Maintenance of Social Anxiety in Stuttering: A Cognitive-Behavioral Model

Our second article today is brought to you by Allison Forrester:

Iverach, L., Rapee, R. M., Wong, Q. J., Lowe, R. (2017) Maintenance of Social Anxiety in Stuttering: A  Cognitive-Behavioral Model. American Journal of Speech Language Pathology. 26: 540-556. American Speech-Language-Hearing Association.

This article addresses the application of leading models, which describe cognitive-behavioral factors that contribute to the maintenance of social anxiety in nonstuttering people, to the experience of social anxiety for people who stutter. Social anxiety is a chronic anxiety disorder, which tends to be disabling as well, negatively impacting people’s lives. These models were applied to stuttering to determine cognitive-behavioral processes that may increase the persistence of social fears related to stuttering. They found that social anxiety in people who stutter may persist due to multiple factors, such as, negative social-evaluative cognitions, attentional biases, safety behaviors, fear of negative evaluation, anticipatory and post-event thinking. In conclusion, the identification of these factors may help inform and develop psychological treatment programs for the people who stutter. These treatments may address social anxiety and psychological needs of these individuals. The article discusses the processes that were found to be common in the models and they were used to identify five main ideas that may play a role in the maintenance of social anxiety in stuttering. These ideas are as follow: Socially anxious individuals assume that they will be negatively evaluated by others and overestimate the consequences of negative evaluation; socially anxious individuals form a negative mental representation of the self as seen by the audience, socially anxious individuals engage in negative self-focused attention and demonstrate attentional biases towards social threat; socially anxious individuals engage in cognitive and behavioral strategies to temporarily reduce anxiety; and socially anxious individuals engage in anticipatory and post-event processing.

Social interaction and communication are essential parts of an individual’s life and are required in almost every facet of daily life. Stuttering is a complex communication disorder which occurs in ~4-5% of the population. Social anxiety is a chronic, disabling anxiety disorder that occurs in ~8-13% of the population. Research shows that ~22-60% of people who stutter (adults) also have social anxiety and ~24% of adolescents who stutter have social anxiety. In summary, people who stutter may experience negative social reactions over and over, which leads them to have greater social anxiety based on the belief that negative evaluations will occur in social situations. The findings in this article were what I expected to discover.

Thanks, Allison!

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5 thoughts on “Maintenance of Social Anxiety in Stuttering: A Cognitive-Behavioral Model

  1. Katie Cohen says:

    Great points Allison! I can agree that the 5 ideas mentioned are an accurate written description for the factors of social anxiety. These ideas could be used as talking points when a student shares about a challenging communication event. Based on what my stuents have shared, there are a few who probably are suffering from the social anxiety occuring with stuttering. It seems that just like stuttering, social anxiety is a disorder that doesn’t have an easy fix. I wonder if there is any research to claim that social anxiety can occur in combination with other communication disorders.

  2. Jamie Priddy says:

    I can definitely see how social anxiety would be crippling and ongoing for a student who stutters, particularly our middle and high school students who are already experiencing a lot of social and emotional changes aside from their speech disorder. I can even identify personally with some of those descriptive points for social anxiety just from having a more introverted personality. It is so important for us to take this into consideration when working with our students. Maybe sharing our own challenges in social situations (ex: I have a super hard time speaking in public) would be reassuring for them and bring them some comfort in knowing they aren’t alone.

  3. Jane Stosberg says:

    I am glad to read your summary of this article. I have a student who stutters on my caseload who has social anxiety and the interaction between those 2 has really come into play this school year. Last year, I decreased the student’s speech services and he was on the path to dismissal. But some negative social events happened this year and his anxiety has increased significantly as a result. He no longer is using his fluency building skills and his stuttering is more pronounced than ever. As I have read the literature on this topic, I have begun to realize how much more research needs to be done.

  4. Kelly Miklosh says:

    Thanks for the article review! This article confirmed I need to do a better job at addressing the cognitive-behavioral piece in my therapy. I have an adolescent who has increased difficulty implementing his fluency enhancing strategies in conversational speech and I highly wonder if the reason why is correlated to the cognitive-behavioral aspect.

  5. Krista RIce says:

    Thank you for your summary! I agree with your expectations that people who stutter may have more social anxiety because of the fear of negative evaluations in social situations. The student I currently work with for fluency does not appear to present with anxiety in social situations. This student is just now beginning to acknowledge that he does stutter and we are working on him identifying when it occurs, what situation is he in when it occurs, what physiological factors are present, and how he feels when it occurs.

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