About the Authors

Dr. Scott Palasik has been a Certified Speech-Language Pathologist for fifteen years. He’s an Assistant Professor at the University of Akron (UA) where he teaches graduate Fluency Disorders course (on campus and distance learning), Voice Disorders and Cleft Palate, and Support Systems for Families and Individuals with Communication Disorders, along with supervising graduate students in clinical Education. He also is the director of the Mindfulness ACT Somatic Stuttering Lab, and performs research with Acceptance and Commitment Therapy (ACT), unconscious and conscious attitudes about stuttering, and environmental and social effects pertaining to dysphagia. He has presented at many local, regional, state, and national conventions about Mindfulness and ACT. He has been a member of the ACBS (Association of Contextual Behavioral Sciences) for eight years and is the President of the Ohio ACBS Chapter. He is also the co-founder of the UA Campus walk for Suicide Prevention.

Dan Hudock, Ph.D., Certificate of Clinical Competence of Speech-Language Pathology (CCC-SLP), is an Assistant Professor at Idaho State University in Pocatello, Idaho, USA. As a person who stutters himself, he is very passionate about fluency disorders and helping those with fluency disorders. One aspect of his research interests resides in exploring effective collaborations between Speech-Language Pathologists and Mental Health Counselors for the treatment of people who stutter. He is also Director of the Northwest Center for Fluency Disorders, which hosts a two-week summer intensive clinic. For more information about research, clinical, or support opportunities please visit http://www.northwestfluency.org/.

Chad M. Yates, Ph.D., Licensed Professional Counselor (LPC), is an assistant professor in the Idaho State University’s Department of Counseling. At ISU Chad teaches group counseling, basic counseling skills, addictions, and assessment and research procedures. Chad’s counseling experience includes working with individuals with substance abuse disorders, batterers and survivors of domestic violence, families, and as a generalist treating many diverse client concerns. Chad has served as the mental health coordinator for the Northwest Center for Fluency Disorders at ISU. He has helped to develop the Acceptance and Commitment Therapy (ACT) manuals and procedures for clients and clinicians at the clinic and supervises the counselors providing ACT.

How often do we live every moment, and every behavior (ACTion) by what we believe? As a person who stutters (PWS), how often do you make sacrifices for your desire to communicate and share with others, because negative thoughts arise related to your stuttering?  Our minds are powerful sources that can influence choices about how we choose to talk. But like Russ Harris (2009) wrote, “Your mind is not your friend-or your enemy…It’s very useful for all sorts of purposes, but if we don’t learn how to handle it effectively, it will hurt us” (p.7).

Acceptance and Commitment Therapy (ACT) is an approach to address basic human suffering. The acronym, ACT, ( pronounced as one word) refers to taking “action” towards one’s values and encouraging movement. This simple word (ACT) can instill a sense of perceived control over negative thoughts and physical behaviors such as making choices of what speaking situations to speak in, what to say, how to talk, who to talk with, and when to engage with others. By moving towards more psychological flexibility, the idea of allowing one’s self to choose thoughts and actions despite the presence of negative thoughts, PWS can find freedom where historically they might have felt held prisoner by their own negative thoughts about themselves and their stuttering.

The ACT model consists of six principles:

1. Contact with the Present Moment – Being aware of your thoughts before, during, and after speaking situations
2. Acceptance and Willingness – Being willing to open up and accept any of your stuttering related thoughts and behaviors
3.  Thought Defusion – Observing your thoughts about stuttering and being able to let them go without judgment
4. Self as a Context – Seeing yourself as a whole person and understanding that stuttering along with your thoughts related to stuttering are aspects many other characteristics, behaviors, and experiences that make up the whole person
5. Defining Values – Knowing and defining what matters to you and relating your Values to speaking situations, stuttering moments, and beliefs and attitudes toward yourself
6. Committed Actions – Creating goals of self-acceptance and overcoming experiential avoidances by speaking in situations and interacting how you want to based on your values

These principles can be worked on in any order, but let’s start with Contact with Present Moment, also referred to as being mindful. Being mindful and present comes in all forms. One of the most common is asking a PWS to participate in guided meditations (focusing on the breath) with a Speech-Language Pathologist (SLP) or Mental Health Professional (MHP), focusing on the breath. When practicing mindful attention to the breath, PWS are learning how to live in the present. Mindfulness is not having a blank mind, in fact it is rare that we do not have thoughts coming and going. Instead, mindfulness is the practice of allowing thoughts to come and go freely without judgment. It can essentially retrain your mind to focus its attention on what is happening now instead of passing judgment on your racing thoughts.

Mindfulness can be a mechanism for PWS to bring awareness to their negative attitudes about stuttering and can also start the process of letting negative thoughts go. Not pushing thoughts away or replacing thoughts, but rather accepting thoughts as words without attaching judgments. Being more mindful and present of thoughts can teach PWS that they don’t have to act on negative thoughts, but that they can simply be willing to see them. This process may help PWS let go of past thoughts like, “I stuttered on the phone last month, and it was awful” along with letting go of worry filled thoughts, “I know when I say my name on the first day of school I will stutter and everyone will laugh.” These might be common thoughts related to the past and future events. So, getting in contact with the present moment allows PWS to live in the NOW.

Acceptance and willingness, the second principle of ACT, can allow a PWS to stand face to face with their feared or negative thoughts about stuttering. Acceptance does not mean you have to say: “I like stuttering.” In ACT, one doesn’t have to like something to accept it as a part of them, but instead acceptance is being willing to walk with stuttering and not let it hold you back from living the life you desire. For example, you may not like the fact that you stutter, but your stuttering is a part of you and has helped make you who they are. You may try to hide the fact that you stutter (e.g., with decreased eye gaze, changing words, or not talking when you want to). So by accepting your stuttering and yourself, you can enhance your identity and confidence. Trying to hide something takes a lot of time and effort, but by accepting stuttering and the thoughts related to it, you can reduce the impact that stuttering may have on you and you can start living your life.  So with ACT, acceptance means to be willing to make contact with negative thoughts in order to examine the thoughts your use to judge stuttering. Just being willing to connect with negative thoughts about stuttering can be one of the first steps toward accepting stuttering and can help decrease negative thoughts and behaviors.

Thought Defusion is the third principle of ACT. This principle can allow a PWS to let go of thoughts, all thoughts, without judging them. PWS can develop a variety of judgmental thoughts that may keep cycling through their minds. Thoughts like: “I will never talk perfectly,” “Stuttering is all I do,” and “I know people laugh at me every time I talk, so why bother talking.” These countless ways PWS create negative attitudes toward stuttering can be held on to and can cause avoidance during speaking (e.g., blocks, interjections, and/or avoidance of speaking entirely). Being able to see thoughts about stuttering as basic words and language, can help let go of negative attitudes built up over years.

With the ability to be present with one’s thoughts, accepting thoughts related to stuttering, and letting go of negative thoughts, a PWS can  step back and obverse themselves and their thoughts as a whole person with many different parts. This is the fourth principle of ACT, Self as Context. One way PWS can practice observing themselves as a context is to describe speaking situations and thoughts associated with an event in the third person, replacing “I” and “me” with your name and “he/she” and “him/her”. So if Dan felt he had a poor speaking experience ordering pizza, and he was practicing self as content language (a narrow observation of self), he might say:

 “I ordered a pizza last night and it was horrible. I was nervous, and was going to hang up, like I always do. When I did go to order I stuttered like crazy and couldn’t get a word out. I’m a professor who teaches speech language pathology, I can’t believe I still talk this way.”

If Dan was practicing self as context (a wide observation of self) he might say the following:

 “Dan called to order a pizza last night. Before ordering he noticed that he had thoughts about the other person hanging up on him. Just before ordering, Dan felt his chest tighten and his face was warm. He thought of hanging up, but he didn’t. When it came time to talk, he observed several stuttering moments. Some were a second long, some shorter. When Dan was finished he was aware of negative thoughts about his speech, and also noticed a sense of accomplishment for ordering the pizza. He looked forward to eating it.”

By describing behaviors and thoughts as a context, from an outside and wide point of view (e.g., “Dan noticed that he had negative thoughts about his speech”), it can allow a PWS to distance themselves from the thoughts and negative emotions attached to them. This allows them to see what happened during a speaking situation with decreased judgmental language. Once a PWS gets used to looking at themselves from a distance, they can move toward using first person language with “I” and “me” (e.g., “I noticed that I had negative thoughts about my speech”).

If asked, “Who are you?” what would you say? Most might list things they do (.e.g,  “I’m a student,” “I’m a dancer”). PWS might say, with some levels of self-judgment, “I stutter.” What’s important about this question is that the things we do, like dancing, being a student, and being a PWS, are parts of us but may not be who we are at the core. The fifth principle of ACT, Defining Values, is a time to discover the parts of us that can dictate the choices we make and how we want to live. Values are chosen by us, and not chosen by anyone else. Some common values that many people hold are, “To be honest to myself and others,” and “To be compassionate to myself and others.” What’s important about defining values is that they involve YOURSELF and OTHERS.  By adding “to myself” when defining values, it creates a commit to one’s self and a practice of living those values in a more conscious (mindful) manner.  Remember, living by our values is a process, which PWS can think about when planning how to interact in speaking situations. It is our values that move us toward accepting ourselves and our role as a communicator in any speaking situation we choose.

The final ACT principle is Committed Actions. A PWS is no different than a person with any other psychological barrier. Growth and commitment to actions is individualized to each PWS. One way to start thinking about committed actions is to develop a series of tiny, medium, and giant goals. For example, if Scott wanted to express a concern to his boss, and was anxious, he might list the following goals:

GIANT GOAL: “I will make a phone call to my boss about a concern I have.

 TINY GOAL “Once today I will think about making a call to my boss about my concerns.”

MEDIUM SIZE GOALS:  “I will write out what I want to say to my boss.” “Twice today I will practice picking up the phone and saying what I want to say to my boss.”

Each PWS is unique, so, tiny, medium, and giant size goals are relative to each person. Another example might include a giant goal of, “Dan will pseudo stutter when presenting to his class.” A tiny goal of, “Dan will pseudo stutter to himself five times today.” And a medium goal of, “Dan will pseudo stutter one time with his friend Chad.” As you see, by starting with a giant goal first you are setting your sights on the wide observation, followed by a tiny goal (seeing the first step), and then medium goals (creating steps along the path and moving toward the giant goal). Like Luoma, Hayes, and Walser wrote, “What matters most is maintaining forward movement and growth, not the amount or the rate of movement” (p. 166).

Acceptance and Commitment Therapy (ACT) can be seen as a way of life, not just a way to do therapy. ACT can help PWS create mental chooses and make decisions for themselves about how, who, what, where, and when they want to communicate with decreased judgments. ACT can allow PWS to be more psychologically flexible with the choices they make and how they live with stuttering. Being accepting and committed to one ’s self as a PWS can lead to the feeling of not needing to push away thoughts, or cling to thoughts. Rather, PWS can be present with their thoughts about stuttering, who they are and want to be. Defining values can help PWS be willing to choose and observe themselves as a whole person and in everyday actions and speaking situations.

Disclosure and Appreciation: Scott and Dan are PWS. Scott, Dan, and Chad would like to thank all of you who read this for being advocates for yourselves and PWS. It was our pleasure and honor to be a part of this wonderful conference.

With compassion and kindness,

Scott, Dan, & Chad

References

Harris, R. (2009). ACT Made simple: An easy-to-read primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

Luoma, Hayes, & Walser (2007). Learning ACT: An Acceptance & Commitment Therapy skills-training manual for therapist. Oakland, CA: New Harbinger.