Hierarchical level: Each level explains why stuttering recovery is inadvertently PREVENTED during our lifetime. What are your thoughts on it?

Hierarchical level: Each level explains why stuttering recovery is inadvertently PREVENTED during our lifetime. What are your thoughts on it? *Let's envision a scenario: a person who stutters* ***(PWS)*** *speaks with their SLP therapist. In this example, the PWS’s subconscious brain triggers the amygdala resulting in stuttering. So the main question is: What is happening here on multiple levels?* **What is happening in a hierarchical ladder:** **Neurobiological level:** the amygdala activation is part of the person’s automatic appraisal and physiological response to perceived threat. **On the conversation level:** PWS (people who stutter), generally, prioritize the forward flow of communication. That is — even when an approach-avoidance conflict (an amygdala appraisal inhibition-response) produces stuttering — we should prioritize continuing and executing speech (moving the conversation forward) rather than trying to resolve the appraisal–amygdala-inhibition loop. **On the cultural, moral, or ethical level:** acceptance, exposure, and desensitization techniques are prioritized — even when they do not appear to immediately “resolve” our **unique** appraisal-amygdala-inhibition loop. Basic labels (for example, labeling the experience as “fear”) tend to be given negative valence and treated as something to reduce in order to make it easier to execute speech **(further reinforcing the error-avoidance mechanism or protection mechanism of the amygdala)**. **On the professional/field level:** SLPs generally do not want to stray from modern, tested theories and techniques. Experimental or untested approaches can be unsafe (or harmful) for the person who stutters. Clinicians are bound by ethical codes that favor evidence-based practice. Therapists are trained in specific models; branching outside those models risks working outside competence. Standardized techniques allow predictable planning, supervision, and quality control. **Insurance** often require evidence-based codes for reimbursement; this limits what clinicians can provide. Prevailing models maintain credibility. When many clinicians use the same techniques, data can be collected and research can refine practice. **Cultural / moral / ethical**: SLPs, generally, stigmatize approaches that does not reduce fear; SLPs often encourage values about acceptance approaches even if they seem ineffective to successfully address their unique appraisal-amygdala-response loop); SLPs often stigmatize paths towards stuttering remission or subconscious fluency **Societal / structural**: public attitudes and education systems often encourage disability law and access to care - further reinforcing or maintaining the previous mentioned levels **Research / epistemic**: research evidence and funding prioritize objective, measurable findings rather than research findings that are difficult to measure or quantify i.e., a subconscious appraisal-amygdala-inhibition state response is difficult to measure statistically, or difficult to empirically support **Global / public-health**: WHO or national campaigns affecting fluency goals / priorities \~\~ Your thoughts?