Anxiety and Stuttering
Hi,
My name is Ryan Connolly and I am a SLP graduate student writing this post. Present day research supports the correlation between Anxiety and Stutteirng. What have been the most practical strategies you have received from either SLPs or MH counselors to decrease negative symptoms of anxiety surrounding Stuttering. In contrast, what are some unhelpful strategies that have caused maybe more anxiety towards Stuttering that we as clinicians should not practice.
Hi Ryan,
What a question! In my personal case, the links between stuttering and anxiety are so complex that I would struggle to give you a list of ‘strategies’.
I can tell you that, in general, what really made a difference for me was the meaning (and goals) of therapy. When I was a child, with the speech therapist we focused on exercises to ‘manage’ (hide, avoid, evade) my stuttering, and this only increased my anxiety, to the point that I no longer wanted to go to school. As much as we try to convince ourselves that we can ‘manage’ it, inside we know that we cannot, that sooner or later we will lose control, that sooner or later something unpredictable will happen… the anxiety, in my case (I am a covert stutterer) stemmed from this internal conflict.
I hope I have given you an answer, however incomplete!
Andrea
Hi, Ryan. Thank you for these excellent questions.
I will answer from a purely personal perspective, and one which may not be ideally suited for all who stutter. Indeed, dealing with anxiety and stuttering would probably be quite different for each individual who stutters.
First I will answer as to what helped me more than anything else in dealing with stuttering anxiety. This answer might surprise people who are familiar with my personal journey with stuttering and different therapeutic approaches, as these days I strongly embrace the concept of self-acceptance, and don’t embrace fluency shaping techniques as I used to.
From the now-defunct Precision Fluency Shaping Program, I learned quite a few very helpful fluency techniques, and the one that I found most helpful in reducing anxiety was a method of relaxed diaphragmatic breathing. This technique was called the “Full Breath Target”.
Although I no longer practice fluency shaping techniques as a general rule (my philosophy now is to fully embrace self-acceptance, to accept myself as a person who stutters, a person who happens to have a speech difference), I still find occasional practicing of the Full Breath Target to greatly help me in reducing anxiety before especially difficult situations.
The Full Breath Target can be summarized this way (a summary which I wrote as a practice guide, based on what was taught in the Precision Fluency Shaping Program):
INHALATION
1. Slow expansion of the diaphragm
2. Smooth expansion of the diaphragm
3. Relaxation of the throat and vocal tract
4. Relaxation of the articulators (lips, tongue, jaw) and mouth area
5. Comfortably full inhalation
TRANSITION BETWEEN INHALATION AND EXHALATION
6. No hesitation between inhalation and exhalation
7. Continued relaxation of the throat, vocal tract, and articulators as exhalation begins
EXHALATION
8. Relax the diaphragm to begin exhalation
9. Continue to exhale until diaphragm is fully comfortably relaxed
10. No aqueezing or forcing out air at end of exhalation
Then the breathing process begins again.
I often do a breathing exercise based on these principles before an especially difficult situation, and this generally helps me reduce anxiety – at least for a while.
The other question you asked concerns unhelpful advice for combatting anxiety.
Although individuals may be different in this respect, I found that it wasn’t helpful to suddenly throw myself into all possible situations in which I had anxiety about stuttering. This is an approach which some clinicians advise. When I followed this kind of advice, my stuttering fears/anxieties in my more difficult situations were really strong, and my stuttering was typically very severe. Then the difficulties I experienced in these more difficult situations “spilled over” into my easier ones.
For me – and I believe for many others who stutter – a better approach is to focus on gradually increasing one’s comfort zone little by little. In other words, one reduces avoidances gradually, rather than suddenly all at once. One would first face many easy situations, then work on moderately difficult situations, then more difficult situations. Of course, sometimes one can’t avoid very difficult situations – they come up in life. But in that case, one learns to just accept that very difficult situations come up once in a while, and to then afterwards calmly continue to work on facing easier situations one is more comfortable with.
The idea here is to gradually expand one’s comfort zone, rather than jumping into everything all at once. I think many who stutter, like myself, would be comfortable with this type of approach in reducing avoidances and stuttering situational anxiety.