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!


Scholarly Article Reviews-Week 1

We have 2 reviews for you this week!

The first article review is brought to you by Katie Cohen, SLP at Maupin and Roosevelt-Perry Elementary schools:

Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Stuttering in School-Age Children: A Comprehensive Approach to Treatment. Lang Speech Hear Serv Sch, 43(4), 536-548.

This article is a response to an article written and published by the editor of LSHSS, Dr. Marilyn Nippold that included the following scenario:

A young SLP contacts a former professor to request help with a student, Ben, for whom she is assessing and developing a treatment plan.  The former professor responds to the SLP stating there is a need for more research on treatments that specifically decrease the frequency count of stuttering events for the pediatric population.

· I have an issue with this: The former professor should have suggested another resource, maybe a colleague or practicing SLP from whom this SLP could have gotten some help on creating a treatment plan for Ben rather than broadly stating that we need more research.

In her article, Dr. Nippold formally calls for more research on treatments that decrease the frequency of stuttering.

This article responds to Dr. Nippold directly using three themes.

Theme 1. Agreement with Dr. Nippold’s call for more research.

Very straightforward.  I agree we do need more research on techniques to improve speech fluency.

Theme 2. Overview of recent literature including strategies to improve speech fluency, as well as, increase acceptance and decrease negative consequences.

Suppose an SLP solely focuses on decreasing the frequency count. If students avoid certain words and respond in very short utterances, they will likely exhibit a decreased frequency count. However, this can occur with increased anxiety, fear, and lack of acceptance.  On the other hand, acceptance can “lead to reduced stuttering severity, increased fluency, and improved communication.” Acceptance is an integral part of the therapy process and includes concepts that are also central to mindfulness, acceptance and commitment therapy, as well as, cognitive behavioral therapy.

Stuttering is a multi-dimensional disorder; therefore, there is not one specific treatment type to help our students with fluency impairments.

Theme 3. Several strategies to minimize the adverse academic impact of stuttering on the school age population.

The authors’ strive to make suggestions that are “consistent with common clinical practice” and “reflective of real life experiences”.  Here are two long-term objectives (LTO) with short-term objectives (STO) the author’s provide.

LTO1: Ben will experience a decrease in bullying.

STO1.1: Ben will talk with the SLP about what is going on in the classroom.

STO2.1: Ben will participate in a fluency group with other students who have a fluency impairment. –Ben will gain acceptance, identify a role model, and practice self-expression in a safe environment.

STO3.1: Ben will invite a close friend/ classmate to attend a speech therapy session with him at which Ben (with the SLP) will educate the peer about stuttering.

STO4.1: Ben will create and give a presentation to his class in order to teach about stuttering.


LTO2: Ben will be able to answer questions when called upon.

STO1.2: Ben will raise his hand to participate in class at least once each day. – Ben has a sense of control over when he speaks, which decreases the anxiety, however, he is still answering a question.

STO2.2: Ben will answer questions out-loud on prearranges topics of his choice that he is most comfortable with. – This will improve his participation in the classroom, as well as, build confidence.

Comprehensive assessment:  When evaluating (or in some cases re-evaluating) a student with fluency of speech needs, it is imperative to look closer at the whole picture in order to develop a treatment plan more tailored to the individual student’s needs.  Factors that should not be overlooked include:

· classroom participation via observation and teacher (or instructional assistant) interview

· emotions via observation and interview (parent, teacher, self, etc.)

· fluency count via direct measure of speech sample

· avoidance behaviors via observations and interviews (parent, teacher, self, etc.)


In summary, this article claims that SLPs, when working with school-aged students with fluency impairments, should focus on decreasing the frequency count in addition to -rather than instead of- acceptance.

Thanks, Katie!

MLK Day and Literature Unit

Welcome back!! I just wanted to remind you of the literature unit for January. If you did not see it the first time, you can find it here.

If you are looking for some materials to incorporate MLK day into your sessions, the TPT store has some great resources! I clicked the “free” box and still came up with some great options for therapy!! This was the very first item that popped up for me. It struck me that this would be good to use with the EET prompts (although you would have to add a space for “what else”).

How are you getting back into the swing of things?

**If you have a recommendation for the January “SPOTLIGHT” Please send me who and why (very briefly) ASAP!!**