>"change the word" Firstly, I want to mention that if you substitute a word, then you are telling your body that your anticipatory anxiety is real in your mind. This is the opposite of your goal, to make the trigger less real in your mind. Counter argument: But if having anticipated stuttering you try to say a word and find that you stutter on it, then your anticipatory anxiety in this instant was accurate and justified – you have correctly anticipated that you will stutter on the word. So, yes, in this instance the anticipation is reinforced. However, if despite stuttering, you are nevertheless able to immediately move forward and get your message across, then although the anticipation of stuttering is reinforced, the anxiety associated with not getting the message across or eliciting negative listener responses is not reinforced. As I see it, anticipation of stuttering is not a problem. The problem is the anxiety (and trauma) that may or may not be associated with that anticipation. I often anticipate that I will stutter and often those anticipations are accurate, but ever since I started allowing myself to continue to communicate in whatever other ways are possible (skipping letters, word substitution, using rhythm, writing it down, etc. etc.) the anxiety that used to be associated with such anticipations has completely vanished. So what I’m suggesting here is that, in fact, the anticipatory anxiety that PWS experience is justified inasmuch as it is indeed based on real past experiences and often it immediately precedes real stuttering blocks. However, it tends to have more to do with having repeatedly experienced the unpleasant/punishing effects of communication failure and social rejection rather than of straightforward stuttering. For example, if you have a room full of people becoming impatient with you because you have got stuck on a word for too long, that will quite likely lay down traumatic memories that will recur for weeks months or years afterwards when you find yourself in a similar room. Whereas if you can keep moving forward thanks to some or other crutch, then you can avoid all that trauma happening in the first place. Just to put this approach into a wider perspective, on a lot of occasions I’ve seen English speaking people here in France, trying to ask for something. Because the pronunciation of French is very different to English, often the French people don’t understand what the English person is trying to say. So then, the English person repeats the phrase, a bit louder – as one might do when speaking to someone who is deaf. The English person often ends up repeating the word several time – in exactly the same way, but each time using a bit more force and getting a bit louder. Then the French person feels like he is being shouted at and at that point generally stops listening to the English person and starts to ignore them. Then the English person gets agitated, having concluded that the French person is not listening to them. The net result is communication failure and English people who have found themselves in this situation often conclude that French people are impolite and arrogant towards the English and don’t listen to them. They also start to anticipate that this sort of thing will happen again in the future – and it generally does. The obvious solution in such situations would be for the English person to write down whatever it is he wants to say. Of course, he should try to say it himself first, but if that doesn’t work, it only makes sense to try using different words that mean the same thing, and if that fails, then show the written note to the French person. What I keep plugging away at here is that successful, timely communication of our messages is all-important. As long as we have some crutches or safety-nets that ensure that such communication can happen despite our stuttering, then the anxiety associated with stuttering will subside and very quickly die away completely. If we don’t have such crutches and safety-nets our anticipatory anxiety will be justified and will be reinforced. The only caveat to this is if a PWS has for one reason or another come to the (unhelpful) conclusion that “stuttering is bad” and that he should not do it – or that he should try to hide it. And that if he stutters he has in some way failed – and his self-esteem is dented. This is an unhelpful understanding of stuttering that is often instilled in PWS through the parents, the society in which they live etc. etc. Of course, severe stuttering really is undesirable – inasmuch as it makes listeners impatient and often results in social rejection. And it makes sense to avoid severe stuttering in whatever ways possible. But mild-stuttering is not at all a problem. Indeed, a bit of mild stuttering can sometimes be a good thing. The bottom line is that, if a PWS does not feel like he can use alternative ways of getting his messages across he will most likely never overcome his fear of stuttering and thus never get the stuttering under control.