Friday, December 16, 2016

Are you considering speech therapy?

If you as an adult or teen are considering speech therapy, the following tips may assist you:

1.   There can be no doubt that some people find stuttering therapy useful, either in the form of counselling, learning speech techniques, doing exercises provided by the therapist etc. Conversely, others complain that they have not been helped adequately. Often they say that they quickly achieve relative fluency when in the speech clinic, but are unable to maintain this fluency outside of the clinic.

2.   Therapy can be either one-to-one sessions with a therapist or group therapy, often in the form of a workshop or intensive course. While one-to-one sessions can be useful for clients who are hesitant to speak in a group setting, group therapy has the benefit of meeting other people who stutter, so providing opportunities for sharing problems and helpful experiences.

3. Much will depend on your expectations of therapy. Chronic stuttering is difficult to cure 100%. A more realistic expectation would be to aim at improved management of the disorder. Work toward clearly defined, practical goals such as speaking on the telephone, or making presentations before an audience, rather than a vague ideal of better speech.

4. Find a therapist who specialises in stuttering and has the professional qualification to back it up. Speech therapy encompasses many speech disorders, and stuttering is only one of them. These days, the field has broadened to such an extent that, in some countries such as the US, a student therapist can qualify as a speech pathologist / therapist without actually having followed a course in stuttering.

5.   Much will depend on the therapist and her knowledge and skills, as well as her view of stuttering. As in all professions, some professionals are better than others. Some will specialise in one particular approach or technique; others will be flexible in applying a treatment type according to the needs of the client. If you find that you are not making progress with a particular therapist, or a particular type of treatment, you should discuss this with her so that another treatment may be tried; or it may even be necessary to find another therapist.
6.   Try to improve your own knowledge on stuttering, as a preparation for therapy. Join a few Facebook groups for people who stutter; read some of the free online books on stuttering HERE.  Stuttering is to a large extent stress-related, so improve your knowledge of stress and how it can affect stuttering. Eg. the improvement often resulting from therapy within the clinic may be the result of reduced stress levels as you become comfortable with the therapist; outside of the clinic, however, all the usual stressors in your life may still be present, thereby impacting on fluency.

7.   If you are considering following an intensive group course from an organisation treating people who stutter, make sure that it is not a bogus money-making scheme – ask around on the internet. Ascertain if they offer long-term follow-up support and refresher events; don't trust them if they offer a quick cure. Ask if the first day of the course is free or if the fee is returnable should you decide midway that the course is not for you.

8.   Last but not least: Speech therapy seems to work best where there is a shared responsibility between client and therapist. Stuttering therapy is actually for 99% self-therapy; the therapist can only advise and guide, but it's the client who has the problem and who needs to do the real work. In other words: Become your own "therapist"! Wishing you all the best in your journey.

Friday, July 22, 2016

Is stuttering a manifestation of TMS?

Is stuttering a stand-alone speech defect, or part of a broader mindbody disorder known as TMS (tension myositis syndrome)?

TMS, which was first put on the map by the pioneering Dr John Sarno, MD, is not an officially recognised medical ailment even though some prominent doctors accept that it exists. Though TMS is usually associated with chronic pain such as lower-back pain, many other disorders such as ulcers, sinus problems, carpal tunnel syndrome, certain headaches / migraines, dry eyes, night muscle cramps, heartburn, eating disorders, "growing pains", chronic fatigue syndrome, various skin disorders, OCD, panic attacks etc. etc. may actually be camouflaged TMS - physical symptoms having an underlying psychological base.

Spasmodic dysphonia, another speech disorder involving the vocal cords, may also be TMS-related; but stuttering is seldom thought of as perhaps being a form of TMS, in some cases at least, even though a comparison yields interesting results. Both TMS and stuttering are stress-related; and in both cases, muscle cramps / spasms or muscle “locking / freezing” play a major role (lower-back TMS: tension-related muscle cramps in the lower back causing pain. Stuttering: conditioned struggle reflexes in response to a tension-related “locking” of the vocal-cord muscles).

‘Knowledge therapy’

Dr Sarno regards repressed, unconscious psychological rage – or other repressed emotions such as fear, shame / guilt or sadness – as a major cause of TMS. According to him, TMS acts as a distraction, being a rather rough-and-ready defensive and survival technique from the more primitive parts of the brain; by creating pain or other disturbance through tension-induced hypoxia (lack of oxygen) via the autonomic nervous system (ANS), the conscious mind is distracted away from the inner conflict (which the primitive mind regards as more threatening than the actual external symptom). Other experts believe that TMS is the “inner child's” way of signalling its distress. TMS could therefore also be seen as rough “messages” from the subconscious, from the inner self, that all is not well and that corrective steps are needed.

Perfectionists apparently are highly susceptible to TMS. Perfectionism and "goodism" (the tendency to be as ethical and moral as possible) are particularly enraging to the subconscious "id" (the primitive inner animal / child-like part of the brain).  

Treatment for TMS consists of soothing the inner child, "knowledge therapy" and, in severe cases, counselling; some people are cured simply by reading a book on TMS, thereby bringing to consciousness the psychological underlay of their physical symptoms, and becoming aware of long-hidden feelings that manifest themselves as ailments.

All this will sound pretty crazy if you share the mindset of modern Western medicine with its strict mind-body division. Don't get me wrong - Western medical science has reached fantastic heights in the past century and should be respected for that; but it suffers from a blind spot when it comes to the grey area between mind and body. Western medicine's epic breakthroughs in the modern age, thanks to its focus on the material body, has seduced it to disregard the more hazy area of mindbody health.

 I must admit that I would not have written this article five years ago. I'm not really into unconventional medicine; but some years ago I had the misfortune of suddenly experiencing excruciating lower-back pain. I won't bore people with the details, but after following the usual conventional route of MRI scans and an epidural injection, without much success, I basically solved my back problem by reading a few TMS books and following their advice. So in my experience, TMS is real. Since then I suspect that some of my other, mainly stomach-related, previous ailments were actually TMS-related. I'm even wondering whether my lifelong stuttering, though mild these days, is part of TMS and whether TMS treatment will have an effect on it. 

A vicious circle

TMS is, of course, radically different from current mainstream views on stuttering. Current mainstream thinking regards developmental stuttering as a neurological disorder, with the cause or causes not being psychological in nature. I have no doubt that stuttering has a genetic and neurological component, and that some kids are predisposed to begin to stutter. But does this exclude the possibility of unconscious psychological factors in the period when children begin to talk?

Let's consider the onset of stuttering, usually between the age of 3 and 5. For some predisposed kids, overt stress seems to be the trigger; for instance, some children begin to stutter after a traumatic incident such as a car accident, or after having been bitten by a dog, or after a parental divorce. Here the stress trigger seems clear.

In most cases, however, the stress is not so obvious. It could be argued that the actual learning of language also involves stress triggers: the child needs to master complex grammar, new meanings and difficult pronunciations, all of which could overstress a still immature speech system.    

But perhaps a psychological stress trigger is also possible? Consider, for instance, the following scenario: a child, perhaps rather sensitive by nature, wants to please his parents, but soon learns that anger (fighting / resisting), a normal response to ordinary day-to-day irritations and part of the fight / flight / freeze reaction, is frowned upon. He quickly adapts to this by repressing his "fight" response and instead initiates the "freeze" response (if "flight" is not an option); in other words, he does nothing and keeps quiet (perhaps starting on the road to a degree of introversion - but that's another story which I won't go into here). Repressing the fight response, however, merely relegates his anger to his subconscious, so that unconscious rage begins to build up. The same may happen with other emotions that the child regards as socially inappropriate, such as sadness, fear and anxiety. And unconscious emotions, so Dr Sarno has taught us, can generate tension and seek a physical outlet.

In this individual the outlet is the vocal cords that “lock” or “freeze”  - as per the pioneering work of Dr Martin Schwartz, who was instrumental in identifying the role of the vocal cords that freeze when overstressed. Apparently some people are genetically and neurologically predisposed to direct their tension to their vocal cords, just as others direct their tension to other body parts. And so the stress response of freezing becomes a physical “freeze” of the vocal-cord muscles; and the child begins to stutter - the actual sound or word repetitions are simply conditioned reflexes in response to the vocal-cord freeze. The stuttering, in turn, will increase the unconscious inner rage and stress, so that a vicious circle is created, established and strengthened over the years.

The TMS argument can be taken even further. TMS experts would argue that mindbody issues are often symbolic; that the mindbody often chooses a particular body part to symbolically communicate its message. In his book The Great Pain Deception, Steven Ozanich says, in discussing spasmodic dysphonia, that the vocal cords are common targets of tension since the voice is a mechanism of expressing self.

A major question would be the following: if stuttering is a type of TMS, is that TMS still active in adulthood; or did the TMS only occur in early childhood, so resulting in stuttering and creating the conditioned responses, after which the TMS itself receded so that the conditioned stuttering remained as a leftover, continuing into adulthood? 

Major implications for treatment

If the stuttering of some people is indeed a type of TMS, it has major implications for treatment. For instance, if unconscious rage is identified as a driver of stuttering in an individual, he could perhaps be helped by focusing on assertiveness. Assertiveness could be seen as a “civilized”, subdued and socially acceptable form of anger, thereby tapping into, channeling and discharging the unconscious rage. (For a short summary of assertiveness as a tool in improving fluency, check out THIS CHAPTER of my free online book, Coping with Stuttering. And for an excellent TED talk on how a few assertive body positions will actually change your body chemistry to make you more relaxed and assertive, click here.)

A major part of TMS treatment is to convince the patient's conscious as well as subconscious mind that the problem is fundamentally psychological and NOT structural (after, of course, having excluded the possibility that there is indeed a serious structural defect or injury). This convincing is necessary so that the subconscious mind - the level at which the problem arises - will stop trying to distract you by means of the symptoms. If the subconscious mind becomes aware that its distraction tricks no longer work, it stops its mischief. I know, it sounds unbelievable - but it works. The proof of the pudding lies in the eating. So many people have benefited from TMS treatment that it needs to be taken seriously.

Applied to stuttering, it would mean that you have to be convinced, and have to convince your subconscious, that unconscious emotions drive your stuttering. Superficially seen, this flies in the face of current theories on a neurological cause of stuttering; though, as said, a neurological predisposition does not necessarily exclude emotional drivers of stress.

A complicating factor, of course, is that stuttering is usually developmental, with onset before school-going age, which means that the years or decades of stuttering and its conditioned components - the force of habit - will need to be taken into account.  

Finding your own way

All this is of course speculation; even if it has merit it may be extremely difficult to convince both speech experts and people who stutter, as there is a lot of resistance to the seemingly very alternative and way-out TMS concept ... most people prefer to listen to conventional, officially accepted medical advice. Also, most people hate the idea of having to deal with "mental" issues that still carry the stigma of perhaps being crazy.

Most speech professionals, again, will say that the psychological approach to stuttering has long since been discarded, and that the focus these days is on neurology and brain scanning. They will be quick to tell you that Freud, the father of modern psychology and of psychoanalysis, did not succeed in treating people who stuttered (even though we have come a long way since Freud, with our knowledge of psychology and stress having expanded enormously since then).

So once again it is up to the individual with an open mind to try and find his own way, and experiment with this, or any other, approach which makes sense. Fortunately a small but growing number of doctors are embracing the TMS concept and treating patients accordingly.   

If you're interested in TMS, check out the TMS Wiki site HERE where you will also find a growing list of disorders that may actually be types of TMS. And for a very comprehensive book on TMS in some of its many manifestations, have a look at Steven Ozanich's The Great Pain Deception: Faulty Medical Advice Is Making Us Worse. It may radically change the way you view health. And isn't stuttering a part of health? Or else read any of the books by Dr John Sarno, MD, for instance The Divided Mind: The Epidemic Of Mindbody Disorders.  Also consider joining the Facebook group on TMS.

For those who stutter and wish to experiment with this approach, I would suggest that you (1) work on adopting an assertive manner just before speaking, as mentioned above; and (2) read one of the TMS books, such as The Great Pain Deception mentioned above, substituting the word "pain" with "stuttering". In other words, read the book as if it were all about stuttering instead of chronic pain. If the stuttering of some people is indeed a type of TMS, the chronic laryngeal blocks may just be the subconscious mind's way of distracting you away from unconscious emotions; (3) keep a daily journal of your experiences with and feelings about your speech - journalling is a highly successful tool used by TMS sufferers (4) continue with stress management (read my chapter on stress management) , plus your favorite fluency technique - personally I prefer the Passive Airflow Technique - to either prevent or minimise speech blocks (vocal-cord freezing) and the resultant stuttering. 

Feel free to provide feedback in the comments section below if you are experimenting or have experimented with TMS treatment for stuttering. PS Don't be upset when things get worse before they get better! This is typical in TMS treatment, as the subconscious tries to maintain the status quo when it notes that things are changing.

Update January 2017: According to new research, there are indications of reduced blood flow to the brain's speech centres during stuttering. This could strengthen the argument that stuttering is a type of TMS. It could be that the central nervous system reduces the blood flow to the speech centres, thereby reducing the oxygen supply to those areas, so messing up these centres and resulting in the dyscoordination of the vocal cords and the resultant vocal-cord freezing that in turn results in stuttering. Check out this research article. 

Monday, October 12, 2015

'Tightening' of vocal cords results in stuttering, says AIS

Emily Blunt, the beautiful UK actress who is also a board member of the American Institute for Stuttering (AIS). The AIS has come out in support of the concept that stuttering results from a tightening or closure of the vocal cords.

Good news for people who stutter is that the American Institute for Stuttering (AIS), a leading organisation in New York offering treatment for this disorder, has joined those who believe that stuttering results from a tightening of the vocal cords.

The role of the vocal cords in stuttering has for decades been a hotly debated issue among speech experts. Though speech therapists generally accept that the vocal cords can behave unnaturally during stuttering, the traditional view has been that word and sound repetitions, prolongations and unnatural vocal-cord behaviour are all primary manifestations of this mysterious disorder.

In contrast there has been, for many decades, a dissenting line of experts who insist that an unnatural tightening, "locking" or "freezing" of the vocal cords, apparently caused by excessive tension on the cords, triggers the speech repetitions and other struggle behaviours. In other words, the internal vocal-cord spasm happens first and leads to the other, more visible symptoms. 

Fundamental implications

"It appears as if there is a timing problem in the communication of signals from the brain to the speech mechanism. This 'glitch' results in a tightening or closure of the vocal cords. Because of this tightening in the throat, breathing and mouth movements become forced and laboured," according to the AIS's current website.

The view that vocal-cord spasms result in stuttering has fundamental implications for stuttering treatment, as it implies that the focus of treatment should be on the vocal cords, instead of attempting to deal with the stuttering itself. If the vocal cords can be made to behave, the stutter is aborted as it depends on the cord spasm occurring. 

This blog has consistently argued for years that stuttering is a conditioned reflex, resulting from a tension-related "locking" of the vocal cords. Traditional treatment aimed at the stuttering itself is misplaced as it does not address the true problem, namely the erratic, abnormal behaviour of over-tensed vocal cords. The vocal-cord muscles seem to behave this way because, when overstressed, the fine vocal-cord muscle coordination necessary for normal speech breaks down.

Reflexive attempt

A vocal-cord tightening (or "block" as it is called by people who stutter) can easily be reproduced artificially, according to the AIS website. "Take in a breath of air, keeping your mouth open, and hold your breath. Then let little puffs of air out. Feel the sensation in your throat. You just closed your vocal cords on purpose. If you stutter, this feeling will be all too familiar. Now, do that again. Hold your breath with your mouth open, don't let any air out at all and try to speak.

"If you don't stutter you have just created the physical sensation of what we call blocking. You know what you want to say, but imagine trying to speak and nothing comes out. Those who stutter, experience this all the time. It's as if they are choking when trying to speak.

"In a reflexive attempt to help the person speak, the mouth muscles (articulators) then kick into 'overdrive' to compensate for the vocal cords that aren't 'working'. This is the aspect of stuttering that most people see."

The AIS's view of stuttering shows that this approach to stuttering is gaining ground within therapy circles. Hopefully other speech professionals will follow their example. This is a major step toward improved and more realistic stuttering therapy.              

Wednesday, September 30, 2015

Helpful website for improving your life skills

I believe that good life skills, such as avoiding perfectionism, building self-image, being your own best friend etc. are a crucial part of stuttering management.

These skills tend to reduce inner stresses, thereby lowering base-level tension which plays such an important part in stuttering. Unfortunately we often forget to apply these useful concepts in our day-to-day life, and it really helps to be reminded of them regularly.

For the past few months I have been a subscriber of a very useful site that sends out regular messages with good, common-sense advice for maintaining a positive and less stressful outlook on life and life's challenges. It's called The Positivity Blog. The regular emailed messages are free, though paid courses are also available if you want to go more deeply into any of the particular topics.

I have found that the regular messages help me stay on track and on top of things. If you're interested, feel free to check out The Positivity Blog by clicking HERE. 


Tuesday, June 2, 2015

Dr Martin Schwartz's Training Course for People who Stutter now available for free!

Dr Martin Schwartz has been so generous as to make his 2008 DVD-based Self-therapy Course for People who Stutter available to the general public for free, and it gives me great pleasure to present the course here on my blog. Much thanks to Dr Schwartz for this great gesture.

The course consists of three videos plus a manual and a workbook. Note that Dr Schwartz also highly recommends that you acquire the MotivAider, an electronic appliance that will remind you to use your speech technique. 

Video 1, titled The Understanding, explains why people stutter. What we see and hear as "stuttering", is merely struggle behaviour resulting from the vocal cords that have "locked" due to excessive tension on the cords. Here is video 1: (If you have a mobile phone or tablet, or have problems in viewing the video, watch it on YouTube HERE )


But what can we do about this vocal-cord lock? Video 2 is all about treating the cord lock, not the stutter itself. When we reduce the tension on the vocal cords, we lower the possibility that they will lock (and cause a stutter). In video 2, the Slowed First Syllable technique is explained - the first of various techniques to reduce pre-speech tension on the vocal cords. Herewith video 2: (View it HERE on YouTube if you have a mobile appliance or are unable to open the video.)  


In the third video, Dr Schwartz discusses another powerful technique to reduce vocal-cord tension: the Passive Airflow Technique: (View it HERE on YouTube if you have a mobile appliance or are otherwise unable to open the video.)


The really excellent manual will be found HERE.  It should be downloaded for study as it contains a lot of important information for people who stutter. And click here for the workbook which should also be downloaded, as it contains various "homework" exercises to which Dr Schwartz refers to in the videos.  

Do read and study the manual carefully! An understanding of stuttering is actually part of the treatment - knowing how stuttering occurs makes it easier to deal with it. 

Note that though this is basically a self-help programme, it is strongly recommended that you get a "monitor" - a therapist / friend / spouse / significant other / parent etc. to assist you with the various exercises. Better still, try to combine this with joining a stuttering support group in your area, and do the exercises as part of their meetings. 

I attended two Schwartz workshops in the 1980s, joined the support group which was formed afterwards, and have been helped much by them. It's not a miracle cure though and will require time, work and dedication - but I believe this is the best available. If you intend to do the course, I wish you well! For any questions, join the Passive Airflow Facebook group which you will find here.