Tips to improve stuttering according to a PhD researcher (Covert repair hypothesis, Explan theory and Vicious Circle hypothesis) - reduce the need/expectation for perfect speech & resist the urge to go back to repair our speech errors

Tips to improve stuttering according to a PhD researcher (Covert repair hypothesis, Explan theory and Vicious Circle hypothesis) - reduce the need/expectation for perfect speech & resist the urge to go back to repair our speech errors This is my attempt to summarize [this](https://www.researchgate.net/publication/352380093_REVIEWING_THE_COVERT_REPAIR_HYPOTHESIS) research paper that describes three psycholinguistic theories of stuttering. **Three psycholinguistic theories**: * **The covert-repair hypothesis** (Postma and Kolk) is a model that explains speech disruptions as an outcome of hyperactive self-monitoring of inner speech. An error in the centrally devised speech plan (e.g., in the phonetic plan) is detected subconsciously and, because the speaker’s system attempts correction before it reaches the surface, we stutter * Covert = hidden, Repair = correcting the intended speech * **Speech plan**: The execution of the speech plan is articulation of: 1. overt speech or 2. inner speech. The process of speech planning is: (1) perceiving something meaningful \[semantic processing\]; (2) finding words to describe it \[lexical processing\]; (3) putting those words in the correct order \[syntactic processing\]; and (4) computing the sequence of sounds that are needed to convey those words \[phonological encoding\]. In my opinion, PWS could use all 4 aspects as a reason (aka self-made condition) to stop instructing to move speech muscles * **Covert-repair process**: With strong emotions and indecisiveness - we obsessively check our (phonological encoding of our) inner speech whether the words are okay. The positive effect of *covert error repair* is that it can prevent errors of speech planning from being spoken out loud, so listeners remain unaware of their presence. However, because *covert error repair* stops speech planning errors from being spoken out loud, we instruct ourselves to stop moving our speech muscles (resulting in a speech block) * **The Vicious Circle hypothesis** (Vasić and Wijnen): A vicious circle whereby our attempts to repair dysfluencies lead to more dysfluencies. A combination of hypervigilant speech monitoring and unrealistically high expectations with regard to how perfect one’s speech should sound causes people who stutter to initiate large numbers of error repairs that are unnecessary, and these unnecessary error repairs account for the majority of speech blocks * **EXPLAN theory** (Howell & Au-Yeung): Words and sounds are constantly competing with one another for slots in the speech plan. The most appropriate words/sounds become more highly activated than less appropriate ones. EXPLAN: EX = execution, PLAN = planning * **Auditory masking**: If we don't hear the sound of our own voice (or when we rage), we prevent ourselves from perceiving speech errors (which normally prompt us to stop and change our speech plan) which can result in stopping with: 1. self-monitoring and 2. correcting our speech plan, because we no longer care how our speech sounds or whether it contains any errors * Stuttering is a moment where we hold back speech **Speech rate**: * If the aspects (1), (2) or (3) of speech planning is slow, the amount of time left for phonological encoding (4) to be completed before the speaker wants to start speaking will be reduced * Speaking too fast can lead to difficulty to correct speech errors. In combination with an unhelpful attitude (e.g., *1. perceiving speech errors as to be avoided) and 2. perceiving that one's feedforward system is unreliable unless one speaks slower),* could lead to speech blocks **Tips**: * In order to outgrow stuttering as an adult, it's effective to: * (1) Accept (or acknowledge) that our language and speech production capacity is mildly impaired * (2) Lower the standard of speech that we aspire to during a speech block * (3) Resist the temptation to go back to repair our speech errors * Don't overestimate the fact that your overt speech is error prone * Don't overestimate the fact that you are sensitive to sensory experiences * Don't overestimate the need to monitor your speech or to be critical of its quality * Don't speak on a fast speech rate of how you imagine controlling your feedforward system, rather speak on a speech rate of putting complete faith in the feedforward system. In the feedforward process, non-stutterers decide/instruct to move the speech muscles before they say it (instead of making decisions after monitoring the outcome of speech by changing **speech plans**) * Don't overestimate the need to repeat what you have already said * **Mindfulness exercise:** * (1) sit alone with eyes closed, observe in your mind the stuttering anticipation + emotions + unhelpful reactions + unhelpful strategies. The goal is: identify and analyze your unhelpful stutter behavior, perceptions and attitude * (2) learn to stay calm and breathe calmly while deliberately observing anticipatory fear and your unhelpful behavior and perceptions. Do this exercise for each 'unhelpful self-made condition' * (3) acknowledge that doing 'unhelpful self-made conditions' are considered avoidance-behaviors that maintain the stutter cycle **Aspects that I don't agree with**: * "***An error in the centrally devised speech plan (e.g., in the phonetic plan) is detected subconsciously***" \[deficit with phonological encoding\] - I agree, additionally I'd like to propose how some self-made conditions (that I experience) bring about an error in the speech plan: 1. New condition: I will never change my speech plan because of anticipation 2. Old condition: try again the same syllable (aka speech block) 3. New condition: continue after the speech block 4. Old condition: control feedforward system directly 5. New condition: only focus on choosing (the execution of the feedforward system) 6. Old condition: I won't close my larynx, because I fear that I can't open it (avoidance-behavior) 7. New condition: whenever I speak, focus on choosing 8. Unhelpful condition: needing to struggle on moving speech muscles 9. Unhelpful condition: needing to be stuck (in a speech block) 10. Unhelpful condition: needing to think and behave like a stutterer 11. New condition: I will always deliberately do the opposite of unhelpful conditions e.g., closing larynx with anticipatory fear (in order to scare my unhelpful instinct/intrusive mental state) 12. Unhelpful condition: needing to tense abdominal muscles (compare it to continuing to ride the bicycle on a toddler's 3-wheeler into adulthood) 13. Unhelpful condition: obsessively needing to correct speech errors 14. Unhelpful condition: needing to block in order to indicate to listeners that we are still trying to speak 15. Unhelpful condition: needing to block or do repetitions in order to maintain the speech rhythm 16. Unhelpful condition: needing to wait to move speech muscles (as if I speak too fast) 17. New condition: I will never use avoidance-behaviors (aka doing above unhelpful conditions) ​ * "***and, because the speaker’s system attempts correction before it reaches the surface, he or she stutters***" (Yairi, p. 136) - I disagree with 'attempts correction', because it's effective to attempt a helpful correction e.g., instructing to move speech muscles in spite of sensory experiences; staying calm while experiencing sensory information; or relaxing abdominal muscles. So, I suggest to replace 'correction' with 'unhelpful correction' * "***It seemed to me to be unlikely that stuttering was uniquely associated with the tendency to make excessive numbers of errors of phonological encoding, because errors should be evident to us in our inner speech when we listen to our thoughts***." - I disagree, because we are wired to communicate differently when executing the phonological encoding for overt speech *versus* inner speech (e.g., the execution threshold is likely to be lower in inner speech). An argument could be made, that our stutter mental state includes an unhelpful attitude to handle above 'unhelpful self-made conditions', which applies to overt speech but not to inner speech * "***Do PWS have slow phonological encoding?***" - In my opinion, yes absolutely because of the hyperactive self-monitoring of unhelpful self-made conditions * "***Do stutterers engage in excessive/unnecessary error-repair activity***?" - In my opinion, yes absolutely, because of our unhelpful attitude of perfectionism (of how perfect one’s speech should sound) and dysfunctional belief system e.g., our feedforward system is unreliable, I need to directly control the feedforward system and I need to try unhelpful behaviors - which is reinforced in the lack of a better strategy and lack of accurate knowledge * "***Rather than errors of word selection or word ordering***" - In my opinion, PWS who strongly identify with being, thinking and behaving like a PWS, have reasons (aka self-made conditions) about errors of word selection or word ordering as well. In fact, everything in life (and all life aspects) could be a reason that we associate to instruct to stop moving speech muscles * "***The difference between how we pronounce single words in isolation and in combination reflects three processes: elision – the omission of a sound between two words; assimilation – the merging of two sounds, and liaison – the pronunciation of an otherwise silent sound when the next word is vowel-initial***" - In my opinion: PWS apply elision, assimilation and liaison in unhelpful ways e.g., we may have wired ourselves through self-made conditions to fear pre-closing the larynx and therefore avoid this. Unfortunately, speech therapies likely have never approached this relevant aspect of avoidance-behavior, which likely prevents the progress of outgrowing stuttering in adults * "***EXPLAN hypothesis – that rapid repetitions result from an automatic ‘re-start mechanism’ that repeatedly re-executes whatever bits of speech plan are already available for execution whenever the speaker tries to execute bits of speech plan that are not yet available for execution.***" - In my opinion, doing repetitions is a secondary behavior, whereas speech blocks are primary behaviors. Basically, the more we reduce 'repetitions' to avoid speech blocks, the more we will do speech blocks and, thus, the less we do secondary avoidance-behavior. Once we learn to turn repetitions into speech blocks, it's my belief that the *execution threshold* will be achieved much easier * "***The idea behind such ‘dual-task’ experiments is that the secondary task uses up any surplus processing power the speaker may have, leaving him with too little processing power to be able to monitor for speech errors or initiate speech error repairs.***" - In my opinion, this method comes with severe limitations, because the unhelpful behavior/perception in some PWS are so hardwired that, even if they do dual-task experiments, their instinct won't be able to distinguish 'speech error repairs' from speech with low processing power, and therefore in some PWS the speech error repairs may go beyond 80%, whereas in other PWS it may go below 20% depending on our self-made conditions how we wired ourselves. I'm referring to a stutter mental state that is so subconscious, that we don't have control over the process (and therefore no control over reducing speech error repairs even if we engage in dual-task experiments). However, I do agree that the conscious aspects are reduced regarding monitoring and repairing speech errors. Another limitation is, that some PWS (me included), are not able to perform the second task while experiencing severe speech blocks e.g., because we have wired ourselves to increase secondary characteristics resulting in: 1. 'spacing out' or 2. loss of control of your own body and everything around you - this could then result in prioritizing 'monitoring and repairing speech errors' over focusing on the second task * **Question**: What are all the errors that lead to speech blocks? (besides errors of speech plans) * **Question**: How can a PWS sense, notice or experience whether a **low or too high** execution threshold brought about a speech block? * **Question**: How can PWS sense, notice or experience: error-prone speech? * ***Question: What are 10 strategies to lower our execution threshold***? For example, * lowering the standard of speech that we aspire to, * lowering our expectations of perfect speech (of how perfect one’s speech should sound), * expecting fear of stuttering anticipation, * lowering the need to speak accurately/appropriately, * allowing more speech errors, * perceiving correctly phonologically encoding as less important, * stop applying self-made (anticipatory) conditions regarding the execution threshold like "I will always be a stutterer so I'll never be able to control the execution threshold", * stop applying a condition to be indecisive to instruct movement of speech muscles, * turning repetitions into speech blocks, * becoming less sensitive to (or more tolerant against) minor imperfections in our speech, * becoming less sensitized to our dysfluencies, * practicing prosodic speech without avoidance-behavior: For example, by reading out loud, imitating public speakers or imagining how your family/close friends speak. **Argument**: because the more your speaking skills improve, the less your need to monitor/correct your speech plan (aka confidence). However, a counter-argument is that fearing stuttering anticipation can completely negate this. This brings me to the different variaties of confidence, whereby confidence to speak in the anticipation of stuttering that reduces the freeze-effect, is likely much more effective than other types of confidence to outgrow stuttering as an adult! [This](https://www.reddit.com/r/Stutter/comments/114cxqx/tips_to_improve_stuttering_according_to_a_phd/) is my follow-up post.