>*"I think Alexythimia may be a big contributor to stuttering for some, if not all people that stutter"* There are actually two research studies about this: * "Alexithymia in adults with persistent developmental stuttering" by Mazzocchi et al. (2016), which found a high prevalence of alexithymia in adults with persistent developmental stuttering * "The prevalence of alexithymia in adults who stutter" by Gavelin et al. (2016), and found that individuals who stutter had significantly higher levels of alexithymia than individuals who do not stutter ​ *"I believe emotion is the main culprit. Emotion is largely the fuel for stuttering. And when someone cannot properly have a way of dealing with emotions from recognition of them, to expression of them, to prevention of unnecessary ones, it can lead to confusion and muscle tension."* I believe you are right. In fact, many researchers found a correlation between emotions and stuttering: * See the research [studies](https://www.google.com/search?q=%22covert+repair+hypothesis%22+%22research%22+%22stuttering%22) on "**Covert Repair Hypothesis**", that suggest that stuttering arises from the attempt to conceal or repair speech errors, due to negative emotions such as anxiety or frustration ​ >*"Alexithymia is characterized by an impaired ability to be aware of, explicitly identify, and describe one's feelings (Nemiah et al., 1976)."* **In my opinion:** In my viewpoint, I also think that most PWS apply their awareness in an unhelpful way that increases blocks, anticipation and avoidance-behaviors. Emotions from negative reactions has been well researched. So let's go deeper and even beyond the anticipation of negative reactions, and beyond situations where PWS are teased or criticized for their speech (or experience negative outcomes as a result of their stuttering): * people with alexithymia may: * have difficulty recognizing and expressing their emotions * have a limited vocabulary for describing their feelings * struggle to differentiate between different emotional states * have difficulty processing sensory information, including proprioceptive feedback (sensations from the body's own movements) and interoceptive feedback (sensations from internal organs) * have difficulty regulating their emotions or its arousal * Most adults who stutter anticipate stuttering and experience anticipation anxiety from this, right? Stuttering anticipation is not true, but we are reacting to something we imagine in this viewpoint. So, we experience a feeling, but we perceive, label and identify it incorrectly. The negative result is that it increases stuttering, avoidance-behaviors, emotions, unhelpful corrections (such as tensing due to a lack of a better solution) and anticipation * In the viewpoint of Alexithymia, one viewpoint may be that no one is able to predict behaviors. If you are walking, can you predict that you will move your legs in 5 seconds? No. No one can anticipate behaviors of oneself. Jackson (2020) states that stuttering anticipation is created from repetitive negative thinking. We experience negative feelings from stuttering anticipation, but the description of a feeling of anticipation is fake, right? Let's all discuss this in the comment section **Conclusion:** All these points can then interfere with attention, concentration and decision-making. I argue, that if the emotions raises the [execution threshold](https://www.google.com/search?q=%22stuttering%22+%22research%22+%22execution+threshold%22) too high, that we then either subconsciously decide/instruct to do the following avoidance-behaviors: (1) inhibit execution of speech movements, (2) avoiding focusing on prosody, (3) avoiding the speech plan. Avoiding **anticipation** reduces anxiety temporarily, but the negative effect is that we tell our instinct that anticipation is dangerous and to be avoided, so the next time that we speak, these triggers may become stronger which then leads reinforcing emotions, anticipation and avoidance-behaviors. ​ * People with Alexithymia may have difficulty processing sensory information. I argue, that most (if not all) PWS also have difficulty processing this sensory information because of the unhelpful attitude: "I prioritize feedback control over feedforward control", see the DIVA model ([research](https://www.google.com/search?q=%22research%22+%22diva+model%22+%22stuttering%22+%22sensory+information%22) model) that explains this better. This is my attempt to explain this in my own words: * PWS may visualize how they block. PWS may look away or blink eyes e.g., to reduce visual feedback in a failed attempt to manage stress * hearing our own stuttered speech could give the impression that the throat, respiratory or mouth muscles are stuck. We could then feel bothered and lose faith in our ability to move the muscles necessary to say the words we wanted to say. This could lead to reinforcing overreliance on feedback instead of putting complete faith in our instinct to speak subconsciously, resulting in inhibition of executing motor movements * PWS perceive either more or less speech errors when they hear background music or background noise. If we speak in unison at the same time as classmates, then we are focusing on hearing everyone (rather than focusing only (1) on my own voice, or (2) on the current feared letter) which may lead to not caring anymore about correcting speech errors in speech plans. This could then lead to not inhibiting execution of speech movements and then we won't block * if PWS perceive (1) too much air pressure, or (2) tension during a block, as a problem and to be avoided. Then it could lead to strong emotions, holding back speech, avoidance-behaviors or unhelpful corrections. Importantly, physical tension of speech muscles can never lead to a speech block, rather 'blaming tension' (and the need to reduce it) leads to strong emotions and fight flight freeze * PWS may excessively monitor, feel or locate the movement of speech muscles, tracking the outcome of speech, or evaluate whether we are able to make fluid speech motor motions in the anticipation of stuttering. This unhelpful attitude of monitoring and evaluating to decide whether to hold back speech, is unnecessary and could lead to self-doubt, a negative self-image and negative self-talk (which reinforces strong emotions, anticipation and avoidance-behaviors) * PWS may sense the position and movement of mouth muscles. Consciously applying proprioceptive feedback to maintain fluency is not only unnecessary but will only lead to perceiving (more) speech errors and then we could get the urge to hold back speech * PWS may try to speak fluently by consciously timing the breath with the coordination of speech movements, which may then lead to (1) paying more attention to stuttering, (2) trying to directly operate the feedforward system (which is not possible, even for non-stutterers), or (3) scan for stutters. This could then result in evoking negative emotions which could lead to holding back speech **Conclusion**: PWS often perceive these kinds of feedback as: 'My speech error is a problem and to be fixed or avoided.' However, if we make a habit of relying on sensory information (in a failed attempt to manage fluency), it will only enable us to perceive (more) speech errors, in my opinion