Tips to improve stuttering according to a PhD researcher (Variable Release Threshold hypothesis)

Tips to improve stuttering according to a PhD researcher (Variable Release Threshold hypothesis) This is my attempt to summarize this [research](https://www.researchgate.net/profile/Paul-Brocklehurst) paper. **Background information**: The PhD researcher was a severe stutterer. At age 21, he started [Zen-mindfulness](https://www.google.com/search?q=zen+mindfulness) in a meditation group. He outgrew stuttering as an adult, by meditating each morning and evening for 18 months, and his stuttering didn't return. However, a couple of years later after moving to another country and learning Greek, he lost his confidence to speak freely, he started fearing that stuttering would return and then he adopted an unhelpful attitude of avoidance-behavior (e.g., avoiding situations and words). Then his stuttering returned. But in a much lighter form. **Theory**: * Stuttering is a very individual condition, and not all methods will help all PWS equally * Dividing words or tensing speech muscles don't cause speech blocks. Non-stutterers do exactly the same thing * Speech blocks can be triggered by anticipating stuttering * **Variable Release Threshold hypothesis**: speech plans have to attain a certain minimum threshold of electrical activation before they can be released for motor execution. The release threshold goes up and down depending on the speaker's perception: 1) to say important words clearly, accurately and 2) to avoid making mistakes or speak inappropriately. However, if the release threshold rises beyond a certain point, some sounds and words won't be activated to release motor execution (resulting in a speech block) * Memories of events that are more recent or that made a strong impression on us are quicker to activate. Memories that have been frequently reinforced by other similar memories are quicker to activate * **Process of spreading activation**: The stutter mental state can be reactivated by sensory experiences/information and other related memories and thoughts. When a memory of a word becomes activated, it becomes a speech plan * **Very low execution threshold**: perceives no need to respond appropriately or correctly. It also may result in a phonological error (e.g., saying Terry instead of Jerry) * **Low execution threshold**: perceives no need to respond accurately. It also may result in a phonological error * **High execution threshold**: perceives a need to respond carefully and appropriately. If we speak too fast, the word we want to say is still below the release threshold, whereas if we wait a little bit we say the word fluently because the word will exceed the release threshold * **Too high execution threshold**: perceives to stop deciding/instructing a fluency speech plan or start instructing a stutter speech plan. Because of anticipation of communication difficulty or possible failure - caused by negative experience \[impairment preventing us from attaining a high quality of speech production\] like A) the listener is not cooperative or not paying attention to what the speaker says, B) the speaker is unable to clearly pronounce words (when having a sore throat or blocked nose), C) or the speaker is unaware of the reason for his failure to make himself understood, D) or high expectation of how perfectly we should speak. We will block no matter how quickly or slowly we try to speak * Toddlers learn that in certain social situations, certain verbalizations are likely to be punished rather than rewarded. Now, a conditioned reflex develops that inhibits them from producing those verbalizations in situations where punishment is likely to result. A toddler then learns to hold back speech e.g., when parents respond negatively **Tips**: * Don't overestimate the need to respond clearly, carefully, appropriately or correctly * Don't overestimate the need to correct speech errors * Don't overestimate your attention to stuttering and listeners responses * Accept (or acknowledge) your unhelpful attitude (that handles negative behaviors/perceptions/experiences). Learn that it's okay to speak less accurate/appropiate (than non-stutterers) * Just say what's on your mind \[only physical actions\]. So, don't visualize/feel first * Stop visualizing and scanning for speech errors. This will lower the release threshold, increase speech mistakes (which you can learn to **accept**), make speech faster and decrease a (fight flight) freeze effect * Create a new belief, that your new way of speaking makes your speech understandable enough to listeners * Move to (or create) an environment where listeners adjust their expectations or practice stoicism that helps avoid irrational decision making * **Unhelpful self-made condition**: if our quality of speech improves, we will lower the release threshold. However, as long as we depend on a high release threshold we can never prove this to ourselves. The negative result is a vicious cycle (infinite loop), that we need to break * **Unhelpful self-made condition**: feel bothered when stuttering or anticipating stuttering * **Unhelpful self-made condition**: pay attention to how we move speech muscles to evaluate the success of the spoken word in order to remove helpful conditions (e.g., pre-closing the larynx) ​ **Aspects that I don't agree with**: * "***He lost his confidence to freely speak resulting in a relapse***" - I disagree with adopting a lack of confidence. In my opinion, his stuttering may not have returned, if he adopted the following attitude: 1. not feeling guilty of outgrowing stuttering 2. not gaining a sense of imposter syndrome 3. not feeling like attaining freedom without closure * "***Tensing speech muscles don't cause speech blocks***" - I agree and disagree. Yes indeed, even if we tense our muscles as much as we can, then the physical tension can in no way result in a freeze response in the speech muscles. However, mentally, the intrusive thought 'I experience muscle tension' may result in the impression of 'getting stuck'. This could then result in paralyzing the movement of speech muscles * "***Outgrow stuttering as an adult***" - If you read this post, in your opinion, should we aim for increasing or decreasing our release threshold (to outgrow stuttering as an adult)? Note that A) if non-stutterers increase it (e.g., when pronouncing a new, foreign word) it will improve his fluency and B) if people who stutter increase it, they will freeze speech muscles C) and if people who stutter decrease it, then they will perceive the speech errors as a problem and to be avoided, resulting in maintain the stutter cycle. Conclusion: So, in my opinion, there is no correct answer whether to increase or decrease the release threshold, rather it's more effective to adopt a helpful attitude (to change the way how we handle negative perceptions/experiences) to outgrow stuttering. * "***Unrealistically high expectations are most likely to arise in individuals who are unaware that their speech production system is in some way impaired***" - I agree, in my opinion: Before I identified/analyzed (Van Riper) my unhelpful stutter behavior, perceptions and triggers, I wasn't aware of why I stuttered exactly resulting in high expectations. After the analysis phase I was able to distinguish these, which made it possible to accept (or acknowledge) what I can and can't control (yet) resulting in changing my unhelpful attitude (for example, 'adopting a new definition of success. Success is not fluency, rather improving my attitude in handling unhelpful perceptions/behaviors', not paying attention to stuttering and adopting 'even-if conditions'). This then resulted in lowering my expectations * "***We speak more fluent when listeners adopt a positive attitude (e.g., parents that are listening carefully to what we say instead of responding*** ***inconsistently/unpredictably***)" - In my opinion, PWS should stop expecting change outside of themselves (because it's not about depending on external sources). I suggest to add a 'stoic'-course in modern speech therapy programs, so that PWS learn to stop caring about listeners responses * **Questions**: What is an alternative term for 'release threshold'? It's not: anxiety. Is it 'perceiving important words'? Is it 'the need to avoid unclear speech'? Is it 'reinforcing overreliance on paralyzing speech muscles?' Is it 'being disrupted to instruct to move speech structures?' * **Question**: "***Any of these reasons – alone or in combination – could cause the release threshold to rise too high and prevent the stutterer getting his words out***" - Do you mean by 'alone' that PWS without a predisposition also could experience the VRT-effect that result in a speech block? * **Question**: "***If we speak too fast, the word we want to say is still below the release threshold, whereas if we wait a little bit we say the word fluently because the word will exceed the release threshold.***" - How does time influence specifications (e.g., perceiving no need to respond appropriately, correctly, accurately or carefully)?