Stammering and its therapy: a cognitive or physical problem?
By Mike Jones

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It is almost nine years since I wrote 'Towards re-programming the stammering mind' which appeared in Speaking Out (Autumn 1997). Since then I've got over my own stammering and ran scores of workshops on the Neuro-linguistic Programming (NLP) approach. In this article I will:
Compare cognitive versus behavioural approaches to stammering.
Summarise what I now believe stammering is - nine years on.
Reflect on suitable candidates for a cognitive approach.

It always made sense to me that if people who stammer talk easily sometimes, that had to reflect differences in how they might feel and think at different times. It is accepted that thoughts, feelings and behaviour are intimately linked (cognitive behaviour therapy is based on this). Developing new physical behaviours (costal breathing; slow speech; etc) or new thought patterns could potentially produce the same results. However, my experience was that feelings often stopped me using physical techniques. Feeling nervous stops anyone performing their best.

When I learned NLP in 1996 it gave me tools to change many thought patterns around communication. The result over many months was an easing of my 'covert avoidance' problem. The recently popularised Neuro-semantics (NS) is closely related to NLP and offers further cognitive tools (see Bob Bodenhamer's recent book 'Mastering Blocking and Stuttering'). My personal experience showed that cognition (thought) is definitively part of stammering.

My view is that stammering is an example of a response common to animals and humans - fight-flight-freeze. This is thought to have evolved to protect us against predators. Basically we fight, run away or become still enough to be overlooked. Humans have developed a more sophisticated consciousness than other animals which allows us to think about things. The downside is, our very thoughts can sometimes be threatening enough to trigger the 'predator response'! Have you ever experienced a fight or flight or freeze in relation to speech? But why exactly?

My theory is that an early speech dysfluency (a natural part of learning to speak for many) triggers one or more significant 'threatening' responses from a family member or other person. A significant threatening response is any behaviour that (to the child) differs markedly from what they have come to recognise and feel as safe. This would be more likely in families where they know about stammering - e.g. "Johnny is starting to stammer like Uncle George". Threatening responses to dysfluency might include anxiety; over-concern; or worse, anger; scorn; "speak properly", etc. Such scenarios could trigger fight, flight or freeze in a child, making a dysfluency worse, or at least perpetuating it. Importantly, if a 'threat' did not occur, a dysfluency could resolve naturally. I have seen this with my own son. I know some parents will take this as me pointing a finger of blame towards them, but that is not my intention; the parent's response is as valid a human reaction to what is happening as the child's. However, if they had known that ignoring might have been useful it could have been worth trying. Of course if a child does seem distressed about talking at an early age then some intervention would be called for:

Repeated dysfluent experiences would become associated with certain situations, words, people etc.

The child would over time develop all kinds of ideas and beliefs about those same people, places, words and also about themselves.

The child's memories and thoughts about the problem would eventually become, in themselves, consciously 'threatening' and trigger negative feelings. 'Knowing' about the problem thus perpetuates the problem and continually reinforces it through repeated negative experiences. This history then forms the basis of the person's identity - "I am a person who stammers".

I believe this whole cognitive structure is 'stammering'; the original dysfluency was only ever a seed from which the problem grew through natural responses to environmental challenges.

To summarise, I believe stammering is an unresolved dysfluency triggered by situations, words etc and made worse by one of three natural responses to the felt experience: fight = attack the problem (overt stammering); flight = avoid it (covert stammering) or freeze = total block.

If this is correct, a behavioural approach to stammering could be likened to trying to modify a computer printer's hardware to stop it producing sporadic gobbledegook when what's needed is a change in the 'software' that actually provides the printing instructions.

A different view The 'witness state' is where you remove yourself from the moment and go 'up a step' from where you can witness your behaviour more objectively. From the witness state, you can get out of the emotional baggage of the moment, and get a glimpse of the big picture. You will know the state when you reach it, because it is non-judgmental and unemotional.

Who are suitable candidates for cognitive therapy? I think it may be difficult with children because they may not have developed a sufficiently strong intellectual capacity to think through the issues. All adults are candidates - as long as they have some capacity to think analytically. The approach requires much study and application and is no easy 'cure' - it is a life changing journey, the duration of which is impossible to predict. The biggest hurdle in this approach is learning the method and applying the tools appropriately and for long enough. I am therefore continually striving to devise new teaching formats. My latest is '10 steps to ease in communication'

Step 1 is to be clear about what a specific issue is and to describe why it is a problem. This seems obvious but actually asking yourself WHY is talking to Aunt Hilda a problem can uncover things like beliefs about people like her, beliefs about the possibility of having good relationships with people like that ... and a host of other things. Steps 2-4 go on to clarify the whole cognitive structure of a specific problem. Steps 5-10 describe how to apply the cognitive tools to 'reprogram' what was specified in steps 1-4 and how to 'program' in resources that support the implementation of the changes in the real world.

If only it could be 1 step! Maybe one day.

From the Spring 2006 edition of Speaking Out, pages 6-7

'Steps to ease in communication' - 2 day Reprogramming the Stammering Mind workshops by Mike Jones.

Feedback

From Dr Tom Weidig: The effects of stammering don't show the cause (Speaking Out Summer 2006)

Neuro-linguistic programming can be a useful technique to get and stay motivated to change your behaviour and attitude to stammering in the long-term. Other motivational techniques also exist as Rich Whincup's article on sports psychology shows. However, I am not impressed with Mike Jones' attempt to venture from his own experiences as a stutterer and parent, and field of expertise in NLP, into the theory of stammering.

First, he offers a strict uni-dimensional view: stammering is a cognitive and not a physical problem. In fact, stammering can and very likely is both: a physical problem which also kick-starts cognitive problems which then aggravate and re-enforce stammering. Second, he does not recognise the variety in the relative strength of physical and cognitive issues in individuals. For a mild or covert stutterer, the cognitive side might be dominant. But I have yet to see a severe stutterer overcome stammering just by changing attitude. Third, according to Jones, dsyfluent children have reacted to their environment. But then how come my brother and millions of kids who grew up in far worse homes do not stutter? Fourth, Jones presents his theory without mentioning or addressing the seemingly contradictory research evidence: If he is right, why do more boys stutter? Why are stutterers worse in finger tapping and dual tasks? Why are our brains functionally different according to brain research?

To summarise, I strongly believe that NLP, and other techniques, can be very useful to tackle cognitive issues. And I am convinced that for some, especially mild and covert stutterers, such an approach has helped a lot, maybe not in eliminating dysfluencies completely but in living a fuller life without fear or shame of speaking situations. But to deduce a theory of stammering from such individual cases is a logical fallacy.

Dr. Tom Weidig,
www.thestutteringbrain.blogspot.com

Reply by Mike Jones: NLP can help everyone (Speaking Out Autumn 2006, pages 18-19))

There is research indicating that biological/genetic factors are associated with stammering. My article (subject of Dr Weidig's comments in Speaking Out, Summer 2006), was not arguing against the existence of such factors.

Dr Weidig agrees that NLP may be of use in 'mild or covert' cases but doubts whether a 'severe stutterer' could be helped. His comment implies that 'severe' stammering is definitely a 'biological' problem.

The Lidcombe Program is widely accepted as being highly efficacious in childhood dysfluency. This program appear to be a cognitive-behavioural intervention (like NLP) in which behaviour [speech] irregularities are corrected in a way that avoids negatively affecting social confidence.

In view of the success of Lidcombe, should not cognitive-behavioural interventions work in adult stammering - severe or otherwise? I would expect so, unless there is a progression to 'severity' (and therefore Lidcombe wouldn't encounter severe cases because of its early stage of intervention). If severity is linked to biology, how do we explain that many people who stammer severely can be easily fluent in certain situations?

In debating these issues we can use 'medical' or 'biopsychosocial' thinking. In the latter, 'biology' is something that predisposes individuals towards certain conditions, but the realization of those conditions is viewed as being dependent on complex environmental, social and psychological factors. In contrast, medical thinking involves the 'identify and fix what's broken' approach (e.g. with drugs; medical devices etc.). It is not always clear which approach is appropriate. For example, although genetic and biological factors are linked with depression, cognitive-behaviour therapy is proven as effective as any drug for treatment.

NLP is not medical; simply stated, if easy fluency is sometimes available to a person who stammers then cognitive-behavioural factors leading to such fluency can be defined and then utilized more and more often until a new fluent state is habitualised.

Mike Jones MSc PhD
'Steps to ease in communication' workshops

See also: NLP page