# Speech-Language Pathology/Stuttering/Response Selection Under Stress/Speech-Related Fears and Anxieties

Introducing yourself to an attractive person. Raising your hand to answer a teacher's question. Ordering in a restaurant. Calling a store to ask if they have what you want. Making a toast at your best friend's wedding reception. Calling to order a pizza. Leaving a voicemail.
Do any of these make you nervous? Any that you never, ever do? Everyone is nervous about some speaking situations. Public speaking is humanity's most common fear, greater than the fear of death. Few women will introduce themselves to a man to ask for a date, or call a man who's given his telephone number and asked for a date. Ordering in a French restaurant is scarier than ordering at McDonald's.

## The Predator Approach

Rent the video Predator, starring Arnold Schwarzenegger and Jesse Ventura. Settle down with a bowl of popcorn to watch the governor of California and the governor of Minnesota discuss school funding and property tax reform. Just joking. Back in 1987, Schwarzenegger and Ventura were action movie heroes. In Predator the men shoot a variety of large weapons, including an M-134 7.62mm minigun and an M-79 grenade launcher.
Now write down a list of speaking tasks that you don't do, that non-stutterers don't think twice about doing. Let's say that you're afraid to leave voicemails on answering machines. Write down all the speech therapy tools you can use in this situation. Imagine yourself as Schwarzenegger and Ventura making a list of weapons to bring. But instead of arming yourself with a minigun and a grenade launcher, your weapons for voicemail could include:
* Practicing your message before you call.
* Fluency skills, such as slow speech with stretched vowels, relaxing your breathing, or relaxing your vocal folds.
* Using a DAF/FAF anti-stuttering device.
* A hierarchy of stress, beginning with calling your own answering machine, then calling your speech-language pathologist's answering machine, then calling a friend's answering machine, then calling a business's answering machine (e.g., calling restaurants before they open asking if they have banquet facilities), and finally calling that attractive person of the opposite sex.
Don't stop listing your arsenal until you look at the list and laugh at how you'll blow away that poor little voicemail. Then think of one more weapon to add to your list. You're ready when you're confident that you won't stutter.
Let's say that your message is, "You're the most wonderful person I've ever met. I can't wait to see you again." Using all of your fluency weapons, pick up the phone and call your own answering machine. Check your messages. Pretty good, huh?
Now call yourself again. This time, reduce or throw away one of your weapons. If you used one-second stretched syllables on the first call, call yourself using half-second stretch. Then go to quarter-second "slow normal" speech.
If you used an anti-stuttering device on the first call, don't use the device for your next call.
If you practiced the message on the first call, say something spontaneous on your next call.
Step by step, throw away your weapons, until you can call your own voicemail fluently, without effort or fear.
OK, if you're a non-violent person, think of this as a multifactoral approach to stuttering therapy. Instead of relying on one fluency skill, take one item from the auditory processing category, e.g., an anti-stuttering device; one item from the speech motor control category, e.g., relaxed vocal folds; one item from the stress control category, e.g., using a hierarchy of stress; one item from the neurotransmitters category, e.g., medication, etc. Don't select all your fluency skills from one category, e.g., gentle onsets, diaphragmatic breathing, relaxed vocal folds, etc.

## Make a Stress Hierarchy

Now take a step up the stress hierarchy. Call your speech-language pathologist and leave a message. (If you're not in speech therapy, call a friend or relative.) Begin with your full arsenal of fluency weapons, then call back, using fewer fluency weapons. Then work your way up your stress hierarchy. If you feel any twinge of fear on a call, take a step back until you feel confident again.
Approaching feared speaking situations can be like fighting a grizzly bear armed only with a pocket knife. Scary speaking situations combine to look like a ten-foot-tall bear. Most speech therapy programs give you only one weapon.
Divide your general fear of speaking into specific fears. The giant bear becomes many small bears. Now create a stress hierarchy, with a small bear on one end, and a bunny rabbit on the other end. And instead of having one weapon, which your speech-language pathologist (or the expert who trained her back at the university) assured you was the One True treatment for stuttering, you now have a variety of fluency skills.
You're armed like Arnold Schwarzenegger, you're hunting bunny rabbits, and you're in a pet shop before Easter. Armed to the teeth with speech therapy skills, there's no possibility of stuttering in your feared situation. Heck, it isn't even a feared situation anymore!
You now see why this chapter follows the auditory processing chapter and the speech motor learning and control chapter. The previous chapters gave you many weapons for your fluency arsenal. Now that you have many fluency skills you have no reason to fear speaking situations. Work your way down your list of feared speaking situations until you have no more speech-related fears and anxieties than an average non-stutterer.

## Further Reducing Fears and Anxieties

When you run out speech-related fears and anxieties that non-stutterers aren't scared of, make a list of speaking situations that scare non-stutterers. Remember when I said that your speech can be better than non-stutterers? When you're ready, move on to these areas:
* Walk up to strangers at parties. If you're single, pick attractive persons of the opposite sex. Say that your speech therapist wants you to talk to strangers and ask if you can talk to this person. If you have an anti-stuttering device, ask if it's OK to use it. No one is going to say no. I met one of my ex-girlfriends this way.
* Join Toastmasters International to learn public speaking skills.
* Sign up for a beginning acting class at a university or community theater. Acting classes are the most fun you've had since sixth grade.
* Put together some funny stories and sign up to do stand-up comedy on amateur night at a nightclub.
* Sign up for voice lessons. Amaze people by singing at social occasions.
* Learn a foreign language. Talk to cab drivers in their native language.

## Stress Is the Absence of Choices

We experience stress when our plans are thwarted. We try to reach a goal, and some little thing stops us. For stutterers, that little thing often is an inability to communicate.
E.g., you go to a fast-food restaurant to buy a cheeseburger. You can see the cheeseburgers behind the counter. You can smell the cheeseburgers. You even have correct change in your hand. All you have to do is say, "Cheeseburger"&#151;but stuttering stops you.
Instead of thinking of stress as thwarted plans, think about your choices. You could point at the cheeseburgers. You could write "cheeseburger" on a note. You always have choices.
If you focus only on reaching your goal, you miss opportunities that may be better than your goal. E.g., you miss the salmon pesto salad the restaurant just added to the menu.
Or you pantomime "cheeseburger" as if you were playing charades. You feel ridiculous, and people in the line laugh at you. Then a movie producer offers you a million dollars to star in his new "stupid and stupider" movie.
OK, that's unlikely. Just realize that you always have choices. As you imagine your choices, you'll feel your stress going away. Your insurmountable problem now looks like a variety of choices (see the section Personal Construct Therapy.

## Use a Partner to Center Your Emotions

When you feel stressed, find a partner who expresses the opposite emotion.
E.g., if you're fired from your job. You come home feeling like a failure and you'll never succeed. You don't want a partner who agrees with you.
Instead, you want a partner who'll tell you that you're smart and hardworking, and you'll soon find a better job.
Picture your emotions like a car with a manual transmission. To shift from one gear to another gear, you have to shift through neutral gear. Similarly, to shift from feeling stressed to another emotion, first seek your emotional center.

## Reduce Your Child's Stress

No studies have tested whether reducing stress affects children's stuttering. But you can try and observe whether this helps your child's speech.
Don't demand that your child confess guilt (fear of punishment). When your child experiences overwhelming emotions, e.g., is afraid to do something, don't demand that your child explain why he or she feels overwhelmed. Emotions are in a deeper, older brain area. Language is a higher, new brain function. An emotionally overwhelmed child may be unable to speak.
Don't insist that your child talk in an unfamiliar situation, e.g., at a new day care center (uncertain what to say, fear of embarrassment, uncertainty of status with new children). Situations that feel comfortable to you may be stressful to your child. Try to see stress from your child's point of view.

## Reduce Your Listener's Stress

Stuttering is a rare disorder. Many people have never met a stutterer. I've had listeners ask if I was having a medical emergency, or ask if I was cold (apparently I looked like I was shivering). I have no doubt that other listeners thought that I was mentally retarded or psychotic, perhaps dangerous. Reduce their fears by saying that you stutter.
Some listeners think that they did something to make you stutter. Other listeners wish there were something they could do to help you. Tell them that you stutter. If they have any questions about stuttering, they'll ask you.
Make a joke about stuttering. Or you could put stuttering on your business card, perhaps describing you as chapter leader of your local stuttering support group.
Better, tell listeners that you're using speech therapy skills. Ask if your fluency skills sound weird, then do what your speech-language pathologist wants you to do (e.g., breathe with your diaphragm, relax your vocal folds, slow down your speaking rate). Ask if your stuttering therapy speech sounds better than your stuttering.
Ask the listener to remind you when you miss a speech motor control target. You could ask listeners to remind you when you stutter, but they'll be uncomfortable doing this, and you'll feel embarrassed if you don't have good control over your stuttering. Instead, ask listeners to remind you when you miss targets, e.g., you talk too fast. You should have better control over that.
If you're doing speech therapy, tell listeners you'll pay $1 for each missed target they point out (see my Romantic Disaster of 1996).
Lastly, if you use an anti-stuttering device, show it to your listener and ask if she minds if you use it. This is perhaps the best way to tell listeners that you stutter. Listeners invariably ask questions about the devices. In contrast, listeners rarely ask questions about speech therapy, e.g., vocal fold relaxation isn't of great interest to the general population. But everyone wants to know how anti-stuttering devices work. Suggest that the listener try on the device, and adjust it to make the listener stutter (by maximizing the delay, or moving the pitch shift up and down). When I do this, other people come over to see what's making their friend trip over his or her words. They give me positive feedback about my stuttering, laugh at their own failure to talk, and experience for a few minutes what it feels like to stutter.

## Alternative Ways to Reduce Stress

If stuttering is the only way you know to reduce stress, you'll always stutter in stressful situations. Instead, learn alternative ways to reduce stress. Take a stress reduction class. Read books about handling stress.
One of the best ways to reduce stress is to relax your breathing. Stress reduction classes teach this. Or take a meditation or yoga class. Relaxed breathing not only reduces stress, it helps stutterers talk fluently.

## Look for Stuttering-Reducers

Imagine a stutterer reading a projected PowerPoint presentation aloud to an audience. He scans the slides for feared words. Sure enough, there's a p-word. And an s-word! He scans the prodigious thesaurus in his brain, looking for words he can substitute. But the audience is reading the slides projected on the screen. Will they think he's illiterate if he substitutes or skips words? But what if he blocks and the audience discovers that he stutters! What can he do?
He's looking for stuttering-increasers. I.e., he's looking for ways to stutter. And, sure enough, stuttering-increasers&#151;difficult sounds, feared words, judgmental listeners&#151;abound, if you know where to find them.
Imagine another stutterer, also reading aloud to an audience. Instead of looking for stuttering-increasers, she looks for stuttering-reducers:
* With her text prepared for her, she can focus on using her speech therapy skills instead of thinking about what she's saying.
* She can pretend to be a robot reading machine. The robot has no emotions, it just sees words, moves its mouth, and words come out.
* She can wear an anti-stuttering device and the audience will think it's a microphone for the PA system.
* When she introduces herself she can say that she stutters. Audiences love presentations that start with a joke, so she could start with a joke about her stuttering.
You'll recognize this as a variation of the Predator approach.

## Increasing or Decreasing Stress in Therapy

Stuttering therapy typically begins with a stutterer learning closed-loop speech motor control in a low-stress environment, e.g., chatting with the speech-language pathologist, or alone practicing word lists.
The stutterer gradually moves from closed-loop speech motor control to open-loop speech motor control. When he achieves fluent open-loop speech motor control, the speech-language pathologist takes him to a shopping mall for "transfer" practice. Then they're finished with speech therapy and he's on his own.
The result is fluent open-loop speech in low-stress environments, and relapse to open-loop stuttering in high-stress environments. The relapse shake the stutterer's self-confidence. Or the stress de-myelinates (weakens) fluent speech motor programs. A single high-stress, dysfluent experience might destroy weeks of low-stress practice.
Or both. The stutterer then gets into a vicious cycle of stress and relapse leading to more stress and more relapse.
A better plan would be to train a stutterer to recognize stressful situations, and consciously switch to closed-loop speech motor control (i.e., very slow speech) in high-stress environments. When he feels his stress diminishing he can switch to open-loop speech motor control (i.e., normal-sounding speech).
For example, I used to meet strangers and say, "My speech-language pathologist wants me to talk to strangers. May I talk to you?" I would then use very slow closed-loop speech motor control. After we had a friendly conversation going and my fears and anxieties diminished, I'd use the "slow-normal" speaking rate that mixes open- and closed-loop speech motor control.
In other words, with traditional therapy the stutterer switches between stuttering and fluent speech, as situations change between high-stress and low-stress. Instead, I switched between closed-loop and open-loop speech motor control, as stress changed. The result was that I constantly myelinated (strengthened) the fluent speech motor programs in my brain. Most important, I strengthened my brain's connection between stressful situations and closed-loop speech motor control. Switching to closed-loop speech motor control in a stressful situation should be as habitual as remembering to count to ten before punching someone.
You might object that severe stutterers may be unable to produce even two-second stretch closed-loop speech motor control in stressful situations. I.e., their fluent speech completely breaks down under stress. So use the Predator approach.
Or you might object that closed-loop speech motor control sounds "weird," and stressful situations are where you most want to sound normal. When I said to strangers, "My speech-language pathologist wants me to talk to strangers&#133;#133;" no one ever refused. Most people then asked me questions about stuttering therapy. As long as the stutterer tells listeners that he is using special "speech therapy speech," sounding "weird" isn't an issue.

### References

* ^ Nippold, M., Rudzinski, M. "Parents' Speech and Children's Stuttering: A Critique of the Literature," Journal of Speech and Hearing Research, 38:5, October 1995.
* Next section: Personal Construct Therapy: You Always Have Choices
* Back to Table of Contents