Regulated breathing as a treatment for stuttering: A review of the empirical evidence.

Abstract Regulated Breathing (RB) is a behavioral treatment for stuttering designed to address airflow irregularities by teaching breathing patterns that are incompatible with stuttering. The current paper describes the RB procedure and reviews published literature to examine the empirical support for the efficacy of RB. Existing data indicate that RB is an effective treatment for stuttering and could be considered a "probably efficacious" treatment according to the criteria described by Chambless and Ollendick (2001). Limitations of the present literature are discussed, as well as suggestions and possible directions for future research. Keywords: Regulated Breathing, Stuttering. Introduction Stuttering is characterized by a disturbance in the normal fluency and time patterning of speech (APA, 2000). Speech disturbances include frequent occurrences of sound, syllable, and whole-word repetitions; sound prolongations or hesitations; interjections; broken words; or circumlocutions. The Diagnostic and Statistical Manual of Mental Disorders includes the criterion that stuttering interferes with academic, occupational or social functioning and must not be better accounted for by a speech-motor or sensory deficit (APA, 2000). However, a diagnosis of stuttering in young children is often given even in the absence of functional impairment. When young children are diagnosed, speech patterns are usually evaluated and compared to the normal fluency for their age group (APA, 2000). Clinicians also take into consideration developmental and emotional factors that can disrupt a child's speech (Williams, 1985). Prevalence rates of stuttering are approximately 1% (Bloodstein, 1995) but can be as high as 5% during childhood (Leung & Robson, 1990). The onset of stuttering usually occurs between the ages of 2 and 6 (Andrews et al., 1983; Homzie & Lindsay, 1984) and is more common in males. The male-to-female gender ratio is 3 to 1 during childhood and increases to 5 to 1 in adulthood (APA, 2000, Bloodstein, 1995). Although a specific cause for stuttering is not known, it is believed to be a heritable disorder (Felsenfeld et al., 2000; Andrews, Morris-Yates, Howie, & Martin, 1991). Stuttering is associated with various airflow irregularities. Healey (1991) suggested that stuttering is primarily associated with the tightening of the laryngeal muscles in the throat, resulting in a disruption of airflow and speech production, and Bloodstein (1995) noted that in some cases a complete cessation of breathing or an irregularity of the respiratory cycle occurs during stuttering. Also, people who stutter tend to have less airflow during speech difficulties involving the coordination of laryngeal muscles, which results in decreased air volume in the lungs before speech initiation (Stager, Denman, and Ludlow, 1997). To address the issue of airflow irregularities in stuttering, modification of speech-related respiratory behavior is believed to be useful in the treatment of the disorder. Description of Regulated Breathing Regulated Breathing (RB) is a multicomponent behavioral treatment that attempts to inhibit stuttering by teaching a speech-related breathing pattern that is incompatible with stuttering (Azrin & Nunn, 1973). RB consists of several different treatment components, including awareness training, relaxation, competing response training, motivation training, and generalization training. It shows significant overlap with habit reversal, a procedure designed to treat nervous habits and motor tics. Awareness Training. Awareness training is comprised of four techniques. During response description, the client deliberately stutters and provides a detailed verbal description of physical movements, sounds, and sensations (tension) associated with his or her stuttering. The second awareness technique, response detection, requires a client to point out a stutter when it occurs. …