to find a way to live, survive, and even to thrive. Meditation and letting go of negative thoughts has certainly been a key action for me on my journey.

    Reading your paper, I am reminded of the basic CBT loop of Thoughts->Feelings->Physiological Responses->Behaviors->Thoughts. It all connects so well.

    Your paper will, I am sure, be referred to by many of us as one of those landmark papers where things are explained so well.

    Thanks very much.
    Hanan

    • Dear Hanan,
      HI! It is so nice to meet you (virtually, perhaps one day we might meet face to face). Where are you writing from?
      You bring up a GREAT point about the CBT Loop. I use the image of that loop when performing ACT and mindfulness seminars because it really summarizes the basic operations of a human being. If I can ask a few questions, specifically, what have you done with meditation (specific styles) and mindfulness or CBT or psychotherapy that has help you with legging go of negative thoughts? You of course don’t have to share, however for me, the more we share our perspectives and experiences, the more WE ALL learn.
      How I began with ACT is I joined a psychophysiology lab (where I first learned ACT) during my PhD and joined mindfulness group where we practiced sitting meditation and learned different styles of meditation (Metta, Vipassana, etc). I then went on to sit with different Buddhist Monks and doing workshops with the founders of ACT. My mindfulness practice has now bleed over into an art type feel learning to do Zentangle and writing novels. In a nutshell, that is my current journey and it will be with me forever.
      Feel free to share yours (if you wish, that is).
      It was so nice to hear from you, and check out the other ACT paper at this conference by Katie Gore. Also, if you want to read an article I with Jaime Michise on ACT, I can send that to you via email (my email is spalasik@uakron.edu).
      Have a great day! And thanks for your kind words, it was a great experience writing this with Dan and Chad (two great guys!!).
      With compassion and kindness,
      Scott (Dan and Chat)

  3. I believe my favorite line of this paper is that “acceptance is being willing to walk with stuttering and not let it hold you back from living the life you desire.” I love the idea of tiny, medium-size (baby steps), and giant goals as one seeks to grow and live fully in spite of the stuttering. 🙂

    • Ana Paula,

      HI! Thanks for dropping in and writing! I love the smily face at the end.
      Acceptance is a hard road to hoe because we are hard wired to be negative (negative bias – Rick Hanson), but when we realize that life is more than the negative thoughts that pop up (out of instinct), and that we can link all thoughts and experiences to how we want them to be, life can take on a new perspective. One of continued growth towards the person we want to be. All while knowing that we don’t get anywhere without taking steps. A baby takes 15 steps to cover 10 feet, while an average adult might take 4 steps. But here is the what they have in common, they are both coving the same distance. So no matter how big the step, the journey is what we are experiencing.

      Much compassion and kindness your way,
      Scott

  4. Are ACT and REBT Related: Is There Synergy to Be Had

    Congratulations on a well written paper. As one of the erstwhile advocates of integrating work on attitudes, emotions and beliefs into stuttering therapy, I want to welcome you to the fray. My friend Walter Manning wrote in the foreword to Stammering Therapy from the Inside: New Perspectives on Working with Young People and Adults edited by Cheaseman, Everard, and Simpson that the authors in that book are embarking on a new adventure reminiscent of the classic British adventurers. You may not be British, but you sure are in the spirit of Lewis and Clark continuing the exploration. My own background includes being a Rational Emotive Behavior Therapy (the erstwhile Cognitive Behavior Therapy) advocate on stutt-as long as thirty years ago.

    I am interested in finding the common ground between REBT and ACT. This would be to borrow techniques and tools from ACT to help my clients evolve their attitudes, beliefs, and emotional state when dealing with speaking.
    The areas of commonality that I have picked up is the reframing of the stuttering experience and taking out the negativity of our attitudes. This does not mean that there are no differences in our approaches as well as some misunderstanding of each other’s theories. For the time being I would like to stress the commonalities such as value clarification and goal orientation. I really believe in what I wrote in my article, especially the desired outcome which my work with my clients has validated.

    • Dear Gunars,

      Hi! It is a pleasure to meet you (virtually that is) . As an explorer yourself, you know the excitement and challenges one feels to step forward with new ideas and allow patience to be a value that keeps you grounded. I might not be English (dang!) but my heritage is part Irish and French, so I have European roots (along with Polish and American Indian – Ottawa).

      How are REBT and ACT similar? I’m going to go through some of the Steps you used in your paper to show how I believe there are many overlaps. The beauty about where we are right now in psychology is that CBT, ACT, and so many other theories provide so many places of overlap where they blend, which truly is beautiful.

      STEP 1: Both REBT and ACT look to build report. The application of using ACT as a way to connect with a client immediately is displayed right away. ACT is a conversation between client and clinician. Unlike classic CBT, where a clinician was continuously asking questions and reframing a client’s thoughts, ACT is dance where the client shares and the clinician shares. We all experience suffering and joy. So ACT encourages the clinician to share their own journeys with these two life experiences. By a clinician sharing information about themselves about challenging events, their values, and goals they have with personal challenges, it allows the client to see the process of ACT unfold before them, another application of ACT besides just stuttering (but a life style), and can give the client an opportunity to play teacher or clinician by practicing active listening and thinking deeper about ACT (practice). Thus all building rapport quickly.

      STEP 2: The awareness piece, or contact with the present moment is another common thread between REBT and ACT. Both theories are facilitating consciousness of thoughts (behaviors) and physical actions that the client might not be aware of through mindfulness practices, conversations, and stepping outside one’s self to view a speaking situation objectively rather than subjectively (in ACT this is called Self as Context).

      STEPs 3& 4: These steps sound very similar to the ACT principle of thought defusion. The idea of not gripping on to thoughts, but rather viewing them as words and language that we give power to. With decreased power put on negative thoughts, one can see their behaviors (mental and physical) as movements (actions) rather than on governing the other. This leads to STEP 5 where you ask why we as humans tend to think irrationally.

      STEP 5: During the entire ACT process from contact to the present moment all the way through committed actions, we are having continued conversations about the language we use and whether that language is in line with each person’s chosen values. With stuttering we often go back in time to try and discover some potential past experiences that a client holds on to and has mentally reframed a speaking situation to make it a story, rather what might have really happened. We all create stories of our lives (frames we associate with other experiences) within our minds. The challenge is, our minds are accurate witnesses because we come from a bias. When we use ACT we discuss this idea that we are, by nature, irrational because we make up stories lines about speaking situations that really aren’t there. Example: “I know people are laughing at me when I order food at a restaurant.” What evidence is there to prove this? A person might see a distance waiter laugh, but what are they truly laughing at? Question like this bring out the story and break down the language one might use.

      STEP 6: This goes along with Thought Defusion and Self as context and brings a person to their values. Showing that their values (e.g., being a good person for me and other) can have more impact than thoughts we give power (e.g., I can’t talk at all because I stutter.) Like REBT, during contact with the present moment, and throughout ACT, we are teaching clients to let go of thoughts (all thoughts), to appreciate them as they come (even give them a hug if you wish) but to try and come back to the present moment because that is where we ALL live. You said, “irrational ideas start with must”. We agree. With ACT, Kelly Wilson developed Word Prisons (e.g., words like always, never, must, should, fair, unfair). These words drive the psychological behaviors to be irrational (in REBT terms) or fused (in ACT terms).

      I could go on about how I see REBT and ACT overlap. I guess, for now (we can keep having conversations, as this how we grow). It appears that REBT and ACT overlap in the basic idea of examining language. Looking the thoughts a client uses and breaking those words appear to take away the power by detaching the hold on to the meaning. By doing this, it is allowing the client to “Reframe” their own thoughts and how they perceive the world and experiences.

      These are just my first thoughts on your great question about how REBT and ACT might have commonalities. Please feel free to share your perspective. Again, this was just a starting point (as I don’t know how much room I’m allowed when I reply to a post…)

      Have a wonderful day, ISAD Conference, and enjoy the life you choose to live!
      With compassion and kindness,
      Scott

  5. Hi Scott, Dan and Chad, I thoroughly enjoyed your paper. Your excellent examples make the ACT principles come alive. I like the progression from tiny to medium to giant-size goals – so workable! Over the past few years, ACT has certainly helped me get “unstuck” many times and start moving along again in my journey. Scott, so looking forward to the workshop in less than two weeks now! My best to all.

    • Dear Rob,

      Hello! Thanks for your feedback and excitement! If you get a chance to talk with Chad and Dan, you will love these guys! They are right up our Alley and it was a pleasure to work with these to bright and deeply caring individuals who get how to live by ACT principles an just appreciate all that life has to offer!

      See you in 8 days! NC, here we come!
      With compassion and kindness,
      Scott

  6. Hello, Scott,

    I am, as you know, a proponent of mindfulness as a means of resolving stuttering problems. So I know that what you share here can be very helpful as it is built around key features of mindfulness practice, such as acceptance and mindfulness itself.

    I am glad you mentioned that it is helpful to consider ACT as a way of life, not just therapy. Viewing the practice of mindfulness that way is a huge reason it has been transformative for me. And so has relating to myself with kindness and compassion, whether or not I stutter or am afraid that I might.

    Thanks, Scott.

    Ellen-Marie Silverman

    • Ellen-Marie,

      Hello! It is always a pleasure to hear from you. You bring up a great point about ACT and mindfulness being a way of life. Living by our values is a way of life, which sounds like a no-brainer, however how many times are we attentive to those values, unless we train ourselves to be mindful.

      Because we are programmed to be negative (to create anxiety for our survival), being willing to be face all thoughts and essentially going against parts of our basic survival skills take practice.

      Anyway, we could talk and talk about all of this. Again, it is ALWAYS a pleasure to hear from a fellow meditator, and mindful soul!

      With compassion, kindness, and Namaste to you!

      Scott (Dan & Chad)

  7. Hi fellas,
    What a useful and universal set of strategies for motivation! As a person with not a stutter, but anxiety, these suggestions are great for keeping me at ease, more relaxed, and confident. As a future SLP, I can use a guide such as ACT for clients who stutter and show how it can relieve the anxiety of a person such as myself. Like you quoted, our brains don’t always carry-out the best performance for us- we have to teach it. That’s why there is a a ‘scumbag brain’ meme after all, right? http://i.imgur.com/jo3sJRC.png
    Tammi ‘Swiss’ K.

    • Tammi,

      HI! It is lovely to meet you (virtually). If you liked this paper, check out Katie Gore’s ACT paper just a few above ours on the main page. Wonderful!!!

      You bring up a great point about ACT being a great tool for anxiety. ACT has been used for many things, including anxiety, PTSD, obesity and chronic pain (to name a few). What is amazing about ACT, is that this approach is for ANY PERSON as a life style. Can you imagine if we all lived by our chosen values (e.g., being a kind person for myself and others, being a compassionate person for myself and other, being an honest person for myself and others)? The world would be more positive, less judgmental, and more accepting of differences. What a wonderful way to be!

      On a personal note, I’ve noticed that the more I live ACT the less I need to spend time focusing on judgmental thoughts and judgmental people. I’ve come to the question, “How do I want to spend my time?” Which is a continuous mindfulness practice in and of itself!

      Thank you for writing!

      It was such a great time writing this paper with Chad and Dan. Two great guys!

      With compassion and kindness,
      Scott (Chad & Dan)

  8. Hello to the Three Fluenceers!
    “Our minds are powerful sources that can influence choices about how we choose to talk”. Stuttering like bicycle riding is more often than not a behavior learnt in childhood and cannot be unlearned; but we do not have to hop on our bike to get from A to B. Twenty five years ago I used belly breathing, meditation and visualization to get on top of my stutter and teach myself to talk as nature intended. If it is of interest to you I have produced a web page to tell my story. http://www.stutterfreesteve.weebly.com
    Regards
    Steve

    • Steve,

      It is very nice to meet you! Something that is valuable in our world is being able to listen to, and express stories. That being said, thank you for sharing yours above, and on your website. I so do enjoy hearing about people’s journeys because each is unique, and each has lessons to be learned.

      Thanks again! Have a wonderful day!
      With compassion and kindness,
      Scott (Chad and Dan)

  9. Hi Dan, Scott and Chad,

    I enjoyed reading your paper. I know that ACT has been used successfully for a lot of other difficulties and it sounds like it holds great potential for helping people with stammering. I would be interested to know whether you have access to any outcome data looking at using ACT with people who stammer particularly whether you see reductions in stammering and/or changes in thought processes.

    Regards
    Amy
    SLT trainee

    • Dear Amy,

      Thank you for writing! We appreciate you taking the time to read our paper. That is the wonderful thing about this conference, there is so much to great things to read from people who just love PWS.

      We are collecting some data on using ACT with clients who stutter. One case study we have is with a moderate (on the SSI-4, so physical behaviors) college student, who when we first starting seeing him was moderate to severe with respect to his affective and cognitive components (lower score on AAQ-2, moderate on the OASES, and more). So we taught him ACT for the first year. What we saw is that his scores on the OASES changed to mild and his scores on the AAQ-2 (which indicates increase psychological flexibility). What is also interesting is that we saw his total disfluencies go down, and his stuttering behaviors change to more normal disfluencies, and his secondaries decrease. The more he entered into speaking situations that HE chose because he wanted to, and because it was in line with values he consciously talked about, the less he put time into thinking about his stuttering. Again, doing counseling with all of the principles at once.

      I hope that answered your question a little.

      Thank you again for writing! ACT can be seen as a life style, rather than fluency tools. That is how we teach it.

      With compassion and kindness,
      Scott (Dan and Chad)

  10. Thank you Dan, Scott, and Chad for your informative article which so clearly delineated the aspects of ACT. As a graduate SLP student, this has been my first exposure to ACT therapy and I found it to be intriguing. With regard to the third principle, Thought Defusion, while I understand the benefit of identifying thoughts for what they are and not allowing them to cause a buildup of negative emotion or beliefs about oneself, I wonder if you could provide any practical suggestions for helping clients achieve this goal. What resources would you suggest for further detail on this topic?
    Thank you so much,
    Rochelle

    • Rochelle,

      Hi! Thank you so much for writing! I love your last name! What ethnicity is it?

      You ask a great question about “Thought Defusion” One technique we use to address thought defusion is to have a client say difficult thoughts, feared thoughts, or common negative thoughts in accents, silly voices, and/or singing them. What this does is essentially desensitize the client from the thought, putting distance mentally from them and the a thought that has potential holding them back from entering into a speaking situation.

      For example, we had an adolescent boy who didn’t talk on the phone for two years because of one phone call he made to Walmart where the listener laughed at him. Once he told us this, we had him write down what happen (this gets it out of him so he see his thoughts as words and language). We then had him explain the situations in his favorite accent. After a few minutes of going back and forth between client and us doing accents, and being generally silly, we then talked about the situation and how he felt and perhaps reasons people might laugh on the phone, The more he created options, the less he “fused” to the thoughts that kept him from talking on the phone. With in two sessions of these activities he was calling Walmart, the very place that laughed at him in the first place. He would do these in session. Further, he wanted to make other calls to different places every week. He was a wonderful young man, who did great work for himself. We give him all of the credit!!! He was “willing!” to work.

      That is just one situation. Did that help? Let me know.

      Thanks for writing!!! Have a wonderful day!!
      With compassion and kindness,
      Scott

  11. Hello again,
    I have an observation, really more of a question.
    ACT therapy seems to be based on meditation of the Buddhist variety which is a practice very much to do with the mind; using the breath and the body as enablers. This is understandable as it was developed by a psychologist and their concern is generally problems of the mind.
    I am a hands on simple sort of a guy and I see stuttering behaviour as two mechanical problems and an electrical problem. Namely anxiety induced shallow breathing, excess tension in the vocal apparatus and a troublesome circuit board,the brain. Problems of both the body and the mind.
    Would it not make some sense to develop a therapy with a psychologist versed in the principles of Yoga? Yoga is not just a physical practice but is also a practice of meditative awareness with particular emphasis on the breath and tension reduction.
    An interesting read is “Yoga as Medicine” by Timothy McCall M.D.
    Kind Regards
    Steve

    • Here is a quote attributed to Dr Jon Kabat-Zinn the father of mindfulness in modern medicine where he combined both Buddhist and Yoga techniques.
      “People need different doors to come in to the room, so to speak, of self awareness and self knowing. Some people just can’t go through the mind door. They get the body door instantly.”
      Kind Regards
      Steve

    • Dear Steve,

      Hello! ACT has a history of being linked with all kinds of mindfulness behaviors, with Yoga being one (which also came from Buddhist practices as you already know). I attended an ACT and Yoga synergy weekend (four days of both). We have done Yoga with our clients who stutter too. And there have been studies using Yoga, body movements, with stuttering. I think it is safe to say most of the more modern SLPs who do a lot of Stuttering treatment use all kinds of therapy, which includes all aspects of the individual including both mind and body. Most SLPs know and do a variety of treatments as to fit the treatment to the client, not the client to the treatment, which lovely for everyone involved.

      Thank for sharing and for asking question! Both are vital parts of team learning.
      With compassion and kindness,
      Scott, Dan, and Chad

  12. Hello Scott, Dan, and Chad!
    I am currently a grad student taking Dr. Hudock’s class online! I am thoroughly enjoying it and thankful to have my misconceptions and lack of understanding be replaced with enlightenment and even more interest. I recently commented on a paper where the SLP was a PWS and felt he “walked the line” at various times. I felt encouraged to ask him how I would help one of my clients in my elementary placement address his stuttering when he really isn’t bothered by it or notices he does that. Reading your principles gave me some ideas that will help me “walk that line” of working with my client to become a better communicator without causing him to become self-conscious and lose his desire to speak with others without reservation. He’s a great 2nd grader! I am thinking to help gently bring awareness to his stutter is to have him describe himself. This is something that Dan mentioned. I also thought it would be a good idea to have him talk about things he likes to do and things he really doesn’t like to do. Maybe from those three inquiries I may find a door that will let me approach more meaningful sessions with my client. (He really doesn’t enjoy working on overt strategies as he doesn’t see a need to apply them. I honestly don’t see the benefit in them, as well. If he doesn’t care about it, then why make him feel like he should? Am I wrong to think this way?) If you have any other ideas or direction, I would be thrilled to hear them and very appreciative. Thank you for your wonderful paper!

    • Dear Correne,

      Hi! You are lucky to have Dr. Hudock as your professor. He’s a great guy, smart cat, and a wonderfully caring individual who I”m proud to call my friend.

      It sounds like you are on the right track. If your little client is in 2nd grade, he is most likely aware of his speech. Just because he is aware, doesn’t mean he has to feel bad about it either (which is something we sometimes don’t think about). For example, I’m aware that eating sugar cereal like “Boo Berry” and “Franken Berry” are not the best cereals in the world, but I don’t care that much. So my awareness is high, but I don’t have to feel bad about it.

      Anyway, I like your idea of having him describe himself. A good way to do that is with a values tree, where the client (and you) create a tree that has things people see about him (his behaviors, hobbies, roles, and how he appears) as the leaves and branches and the roots are his values (his morals and manners). The trunk is the conversation you two create when talking about values and what people see. You can keep adding to this and really find out who the clinic is. You can have him cut out pictures from magazines that represent him. Or,he could bring in pictures for from home. Either way, having him get to know his true self and link that to how he chooses to act, are good therapy tools to be mindful of self, to say the least.

      Good question. Keep asking questions! That is how we learn.

      With compassion and kindness,
      Scott

  13. Hi Scott, Dan, and Chad

    I really enjoyed reading your paper! I am a graduate student studying to be a SLP and have not heard about this therapy approach before. This model is something that I can definitely see myself using in the future when I am practicing. I really like the idea of creating the giant goal first, so you know what you’re setting your sights on, then making the tiny goal, which seems very doable compared to the giant goal, and then creating the medium goals to help you reach the giant goal. Do you have any suggestions for how you would implement the third principle, Thought Defusion, in therapy? Helping someone to let go of the negative attitude that they have built up over years seems like quite the challenge, so I am wondering where you would start? Thanks!

    • Dear Mcvea003 (sorry, I wish I knew your name to make it more personal),

      Hi! Thank you for writing. You ask a great question about THOUGHT DEFUSION. Somethings we like to do with clients of all ages for THOUGHT DEFUSION are the following:

      1. Write down negative or challenging thoughts, talk about those thoughts and then tear them up.You can also couple this with having the client (and you) write down and talk about positive thoughts, and tear them ALL up. After all, we can fuse to any thought, positive, negative, neutral. (e.g., If someone you know is dying of cancer and a person mourning is in denial, fusing to the thought “Everything will be fine. Just fine.” We can fuse to his when the reality is the opposite

      2. Write down or talk about negative or challenging thoughts (and positive thoughts) and say them all in: silly voices, accents, singing . This process of expressing thoughts in a voice that is not our own helps to desensitize the language of the thought. Again, this process is seeing thoughts as sounds and language and not needing to judge them or label them.

      3. Clients and clinicians can create a story with challenging or negative thoughts and act it out. This again helps to desensitize the language that thoughts are created from.

      These are just a few ideas. Remember, this model overlaps all of the principles so you might be aiming at doing an acceptance based activity and that will touch on being present, thought defusion, the client’s values, and committed actions. Does all of this makes sense?

      Please keep asking question! Questions helps us ALL learn!
      With compassion and kindness,
      Scott (Dan and Chad)

  14. Dear Scott, Dan and Chad!
    I just want to thank you for your wonderful and very much informative article! There is so much wisdom in this material. I totally agree, that the principles and tools in ACT can be very useful, both in life and therapy. I hope to read and hear more from you in the future too.

    Wishing you all three a meaningful and joyful time further!
    Hilda

    • Hilda,

      Hi! It is so good to hear from you. I do miss out interactions, and I’m always glad to read anything you write.

      Thanks for the kind words. Dan and Chad have been wonderful on this paper.

      Have a great day!
      Always, with compassion, kindness, and joy,
      Scott (Dan & Chad)

  15. I got to see ACT in action as I participated in Dr. Hudock and Dr. Yates Northwest Center for Fluency Disorders summer intensive clinic. Something I like about ACT is that it doesn’t set unrealistic requirements or expectations, such as eliminating all negative thoughts, but rather encourages choice, flexibility, and growth in spite of negative thinking. Since the clinic I myself have been learning to incorporate the principles found in ACT. For example, I often find myself consciously trying to distance myself from negative thoughts (defusion) and not beat myself up for being a failure but recognize that it’s instances (or several instances) and that I can improve (self as context). It also helps to focus on why I choose to do the things I do and realize when I am being too hard on myself (defining values). Although applying the steps isn’t something easy (nothing worthwhile seems to be), I also feel that the steps are fairly simple to understand which increases the chance that they will be remembered and utilized. Thanks for sharing this with us!