How to effectively deal with the anxiety that often accompanies the experience of stuttering
Hi
I often encounter people who stutter who have great difficulty with anxiety. The thought of, for example, introducing oneself to someone or to a group of people at work is often perceived as too hard. I know this from my own experience, too.
From speaking with people it seems that dealing effectively with such anxiety is often not adequately covered in therapies.
The question is: What approaches do you take to addressing the social anxiety that often accompanies the experience of stuttering? Also, what resources – books, websites, podcasts, conferences, etc. – would you recommend for the PWS to use along their Journey to deal effectively with this anxiety?
Thanks
Hanan Hurwitz
Hi Hanan,
You ask a great question to kick off the conference. In discussions with my clients about their anxiety, I usually point out that anxiety can be a good thing. It keeps us safe when we are crossing the street. It has us check a baby’s surroundings before placing her in the crib for a nap. However, when anxiety causes us to live a narrow life and close in on ourselves, it is unhelpful. Anxiety is a natural response to unpleasant memories. As humans, we have evolved to engage in escape behavior when confronted with a negative stimulus and for many people, stuttering is uncomfortable and new situations stressful.
I think examining the anxiety, then finding ways to create mental flexibility in managing it can be helpful. I believe labeling it can be the first step (this is my anxiety making me feel this way.) The difficulty arises from the fact that anxiety surfaces when we feel most vulnerable (under time pressures, new situations, at 3:00 a.m.) and that makes it more complicated. Perhaps we develop skills for managing it the more that we sit with it? I love the book by Susan David “Emotional Agility.” She points out that our most difficult emotions arise from our values. She claims that we mourn when losing someone, because we valued our time with them. We become anxious because we want to make a good impression, have someone love us, interact easily with us. So, we become anxious because we value human connection.
I wish managing anxiety were easy. But, the reality is that it is extremely difficult and does not follow a linear path. It ebbs and flows based on our life experiences and surrounding ourselves with others who share that experience can provide comfort and provide the first step.
There was a recent paper written by Elizabeth Bernstein entitled “Stress in Your Life: Embrace It” describes a Rational Emotive Behavior Therapy. Gunnar Neiders and Heather Grossman has also written a great book about REBT–Rational Recovery From Stuttering: Think Clearly, Speak Freely, and Live Fully.
Thanks again for your question!
Hi Hanan,
Yes, I agree. There are approaches that work on reducing the frequency of stuttering (fluency shaping), those that work on reducing its severity (stuttering modification) and then there are some that work on both (hybrid approaches). But what we need is an approach that does both, and in addition, makes the PWS able enough to deal with the emotions and thoughts that accompany stuttering. What we also need is an approach that does all of these things for the long term. In my experience, a combination of speech-based approaches and CBT does all of the above things. By increasing a person’s awareness of their own thoughts and feelings related to communication, CBT helps them gradually modify these to bring about healthy coping behaviors. It takes a PWS from self-blame to acceptance, teaches them to raise the bar gradually (or not at all), focuses on pleasure of the process rather than mastery over the product.
There are several good reads on CBT in general and CBT for stuttering in particular. Gunars Neiders’s book “From stuttering to fluency: Manage your emotions and live more fully” talks about his approach called REBTS, or rational emotive behavior therapy (a type of CBT) focused on thoughts and feelings stemming from stuttering. Any books by Raymond Giuseppe, Windy Dryden, Albert Ellis, and Paul Hauck are wonderful resources on CBT. Dr. Paul Hauck has written a series of self-therapy books, like “Why be afraid?” and others. The Australian Stuttering Association currently runs a therapy program that deals with social anxiety in persons who stutter.
I do want to add a word of caution for speech therapists here. Using CBT for stuttering is a great idea, but make sure you are certified to do so. If you’re not trained in the use of CBT and you’d like to at least use components of CBT in your counselling, ensure you’ve read extensively about the approach and its practical applications. And finally, if the anxiety seems to be extending beyond speaking, or seems more like generalized anxiety, do not hesitate to refer the patient to a clinical psychologist.
Looking forward to a lot of reading and sharing through this exciting month!
Pallavi
Hanan,
One other thing that many people who stutter report as being helpful for them is creating a detailed situation hierarchy for the speaking task that they find anxiety producing and systematically working their way up the hierarchy. Introductions are a common one for many people who stutter. It seems that some individuals are more comfortable starting with introducing themself to people who they will probably never see again…for example, clerks and cashiers at stores, salespeople or receptionists they reach by phone, waiters or waitresses, etc. So they start with this step and do it OFTEN until it gets easier and easier. Once they become desensitized, they try something a bit harder – again over and over until it feels fairly easy, working their way up their hierarchy. The confidence this builds often leads them to seek out opportunities wherever they go to practice giving their name as often as possible. Desensitization can be a powerful tool and it simply requires breaking down the challenging situation into smaller steps.
Often, as the previous responses to your question have mentioned, managing the thoughts a person has that create those feelings of anxiety is an important component of therapy and facilitates people finding the courage it takes to step out of their comfort zone to try to become desensitized to these challenging speaking situations. I find Acceptance and Commitment Therapy (ACT) to be helpful with the difficult thoughts and feelings that so often accompany stuttering. There are 6 aspects of ACT and all are important in their own way but defusion, in particular, is a useful skill that helps individuals learn how to create some distance between their negative thoughts and themselves. This results in them being less impacted by their negative thoughts. An excellent book written for the layperson about ACT is called “The Happiness Trap” by Russ Harris. I think that the anxiety experienced by people who stutter is something that has to be chipped away, little by little, but the process is neither easy nor quick.
Best,
Tricia
Thank you so much, Rita, Pallavi and Tricia.
I appreciate the time and care you took to respond. It’s very helpful to me, and I am sure that your wisdom will be helpful to many others.
Hanan