Avoidance Reduction Therapy for Stuttering (ARTS) Notes

Chapter 9: Avoidance Reduction Therapy for Stuttering (ARTS®)

Author: Vivian Sisskin

Introduction

• Stuttering Perception: Clients often evaluate their success in binary terms (good vs. bad days), reflecting prevalent societal views.
• Quality of Experience: Encouragement to reflect on qualitative outcomes in communication rather than solely on fluency.

What is ARTS?

• Overview: A modification approach focusing on reducing struggle and emotional reactions associated with stuttering, rather than increasing fluency.
• Key Quote: “Grant me the serenity to accept the things I cannot change…” Adaptation of the Serenity Prayer.
• No Tools Required: Rather than using tools to manage stuttering, ARTS focuses on reducing learned escape behaviors and emotional reactivity.

Theoretical Roots

• Joseph Sheehan: Pioneer in stuttering modification, incorporated insights from Conflict Theory and Role Theory.
• Conflict Theory: Stuttering seen as an “approach-avoidance conflict,” leading to various avoidance behaviors.
• Role Theory: Enacting fluent roles can lead one to feel ashamed. Accepting the role of a person who stutters can ease anticipatory anxiety and promote authenticity.

Iceberg Analogy

• Visible vs. Covert Behaviors: Overt behaviors (repetitions and prolongations) are surface issues; deeper emotional issues (fear, shame) lie beneath. Addressing covert issues is crucial for treatment success.

Central Theme of ARTS

• Suppression: Suppressing stuttering leads to chronic struggle. Clients are encouraged to reduce control and embrace open stuttering.
• Habituation of Escape Behaviors: Clients often adopt behaviors to avoid stuttering, which become ingrained.

Disruption of Normal Talking

• Struggle vs Fluency: Emphasis on understanding struggle as an interplay between fear and stuttering rather than merely a problem of disfluency.

Preparing Clients for ARTS

• Understanding Challenges: Explain the impact of stuttering on social, psychological, and emotional well-being. Utilize the ABC model (Affect, Behavior, Cognitive) to demonstrate interaction between feelings, behaviors, and thoughts.

Culture of ARTS

• Cultural Shift: Transition from valuing fluency to pausing for effectiveness and comfortable communication. New definitions of success emerge based on being authentic rather than suppressing stuttering.

Core Principles of ARTS

1. Action: Therapy should be active; clients engage in commitments to reduce avoidance.
2. Support: Community and peer support enhance motivation and accountability.
3. Semantics: Reframe negative connotations surrounding stuttering; using responsibility language.
4. Problem Solving: Encourage clients to identify their challenges and develop solutions independently.
5. Assignments: Structured tasks that encourage comfort with speaking situations.

Treatment Outcomes

• Efficiency, comfort, spontaneity, and joy in communication as key goals.
• Change in attitudes and beliefs about stuttering leads to better emotional responses and behaviors.

Building Self-Acceptance

• Self-acceptance is a journey; involves moving from embarrassment to embracing one’s identity as a person who stutters.
• Stages of Self-Acceptance: Range from acknowledgment of stuttering to comfortable manifestation of it in various social settings.

Conclusion

• Effective ARTS therapy emphasizes reducing struggle, fostering acceptance, and pursuing genuine communication.
• Clients can recognize their progress by reflecting on how they experience and handle disfluencies over time instead of focusing solely on fluency.

References

• Sheehan, J.G. (1970). Research and treatment in stuttering.
• Other references range from theories to practical techniques for addressing stuttering through ARTS.