I have spoken briefly in previous posts, about the different forms of speech therapy that are available to people who stutter, and I have also spoken briefly about the various methods of approaching the psychological side of stuttering, but are you aware that you can alter your experiences associated with stuttering, (and speaking anxiety in general), by actively altering the way that you see and interact with other people, and the world around you.

I believe that stuttering is like a vine that has wrapped itself around every aspect of your being, and in order to remove the influence of stuttering from your life, you not only need to look at using some of these mainstream speech therapy approaches, but you also need to understand how these vines have formed, and how they influence your behaviour, and then how to go about removing these vines. These vines are made up of issues to do with:

1) Judgement
2) Perfection
3) Expectation
4) Power
5) Control
6) Acceptance
7) Approval
 8) Fear

Now this is by no means an exhaustive list of what I believe make up the vines that hold stuttering in place, but I believe that they encompass many of the major issues that we all need to look at. As mentioned, this list is not exhaustive and each of us will have additional vines specific to our own persona, but I think what I have to say here, will get you thinking about the type of individual emotion or behaviour, that could be holding stuttering and speaking anxiety in place for you. You are unlikely to read this anywhere else so let’s go slowly and look at these in turn closely.

Judgement
Judgement makes up one of the main vines that holds stuttering in place. When you are speaking in a dysfluent manner, you are invariably engaged in running a “mind reading” program in your head, while at the same time you are trying to operate a communications program. This mind reading that is going on is a process of assessing how the other person, and any secondary or adjacent listener, is judging you while you are in the process of speaking, and more likely, stuttering. This additional program that is running, may account for some of the unusual brain activity witnessed in the brain of a person who is stuttering, as this program is highly, and probably abnormally, active while we are speaking. Now we all think we know exactly how the other person is judging us, and the fact of the matter is that, for all intents and purposes, in our world, we DO know what the other person is thinking. So how is it that we know how we are being assessed or judged? Well the real fact of the matter is that we DO NOT know what the other person is thinking at all, and if in fact they are judging us in a positive or a negative manner, if there is any judgement going on at all. What we are certain of is our own perception of judgement by the listener towards us, and that is all that really counts in our concept of what is real. The fact of the matter is that the toxic judgements that we are experiencing, are in fact our own judgements of our self, that we are bouncing off the other person back at our self. Now this does not only apply to people who stutter, but every one of us when we experience some form of performance anxiety e.g speaking in front of a group. So why is it that we judge ourselves negatively, and how can we correct this errant thinking. Well it is perception of our own experiences in life, but more so it is a reflection of our own personal ethos and approach to life. If you are judgemental in your thinking towards others, who display some form of disability or unusual behaviour, then to that same degree of judgement will you apply it to yourself, through the eyes of others. If you are judgemental of others, you will surely use that same criteria of standards to bounce your own judgemental thoughts about yourself, off the other listener to that same degree, and depending how toxic those thoughts are, your level of anxiety about that judgement that will effect your speaking performance will follow. You may want to read that again, to ensure that you have absorbed what has been said there, as it is VERY important to understand and embody from this point on. The secret to unwinding this vine, that is holding your stuttering in place, is to look on all fellow humans for what they are, a fellow human, who like you, experiences a range of emotions, including love, and never attempt to pass a judgement on them in any situation. Human existence is a tapestry of dichotomies and differences. Behind those eyes or that voice is a soul that is connected to your soul, and any behaviour you experience, both acceptable or unacceptable to you, is just “you on another day”. It is behaviour that you yourself have demonstrated, or are likely to demonstrate in the future at some time. If you must judge, judge others for the differences and uniqueness that God has given them, in a positive and accepting way, and you will soon find that you are judging your own, less than perfect speaking behaviour, in the same more accepting way when you speak to others. By beginning to live your life with a less judgemental approach to others, you will begin to remove one of the major vines that is holding your experience of stuttering in place.

Perfection & Expectation
Another vine that is holding stuttering in place in your psyche, is the concept of perfection. Many of us have the illogical concept in our brain, that certain activities must be executed in a more than socially acceptable or perfect manner. Perfection is a result of fear. We believe that our speech pattern has to be perfect in any particular situation, otherwise we will not make the desired social impression, and we have a belief that that is bad, and will result in an undesirable outcome. The result of this is procrastination and avoidance. It is the content of your mind, not the speed and fluency of your delivery, that is what is important. Whether you are a person who stutters or not, aiming for increased knowledge is achievable, perfection in speech delivery is less achievable for the majority of us, so should be viewed as a skill that we may or may not have, not a prerequisite for social acceptability. Aiming for perfection will add to your speaking anxiety, add to your procrastination in moving forward in any situation, and add to your avoidance behaviour in situations where you do not believe you will be able to reach your expectations. If your expectations are too high, or are not reasonable given the facts that operate in any situation, then you are just continually setting yourself up for frustration and disappointment, however that manifests itself in your behaviour and your speech. Shed the vine of perfection by practicing some deliberate dysfluency. Although the logic of deliberately being dysfluent may seem a foreign concept to you, it is totally different to the normal stuttering behaviour that you experience, in that in the “real” stuttering moment you are “out of control”, and in some cases at the exact moment of the speech block your “awareness” is not fully present. In a “deliberate stuttering” situation, if it is performed correctly, you are “in control” and your “awareness” is present. You are able to see that imperfection in speech delivery is something that most people overlook, especially if you give them the vibration that you are OK with it. Shed the vine of perfection, and bring your expectations in line with the reality of the situation, and further remove one of the supporting vines that holds stuttering in place for you in your world.

Power & Control
Another set of vines that tend to hold stuttering in place are issues to do with Power and Control. Many people who stutter, are reluctant to exercise a level of power and control in their life, out of fear of how it may impact on them in the eyes of another. Many people who stutter tend to figuratively see a verbal exchange as taking place on a small mountain, where one person has to be on top of the mountain, while the other has to be on the bottom. In any verbal exchange many people who stutter, tend to subconsciously assess who should be on top, and who should be on the bottom. Invariably the person who stutters tends to place themselves on the bottom and, figuratively speaking, hand control of the situation to the other person, who they have given their power to, and place them on top. In many cases it is akin to handing the remote control that determines your behaviour, over to the other person. In many cases there is no logical justification, as to why the other person should be given control of the situation. It could be for as little a subconscious reason as their assertive or authoritarian look, or the tone of their voice, but more likely their perceived authoritative position. Invariably after some form of treatment for our dysfluency, we often manage to place ourselves on the top of this fictitious mountain, only to feel most uncomfortable in this position, and thereby placing added stress and anxiety on ourselves. Many of us choose to subconsciously gravitate back to the bottom, where we feel more comfortable, and this is one of the less understood psychological factors that leads to the concept of stuttering relapse. Allowing the vine of power and control to dictate your response, in any speaking situation, places unnecessary performance anxiety on you, and the result for a person who stutters, is increased dysfluency. It is better to see the situation in a way that there is not one mountain, but a mountain for each person. Each person is on his own mountain rather than one on top and one on the bottom. If you must see the world as a single mountain, when you are in verbal exchange, then take the position of power on top, but exercise that power with understanding, compassion and empathy and do not try to control and manipulate others to your own benefit. The power and control vine holds your stuttering behaviour in place, by making you feel uncomfortable whenever you are speaking to a person who perceptions have you believe is in a position of authority. Accept that you have the right to your own level of power and control in these verbal exchanges, and shed this vine from the mix, and further loosen the grip that stuttering has on your sense of self.

Acceptance
The next vine I would like to talk about in this post is that of acceptance. In order to begin to remove the vine of acceptance, we must first accept what is. We must all learn to start from a base of acceptance of what is. No matter what it is in your life that you are not happy with, you must first deeply and completely accept its existence as a fact. If you are a person who stutters, you MUST accept that fact. If you cannot accept it as your reality, then you will continue to hold it as your reality when you start to try to loosen its grip on your life’s direction. Not only must you privately accept this fact, but publically accept it as well. If you refuse to accept the total reality of your stuttered speech, and speaking anxiety, you will always be trying to hide it, ever if you learn to control it. If you are a person who stutters, and are attempting to use a technique to try to control your stuttering, you will always oscillate towards trying to hide it by trying to “sound normal”, or trying to “sound like the other person”, instead of doing what you need to do to control and improve your fluency. Accept your situation and this vine will also begin to lose the support it is giving to your dysfluency problem.

Approval
We all seek some degree of approval, but as a person who stutters this need for approval can often work in a counterproductive way, in that whenever we believe that the listener may not approve of what we are about to say, we increase our anxiety level and the result is invariably greater dysfluency. It is OK to not receive full approval for our opinions, and for what we have to say. No one is always going to agree with what you have to say, and no one is going to always like what you have to say, but if you respect others, speak to them as you would have them speak to you and speak from the heart with others mental welfare in mind, whenever possible, you can remove the vine of approval that is another support surrounding your stuttering.

In the next post I will talk about the most important vine of all. That of fear and how you can seek to remove fear not only from your speaking environment but also from you life in general. In the meantime, I again urge you to subscribe to my RSS feed or email notification, so that you do not miss posts about subjects and content that you will not read anywhere else. If you found this post useful or thought provoking in any way, please make a comment.

Some time ago, a young reader of the Stuttering Brain blog, wrote this frank and open account, of her stuttering feelings. I quickly typed my thoughts down into a response to her, (a bit longer than was expected), which I now want to share with any other young, (or old), readers who may find these ideas helpful.

 Sweet 16’s email

Yeah, I tried a self-help group, attended a stuttering conference, and tried stuttering therapy countless times. I also got an iSpeak SpeechEasy device. I seemed to have stopped stuttering 6 months ago, and it was the greatest days of my life, but then suddenly it came back, and it came back HARD. I can hardly speak a single word without stuttering, and I’ve had to give up countless times in the middle of a sentence I realized I can’t finish. I’m at the point where I would rather lose my voice permanently, so no one would expect me to talk, than to keep struggling and forcing myself to get through one single sentence, and the embarrassment that follows. I know I’m only 16 years old, but I have so much stress from life right now, and I so badly want to go to college and get my life-long dream job, (a computer repair technician- talking is a MAJORLY important part of the job). Life isn’t going to get better, its going to get worse, and there’s going to be more stress. I know there’s no cure. I’ve been told it countless times, and it runs through my head everyday. I know that Pagoclone or any other pills will NEVER, no matter how bad I want them to, take away my stuttering. But right now, my stuttering is so bad, that anything that will improve my speech by 20% will be a miracle to me. If you’ve been stuttering since you were little, too, then you would know what it feels like to think of your whole life ahead of you as hopeless, and a life that will mean nothing to the world. Even just enough voice to tell people what it feels like to stutter would be great. Sure, I could write a book, but I’m not a writer. I have no special abilities at all, and no good looks. That’s why I have to rely on my personality fully. I want to be the person who can accept their stuttering and make people laugh, (in a good way), but I can never see that happening. I can’t even see getting married. And I want to stand at the front of the church wearing a beautiful white dress and be able to at least say, “I do.”

P.S. I’m sorry for writing such a long message, but you’re a stutterer too, (I presume), and you may be the only person in the world who would understand, or in the least bit care. I could write a 50,000 page book on what it feels like to be a stutterer, and the probability of non-stutterers actually understanding it, or even reading it is so low that it’s pointless to waste my time writing it. I wish that some stutterers would just compile a book of how it feels to stutter, and make it interesting enough that people WOULD actually read it. Not laugh at it. I’d be willing, if I could find more people, and if my life was more interesting. Thank you for your blog, and your interest in helping people. I want to be like you and do the same.

 Stuttering Jack’s response

I feel for you, and all of us who have severe speech blocking and associated high anxiety, know exactly how you feel at this difficult time in your life, where you have everything ahead of you. I believe that one day you, like some of us, will come to see your particular problem as a blessing rather than a curse. It will certainly shape your life, but you will be the architect of your existence, and you must learn to mould your life with the clay that you have been handed.

Firstly, what you must do is accept what is. You will never be able to change until you first deeply and completely accept the situation, and learn to fully love yourself as you are. Take full responsibility for your situation. You are not a victim to be washed around by the tides of life. It is within your power to change, and the answers for YOU are all out there to be discovered. You just have to seek them out, and it will be the journey, not the destination, that will nourish your soul. Love yourself and love everyone you speak to, as this alone will help wash away the fear of communicating with others.

Secondly, you must stop using negative affirmations and visualisations. These are powerful forces that are currently working against you rather than in your favour. Instead of negative affirmations like, “life isn’t going to get better, it is going to get worse”, “I know there is no cure”, “an improvement will be a miracle”, “whole life ahead of you is hopeless”, “a life that will mean nothing to the world” and visualisations like “I can never see that happening”, “I can’t even see getting married”, I want you to use positive affirmations and visualisations that create, in your mind, the pictures and images that you want to see, in your life, even if they seem such a distant dream to you, and keep them in the forefront of your mind, in big and bright colours. See yourself in that ideal picture, and feel what it would be like to live that dream. Do this every day and you will begin to move towards that, even if it seems so far away.

The most encouraging comment that you made, was that you recently did something to experience total fluency, for an extended period of time, then stuttering returned. Now that tells me, and should tell you, that there is a combination, (or number of combinations), that will unlock stuttering for you. You have found it once, now it is time to start your own little, “Sweet 16 research program”, to find a combination that is going to bring back what you have already shown yourself is possible. Who said stuttering cannot be cured? Stuttering can be cured, but it is an individual path for each person, that can be a short path or a long path. A cure for you may not be total fluency, and your cure may not be found down the same path, that others may choose to take, but you must believe that YOUR cure is achievable. It can be an easy path for some, or it can be an epic journey, but the longer the path to your own personal nirvana, the more you will find out about yourself, as an individual soul, and the more you will find out about life in general. Your cure may not be total fluency, it is more likely to be a level of acceptance, and a method of controlling your problem, but you will find YOUR answer, if you take responsibility for finding the answer and start your search now.

If you would like a few more tips to start you on your journey, here are a few:

1) Realise that you are more than your speech dysfluency. Look for the positive aspects of your nature, and continue to work on improving your non-speech gifts, and work on anything that can improve your confidence and self esteem.

2) Continually behave in as confident and self assured manner as you can.

3) Because the nature of your problem that you have described is, “more than just a tangled tongue”, and is in fact like a vine, that has wrapped itself around almost every aspect of your nature, you are going to have to approach your treatment, in a very systematic way, for it to have a reasonable chance of success. Here are the steps:

a) As mentioned above, acceptance of “what is” is a must.

b) Love yourself for who you are, including the stutter, is a must.

c) Before treatment, you must go out and learn to deliberately stutter. Not in the out of control blocking way that “happens to you”, but in a more relaxed, in control, repetitive way that you create. If the brain believes it has to create stuttering, learn to do it on your terms, not on the stutter’s terms. Stuttering used as a tool, is a completely different experience to the stuttering we are used to, that we feel we have no control over. When you deliberately be dysfluent, you are still, “in the moment”, and can function, where as with out of control stuttering, you are not, “in the moment”, and cannot, in many cases, think clearly. This is a big subject in itself that I cannot go into right now, but you must learn to stutter more fluently, as part of any stuttering treatment program, even if its goal is the eliminate your stuttering.

d) Following your learning and accepting of a controlled stuttering method, to help you when all else fails, you must learn methods to remove the emotions that you have built up in your body, associated with your stuttering. Learning EFT, (www.emofree.com), will assist in this area if you want to give it a go. You must also learn to think correctly about the world, and your place in it, in order to try to control your stress and anxiety levels. For this I can recommend Bob Bodenhamer’s book, about a neuro-semantic approach to stuttering treatment. Once your thoughts and emotions have been treated, you are ready to learn to remove your physical speech dysfluency.

e) You need to be very selective in choosing a stuttering treatment program that is right for you. Unfortunately, at this point, no one has undertaken an exercise to easily do this for the different manifestations of stuttering, but it will eventually come, and I am working towards that myself. As learning to control your stuttering is basically a behavioural process, the longer and more intensive the process, the more effective and lasting I have found treatment to be for someone with the level of difficulty that you describe. I would be seeking out an extended intensive program, although the success you will have in one of these, will depend on the level of skill and experience of the clinician involved, and I cannot recommend anything for you here, so you will have to do your own enquiries or a bit of trial and error. Unfortunately the current trend is towards shorter treatment programs which, I believe, is not the way to go in treating the chronic and severe stutterer. Certainly weekly, 1 hour visits, to an SLP will not help what you are describing as the severity of your problem. Intensive courses are not cheap, but that is the level of financial commitment that you are going to have to invest, if you are to start out in a well equipped fashion, on your life journey towards freedom from stuttering. Don’t be discouraged, if one form of treatment has not worked for you in the past, especially if it was not taught in an intensive environment. Finally look for a treatment program that does not end when you walk out the clinic door, following initial treatment. Look for a program that realises that stuttering treatment is a staged process, and therefore offers ongoing retreatment and support at a reasonable cost.

f) What ever speech reshaping program you choose, realise that you will be fluent if you are “CONSCIOUSLY” “AWARE” of ALWAYS applying your learned skills, or you will eventually relapse. This is not true for all people seeking treatment, but once again, for your severity, this will be the level of commitment that you will probably need to apply. Now you will relapse anyway to some degree as we all do, that is for certain, but with each relapse comes a learning experience. A relapse is not a excuse to give up. I believe your journey towards fluency does not really start until you have your first relapse. Relapse is an opportunity to learn about you, and what you have to do to achieve your goals. For most people, a level of acceptance of stuttering is the best answer, as I have written about in my earlier blog postings, but if your goal is fluency, and all that comes from that, you will have to plan what you will do when you relapse.

g) The best relapse management tool is membership of a post treatment support group. You need to gather a list of people who are working with the same speech tools as you, and have the same fluency goals as you. When you relapse, you get together with these people for a day or two or longer, and you go through the process that your learned in your intensive program, and drill the skills back into your brain, and you go out and try again to make it last longer. As mentioned, this is not for everyone, but if you have a severe stutter and it works for you, then that is what you have to do.

h) When you are having success you must start to move outside your comfort zone, and use your ability to speak more fluently. That will also involve its own set of challenges, that I cannot go into here, but joining a Toastmasters or speaking group, has proven to help many people on our journey to achieving more consistent fluency skills.

By all means try Pagoclone when it comes out but as you said, at best, it is likely to make it easier for you to get through your blocks, not completely remove stuttering from your life. Whether that continues to have the same effect over time, or whether you need to keep increasing the dose, and whether you can afford the heavy weekly cost, only time will tell, but undoubtedly it will be where many people will choose to stop on their journey.

Your Speech Easy, as you have seen, works great out of the box, but our brains soon make the timing adjustment to get our stuttering back on track. To be fair, some people have continued to have success with DAF devices, so don’t write them off too quickly, as they are a great gadget to have in your, “box of tricks”, when you feel the need for something like that, I only wish that the distributors of these devices would sell them for under $1,000, which would still give them a profit.

Sweet 16, don’t let your stuttering control your life. You are the captain of your vessel, and you can take it in any direction you want to go, and even if you go through the stormiest of weather, there is always a calm harbour ahead of you, if you just keep moving forward. Many others have taken the same journey as you are now on, so make contact with these people and assure yourself that you are not alone.

Love,
Stuttering Jack

Cognitive Behaviour Therapy, (CBT), is a behavioural approach to addressing thoughts and feelings that lead to anxiety, and, in the case of the person who stutters, social phobia. CBT is increasingly being used as a tool to treat stuttering, based on the premise that stuttering is aggravated by anxiety, and in many cases this anxiety level can be managed, especially if the anxiety is related purely to the belief, that the person might stutter, and what that will mean to them. 

Having said all that, I do not believe that CBT is a viable approach for ALL people who stutter especially those who have severe speech blocking. I believe it is better suited to those people who I would rate as a mild stutterer (1,5 or 1,4 on the Stuttering Jack Scale of severity). That is, people who are low on the actual physical scale, but high on the psychological scale of severity. This includes what we would refer to as covert stutterers. So a person who has mild and irregular speech dysfluencies, but high psychological reactions to incidences of dysfluency, is more likely to benefit from CBT, than a person with severe and constant dysfluencies. This is an example of how it is most important, that we have some form of scale, when talking about stuttering. For to say that CBT will definitely help “stutterers”, is a misleading statement. You might be interested in reading my first two post on this subject. 

Research has shown that the parts of the brain that control anxiety, are linked closely to the areas that control speech, so it is not unusual that anxiety levels effect speech fluency. Anxious thoughts that a person has about how they might be being judged by the listener, will invariably contribute to a degree of stuttering, as the focus is taken off the conversation and put onto anxiety provoking thoughts. It goes without saying, that if we can take the focus off these distracting thoughts, then they will no longer have the anxiety producing effect that they are currently having. 

It must be understood, that our thoughts and feelings are so important in determining our emotional state, and the way that we see the world around us. If we want to change our behaviour, we must first look at how we are thinking. By changing the way we think about a speaking situation, we can change the experience that we have in that speaking situation. Recognising this can be a break through for some people. 

CBT therapy, teaches the person who stutters to look at the thoughts that they are having and attempts to have the person see, that those toxic thoughts, invariably have no basis in fact, logic or experience, so should be negated in moving forward into the speaking situation. If thoughts can’t be negated, the aim is to learn to challenge those thoughts with a view to altering them to less anxiety provoking thoughts, when facing a particular speaking situation. Once again this is more easily achieved for mild or covert stutterers than chronic overt blockers. 

The CBT practitioner, talks about the different types of thought groups that can create increased levels of anxiety. These thought groups include, unrealistic standards of social performance, unrealistic beliefs about the consequences of poor performance, and, unrealistic negative beliefs about oneself. These thoughts lead to a level of perceived negative evaluation from the listener, and, lead on to social phobia, which can be a more difficult extension of anxiety to address. 

After the individual begins to understand the role that thoughts and emotions play on our feelings, and, how that effects our anxiety level, which in turn effects our degree of stuttering, he then moves onto identifying the specific thoughts, that are causing the problems to do with his own individual speech. 

When a problem thought is identified like, “if I stutter people will laugh at me”, or, “if I stutter no one will employ me”, or, “if I stutter they will think I am incompetent”, or, “if I stutter they will think I am weird”, the individual is taught to challenge that thought, by asking the following eight standard CBT questions about the thought: 

1) What evidence do I have that the thought is correct?

2) What evidence do I have that the thought is wrong?

3) What would I tell a friend, if they had the same thought, that would help them?

4) What would a very understanding and supportive friend say, to help me eliminate this thought?

5) Do I think I am worrying unnecessarily about something, that I have no control over?

6) How does the thought make me feel – good or bad?

7) Would there be benefits to me giving up thinking this thought?

8 )  What is the worst outcome that could occur, if this thought were true?

The individual is quite often encouraged to carry a notepad with them, and when a negative thought enters his mind, that is causing anxiety, he is encouraged to ask these questions about the thought, until he is able to consciously replace the thought, with a more resourceful thought based on evidence, and the anxious behaviour is diminished. 

A CBT program generally continues to talk about how we tend to use “safety behaviours”, like avoidance, so that our feared situations do not actually occur. Through such behaviour, we are continually reinforcing our feelings about the feared situation, by instantly gratifying ourselves with reduced anxiety, from applying our own individual form of safety behaviour. CBT theory argues that unless we face our fears, we will never give ourselves the chance of seeing that our assumed outcomes of the situation, are invariably wrong, illogical and even abnormally catastrophised. 

There is a natural response to the fear stimulus, that is often referred to as the “fight or flight” response. Whenever we are faced with a feeling of fear, the brain throws the body into an automatic, almost reflex response, and the natural reaction to this is invariably avoidance. This can, over time, lead to a level of social anxiety in the person who stutters. When faced with the thought that we will be judged negatively by others, it is not unusual to choose avoidance, as the easiest option. Having said that, if avoidance is not giving you the outcome that you truly desire, the best strategy to adopt, is to face your fears in these speaking situations, to discover the real outcome, rather than your imagined outcome. For it is only through facing fears, by moving outside your individual comfort zone, that fear and anxiety can ever have a chance of being reduced. It is often said in CBT that, “thoughts or predictions are NOT facts”.

Frequently, CBT involves self imagery or visualisation, where the individual is required to imagine that he is in a feared speaking situation. While in such a situation, he is asked to become aware of the images that he is producing in his head and describe what he sees, both in his own behaviour, and the behaviour of the listener. If the image is what would best be described as, “negative”, then the individual is encouraged to re-imagine the situation, in a more positive, or less negative way in an effort to override the negative experience.

CBT also seeks to address the perceptions that we have about the opinions of others. The main perception that is addressed is the perception of approval, or, disapproval. Invariably the person who stutters believes that the listener will disapprove of his stuttering. The CBT practitioner will explain that, only your thoughts can create the emotional disturbance that make you feel uneasy, as a result of a social rejection, or negative evaluation. Perceptions are within your own power to alter, and your own perceived negative evaluation only gives the listener power over you, that you have given them. If there is any actual negative evaluation, it is generally not about “you”, but more about the person doing the evaluation.  The concept of “predicting”, is also addressed as we tend to predict the worst, with quite often no justification further adding to our anxiety level.

The typical CBT program then goes onto address the common issue of social perfectionism, as another form of social fear. Aiming for perfection, invariably leads to procrastination and avoidance. We can often become overly worried about what other people think of us, if we make a mistake or if we stutter, and this, once again, leads to avoidance, procrastination and excessive use of safety behaviours. Having a perfectionist approach to speech fluency, will increase anxiety and stuttering, as it makes the speaking environment very stressful. It is a useful exercise, to pretend that you are writing a letter to yourself or a friend, explaining why it doesn’t matter what other people think of you.

Social perfectionism, is addressed in CBT by encouraging the individual to deliberately make a mistake. In addressing stuttering, the mistake would be to deliberately stutter. This can be very difficult for the social perfectionist, but continuing to avoid certain speaking situations, only gives strength to the avoidance, and only by facing the situations that one avoids, without safety behaviours, will one understand that their behaviour itself, is invariably reinforcing the fears.

Another area generally addressed as part of a CBT program, is our perception of how things “should be” in our concept of the world. Are your individual perceptions resourceful to you, or not resourceful to you? Are they creating a situation where failure is inevitable, where you feel shame and frustration? As part of this process, post event analysis is quite often discussed. Are you continually going over in your mind the failures that you experience? Continually reliving your failures, only seeks to reinforce them as part of your future thoughts. Rescripting these events, to more resourceful imaging in your mind, will facilitate the brain, in remembering the preferred outcome you were really seeking.

As mentioned earlier, CBT has the possibility of being helpful for the mild or covert stutterer, who tends to catastrophise the possibility that they, “might”, have some infrequent experiences of dysfluent speech, and what that means to them. But, I believe, it will prove to be less helpful for the overt and chronic stutterer, with years of “experience”, that confirms his beliefs, about the effect of severe stuttering on himself, and his listener. This person “knows”, what will happen, and, “when” it happens, and, “how bad” it happens, and, what the outcome generally is. This is not imagined or catastrophised. It is no good telling the chronic stutterer, that his stuttering will not make a negative impression on the listener, when his life’s experience confirms his belief. It is no good telling the severe stutterer, that people will not treat him differently, if he has severe and repetitive speech blocks, when his experience confirms this belief. It is no good telling the severe stutterer, not to worry what others think, when he is really concerned more about his own judgement of himself. This is especially true if he is fluent in many situations and is able to experience the world as both a fluent and dysfluent speaker. Sometimes avoidance and other safety behaviours are a more peaceful way for the severe stutterer to live than continually putting her hand into the fire to see if she still experiences pain. CBT practitioners, working with severe stutterers, need to be reminded that stuttering is more about neural deficits in the brain, and less about cognitive processing. Having made that comment, it is fair to say that CBT is more about altering the pychological experience of stuttering, not the physical experience of speech dysfluencies, and in that regard anything that can make the experience of stuttering less painful for the stutterer, is worth giving a try.

One final comment. I do believe that CBT can be used successful in treating severe stutterers, if it is implimented as a fluency shaping program add-on, to assist the individual, not to accept their stuttered speech, but to accept their new way of speaking, which for some, can be as hard to accept as the stuttered speech. I will talk more about this in a future post on the key aspects of conducting a successful fluency shaping program. 

In the next post I will talk about NLP and Neuro-Semantics, and how they can have an equal or greater impact on the psyche of the person who stutters. In the meantime, I again urge you to subscribe to my RSS feed or email notification, so that you do not miss posts about subjects and content that you will not read anywhere else. If you found this post useful or thought provoking in any way, please make a comment.

In my last couple of posts, I have spoken about the psychological side of stuttering, and how our speaking anxiety, is largely as a result of the perceived consequence of speaking with dysfluent speech. I spoke about some of the typical destructive and anxiety provoking consequences, that we can conjure up in our mind. This type of thinking has been referred to by some as “stinking thinking”. 

Thinking this way is not resourceful to us. It is guaranteed to make us stutter worse, because of the consequence that we place on being dysfluent, in these situations. For example, “if I stutter in this job interview I will definitely not get the job because everyone hates stuttering people”. If you layer that with further negative thinking like, “ if I cannot get a job I will have no income”, and then continue to add to that further layers like, “if I have no income I might become homeless”, “if I am homeless I may not have any food”, “if I have no food I will die”. Now obviously we are not conscious of layering these thoughts onto thoughts, but we certainly do it subconsciously, and in a fraction of a second. If we do not recognise, and accept, that many of our fears, subconsciously layer themselves back to the “fear of death”, we will not understand why there is such fear and anxiety, associated with having some trouble in getting words out of our mouth, and into the other person’s head. We are born with an innate belief, which is often confirmed through our childhood experiences, that those who are “obviously flawed” in some way, are often singled out and marginalised, or “sacrificed” in some way by the group. So there is a deep fear there within every human being, of being seen to be “different” when we know we are otherwise. Such thoughts, if allowed to run rampant in your head, can lead to panic attacks, or at the least, a constant high level of anxiety, and can totally control the direction in which your life progresses. Can all fear be traced back to the fear of death? At the deepest layered level “YES”. This is a key understanding that you must have, if you are to alter your innate and reflex thinking, about situations where you are allowing the consequence of your dysfluent speech, to determine your anxiety level. You must learn to intervene at the base thought, so that increasingly toxic thoughts, do not escalate the consequences of dysfluent speech to the point where they send your speech spiralling out of control and into uncontrolled avoidance, shame, embarrassment and panic, which ultimately leads to ever increasing levels of stuttering. 

If we accept that creating negative consequences, of dysfluent speech, are leading to higher anxiety, and that these consequences, are as a result of our own thoughts and feelings, and that we can change these thoughts and feelings, then we can start to look for ways to make these changes. 

So how can this be achieved? There are various methods that have been, and are used, to train people, not only people who stutter, to look at the validity of their thoughts and feelings.

 The first of these is a process known as Cognitive Behaviour Therapy, also know as CBT. CBT teaches the individual to look into and analyse the negative thoughts, and the negative consequences, that they see a particular action will have, and look for the real validity in those perceptions. Ideally the CBT practitioner helps the individual to see that there is no validity in the analysed perception and that the thoughts were in fact illogical to varying degrees and lack substantiation. In this case the thoughts revolve around stuttering. For instance if the individual may have the perception that if he blocks and stutters, the listener will think he is “retarded in some way”, or, “of lesser intelligence”, or, “not telling the truth”, (see the list of general consequences in my last post). Closer analysis of these thoughts are aimed at revealing that there is no evidence to support them as truth. By getting the person who stutters, to see how unfounded or illogical these thoughts are, by constantly asking what evidence they have for these perceptions, one can learn to replace these thoughts with more logical, and more personally useful thoughts, and so lower the speaking anxiety level. 

The second and less known process, is known as Neuro-Semantics, which is an offshoot of a process known as Neuro Linguistic Programming, also known as NLP. This method works on the premise, that if you can speak fluently in any particular situation, you can learn to speak fluently in all situations. To do this, you need to learn to identify the “state of mind” that you are in when you are fluent, and the different states that you are in when you are blocking and stuttering, and then learn to step into that fluent state of mind, at will. It works on the premise that stuttering is a “thinking problem”, that manifests in a “speaking problem”. Neuro-semantics seeks to change the meanings that you have given to certain events, in your life experiences, from being fear based to being more resourceful to you. The premise is that blocking and stuttering is panic and anxiety expressing itself in the muscles that control speech. Just like a panic attack, a speech block is triggered psychologically. This work has been pioneered by Dr Bob Bodenhamer, in consultation with Michael Hall, both master practitioners in NLP and Neuro-Semantics. The theory and practice involved in mastering these methods of reducing speaking anxiety, are not simple to understand and put into practice, so guidance from a master practitioner in this method is advisable, but hard to find. Thankfully Dr Bodenhamer, has published a book on how to understand and apply this process, which for the cost of a weeks supply of Pagoclone, would be a very worth addition to your “toolkit” to attack speaking anxiety and stuttering. The book is called, “Mastering Blocking and Stuttering”. I personally believe that Neuro-Semantics starts off where CBT leaves off and is a more powerful process. 

There are other methods of addressing the psychological side of the personality, that has developed wrapped in the “vines of stuttering”, and one of those is Personal Construct Therapy, also know as Narrative Therapy. In simple terms, that method looks at the way that the person, has constructed their whole persona as a person who stutters, and endeavours to address the difficulties that the person faces in developing the persona of a fluent or more fluent speaker. 

Other methods include visualisation, meditation and modalities that seek to remove the emotions and trauma trapped in the energy fields of the body, as a result of stuttering experiences and other personally disturbing experiences, that contribute to your reflex fear and anxiety levels. These methods include such emerging modalities as, “pranic healing”, and, “emotional freedom therapy”, also known as EFT. But once again, these are all topics for coming posts, so I again urge you to subscribe to my RSS feed or email notification, so that you do not miss posts about subjects and content that you will not read anywhere else. If you found this post thought provoking in any way, please make a comment.

 In my last post, I spoke about the components that make up the speech related anxiety level of a person who stutters, and I pointed out that irrespective of whether you have had some speech therapy to alter the “probability of stuttering”, you need to work on the component of, the “consequence”, of the, belief, that you are about to block and stutter. In this post, I will talk about how we as individuals, determine those personal consequences, but before that I would like to comment on anxiety in general, and the role that it plays in determining the severity level that stuttering occurs at.

I was reminded by one of my readers, that there are different triggers for anxiety, and that in my last post, I mainly spoke about anxiety that we experience that relates, directly, to our expected performance as a speaker. There is of course general anxiety, that has nothing to do with our speech. Having said that, all anxiety, whether it is speech related or general, is still a factor in determining the, probability and consequence, of speech dysfluency, and we will talk about all that now. 

Most people suffer from stress and anxiety, to some degree, and the effects of stress and anxiety effect people in different ways. One of the ways that stress and anxiety effect people who have a, propensity or tendance to stutter, is that they are more likely to stutter when their anxiety level goes above, what I call, their “stuttering threshold anxiety index level”. Why this is, is not fully understood, but some believe that under stress and anxiety, the demands required to produce fluent speech by a person who stutters, are greater than the brain’s capacity to produce that fluent speech, so a breakdown in fluency occurs. Some would argue, that when the anxiety level reaches a certain point, the person who stutters goes into a level of, “fight or flight” response. In doing so, the body prepares itself to fight or flee, and resources for fluent speech are not high on the bodies agenda in this state. John Harrison, in his book “Redefining Stuttering” talks about what he calls, “approach avoidance conflict”, where part of the self, (the adult part), wants to approach the speaking situation, while another part of the self, (the child part), wants to avoid it. With one part of the self wanting to go forward, and the other part wanting to retreat, the result is a stand still, which manifests in a speech block. Bob Bodenhamer, in his book, “Mastering Blocking and Stuttering”, refers to the anxiety of a person who stutters, manifesting in the muscles used to produce speech. No matter what the reason is, it is clear that for most people who block and stutter, the degree of stuttering is generally increased as their anxiety level increases. 

What we need to understand, is that our anxiety level is self created to some extent. It is a, “do-it-yourself job”. An, “inside job”, if you like. It is as a result of our subconscious determinations of probability and consequence, combined with our innate general level of arousal. Having said all that, our responses to stimuli, that lead to our determination of probability and consequence, tends to come as a “reflex reaction”, as a result of past experience, but we can learn to override those “hard wired” reflex reactions. 

As people who stutter, how can we take control of our reactions? We can do this by challenging these reflex thoughts and feelings, that have been, “programmed”, into our psyche, from our past beliefs, and our own assessment of reality, and “the way the world is”. This programming, has mainly come from our childhood, where were accept the world as we see it, rather than question if the beliefs that we are building about the world, and our place in it, are going to be resourceful to us as an adult or not. We can, and need to, begin to replace these perceptions of the world, with more resourceful analysis, by questioning these somewhat automatic responses to the stimulus before us. If we accept that our initial reflex assessment of the, “consequence” of our stuttering, might be flawed, we can begin to train ourselves to question this assessment.  

As a person who stutters, we have invested a great deal of time in developing the ability to, “mind read”. What I mean by this is that, while we are in the process of speaking, we are attempting to assess what the listener is thinking about us, in terms of what we are saying, how we are saying it, our level of intelligence, and generally, our validity as a person. Brain studies have shown activity in parts of the brain of a person who is stuttering, that is not normally active in a fluent speaker while they are speaking. Could this activity be related to this secondary, “mind reading” program, that is running while we are trying to speak? It is understandable, that it would be difficult to speak, and think about what we are wanting to say, while we are trying to assess what the other person is thinking about us, and what the consequences of that might be to us. Not only are we concerned about the primary listener’s response, but also the secondary listeners response. By secondary listener I mean the people around us, not directly involved in the conversation, who are hearing us speak. How often are you just as concerned about what others, who are hearing you speak, are thinking, and what you perceive the consequences of their thought might be.

Some self destructive and anxiety provoking consequences, that we can conjure up in our mind, are thoughts like:

1) The other person will think I am stupid, or of low intelligence, if I block and stutter.
2) The other person will think I am not telling the truth, if I block and stutter.
3) The other person will think I do not know what I am talking about, if I block and stutter.
4) The other person will think I do not know my own name, or my street, or my town, if I block on those words.
5) The other person will think I am stupid, because I have forgotten the name, of the person I am wanting to introduce, if I block on their name.
6) The person will not employ me, if I block and stutter.
7) People will not want to be my friend, if I block and stutter.
8 ) The girl or guy, will not want to talk to me, or go out with me, if I block or stutter.
9) Those listening, will laugh at me, if I block and stutter, and that makes me feel really bad. 

This list could go on and on, and although each person’s list would contain these main concerns, mentioned above, to varying degrees, each person would have a further list, that would be peculiar to them, based on their life’s experience. In next weeks post, I will talk more about how we, tend to subconsciously layer toxic consequences of dysfluent speech, upon other toxic consequences, to create real speaking anxiety, and even panic. I will also talk about methods available for us, to begin to unwind this vine of, “stinking thinking”, that contributes to our level of dysfluent speech, and in that regard I invite you, once again, to subscribe to my RSS or email notification, so that you do not miss the next important post on this subject.

As mentioned in my last post, people who stutter appear to have a lowered capacity to manage the speech mechanism, when their anxiety level goes above a certain threshold level. If we realise and accept that, we can start to look at what are the components that determine our level of anxiety. Well I am going to let you in on a little known secret about the components that make up your anxiety level, as a person who stutters, and what you can do to reduce your anxiety surrounding stuttering. 

There are two main components that contribute towards your speaking anxiety level, and your subconscious brain knows this, even if your conscious brain does not. In any situation where you have to speak, your brain does a quick “calculation” that basically will determine how anxious you become about that speaking situation. In simple terms, it takes each component, and gives it a rating out of 10, then multiplies the two ratings together, and that gives you an anxiety index level as a rating out of 100. Now this all happens in a fraction of a second without you knowing it. 

So what are these two components that the brain considers in determining how anxious you are in any speaking situation. Well the first component is:  

Probability.  

Your subconscious brain asks itself this question. “What is the, probability, of me blocking or  stuttering in this situation”? As mentioned above, the answer is effectively expressed in terms of a score out of 10. So if you “believe” for one reason or another that you will be totally fluent, then your brain gives that a score of 0. If you believe there is a bit of a chance that you will stutter, then your brain might give it a rating of 2 or 3. If however the assessment is that you are very likely to stutter, then a 7, 8 or 9 might be the rating. Now where does this assessed rating come from? Well, it is an accumulation of all your experiences of speaking to different people in different situations, and the older you get, the more of a reflex this subconscious calculation becomes. 

The second of the two components is: 

Consequence. 

Your subconscious brain asks itself this question. “What will be the, consequence, of me stuttering in this situation”. Once again the answer is effectively expressed in terms of a rating out of 10. So if you believe for one reason or another, that it really does not matter if you block and stutter, and there will be no consequence at all, then your brain gives that a rating of 0. If there are some concerns about what the impact that your blocking and stuttering may have in some way, then the score starts to climb the scale to a 2, 3 or maybe a 4. Now if your assessment of the consequences of stuttering are such that you believe it is likely to be, catastrophic to you in some way, then the score can reach a 9 or even a 10. Ratings of 9 and 10 would have to fall into the category of a panic attack, and many people who stutter would know exactly what I am talking about here. 

So let us say that your subconscious brain assesses the, Probability, of you stuttering as being a 4, and it assesses the, Consequence, of you stuttering as being a 2. The total rating the brain has assessed is an 8. That is a speaking anxiety index level of 8, out of a possible 100. Now if the speaking anxiety level where stuttering is likely to be triggered in is say, 20, then you are unlikely to stutter or speak with a level of dysfluency that is greatly noticeable to you. That is not to say that there will be no stuttering. It is just that it is likely to be of a level that is inconsequential or unnoticeable to you, and is basically a result of habit rather than dysfluency caused by anxiety and fear. 

If on the other hand, your subconscious brain assesses the, Probability, of you stuttering as being a 9, and it assesses the, Consequence, of you stuttering as being a 5, the rating your brain has assessed, is 45. That is a speaking anxiety index level of 45, out of a possible 100. Once again, if  your speaking anxiety level where stuttering is likely be triggered is 20, and your brain has the body at an anxiety index factor of 45, then a high level of stuttering will be evidenced, even though your concern about the speech dysfluency is only moderate. 

Now, I do not want to complicate this any more than is necessasry in order to give you an understanding of the components that are making up your level of anxiety, but there is a third component that is related to Probability, and that is, Degree. By degree, I mean that a person who stutters my have a level of variability in the degree of their blocking or stuttering. Degree is also closely related to the anxiety rating in that the higher the anxiety rating, the higher the degree of dysfluency. This is a complex component because it is circular to some extent, in that a greater degree of stuttering can lead to a higher “consequence” score, and therefore a higher anxiety index rating. For the purposes of this post, we will ignore, degree, as a component in understanding anxiety.  

So why is it important to understand these two main components that make up your anxiety level? Well for those of you who are mathematically inclined, you will have already realised that if you want to bring down your “anxiety index level”, then you can begin to eliminate a lot of the problem, if you agrees that a  lot of your fluency problem is related to your anxiety level. 

It is clear then, to bring down the anxiety level, you have to find ways of reducing the probability of speaking dysfluently and/or reducing the consequence of such speech dysfleuncy. 

In previous posts we have spoken, in broad terms, about the options that are available to facilitate a person in the process of reducing the, “probability of stuttering”, to a degree that it is not a concern, however, we will assume that the person is unable for one reason or another to reduce the probability of dysfluent speech, or that, even though their physical stuttering has been reduced, or even eliminated, they are still concerned about the consequences of blocking or stuttering, if it was to occur . We must then begin to work on reducing the consequence of speech dysfluency, and this will be the topic of my next blog post, so in that regard I once again invite you to subscribe to my RSS feed, or my email notification, so that you do not miss my next post, where we will talk extensively about how to reduce the consequences of blocking and stuttering. Finally, I urge you to make a comment on what I have outlined here. Thank you.

In my last post, I spoke about the two main general approaches that make up speech therapy for stuttering. Those approaches, being the fluency shaping method and the stuttering modification method, also known as “stutter more fluently”. I concluded by mentioning the fact that, irrespective of which form of speaking modification method is used to reduce the physical symptoms of stuttering, one cannot gain total fluency or anything approaching it, unless one realizes, that the key to real progress, lies in the intervention on the psychological side.  

Research into the cause of stuttering, over the last decade or so, has confirmed that there are definite anomalies, within the brain of a person who stutters, that are a major factor in identifying the cause of stuttering, however, it is a little understood fact that we are capable of “rewiring” or “circumventing” those faulty parts of the brain, so that the symptoms of stuttering can be reduced, and quite substantially. 

When I say that the symptoms of stuttering can be reduced, we immediately think of the physical action of stuttering, which includes, speech repetitions, prolongations and cessations of sound or blocks, as well as the secondary behaviour associated with the struggle to get the words out fluently. However, as was the subject of my post on the Stuttering Jack Scale of assessing the severity of stuttering, there are other less obvious symptoms of stuttering that need to be considered when talking about the symptoms and degree of stuttering. I am of course referring to the psychological symptoms which include fear, shame, anger, guilt, confusion and lack of clear thought, anxiety and panic, frustration, embarrassment, isolation and social phobia etc. It is common for a person who stutters to be fearful of the judgement of others towards their dysfluent speech. If the individual perceives the situation in a very negative way, he or she can develop a high level of anxiety about the prospect of stuttering. This can even approach feelings of panic at being “out of control”. As a result, one can become confused about topics which are normally easy for them to talk about. Some people describe this situation as “greying out”, as the mind tends to go blank when trying to verbalise an answer while stuttering. Stuttering and/or the fear of stuttering can lead to a degree of social phobia, and studies have shown that a high percentage of adults who stutter demonstrate the symptoms of social phobia. 

Most people who do not stutter, would have experienced varying degrees of anxiety if and when they have been called on to make a speech in front of an unfamiliar group without being prepared. As thoughts flood the brain about how others will judge them, and what that means to the individual, the mind can go blank, and speech can become dysfluent in the most eloquent of people, especially if confusion and time pressure are added to the equation. Some people who stutter, can also feel emotions that can cause embarrassment, and anger over the situation that they find themselves in. As a result, some individuals can choose to isolate themselves to varying degrees from people who they have trouble speaking to, and avoid situations that they tend to stutter more frequently in, hence, leading to the varying levels of social phobia, referred to above. So there are really, as mentioned, two strains of symptom that make up the disorder, known as stuttering, and these two symptoms can vary from person to person, situation to situation, and also vary in degree from day to day. 

While the physical symptom of stuttering is extremely frustrating for the person who stutters, the majority of people who stutter would confess that it is the psychological impact on them that is by far the hardest symptom to live with. Now if that is the bad news, I also want to tell you why it is reason to also be the good news. 

Why it is the good news is that while it may often be a long, costly and complex process to directly alter the physical symptoms of stuttering, which as we have said are to do with neurological anomalies in the brain, it is possible for the person who stutters to alter how he or she reacts to the thoughts and feelings that trigger the blocking and stuttering, and even better, the individual is able to change the thoughts about the stuttering experience, and as a result alter the reaction to it to be more resourceful rather than destructive. 

Our thoughts about a stimulus or stuttering trigger, be it a person or a situation, are what gives rise to anxiety and once our anxiety reaches a certain level the stuttering will appear. Having said that, anxiety is not a prerequisite for stuttering but it certainly aggravates the problem. What is a prerequisite for stuttering is the programming of our belief system and the programming of the stuttered speech habit that has become hardwired into the brain at an early age. 

It is interesting to note that every person who stutters tends to stutter in their own way, and it has even been said that the physical act of blocking is actually an effort to try not to stutter. It is a manifestation of the effort to try to get the word out. It is also interesting to note that the individual’s way of stuttering is never forgotten or removed from the brain, and in cases where an individual has been successfully treated using a fluency shaping method, and does not stutter for many years, if the stuttering returns it does not return in a different way but the exact same way that was peculiar to the individual before being successfully treated, many years before.  

As mentioned, the belief system plays a major part in the degree of stuttering that a person will exhibit at any one time. In that regard it can be argued that where a person is fluent in one situation, and not fluent in the next, it is as a result of the actions of the belief system, in that to trigger the stuttering one must first think about stuttering, which then triggers the belief that one will stutter. This then in turn triggers the brain to look for words that it believes will require extra effort to get out. This then triggers what, Bill Parry, calls a “stuttering valsalva manoeuvre”, where the body, through the respiratory system, tries really hard to get the word out and consequently gets caught up in what John Harrison calls a “stuttering approach avoidance conflict”, and the result of all this is a speech block. Now that is all getting a bit complex at this point in time but as you can see, to successfully treat both the physical and psychological symptoms of stuttering, one needs to understand what is going on. 

At this point we will leave the complexity of treating the physical symptoms and continue to concentrate on how we can control the anxiety associated with stuttering. In my next blog post I will reveal some little understood secrets of what contributes to our levels of stuttering associated anxiety, and, give you some tips on how to reduce that anxiety. So in that regard I once again invite you to subscribe to my RSS feed or email notification so that you don’t miss the coming blog posts where I will begin to reveal how I have been able to successfully turn a “5,5 stuttering problem”, into “0,0 stuttering freedom and speaking confidence euphoria”.

In my last post, I spoke about my belief that speech therapy is not always a necessary approach for all people who wish to remove stuttering from their life, especially those who have what would best be described as a mild to moderate form of stuttering, as determined by the Stuttering Jack Scale, as the speech outcome from speech therapy is unlikely to be sustainable for most of them. I urge you to read that article before reading this one. That article was not to deter an individual from speech therapy. It was just to say that it might not be as helpful and as long lasting as working more on applying methods aimed at achieving an initial level of acceptance of the speech dysfluency, while working on the psychological side of the issue, by facing and conquering the fear of speaking dysfluently. Many people with a mild to moderate stutter, have been more successful with dealing with their speech dysfluency, by adopting the approaches that I briefly mentioned in that previous post. I concluded that post by saying, “if however, one is in the higher levels of the scale for physical and psychological symptoms of stuttering on the Stuttering Jack Scale, then speech therapy will be a must if the individual is to have any chance of achieving the fluency level that is desired”. 

If the individual is going to seek some form of speech therapy, one must first decide if totally fluent speech is to be the goal, or a more fluent and acceptable form of speech dysfluency that is currently being experienced. Having said that, it is only natural that the ultimate aim of any person with a speech dysfluency is to speak totally fluently, but that is unlikely to be a realistic goal for most people. If total fluency is the goal of the severe stutterer, then the only way to achieve that is to take the process of speech production from auto to manual. This is achieved by becoming totally aware of the breathing patterns, movement of the tongue and lips, the rhythm of the speech, the continuity of the words, the speed of delivery at the start of utterances as well as during the delivery, and also the intonation or melody in the voice. As mentioned, for the individual with a severe stutter total fluency in all speaking situations can only be achieved with total concentration and awareness of the process of speech delivery.  

Speech therapy that is designed to achieve this goal is know as a fluency shaping method and must be taught in an intensive clinical environment, with gradual and controlled exposure to all outside speaking situations, when the skills required for the correct delivery of speech, using this method, have been acquired. There are only a handful of clinics around the world that offer this form of treatment, which ideally needs to be in the form of a three week intensive to get the desired results. Courses teaching this method that run for less than that period of time, are less effective in that they have to rush the process of teaching the required skills, and then fall into the trap of sending the client back into the outside world much too early, and the skills are quickly eroded for reasons that include those mentioned in my last post. 

If an individual has a severe stutter, and is successful with a fluency shaping method of treating their stuttering, they will always benefit greatly from joining a support group, especially if the support group is made up of other people who have done the same program and are also working on achieving a high level of fluent speech, in all situations. The group environment gives the much needed support required to maintain the skills and move forward.  

Fluency shaping, if taught properly, will allow the individual to speak totally fluently if used as it has been taught to them, but when the demands on the individual are increased and everyday stress levels are escalated, the skill level can fall, and as a result the stuttering level can increase, and quite often return to its former level of severity.  Fluency can be hard to regain when the individual begins to lose confidence in their ability to apply the technique in all situations. This can be exacerbated by the fact that fluent speech, in all situations, is not always predictable. Skills can however be reinstated without returning to the speech clinic, but it does require undertaking a period of using the skills in an exaggerated form to reinstate the level of focus and awareness in the brain, and this is best facilitated through the use of the “speech buddy system”, and support group organised “booster sessions”.  

The skilled practitioner of a fluency shaping method can become more fluent than most normal speakers, yet total fluency, in ALL situations, can be illusive if the psychological side of the problem is not equally addressed, but this is the subject of a future post. 

As you can see, if you are a 5,5 Stutterer or close to it, with high levels of speech dysfluency and associated anxiety surrounding speaking, it can be an “all consuming” pastime to achieve total fluency and freedom from speaking anxiety in all situations, but it is possible, if that is needed to fulfill your life goals. 

Once again, this is extremely hard to achieve unless one has a burning reason to be totally fluent, matched by a high motivation level, combined with a belief that speech fluency is a “no compromise” issue in life. 

Having said that, if the individual is a mild, :2,2 Stutterer”, or close to it, and still wishes to undertake a fluency shaping technique course, and try to adopt the skills taught whenever possible and needed, a high level of fluency can be achieved relatively easily in most situations but, as mentioned in my previous article, it is unlikely that a person with a mild stutter will persist with the level of awareness and concentration needed to consistently apply these methods. 

The fact of the matter is, that by far the majority of people who have an obvious speech dysfluency, are going to be unable to achieve these ultimate levels of fluency that some stutterers have been able to achieve. For the average person, the best answer for speech therapy is more likely to be a method known as “stuttering modification treatment”, or, “a stutter more fluently program”, rather than a fluency shaping program. In a stuttering modification program, the individual is taught to not resist or mask the urges to be dysfluent on certain words and sounds, but to go ahead and be dysfluent, but in a more fluent way. This may sound a little strange or counterproductive at first, but it is a highly successful form of treatment where the individual aims to remove major, and out of control, blocking behaviour and replace it with a form of “voluntary stuttering”, that is more repetitive, yet free flowing in the direction that the speech utterance is moving, rather than halted dysfluency in the form of severe blocking. The individual must, however, come to terms with the fact that a form of speech dysfluency is an inevitable, yet acceptable, behaviour for them to have, and learn to accept the new form of free flowing stuttering as a desirable outcome. 

In both forms of treatment, which are designed to eliminate or modify the overt speech dysfluency, the level of outcome is always dependent on how well the individual is able to also change or modify the psychological side of their stuttering problem, and that is the topic of my next post, and in that regard, I invite you to subscribe to the blog RSS feed or email notification so that you do not miss the next and future interesting articles.

As you are aware, there are many different forms of speech dysfluency that we label “stuttering”, and I attempted to come up with a simple, “rough and ready” way to differentiate between them in my last post about the Stuttering Jack Scale. The reason that we need to differentiate between them, is that it is very important to know these degrees of stuttering if we are to give constructive advice about potential treatment strategies for speech dysfluency.

What we must understand is that, as an adult, your personal communication style has become hard wired into your system, and unless you consciously try to alter it, that communication style is going to stay with you. This is not just the stuttering pattern but also includes such aspects as the speed of delivery, the enthusiasm of delivery, the response time, the number of words uttered on a single breath, the pause lengths within speech etc. In addition, most of the psychological responses to visual triggers have also become almost a reflex action by the time you are an adult.  So in response to a certain visual or auditory stimulus, you will generally react in the same way, as far as your psychological response, and your resultant speech pattern in that situation. So you must understand that, it is going to be extremely difficult to change, over the long term, those innate responses by undertaking a short speech retraining course.

There are many methods of fluency reshaping that can change your thinking and speaking behaviour in a clinical situation. Some will reduce your level of speech dysfluency a little, and some will completely eliminate it in that environment. A few are even capable of having you speak totally fluently in all, “outside the clinic”, situations for a period of time, but your innate communicating style eventually overrides the new style that you have been taught, and the stuttering will return to varying degrees, if not totally unless you can maintain your awareness and consciousness on your new speaking technique, while speaking in every situation.

As mentioned, it is not difficult to teach a person a method to eliminate their stuttering in a clinical environment, or outside the clinical environment, if the treatment is done in an intensive form, and taught by a highly trained and experienced clinician. In the intensive course, the individual is taken out of their normal environment and subjected to an exaggerated form of the new speaking method. This exaggeration method, is designed to get the brain to focus on a certain way of breathing and speaking, that eliminates dysfluent speech. If this is taught in a rigid fashion, over an extended period of time, fluent speech can be achieved, however, the innate or old form of communication style, speech pattern, and focus of attention while speaking, will eventually return. This is known as relapse. The length of time before this relapse tends to occur will include, but is not limited to, these factors:

1) The length of time that the reshaping process was consistently applied in the clinical environment, be it a day, a week, or three weeks.

2) The degree of difference between the old innate speaking pattern and the new learned speaking pattern.

3) The personality of the individual.

4) The motivation of the individual.

5) The degree to which consistent fluent speech plays an important part in the life of the individual.

6) The severity of the dysfluency problem.

7) The environment that the individual will return to in employment, social, and family life.

8 )  The support given to the individual in the change process, following treatment.

There are so many factors conspiring against the individual to alter the behaviour patterns that are holding their speech dysfluency in place, that it is almost impossible to achieve the results from therapy that one is ultimately seeking, and a level of acceptance, of something less than ideal, is inevitable. That level of acceptance of speech dysfluency, generally settles at a level that is not greatly different to the level of physical stuttering prior to the speech treatment, for most mild to medium forms of stuttering in individuals.

So one must ask, is seeking treatment for the physical symptoms of stuttering a must for most stutterers. I believe that it is a debatable issue, if relapse is almost a certainty, and avoidance of an extreme emotional roller-coaster ride is to be avoided by most individuals. If we are to make such a bold statement, we must ask ourselves, why most of the stuttering treatment programs claim that 70 to 90% of clients are happy that they did the treatment program. Well, apart from the likely fact that that these statistics may not always be correct, the fact remains that most people, with what would be best described as a mild speech dysfluency, are happier after having attended treatment, but not because their physical speech dysfluency has changed dramatically, but because their psychological reaction to it has altered for the better.

This has come about through:

1) An admission to themselves, that they have a problem.

2) An admission to others, that they have a problem.

3) A meeting of other normal, successful, and well adjusted people, like themselves who share their problem, and a realisation that they are not alone.

4) An introduction to the concept of voluntary stuttering and the benefits of its use.

5) An introduction to the concept of advertising, or self disclosure, to strangers that they have a speech dysfluency.

6) A learning of an alternate method of speaking, to reduce or control the dysfluent speech.

7) Arriving at an altered psychological state, where it is believed that the dysfluent speech is no longer a psychological issue.

8 ) A realisation that nothing in their life has greatly changed, as a result of more fluent speech, that has come at a cost.

Now as you can see, there is only one aspect, above, that involves the actual learning of a fluency enhancing method, and that is the learning of a physical method to control the speech dysfluency. The others can all be undertaken outside of a speech therapy environment, as they involve reshaping the concept of the world that the individual has created in their mind, and their place in it. Reshaping what it means to the individual to have a degree of dysfluent speech. That is within the individual’s own powers to change, and it is as a result of this, non-speech related process of change, that real treatment for dysfluent speech can be achieved. Simple solutions such as joining a local Toastmasters Club, regularly attending a stuttering support group, reading  John Harrison’s and Bob Bodenhamer’s books, (sold here), are all ways of learning to reduce the negative experience of mild to medium speech dysfluency.

So in conclusion, I can summarise by saying that if the person who stutters is low on the Stuttering Jack Scale, as far as physical speech dysfluency, yet in the average to higher range on the psychological scale, then speech therapy, in its many traditional forms, is unlikely, in the long term, to bring freedom from stuttering. Greater results can be achieved by accepting that the mild and infrequent (in terms of % syllables stuttered) dysfluency, that is being experienced, is “something that you do, not something that you are”, and then working on bringing down the rating on the psychological side of the Stuttering Jack Scale. Undertaking a long and costly process, to hopefully achieve reduced dysfluency through speech therapy, should really be given careful consideration, as you are unlikely to adopt the new way of speaking, that you will be taught. This is not because you do not want to adopt it, but because it will be so different to your innate and accepted speech pattern, that it will be almost impossible for you to maintain. On the other hand, if you are in the higher levels of the scale for physical and psychological symptoms of stuttering on the Stuttering Jack Scale, then speech therapy will be a must if you are to have any chance of achieving the fluency level that you seek, and that will be the subject of my next post, and in that regard I invite you to subscribe to this blog above to ensure that you do not miss the next post. In the meantime I also invite you to make a comment about what I have had to say here. 

In my last post, I pointed out that when we talk amongst ourselves, and with others, about stuttering, it is too easy to say, “I stutter”, or, “he is a person who stutters”, and we expect that the other person knows exactly what you are talking about, but I asked the question, do we know what is being talked about, or, do we just make assumptions based on our own experience of what stuttering is, from what we have seen or experienced ourselves. I argued that it is the later, and that unless we use some other universally understood descriptive terminology when we describe and comment about the stutter, then we have no idea what is being described.

What I am trying to say here is that, the term “stuttering” is so broad, that it cannot, in isolation, be used to describe the many different forms of speech dysfluency. For example, I can say that John is a stutterer, and Sam is a stutterer, and Bill and Tom are also stutterers, but are they all experiencing the same phenomenon? The answer is likely to be, no! Stuttering has both a physical component and psychological component, and there is great variation in the degree of both, from one person to the next.

On the physical side, John may have some repetitions in his speech, but no blocking. On the psychological side, he may not give any thought to the fact that he has a level of speech dysfluency, and does not avoid any speaking situations because of it. On the other hand, Sam may have severe and regular speech blocks. He may avoid some words, and substitute others. His stuttering may completely control all aspects of how he lives his life, both professionally and socially. We then come to Bill, and he may have what some see as a pronounced speech dysfluency, with a combination of repetitions, prolongations and some blocking, however, on the psychological side, Sam may not be concerned about it to the same degree as Bill, in that it does not effect the way he lives his life in any way. Finally, we have Tom, and he may have what appears, to the outside world, to have no problem with speech fluency at all, yet he has a great fear of the possibility of blocking and stuttering, and as a result, he is highly anxious about that possibility, so lives in fear of it happening at some time. All these personalities would say that they have a stutter, or are a person who stutters, and seek treatment for stuttering, but if they were all to hear that the other was a stutterer, they could only assume, in absence of any other descriptive terminology, that the other experienced stuttering in the same way as them. This becomes a problem when we are talking about stuttering in regard to how it has affected us in various areas of our life, how successful treatments have been for us and so on.

So what is the answer? Well the speech pathology profession has recognised that the degree of stuttering needs to be understood when offering to treat a person who stutters, and as a result certain questionnaires have been developed to determine the severity of the stuttering, from both a physical and psychological perspective, and two of the most widely used questionnaires are the OASES test and the WASSP test, however, these are only useful for a full academic analysis of the problem rather than for a quick and self evident assessment method to be used in casual conversation, where understanding of degree is necessary.

So what is a quick and self evident method? Well there are basically two main aspects to stuttering severity. The first is the severity of the physical degree of speech dysfluency, and the second is the severity of the psychological affectation on the individual, as a result of the speech dysfluency. Now in the stuttering support group that I coordinate, and the circles that I move in, we have for many years, used what others now call, the “Stuttering Jack Scale”. We give the physical symptoms a quick rating of 1 to 5, where 1 is mild repetitive stuttering and/or mild speech blocking, while 5 is severe and frequent blocking. 2, 3 & 4 are degrees in between. Now in the same way, we also give the psychological symptoms a quick rating of 1 to 5, where 1 is where the person sees the speech dysfluency as more of an irritation, or inconvenience, than a major issue, while the 5, is associated with social phobia, panic attacks and extreme anxiety surrounding the physical symptoms.

So how do we use this? Well, when talking about a person who stutters, we would say, John is a “1,1 Stutterer”, or Sam is a “5,5 Stutterer”.  The first number refers to the degree of physical symptom, while the second number refers to the degree of psychological affectation. We might describe Bill as a “5,1 Stutterer”, while Tom would be a “1,5 Stutterer”. We might choose to tone our simple self assessments up or down a little, depending on how many other people we have seen or met who stutter, in saying, I am a “4,2 Stutterer”, and so on. The people that I associate with, and talk to, all clearly understand that when I say, “yes, but he is a 1,1 Stutterer”, we all instantly know that the person has a mild stutter, but does not let stuttering worry him, and sees it as a an inconvenience or irritation. We say, if that is the case then he may do better with a CBT or Neurosemantic type of treatment, as opposed to an intensive fluency shaping approach. If someone says, “no, he is a “5,5 Stutterer”, then we know  that this stutterer has a real problem, and that would instantly and simply explain a lot of his behaviour. We would instantly start thinking about other treatments that would be different to what the, “1,1 Stutterer”, might be better directed to, and so on. All this is better than saying, “I am a stutterer, but I just get on with my life, why don’t you”, or, “I am a stutterer and I can’t find any treatment to help me, and my life is just a mess, why isn’t yours”. Using the “Stuttering Jack Scale”, one might be better described as, a “3,1 Stutterer”, and the other better described as, a “5,4 Stutterer”.

Now my little method does not replace the full clinical assessment methods mentioned above, that should be undertaken before any treatment is administered to a person who stutters, and it is not trying to usurp the use of more technical and professional terms. It is just a, “rough and ready”, way of clarifying to another person what is being referred to, when talking about an individual, who has a speech dysfluency problem. It can be used by professional and consumer alike as a simple universal terminology to put the other person, “in the ball park”, with reference to what is being described as, stuttering, in different individuals.

Do I need a clearer description of what is referenced by 1 – 5 in both groupings? Well maybe yes, but that would only serve to confuse and be a source of debate. One should be clear what a 1 is compared to a 5, in each classification, and as for what is a 2, 3 or a 4, really doesn’t matter, as the required message has been passed along to a sufficient degree, for the purposes of casual conversation, needing reference to degree of stuttering.

So do you know any “5,5,stutterers”? How about a “1,5 stutterer”, (who falls into the category of a “covert”). Are you a “1,1 stutterer”? Then maybe all you need to do is reshape the world that you see before you, do a bit of disclosure, and some voluntary stuttering, and get on with your life. If you are a “5,5 stutterer”, then you need to subscribe to my RSS feed because we have a lot more to share with each other on this blog. For I am a “0,0 stutterer, and, a 5,5 stutterer”, all rolled into one, but that is the subject for another blog post here. If you plan to read all my blogs, or follow me on Twitter, Facebook etc, please become familiar with this simple system so that our conversations are more meaningful. In the mean time, I invite you to comment on this post as to the soundness of the “Stuttering Jack Scale”, and where you believe you sit on the scale.