Monday, December 24, 2012

Speech therapists' training does not include stress studies!

That elephant again ....

It's official - the training of speech therapists / pathologists does not include stress studies, as per the answers at the 2012 ISAD (International Stuttering Awareness Day) Online Conference in response to my questions. This seems to be a serious omission and probably a major reason why traditional stuttering therapy so often fails.

This blog has consistently stated that stress is a major factor in stuttering, and that it is not possible to truly understand stuttering if one does not understand stress. Stress studies have become a popular topic for medical journalists since the "father" of stress studies, the Canadian biologist Dr Hans Selye, began his research decades ago. Since then, much has been written about how stress impacts both people who stutter (PWS) and non-stutterers. Yet for some reason this research has not reached the speech therapy establishment.

Part of the reason for this inability to acknowledge stress is its hybrid position - stress is neither a purely psychological nor a purely physiological phenomenon, but a much more complex combination involving both mind and body - just like stuttering itself. Therefore the approach to stress as well as stuttering should be holistic, combining a fluent-speech technique with stress management to improve fluency.

My question to the speech therapists at the ISAD Conference was:

"Dear Panel, I have always wondered how stress - meaning the rate at which we live at any particular moment in time, as defined by the "father of stress studies", Dr Hans Selye, the Canadian biologist - fits in with stuttering. Some twenty years ago when the issue of stress and stuttering was discussed, speech and language pathologists (SLPs) would prefer to use the psychological term "anxiety", but these days more and more do seem to acknowledge that "stress", in the wider meaning as used by Selye, can play a major role in stuttering. For instance, a person may have high levels of stress without having feelings of anxiety. Yet many PWSs still do not seem to be aware of how stress impacts on their fluency. My questions are: Is stress the elephant in the stuttering room? And are stress studies part of the curriculum for SLPs and if not, should they be? Many thanks for your response and kind regards."

Two replies were posted, the first from Gary Rentschler who wrote: "Peter, I'm not sure that many have made the distinction between stress and anxiety. Thanks for making a thought-provoking point."

The second was from Kevin Eldridge:

"Peter, First of all, thank you for introducing me to Hans Selye. It ran a quick search and skimmed a bit of the information before responding. I feel that you bring up a very important distinction. I would agree that Stress and Anxiety are very different beasts. If I am understanding the little bit I read (and I do plan on reading more), in Dr. Selye's view, stuttering in itself would be the noxious stimuli that leads to stress. For many adults who stutter, one could assume that they are in the "exhaustion stage" of adaptation secondary to the long term presence of the noxious stimuli (the stuttering). Seyle talks about weakened immune system and biological damage being a result of this long term exposure to distress. I wonder if Seyle would look at it this way, and if he would expect PWS to have such damage at some level. I have practiced Mindfulness for a number of years now, and recommend my clients do the same... as a way to stay in the moment, and therefore decrease the effect of ANXIETY of future events, but Mindfulness work also reduces the effects of STRESS. I will have to think much more about this distinction. // On a personal note, as a PWS (who is also an SLP), I know that when I am stressed (not anxious) I am much more susceptible to speech disfluencies. This was even more noticeable earlier on in my "recover" process.// Thank you once again for introducing us to Hans Selye!"

I rest my case. What do you think? If you stutter and if you have had speech therapy before, do you think that speech therapists generally have a good grasp of stress, how it impacts on stuttering, and stress management? Feel free to take part in the poll:


  1. I find stress to be a fascinating factor when referring to stuttering. It is amazing that a very small amount of stress can have a huge impact on our speech. Here is how I put this into action. Most stammerers are fluent when alone. If I have a conversation aloud while alone, I am completely fluent. The minute you add in any sort of listener, even an answering machine, the speech changes. Add in someone I am extremely relaxed and comfortable with, and it still is not like speaking while alone. Are there different parts of the brain being used when talking alone and when talking with a listener? Or is it sometimes an imperceivable amount of stress that completely changes the dynamics of our speaking?

  2. Hi Jesse - I would say that the amount of general stress as well as the amount of local vocal-cord tension certainly plays a role - we have a "stutter threshold" and when that is exceeded, the risk of stuttering is increased. But the correlation between stress and stuttering is not 100%. There are also other factors at work, for instance the learned, conditioned component of stuttering. Much of stuttering as well as stress is learned and conditioned. What happens is that the stresses and the stutterings of the past may have established themselves, so that stuttering may occur unexpectedly, eg. when triggered by current events, or even while feeling relaxed. Then also there is a difference between general body stress and localised vocal-cord tension. These two can influence one another but are not the same thing. For instance, we may feel relaxed (low general stress) but the local vocal-cord tension may be high so that we stutter more. Conversely, general stress may be high but local cord tension low, so that we are fluent while feeling stressed. There is also the distraction factor.