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From: Gunars Neiders
Date: 20 Oct 2007
Time: 20:43:10 -0500
Remote Name: 67.171.0.68
Erin, you asked some very important questions regarding 1) relationship fear/anxiety and disfluency, I added (at no extra cost :-) ) in my answer 2) relationship between fear/anxiety and struggling and forced speech; 3) fear/anxiety and ability to use fluency shaping techniques (such as easy onsets) and speech modification techniques (such as pullouts) and finally 4) fear/anxiety and avoidance of sounds, words, speaking situations, careers, and social contacts. Answer #4: Let me answer them in reverse order fear/anxiety will increase the probability that a person who stutters will avoid sounds, words, speaking situations and challenging careers and delimit social contacts. Yes, the avoidances will in turn increase the fear/anxiety. Answer to #3: My experience has been that I cannot apply stuttering management techniques as well when I am fearful or anxious. Many other people have indicated the same thing. The inability to apply stuttering management techniques causes me anxiety that I will not be able to apply them. A vicious circle. Answer to #2: When we are under stress of fear/anxiety we tend to fall back into old patterns or struggling and forcing. In turn struggling/forcing is what causes people who stutter to get real social punishment. This social rejection, ridicule, etc. causes people who stutter to not only become afraid of struggling and forcing but of all stuttering behavior. Finally, I come to your question. Answer to #1. Does fear/anxiety increase disfluency? I believe that it increases the frequency of disfluency, the severity of disfluency, the duration of disfluency, and the struggling and all secondary symptoms. It increases shame and decreases motivation to work on the speech. In turn the increase in disfluency increases the fear/anxiety. Yes, everything appears to be reciprocal. Finally you ask if the speech and language pathologists should focus more on emotional aspects or techniques. I believe that focusing on attitudes, emotional aspects, and speech techniques all increase the fluent speech. Techniques show the client that he or she *can* control how they speak and break the bad habits of struggling and forcing, but without a calm rational outlook or attitude about the speech, and while having disturbed feelings such as anxiety, fear, shame or guilt, it will be hard to employ any techniques and break the dysfunctional habits of speaking. I think that any and all opportunities to break the vicious circle should be used. Historically, not enough cognitive behavioral techniques, such as those from Rational Emotive Behavior Therapy, have been used in therapy. I hope that you, of the new generation will improve in this aspect.