stuttering modification

stuttering mod

teaching stutterer to "modify" moments of stuttering

easier way to stutter

nature of stuttering

disorder of timing

disruption in proper timing and sequencing of muscle mvmnts involved in producing a word

speech behaviors targeted

teach how to cope with disruptions

modify hard/tense/struggled moments into slow/effortless/easy ones

transitions from sound to sound should be gradual

artic contacts should be light

fluency goals

for advanced: "controlled fluency/acceptable stuttering"

"minimal" level of stuttering

feelings and attitudes

frustration, fear, shame

desensitization to stuttering and others' reactions

become less emotional about stuttering

better able to modify later

maintenance

teach client to become own clinician

change self-concept

relapse is major issue

steps

identification

desensitization

modification

stabilization

identification phase

identify core/secondary behaviors, feelings/attitudes

use mirror/audio/video/speaking situations/phone calls

goal is "free and easy stuttering" or a clean stutterer

desensitization phase

confronting via self-disclosure

less emotional reaction (freezing, clinician pantomimes client's MOS)

less reaction to listeners' reaction (voluntary stuttering, speaking situations)

modification phase

easier way of stuttering

word is said in slow motion

transitions are gradual

contacts are light

practice

modification techniques

cancellations

pull-outs

prepatory set

cancellations

complete stutter, try again and make first sound light into transition

pull-outs

as stutter occurs, make light contact correction in event

prepatory set

light contact before it happens

stabilization phase

automatization

dvlp own assignments

become own clinician

refresher weekends

support groups

ACT

acceptance and commitment therapy (a counseling approach)

most effective way to make changes in life is by fully accepting what it is

acceptance is opposite of resistance (don't fight it)

acceptance

SLP accepts stuttering-- client encouraged to do the same

dvlp non-judgmental awareness and attitude

long-term goals of desensitization

self-disclosure encourages openness and gives client permission to stutter/helps becoming more comfortable with stutter

respond rather than react to stutter

6 core processes of ACT

1. experiential acceptance and willingness

2. valued living

3. contact w/ present moment

4. thought defusion

5. transcending self/perspective taking/self as context

6. commited action

experiential acceptance and willingness

moving fluidly through our thoughts is a choice

opening up to whatever stuttering-related thoughts/reactions/behaviors that arise

valued living

by allowing us to see "whole self" we can change storylines we've created about ourselves and better connect with values

PWS can have fears/worries/negative thoughts and still have values

contact w/present moment

be in the now of all speaking situations rather than in past experiences or future fears

thought defusion

the more we try to suppress/avoid/fight thoughts, the more they come back

observing thoughts regarding stuttering moments/reactions/situations as they come and go w/o judgment

transcending self/perspective taking/self as context

making small shifts in how we address self can influence ability to regulate thoughts/feelings/behavior under social stress

external perspective of whole self

committed action

effective action guided by values

create plan to achieve goals (speech ladder)