The scariest thing about
stuttering blocks is that they tend to occur automatically, involuntarily,
and without any conscious control. Suddenly you are aware that an
up-coming word is blocked – often before you even try to say it. You feel
as if it contains an insurmountable “brick wall.” You become overwhelmed
by a seemingly uncontrollable urge to use physical effort to force the
word out. You momentarily forget everything you may have learned about
fluency techniques. In your panic, you instinctively revert back to your
old, established struggle or avoidance behaviors – as if no other choices
are possible. These experiences may leave you feeling helpless, confused,
frustrated, and despairing of any hope for improvement.
The triggering of stuttering
blocks closely resembles what happens during the body’s “fight-or-flight”
reaction to fearful stimuli. For example, if you were hiking in the
countryside and suddenly saw something at your feet that looked like a
rattlesnake, you would automatically react to the danger, without even
thinking. Your brain is programmed to do this instantaneously as an aide
to survival. Your reaction might be particularly strong if you knew that
the area was infested with poisonous snakes, and you were already worried
about being bitten.
Here’s how it works. The
fearful stimulus – the vision of the snakelike object – is transmitted
from the visual cortex of your brain to a part of the brain called the
thalamus, which acts somewhat like a switchboard. The
thalamus relays the information to other parts of the brain, including the
amygdala – a structure in your limbic system (or “emotional
brain”) where fearful memories are stored. (There is an amygdala
on each side of the brain, but we'll just use one as an example.)
If the stimulus is similar
to something fearful, the amygdala automatically sounds an alarm, telling
the hypothalamus to begin the “fight-or-flight” response. The
hypothalamus does this by activating the sympathetic nervous system
(a branch of the autonomic nervous system) as well as the
adrenal-cortical system, causing various glands to release
adrenaline (also known as epinephrine) and approximately 30
other stress hormones into the bloodstream. These hormones cause the mind
and body to prepare for emergency action to deal with the danger. Your
heart rate and blood pressure increase, your muscles tense up, your larynx
may close to perform a Valsalva maneuver, and your brain becomes focused
solely on responding to the threat. Emotionally, you feel a jolt of
intense fear. As a result, you jump away from the snake-like object
without even thinking. Acting in response to the fearful stimulus helps
to reduce the intensity of your anxiety.
All of this happens before
your sensory cortex interprets the sensory data and your
hippocampus compares it to other conscious memories in order to
establish the proper context. After interpreting all the data, you may
determine that the object is not a rattlesnake after all. Perhaps you
determine that it’s a harmless garter snake or just a stick. But that
doesn’t matter. The fight-or-flight response assumes the worst and
follows the “better safe than sorry” principle.
After the perceived danger
has been dealt with, the parasympathetic nervous system (another
part of the autonomic nervous system) is activated and returns your bodily
functions to their normal state.
During speaking situations,
a similar chain reaction may occur. Your experiences may vary, but
typically, the Valsalva-stuttering response seems to work like this:
You begin by
entering the speaking situation with a variety of fears, attitudes, and
negative expectations that increase the sensitivity of your fear
response system. These may include your image of yourself as a stutterer,
your belief that speech will be difficult, your fear of making a bad
impression by stuttering, and memories of stuttering in similar situations
or when talking to the same listeners.
Prior to the
act of speaking, the language-processing parts of your brain select
appropriate words and arrange them into sentences. (Or, if you are
reading aloud, your brain must decode the written words and translate them
into speech.) During this process, you come to an important word, or a
word that is the same, similar, or begins with the same sound as a word on
which you blocked in the past.
instantaneously, your amygdala matches this word to fearful memories of
the same or similar words or sounds. It anticipates that you will have
difficulty in saying the word. Automatically, it sends an alarm to your
hypothalamus initiates the “fight-or-flight” reaction, causing stress
hormones to flood your body and brain.
Some of these
hormones invade the area of your brain that is putting together the
muscular motor program for saying the feared word. In place of the motor
program for phonating the vowel sound, it causes your brain to insert a
motor program for your larynx to perform effort closure as part of
a Valsalva maneuver. This is what you first perceive as being the
“block.” You may feel as if the word contains a “brick wall” – which is
actually the motor program for effort closure in the place where phonation
of the vowel should be. Without the motor program for phonating the
vowel, you can’t say the word. You can say other things, but not the
specific word or syllable that contains the motor program for effort.
You may feel a
jolt of fear. You mind and body are taken over by the stress hormones,
which focus your attention entirely on the struggle. The stress hormones
cause you momentarily to forget anything you may have learned in speech
therapy. They are screaming, “Force! Force!”
Even if you
remember what you are supposed to do, you feel totally out of control.
You experience an overwhelming urge to build up air pressure in an attempt
to force out the word.
In your panic,
you find yourself reverting to the same kinds of repetitions,
prolongations, blocks, and other struggle or avoidance behaviors that you
used in the past.
The more you
attempt to force out the word, the stronger the blocks become, and the
less the larynx is prepared to phonate the vowel sound of the word.
the word reinforces your belief that speaking is difficult or that a
particular word or sound is hard for you to say. This increases the
sensitivity of your fear response even more. Therefore, your blocking on
one word may increase the likelihood that you will block on others.
effort and force may temporarily reduce your anxiety. You may get the
false impression that effort and force succeeded in eventually getting the
word out. Therefore, these behaviors are rewarded and reinforced – even
though they actually strengthen and prolong the blocks and perpetuate your
When used appropriately, the
body’s fight-or-flight response is an aid to survival, because it helps to
keep you safe from dangerous situations. However, it is not at all
helpful for speech. Nevertheless, you may have developed a strong
attachment to your “stuttering alarm system” – perhaps because it somehow
makes you feel safer. Therefore, you may have a hard time giving
it up – even though your reward would be easier and more enjoyable speech.
requires a multi-pronged approach that reverses the Valsalva-stuttering
response at every stage and at every level – psychological, neurological,
and physiological. This is the goal of Valsalva Control Therapy.
2011 by William D. Parry