About the authors:  Heather L. Grossman, PhD, CCC-SLP, BCS-F has worked with children and adults who stutter for over 25 years and was among the first select group of speech-language pathologists to receive board recognition as a specialist in the treatment of fluency disorders from ASHA. She has been the Director of the American Institute for Stuttering (AIS) in NYC since 2011. Dr. Grossman is extremely active in the stuttering self-help community. She is a frequent presenter at conferences of the National Stuttering Association and FRIENDS – the National Association of Young People who Stutter as well as national and international professional conferences. Before joining AIS, she was the speech services coordinator at Hofstra University and an adjunct professor at Long Island University, Mercy College, and Queens College. She received her doctorate degree in 2008 at the University of Louisiana at Lafayette where she researched aspects of the phenomenon of voluntary stuttering.

About the authors: Gunars K. Neiders, Ph.D. Elec. Eng., Psy. D. He is the author of the dissertation entitled “Theoretical Development of a Proposed Rational Emotive Behavior Therapy Based Model to Treat Persons with Chronic Perseverative Stuttering Syndrome” and book “From Stuttering to Fluency: Manage Your Emotions and Live More Fully”. His experience as a person who stutters, a licensed psychologist in private practice in Washington State, USA, and stuttering coach over Skype, resulted in the paper “Rational Emotive Behavior Therapy of Stuttering via Skype: Case Series Studies” presented at the International Fluency Association 8th World Congress in Lisbon, Portugal, July 6-8, 2015. Dr. Neiders also works part time training Psychology Doctorate students. He is currently writing a workbook to document the step by step application of REBT to stuttering therapy.

What REBT Teaches

Rational Emotive Behavior Therapy (REBT), founded by Albert Ellis in the 1950’s, is considered the Granddaddy of Cognitive Behavioral Approaches. It is a form of psychotherapy and a philosophy of living that can be very effectively applied to stuttering treatment. It is an extremely helpful adjunct to other therapies, including avoidance reduction and stuttering modification approaches.

REBT is based on the premise that we do not become upset directly because of the events that happen to us. Rather, the beliefs we hold about these events cause us to become depressed, anxious, enraged, etc. If, for example, you feel someone is laughing with you, you will likely have a very different response than if you perceive them as laughing at you. The idea that our beliefs upset us was first articulated by Epictetus around 2,000 years ago: “Men are disturbed not by events, but by the views which they take of them.”

REBT helps people who stutter (PWS) work to identify, dispute, and come to modify the self-defeating, unhelpful core beliefs they have about their speech and stuttering. It provides an extremely powerful way of improving one’s emotional responses as well as physical aspects of stuttering. Rather than over-hauling the entirety of speech, REBT work modifies the intrusive thoughts that disrupt speech in the first place. The goal of this work is to achieve free-flowing speech.

A person with free-flowing speech:

• Communicates effectively. He says what he wants to say, where and when he wants to say it, with and without stuttering.
• Is open to self-disclose stuttering, to stutter openly, and talk about it with others, both casually and seriously.
• Recognizes that all people have breaks in their fluency and accepting that being perfectionistic about fluency is unhelpful.
• Stutters with varying frequency and tension but always with self-dignity and confidence.
• Recognizes that while he may prefer fluency, he does not demand it or put himself down for stuttering “too much.”
• Engages in minimal avoidance behaviors or use of tricks/crutches to minimize/push through moments of stuttering. When he reverts to these behaviors, he is self-aware and reacts without self-downing or having shame about shame!

REBT is a semantic therapy. This means that the words we use are critical, since they affect how we feel, think, and act. It is of the utmost importance that, following the example of General Semantics, during both self-talk and talk to other people, we use words wisely, both with respect to their actual meaning and with respect to the connotation that might have unintended consequences.

Core Beliefs that hinder Free Flowing Speech

We generally make ourselves miserable by holding onto a set of inflexible beliefs about how we, how others, and how the world “should” and “must” be. These are:

1. I must do well and win the approval of others for my performances or else I am no good.
2. Other people must treat me considerately, fairly and kindly, and just as I want them to treat me.
3. I must get what I want, when I want it; and I must not get what I don’t want.

The first belief often leads to anxiety, depression, shame, and guilt. The second belief often leads to rage, passive-aggression and acts of violence. The third belief often leads to self-pity and procrastination. It is the demanding nature of the beliefs that causes the problem.

In situations where PWS are not worried about possible negative consequences of stuttering and are not telling themselves they “should be fluent,” they usually find their speech flows more freely. The ultimate expression of this freedom comes about when the individual is speaking aloud when alone. You will note that at these times, the PWS is not using an external “tool” or “technique” to speak fluently. Rather, he/she is simply not engaging in negative self-talk or evaluative thoughts that serve as the source of extreme negative emotions, struggled speech, and self-defeating avoidance behaviors.

On the other hand, in situations where the PWS experiences strong negative reactions related to stuttering (for example, worrying that one will be laughed at in a situation where the listener appears judgmental) the following occurs:

• The belief “I should not stutter here” activates increased emotional activity
• There is an increase in stuttering frequency and severity (duration, struggle, tension)
• The individual attempts to avoid stuttering by pushing through blocks, engaging in secondary/accessory behaviors such as blinking of eyes and snapping of fingers and

and/or other self-defeating avoidance behaviors

The look of the judgmental listener does not directly cause this negative chain of thought, unhealthy over-emoting, and unhelpful behavior.  Rather, unhelpful core beliefs that perpetuate that stuttering is bad and something that should be hidden are the cause of unhealthy over-emoting and the forced, struggled speech.

We can further identify five categories of emotional “hot-links” as they apply to stuttering that hinder free-flowing speech:

1. Condemnation & Damnation of Self or Others. This is a belief that if a PWS does not live up to his/her expectations that he/she overcomes stuttering he/she should be damned and punished.
2. “I-can’t-stand-it”-itis. This is the devout and misdirected belief that a PWS can’t stand the discomfort and frustration of a given situation.
3. Awfulizing. When a PWS exaggerates the degree of badness of stuttering or spends too much time dwelling on some unfortunate event, he/she is said to be awfulizing.
4. I’m Worthless. This arises from the quaint belief PWSs should be rated and categorized as to their worth using stuttering as the determining characteristic. Your stuttering does not make you worthless just as fluency does not make an individual worthwhile.
5. Always & Never. This belief is frequently a pessimistic conclusion based on insufficient data. What sense does it make to say, “So far I have not been able to recover from stuttering, therefore I will never be able to do it.”

The real work of therapy is achieved by disputing and doing action-based exercises to counter the unhelpful thoughts and self-talk. Each belief is classified as irrational/unhelpful if all the following questions are answered in negative. For each inflexible demand or unhelpful belief, we explore: 1) where is the evidence? 2) does it logically follow from real-world observations? and 3) does it help the individual achieve his/her goals? If a belief is found to be irrational/unhelpful, these same questions can be used forcefully to convince oneself that the belief is not sound.

For example, “Why must I win everyone’s approval?” Upon exploration we realize that while it is fine to prefer being approved of by others, there is no reason why we absolutely must have this approval.

Learning to generate disputes for your own unhelpful core beliefs takes a great deal of practice, passionate questioning, repetition and consistency. We encourage clients to journal thoroughly as they go through this process.

You can live life fully with stuttering

REBT provides the solution to self-downing: unconditional self-acceptance, with or without stuttering. You don’t need to change a single thing except your attitude. Self-acceptance is available to you no matter what, even when you behave foolishly, and no matter how severely you stutter. You simply choose to accept yourself and nothing else is required.

Unconditional self-acceptance is a process where you actively acknowledge without judgment the following:

1. I am a fallible human being; I have my good points and my bad points
2. There is no reason why I must not have flaws
3. Despite my good points and my bad points, I am no more worthy and no less worthy than any other human being.

Acting on your positive self-talk will help you achieve self-respect and dignity

If you want respect, it sure helps you if you believe in yourself. You cannot expect another person to respect you if you do not treat yourself with respect. If you feel you are not being treated with dignity, you need to be willing to stand up for yourself.

Listeners will take their cues about how to treat you from you. Consider how you self-disclose your stuttering. Do not apologize or look defeated. Instead, stutter with confidence, maintaining normal eye contact and social contact with your listener. Request what you would like from your listener (eg. “Hello, I stutter, please be patient as it will take me some extra time to speak.”)

Try to be mindful of your self-talk about stuttering:

Rather than: Resenting that you HAVE to self-disclose, feeling it is something you are giving the other person,

Try: Recalling that self-disclosure allows you to stutter freely, and feel PROUD of how you disclose with confidence, even though it’s not always easy

Rather than: Condemning yourself for stuttering with struggle and tension,

Try: Giving yourself credit for saying what you want to say, especially since it may result in more stuttering. Remind yourself that you are resilient.

Rather than: Beating yourself up for avoiding a word or situation,

Try: Using the fact that you now have the awareness that these behaviors are NOT helpful as a positive reminder of how far you have come.

Rather than: Feeling bad because you let yourself get embarrassed that you stuttered,

Try: Having pride that you pushed through discomfort. You made eye contact even though you were uncomfortable stuttering.

 

Some activities to complement work on shifting unhelpful core-beliefs:

Sometimes the best self-talk and emotional state does not alone change the stubborn habits of forcing and struggling with the speech. There is after all, a learned motor component to stuttering akin to a habit. There are many ways to construct activities to further lessen struggled speech. We will introduce a couple samples here as they apply to REBT:

Hanging onto a stuttered word

What are you trying to accomplish?

You intend to show your whole brain that it is possible to not feel the urgency to get out of a block using a crutch or other avoidance. You are desensitizing yourself to moments of real stuttering so that you can become less negatively reactive to tense moments of stuttering. You are working on being fully present while you are stuttering. You are learning that you have agency regarding your stuttering.
What beliefs do you acquire?

1. “ I can learn to stay calm even when I stutter.”
2. “ I can stand disfluency no matter how severe and how long it is.”
3. “There is no reason why I cannot fully experience and explore my relationship with my stutter.”
4. “While it is not comfortable to stutter openly, especially in front of others, I am entitled to do so.”

How is it to be done?

Mindfully “catch” yourself in a moment of stuttering. Experiment with “holding” onto the position of your mouth and audibly extending the stuttered sound. Your intention is to break your habit of postponing, avoiding, or pushing through moments of stuttering and to be able to stay present and mindful when stuttering. It does not have to be tension-free or sound pretty. Hold the stutter a full 3 seconds longer than you otherwise would. Calmly continue speaking.

See demonstration by GN on YouTube at https://youtu.be/e-cC3WsBrTM

Begin by practicing for about 15 minutes while alone in the mirror. This is a faked version that in appearance is the same as the real thing. Then find a situation where real disfluencies come up so you can do it for real in front of your stutter buddy or therapist. Finally, do it in front of a friend or stranger or over the phone with the friend or stranger. Use REBT to convince yourself that nothing horrible, terrible, and awful happens.

Cancellations

What are you trying to accomplish?

You are trying to break your habitual pattern of stuttering with struggle and avoidance. Ultimately, cancellations train you to stutter in a more confident, forward-moving, non-avoidant manner. Since during moments of stuttering, it is difficult to not push through or use a physical secondary or other crutch, it is very helpful to modify these characteristics after they occur. You are building a new stuttering muscle memory. You are doing behavioral work to support the re-shifting of core beliefs that help you achieve free flowing speech.
What beliefs do you acquire?

1. “Even in the middle of a real-life conversation, I can practice stuttering openly.”
2. “I am allowed to take some extra time for my speech. There is no need to rush.”
3. “If these listeners are confused by what I’m doing, I can explain what I’m doing or I can just go about my business without worry!”
4. “Even though it is natural for my body to revert to avoidant stuttering, I still have the power to make change.”

How is it to be done?

See the following YouTube video for a demonstration.

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First practice alone. Simulate as best as you can what happens when you really have a tense stutter. Complete the entire word, stuttering through to the end. Then, take a very mindful pause of at least 2-3 seconds to contemplate your tense, avoidant stuttering behavior. Then, repeat the word, being sure to stutter the word voluntarily using free flowing bounces or another form of forward-moving intentional stuttering. Do not say the word fluently as this reinforces the idea that fluency is the direct goal of your work.

After practicing alone, find a situation where you stutter with a stutter buddy or therapist. Finally, try doing cancellations in front of a friend or stranger or over the phone. Again, you may find it difficult to successfully “cancel” each moment of tense stuttering. Notice your body and thoughts at these times; these are opportunities for growth.

Summary:

REBT, a powerful, evidence-based therapy, can help PWS identify, dispute, and come to change the self-defeating, unhelpful core beliefs they have about their speech and stuttering. This change results in improvements in both emotional and physical aspects of stuttering. For PWS, the tools of REBT not only increase the frequency of free- flowing speech, but also facilitate the achievement of self-acceptance, self-respect, and dignified treatment by others in work and school situations.

For further reference about REBT:

Clark (2008) SOS Help for Emotions: Managing Anxiety, Anger & Depression

Neiders and Ross (2013) From Stuttering to Fluency: How to Manage Your Emotions and Live More Fully.