F.M. Alexander Technique in the Treatment of Stuttering – A Randomized Single-Case Intervention Study with Ambulatory Monitoring
Authors: Dorothea Schulte, Harald Walach
Journal: Psychotherapy and Psychosomatics (2006)

The Alexander technique (AT), a body-oriented method using mental direction of awareness, is named after its founder, the Aus-tralian actor Frederick Matthias Alexander (1869–1955), aiming at the modiﬁ cation of physiologically unfavorable automated habits and postures. Habitually executed movement patterns can be un-favorable and damaging. Alexander himself was able to cure his own functional dysphony by employing the principles of his tech-nique. In addition, he also successfully worked with stutterers. Stuttering is frequently associated with high tension in the mus-cles involved in speaking [1] and with neuromuscular coordination problems [2] . A reduction of such an increased muscular activity leads to reduction of the symptoms of stuttering [3, 4] . The most conspicuous feature of stuttering is the self-conditioned secondary symptoms, i.e. the patients’ effort of ﬁ ghting and overcoming stut-tering when it occurs [5, 6] . Gradually, the strain increases and the secondary symptoms are automated into a strenuous and burden-ing habit. AT offers a systematic way of modifying such habits as stuttering-related increase in muscle tension and thus a possibility of coping with fears of expectancy. Scientiﬁ c evidence for AT’s efﬁ cacy is missing despite its popu-larity [7] . We decided to combine an experimental evaluation tech-nique with the highly individual approach of AT. For ethical reasons, we decided to recruit subjects who had experienced some therapy, but who had not been treated for 1 year prior to the study and who still had considerable residual problems with their stuttering. The 2 subjects came from a pool of local self-help groups and therapists who were alerted to the study and signed up for free treatment. We used a single-case, time series design with a randomized beginning of the intervention, as described by Edgington [8, 9] and Wampold and Furlong [10] . The random component in our study was the randomized allocation of the beginning of the intervention within a 30-day intervention period after a 5-day baseline. Data acquisition was by ambulatory monitoring and in situations of ev-eryday life, using a pocket PC by Psion, series 3a (Psion™ PCL, London, UK) [11] . The subjects were asked to reply to questions concerning their experiencing of and coping with stuttering imme-diately after episodes of speaking 3 times per day. Questions were related to anxiety, making contact with the body, using Alexander directives, general feeling, stuttering, quality and acceptance of stuttering, avoidance of words or letters, speed and trying to inﬂ u-ence stuttering by diverse techniques including AT. Variables were evaluated using a randomization test according to Edgington [9] . Randomization tests calculate a simple test sta-tistic and permute this calculation through all possible arrays of data. The test statistic we used was the mean difference of a target variable between baseline, up to the intervention point, and the intervention period including the postobservation period. The number of all the hypothetical differences, which are larger or equal to the one obtained empirically, divided by the number of all po-tential differences gives the true probability that the empirically observed value could have occurred by chance. In addition to the data acquired by Psion entries, audio and video recordings of con-versations within and outside of a treatment session were done in order to detect modiﬁ cations in stuttering severity. The subjects attended 30 lessons in total, which took place 2–4 times a week. Lessons were basically structured in two sections:(1) teaching of the basic principles of AT; (2) applying AT while speaking. The ﬁ rst subject was a 27-year-old female student who had been stuttering since the age of 3 with a history of multiple therapies. Stuttering was still a residual problem which occurred in difﬁ cult situations. The second subject was a 47-year-old male professional working in an industrial enterprise. He has been stuttering since the age of 5 and has had multiple speech therapies and psychotherapies, including pharmacotherapy because of depression. Both subjects described their stuttering problem as medium in sever ity. Although the subjects did not display high stuttering rates at the beginning of the study, a further improvement could be demon-strated in both subjects. The female subject’s stuttering rate was between 2.5 and 4.6% before attending AT lessons, and only 0.3 and 0.74% after about 14 lessons to the completion of this study ( ﬁ g. 1 ). The male subject’s rates improved accordingly (from 5.24/8% to 0.64/2%).