I had a really strange conversation with my husband a short while ago because I was going through a bad spell and I didn't know why. I was kinda frustrated because I felt like my speech had been improving so much and now suddenly there was set back. He looked at me like I had two heads.He said "you think there are these wild fluctuations in your fluency from day to day or week to week or months to month but there aren't. What is wildly fluctuating is your awareness of it. Your fluency is the same with small changes on a day-to-day basis, but in the grand scheme of things your fluency is the same. But you sometimes become hyper aware of it and I think that makes you think that your fluency is low, when its not. Its that hyperawareness that the biggest part of your anxiety." I want to add the man is not an SLP so lets put a question mark, but its definitely something to think of. I feel like there's some truth to it. Whenever I am hyper aware, I feel like speaking is harder and even small delays or repetitions that hardly anyone notices, to me feel like these horrible pauses and blocks. How to overcome: People say desensitize, advertise, voluntary stuttering. Its like training your brain to say "if I stutter I stutter, YOLO!" But that's harder said than done. My personal approach is first of all, practicing fluency shaping all the time. If you are talking, you are in control. Then, when I have the tools to not get stuck and have established a baseline of manageable fluency, I set goals for talking and practicing with other humans and then meeting those goals. Every succesful goal then leads me to get a new goal of a feared situation like phone calls, drive throughs, saying clinical orders asking directions, asking questions, asking for the time etc etc etc. Every success kind of gets rid of that emotional block in your brain that says :"I can't do this, or I'm gonna stutter" because there is proof that **you can do this**, and you will be fluent. If you give yourself the skills and chances to succeed, you will. FYI the reverse is also true, if you aren't ready and you put yourself in these severely stressful situations and then have a proper communication failure or breakdown, then it just reinforces that emotional block that "you cannot do it" which becomes a horrible self fulfilling prophecy or pattern. So be careful. And there are people who say, just accept it blah.... not my style.