Note from ISAD Online Conference Committee:  Many of the websites linked in this paper are French language.  If you do not speak French and would like to gain some understanding of the content of the site, we recommend you use the Google Chrome browser, which should offer an automatic translation of the page content when loaded.

About the authors:

Hélène Bodson has a Master’s degree in linguistics where her thesis focused on First Nations children’s language. She is completing her MHSc in speech-language pathology at the University of Ottawa. Stuttering, speech sound disorders and bilingualism are among her interests.

Pat Roberts has been a professor in speech-language pathology at the University of Ottawa since 1995. Stuttering is one of her areas of interest, both in her clinical work, and her research.

Introduction

Stuttering is probably as old as speech itself (Wingate, 1997). Aristotle’s theory on the equilibrium of the humors may be out of date, but the quest for a cure certainly isn’t. Online, one can find many websites offering solutions. However, websites do not always have reliable information (Scullard, Peacock, & Davies, 2010). People who stutter (PWS) and the parents of children who stutter increasingly look to the internet for medical information and base their opinion about therapies on what they find online. It is therefore relevant to ask: how accurate is what the internet says about stuttering?

This paper is a brief attempt to answer this question. Two aspects of the cures for stuttering found online will be evaluated: (1) treatments for anxiety, and (2) treatments and advice to consult or buy online.

Method

Only the most accessible websites claiming to cure or diminish stuttering were used in the current paper. The research was conducted online from May to July 2014. Using Google’s search engine, we searched the Web for key words related to stuttering, cure, and solution. The first 30 sites found in French and in English were analysed.

The claims made online were then compared to what the scientific literature says (i.e. the PsycINFO database, Google Scholar). The themes retained for analysis met the following two criteria: (1) the existence of a scientific (peer-reviewed) literature on the topic; (2) a risk of financial or psychological damage to people who stutter (PWS) who follow the online advice.

Results

In this paper, we will discuss the accuracy of the information found online about therapies that aim at anxiety reduction and, finally, programs and advice that can be found for free or bought online. Each website mentioned is identified by number in the text.  Each number relates to the list at the end of the article and also hyperlinks directly to the website. Journal articles and books are listed by author’s name in the list of references.

Three approaches to reduce anxiety

Communication situations can be stressful for PWS. While stuttering is not caused by anxiety (Craig, 1990; Guitar, 2014; Ingham, 1984), anxiety can influence stuttering in ways that seem complex and are not yet fully understood (Craig, Hancock, Tran, & Craig, 2003; Craig, 1990; Helgadóttir, Menzies, Onslow, Packman, & O’Brian, 2014). There is no guarantee that a reduction of anxiety will reduce stuttering severity in adults.

What the Internet says

Amongst the most popular sites are those claiming to reduce or cure stuttering through hypnosis, yoga, or meditation.

Hypnosis. Some websites promoting hypnosis promise a cure for stuttering or have ambiguous statements that do not explicitly promise a cure, but imply a reduction of stuttering (4). However, the confident tone seems to encourage readers to believe that hypnosis can cure stuttering. Other sites are bolder (and ethically worse): they explicitly promise a cure (9).

Yoga. Some yoga schools claim that yoga can be used for any condition. Unsurprisingly, it has also been considered as a stuttering treatment. Some claim daily yoga practice can help control or even cure stuttering. Some yoga websites mistakenly describe stuttering as a secondary effect of anxiety (11). Others state boldly (and falsely) that yoga is a remedy for stuttering. This is notably the case in Balakrishnan’s book: Yoga for Stuttering (12). Written by a speech-language pathologist (SLP) holding ASHA certification, this book was written for the PWS who have not been helped by other therapies. The book proposes yoga (including some meditation) as a way to achieve fluent speech.

Meditation. Some websites suggest meditation as a solution for stuttering. Unlike most websites proposing hypnosis or yoga, meditation websites rarely promise a cure. On some websites, “cure” is redefined. It does not mean stopping the stuttering, but being able to do anything one wants despite the stuttering (14). Similarly to yoga, an SLP, Silverman published a book in 2012: Mindfulness and Stuttering (16). A paper on this topic was also part of the 2011 ISAD (15). Based on her personal experience, Silverman proposes that Mindfulness-based stress reduction (MBSR) can help stuttering by reducing the amount of stress and negative self-talk. The author writes that constant practice of MBSR can improve quality of life and help with fluency. She does not promise a cure; instead, she presents meditation as an aid.

What the science says

Relaxation methods, such as breathing control, have traditionally been used in stuttering therapy (Gilman & Yaruss, 2000). These can reduce anxiety and sometimes secondary behaviours. We will now briefly review what science has to say about hypnosis, yoga, and meditation.

Hypnosis. The American Psychological Association (APA, 2014) has recognized hypnosis as a procedure that can induce a state of relaxation. Many authors promote hypnosis because relaxation can diminish fearfulness in communication situations (Ingham, 1984). Barker, Cegala, Kibler, and Wahlers (1970) considered hypnosis to be preferable to desensitisation, because it requires less effort from the PWS. However, there is no evidence that hypnosis has long-term effects (Bloodstein & Bernstein Ratner, 2008; Van Riper, 1973).

As with all stuttering treatments, transfer and maintenance are challenges faced by hypnotherapy (Bloodstein & Bernstein Ratner, 2008; Van Riper, 1973). Studies demonstrating the efficacy of hypnosis as a treatment for stuttering are flawed. In most, stuttering severity pre- and post-treatment and long-term outcomes are not measured at all or are measured in ways that do not meet basic reliability standards (e.g. Lockhart & Robertson, 1977; Moss & Oakley, 1997). In two recent studies, PWS who received hypnotherapy reported no long-term benefits and low levels of satisfaction (Euler, Lange, Schroeder, & Neumann, 2014; Yaruss et al., 2002).

One study claims hypnosis can help reduce stuttering severity after just 8 sessions (Kaya & Alladin, 2012). The study, unlike many, includes a detailed description of the method, which involves abdominal weightlifting to improve breath control, slowed speech (learned in a single session), hypnotic suggestion, and prayer. One year after the treatment, most participants (55 out of 59) reported they still had fluent speech. No speech samples were analysed at follow-up. Although the results are encouraging, the authors note that it is impossible to know which aspect of the treatment contributed most to the progress observed (Kaya & Alladin, 2012). A placebo effect cannot be ruled out in this very weak, single-group study.

Knowledge about stuttering and hypnosis is incomplete. It seems that hypnosis can be helpful for anxiety (Mairs-Houghton, 2012). However, does hypnosis cure stuttering? Given the current, available information, our reply is the same as Van Riper’s in 1973: “No!”.

Yoga. Unfortunately we have been unable to obtain a copy of Yoga for Stuttering (12) (if anyone has a copy, please contact one of us!). One review of the book says it states that “stuttering [is] caused by a disorder in the brain’s right hemisphere” (12). The description of the book, as shown online (on Amazon and the publisher’s website), proposes yoga as an alternative to medication and electronic devices. This could be interpreted as meaning that these are the two main approaches offered by speech language pathologists or other professionals. Yet there is no effective medication for stuttering (Caveney, Giordani, & Haig, 2008) and electronic devices are not often used by clinicians treating PWS (Ramig, Ellis, & Polland, 2010). The back cover of Yoga for Stuttering suggests that fluency will be achieved with yoga through relaxation. As with hypnosis, the claim that yoga can cure stuttering seems to be based on the incorrect assumption that anxiety causes stuttering.

One study on the relationship between yoga and stuttering observed a reduction of participants’ stuttering severity and anxiety level after yoga classes (Kauffman, Molden, Hailperin, & Klein, 2010). These results are encouraging, but await confirmation (repeating the study with a larger group and with a suitable control group, for example). Therefore, as of today there does not seem to be convincing evidence that yoga could be an effective treatment for stuttering.

Despite the common belief that yoga reduces anxiety, the evidence on this is mixed. Some authors remain skeptical and conclude that this benefit of yoga has yet to be proven (Kirkwood, Rampes, Tuffrey, Richardson, & Pilkington, 2005; Li & Goldsmith, 2012; Saeed, Antonacci, & Bloch, 2010). Other authors report decreased anxiety measured both by self-report (Rao et al., 2009; Streeter et al., 2010) and by physical changes, such as changes in levels of neurotransmitters (Streeter et al., 2010). Although many studies have flaws such as lack of randomisation (Field, 2011), recent studies have shown yoga to be effective for anxiety reduction in healthy adults (Streeter et al., 2010) and in those with some medical conditions (Field, 2011; Rao et al., 2009). Interestingly, many yoga classes include a period of meditation, making it impossible to separate the contribution of the physical postures from the period of meditation.

Meditation. Different forms of meditation, including MBSR, have been shown to reduce anxiety in a variety of contexts (DeBerry, 1982; Grossman, Niemann, Schmidt, & Walach, 2004). Transcendental meditation and MBSR can reduce the anxiety of PWS (de Veer, Brouwers, Evers, & Tomic, 2009; Mc Intyre, Silverman, & Trotter, 1974). MBSR can also help with the desensitization process in PWS (Boyle, 2011; Plexico & Sandage, 2011).

MBSR influences the autonomic nervous system (Greeson, 2009; Tang et al., 2009). Meditation also affects the activity of the parasympathetic nervous system (Ditto, Eclache, & Goldman, 2006) and increases control over stress (Tang et al., 2007). Moreover, many benefits for mental health and quality of life have been observed (Grossman et al., 2004).

 Stress can make motor control more difficult, especially fine motor movements. This is something we all see in daily life. It seems logical, therefore, that lowering stress levels might help PWS reduce some moments of stuttering. Meditation and relaxation techniques might help improve quality of life of PWS.

A misunderstanding of the relationship between stuttering and anxiety seems common in the explanations presented by websites, especially those that propose hypnosis or yoga. The promoters of meditation advise it for anxiety reduction in PWS. Everyone can benefit from reducing stress and anxiety levels. Critically, however, there is no clear evidence that anxiety causes the disorder of stuttering. Moreover, these interventions and the related merchandise (e.g. DVDs) cost money.

Treatment programs and advice for people who stutter

Online, other than the treatments for anxiety, videos, recommendations and programs are offered to the PWS looking for a solution.

What the Internet says

A wide array of websites offer solutions to stop stuttering or control it. Quite a few of these websites are written by PWS. Blogs contain messages, videos, and programs to cure stuttering (18a, 18b, 18c, 19a, 19b, 20, 21a, 21b). The resources offered can also help PWS deal with negative emotions related to stuttering. While some blogs redefine “cure” as talking without fear of shame rather than perfect, fluent speech (18a, 18b, 18c), other blogs have ambiguous statements, speaking of “getting rid of stuttering” and then stating that no cure exists (19a, 19b). Some blogs offer novel methods (20) or adaptations and variations from speech-language pathology methods (19a, 19b, 21a, 21b, 26a, 26b). Some offer guarantees (20), while others offer testimonials about techniques (18a, 18b, 18c).

Life coaches and associations also offer programs to PWS. With no more credentials than being PWS themselves (27, 29), some offer advice for free (22a, 22b, 23, 29) others for a fee (24, 26a, 26b, 27). Some websites claim relaxation or staying below a threshold of laryngeal tension can cure stuttering (22a, 22b, 25). Others propose articulation exercises to relax the speech mechanism (23). Some claim stuttering can be treated by exhibiting confidence (29) or that PWS chose to stutter and, therefore, can decide to stop stuttering (30). Such claims can be harmful for PWS since they give unrealistic hope. Sites claiming that stuttering is a choice place a heavy burden of blame on PWS.

Another resource found online is the McGuire program. Run by PWS, this program promises acceptance of stuttering, psychological wellbeing, deep breathing and “eloquence”. Its founder claims that fluency comes naturally with acceptance and eloquence (26a, 26b). Little research supports the program despite its 20 years of existence and relapses are known to occur (26a, 26b). Whilst the opinions of SLPs are welcome, they are advised to not use the program (26a, 26b).

What the science says

None of the previously mentioned programs and advice would pass the twelve tests mentioned by Bloodstein and Bernstein Ratner (2008) to demonstrate the effectiveness of stuttering treatments. Only the Valsalva program website has data (25) and websites generally don’t mention drawbacks or failures. Only the McGuire program mentions maintenance and relapses (26a, 26b).

Many websites propose desensitisation or tips to deal with psychological aspects of stuttering (18a, 18b, 18c, 19a, 19b, 20, 24, 26a, 26b, 27, 28). Although it is an essential part of many therapies, by itself, desensitisation has a very limited short- and long-term impact (Andrews, Guitar et Howie, 1980).

Some websites propose methods based on stuttering modification or fluency shaping techniques (18a, 18b, 18c, 19a, 19b). These adaptations are not always accurate (18a, 18b, 18c), but their authors generally mention disclaimers (18a, 18b, 18c, 20).

Some sites state – incorrectly – that tension in the larynx is the cause of stuttering (20, 25). While some PWS experience blocks due to laryngeal tension, others do not. The larynx cannot be considered as the primary source of stuttering.

Support groups can be helpful for PWS (Yaruss et al., 2002) and some websites (18a, 18b, 18c, 19a, 19b, 20, 26a, 26b, 27) offer a supportive environment. Nevertheless, the inaccurate information found in cyberspace can mislead PWS into false hope, expensive ventures, or both.

Conclusion

One must be cautious when consulting websites about stuttering treatment. The solutions found online are sometimes supported, to some degree, by science, though more often, not. However, none can offer reliable information about long-term effects of the techniques and products they recommend. Some can be expensive. Many make promises that are unrealistic and misleading. Several websites misrepresent the methods used by SLPs (e.g. medication).

Clinicians, PWS and their relatives should be cautious about information found on the Internet. It would be helpful to have a list of reliable sites or pages available on-line, although given how websites appear and disappear, this might not be feasible. Websites claiming there is one key, one cause, or one remedy to stuttering should raise a red flag in the reader’s mind: a warning sign that a website’s information is likely incorrect.

We invite readers to share their thoughts and to comment on this paper. We are currently working on a more detailed report on what the Internet says about stuttering.

Examples of websites and resources available online

(All websites were consulted in May and July 2014)

Three approaches to reduce anxiety

Hypnosis

1. Forum: L’hypnose comme solution pour vaincre le bégaiement? (Hypnosis as a solution to conquer stuttering): http://www.transe-hypnose.com/sujet/lhypnose-comme-solution-pour-vaincre-le-begaiement.214/
2. Hypnotherapy clinic: Traitement du bégaiement en hypnothérapie (Treatment of stuttering in hypnotherapy):
   1. Article: http://www.orgadia.com/hypnotherapeute-paris/hypnotherapie-articles/hypnose-begue-begaiement-trouble-langage-pathologie.htm
   2. Testimony: http://www.orgadia.com/hypnotherapeute-paris/hypnotherapie-temoignages/hypnose-begue-begaiement-trouble-langage.htm
3. Blog: Vaincs ton bégaiement et accomplis tes rêves – Mon Histoire (Conquer your stutter and realise your dreams – My story): http://www.begaiement.com/mon-histoire/
4. 1. Stop stuttering with hypnotherapy: http://www.hypnosisdownloads.com/clinical-hypnotherapy/stuttering
   2. Hypnosis for stuttering (or stammer): http://www.hypnosis.me.uk/pages2/stuttering.html
5. Hypnotherapy directory: http://www.hypnotherapy-directory.org.uk/articles/stuttering.html
6. Can hypnotherapy assist people who stammer?: http://www.masteringstuttering.com/articles/can-hypnotherapy-assist-people-who-stammer/
7. Enfants, bégaiement, hypnose (children, stuttering, hypnosis): http://www.docteur-hypnose.com/fr/traitement-par-hypnose/guerir-famille/traitement-begaiement-enfant-hypnose-aa140.html
8. Video: Séance hypnose pour diminuer le bégaiement (hypnosis session to reduce stuttering): https://www.youtube.com/watch?v=7HDJBvvMxxA
9. Benyan hypnosis center: http://www.hypnosiscenter.com/hypnosis-scripts/hypnosis-script-stuttering-patter.htm

   Yoga

10. Online book: Yoga et psychothérapie (yoga and psychotherapy): http://auriol.free.fr/yogathera/YetP/c1-therapie.htm
11. How Yoga Helps Control Stuttering: http://fscigroup.com/cures-for-stuttering/How_Yoga_Helps_Control_Stuttering.php
12. 1. Balakrishnan, J. M. (2009). Yoga for Stuttering: Unifying the Voice, Breath, Mind et Body to Achieve Fluent Speech. North Atlantic Books.  http://www.amazon.ca/Yoga-Stuttering-Unifying-Breath-Achieve/dp/1556437684
    2. Review of the book: http://www.bookclubs.ca/catalog/display.pperl?isbn=9781556437687
13. Yoga for curing stammering: http://www.yogawiz.com/askquestion/390/yoga-for-curing-stammering-want-yoga-exercise-to-c.html

    Meditation

14. Newsreport: Thomas, guéri du bégaiement grâce à la méditation (Thomas, cured from stuttering with meditation) : http://www.francetvinfo.fr/societe/video-mettre-en-route-le-travail-sur-soi-pour-combattre-le-begaiement_441384.html
15. ISAD paper: Silverman, E.-M. (2011). What to expect from mindfulness. International Stuttering Awareness Day.  https://www.mnsu.edu/comdis/isad15/papers/silverman15.html
16. Silverman, E.-M. (2012). Mindfulness et stuttering: Using eastern strategies to speak with greater ease. North Charleston, SC: CreateSpace.  http://www.amazon.ca/Mindfulness-Stuttering-Eastern-Strategies-Greater/dp/1478385111/ref=sr_1_1?ie=UTF8etqid=1404235847etsr=8-1etkeywords=%27Mindfulness+%26+Stuttering.+Using+Eastern+Strategies+to+Speak+with+Greater+Ease%27%27+de+Silverman%3F
17. Mindfulness and Stuttering: How can mindfulness help?: http://www.stammeringresearch.org/mindfulness.pdf

    Programs and recommendations for PWS

18. Blog: Je bégaie (I stutter):
    1. http://www.jebegaie.com/
    2. About a cure for stuttering: http://www.jebegaie.com/begaiement-conseils-et-informations-pour-le-surmonter/guerir-du-begaiement-mythe-ou-realite-laurent-de-goodbye-begaiement-est-mon-invite
    3. About techniques to control stuttering: http://www.jebegaie.com/begaiement-conseils-et-informations-pour-le-surmonter/technique-stop-n-go-pour-maitriser-et-controler-le-begaiement
19. Blog: Goodbye bégaiement (goodbye stuttering):
    1. About stopping stuttering in 1 week: http://goodbye-begaiement.blogspot.ca/2011/01/comment-cesser-de-begayer-en-1-semaine.html
    2. About voluntary stuttering: http://goodbye-begaiement.blogspot.ca/2009/11/le-begaiement-volontaire.html
20. http://www.begaiement.com/methode/
21. Free method to stop stuttering:
    1. Blog: http://arreterdebegayer.over-blog.com/
    2. Forum: http://forum-begaiement.fr/j-ai-arrete-de-begayer-methode-gratuite-t3029.html
22. Websites about the threshold hypothesis of stuttering:
    1. http://copingwithstuttering.blogspot.ca/2010/02/possible-cause-of-stuttering.html
    2. http://stuttersense.blogspot.ca/2011/10/on-threshold-of-stuttering.html
23. Report: Guérir du bégaiement (Stuttering cure): http://www.les7duquebec.com/7-au-front/guerir-du-begaiement/
24. Program: Association vaincre le bégaiement (Conquer stuttering association): http://www.vaincre-le-begaiement.fr/index.php?p=12
25. About the valsalva hypothesis of stuttering: http://www.valsalva.org/NSA2011.htm
26. The McGuire Program:
    1. Newspaper article about the McGuire Program: http://www.dailymail.co.uk/health/article-1251301/I-stammer-stutter-halt-Remarkable-cure-offer-hope-thousands.html
    2. The McGuire Program’s official website: http://www.mcguireprogramme.com/en
27. The PRO9OD Speech System: http://pro90d.com/
28. Wikihow: How to stop stuttering: http://www.wikihow.com/Stop-Stuttering
29. Video: How to stop stuttering – 3 tips to start speaking fluently: https://www.youtube.com/watch?v=4lfcMNSd0RI
30. Video: Tony Robbins – 30 years of stuttering, cured in 7 minutes!: https://www.youtube.com/watch?v=3eOJaprDCDA

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