ARTICLE IS NO LONGER CURRENT. FOR THE LATEST INFORMATION ABOUT THE
VALSALVA HYPOTHESIS, VALSALVA STUTTERING THERAPY, AND THE NEW SELF-HELP
EXERCISES, SEE THE REVISED AND EXPANDED THIRD EDITION OF UNDERSTANDING &
CONTROLLING STUTTERING (2013), NOW AVAILABLE FROM THE NATIONAL STUTTERING
The following outline is based on suggestions for Valsalva
Control that are discussed in much greater detail in
Understanding & Controlling
Stuttering: A Comprehensive New Approach Based on the Valsalva Hypothesis
(2nd ed., 2000, updated 5th printing, 2009), available from the National Stuttering Association. Please
understand that this is only a brief outline. A full description and
appreciation of the suggestions, exercises, techniques, and their rationale can
only be obtained by reading the book.
Valsalva Control is an experimental approach to stuttering
Although there are not yet any scientific studies of Valsalva Control, anecdotal
reports indicate that numerous persons have found Valsalva Control exercises to
be helpful, even on a self-help basis. However, for Valsalva Control to be
most effective, one will probably need the help of a speech therapist who is
familiar with this approach. This author has personally observed dramatic
results in a clinical setting. The following
suggestions are not intended to be a substitute for individual diagnosis,
treatment, and counseling by a qualified speech-language pathologist or other
appropriate health-care professional.
Decide if you are a candidate for Valsalva Control
Valsalva Stuttering Therapy is designed to reduce Valsalva
stuttering - stuttering that involves the body's Valsalva mechanism.
This behavior typically occurs in persistent developmental stuttering.
It does not necessarily occur in other types of disfluency.
Read Diagnosing Valsalva Stuttering:
and see if you meet all or most of the suggested
criteria. If you do, you may be a good candidate for Valsalva
Control. Even if you don't, you could still give it a try and see if it helps.
Understand the Valsalva mechanism and its possible involvement in stuttering
Learn about the Valsalva mechanism and its normal function.
The Valsalva mechanism consists of neurologically coordinated
muscles in the mouth, larynx, chest, and abdomen. It is designed to perform a
Valsalva maneuver to increase air pressure in the lungs by forcefully
closing the upper airway while the chest and abdominal muscles contract. This
assists us in many types of physical effort and in forcing things out of the
body. (See Understanding & Controlling Stuttering: A Comprehensive New
Approach Based on the Valsalva Hypothesis for a full discussion.)
Understand how activation of the Valsalva mechanism may interfere
In response to the anticipation of difficulty, stutterers may feel
that physical effort is needed to force out the words. This may result in:
Excessively forceful closures of the mouth or larynx;
Interference with normal preparation for phonation.
(See Understanding & Controlling Stuttering: A
Comprehensive New Approach Based on the Valsalva Hypothesis.)
Understand how the Valsalva mechanism's interference with speech
may be perpetuated by the Valsalva-Stuttering Cycle.
See if you are activating your Valsalva mechanism during speech -
particularly when you anticipate difficulty in speaking, feel that speaking will
require extra effort, or feel that it is especially important to say the words
Understand that, even though using the Valsalva mechanism to exert
effort may feel like the correct or necessary thing to do, it actually makes
fluent speech impossible.
(Again, refer to Understanding
& Controlling Stuttering to get a broader understanding of this.)
Key Suggestions for Speaking
Breathe abdominally, relaxing your abdomen as you exhale.
Speak each phrase at the same time you relax your abdomen.
Concentrate on phonation.
Imagine that you are humming as you begin
Focus on the vowel sounds, and pinch
on the vowel sounds of stressed syllables (squeezing your thumb and finger
To make sure that you relax the Valsalva mechanism whenever you
speak, think of speech and phonation as flowing from the relaxation of your
Relaxing the abdomen should be the underlying act that controls
your speech. This same act will also control the Valsalva mechanism.
Rather than trying hard to say words, your intention
should be to relax your abdomen and let the air flow freely. Focus
on expressing yourself in the river of air that flows from relaxing your
Practice ways to relax your Valsalva mechanism while speaking.
Practice abdominal breathing.
Breathe from your diaphragm. After inhaling, don't hold
your breath. Allow your larynx to remain open.
Exhale by gradually relaxing your abdomen. As you do so, the
diaphragm will also relax, allowing the lungs to contract of their own accord.
Relaxing the abdomen will also help to relax the entire Valsalva mechanism.
Do not force the air in any way. It should be completely
"passive," flowing gently through your open larynx without any effort on your
Speak each phrase at the same time you relax your abdomen and
exhale (as described in the "Key Suggestions for Speaking," above).
Learn to emphasize phonation in speaking. This will both
help to relax the Valsalva mechanism and prepare your vocal folds to phonate
Regularly read to yourself using continuous phonation.
Learn the "Humdronian speech" exercise.
This is aimed at relaxing the Valsalva mechanism, promoting
phonation, and programming our brains to treat words as sequences of movement
rather than as "things" to be forced out.
The Humdronian speech exercise replaces the "Adronian
Speech" exercise that was described in Understanding & Controlling
Valsalva Control Update for details.
Practice speaking by reading aloud to yourself for 30 minutes
every morning, following the "Key Suggestions for Speaking" described above,
before going about your regular activities.
Even better, follow a regular routine, including exercises in
Valsalva relaxation, abdominal breathing, phonation, Humdronian speech, and the
"Key Suggestions for Speaking." Then
gradually ease into normal, resonant speech.
Additional exercises to control the Valsalva mechanism.
Become familiar with the Valsalva maneuver, what it feels like,
and what muscles are involved.
Alternately use your larynx, lips, and tongue to block the upper
airway. Feel what other muscles also become tense, including the chest,
abdomen, and rectum.
Then practice stopping the Valsalva maneuver by relaxing your
Practice relaxing the Valsalva mechanism.
Start with the lowest muscle in the Valsalva mechanism - the
puborectalis muscle, which is located inside your body, an inch or two above
the anus. Gradually contract your rectal muscle, to familiarize yourself with
the feeling of increased tension. Next, reverse the process by gradually
relaxing the muscle. Alternatively, you can start higher up by relaxing
your abdominal muscles.
Now spread the relaxation upward through your abdomen, through
your chest, and all the way to your larynx. The larynx should feel relaxed and
open, with air flowing freely through it.
Feel the relaxation continue upward, from your throat to your jaw,
your tongue, and your lips. Your mouth will feel loose, relaxed, and open.
Feel the relaxed openness, from your mouth and larynx to your rectum. Hold onto
that feeling as long as you can through the day.
Purposely refrain from doing Valsalva maneuvers, even in
those activities in which they normally occur.
Most people have an instinctive tendency to close the larynx and
tense the chest and abdomen when exerting effort (such as lifting, pushing,
pulling, etc.) or trying to move the bowels. You can override this tendency if
you intentionally keep your larynx open.
Develop a positive, Valsalva-free attitude toward speech and stuttering.
Learn about the "Fluency Cycle." (This is discussed in
Controlling Stuttering, Chapter 23, ”Principles of Valsalva Control.”)
Replace your negative attitudes and expectations about speech 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.
Resist the urge to "try hard" in speaking. As a part of
your attitude change, root out any inclination to exert force or effort force to
get the words out. Recognize that fluent speech needs very little effort and
that "trying hard" only interferes with fluency.
Remember that words are not "things" that can be physically
"forced out" by means of a Valsalva maneuver. Learn to treat words as
phonation and a sequence of movements, rather than as "things" to be forced out.
View your speech objectively. Eliminate the negative reactions
you may have to your stuttering. Don't view stuttering as confirming that
speech is difficult. Don't get the false impression that excessive effort
ultimately succeeded in forcing the words out.
Remember that speech is not a test or a measure of your worth as a
person. Learn from your speaking experiences, both fluent and disfluent, and
maintain your self-esteem, regardless of fluency.
Keep a proper perspective.
Remember: No speaking technique should be considered a magical
ticket to fluency - this one included.
Controlling stuttering is a long-term project that requires a lot
of patience and practice, a thorough understanding of the underlying principles
involved, and fundamental changes in one's attitude toward speech and
While seeking to improve our fluency, we must also remember that
fluency is not the meaning of our existence, and it should never be the basis of
The quest for perfect speech is unrealistic, unnecessary, and
ultimately self-defeating. We may never reach the point where we are absolutely
fluent all the time. And that's okay.
Instead our goal should be to make speech easier and more
Don’t put pressure on yourself to “prove” anything. Allow
improvements in fluency to come in their own good time and of their own accord.
2002, 2004, 2009, 2010, 2012 by William D. Parry