Abstract
Background: The impact of stuttering far exceeds its effects on speech production itself. It includes increased anxiety levels and avoidance of speech situations that may impact the general quality of life. Therefore, psychological treatment methods have been incorporated into speech therapy programs with positive results. Acceptance and commitment therapy (ACT) is a relatively recent addition to the field of stuttering. In this case report, we present a pilot program of integrating acceptance and commitment therapy (ACT) with stuttering modification therapy for adults who stutter. Method: Eight adults who stutter entered the approximately year-long program, which consisted of three parts: group ACT, individual/pair stuttering modification therapy, and monthly stabilization/follow-up sessions. Results: Improvement was observed in group mean measures of mindfulness skills, speech-related attitudes, anxiety, daily communication, quality of life, and stuttering frequency. Improvement in quality of life was also self-described by participants throughout the program. Conclusions: Participant improvement and positive self-reports suggest a potentially promising effect of combining ACT with stuttering modification therapy. Further research is needed to evaluate treatment efficacy.
References
1.
Bryngelson
B
. Suggestions in the theory and treatment of dysphemia, and its symptom, stuttering
. Commun Educ
. 1952
Mar
;1
(2
):131
–6
.0363-45232.
Sheehan
J
. Conflict theory of stuttering. In: Eisenson
J
, editor. Stuttering: A symposium
. New York (NY)
: Harper & Brothers
; 1958
. pp. 121
–66
.3.
American Psychiatric Association
. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013
May 22.4.
Guitar
B
. Stuttering: An intergrated approach to its nature and management
. Baltimore
: Lippincott Williams & Wilkins
; 2006
.5.
Panayiotou
G
, Karekla
M
, Mete
I
. Dispositional coping in individuals with anxiety disorder symptomatology: avoidance predicts distress
. J Contextual Behav Sci
. 2014
Oct
;3
(4
):314
–21
. 2212-14476.
Yaruss
JS
. Describing the consequences of disorders: stuttering and the international classification of impairments, disabilities, and handicaps
. J Speech Lang Hear Res
. 1998
Apr
;41
(2
):249
–57
.
[PubMed]
1092-43887.
Craig
A
, Tran
Y
. Trait and social anxiety in adults with chronic stuttering: conclusions following meta-analysis
. J Fluency Disord
. 2014
Jun
;40
:35
–43
.
[PubMed]
0094-730X8.
Iverach
L
, Menzies
RG
, O’Brian
S
, Packman
A
, Onslow
M
. Anxiety and stuttering: continuing to explore a complex relationship
. Am J Speech Lang Pathol
. 2011
Aug
;20
(3
):221
–32
.
[PubMed]
1058-03609.
Craig
A
, Blumgart
E
, Tran
Y
. The impact of stuttering on the quality of life in adults who stutter
. J Fluency Disord
. 2009
Jun
;34
(2
):61
–71
.
[PubMed]
0094-730X10.
Yaruss
JS
. Assessing quality of life in stuttering treatment outcomes research
. J Fluency Disord
. 2010
Sep
;35
(3
):190
–202
.
[PubMed]
0094-730X11.
Franken
MC
, Boves
L
, Peters
HF
, Webster
RL
. Perceptual evaluation of the speech before and after fluency shaping therapy
. J Fluency Disord
. 1992
;17
(4
):223
–41
. 0094-730X12.
O’Brian
S
, Onslow
M
, Cream
A
, Packman
A
. The Camperdown Program: outcomes of a new prolonged-speech treatment model
. J Speech Lang Hear Res
. 2003
Aug
;46
(4
):933
–46
.
[PubMed]
1092-438813.
Schwartz
D
, Webster
LM
. A clinical adaptation of the Hollins Precision Fluency Shaping Program through de-intensification
. J Fluency Disord
. 1977
Mar
;2
(1
):3
–10
. 0094-730X14.
Bloodstein
O
, Bernstein Ratner
N
. A handbook on stuttering
. Clifton Park (NY)
: Delmar Cengage Learning, Inc
; 2008
.15.
Menzies
RG
, O’Brian
S
, Onslow
M
, Packman
A
, St Clare
T
, Block
S
. An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering
. J Speech Lang Hear Res
. 2008
Dec
;51
(6
):1451
–64
.
[PubMed]
1092-438816.
Iverach
L
, O’Brian
S
, Jones
M
, Block
S
, Lincoln
M
, Harrison
E
, et al. Prevalence of anxiety disorders among adults seeking speech therapy for stuttering
. J Anxiety Disord
. 2009
Oct
;23
(7
):928
–34
.
[PubMed]
0887-618517.
Martin
RR
. Introduction and perspective: Review of published studies. In: Boberg E, editor. Maintenance of fluency: Proceedings of the Banff Conference. New York, NY: Elsevier North-Holland;1981
; p. 1-30.18.
Menzies
RG
, Onslow
M
, Packman
A
, O’Brian
S
. Cognitive behavior therapy for adults who stutter: a tutorial for speech-language pathologists
. J Fluency Disord
. 2009
Sep
;34
(3
):187
–200
.
[PubMed]
0094-730X19.
Beck
AT
. Cognitive therapy: nature and relation to behavior therapy
. Behav Ther
. 1970
May
;1
(2
):184
–200
.
[PubMed]
0005-789420.
Helgadóttir
FD
, Menzies
RG
, Onslow
M
, Packman
A
, O’Brian
S
. Online CBT I: bridging the gap between Eliza and modern online CBT treatment packages
. Behav Change
. 2009
Dec
;26
(4
):245
–53
. 0813-483921.
Lowe
R
, Helgadottir
F
, Menzies
R
, Heard
R
, O’Brian
S
, Packman
A
, et al. Safety behaviors and stuttering
. J Speech Lang Hear Res
. 2017
May
;60
(5
):1246
–53
.
[PubMed]
1092-438822.
Beck
AT
. Depression: Clinical, experimental, and theoretical aspects
. Philadelphia (PA)
: University of Pennsylvania Press
; 1967
.23.
Hayes
SC
. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies
. Behav Ther
. 2004
Sep
;35
(4
):639
–65
.
[PubMed]
0005-789424.
Harris
R
. ACT made simple: An easy-to-read primer on acceptance and commitment therapy
. Oakland (CA)
: New Harbinger Publications
; 2009
.25.
Hayes
SC
, Strosahl
KD
, Wilson
KG
. Acceptance and commitment therapy: The process and practice of mindful change
. New York (NY)
: Guilford Press
; 2012
.26.
Luoma
JB
, Hayes
SC
, Walser
RD
. Learning ACT: An acceptance & commitment therapy skills-training manual for therapists
. Oakland (CA)
: New Harbinger Publications
; 2007
.27.
Mindfulness
KZ
. Mindfulness
. 2015
Dec
;6
(6
):1481
–3
. 1868-852728.
Arch
JJ
, Eifert
GH
, Davies
C
, Plumb Vilardaga
JC
, Rose
RD
, Craske
MG
. Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders
. J Consult Clin Psychol
. 2012
Oct
;80
(5
):750
–65
.
[PubMed]
0022-006X29.
Dalrymple
KL
, Herbert
JD
. Acceptance and commitment therapy for generalized social anxiety disorder: a pilot study
. Behav Modif
. 2007
Sep
;31
(5
):543
–68
.
[PubMed]
0145-445530.
Lillis
J
, Kendra
KE
. Acceptance and Commitment Therapy for weight control: Model, evidence, and future directions
. J Contextual Behav Sci
. 2014
Jan
;3
(1
):1
–7
.
[PubMed]
2212-144731.
Orsillo
SM
, Batten
SV
. Acceptance and commitment therapy in the treatment of posttraumatic stress disorder
. Behav Modif
. 2005
Jan
;29
(1
):95
–129
.
[PubMed]
0145-445532.
Luciano
JV
, Guallar
JA
, Aguado
J
, López-Del-Hoyo
Y
, Olivan
B
, Magallón
R
, et al. Effectiveness of group acceptance and commitment therapy for fibromyalgia: a 6-month randomized controlled trial (EFFIGACT study)
. Pain
. 2014
Apr
;155
(4
):693
–702
.
[PubMed]
0304-395933.
Cheasman
C
, Everard
R
. Embrace your demons and follow your heart: An Acceptance and Commitment Therapy approach to work with people who stammer. In: Cheasman
C
, Everard
R
, Simpson
S
, editors. Stammering therapy from the inside: New perspectives on working with young people and adults
. Guildford, UK
: J & R Press
; 2013
. pp. 267
–302
.34.
Corcoran
JA
, Stewart
M
. Stories of stuttering: A qualitative analysis of interview narratives
. J Fluency Disord
. 1998
Nov
;23
(4
):247
–64
. 0094-730X35.
Boyle
MP
. Mindfulness training in stuttering therapy: a tutorial for speech-language pathologists
. J Fluency Disord
. 2011
Jun
;36
(2
):122
–9
.
[PubMed]
0094-730X36.
Beilby
JM
, Byrnes
ML
, Yaruss
JS
. Acceptance and Commitment Therapy for adults who stutter: psychosocial adjustment and speech fluency
. J Fluency Disord
. 2012
Dec
;37
(4
):289
–99
.
[PubMed]
0094-730X37.
Scott
P
, Jaime
H
. The clinical applications of acceptance and commitment therapy with clients who stutter
. Perspect Fluen Fluen Disord
. 2013
Nov
;23
(2
):54
–69
. 1940-759938.
39.
Blomgren
M
, Roy
N
, Callister
T
, Merrill
RM
. Intensive stuttering modification therapy: a multidimensional assessment of treatment outcomes
. J Speech Lang Hear Res
. 2005
Jun
;48
(3
):509
–23
.
[PubMed]
1092-438840.
Barlow
DH
, Ellard
KK
, Fairholme
CP
, Farchione
TJ
, Boisseau
CL
, Allen
LB
, et al. Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook
. Oxford, UK
: Oxford University Press
; 2010
. 41.
Baer
RA
, Smith
GT
, Hopkins
J
, Krietemeyer
J
, Toney
L
. Using self-report assessment methods to explore facets of mindfulness
. Assessment
. 2006
Mar
;13
(1
):27
–45
.
[PubMed]
1073-191142.
Sheleg
Z
. The Effect of Coping Strategies on Ego Depletion and on level of Performance on an Attentional Task (Unpublished master's thesis). Jerusalem: Hebrew University of Jerusalem; 2012
.43.
Brutten
GJ
. Behavior assessment and the strategy of therapy. In: Lebrun Y, Hoops R, editors. Neurolinguistic approaches to stuttering. The Hague: Mouton; 1973
. p. 8-17.44.
Brutten
GJ
. Stuttering: Topography, assessment and behavior change strategies. In: Eisenson J, editor. Stuttering: A second symposium. New York, NY: Harper and Row, 1975
. p. 199-262.45.
Brutten
EJ
, Janssen
P
. A normative and factor analysis study of the responses of Dutch and American stutterers to Speech Situation Checklist.
In: Urban GJ, editor. Proceedings of the 18th Congress of the International Association of Logopedics and Phoniatrists. Rockville, MD: ASLHA, 1981
. p. 281-646.
Vanryckeghem
M
. The Behavior Assessment Battery: An update.
Proceedings of the XXIVth Congress of the International Association of Logopedists and Phoniatrists
. Nijmegen
: Nijmegen University Press
, 1999
.47.
Ezrati-Vinacour
R
, Levin
I
. The relationship between anxiety and stuttering: a multidimensional approach
. J Fluency Disord
. 2004
;29
(2
):135
–48
.
[PubMed]
0094-730X48.
Yaruss
JS
, Quesal
RW
. Overall Assessment of the Speaker’s Experience of Stuttering (OASES): documenting multiple outcomes in stuttering treatment
. J Fluency Disord
. 2006
;31
(2
):90
–115
.
[PubMed]
0094-730X49.
Yaruss
JS
, Quesal
RW
. Overall assessment of the speaker’s experience of stuttering (OASES)
. Bloomington (MN)
: Pearson Assessments
; 2010
.50.
Freud
D
, Kichin-Brin
M
, Ezrati-Vinacour
R
, Roziner
I
, Amir
O
. The relationship between the experience of stuttering and demographic characteristics of adults who stutter
. J Fluency Disord
. 2017
Jun
;52
:53
–63
.
[PubMed]
0094-730X51.
52.
Ambrose
NG
, Yairi
E
. Normative disfluency data for early childhood stuttering
. J Speech Lang Hear Res
. 1999
Aug
;42
(4
):895
–909
.
[PubMed]
1092-4388© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
