StutterSense

Is your speech worse in cold weather?

2012-01-25T15:55:00.000+02:00

Recently someone mentioned on The Stuttering Community website that his speech gets worse when it's cold. This has also been my experience, and it has led me to compare this with the fact that when it's cold, people naturally tend to protect themselves from the weather by tensing a number of muscles - we hunch our shoulders, tense our arms and keep them close to our bodies to keep warm, stiffen our necks etc.

If you believe, as I do, that stuttering is fundamentally the result of stress/tension-sensitive muscles of the vocal folds (also known as vocal cords) that "lock" when over-tensed, it makes sense that cold weather could make stuttering worse. Somewhat similar to us tensing our limbs in cold weather, our stress/tension-sensitive vocal folds' tendency to lock may increase when temperatures are low. Alternatively, general body stress may be higher when it's cold, so increasing base-level stress which in turn decreases fluency margins. (For an explanation of "base-level stress/tension", "fluency margins" etc. check out THIS CHAPTER  of Coping with Stuttering, my online book on stuttering.)

Conversely, one would expect that, in hot weather, stuttering may be less severe for many people who stutter. When it's hot, people generally tend to relax more, to "let go" and not hunch their shoulders and body muscles. Of course, one cannot generalise too much as stress / tension patterns differ individually and according to circumstances; but there may be an underlying trend here. Personally  I have definitely found that my fluency is much better in summertime.

If cold weather impacts your fluency negatively, it could perhaps help in particular to keep the neck and throat warm with a scarf, and to generally try to keep as warm as possible. If this helps, please let me know by adding a comment below this post. Also please participate in the informal survey on the left side of this blog where I ask if cold weather makes your speech worse. Surveys such as these, even when informal and "unscientific", help to stimulate interest and further research, increase knowledge and improve ways of dealing with stuttering.

'Regulated Breathing', a.k.a. Airflow

2011-12-23T18:37:00.001+02:00

I amexcited about a discovery I recently made.

For thepast few decades I have spent much time in trying to promote the PassiveAirflow approach to stuttering, as in my experience this is a step in the rightdirection. However, what always worried me was the apparent scarceness ofobjective, independent research to back it up.

But recently (and better late than never!) I found out that the Airflow approach,which is a proprietary technique and has recently been patented, has itsgeneric equivalent called the Regulated Breathing (RB) approach. RB has beenknown since 1974 when an article titled “A rapid method of eliminatingstuttering by a regulated breathing approach” by Azrin, N.H. & Nunn, R.G. waspublished in Behavior Research andTherapy, 12, 279-286.

This wasfollowed by various clinical experiments, workshops and resulting articles, themajority of them showing positive results with stuttering children as well asadults. For an online 2006 article appearing in The Journal of Speech-Language Pathology and Applied Behavior Analysissumming up the experiments up to 2006, check out THIS LINK.

Aninteresting feature of the RB experiments is that the proponents thereof aremostly psychologists. A probable reason for this is that RB, and the relatedAirflow approach, form part of the behaviorist branch of psychology.Behaviorism, in plain English, is that section of psychology in which HABITplays a major part.

If anybodyis interested in trying out RB, do check out the above academic article, orelse google ‘Regulated Breathing Stuttering’ for more details. Apart from the Airflowtherapy offered by the National Center for Stuttering (NCS) in New York I don’tknow of any institution where this therapy is offered, but the followinginstitutions have done work in this respect and may provide courses: in the US:North Dakota State University (dept of psychology), Southern IllinoisUniversity, Oregon Health & Science University, Western Michigan Universityand the University of Wisconsin-Milwaukee. Outside of the US: Laval University,Quebec, Canada and Leiden University, the Netherlands. Work has also been donein Norway.

In Nigeria, Africa, an academic book on RB was published this yearwhich can be bought via Amazon – check out the link HERE.

The Airflowself-help program offered by the NCS at http://www.stuttering.com/ at this stage seems to be the most organizedand advanced RB facility. The program (consisting of a range ofCDs, videos, a book, a manual etc.) is not cheap, however – for orders outsidethe US the cost is $120-90.

A word ofcaution – for adult PWSs, RB is NOT a miracle method and may requireperseverance and daily practicing. It also may not work for everybody. This isfor the PWS who is really serious about improving his fluency. For children andteens it should be much easier, however. When my stuttering son was about ten years of age I taught him theairflow, and it did wonders for him. I hope that the above information will be of help. Check out my own online book on the Airflow approach which can be read HERE.

On the threshold of stuttering

2011-10-10T21:02:00.001+02:00

Having experienced the challenges of stuttering as well as severe headaches, I have recently become interested in the similarities between these afflictions. In particular it would seem that both have a ‘threshold’, below which stuttering as well as headaches do not occur (counting out the consistent or non-situational stutterer who stutters irrespective of the situation – more about this later in this post).

In an excellent book on headaches and migraine – Heal your Headache – by a neurologist, Dr David Buchholz, it is stated (on page xxii): “If you can keep your total trigger level below your threshold for activation of migraine, the mechanism will not become activated and you’ll be symptom-free.”

Dr Buchholz’s book is receiving very high rates from readers at the Amazon website, with more than 250 reviewers giving it five stars. Since reading the book and applying his ideas my headache problems – which I feared had become chronic – have all but disappeared, so I’m taking everything he says very seriously. One of his ideas is that most headaches are really part of what is known as migraine – what we call migraine is simply a very severe headache, at the far end of the headache spectrum. A light headache, then, is a minor form of migraine.

In Dr Buchholz’s view, many things can trigger the headache mechanism: stress, dietary triggers (inter alia caffeine, chocolate, MSG, nuts, processed meats / fish, citrus fruits, onions, aged cheeses, yogurt etc. etc. – quite a list!), bright light, too little or too much sleep, hormones, eye strain, changes in barometric pressure (eg. air travel) etc. etc. All these triggers have a combined impact, and if the total impact exceeds your headache threshold, the mechanism is activated and you will start developing a headache. The higher you exceed your threshold, the more severe the headache will be.

This made sense to me and was in line with my own experience of headache. It also explains why it is so difficult to identify any particular trigger as a headache trigger, as a single trigger may not be sufficient to result in a headache and so be identified as the “cause” of the headache. So, for instance, just eating a bar of chocolate may not result in a headache because the threshold may not have been reached. However, when OTHER triggers are also present (such as eating chocolate while also stressed, or while also having slept too little), that chocolate may just be enough to take you over the threshold and cause a headache.

The headache of stuttering

This theory of headache, and particular of a headache threshold, makes sense. And what’s more, it’s relevant for people who stutter. Because don’t we who stutter situationally also have a stuttering threshold? When we stutter, is it because we have exceeded our stuttering threshold? Conversely, if we don’t stutter, is it because we are “below” our threshold? I believe that that is exactly the case.

I believe that when we have a “good day” of fluency, it is because we live and speak below our threshold level. Conversely, when we have a “bad day”, we continuously exceed our stuttering threshold.

It follows that, in order to improve our fluency, we need to avoid exceeding our threshold. This means managing our stress so that the tension on our vocal cords does not rise above the level at which they will “freeze”, thereby resulting in what is known as stuttering. I have found this model of stuttering – managing one’s stress as well as one’s vocal cords so as to keep vocal-cord tension as low as possible – to be very helpful in managing my speech better.

The idea of a stuttering threshold is not new and has been worked out by Dr Martin Schwartz in his book Stutter no more. According to Dr Schwartz, the horizontal threshold line is not the only level of importance in stuttering. There is a second line (usually below the threshold) indicating base-level tension (I prefer to call it base-level stress). Base-level stress is the total of all the general stresses impacting on your nervous system. Then there is a third factor indicating localised vocal-cord tension (which Schwartz calls "speech tension"). Vocal-cord tension is usually above your base-level stress – in other words, it fluctuates between your base-level stress and your threshold. Check out the following diagram illustrating what happens when John, who has to say his name, reaches his threshold:

When you don’t stutter, your localised vocal-cord tension is below your threshold, and usually above your base-level stress. When you do stutter, it means that vocal-cord tension has exceeded your threshold.

Note that base-level stress is not a static line – it can rise or fall depending on your general stress. If your stress is high, the margin between your threshold and your base level shrinks. In other words, you have less space in which to speak without stuttering.

Conversely, if your stress levels are very low, the margin in which you can speak fluently increases dramatically. For more information on the stuttering threshold, check out the chapter in my online book which you can read HERE.

I believe that this model of stuttering is correct, that it is a huge step forward in understanding stuttering and that it is not getting the attention it richly deserves.

Last but not least – what then about the non-situational stutterer who seems to stutter irrespective of tension levels? Non-situational stutterers seem to be in the minority, with most stutterers being situational. It could be that the non-situational stutterer’s threshold is unusually low, so that he / she lives and speaks above the threshold on a permanent basis. Or else the individual’s base-level stress is so high that the margin within which he can speak fluently is minimal or non-existent, resulting in a permanent state of exceeding the threshold. Looking at it from a different angle it could be argued that this person’s vocal-cord tension and / or base-level stress has / have become chronic and well-established, in line with the general principles of learning and conditioning.

Caffeine and stuttering - another paradox?

2011-09-01T19:57:00.000+02:00

It is well known that caffeine, a major ingredient of eg. coffee and tea, can result in increased stress levels, and as a result many people – me included – believe that people who stutter should avoid caffeine-containing drinks and foods, as stuttering is, for many people if not most, to some extent stress-related.

A feature of stuttering, however, is that it can be fascinatingly paradoxical – and this could also be true of the relationship between stuttering and caffeine. For instance, in a recent web discussion a member of the Stuttering Community mentioned that he stopped taking caffeine for close to eight weeks (long enough to exclude any withdrawal effects), that his fluency actually deteriorated during that time, and only improved again after he resumed his caffeine intake. How can this be explained?

I can think of a few possible reasons:

1) Though caffeine is an “upper” and can boost energy levels, it is paradoxically also a pain reliever and is used in various painkiller pills. Its anaesthetic effect may impact on this particular person’s central nervous system in a special way, resulting in a reduced stress base level. It is well known that not everyone responds to substances in the same way, and caffeine may have this effect on this particular person.

2) Though the lack of caffeine generally can reduce stress base levels because of its PHYSIOLOGICAL, chemical effect, this reduced stress may actually and paradoxically be PSYCHOLOGICALLY stressful for some people. The individual may, perhaps subconsciously, not be “used” to feeling this way. It is a new state of affairs for him to which he, and his usual coping mechanisms, are not accustomed, and his system responds by increasing base level tension, resulting in more stuttering. So less stress can actually cause more stress!

3) The mild "high" experienced after taking caffeine may manifest itself in increased energy, optimism, confidence and a general sense of wellbeing (isn't that why caffeine-rich coffee or tea is so popular?), and these effects can in some people perhaps reduce stress, so improving fluency.

It seems an interesting topic. Update: in an informal 2011 survey conducted on my blog on the effect of caffeine on fluency, 20 people participated. 7 (35%) said that caffeine made their speech worse, 2 (10%) said that it made them more fluent, 6 (30%) said that it had no effect on their fluency and 5 (25%) said "What the heck, I love caffeine!"

Postscript: since writing this post I have stopped taking all caffeine, mainly because of chronic headache problems. The headaches are much better now, but how I crave a cup of strong, rich, REAL tea! The non-caffeine rooibos teas are OK, but it's not the real thing. But then one does have to make some changes in the course of one's life for the sake of health.

Distractions - taking the mind off stuttering

2011-05-18T18:14:00.003+02:00

For most people, distractions play a rather negative role, as in the picture above. They take your mind off things that are, or should be, more important – such as the traffic, doing your homework or working on a task in the office.

For someone who stutters, however, a distraction can have a somewhat beneficial effect in that it may temporarily make you more fluent – fluent enough to say that difficult word, or get through that problematic sentence; though some People Who Stutter (PWS) find that a distraction actually makes speaking more difficult as it interrupts their train of thought, so increasing their tension. Whatever the PWS's response to a distraction - for some reason the role that distractions play, both in stuttering and in therapy, is under-emphasised by speech therapists as well as PWS themselves.

This under-emphasis on distraction as a factor in stuttering is one of the reasons why so much confusion surrounds stuttering. It would even appear that some therapists either have no knowledge of the nature of distractions, or deny that these impact on stuttering.

Recently I was shocked by a survey appearing on stuttering websites from a student speech therapist doing research for an assignment on secondary stuttering behavior (eg. stamping your foot or blinking your eyes before saying a word). From the questions in the survey it was clear that the student had no idea that the cause of secondary stuttering behavior is rather simple. Secondary stuttering behavior is merely distraction behavior. An individual who blinks his eyes before speaking may have found that, in the past, this seemingly natural and inconspicuous action, which is socially acceptable, has helped him to pronounce a sound on which he would otherwise stutter – because the action momentarily distracted him from the feared sound. So when he again experiences a stuttering block, he uses this trick – the eye-blinking – to free him from the block. When the trick succeeds, he is rewarded by saying the word fluently. In this way the trick is, through the principles of behavioral learning, reinforced and gradually becomes established as a learned habit.

Unfortunately the distraction behavior tends to have a temporary effect, because in the course of time the mind becomes accustomed to the distraction so that it gradually loses its fluency effect. As a result a stronger distraction is needed to be effective – the innocuous blink becomes an unnatural, socially unacceptable tight closing of the eyes. But in time even this loses its effectiveness. So the PWS is now worse off – not only does he stutter, he also exhibits unnatural eye-blinking which has become a learned habit.

As secondary behaviors are learned, they can be unlearned. If you do suffer from secondaries, try the following procedure:

Identify the exact nature of the automatic behavior, so that it can be broken up in smaller parts that are easier to eliminate

Begin to change the behavior, thereby weakening it, instead of trying to eliminate everything at once. For instance, someone who experiences a nasty head jerk to the left, should try jerking it to the right, or backward or to the front.

Literally ANYTHING that will take your mind off the feared word or sound, can break the block; probably because the distraction momentarily reduces vocal cord tension, so releasing the locked vocal cords. Intense emotions such as anger or aggression can serve as distractions. Even the block or the stutter can distract you from the source of the stress. Very fast speech can serve as a distraction. EVEN STRESS ITSELF, which usually aggravates stuttering, can distract one from stuttering, as is clear from the following example from The Nature of Stuttering, by Charles van Riper, as told by one of his patients:

A member of a submarine crew discovered a serious problem within the submarine’s machinery. To his own surprise he managed to rattle off a series of rapid emergency orders even while under huge pressure. He was 100% fluent (though his hair turned grey afterwards!) and ascribed his fluency to not really thinking about his speech due to the seriousness of the situation.

Many PWS have described similar surprising bouts of fluency. Another telling example illustrating the workings of distraction comes from the Netherlands, as far back as the Second World War. A speech therapist remarked being struck by the fact that his patients had few speech problems during the time that Germany invaded his country (May 1940). During a three-week period in which the entire country was in chaos, his patients also stayed away from his consulting room. Gradually the situation stabilised and ordinary life was resumed.

When his patients returned, they more often than not said that their speech had been excellent during that period. One of them explained it this way:

What is happening now is of such magnitude that one’s personal problems seem insignificant. When the survival of one’s country is at stake, one’s personal difficulties become unimportant. (P Faber, Achtergronden van stotteren en spreekangst, 1979)

It is known that some PWS’s change their environment for the purposes of distraction, in an effort to be fluent. Dr Martin Schwartz mentions the case of an individual who not only changed his name, but his employment and city of residence as well – the novelty distracted his attention from his speech. Naturally the improvement did not last long, as his mind gradually became used to his new environment, so that the stutter re-emerged.

Even a fluency technique taught to a PWS by a therapist can serve as a distraction, taking away one’s attention from feared sounds. If, however, the technique is entirely dependent on its distraction value, it may only have a temporary beneficial effect.

Various therapies are built around the distraction phenomenon. The strange mouthpieces which were sold to PWS’s in the 19^th century were merely distraction gadgets which intentionally made it difficult to speak normally, and so distracted people that they would not stutter. Many masking types of apparatus also seem to be based on distraction to a greater or lesser extent. The SpeechEasy appliance, which creates a choral effect in your ear so that, when you speak, it sounds as if you speak in unison with others, has helped some PWS’s, with distraction probably playing a large role – and as the effect of distraction is temporary, it is no surprise that many users of the SpeechEasy have only experienced temporary relief. The ‘syllabic speech’ technique, also called ‘rhythmic speech’, where you learn to speak in rhythmic syllables, also seems to be largely a distraction technique.

This is not to say that distraction as a technique or as a therapy approach is of no use to the PWS. Sometimes it is better to have some fluency, even if it is temporary. The informed PWS, however, should be aware of the effect of distraction and its nature. It can be of use, but don’t be fooled by the temporary fluency so obtained – and don’t fall for quick-fix therapies that are wholly based on it. Also: if we appreciate the nature of distraction as a phenomenon in stuttering, stuttering itself becomes easier to understand.

Thiamine - a breakthrough in stuttering treatment?

2011-03-05T13:02:00.001+02:00

Thiamine as seen under a microscope

About 30% of adult males who stutter may significantly benefit from taking 300 mg of thiamine (ordinary vitamin B1) per day, according to a recent study at the National Center for Stuttering.

“38 male stutterers between 21 and 37 years of age were randomly divided into two groups. One group received 300 mg of thiamine per day and the other a placebo,” said Dr Martin F Schwartz, executive director of the Center.

The subjects were given standardised tests for stuttering prior to the experiment and again at its conclusion.

“The findings for the vitamin group were highly significant, with a before and after difference of such magnitude that the likelihood of it occurring by chance was less than one in a hundred.” Only 6 of the 19 subjects showed the dramatic effect, however.

“It was decided to follow these six individuals to see if the effect persisted. They continued to take what was now openly acknowledged to be the vitamin. It has been more than seven months and their speech has remained essentially free of stuttering,” said Dr Schwartz.

“If the results of this study are valid (and only replication by independent investigators will establish this), then approximately 30% of adult male stutterers can have their stuttering cured by the simple expedient of taking 300 mg of thiamine daily.”

Note that those with dietary habits that could negate the effect of thiamine, or those with a medical condition that would interfere with thiamine absorption, were excluded from the experiment.

“Fortunately the lack of toxicity for thiamine, even well in excess of the amounts used in this study, has been well documented. As with all supplements, however, those interested in trying thiamine should always first consult their doctor.”

The dosage specified is for adult males, not for children or adult females. Research on these populations is apparently underway.

Dr Schwartz said that the effects, if any, can be seen within two weeks. If no effects are seen after this period, none will occur and you can assume that thiamine will not be of benefit. Click HERE for the actual media release and HERE for the original study.

It is important to note that some conditions, foods and minerals have anti-thiamine properties. “Thiamine deficiency can be caused by malnutrition, antacids, barbiturates, diuretics, a diet high in thiaminase-rich foods (raw freshwater fish, raw shellfish, ferns) and/or foods high in anti-thiamine factors (tea, coffee and carbonated beverages), tobacco and by grossly impaired nutritional status associated with chronic diseases, such as alcoholism, gastro-intestinal diseases, HIV-AIDS and persistent vomiting,” according to Dr Schwartz.

My comments:

If you are interested in starting with a daily 300 mg thiamine course for two weeks (the time needed to see if the vitamin benefits your fluency), it would make sense to also stop taking eg. tea, coffee, carbonated drinks, antacids and the other foods mentioned above for that period, as these could neutralise the thiamine taken and negate the experiment.

The study was not very big, and different results might be obtained when using larger groups of people who stutter.

Though Dr Schwartz has not suggested any reasons why thiamine may have this effect, it could be due to significant stress reduction. He has in the past recommended vitamin B Complex (which includes vitamin B1) together with vitamin C, magnesium and calcium for lowering stress and muscle tension (so as to ultimately reduce vocal-cord muscle tension), so if he is correct it could be that vitamin B1 (thiamine) is the main stress-reducing factor in B Complex.

On the other hand, if the thiamine effect is NOT the result of stress reduction but due to some other unknown factor, we are in unfamiliar (but exciting!) country.

Stuttering treatment through medication, drugs, supplements etc. has a long and complex history. Various drugs have throughout the years been tested for their effect, if any, on stuttering – Pagoclone being the latest – and up to now the results have generally been disappointing, with many stutterers complaining of negative side-effects. Others, however, have benefited to some extent. How can this be explained?

In my view, the benefits obtained in this way are simply the results of temporarily reduced stress levels. For instance, I have often found that, when suffering from the flu or a cold, certain painkillers and flu medicines improve my speech as they make me feel somewhat numb and drowsy. They anaesthetise the central nervous system and the so-called ‘mental scanner’ with which we scan for feared words. They can also reduce general tension levels and also, and more specifically, can reduce vocal cord tension. Alcohol can have a similar effect. Regrettably, some stutterers use various illegal and unhealthy drugs in an effort to improve their speech. What really happens is that some of these drugs have the effect of simply reducing stress levels. Far better to stay clear from detrimental drugs, and rather take health-promoting over-the-counter supplements that produce exactly the same effect – by reducing tension levels.

I have in the past taken stress-reducing supplements and they have definitely been helpful in taking the edge off stuttering. These days, however, B Complex gives me headaches so I’ve stopped this, though I still take magnesium (slow release), potassium (slow release) and calcium pills. The combination of these three is usually recommended as a muscle relaxant, and I take them mainly because of another problem - leg muscle cramps which I get at night. They are very effective for muscle cramps, and they also seem to improve my fluency though it's difficult to prove.

I’m sure that stress-reducing supplements can be highly beneficial for many stutterers, particularly those with high stress levels. I have found that, in combination with using a fluency technique, they are indispensable. They lower tension levels to a point where you can apply your fluency technique with success – these techniques are difficult to apply if stress levels are too high. Try it – you have nothing to lose!

Postscript - results of my informal 2011 survey on this blog:

The question was: Does 300 mg of vitamin B1 (thiamine) per day improve your fluency? 57 people responded as follows:

"Dramatic improvement!" - 6 people (10%)
"Has helped somewhat" - 8 people (14%)
"Hasn't helped at all" - 8 people (14%)
"Haven't tried it yet" - 29 people (50%)
"Don't believe that it will work" - 6 people (10%).

Note that, as at the end of 2011, 24% of the respondents indicated that thiamine helped them, either "dramatically" or "somewhat". This is not far from the 30% mentioned in Dr Schwartz's findings - my poll was far from being scientific. Even so it is a further indication that people who stutter should seriously consider trying out thiamine to see if it improves their fluency.

Truly the speech of a king

2011-02-17T20:43:00.002+02:00

Colin Firth, as the later King George VI, at Wembley
in 1925 - an ordeal both for him and his listeners

I recently saw "The King's Speech" - what a magnificent movie! A few points which particularly caught my attention:

1) The movie depicts the king as a rather interiorised stutterer, with blocks rather than repetitions or prolongations.

2) He seemed to swallow a lot in order to try speaking - an old trick in an effort to open the locked vocal cords. Apparently the cords do open somewhat after swallowing, and he used this natural opening mechanism to try and speak. As with so many other anti-stuttering tricks, the swallowing trick only works temporarily, after which it loses its effectiveness and can even become a habit and part of the problem.

3) His speech coach, Lionel Logue, taught him all the tricks and therapies in the book. Though speech therapy was in its infancy (still is?), Logue seemed to do very well with techniques that became well known later - i.a. breathing and physical relaxation techniques, singing and distraction therapy (standing on your toes to avoid a block, and speaking while not being able to hear yourself). From a psychological point of view, Logue seemed to have an excellent grasp of the value of stress reduction via providing tons of sympathy and friendship.

4) It was interesting to see how the king's speech gradually improved through this friendship. He definitely relaxed and loosened up in the course of the movie, so improving his speech. There can be no doubt that kindness and friendship received reduce stress, particularly for an individual such as the king who had to function within a stressful formal, cold, strict and rigid social structure.

5) The movie shows that even fluency 'tricks', such as being fluent when you can't hear yourself speak (for example, when speaking while loud music is played in the background), can be of use - in this case it demonstrated graphically that fluency IS POSSIBLE under certain circumstances; and that there is hope.

6) On YouTube I listened to a recording of the king's real speech after war had been declared, and his speech was indeed quite good and very similar as in the movie - there were many pauses but having regard to the solemn occasion these pauses added gravitas and dignity.

7) Beautiful acting, with Colin Firth's effective use of his eyes to say so much. On occasion only his eyes show his apprehension and real fear on hearing what demands will be made on his non-existent communication skills.

A wonderful movie, never trivialising the issue nor sentimentalising it. This should do so much for public awareness of stuttering ...

Role models for people who stutter - good or bad?

2011-01-20T22:13:00.001+02:00

On occasion one hears about courageous people who stutter (PWS) who tackle their dysfluency head-on, taking on challenging jobs requiring sophisticated speaking skills. An example is the Autumn 2010 issue of Speaking Out, the magazine of the British Stammering Association ( www.stammering.org ), in which a determined 2nd year law student wrote about his decision to become a barrister (known as a trial lawyer in the USA, and an advocate in some other countries) - a job requiring excellent public speaking skills and the ability to speak when under stress.

In the same issue of Speaking Out, the editor wrote: " ... people who stammer may also limit themselves in terms of what careers they think are possible ... I hope one thing Speaking Out and the BSA website can do is help get over the message that there are people who stammer successfully doing jobs that many would think they are excluded from, and if you really want to do something then seriously consider going for it, stammer or not."

The above comments may contain some truth. However, these successful PWS's should not be regarded as role models for other PWS's. My own view:

Firstly, I take my hat off to PWS's who take on challenging jobs requiring excellent speaking skills. But this does not mean that I should follow in their footsteps, and I should not feel pressurised to do so or feel inadequate or guilty because I haven't done so. PWS's differ from each other. We have different personalities, different forms of stuttering and stuttering severity, and different stress and tension patterns.
It follows that some PWS's may never really improve their fluency, so that the progress made by some will be out of reach for others. Real progress depends on many, many factors.
It is always interesting and fruitful to hear about other PWS's who have succeeded in overcoming or successfully managing the disorder, and certainly much may be learnt from them. Their success, however, should not tempt us to compare ourselves with them. There is a fine line here which should not be crossed.

Actively tackling stuttering is a personal choice WHICH MAY OR MAY NOT lead to progress and improved fluency, depending on many factors and circumstances. Sure, if you feel that you can handle it, by all means pursue the challenging, fluency-demanding job you crave - remembering, however, that stuttering, for many people, is stress-related, that some jobs are more stressful than others, and that the choice of job is one of the most important decisions that you will ever make.

When I was still involved in self-help groups for PWS's I met so many people who had major problems at work because of their dysfluency - and many of them were in speaking-intensive jobs BECAUSE WHEN YOUNG AND LOOKING FOR A JOB, THEY CHOSE TO IGNORE THEIR OWN LIMITED FLUENCY LEVELS. Don't let it happen to you!

The virtuous circle of stuttering

2010-12-20T12:26:00.002+02:00

Emily Blunt on the cover of Esquire

Part of the problem of stuttering is that this communication defect often presents itself as a vicious circle, where stress results in more stuttering, which in turn creates more stress for the sufferer. I am convinced, however, that this vicious circle has a positive mirror image - a virtuous circle, where better fluency results in less stress and therefore less stuttering.

When reading the life stories of famous stutterers who achieved success and significantly improved their speech it seems to me that they have somehow managed to get into this virtuous circle, perhaps without actually being aware of it. Some movie actors who used to stutter badly, such as Emily Blunt, may be examples of this phenomenon.

The saying goes that nothing succeeds like success, and this is true also of stuttering. I think that some talented people achieve initial career success because of their talent even when they have a stutter. This initial success increases their confidence, thereby lessening speech-related stress and tension levels and improving their fluency. The improved fluency in turn further reduces their stress and boosts confidence, and so a virtuous circle is created, paving the way to a successful career.

In interviews, Emily Blunt mentioned that her road to better fluency began when still in school, when a teacher suggested that she should act in a play, using a fake accent. Emily discovered that she was fluent when speaking in a fake accent, and apparently this newfound fluency was such a boost for her that she went on to become a famous actress. Speaking in a different accent serves as a distraction device for stutterers - it distracts your mind away from stuttering, and though the effect is usually temporary for most stutterers, it may just have given Emily the confidence she needed to send her on her way to success.

In technical terms: the confidence boost significantly reduced her "base-level tension" to far below her stuttering "threshold", resulting in greatly increased fluency margins. A significant reduction in base-level tension is usually the underlying cause of dramatic fluency improvements (and even the occasional real cure, though this doesn't happen often). For a description of terms such as "base-level tension" and "threshold", please see my book's chapter 'A possible cause of stuttering' which you can read HERE - use the search facility provided there to search for the terms inside the chapter.

I believe that confidence, and SPEAKING CONFIDENCE in particular, are major factors in stuttering, as they reduce speech-related stress and tension. I also believe that people who stutter can learn much from studying success stories such as Emily's. We who stutter should all try to get out of the vicious circle of stuttering, and instead become part of a virtuous circle. Even a single fluent conversation, perhaps brought about by using a fluency technique correctly, can be that major boost which may lead you on the way to better speech and success. I'm not saying that the virtuous circle will lead to complete fluency - chronic stuttering is seldom cured 100%, and even Emily Blunt still stutters occasionally - but the improvement in fluency could make a world of difference.

Stuttering while relaxed?

2010-11-21T20:25:00.001+02:00

A person who stutters (PWS) recently wrote me: ‘Even when I’m very relaxed I still stutter. So the theory that stuttering is linked to tension is wrong!’

My answer:

Don’t confuse ‘stress’ with ‘tension’. Stress and tension are not quite the same – stress is a more general term and can be measured by blood pressure, heartbeat, perspiration etc. Tension is more localised and refers to a set of muscles, such as the vocal cord muscles. Stress and tension are, however, to some extent linked; for instance, general stress can increase localised muscle tension.

General stress CAN and usually DOES have an effect on the vocal cord muscles of PWSs. Many PWSs (probably most) report that their speech is worse when they are stressed.

In some situations, however, the PWS’s vocal cord tension can be high though his stress level is not. To understand this phenomenon, one has to remember that another factor comes into play in stuttering, namely HABIT, also known as LEARNED BEHAVIOUR.

The force of habit

Stuttering tends to become a habit, and in the course of years it can become deeply ingrained and lodged in your subconscious. After many years of stuttering your subconscious memory becomes riddled with stuttering responses. And not only with stuttering responses – TENSION AS WELL AS STRESS RESPONSES CAN THEMSELVES BECOME HABITUAL. We LEARN to respond in a stressful manner to some things, so that stress usually becomes part and parcel of the stuttering problem.

Stress and habit are therefore major factors in stuttering. These major factors, that is to say stress and habit, are not necessarily present in a 50:50 relationship within the PWS. For many PWSs – perhaps the majority – the stress factor is more prominent than the habit factor. In other words, the speech of these PWSs is very much affected by stress, whereas the element of habit is not as prominent. These PWSs are situational stutterers – they have areas of fluency, especially when relaxed, but stutter when in stress.

Low stress, but high tension

For some other PWSs, the habit factor is more prominent. These PWSs stutter in most or all situations, and overall stress fluctuations seem to have little effect on their speech. What has happened here is that VOCAL CORD TENSION HAS BECOME HABITUAL. These PWSs can be regarded as ‘advanced stutterers’, because the disorder has not only become deeply entrenched, but has taken over most or all of their areas of speaking, eg. even while talking when alone or when talking to a pet etc. Their stuttering is very consistent (as opposed to the intermittent stuttering of the situational stutterer). Their vocal cords are, while speaking, continually in habitually excessive tension - EVEN IF THEY FEEL GENERALLY UNSTRESSED OVERALL.

I suspect that the PWS who wrote to me about him stuttering while relaxed falls into this second category of stutterers. This person’s general stress level may have been low, but his vocal cord tension was high enough to exceed his vocal cord tension threshold.

So in summary, in order to better understand stuttering:

1) Don’t confuse generalised stress with localised vocal cord tension

2) Note that stress USUALLY (but not always) increases vocal cord tension

3) Though stress may be low, vocal cord tension may still be high, for instance due to learning (habit)

4) Conversely, it can happen in some situations that though stress levels are high, vocal cord tension is low, resulting in fluent speech. We are people, not machines, and the correlation between stress/tension and stuttering is not 100%.

Does a sore throat have an effect on your fluency?

2010-10-25T16:38:00.003+02:00

I have often found that when I have a sore throat, my speech immediately becomes much worse. Bearing in mind that I believe that stuttering is caused by stress-sensitive vocal cords, I'm wondering if a sore throat can affect our vulnerable vocal cords.

If the vocal cords are indeed the source of our disorder, it would make sense that inflamed vocal cord muscles further reduce the vocal cords' ability to function normally. On the other hand it could also be that other factors which may accompany a sore throat (eg. a fever) impact on general stress levels which could in turn increase vocal cord tension. Then again, don't forget the possible effect of distraction - a sore throat may act as a distraction, thereby actually IMPROVING fluency temporarily ....

This could be an interesting research topic for clinicians interested in the cause of stuttering ...

Results of my informal survey in 2011:

In an informal survey on this blog in 2011 I asked: "Is your speech worse when you have a sore throat?" 30 respondents took part, and the results were as follows:

13 respondents (33%) answered "Definitely"
8 respondents (20%) answered "No, I am more fluent"
18 respondents (46%) answered "Haven't noticed a difference"

Is voluntary stuttering COUNTER-PRODUCTIVE?

2010-09-17T20:16:00.001+02:00

Voluntary stuttering (VS) – in other words, stuttering on purpose – is a type of speech therapy taught by speech clinicians to people who stutter. It has been a major part of therapy for decades. The question that has been bothering me for many years is whether stuttering on purpose will actually reinforce stuttering over the longer term.

I have never received a satisfactory answer to this question, nor to a second which logically follows the first: have speech clinicians who have for decades promoted VS done harm to people who stutter? Is this perhaps one of the reasons why speech therapy in general has disappointed so many who stutter?

A little background. Though VS is usually linked to the therapy of Charles van Riper – probably the most influential speech pathologist of the 20th century and a stutterer himself – the technique was first introduced by Bryng Bryngelson, another pioneer of speech pathology. This was at a time when speech pathology focused on the psychological side of stuttering, emphasising the stutterer’s speaking fears and avoidance strategies, and devising ways of overcoming these. VS was seen as a method to face one’s speaking fears and avoidances. By stuttering openly and unashamedly, you advertise your stuttering to the world, thereby eliminating the need to avoid speaking situations.

Is VS the best way to advertise stuttering?

It makes sense to advertise your stuttering, so reducing the listener’s expectations of your speaking abilities. But is VS the best way to advertise your stutter?

VS is a child of its times. It really is part of a particular approach to stuttering treatment known as ‘STUTTERING MODIFICATION’, also known as ‘stutter more fluently’ therapy. Underlying this approach is the view that (1) adult stuttering can only be modified, but is seldom or never cured, so that acceptance of stuttering is emphasised; (2) that psychology plays a huge part in stuttering and its therapy; and (3) that the stutterer should never avoid speaking and stuttering, but should rather stutter openly. Stuttering modification therapy was the main stuttering therapy for many years, and is still widely practised. The main aim here is not per se to speak fluently, but to change your own mindset so that the stuttering won’t embarrass you or cause anxiety.

At a later stage, a somewhat opposing approach known as ‘FLUENCY SHAPING’, also known as ‘speak more fluently’ therapy, began to gain ground. This approach was based on later research findings in the areas of behaviorism (which suggested that stuttering is reinforced by habit), stress (which suggested that stuttering is to some extent stress-related) and physiology (which suggested a physical or neurological cause of stuttering). In this approach there is less emphasis on the psychology of stuttering. Clinicians who follow this approach focus on fluency and how to be fluent, rather than on stuttering. They say that a large measure of fluency is indeed a realistic aim for adult stutterers; that much of stuttering is physical; that stutterers can improve their speech by using fluency techniques; and that these techniques must be reinforced by practising, i.e. by making it a habit.

Some stutterers do benefit from VS

From the above it should be clear that BOTH approaches have merit. Stuttering is a complex mixture of psychology, physiology, stress and habit. But where does this leave VS – particularly when you believe, as I do, that stuttering is partly stress-related and partly a habit, REINFORCED EVERY TIME WHEN YOU STUTTER? And do you reinforce and strengthen your stuttering when you stutter on purpose?

The fact is, however, that many stutterers have found VS to be helpful. How can this be explained?

Anecdotal feedback from stutterers who do VS indicates that stuttering on purpose can be useful in various ways, eg. in making your stuttering known to the listener in situations where it is impractical or inappropriate to declare upfront that you stutter. Some stutterers also find that VS helps them in turning a major block into a lighter, manageable repetition.

You might argue that these benefits should conclude the matter. After all, if some (brave) people benefit from VS, it has value. But then again – many well-known treatments have short-term benefits, but cause long-term harm. Is VS a seemingly beneficial approach which in fact perpetuates stuttering by locking you forever into the habit?

Sabotaging the fluency you already have?

The fact is that many stutterers reject VS intuitively without ever trying it; and some reject it after finding it an embarrassing experience. Logic tells us that those who are by nature introvert will find it hard to stutter on purpose. Those who are situational stutterers (i.e. who only stutter in certain situations) and who do have a measure of fluency may feel that it doesn’t make sense to sabotage the measure of fluency they already possess. And for the many stutterers whose speech is much affected by stress, VS could simply increase their tension levels, thereby turning artificial stuttering into real stuttering.

That VS and stuttering modification is not successful in improving speech permanently has to some extent been confirmed by research done on the 3.5 week Successful Stuttering Management Program (SSMP), which offers modification therapy. For more details, check out page 155 of the interesting online book No Miracle Cures, by T.D. Kehoe, who is a qualified speech pathologist. It can be read HERE.

In his very readable book on page 156, Kehoe also reminds us that the goals of stuttering modification therapy are to reduce speech-related fears and anxieties, and not to attain fluent speech. To that I would reply: surely there are other ways to reduce these fears (eg. gradual desensitisation via fluency shaping) without exposing people to the possible long-term negative effects of VS?

My own view, in conclusion, is that VS should be handled with caution, taking note of its benefits but also the potential long-term effects.

Stuttering in later life

2010-08-27T23:02:00.002+02:00

Having reached the ripe old age of sixty a few months ago I thought it a good idea to share my reflections on stuttering in middle age and beyond, as it seems that so little is being said and written on this subject.

With stuttering, the focus is to a large extent on children and teens who stutter, with secondary attention given to adults. Reasons for this, of course, are that more children than adults stutter; and that in early life the chances of recovery are so much better, whereas for the older stutterer the emphasis is on management rather than cure. It therefore comes as no surprise that stuttering after the age of 60 has received little attention.

Stuttering is in a sense a childhood problem, with about 3/4 of all stuttering children fortunately outgrowing it. For the unlucky teens and 20-somethings who have not outgrown it the disorder usually impacts on their social as well as educational or occupational life. This is the time when two major needs present themselves: (1) finding a suitable mate; and (2) training toward and finding the best possible job. Stuttering can considerably frustrate both these needs.

The years can bring better fluency

In later life, however, the social and occupational areas of life look very different from when young. By this time most of us have found a significant other who has accepted our dysfluency; we may be parents or even grandparents (of children who hopefully do not stutter); or, not having found – or having lost – a soul mate, may have discovered that being single also has its benefits. No longer is there the overriding need to be accepted as you are by peers, friends and the broader community; at this age you probably already have a few friends with whom you feel comfortable and who share your values.

Occupation-wise, retirement is no longer the far-off event it once was; and some of us may already be enjoying this long-awaited leisure time – or struggling to make ends meet on inadequate pensions. If you’re still working, you may have achieved a position of seniority and authority, thereby increasing confidence and improving your fluency. Even if you are not the boss, having a few grey hairs tends to earn respect from colleagues – most of whom are younger than yourself – who have, by this time, probably also become used to your way of speaking, which also helps.

Psychologically you’ve probably left behind some or all of your youthful insecurities which contributed to your high tension levels and related stuttering. You know so much more about life, people and yourself, and this huge knowledge base has helped you cope not only with stress and stuttering, but with sorting out, understanding, accepting and making sense of so many things that in the past made your life miserable.

Comfort zones are good for you!

You’ve also probably found nice, safe comfort zones where you can enjoy life without the hassles, ambitions and conflicts of youth. Don’t let the hyperactive ‘shakers and movers’ make you feel guilty about enjoying your comfort zones. These zones have a role to play in managing stress, and they are important for people who stutter. I take issue with people who deride comfort zones as complacency, to be broken out of at all costs. All things can be taken to an extreme and in this sense comfort zones CAN be detrimental if over-emphasised; but having a few enjoyable zones of comfort is absolutely necessary for mental health.

Last but not least - as you age you will probably find that stuttering is no longer the primary health issue affecting your life. High blood pressure, excessive cholesterol and other age-related ailments can present themselves, so that stuttering becomes part of a much wider health spectrum that needs to be managed.

People age differently and the above may or may not apply to you. I hope, however, that these reflections give an indication of what to expect and hope for as you get older. For me, the role of stuttering has diminished through the years to become a relatively minor part of the colourful tapestry that is life.

Does sexual activity affect stuttering?

2010-07-31T17:26:00.001+02:00

This issue is frequently raised in stuttering forums, generating a lot of uneducated comments, reflecting a lot of anxiety, and underlining the fact that so many people who stutter still have very little knowledge of stress and how it impacts on their life and fluency. Stress remains the elephant in the stuttering room, probably in part because it's more fashionable in speech therapy circles to focus on brain scanning research.

The posts in discussions on sex and stuttering reflect various responses to sex, with some saying that sex negatively impacts on their fluency, particularly after masturbating. Others say that sex improves their speech, and yet others feel that it has no effect on their stuttering.

Even for those who have a superficial knowledge of stress, the answer is simple. Sex, like stress and stuttering, has a psychological as well as physical side; and sex CAN (but may not necessarily) increase, or decrease, stress and anxiety levels depending on the circumstances. Sex which is accompanied by guilt feelings (which are in many cases part and parcel of masturbation) can aggravate anxiety and stress levels; and we all know that stress (in any of its many forms) is an important component in stuttering, with more stress generally resulting in more stuttering.

Conversely, sex often acts as a release from sexual and other forms of tension, so lowering stress levels and also reducing stuttering. In many cases it does not have an effect on stress at all.

There really is not much more to it than that. There is not much mystery in the issue of whether sex causes more or less stuttering, if stress is properly understood. A much more interesting question is why people find it so difficult to understand stress. Is it because stress lies in the grey area between psychology and physiology? Are we not yet comfortable with holistic thinking?

Stress desensitization: How to play with a crocodile

2010-07-03T23:35:00.003+02:00

When reading the posts on stuttering forums I get the impression that the term 'desensitization' is mostly used to describe the process where a covert (secretive) stutterer gradually becomes an overt stutterer by not being ashamed of his stutter and stuttering openly. Traditional wisdom has it that stuttering openly and not hiding his stutter is good for the stutterer. Desensitization, then, means the process where you lose your sensitivity about your stutter.

Desensitization, however, is in fact a wide term and can take many forms. It is, for instance, sometimes used to treat people suffering from phobias. Eg. an individual suffering from fear of heights may be treated via desensitization by first exposing him / her to very low and non-threatening heights (eg. an enclosed, windowed balcony on the first floor of a building), until all sense of fear and stress is lost. The patient is then exposed to a slighty increased situation, eg. the second floor balcony, once again until he is fully comfortable and has lost all anxiety and fear while at that level. Only then is he allowed to progress to higher levels.

It would seem that few stutterers use the term 'desensitization' in the above sense, yet this was the meaning as used in the Passive Airflow courses which I attended. Desensitization, in this sense, was a key ingredient in the process in which I cured myself of my stuttering in various situations, eg. ordering food in a restaurant or when doing shopping. That is not to say that I am TOTALLY cured of stuttering, but I am cured IN CERTAIN (AND MANY) SITUATIONS.

Desensitization, in this sense, works as follows for a particular situation such as talking to a shop assistant when shopping. Note that it should be combined with the application of a fluency technique which you have already learned. Only advance to the next step when you feel ready for it and have succeeded in the previous step.

Step 1: Go to a shop and browse around, but don't talk to the shop assistant. Just be aware of how you feel. Do you feel tense? Anxious? Do you feel that you would stutter if you had to speak?

Step 2: Go to another shop, and don't talk. If you are tense, make a conscious effort of relaxing your body and mind as much as possible. Remember that the shop assistant is probably not the owner of the shop, just a (probably low-paid) employee and dependent on your good graces - the 'client is king' and the assistant will most likely be polite and anxious to be of assistance. So you are in a position of power. Be aware of this power.

Step 3: Go to another shop, and don't talk - but assess your stress level. If you are very stressed out and feel that you won't be able to use your fluency technique(s), go home and do a relaxation or physical exercise - anything to get your stress levels down. If you don't know how to manage stress, check out the chapter on stress in my book, which you can read HERE.

Step 4: Go to another shop, relax and just say a single word such as 'Hi' - but say it with the help of your fluency technique; and try to use the technique perfectly. Then leave the shop and congratulate yourself - you have passed a major hurdle!

Step 5: Go to another shop and say a slightly longer phrase such as 'Good morning' - but use perfect technique. Leave the shop and, if successful, celebrate!

REMEMBER: If you stutter or feel stressed at any level of these gradual desensitization levels, go back to the previous level.

Step 6: Go to a shop and say a whole sentence (by using your fluency technique) such as 'Do you sell ... ?' (soap, after shave, etc. - fill in as applicable). Focus on using your technique correctly. If successful, buy yourself a present - you've deserved it!

Step 7: The next time, try having a real conversation with the shop assistant.

Step 8: Continue until you have desensitized yourself from all fear, stress and anxiety in shops.

You get the idea? The key word is GRADUAL; you use your fluency technique at low-stress levels of a particular situation hierarchy; the success achieved through this will lead to speaking confidence and less stress; then you tackle higher levels - and you return to lower levels as soon as you experience difficulty; always evaluating the quality of your technique application as well as evaluating your stress levels.

This approach can be used in so many other situations: ordering in restaurants; phone conversations; public speaking; etc. I provide more details in my book, under the chapter 'Applying the Technique in Real Life' which you can read by clicking HERE.

Densensitization, in this sense, is, so I believe, the key to fluency for people who stutter and who wish to really apply the techniques which they have learned in real life. I have found this type of desensitization hugely effective, even though it is time-consuming. Good luck!

Speech science vs. speech therapy?

2010-06-16T12:35:00.000+02:00

I found the following in a 2007 speech science textbook:

"Abnormal laryngeal behavior has also been implicated in stuttering. Some people who stutter contract the adductor and abductor muscles of the larynx simultaneously, rather than reciprocally. This causes the glottis to be "frozen" in either an open or a closed state. Thus, for example, if it becomes necessary to produce an unphonated sound followed by a phonated sound (as for example in the word 'so'), the speaker may still be contracting his PCA muscle (abductor) at the same time as his IA muscles (adductors). Until the conflict is resolved, the glottis cannot close and phonation cannot begin. The time needed to resolve the conflict may account for the blocks and perseverations that mark episodes of stuttering."

('Speech Science Primer: Physiology, Acoustics, and Perception of Speech' by Raphael, Borden and Harris (2007), on page 97)

Compared to most current views on the cause of stuttering, the above seems a minority view - but then the above is a speech science textbook, not a speech therapy / pathology book. The authors' view seems similar to what Dr. Martin Schwartz (who is not only a speech pathologist, but also has a Ph.D. in speech science) has been saying for many years: that the vocal fold muscles of 1 - 2% of the population are highly sensitive to stress and tend to 'lock' when too tense, resulting in the struggle behaviour we see and hear as 'stuttering'.

Could it be that some speech scientists, as opposed to speech therapists / pathologists, are not seeing eye to eye on the cause of stuttering?

My book now fully online!

2010-05-25T15:38:00.001+02:00

At last I've managed to place all the chapters of my book Coping with Stuttering online. Feel free to read the book, starting HERE. I must admit I'm feeling quite proud - I have used this opportunity to give the original 1996 version a bit of a facelift, updating it in many places.

Looking at stuttering from the 'stress-sensitive vocal cord theory' amounts to a different paradigm - an exciting way of thinking about stuttering. Those who think outside this paradigm and within traditional frameworks will continue to mystify stuttering - their fate is to remain in the old stuttering labyrinth.

I've been involved with Prof. Schwartz's way of thinking since the early 80s, and after 30 years I am more than ever convinced that his vocal cord theory of stuttering is correct. In recent years I can even 'feel' my vocal cords constricting when stuttering, and 'opening' when using airflow, though critics could argue that this feeling could just be other throat muscles moving.

Since becoming involved with blogging and after beginning to place the book and video online, people have contacted me for more info and guidance; and it always amazes me how impatient we PWS are. We want results IMMEDIATELY; we would preferably take a pill - and be fluent! Unfortunately a quick cure doesn't yet exist. Learning to manage stuttering is like learning a new sport or a new skill - it takes LOTS OF PRACTICE. Adult PWSs have stuttered for many years, and the stuttering is probably well established - it will not loosen its grip on you easily. Most things that are of value take time, energy, willpower and perseverance.

In addition you may have to work on the psychological side. You may have stuttered for many years - if so, your subconscious is that of a stutterer. In stuttering management there is a golden rule: WHEN TRAVELLING ON THE ROAD TO BETTER SPEECH, YOU HAVE TO TAKE YOUR SUBCONSCIOUS WITH YOU AS A PASSENGER.

For this reason my book contains a number of chapters on self-image, assertiveness training, visualisation and other psychological topics. More and more stuttering institutions and clinics use similar principles in their programmes, as stuttering is increasingly seen as a problem which should be tackled holistically.

Stuttering is, in a sense, a childhood problem which can been carried into adulthood. Childhood is the time when it should ideally be stopped in its tracks, as it is so much easier to deal with it when young. For this reason I have added a chapter on how to work with stuttering children. I am, of course, not a therapist and have therefore leaned heavily on the work of therapists who specialise in childhood stuttering - but always while keeping in mind the basic principle of this book: that stuttering is caused by stress-sensitive vocal cords. Check out the chapter on stuttering children HERE.

In the chapter 'Breaking the Chain' I continue my own story, describing how I gradually improved my speech - and the discouraging relapses and setbacks. A major source of relapse is the subconscious reaction to improved fluency. The 'stutterer within you' will probably do its utmost to maintain the status quo. Once again the answer is not to lose hope. Not only will you have to be your own speech therapist - you may also have to be your own psychologist ... read this chapter HERE. Once again you need to be VERY PATIENT with yourself - real, permanent change takes time - it could take years.

Effectively coping with stuttering is not only a long-term project, it should also be a group project. DON'T try to go it alone! You really need external support: self-help groups and / or a therapist, or if unavailable, then a telephonic 'buddy system' or even an email group; or use your family as a support group. But don't try to do this all by yourself.

I hope that my book will be of assistance.

Kind regards, Peter

Watch my YouTube video on Passive Airflow!

2010-03-16T20:12:00.000+02:00

I have just finished making my YouTube video on the Passive Airflow Technique and it can be watched by clicking HERE. Feel free to place comments below the video if you have questions or comments, and I will do my best to answer them.

I'm still working on placing my book on the internet and I'm about halfway now. In particular I would recommend the chapter 'A Possible Cause of Stuttering' which can be read HERE. This chapter also contains important diagrams explaining fundamental concepts such as 'base-level tension', 'speech tension' and 'threshold'. An understanding of stuttering WHICH MAKES SENSE is the first step toward improved fluency and is really part of the treatment - by knowing what causes stuttering we can really start facing it.

You may also be interested in the chapter on the Passive Airflow Technique which can be read HERE, the chapter on Learning the Technique which is found HERE and Applying the Technique in Real Life which is HERE.

As said before, this is not a miracle cure and demands time and energy, but it is probably the best road to better speech we have available today as it seems based on correct principles, despite what some so-called 'experts' have said about this approach.

Kind regards until next time!

Important reading - for understanding stuttering

2010-02-18T15:50:00.006+02:00

You may want to read Dr Martin Schwartz's latest book which is now free online, Stutter No More, here. It is IMHO probably the best book ever written on stuttering. For a fuller picture of Schwartz's thinking you may also want to read his earlier books - some copies are still available via Amazon:

Stuttering Solved

You Can Stop Stuttering (co-written by Dr Grady Carter, a medical doctor who stutters and was helped much by the Passive Airflow approach)

Dr Schwartz's views on stuttering are hugely important for all who stutter, so do visit and study his website here. The speech therapy establishment has made a terrible error in opposing and marginalising him. That's one reason why stuttering therapy is, generally speaking, still in the labyrinth of seeking-and-never-finding. Fortunately he has throughout the years trained many individual therapists, and they are gradually coming to the fore and spreading his ideas. Though Dr Schwartz has retired and no longer presents workshops, his institute still offers a CD / DVD self-help course which you can order by visiting his website mentioned above.

I am positive that sense will prevail and that this major breakthrough will be recognised in due course, and I hope to do my bit in speeding this process up.

Stress - the elephant in the stuttering room

2010-02-12T12:35:00.004+02:00

'The elephant in the room' is an expression referring to the strange phenomenon that a hugely relevant or very obvious issue is sometimes ignored, perhaps because it may be politically incorrect or not fashionable to discuss it. Stress, in my view, is the elephant in the stuttering room (see my previous posts on this subject).

I have for many years noticed that my stuttering patterns corresponded to a large extent (not 100%, of course, because we are not programmed machines) to my stress patterns. When I had the flu or a bad cold, my speech deteriorated - but when I drank pain-killing or flu pills which subdued the central nervous system, my speech improved. When I was tired, my fluency levels dropped. In times of important life changes - changing schools, starting a new job, emigrating to a new country, learning a new language, moving to a new house etc. - my speech usually got worse.

It was only after reading Dr. Martin Schwartz's books that it became clear to me that stress levels and stuttering are closely connected. If you stutter, I urge you to also identify your stress patterns and see to what extent they correspond to your stuttering patterns. Identifying a problem and its contributory causes is the first step toward managing a problem.

That, of course, is not to say that stress causes stuttering, because then everybody in the world would stutter. Stress rather seems to impact on an organic component in the human body (the vocal folds, in my opinion), resulting in stuttering.

It follows that stress management should go a long way toward improved speech; and this seems true on a physical as well as a psychological level. For instance, stress can be reduced by jogging, sport or other physical activities, or relaxation exercises, or stress-lowering diets and vitamins; but also by psychological means - eg. developing a problem-solving attitude, positive thinking, a flexible attitude to life, the magic of humour, so-called Type B behaviour (a more relaxed way of living and thinking), stress management in the workplace, stress desensitisation (stress deconditioning), confidence and self-image building, assertiveness training etc. In my book you will find more details.

Stress management, of course, is not enough in managing stuttering. Stress management should be accompanied by using a good fluency technique such as Passive Airflow. But without stress management, the benefits of a fluency technique may be limited, as it is very difficult to apply a fluency technique if you are highly stressed. So stuttering should be tackled by a two-pronged approach, from below (stress management) and from above (fluency technique).

WHY saying our own name is so difficult

2010-02-11T13:54:00.001+02:00

Ever wondered WHY saying your name is one of the most difficult things for us?

In the bad, ugly past, when psychological and psycho-analytical explanations for stuttering were in vogue, the so-called experts tried to sell the idea that we could not say our name because, on a subconscious level, we did not WANT to say it, perhaps because of deep-seated, underlying conflicts.

Today we know more about how stress works. It is difficult to say our name because we know, consciously or subconsciously, that we can't word-substitute our name, and this lack of choice increases stress tenfold.

There have been PWS who have changed their name because of the difficulty of saying it - and then later started to stutter on their new name; once again because they HAD to say it. They did not have space, freedom and alternative options for saying their name. That's how stress works - a lack of options is an important source of stress.

The Basic Speaking Stresses

2010-02-06T16:15:00.007+02:00

Several important types of speaking stress may affect the stutterer's speech:

* Situational Stress - for example the telephone, public speaking, ordering food in a restaurant, talking to a shop assistant etc. This type of stress is learned, as are the majority of stress types.

* Word or Sound Stress - also learned, and reinforced in the course of time. Often it is the result of fear of words / sounds. If you stutter repeatedly on a particular word or sound, you will eventually begin to associate that word / sound with unpleasant emotions, and you will develop an accompanying fear.

* Authority Figure Stress - talking to an employer, teacher, preacher, parent, lecturer, police officer, senior government official etc. These individuals wield power and authority which could be used by them to your detriment. So these people are potential threats - and threats are a well-known cause of stress.

* The Stress of Uncertainty - eg. when talking to strangers, or in a new job, a new school, a new language, a strange country etc., or when saying things that are unpopular. Newness also involves a threat (of not being able to manage the new challenges, or not knowing the appropriate behaviour in the new situation).

* Physical Stress due to exhaustion or illness.

* The Stress of Bad News, eg. discovering that your car has been stolen, or hearing that a relative is seriously ill.

* Speed Stress - caused by speaking too fast. This stress plays a very important role in stuttering. The quicker the speech, the higher the tension on the vocal folds.

* Communicative Stress - this is the pressure on the speaker to be heard and understood. A person's speech is often better when he says or reads something familiar to the listener and if he knows that the listener is aware of the facts. This relieves the pressure on the speaker to convey the message and reduces his communicative stress. Another example: a stutterer may say a sentence fluently, but if you ask him to repeat it, he may stutter - because the request to repeat himself increases his communicative stress.

* Linguistic Stress. Speech and language are interrelated. Most stuttering occurs at the beginning of sentences or words. Stuttering also occurs more often on the emphasised syllable of a word, and on key words such as nouns, verbs and adjectives rather than on more neutral words such as prepositions, conjunctions and articles. All this happens because the vocal folds are under greater pressure in these circumstances.

* Emotional Stress - caused by feelings of frustration, fear, worry, anxiety, guilt etc.

Often several types of stress may impact on the individual. The total of all the different tensions affecting an individual at a given moment is known as base-level Tension. Base-level Tension is the TOTAL TENSION on the vocal folds when a person is NOT speaking or does NOT intend to speak.

Stress? What stress?

2010-02-05T15:02:00.003+02:00

When surfing the stuttering websites it always surprises me that so many people who stutter, and apparently also some speech therapists, seem to have little insight in stress, and how it affects stuttering. Even if they are aware of the stress component they don't regard it as a main factor.

The ideas of Hans Selye, the world-renowned authority on tension, has been around for decades, and stress and tension as terms are commonly used in the popular media. Yet for some reason, this awareness has not sufficiently reached the stuttering community.

In my view, tension and stress are CRUCIAL components in stuttering. In fact I believe that you can't understand stuttering if you don't understand tension and stress.

Below follows a very short summary of the chapter on stress in my book. This is only a description of stress and not the section on stress management.

We all know what being tense feels like - those clammy palms as you await your turn to do an oral examination, the accelerated pulse rate, the lump in the throat, the tumbling, panicky thoughts ... We have several names for these responses: nerves, pressure, excitement, panic, stress, tension, anxiety. But what exactly IS tension?

The Canadian biologist Hans Selye has described tension as the rate at which we live at a given moment. All living beings are subjected to a measure of tension, and any intense experience - whether pleasant or not - temporarily increases that tension. This means that in terms of tension, a painful blow and a passionate kiss can have the same effect.

Tension is often the result of the body's response to a THREAT. This 'fight or flight' response, as it is also known, is a mechanism activated to release the additional energy required to counter the threat. The 'fight or flight' response activates a complex biochemical process resulting in an increase in pulse rate, blood pressure and muscular activity. This last feature is of special significance for stutterers - an increase in muscular activity may also affect the vocal fold muscles.

Stress is excessive tension. A few causes of tension:

1) A THREAT, whether real or perceived or potential, whether vague or clear. Eg. unemployment involves a threat to financial wellbeing, and can result in poverty and hunger. Sitting in a traffic jam when late for work also involves a threat (potential job loss).

Any kind of CHANGE can also include a threat (fears of being unable to cope with the new situation). That's why major life changes such as marriage, divorce, new school, new job, emigration, new house, retirement can result in a lot of stress.

Talking to an authority figure (teacher, lecturer, employer, parent, policeman etc.) can result in Authority Figure Stress - also a potential threat, as he/she can use his/her power / authority to your disadvantage.

2) Physical tension - when exhausted, or due to illness.

3) Lack of recreation and entertainment.

4) Environmental - even the weather, humidity, temperature and age can affect tension levels. Office workers have reported often feeling more tense on a Wednesday than a Friday (before the weekend!) and more relaxed in the early morning than later in the day.

5) Subconscious processes.

As some tension is normal and positive, our goal should be to control and not eliminate tension. Note also that what is stressful for Mr A may not be stressful for Mr B. It all depends on the individual's personality, history and experiences, value system etc.

Fluency techniques only work well when a person's stress levels are not too high, and this is probably the reason why many people do not benefit from these techniques - their stress is way too high. They should first attend to their high stress levels before tackling their speech. This is a very important point, and you will hear it many times in this blog and in my book: stuttering management should consist of a FLUENCY TECHNIQUE COMBINED WITH STRESS CONTROL.

Blocks are the core of stuttering

2010-02-04T10:53:00.006+02:00

Traditionally it has been thought that stuttering consists of three 'core' or primary components: repetitions of words / sounds, prolongations of words / sounds, and silent blocks. Other behaviours such as the use of starters (eg. saying "mmm" before speaking), shutting the eyes, stamping a foot etc. are known as 'secondary' behaviours, as opposed to the core or primary behaviours.

According to Dr Martin Schwartz, however, there is only one core or primary component, namely the block. This block, in fact, is what he calls a laryngospasm - an unnatural locking of the vocal folds in the larynx due to excessive tension. The repetitions and prolongations, which were also thought to be core behaviours, are merely the stutterer's way of coping with the vocal folds that have locked.

For instance, if you want to say 'bomb' and are only able to say b-b-b, it means that you are actually unable to say the sound(s) AFTER the b. Because you are unable to say these sounds, you continue to say b in an effort to finish the word.

Schwartz's view of the core block is a fundamental break with tradition and amounts to a paradigm shift - a change in the usual way of thinking about stuttering. Repetitions and prolongations are NOT core, primary behaviours. They are secondary behaviours. They have, in the course of time, become learned behaviours. They are, in fact, conditioned reflexes, fired by the contracting vocal folds.

This theory of stuttering is in line with my own history and experience of stuttering. I have, through the years, to a large extent managed to control my repetitions and prolongations (though they remain dormant and come to the fore in unguarded moments!); the laryngospasms, however, are something else again and much more difficult to control - my laryngospasms can only be managed by fluency techniques.

The mystification - and demystification - of stuttering

2010-02-03T17:00:00.004+02:00

Many people like mysteries, and like to mystify things. A mystery is interesting and stimulating - and can be frightening. Mysteries puzzle the mind, like ghosts, gods, devils and other 'unseen' things. They are food for thought.

Stuttering was such a mystery for many years, indeed for such a long time that many have become accustomed to thinking of it as unsolvable, or otherwise as an extremely complicated neurological defect. It has become part of our mindset that "stuttering is complicated".

Have you ever thought that, well, perhaps the answer is not really so difficult at all? Is it possible to imagine that? To switch back from the preconceived idea of stuttering as "complicated" to "stuttering is not THAT complicated"?

I propose that stuttering is not very complicated. If you have a basic idea of:

1) How stress works, as explained for the past decades by the Canadian biologist Hans Selye, the world-renowned authority on tension; and

2) How conditioned reflexes and learned behaviour work; and

3) How the vocal folds function,

then it all falls in place, and stuttering loses its mystery - and some of its power over you. Then stuttering starts to make sense. And if you have this understanding, you can start thinking about it in objective terms. You can start isolating it from the terrible personalised emotions associated with it. That, again, is another step toward better control of your speech. If you know what happens to you when you stutter, and WHY you stutter, it becomes so much easier to deal with it.

In my free online book, Coping with Stuttering, I have provided simple explanations of how stress, learned behaviour and your stress-sensitive vocal folds have combined to interfere with your speech. Read my book by clicking HERE.

A slightly different view of stuttering

2010-01-29T23:00:00.002+02:00

You will note that, in this blog, some lesser known terms are used when discussing stuttering - words such as stuttering threshold, base-level tension, laryngospasm, speech tension, word or sound stress, speed stress and others. These terms all have defined meanings that will become clear as I further develop the blog. In particular the meanings will be found in my free online book Coping with Stuttering (which you can read by clicking HERE - you can also use that blog's search engine to find the meanings of these terms). These terms are vintage Schwartz concepts with which he has immensely enriched our insight in stuttering.

Some time after doing Schwartz's intensive course I began to expand my knowledge of stuttering, and gradually I noticed that Schwartz's ideas - which so corresponded with my own experiences of stuttering and seemed so clear and logical - differed somewhat from what is generally accepted by most speech clinicians. This coincided, perhaps not surprisingly, with an apparent backlash from some conservative speech clinicians.

Schwartz was heavily criticised for, amongst others, his first book with the challenging title Stuttering Solved (1976). Highly controversial, the book was translated in five languages. Though Schwartz later admitted that some of the statements in that book were naive, much of the criticism against the title resulted from a perhaps deliberate misreading. The phrase 'stuttering solved' has a double meaning; it can mean that the problem of stuttering has been solved, or it can mean that the cause of stuttering has been found. Schwartz has always insisted that he has indeed identified the cause of stuttering and he has never wavered from this view. This firm conviction may at the time have led him to believe that effective management of all stuttering had also arrived. This was indeed rather simplistic; but it does not detract from his other findings and techniques which are of huge importance to all people who stutter.

Based on the idea that stuttering can be prevented by slightly opening the vocal cords before speaking, he developed the Passive Airflow Technique, which is today used by various individual therapists and stuttering institutes. Like all fluency techniques it is not a miracle cure, needs to be learned from a qualified professional and practised a great deal so that it becomes a habit.

My speech therapy history

2010-01-27T17:21:00.000+02:00

My first therapy was in high school. It mostly consisted of reading in front of the therapist and walking around the campus (the clinic was linked to a university) with her - I had to ask people the time while stuttering artificially. This went on for a few months, and though I hated the therapy my speech improved and I was quite fluent for about 6 months.

In retrospect I now understand why I experienced this temporary fluency after therapy. The therapy had the effect of reducing my stress - therapy tends to do that because of all the attention given to your speech. The therapy reduced my base-level tension to below my stuttering threshold - to the point where my conditioned stuttering reflexes could not be activated. So at the end of the therapy the therapist, a rather pretty young woman, discharged me as "cured". That was in the 60s, when there was little understanding of stress and how it works. Eventually, of course, my stutter returned as my base-level tension returned to its pre-therapy levels - quite understandable, as all the usual stressors of life still remained.

While at university I made a second attempt at improving my speech. At the time I was convinced that the problem was psychological, and I consulted a psychiatrist who supposedly had a good reputation in the treatment of stuttering. His treatment included hypnosis and self-hypnosis, which was to an extent beneficial. He taught me how to relax. I had to do self-hypnotic relaxation exercises for an hour every day... though these helped, the enormous effort which I invested in these exercises was not reflected in the results. I had to learn the hard way that stress control in itself is usually inadequate in stuttering management, even though it can be a valuable supplementary aid.

In the 80s I attended a Passive Airflow Technique intensive group workshop of Dr Martin F. Schwartz, and did the follow-up programmes. I also started attending the self-help support group which was created as part of the workshop. These experiences were turning points in my life. Daily practising resulted in big improvements - unfortunately also followed by immense relapses as the "subconscious stutterer within" tried to reassert itself in response to my newfound fluency, and played havoc with my stress levels. Change can be very stressful. In the course of time, however, my subconscious got used to my improved speech. This process was much helped by the self-improvement books which I devoured at the time. Resulting from all my experiences I eventually wrote my own book on stuttering, and this lead to some media exposure - I even appeared on TV and radio, which went quite well.

To make a long story short: I have made huge improvements during the past 30 years. I am certainly not 100% fluent - chronic stuttering is seldomly cured - but can now manage my most pressing speaking situations. The phone is no longer a major problem; through stress-desensitisation steps I gradually overcame many telephone fears and other telephone-induced stresses. I must admit that I still have some public speaking fears, but this is quite common also in fluent people.

Even so I would not want to jump on the "success story" bandwagon. Though my life has become much easier thanks to stuttering management, I sometimes feel that I spent too much time and energy on it which could have been used for other purposes. But that's life - it takes you in unexpected directions.

Welcome to my site

2010-01-21T14:18:00.005+02:00

Hi, my name is Peter Louw and I am from South Africa.

Stuttering, in my view, is a stress-related, learned communication disorder brought on by an inherited tendency to direct stress to the vocal cords.

Approximately 1 to 2 % of the world's population seem to have this tendency to channel their stress to the muscles of their vocal cords, in the same way that other people direct their stress to the muscles of their neck (neck pain), shoulders (shoulder pain), stomach (ulcers), intestines (spastic colons) or other organs. Due to the excessive stress the vocal cords (also known as the vocal folds) lock, making it physically difficult or impossible to speak. In spite of this difficulty the stutterer will usually TRY to speak. This may result in struggle behaviour, which we see and hear as 'stuttering'. In the course of time the stutter becomes learned behaviour - a conditioned reflex.

That, in a nutshell, is what this site is all about. Though this theory of stuttering has been around for many years and explains most, if not all, of the features of stuttering that have baffled people for so long, it is not receiving the attention it deserves. In addition, many stutterers are not sufficiently aware of the exact nature of stress - in its many forms - and how it impacts on stuttering. This is to their detriment, as insight in the disorder is a first step toward doing something about it.

That's the reason why I wrote my book Coping with Stuttering (1996), and as it's no longer in print I have placed it online and updated it somewhat. You can read it HERE. While my book forms the core of what I wanted to say about stuttering, the Stuttersense blog highlights particular stuttering issues and also serves as an update of my book, which is very much based on the thinking of Dr Martin Schwartz, of the National Center for Stuttering. As I have a full-time job and a family I am only able to write approximately one post per month.

I hope that, after reading my book and this website, you will see stuttering in a new light and will understand its nature. And if you stutter, you will at least be an informed stutterer and know what the options are for you. Best of luck!