My path to less avoidance and more fluent speech has been a long one, but in my day-to-day, English-speaking life, it's now fair to say that stuttering is mostly a non-issue except when I'm particularly tired or stressed, or speaking in an important situation like giving a public talk or being questioned by an immigration officer.

When it comes to foreign languages, though, there's major regression. Before a recent trip to Croatia with my wife, I decided I'd tackle this fear directly. I learned some basic Croatian from language CDs, borrowed a phrase book for extra vocabulary, and on the trip I was able to successfully execute many short conversations such as ordering coffee or asking for directions. However, I still stuttered quite badly at times, with avoidance behavior and struggle even for simple phrases like "good morning".

What was going on here? Had stuttering "returned"? Was there some complex neurological interaction with foreign language processing? I think it was much simpler than that. Here are some of the factors that I think were relevant for me:

• Lack of confidence. I could speak a few basic phrases, but otherwise had big doubts about pronunciation and word choice.
• New sounds. When speaking in English I have a lot of practice forming sounds fluently, but when speaking a language I have to produce and connect sounds I'm not accustomed to (like a rolling "r").
• Defensiveness. As a foreigner, I sometimes felt like I didn't deserve to speak, and didn't want to bother people with by bad Croatian (or to revert to English).
• Perfectionism. I didn't want to risk making major blunders in a new language, thereby embarrassing myself.

Instead, we both felt performance anxiety and resorted to avoidance. Sometimes when hailing a cab or walking into a restaurant, we'd both stall, not making eye contact and hoping the person on the other side of the conversation would engage us first. We didn't want to plunge into English but we were nervous about speaking bad Croatian. For my wife, the avoidance didn't result in stuttering -- she just wouldn't speak at all. But for me, given my history and physiology, avoidance is like oxygen for any spark of difficult speech.

In my experience, stuttering often happens when there's tension or indecision between wanting to say something and holding back. While I'm traveling, this happens all the time. For example, when I'm nervous about speaking but still want to eat dinner or get to the airport on time, I need to decide whether or not to speak. I find casual speech, like making small talk with a taxi driver, especially tricky: on one hand this is pointless and unnecessary speech with plenty of chance to screw up, but on the other hand I like being friendly and getting to know people. In Croatia my stuttering was often worst in these casual situations, where this tension was perfectly balanced. I really wanted to speak, even if it might be hard.

Psychologist Joseph Sheehan (Sheehan, J.G, 1953) described stuttering just as I've often experienced it, as an "approach-avoidance conflict." The idea is simple: we want to speak so we can communicate, but we fear speech because of the possibility of stuttering. When fear is strong we'll avoid speech altogether; when we're not resisting speech, it comes easily. When these factors are in equilibrium, however, they manifest as stuttering.

Approach-avoidance conflicts can happen in many areas of life, basically for any phenomenon that can cause a negative emotional response. For speech, however, avoidance is a potent force. Like many people who stutter, I have an aversion to stuttering that has been reinforced by many unpleasant experiences. When I approach a situation where I might stutter, my amygdala thus kicks into high gear, triggering tensing up and a natural avoidance tendency. Even before I've started to speak, my jaw and chest are tense and my breathing is shallow. I'm physiologically primed for speech to be more difficult.

When I'm actually speaking, the approach-avoidance conflict happens in microcosm. The dynamics of the conflict usually happen so fast that I'm barely conscious of what's going on. At the moment of stuttering I have a choice: to approach speech or pull back. When I start speaking with a strong avoidance tendency, I hold back via prolongations, repetitions, or outright blocking. In a subconscious attempt to avoid the negative emotions of stuttering, I actually cause it to happen.

Sheehan believed that stuttering is perpetuated by avoidance, by the "successful suppression of outward stuttering behavior." We learn habits and coping mechanisms, but they fail us when our automatic responses kick in. Without this conflict, I don't believe that stuttering happens in the traditional sense -- at least it doesn't for me. We may stumble or speak with natural repetitions, but there aren't the struggle behaviors that are typical for people who stutter.

If avoidance perpetuates stuttering, what perpetuates avoidance? In Croatia, my lack of confidence clearly played a role. But did I avoid and stutter because I lacked confidence? Or did I lack confidence because I knew I might stutter? Well, both. The interplay between confidence, avoidance, and stuttering is intricate and complex. I'm certain that if I didn't stutter I would have spoken Croatian more often and more effectively. I would have been more confident, and my confidence would have increased as I practiced speaking.

But like my wife, I'm an introvert with a tendency to be timid in new situations. And let's be honest about my language abilities: my handful of basic phrases didn't make me a native speaker, and my ability to understand spoken Croatian was nonexistent except for 15-20 words and basic numbers. Stuttering aside, I lacked confidence in my speaking ability. This is perfectly natural when you're a complete beginner.

There are no easy answers with stuttering. Confidence can't be conjured out of thin air. A few years ago, for example, I stuttered more severely at work than I do now. But as my career has progressed and I've become more confident in my professional role, I stutter much less. On the other hand, I suspect that one reason for my success at work is increased fluency and decreased stuttering-related avoidance.

What's a stutterer to do, given this chicken-and-egg riddle? Surely the answer is to make efforts on all fronts. Reduce avoidance behaviors even if it's scary and you're not confident. Do what it takes to build confidence in your domain (e.g., by practicing a foreign language). Practice meditation or other techniques to deal with aversion and other negative emotions. Finally, work on the mechanics of stuttering: easy breathing, relaxed jaw and chest, and vocalizations that cause you trouble. With greater mastery comes natural confidence.

A recent survey article by Daniel M. Wegner (Wenger, D.M.. 2009) about the psychology of "ironic errors" -- where our vigilance not to make a mistake under pressure means it's more likely we actually will -- may point the way to more rigorous study of these kinds of strategies. Wegner mentions that effective techniques include "accepting symptoms rather than trying to control them" and "disclosing problems rather than keeping them secret," and he closes by recommending that we "avoid the avoiding." This sounds like folk wisdom I've picked up at stuttering support groups over the years, but it's now being confirmed by some of the most celebrated new research in psychology.

Interestingly, I've noticed resistance in the wider stuttering community to thinking of stuttering as a psychological phenomenon. I think there are good reasons for this: we don't want stuttering to be associated with mental illness or sub-par intelligence, as it has been -- unfairly so -- in the past. But I believe that a critical part of stuttering research and therapy lies in the realm of psychology. Brain impacts body, and vice-versa (Niedenthal, P.M., 2007). Just as a golfer with the "yips" can benefit from the help of a sports psychologist, we need a stigma-free psychology of stuttering with an emphasis on reduced avoidance and successful communication, not perfectly fluent speech.

What does "fluency" even mean, anyway? As Woody Starkweather (Starkweather, C.W., 1987) mentions, language fluency (the ability to learn and pronounce foreign words and sentences) doesn't have much to do with the ability to articulate words in a language without stuttering. While fluency with respect to a foreign language means "proficient," fluency with respect to stuttering has come to mean "perfect": no hesitations or repetitions or pauses.

For me, "stuttering" no longer means just pauses or repetitions or other imperfect speech, but rather speaks to habitual avoidance and struggle behaviors that make communication stressful and difficult. This isn't just some arbitrary redefinition: without aversion and struggle, I bet that most listeners hear my pauses and repetitions only as naturally imperfect speech, not as a speech disorder.

Fortunately, just as stuttering can cause a downward spiral of more severe blocks, decreased confidence, and more avoidance, the same dynamics can also lead to positive synergistic effects. You speak a little better, for example, and this might give you more confidence. Feeling more confident, you might relax a little more. When you're more relaxed, your avoidance tendencies are less likely to be triggered, and you'll speak better. There are many entry points on the path to mastery, and they're mutually reinforcing.

My experience with speaking a foreign language reminds me that even though I've become mostly fluent, I'm not cured. There is no cure -- stuttering is complex and intimately connected with my psychology and neurology. Rather than getting mired in shame when I stutter -- or feeling false pride just because I'm having a good day -- my job is to know and understand the conditions that lead to stuttering and to find my own strategies for success.

Resources

Niedenthal, P.M. (2007). Embodying Emotion. Science, 316, 1002-1005.

Sheehan, J.G. (1953). Theory and Treatment of Stuttering as an Approach-Avoidance Conflict. The Journal of Psychology. 36(1), 27-49.

Starkweather, C.W. (1987). Fluency and Stuttering. Englewood Cliffs, NJ: Prentice Hall.

Wenger, D.M. (2009). How to Think, Say, or Do Precisely the Worst Thing for Any Occasion. Science, 325, 48-50.

You can post Questions/comments about the above paper to the author before October 22, 2012.