The president of a stuttering organization told me why he wasn’t interested in speech therapy. “Why is it that I can talk completely fluently with you and then stutter uncontrollably in another situation?” he asked.
I said, “It’s a dopaminergic disorder.”
He had no idea what I was talking about. He then answered his question, “It’s all in the mind. If I can change my thoughts then I won’t stutter.”
Dopamine is a neurotransmitter associated with reward-motivated behavior, motor control, and the release of various hormones. Too much dopamine, or too much sensitivity to dopamine in particular areas of the brains, is associated with excessive motor activity. Three disorders are associated with excessive dopamine:
- Tourette Syndrome is characterized by unwanted movements (tics) of the eyes, face, hands, feet, or vocalizations.
- Obsessive-Compulsive Disorder (OCD) is characterized by excessive, repeated hand washing, tapping certain objects, or other movements.
- Stuttering is characterized by excessive, unwanted vocal fold closure and articulatory movements (lips, jaw, and tongue).
All of these disorders manifest under stress (but not all types of stress). These disorders are compulsive (against the person’s will). The harder one tries to avoid a behavior the more compulsive the behavior becomes. Hence in support groups members are encouraged to “let go” and manifest behaviors without fear of social stigma or fighting against the behavior.
There’s also a disease caused by too little dopamine. Parkinson’s is characterized by too little movement: in a lack of facial movements, a shuffling gait, and a low vocal volume.
Many dopamine antagonist medications have been tried with stutterers. None have more than minor effects on stuttering. Most have side effects, sometimes severe.
Stuttering reduces stress. Specifically, stuttering reduces stutterers’ systolic blood pressure 10%.[ref]Perkins, W. Dabul, B. “The effects of stuttering on systolic blood pressure.” Journal of Speech & Hearing Research, 16 (4), December 1973.[/ref] That’s more than some hypertension medications.
Stuttering increases listeners’ systolic blood pressure.[ref]Schwartz, Martin. Personal correspondance.[/ref]
The Successful Stuttering Management Program (SSMP) includes disclosure, in the form of going to a shopping mall and telling strangers that you stutter, as a way to reduce stress. A study found only a 10% reduction in stuttering at the end of the program. This modest gain disappeared within six months.[ref]Blomgren, M., Roy, N., Callister, T., & Merrill, R. Intensive Stuttering Modification Therapy: A Multidimensional Assessment of Treatment Outcomes, Journal Speech Language and Hearing Research, 48:509-523, June 2005.[/ref]
Another study found that stutterers who completed a stress reduction course had reduced stress but the effect on stuttering wasn’t measured.
More than a dozen studies have investigated reducing demands on children (indirect therapy), with zero effects found.
The evidence shows that reducing stress alone doesn’t improve fluency. However, I believe that learning to identify and reduce stress will help you when you use fluency therapies.
Social Anxiety Disorder
Social anxiety disorder is fear and anxiety in social situations. There’s no connection between social anxiety disorder and stuttering.[ref]J Commun Disord 2021 Dec 8;95:106179. doi: 10.1016/j.jcomdis.2021.106179. Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents Naomi H Rodgers, Jennifer Y F Lau, Patricia M Zebrowski PMID: 34902801 DOI: 10.1016/j.jcomdis.2021.106179[/ref] Some stutterers have social anxiety disorder but most don’t.
The “Closet Stutterer”
I sometimes hear this story:
Nobody knew that I stuttered. I used avoidances and substitutions to hide my stuttering. But I lived in fear that people would find out that I’m a stutterer. My life was constant stress. I ate liverwurst sandwiches because it was the one food I could say, even though I hate liverwurst. I’d drive across town to stores to see if they had something instead of calling. I avoided p’s like the blague! Then one day I said to myself, to heck with living in fear! I picked up the phone and ordered a pepperoni pizza! It was delicious and I never stuttered again!
The National Stuttering Association annual convention has workshops for “closet stutterers.” These are individuals who have little or no stuttering but great fears of people thinking that they stutter. In contrast, severe stutterers such as myself lack fear of being “discovered” because everyone knows that we stutter. In other words, it’s not unusual for mild stutterers to have more severe psychological issues than severe stutterers.
Some stutterers use stuttering to hide a bigger psychological problem. I stopped selling DAF/FAF devices to France after getting three returns with the same story:
[French accent] The device made me completely fluent. But now I must face my real psychological problems. I can no longer hide behind a facade of stuttering. I would rather stutter than face my real problems.
I’m going to make a radical, unsubstantiated conjecture. I believe that “closet stutterers” are using stuttering to hide a larger psychological issue. If you’re a “closet stutterer,” make an appointment with a psychologist. Unfounded fears and anxieties are what Cognitive Behavioral Therapy (CBT) is for. (CBT has no effect on stuttering.[ref]Menzies, R. G., O’Brian, S., Onslow, M., Packman, A., Clare, T. S., and Block, S. (2008). An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering. J. Speech Lang. Hear. Res. 51, 1451–1464. doi: 10.1044/1092-4388
(2008/07-0070)[/ref]) If the psychologist says you’re mentally healthy with no psychological issues I’ll change my belief and I’ll pay for your therapy session!
Can a Speech-Language Pathologist Treat Speech-Related Fears and Anxieties?
Many speech-language pathologists treat stutterers’ speech-related fears and anxieties. Some SLPs do nothing but talk about your fears and anxieties. They’re not psychologists. If you have speech-related fears and anxieties go to a psychologist, not a SLP.
Can You “Psych” Yourself Out of Stuttering?
Sometimes you see YouTube videos or online courses that promise to cure stuttering without speech therapy. These “gurus” will teach you how to “psyche” yourself out of stuttering by “facing your fears” or “changing your attitude.”
Some of these “gurus” are former stutterers who cured themselves. I believe that these “gurus” were closet stutterers who did some form of psychological self-therapy. Well, good for them! But you should go to a psychologist, not a “guru,” if you have speech-related fears and anxieties.
If You Tried To “Psych” Yourself Out Of Stuttering and You Still Stutter
Stuttering is a dopaminergic disorder. Stressful situations manifest stuttering; the more you try to not stutter to more you’ll stutter. Reducing stress alone won’t reduce your stuttering. Instead, increase your fluent speech skills with Evidence-Based Practice (EBP) stuttering treatments. You can’t “psych” yourself out of stuttering.