Attitudinal and Emotional Components of Stuttering

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Attitudinal and Emotional Components of Stuttering
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Interaction of behavioral, affective and
cognitive components of stuttering

• B
• A C

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Negative emotions associated with stuttering

• Anxiety
• Fear
• Anger
• Unworthiness
• Embarrassment
• Underlying these emotions are emotions of SHAME
  and GUILT (Murphy, 1997).

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Shame and Guilt (Murphy, 1997)

• GUILT
• The uncomfortable or painful feeling that comes
  from DOING something we think is wrong. Guilt
  concerns behavior.
• SHAME
• The uncomfortable or painful feeling when we
  realize that a part of us is defective, bad, or a
  failure. We feel shame for BEING, not doing.

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FEAR

• Fear is the expectation of unpleasantness.
• Fear of
• Social penalty (stigma)
• Listener reaction
• Expectation of communication failure
• Loss of self-control
• Exposure as a person who stutters

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Emotional reactions to social penalty

• Individuals may react differently to fear.
• For those who turn it outward
• Anger, hate, suspicion, quarrelsome.
• Hostility aggression.
• For those who turn it inward
• Timid, shy, apologetic.
• Hostility self-hatred, depression.
• It almost always leads to escape/avoidance
  behaviors.
• From stuttering from speaking.

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Development of Negative Self-Concept (Guitar,
1991)
Perception of self
Perception of others views of oneself
Perception of listener reactions
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Negative attitudes associated with stuttering

• Im not worthy of ________.
• His/her time
• His/her friendship
• That job/position of leadership
• I cant/PWS shouldnt _______.
• Volunteer to speak/speak too long
• Follow that career path
• Subject others to stuttering

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Locus of Control

• Locus of control refers to the extent to which
  (an individual) perceives responsibility for
  their own personal problem behavior (Craig, et
  al., 1984).
• Research suggests that changing the clients
  locus of control, knowledge about stuttering,
  and self-esteem can be important factors in
  meeting a wide number of therapy goals (Blood,
  1995).
• Identify locus of control in the clients
  language about stuttering.
• Research suggests that changes in locus of
  control and other affective components can reduce
  the risk of relapse (Craig, 1998).

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Ideas for Neutralizing and Desensitizing Negative
Feelings
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Ideas for children from Bill Murphy

• We need to normalize stuttering we need to
  normalize failure we need to de-awfulize
  stuttering.
• Its OK to stutter.
• Its nobodys fault.
• Activities
• Externalize stuttering by pseudo-stuttering,
  squashing clay stutters, popping balloon
  stutters.
• Make a movie (role playing teasing and ridicule)
• Youre the expert (teaching others to stutter)
• Self-disclosure (taking to your class about
  stuttering)

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Talking to kids about stuttering.Ideas from
Kristin Chmela

• Restating the message
• So what youre saying is
• Probing for more information
• I was wondering
• Labeling the feeling
• That must have felt
• Validating the feeling
• Its OK to feel
• Observing what you see
• I was noticing that
• Encouraging your desired outcome
• You are.

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Desensitization

• Two typical aims
• 1. Desensitization to ones own stuttering
• 2. Desensitization to situational fears which
  have the potential to provoke dysfluency (and
  impede use of therapy strategies)
• Systematic desensitization (Wolpe, 1958).
• Progressive relaxation followed by progression
  through a ranked hierarchy of speaking fears.
• Client starts with lowest ranked fears,
  maintaining state of relaxation during
  visualization and practice sessions. As lower
  ranked situations are mastered, higher ranked
  items on the hierarchy are progressively
  addressed.

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Desensitization to ones own stuttering(older
children and adults)

• Tolerating stuttering and the feelings it evokes
• Open stuttering
• Voluntary stuttering
• Identifying feelings
• Rating scales
• Pencil and paper tasks

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Developing task hierarchies for activities and
assignments
Book Report
More Disfluency
Cafeteria
Best friend
Clinician
Mom and Dad
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Expanding hierarchies to individualize objectives

• Where?

Classroom
Playground
Group therapy
Home
Therapy setting
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Expanding hierarchies to individualize objectives

• Who?

Critical listener
Teacher
Friend
Parents
SLP
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Expanding hierarchies to individualize objectives

• What?

Presentation
Conversation
Monologue
Sentence
Word
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Expanding hierarchies to individualize objectives

• When?

When nervous
When arguing
When hurried
Around bystanders
On telephone
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Maximizing progress and generalization

• Increase challenges gradually to ensure success
• Team with the client to develop assignments and
  activities
• Work with others as appropriate (see Zebrowski
  Cilek (1997) for guidelines)
• Identify environmental cues that should trigger
  speech strategies

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What is the role of anxiety in stuttering?

• Psychologists recognize two general types of
  anxiety
• State anxiety occurs prior to and during
  situations that the individual finds threatening
• Trait anxiety the chronic state of the
  individual, who may react more strongly in
  stressful situations than would be typical.

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Three accounts of the role that anxiety may play
in stuttering

• 1. Anxiety is the pre-eminent factor in the
  etiology and maintenance of stuttering behaviors
  (e.g., Sheehan)
• 2. Anxiety may significantly aggravate stuttering
  and should be managed to optimize fluency (e.g.,
  Van Riper)
• 3. Anxiety in stuttering individuals results from
  response to stuttering itself if dysfluency is
  reduced, anxiety will subside of its own accord
  (e.g., Ryan).

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• Only therapies premised on positions 1 and 2 will
  typically include anxiety reducing components.
• Two typical methods for controlling anxiety
• Relaxation of state and tension sites
• Densensitization to anxiety-producing stimuli and
  circumstances

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Relaxation

• How to achieve it
• Methods
• Props
• General relaxation strategies
• 1. Progressive relaxation
• Use of focal points, music and breathing
• Breath management

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Ideas for Developing an Internal Locus of Control
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• Developing locus of control

All the strategies in the world won't work if
you can't use them. Learning to "steer your
stutter" Learning NOT ONLY to "avoid skids" but
how to get out of them. You can't drive well if
all you think about is not crashing.
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Ideas for older children and adults

• Improve knowledge about stuttering and the speech
  mechanism.
• Discussing fault and blame.
• Advertising oneself as a PWS.
• Learning about self-help organizations and
  internet resources.
• Becoming your own therapist
• Assignment development
• Making choices problem solving
• Developing challenges risk-taking
• Peer mentoring

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The "One-Minute" Test
What would help me get more out of this?

• What is going right?

What needs to be changed?
Using your client as your guide Developing an
ongoing assessment of the goals and effectiveness
of your therapy
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Ideas for Changing Negative Thoughts and
Attitudes
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Ideas for children and adults

• Exploring and identifying attitudes.
• I think___ statements.
• Redefining success and failure.
• Communication vs. fluency.
• Paradoxical assignments.
• Now, try to stutter with the most struggle you
  can.
• Use of humor/story telling.
• I couldnt say Guinness, so I always got the
  waiter to say it for me by asking, What kind of
  stout do you have?.

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Applications from Cognitive Therapy (Beck, A.)

• Cognitive therapy
• Assumes a thinking disorder reflected in the
  way an individual interprets particular
  experiences.
• Points out biases and proposed alternatives
  resulting in lessening of symptoms.

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The Cognitive Model

• Core Belief
• Intermediate Belief
• Situation Automatic Thought
  Emotion

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Working with automatic thoughts

• Determining the validity of automatic thoughts
• What is the evidence?
• What are the alternative explanations?
• What is the worst/best that can happen?
• What is the most realistic outcome?
• Evaluating automatic thoughts
• Identifying cognitive distortions.
• Evaluate the utility of automatic thoughts.
• Responding to automatic thoughts
• Coping statements
• Automatic Thought
• I should be able to do this. Im so stupid.
• Adaptive Response
• I shouldnt be able to do this yet. Its a
  new skill. Ill learn to do it eventually with
  guidance.