Understanding and Controlling
Table of Contents.
NOW THAT WE HAVE PIECED together a detailed picture of stuttering
based on the Valsalva Hypothesis, we are ready to tackle the ultimate question:
How can this new understanding help us to control stuttering?
In our view, most stuttering is not caused by any lack of ability
to speak fluently, but rather by an interference with that ability
by the Valsalva mechanism - the bodily mechanism for exerting force. We have
seen how this tendency is perpetuated by various psychological and physiological
factors that make up the Valsalva-Stuttering Cycle. After years of stuttering,
these behaviors become deeply rooted in the nerve pathways of the brain,
making them extremely difficult to change. This is why it is so difficult
for people who stutter to stop stuttering.
In this part of the book, we shall lay out a comprehensive game plan to improve
fluency by controlling the Valsalva mechanism and breaking the
Valsalva-Stuttering Cycle. We shall call this approach Valsalva Control
Unlike previous therapies, which may have had an indirect effect on various
steps in the Cycle, Valsalva Control focuses directly on the Valsalva mechanism
itself and attacks all six steps of the Valsalva-Stuttering Cycle.
Although Valsalva Control is experimental, I believe it is worthy of serious
consideration. After decades of failed therapies, this was the approach that
finally gave me a "handle" to my own stuttering, enabling me to achieve a
dramatic and lasting improvement in fluency. But my good results are not
the only justification for this approach. I know that many former stutterers
have written books touting their own personal "cures" for stuttering, and
I realize that one person's success is no proof that the same method will
help others. For this reason, I have gone far beyond my own personal experience
to provide a broad scientific basis for the ideas expressed. Consequently,
Valsalva Control is built on a comprehensive theoretical foundation that
may reasonably apply to all developmental stutterers.
I am not saying that Valsalva Control is the only approach that might
be helpful in controlling stuttering, or that it is necessarily the best
approach for everybody. If you are having success with a particular technique,
stick with it. If you like a particular method but feel it's not helping
enough, perhaps Valsalva Control can supply what's missing.
The suggestions in this book are not cast in stone. They can be modified
or combined with other methods to suit your individual needs. The extent
to which they will prove helpful is a question only you can answer.
Who Might Benefit
Valsalva Control is intended for confirmed stutterers who have been struggling
for some time with the ordinary, developmental type of stuttering. As we
know, developmental stuttering usually starts between ages 2 and 8 (although
it can begin much later in some cases) and covers the vast majority of people
However, Valsalva Control may not be appropriate for people with other types
of stuttering, caused by brain damage or disease. Nor would it apply to vocal
problems such as spasmodic dysphonia (a neurological condition affecting
the vocal cords). These ailments require medical treatment of a totally different
nature. Therefore, if you are not certain that your condition is ordinary
developmental stuttering, see a speech pathologist or medical specialist
(e.g., a neurologist or laryngologist) for a proper diagnosis.
Furthermore, Valsalva Control is not intended for young children who are
just beginning to stutter. As we have seen, the factors that cause a child's
original disfluency may be different from those that perpetuate stuttering
in older children and adults. Today there are "stuttering intervention" programs
designed to nip early stuttering in the bud, before it becomes entrenched.
Our approach, on the other hand, is aimed at older children, teenagers, and
adults, whose stuttering has become a deeply rooted behavior.
Objectives of Valsalva Control
The purpose of Valsalva Control is to unlock the stutterer's inherent fluency
by reducing the Valsalva mechanism's interference with speech. Unlike the
"fluency training" types of therapies, we do not view stuttering as being
a problem with your speech mechanism. Therefore, we will not insist that
you trade your natural speaking ability for an artificial-sounding technique
that allegedly keeps you from stuttering. Although our suggested exercises
may use some fluency enhancing methods (such as airflow and continuous
phonation), the ultimate focus will be on controlling the Valsalva
mechanism, thereby allowing you to speak in a free and natural way.
This will be a gradual process, requiring a complete reprogramming of your
reaction to speaking situations, on both physical and psychological levels.
Valsalva Control offers no quick "cure," no magic trick that guarantees perfect
fluency forever. Rather, it is a rational approach to controlling stuttering
based on an understanding of the Valsalva Hypothesis, as explained in the
earlier parts of this book. It involves attitude changes (to be discussed
in Chapters 24 and 28), exercises in Valsalva control (Chapter 25) and phonation
(Chapter 26), as well as recommended speaking techniques (Chapter 27). Like
any new skill, it will demand continual practice on a daily basis.
The Fluency Cycle
Valsalva Control is organized around six basic rules, each designed to counteract
specific steps of the Valsalva-Stuttering Cycle. Together, these rules form
their own self-reinforcing circle, which we shall call the Fluency
Cycle. They are:
Rule 1. Develop a positive attitude toward speech.
The first step in the Valsalva-Stuttering Cycle is the expectation, either
conscious or unconscious, that speaking will be difficult. The various factors
that may contribute to such an expectation have been discussed in Chapters
11, 12, and 13. This anticipation of difficulty sets off a chain of
psychological, neurological, and physical reactions that lead to stuttering.
Therefore, you need to replace these negative attitudes with a positive
anticipation of speech. Instead of preparing for the worst, look forward
to speaking as an easy and pleasant experience. Rather than worrying
about stuttering, accept the fact that you stutter sometimes and don't
try to hide it. These attitude changes are fundamental to a reversal
of the Valsalva-Stuttering Cycle. They will not come easily, but must evolve
over time, as you build up your confidence by repeated use of the Fluency
Rule 2. Resist the urge to "try hard" in speaking.
In response to the anticipation of difficulty, stutterers may feel that physical
effort is needed to force out the words. As a part of your attitude change,
you must root out any urge to "try hard" in speaking. You must recognize
that fluent speech needs very little effort and that "trying hard" only
interferes with fluency.
Another aspect of this problem, discussed in previous chapters, is the
possibility that stutterers treat words as if they were "things" that can
be physically "forced out" by means of a Valsalva maneuver. In order to avoid
this tendency, learn to treat words as phonation and a sequence of movements,
rather than as "things" to be forced out. An exercise called Adronian
speech will be described in Chapter 26 to help you in this task.
Rule 3. Relax the Valsalva mechanism - don't force!
As discussed in Chapter 7, the stutterer's urge to force out the words is
translated by the brain into neuromotor tuning signals that put the Valsalva
mechanism into a heightened state of excitability. When this happens, the
entire mechanism is prepared to perform a Valsalva maneuver the instant a
triggering stimulus is received. The larynx is ready for effort closure,
rather than phonation, while the chest, abdominal, and rectal muscles are
poised to contract in unison.
A key objective of Valsalva Control is to prevent Valsalva tuning from occurring.
One strategy will be to "tune down" the Valsalva mechanism by relaxing
the muscles that comprise it. I have found that is best accomplished
by focusing on a few specific muscles farthest removed from the movements
of speech - namely the abdominal and rectal muscles. Relaxing them tends
to relax the entire Valsalva mechanism as well. One of our suggestions will
be to relax your rectal muscles, and feel the relaxation spread through
your abdomen and chest, all the way to your larynx.
Breathing methods can also relax the Valsalva mechanism. The technique we
shall suggest is to take a full breath, using the diaphragm, and then
relax the abdomen as you exhale.
As we saw in Chapter 8, a Valsalva maneuver may be triggered by the increases
in air pressure caused by routine closures of the mouth or larynx during
speech. You can reduce this risk if you breathe and speak in ways that
avoid abrupt increases in air pressure. Several existing techniques may
help in this regard, such as passive airflow, easy onset when starting phonation,
and light contacts of the lips and tongue while articulating. These will
be incorporated into our suggestions for speaking, to be found in Chapter
27. As we shall also point out, speech tends to be more manageable and less
stressful when you speak in short phrases and plan ahead for regular
pauses in which to breathe.
Rule 4. Focus on phonation and vowels.
Fluency can be enhanced by methods that focus your attention on phonation
or that emphasize the vowel sounds of speech. There may be two reasons behind
this beneficial effect:
In Chapter 26, we shall suggest exercises and techniques aimed at improving
phonation and keeping the vocal cords ready at all times. One of our principal
exercises, called Adronian speech, will combine phonation with several other
elements of Valsalva Control.
Rule 5. Speak slowly and deliberately, without avoidance.
Slow and deliberate speech has been one of the most common and effective
ways of improving fluency, as we discussed in Chapter 17. Often stutterers
try to speak too fast, as if racing to get the words out before stuttering
catches up with them. This increases the difficulty of speech, as well as
the tendency to use excessive force and to block.
Slowed speech reduces this pressure. It is calming and relaxing. It allows
you to set your own pace. Among other benefits, it simplifies the mechanics
of speech by stretching words out into a more easily handled sequence of
movements. This may reduce the feeling of difficulty and the urge to force
out the words as if they were "things." In addition, the slowing of speech
increases the emphasis on vowel sounds, thereby enhancing phonation.
This rule also seeks to eliminate the many varieties of avoidance behavior
(described in Chapter 10) with which stutterers attempt to hide, postpone,
or avoid their blocks. As long as you hide behind avoidance tactics, it will
be difficult to recognize and deal with the underlying tendency to block.
In Chapter 25, we shall suggest an exercise, called Voluntary Valsalva,
to help you confront the underlying blocks directly, rather than avoiding
Another form of avoidance is the tendency of many stutterers to look away
from their listeners while stuttering. This is unfortunate, because it destroys
personal communication and leaves the stutterer alone in his struggle. Therefore,
a simple but effective rule is to keep eye contact with the listener,
even if you are blocking. Eye contact may help to reduce the blocks
by reminding you of the real purpose of speech þ communication.
Rule 6. View your speech objectively.
The final step in the Fluency Cycle is to eliminate the negative reactions
you may have to your stuttering. This is aimed at counteracting Step 6 of
the Valsalva-Stuttering Cycle, in which the speaker views stuttering as
confirming his original belief that speech would be difficult. Stutterers
may also get the false impression that their excessive effort ultimately
succeeded in forcing the words out.
We shall deal with these negative reactions in Chapter 28, encouraging you
to view your speech objectively, to learn from your speaking experiences,
both fluent and disfluent, and to maintain your self-esteem, regardless of
The Road to Improvement
Just as the Valsalva-Stuttering Cycle is a self-perpetuating, self-reinforcing
circle, the Fluency Cycle is also a circle. But rather than being vicious,
it is revitalizing. Each step in the Fluency Cycle has a positive effect
that naturally leads into the next one.
For example, when you look forward to speaking as an easy and pleasant experience
(Rule 1), you will have less of an urge to "try hard" to force out the words
as if they were "things." When you don't feel the urge to force out the words,
your brain will be less likely to "tune up" your Valsalva mechanism. Without
Valsalva tuning, your vocal cords will be freer to phonate, and there will
be less chance that increases in air pressure during speech will trigger
a Valsalva maneuver that blocks speech. With less tendency to block, you
will have less temptation to use avoidance behaviors. With less blocking
and stuttering, your reaction to your speech is bound to be more positive.
Finally, a successful speaking experience will show that speech is not so
difficult after all, thereby completing the circle by strengthening your
positive attitude in Rule 1.
As you go around the Fluency Cycle the first few times, not much will seem
to change. Your desire to view speech positively may seem contrary to your
actual experiences. Your attempts to control the Valsalva mechanism may seem
hopeless in the face of its long-established power. As you continue to block,
you may be tempted to abandon this approach as just another failure. But
don't be discouraged.
Instead of looking for immediate results, you should begin by treating the
Fluency Cycle as a tool for learning. Your use of the Fluency Cycle
will go through several phases: