You show a lot of self-insight. It’s crazy how subjective and variable stuttering can be. I do think psychological / current-state-of-life factors can affect it immensely, at least for me. One element that is huge, which you pointed to, is the desire to control it. The more you obsess about trying to control, the more fear is present. Not directly related to stuttering, but one therapist (not speech) thought I might have the purely ruminative form of OCD, and the spiraling you described (if I do behavior X, it will worsen my stutter, etc.) made me think of that. That’s what my brain does in general if I don’t stay aware. Again, all about control. So I try to focus more of self-acceptance and working on my negative thoughts around it. That said, stuttering runs in my family, so there does seem to be a genetic component for me as well.