Factors that Turn Off/Reduce Stuttering
Hi Experts! I was just thinking, its a fact that most people who stutter don’t stutter all the time. For example, most of us will be able to speak with normal fluency when we are speaking or reading out loud in a room by ourselves and we are sure nobody is listening. Or often when we are speaking to people we are very comfortable around we become completely fluent as well. This proves that people who stutter are fully capable of speaking fluently. What are the factors that lead to stuttering being switched off in some situations? And more importantly what are the factors that lead to it being switched on in other situations? The most obvious answer I could think of is that stress seems to switch it on, but how does that happen? And I feel like there might be other factors besides just stress.
Excellent question, Alex. This is one of the greatest frustrations for PWS. Knowing that you can speak fluently in one context, then not being able to carry it over into another, makes PWS annoyed and sometimes angry. You are correct in your thinking, communication stressors are at least partly to blame. Fear of stuttering often contributes to increased stuttering. And increased stuttering leads to more stuttering. People and environments that are intimidating, time pressure, fatigue, low confidence levels, excessive background noise, no face-to-face exchange (e.g., telephone calls, drive thrus), high cognitive demands and linguistic complexity can all add to stress and make it difficult to maintain fluency. If there are no people around or you are in a familiar comfortable situation, then there is little to no fear. Stress is low and fluency is high.
Oftentimes in therapy, I have PWS complete a Worry Ladder in which they identify situations that bring them the lowest amount of stress then progress upwards to the highest amount of stress. Quite typically, frequency of stuttering directly correlates with the level of stress the situation brings. After identifying the level of “worry” that comes with each situation, we work on reducing negative reactions that arise in each of those situations. We spend some time reviewing all of the negative comments that pop into his/her head (e.g., “This person thinks I don’t know what I am talking about”) and try replacing them with more positive or neutral thoughts (e.g., “This guy does not understand what stuttering is.”) Practicing desensitization tasks, like pseudo stuttering, can also help reduce fear and strong negative reactions to disfluencies.
Identifying stressful situations and minimizing negative reactions in various situations may lead to increased comfort with communication and potentially lead to higher levels of fluency. It’s also possible to work on reducing negative reactions while simultaneously practicing fluency shaping techniques. I have had a number of PWS report that it was “too difficult” to use any fluency shaping techniques in situations where their stress levels were high. It benefitted them to use techniques from cognitive behavioral therapy (CBT) and pseudo stuttering to help reduce fear and stress. When stress levels were lower, they were able to focus on fluency shaping techniques. While not every PWS chooses to utilize fluency shaping techniques, it’s good to know they can go hand-in-hand with other therapy methods.
This topic usually leads to a great discussion, Alex. I hope this response was at least somewhat helpful to you.
Best,
Tricia
Thanks for the reply! Makes sense Tricia! Fluency shaping doesn’t work for me, but I think pseudo stuttering sounds like a great idea! It seems like trying to hide stuttering makes the stuttering worse, so I can definitely see how that would help.
Hi Alex,
Why do stutterers sometimes stutter and sometimes speak fluently? You ask one of the oldest and no doubt one of the most frequent and perplexing questions about stuttering. I would imagine that if you polled people on the street–including stutterers and speech-language pathologists–what most intrigued them about stuttering, your question would come up perhaps second to “What causes stuttering?”
I would expect that every expert you might ask will give you a different answer, and probably they will all be partly correct. You are right that a host of factors are involved. I won’t attempt to answer your question, but I will offer a few thoughts.
First, there is a body of research which shows that “fluent” speech of stutterers is likely not quite “normal.” For example, using sophisticated measuring instrumentation, articulatory dimensions such as voice onset time are observed to be delayed or different in average stutterers from what is observed in nonstuttering speakers. Note that I wrote “average” in the previous sentence. I would expect that there are cases in which a stuttering person’s fluent speech IS completely normal.
Second, you are right that “stress” or whatever you might want to call negative emotion does typically result in more stuttering. Various parts of the brain have been implicated, such as the hippocampus or limbic system. It is likely that stutterers are less able to manage emotional influence on their motor speech control than people who don’t stutter. But, again, not always! For example, anger typically is associated with fluent rather than nonfluent speech. Also, sometimes in periods of terror or grief, stuttering disappears. Apparently, the “stress” you talk about needs to be at a threshold level but not beyond an upper threshold. It probably also needs to be “habitual” enough such that the newness of an emotional event does not mitigate the stutter-inducing effect of the stress. (People used to call that phenomenon “distraction,” a good term but probably much oversimplified.)
Third, I’ll comment on my own experience, which is probably pretty rare, about the “switch” you mention. In my case, I went through a period in speech therapy during my university years when I could “switch” from real stuttering to almost complete fluency whenever I chose to. At one point, my clinician and mentor, Bill Leith, referred to my two modes as “K-1” and “K-2.” Once during a lecture/demonstration by the late Joe Sheehan, with Bill holding up one finger or two (for the two “K’s”), I pretty much fouled up Joe’s demonstration of what a stutterer should and should not do in various stuttering-inducing (e.g., oral reading in front of a large audience) and fluency-enhancing situations (e.g., auditory masking). I can’t do that as well as I could then, but I can still “switch” from the “stuttering me” to the “fluent me” at will. I like Per Alm’s hypothesis of a “medial” and “lateral” system that seamlessly switches in normal speakers but breaks down in stutterers, because the medial system is awry.
That’s probably enough rambling for this answer. Thanks for the question.
Thanks for the reply Ken! I’ve definitely experienced the effect anger has on my speech. It seems to be something about the angry voice, not the emotions of anger that turn off the stuttering. Sometimes when I would stutter people would say “Scream at me” and then I would immediately stop stuttering. I wish I could just scream all the time.
How did you manage to learn to switch back and fourth between stuttering and almost complete fluency? I can definitely purposely turn my stuttering on and make it pretty much exactly like real stuttering, but unfortunately I can’t just turn it off whenever I want. Do you just leave it turned off all the time? Are there some situations where you can’t quite turn it off all the way?
Alex,
Honestly, I don’t know how I can do the switch. It just happens. Of course, sometimes I get caught in a real stutter and cannot switch–more like the old days. But if I do some voluntary stuttering, I can usually get back to my almost complete, unmonitored fluency. Now I must say that my “fluency” is really not very fluent from a normal disfluency standard. I have a gazillion “uh’s” and “um’s” in my speech, but they are definitely not stuttering. I have a colleague who thinks that I also have a cluttering component. Maybe so.
Sorry, I have never been able to tell any of my hundreds of clients how they might be able to switch like I do. I mentioned that it is apparently quite rare.
Ken
The comments above seems to cover quite much of your questions, Alex, so maybe my comment will not give you much. I also find Per Alm useful as a source in this matter. Anyhow, let me see if I can add something into this dialogue: We know that the brain is working very differently, and that our brain is during the day continuosly analyzing situations and next steps what to do or how to react. The cognitive load is therefore changing much from one situation to another. When you speak or read when you are alone or if you talk to a dog or a child,I assume that the cognitive load is lower compared to what is the fact when you are in a situation where there is of high importance to communicate or to make yourself clear, and there are lots of people liten to you (or a person you are not confident with, is in the room), in which your cognitive load is increasing. Ken’s referring to Alm’s medial and lateral system is one hypothesis which I find interesting myself. In the same time, we know that even this hypothesis might be challenged, especially when we listen to some people who stutter who confirm that they hardly do not stutter when they are not thinking about their speech or stuttering at all. Looking forward to read what others may comment on your very important and often asked question.
I’m interested in your cognitive load hypothesis. How do you think the cognitive load effects speech? By reducing the brains ability to come up with a phonological plan? Or send a proper signal to the articulators? Or does the increased cognitive load increase the tension in the vocal folds or lips and tongue which makes speech more difficult? And is there any way to keep the cognitive load low all the time, so that every speaking situation is just as easy as talking in a room by myself?
I agree with what Hilda wrote, though others would describe similar ideas using different constructs. For example, Bloodstein did his Ph.D. dissertation looking at about 115 different factors that reduce or vary stuttering, a few of which were alluded to in the comments in this thread. But, rather than using the idea of “cognitive load,” he would explain it in terms of “propositionality,” or the idea of some speaking situations hold more importance for the speaker. He developed a “communicative pressure hypothesis,” which basically stated that some of these “fluency enhancing conditions” work because there is less pressure on the PWS to speak (e.g., speaking alone, speaking to a pet or baby, choral reading, etc.). This is certainly not the only plausible explanation for these phenomena, but it was novel in the 1950s for sure, and still has relevance today, in my opinion.
Makes sense Paul! That’s definitely been my experience. I guess we don’t know how pressure to speak triggers stuttering though, hey? That seems to be the key question.
I wish I would be a person who would have much more knowledge about the human brain and how the brain is functioning and contributing to language processing and speech. Anyhow, as a non-professional in neuroscience I will share some of my reflections (which is based on other scientist work of course): We know that the brain is working in networks or as networks, and based on this information, I assume that that there might be different ways in which the cognitive load is effecting speech. If we consider the myelinum as one interesting factor regarding stuttering, then how the brain is sending proper signals to other speech related areas are of high interest. As we know, there are several processes involved in speech; from the level of linguistic and motor planning, up to motor programming and motor execution. Since we also can assume that emotions is very much influencing our speech production, there might be several other networks involved as well. To locate a specific area is therefore difficult (or impossible?:-)) Anyhow, you are asking relevant questions, and I think that there still are quite many questions we have for the neuroscientists to find out. How each person is coping with stress related situations or situations wich involve a high cognitive load level (?), is often a matter of training, even though you stutter or not. We know that exposure exercises are effective for people who stutter as well, either with or without other speech or cognitive restructuring elements included.