|About the author: Mark Irwin is current Chair of the International Fluency Association’s Self Help and Advocacy Committee and National President of the Australian Speak Easy Association, Mark is a former Board Chair of the International Stuttering Association (2001-2007). He has made previous contributions to the understanding of stuttering through papers in the 2002 and 2008 ISAD online conferences, as well as the blog www.stutteredspeechsyndrome.com|
How to get through the stuttering jungle? With support, encouragement and inspiration from many sources I finally feel I’ve made it through. Now it’s my turn to help others. What’s more I know a few short cuts as well as turns to avoid, which will make the journey so much easier for anyone else.
These days stuttering no longer dominates my life or restricts my life choices like it once did. I have successfully managed a busy professional career, an active social life and complex family interactions with an ease I once thought would never be available to me (even at age 40). Among numerous public speaking successes my most memorable achievements were a speech at my daughter’s wedding and my father’s eulogy. I no longer excessively monitor my speech, anticipate stuttering or ruminate over dysfluent experiences. I say what I want when I want. Hey….it makes eating at a restaurant so much more enjoyable J
As a result of this experience I have gained insights which I firmly believe could be helpful to anyone feeling stuck or lost. In addition while I appreciate some people who stutter have chosen acceptance of stuttering as their path, it is my opinion this is a good starting point only; it doesn’t have to be a finishing point. I feel I have the insights now to confidently help anyone move beyond acceptance and to a more fluent future.
What!!!!! I hear some people say….“Don’t you know that stuttering is neurological and /or the result of a speech motor deficit”. “Don’t you know that nothing can be done and any successful management will be inevitably short term with relapse a continual reality.” I know this has been the common sense view for many years but research now shows the brain continues to change throughout life and obviously, under the right conditions, the change can be directed. Certainly that has been my experience and that of many others who have also dealt successfully with stuttering. So if you have an open mind, read on. My intention is to discuss what worked for me, why certain strategies didn’t work and to stimulate a new way of seeing the “stuttering” condition. In brief I hope to provide information for long lasting successful therapy.
There were 3 necessary steps in my journey….1. Understand the Problem. 2. Develop an Action Plan. 3. Take Action
STEP 1. Understand the problem
“To solve a problem first you must define it.” Samuel Johnson
“You can’t change what you don’t acknowledge” Phil McGraw
Stuttering is often (not always) a complex disorder with which to deal. For most people it is much more than a behavioural speech problem. Research shows that between 40% to 75% of people who stutter have such significant emotional and attitudinal difficulties (Kraaimaat et al, 2002, Stein et al, 1996), they can be said to have the additional mental disability of Social Anxiety Disorder (SAD). SAD has its own negative impact on speech and ease of communication generally. The key first step in my recovery was to become aware that Social Anxiety Disorder was co-existing with my stuttering. I needed to take steps to overcome my SAD if my speech, and mindset, was to be improved.
In my mid-twenties I was aware my fluency would vary with the perceived social difficulty of any given interaction. While I believe others may have neurological limitations I had to acknowledge that my stuttering was not about my ability to speak but my ability to manage my emotional health when interacting with others. I had to acknowledge that I had a thinking problem which was showing up as a speaking problem. And in my case the thinking and speaking problems were more complex still. My thinking problem involved not only a fear response that I might stutter at any moment but also tension brought about by my unrealistic expectation that I should speak fluently, intelligently and diplomatically at all times. My speaking problem was complicated by entrenched patterns of behaviour, related to muscle memory and poor breathing habits. In addition, I realised I had formed an association between stuttering and the sound of my own voice. That is, my voice had become so linked (conditioned) with the stuttering experience that it was acting as a trigger for more stuttering.
I called my condition Stuttered Speech Syndrome to distinguish it from the speech event of stuttering. In my case the stuttering was interacting with my social anxiety in a positive feedback loop; each condition exacerbating the other. Not only was I suffering from the speech difficulty of stuttering (that bit of the iceberg above the water) but I was suffering from the emotional and attitudinal pathology of Social Anxiety Disorder (that section of the iceberg below the water). Furthermore I had developed specific phobias to telephone use and public speaking, to the extent I would react with dread just hearing a telephone ring or watching another person use the telephone or speak publically. In addition I had another psychological disorder with which to deal. I had a fear of stuttering (known by the psychological term psellismophobia).
So the first step in my recovery was defining the full extent of the problem. In my case I was able to acknowledge that I needed to deal with Social Anxiety Disorder (related to performance anxiety and perfectionism) as well as my specific phobias to telephone use and public speaking . With regards to stuttering specifically, I recognised I had to overcome the fear of stuttering as well as the habituated stuttering behaviour of ingrained faulty speech muscle mechanics and breathing patterns.
Academic Note. The acknowledgement of Social Anxiety Disorder is significant. Effective psychological and pharmacological therapies for SAD exist (Holaway et al, 2004), but until now have not been accessed because of poor recognition, inadequate assessment, and limited awareness or availability of treatments. It is recognised that therapy for SAD is complicated by the formation of safety behaviours also known as safety-seeking behaviours. These behaviours are defined as behaviours which allow social success, without the need to re-evaluate threat belief (Lovibond et al, 2009). It is my view that improved awareness of the role of Social Anxiety Disorder in stuttering will lead to dramatic improvement in treatment outcomes. Already research shows that the presence of SAD will lead to relapse in speech restructuring (Iverach et al, 2009). Also speech pathologists, either unaware of the presence of SAD in their fluency client or uncertain how to treat it, are inadvertently encouraging the formation of safety behaviours (Helgadottir et al, 2014). In this case the goal of dysfluency reduction is met at the cost of social anxiety maintenance or enhancement. Unfortunately this means that even though the client may be fluent the social anxiety disorder remains thereby negatively impacting on quality of life.
STEP 2. Develop a Helpful Action Plan (and avoid an unhelpful one)
“Begin with the End in Mind.” Stephen Covey
“The journey of a thousand miles begins with a single step” Lao Tzu
Based on my experience I would encourage the following course of action (these items overlap).
- Develop a Positive Self –Image as a Speaker and Communicator. Visualise speaking well and certainly take confidence from the fact that in spite of stuttering there is no reason not to do well in the rest of the communication process by listening well, smiling and being relaxed.
- Deal with Social Anxiety Disorder. Take stock of perfectionistic standards and re-examine the reasons for them. This is easier to do with a realistic plan for life and a personal philosophical perspective. Begin to see each day as providing opportunities for growth and enjoyment rather than as providing difficult challenges to be endured or avoided. Learn to relax socially and the best way to do this is to focus on the other person.
- Deal with fear of stuttering. Voluntary stuttering (deliberate stuttering, VS) is a powerful tool for overcoming stuttering fear. Of course this refers to the speech event only. VS needs to be paired with a relaxed speech pattern and correct breath support. That is, when using VS it is obviously a counter-productive point to voluntarily repeat the old patterns of anxiety, tense facial muscles and lack of breath support which would thereby reinforce these.
- Deal with fear of telephone. The surprise for me was how small the steps of desensitisation needed to be. I went through the process of learning to relax in a chair, then relax in same chair while looking at phone, relax while holding the phone in my hand, relax while looking at myself holding the phone, relax while ringing a friend. Then I needed to flood the experience by making many phone calls in succession.
- Deal with fear of public speaking. There are many organisations offering courses in public speaking. My experience was with Toastmasters International. I found this to be extremely difficult at first resulting in sleepless nights before the meetings. But eventually the warm, welcoming attitude of fellow members, as well as their always positive feedback (remember as a result of my SAD I was my own worst critic), eased my tension and I began to finally enjoy public speaking opportunities.
- Deal with faulty muscle memory and breathing patterns. This was easier to do by observing closely people who spoke well and spending as much time as possible in their company. Practising reading aloud helped initially but interestingly, as I progressed, I found that simply visualising saying 3 linked phrases with pausing and breathing between each helped just as much.
- Deal with negative conditioned reflex from sound of own voice. The only way to manage this is to get used to hearing yourself speaking well. Speak aloud and fluently, pausing every 5-6 words with correct breath support. If this is done as a twice daily ritual then a new pattern of conditioning can develop. It did for me.
Why don’t some people improve in spite of their best effort? (How to avoid an unhelpful Action Plan)
- Overcome Self-limiting beliefs. Many people consider that stuttering has a fixed neurophysiological base and that it is not possible to overcome stuttering. All that can be done is to manage it by continual monitoring. With this belief it is impossible to summon the optimism to push through inevitable set backs on the road to recovery.
- Avoid safety behaviour formation (instead concentrate on remaining relaxed during social encounters even if being dysfluent). As discussed in the above academic note, safety behaviour formation is a significant complication to therapy for social anxiety. A safety behaviour is not defined by the behaviour itself but by whether the client uses it to achieve social success without dealing with erroneous perceptions of social threat. Examples of client developed safety behaviours are covert stuttering (word substitution, use of filler words, circumlocution), avoiding difficult words, talking quietly and mumbling. Examples of therapist suggested safety behaviours include recommendations to restrict verbal interaction to “safe” conversational partners and only ask questions during conversation. It is also noteworthy that a speech restructuring technique itself may become to be used by the client as a safety behaviour.
STEP 3. Take Action
“Life is an action game.” James Rohn
“Let your dreams drive you across the bridge of discipline”. James Rohn
I became intrigued by how people can become successful in any particular endeavour without necessarily having obvious natural ability. Certainly what they appeared to have was drive and determination which is much more about attitude than anything else. Anyone can have the right attitude. I applied what I read in the general area of self-help and encourage the following …
- Keep a journal (write down successes to remind yourself later and chart your own progress)
- Join a self-help group
- Join a public speaking group
- Gain support of friends to provide positive examples of correct speaking patterns delivered in a relaxed manner
- Seek speaking challenges which can be approached in a positive fashion with expectation of success.
- Celebrate achievements
In Summary. Have fun taking your path through the stuttering jungle, however far you decide to go. Seek the company of supportive, encouraging and inspiring people. Lose old safety behaviours and avoid picking up new ones. At the very least you will be certain to overcome social anxiety and you may even go a lot further than you ever thought possible. Best wishes!
Kraaimaat, F.W., Vanryckeghem, M. & Van Dam-Baggen, R. (2002). Stuttering and Social Anxiety. Journal of Fluency Disorders. 27. 319-331.
Stein, M.B., Baird, A., & Walker, J.R. (1996). Social Phobia in Adults With Stuttering. American Journal of Psychiatry, 153(2), 278-280.
Helgadottir F.D., Menzies R. G., Onslow M., Packman A., O’Brian S., (2014) Safety Behaviors and Speech Treatment for Adults Who Stutter. Journal of Speech, Language, and Hearing Research, Vol. 57, 1308-1313.
Holaway R.M., and Heimberg R.G. (2004) In Bandelow, B. & Stein, D..J. (eds) Social Anxiety Disorder. N.Y. Marcel Dekker, Inc.
Iverach, L., Jones, M., O’Brian, S., Block, S., Lincoln, M., Harrison, E., et al. (2009). The relationship between mental health disorders and treatment outcomes among adults who stutter. Journal of Fluency Disorders, 34, 29–43.
Lovibond,P.F., Mitchell,C.J., Minard,E., Brady,A., Menzies,R.G. (2009). Safety behaviours preserve threat beliefs: Protection from extinction of human fear conditioning by avoidance response. Behaviour Research and Therapy, 47, 716-720.
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