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Understanding and Controlling Stuttering

CHAPTER 23.

The Principles of Valsalva Control

By William D. Parry, Esq.

Understanding and Controlling Stuttering.

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.

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 who stutter.

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 Cycle.

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:

First, concentrating on voice may cause the brain to "tune up" the larynx for phonation rather than effort closure. This would help to relax the Valsalva mechanism and reduce the likelihood of Valsalva tuning.

Second, this approach may help to avoid the delays in phonation that are a major component of stuttering behavior. For these reasons, it is important, while speaking, to pay attention to the music and resonance of your voice. Phonation can be further emphasized if you intentionally stretch or prolong words or syllables - a technique that may help when you feel you are going to block.

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 them.

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 fluency.

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:

First, as you concentrate on each step in the Fluency Cycle, become aware of the opposite things that you think and do. Don't just take your old attitudes and behaviors for granted. Take a good look at how they interfere with your speech by perpetuating the Valsalva-Stuttering Cycle.

Then, begin the process of changing those attitudes and behaviors, replacing them with ones that promote fluency. This must be done gradually, paying attention to all six points in the Cycle. It will require continuous dedication, repeated practice, and the use of exercises such as those suggested in the following chapters. As the changes slowly take hold, notice how they tend to make speech easier and more fluent.

When stuttering returns - as it inevitably will from time to time - don't consider this a failure. Instead, learn from the experience. Go back and examine what you were thinking and doing when you blocked. See what aspects of the Valsalva-Stuttering Cycle were involved and understand how they contributed to the relapse. Whatever you do, never give in to the temptation to try harder! Increasing the amount of effort will throw your speech right back into the jaws of the Valsalva mechanism, killing any chance of progress.

Finally, you must learn to consolidate your control over the Valsalva mechanism and extend it to more and more speaking situations.

In the next chapter, we shall begin our quest for change by exploring ways to develop a Valsalva-free attitude toward speech.

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