My last post was about a third way of looking at treatments. Let me give some meat. Here is the story according to me:
1) Genes or incident cause the development of
an unstable speech system that cannot cope with normal demands.
2) At age 2-3, the brain has developed to such an extent (mostly likely associated to use of sentences with grammar) that
normal demands on the speech demands starts to exceed the abnormally low capacity of the speech system depending on the momentary situation.
3) The
excess demand provokes a jam in the speech system leading to a abnormally long delay in initiation.
4) This delay is abnormally long, and causes instinctive reactions.
5) The delay and reactions are joined by conditioned and learned behaviours in response to corrective actions which in turn can make jams more likely.
6) The majority recovers because either the capacity of the speech system becomes better or changes in behaviours lead to fluent speech. For example, the ones with mild deficient capacities might be able to recover.
7) The others keep on stuttering adding further and changing behaviours, also social and psychological.
And the treatment approach is the following:
1) People who stutter can speak fluently whenever the demand is low, e.g. reading aloud when alone and relaxed
despite the abnormally low capacity of their speech system.
2) Stuttering occurs either because of a
too-high-for-their-low-capacity-system demand on the speech system or triggers from conditioned and learned behaviours. And very importantly, you cannot change the low capacity, it will stay forever. But it will v
ary according to day form in the same way as every of your performances, be it intellectual or sports, will naturally vary.
3) The only way that a person who stutters is fluent is when the demands on the low-capacity system is lower than the low capacity
AND there are no triggers from conditioned and learned behaviours.
4) An example is reading when alone and relaxed. Demand is slow because you know what to say, you do not have stress that impacts motor control, you are calm, you make longer pauses due to little time pressure, you read slower due to a lack of fighting for speaking time. Triggers are not triggered because there is no fear, no group pressure, no time pressure, or any other situations that you are conditioned for.
5) The key in therapy is to enable people who stutter to put less demands on their low-capacity speech system and to unlearn trigger to conditioned and learned stuttering behaviour. All therapies act on either of the two to achieve a reducing in stuttering.
6) Fluency shaping creates a new way of speaking and therefore the triggers from normal speech are not present, and this new way puts less demands on speech. For example, a gentle onset delays the start of vocalization and hereby gives the speech system more time to be ready. Moreover, the speech rate is slower, again helping to decrease demand.
And fluency shaping is probably recruiting other brain regions with normal capacity processing, because the speech is not automatic and a lot of prosody is used.
7) Stuttering modification works on the stuttering event to identify and modify it which effectively means unlearning all unnecessary learned secondary and primary symptoms which again help triggering stuttering events. And a lot of psychological work to unlearn triggers of stuttering behaviour and strategies like longer pauses.
8) What I suggested is that both fluency shaping and stuttering modifications are indirect methods, especially fluency shaping. And further, the key is to work directly on lowering the demands on speech system and unlearning triggers or/and learning antidotes. You ignore the stuttering events and you do not re-shape your speech. You use your normal speech that you use for reading alone, and create the conditions that you are able to do it in more demanding situations processing and trigger-wise.
9) Here are a few examples. To reduce demands: longer pauses (well for some like me, just pauses would already help), slower speech rate, think before you speak, reduce stress and anxiety that impacts speech performance. To reduce triggers: do not fight stuttering actively, ignore stuttering, focusing on fluent speech, repeating a sentence that you stuttered until you can say it comfortably fluent, focusing on normal breathing and so on. Everything I wrote down are natural things that a good speaker does any way, and we are able to do them. All fluent speakers get away with a lot, we don't. We need to reduce the demands on our speech system and we need to unlearn the stuttering behaviours.
They walk on solid ground, we walk on ice.
10) Needless to say that this is about changing behaviours, and we all know that a behavioural therapy is difficult and relapse is likely. But what I suggested is that this approach is the most direct way to the goal. I am not saying fluency shaping or stuttering modification do not work, but from my framework they look a bit as not coming to the point. It might well be that these approaches are used because they are easier to implement than a direct method.
OK. That's it! And please don't make the comment: So Tom if you are right, then why don't you try it yourself! Rest assured, I have asked myself the same question! :-)
