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Recover From Stuttering - Notes From the 2014 ASEA Convention

Newsletter 52: June 2014

You may remember reading in Newsletter 47 (January 2014) about the Australian Speak Easy Association (ASEA) National Convention being held at the Gold Coast over three days from 14-16 February. Well we are very pleased to inform you that this event was a great success. Lisa Hudson, our Ezy-Speech Doctor of Speech Pathology, has compiled some notes from the convention:

Grant Meredith – Federation University Australia
Scenari-Aid provides video scenarios so adults can practise their speech in situations such as job interviews, at the bank, a restaurant, at the doctor’s surgery, etc. Designed for adults who stutter but also used for adult rehabilitation.
http://www.scenariaid.com/

Ezy-Speech – Lisa Hudson & David Edwards
Outline of the Ezy-Speech Stuttering Therapy Program. David wore the Breath Band throughout the presentation in order to demonstrate how it encourages diaphragmatic breathing.

Social Anxiety Disorder (SAD) – Professor Ross Menzies
  • No evidence that people who stutter (PWS) have an anxious temperament. The stutter causes the anxiety, not the other way round.
  • “The Sliding Doors Effect” – even a low level of SAD can be disastrous and, as a result, life can go on very different paths.
  • Cognitive Behavioural Therapy (CBT) most effective. CBT is the identification of maladaptive behavioural patterns, thoughts and beliefs. These are then reframed. CBT recognises that thoughts drive emotions:
    o Externalised “shoulding” thoughts →→ anger
    o Perceived threat →→ anxiety
    o Hopelessness/helplessness→→ sadness
    o Self-directed “shoulds”→→ guilt
  • For example, if you are feeling angry, ask yourself, “What is the ‘should’ thought?” and then challenge it using the following 4 tests:
    1. Do I have evidence for this negative thought? (You will almost always have reasons for your thought but not evidence.)
    2. Am I worrying about something beyond my control? Move your attention to something you can control.
    3. Is the thought helpful? What does it DO for me?
    4. The Badness Test: Is it as bad as I think? Am I making too much of this issue? Will it make it into my autobiography?
  • Also use the “I was wrong again” task. Write down every negative prediction that pops into your head. Pull out the list 3 days later and finish writing a sentence beside each prediction: e.g. “I thought I would never get a park in the CBD, ____________.”
  • Safety Behaviours were discussed throughout the conference. Pairing actions with the speaking situation to prevent bad outcomes actually increases anxiety in the long term. It’s a way that your brain reinforces the fact that you have something to be anxious about.

Positive Psychology – Nadine Hamilton
  • Well-Being Theory: determined by 5 factors:
    o Positive Emotions
    o Engagement
    o Relationships
    o Meaning/Purpose
    o Accomplishment
  • Write 3 good things EVERY day.

Self-Help for People Who Stutter – Ann Packman
  • People join support groups for a range of different reasons so it can be difficult to meet everyone’s needs.
  • Those who joined groups to help others feel better about themselves had higher self-esteem & life satisfaction; and lower stuttering rates & self-stigma.

Stuttering and Brain Science – Libby Cardell
People who stutter have brain differences compared to those who don’t in terms of:
  • Function
  • Structure (composition) and
  • Biochemistry

However it has not been determined if these differences are the cause of stuttering or arise due to the brain trying to compensate for the stuttering behaviour.
  
In summary, the following features have been detected in adults who stutter:
  • Overactive right hemisphere and weaker activity in the left hemisphere
  • Underactive left auditory cortex
  • Underactive left premotor and motor cortices (especially in the area for lip and tongue movements)
  • Overactive supplementary motor area (for movement release) and may swap sides for this function.
  • Severity of stutter is implicated by an overactive right Insula and disrupted Basal Ganglia function.
  • To sequence movements, the left frontal regions (for planning) should be active first but aren’t in adults who stutter.
  • The right cerebellum is extremely overactive during the fluent speech of people who stutter – unsure if this reflects modulation issues, interference, or a compensation strategy.
  • These abnormal activations/deactivations decrease significantly when the person is using a speech shaping technique such as Smooth Speech – So is a different speech pathway being used when the person is using Smooth Speech??? Does Smooth Speech circumvent some of those dysfunctional areas??
  • Abnormal brain activity occurs during overt AND imagined stuttering.

Stuttered Speech Syndrome – Mark Irwin
Discussed the case for defining 2 separate conditions: Dysfluency with Phobia (Stuttered Speech Syndrome) versus Dysfluency without Phobia.

Mark is a dentist in Adelaide, South Australia, who specialises in seeing patients with phobias about attending the dentist. His website about stuttering is very informative.
http://stutteredspeechsyndrome.com/

Talking to Partners – Janet Beilby
It is essential that the partner of a person who stutters is directly involved in their therapy. The support for the PWS is important but also, the dynamics of their relationship will change as a result of therapy.

SUMMARY
The conference did not address speech therapy treatment for stuttering. It was taken as given that fluency shaping such as Smooth Speech continues to be the way to address stuttering. The focus was on Social Anxiety Disorder, Safety Behaviours, the role of ongoing support groups, and the neurology of stuttering.

Notes from the Australian Speak Easy National Convention
February 2014
(Compiled by Lisa Hudson)

The Ezy-Speech Team

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