Tuesday, February 10, 2009

Do we need to work on stuttering?

There are two main behavioural treatment approaches: creating fluent speech and modifying stuttered speech. Creating fluent speech is mainly about fluency shaping where you create a new way of speaking that may include gentle onsets, rhythmic speaking and binding syllables, but you also can include treatments emphasising on coastal breathing which leads to fluent speech. Modifying stuttered speech, or what I call dysfluency shaping, is mainly known as van Ripper and post-block modification therapy. You work directly on your moments of stuttering, and you try to modify them. You identify them, you soften your tension, you reduce secondary symptoms associated, and so on. [And there are treatments with external help: pharmaceutical and auditory feedback devices. But no clear evidence for effectiveness.]
I am currently looking at a third alternative behavioural treatment. And the idea is simple. Every person who stutters has the potential to speak fluently, and the vast majority can for example read fluently when alone and in no stress. So the issue is not an inability to produce fluent speech, but an inability to produce fluent speech in realistic more demanding speaking situations where demand can be stress, emotions, formulating your thoughts, preparing what you want to say, uncertainty as to what to say, trigger to learned stuttering behaviours, applying social filters and so on. Therefore, an alternative would be to learn behaviours that allow you to be in a state that allows you to speak fluently. Simple tools are speaking at a slow rate, making longer pauses, staying relaxed in stressful situations, and so on. The advantage is that you do what comes natural to you. You not need to learn something unnatural and you do not need to remind your brain of stuttering when working on stuttering events. 

11 comments:

Greg said...

Not a new perspective, Tom. What you're doing is essentially re-packaging the stuttering modification approach. Stuttering modification isn't about modifying stuttering, per-se. It's roots come from a psychological stuttering perspective, where the etiology of the pathology is the belief that it stems from a personal character flaw. We cant handle the pressure/stress, so we falter under these circumstances.

So from the psychological perspective, the goal of therapy is to reduce speech-related anxiety/stress. Which is exactly the point of desensitization, which is the core of stuttering modification.

So all you're proposing is to focus on the desensitization without focusing on the actual motor-modification part. All fine, all good. But realize that the root of this belief is (in many people) that stuttering originates as a result of a character flaw: that PWS can't "take the pressure". (Not saying that this is what you believe at all--but if you follow your logic, this is where it leads.)

And for what it's worth, it's the path that I've largely taken. Be comfortable with myself. Let your brain work how it wants to work (as unencumbered as possible).

Finally--it's a shame that so many people create a false continuum between SM and FS. When you come right down to it, much of the techniques are the exact same, just coming from a different theoretical perspective.

Greg
http://Stuttering.me

Tom Weidig said...

But it is true "we cannot take the pressure", but it is not US but our speech system that cannot take it neurologically.

We are as resistant to stress as anyone else, but our speech system can jam and we get all these symptoms.

So we need to change our behaviour to put less demand on our speech system.

It is different in the sense that I am not just talking about pyscho stuff, but also about longer pauses and slower speech rate. And it is important not to "mention" stuttering or work on it because it reminds the brain of how important stuttering is.

Greg said...

You're essentially reciting Starkweather's Demands & Capacities model. And it does have some practical merit (as you describe and we both have experienced). But as a scientific model, it just lacks scientific rigor. (As I'm sure you would agree.)

Anonymous said...

Greg said-
"Finally--it's a shame that so many people create a false continuum between SM and FS. When you come right down to it, much of the techniques are the exact same, just coming from a different theoretical perspective."

Lingo's different, outcome is the same for us who stutter. To bad for the kids who stutter that have to have this stuff as "therapy."

Same as it ever was...Both methods are pure Bullsh**...Pure Freaking Bullsh**.

When will we quit buying it?

Ora said...

Anonymous: It's easy to criticize. But what do you suggest? Maybe you're saying nothing works and we should just accept our struggle and pain as part of who we are.

What's your point, exactly?

Greg said...

SM and FS aren't entirely bullsh*t; they both are very limited in results and require tons of cognitive attention to produce. And neither become "automatic".

But--at this point, they're the best (behavioral) treatments we've got. So we can whine, moan and complain about them (and we do have that right), but for someone who wants (or needs) to try and get overt stuttering behaviors under some kind of control, what else is there? So these techniques can be used to help certain aspects of stuttering. And it's up to each of us to find out "if the effort of therapy is worth the benefits".

For me, personally--it used to be. But as I became more secure in myself and my professional competency, the effort in using speech controls just aren't worth it (most of the time).

Greg
http://stuttering.me

Anonymous said...

Anonymous -

I hear the anger. Hang in there.

"The Delimma Facing Stutterers is not Stuttering - It's Talking." - Lee Edward Travis

Maybe that's something to consider working on. It helped me. Good Luck!

ig88sir said...

Greg wrote:
"but for someone who wants (or needs) to try and get overt stuttering behaviors under some kind of control, what else is there?"

Word substitutions, avoidances, talking only in comfort zones (places, people, etc.) .. the stuttering lifestyle basically. I find it better than humiliation. Speech tools work about 10-20% for me..and probably for most.

Ora said...

Greg- you wrote "But--at this point, [SM & SF are] the best (behavioral) treatments we've got. So we can whine, moan and complain about them (and we do have that right), but for someone who wants (or needs) to try and get overt stuttering behaviors under some kind of control, what else is there?"

It's a wonderful question. But it's unclear to me what you're suggesting as an answer.

Are you truly saying that SF and FS aren't of much value? What do you recommend, then - giving in to hopelessness?

I don't mean to be sarcastic - I mean this seriously. Mild stutterers can perhaps manage their lives with attitude adjustments. But what about moderate to severe stutterers? What do you recommend for them?

Thanks.
Ora

tal said...

Tom, I am embarking on a similar approach. The theory is that if I can just get into the mindset that I have when I am alone, then I will not stutter.

The mindsets when I am alone and talking to someone feel very different to me (even the sound of my fluent speech is different -- it sounds more timid when I'm speaking to someone vs. alone).

My current approach is to use paltalk or skype to talk to people, paying attention to how it feels, then muting my microphone for a few seconds now and then and talking to myself so the listener can't hear, then talking to the person again, etc, and paying very close attention to how my mindset changes between the two things, so that I can directly work on making my normal speaking mindset more alone-like.

Ever tried anything like that?

Anonymous said...

I was doing a research presentation on stuttering modification versus fluency shaping. I do agree with some of the points that you make. With delayed auditory feedback (DAF) many research articles have shown that it is completley uneffective when it comes to long term. You seem like a smart guy, but you are not a SLP. Unfortunatley, doing research into this will not gain much respect since you never worked in clinical with a PWS or took underlying classes that specifically deal with speech and language.