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 therapy.  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 Stuttering Therapy.

·        Valsalva Control Stuttering Therapy is designed to reduce Valsalva stuttering - stuttering that involves the body's Valsalva mechanism. Most people who stutter clearly exhibit this kind of stuttering behavior, but some do not.

·        Read Diagnosing Valsalva Stuttering: Suggested Criteria 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 behavior.

·        Learn about the Valsalva mechanism and its normal function.

o       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 with speech. 

o       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.

o       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 fluently. 

o       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.  If you feel it is necessary, you can also prolong the first syllable of each phrase. 

·        To make sure that you relax the Valsalva mechanism whenever you speak, think of speech and phonation as flowing from the relaxation of your abdomen. 

o       Relaxing the abdomen should be the underlying act that controls your speech.  This same act will also control the Valsalva mechanism. 

o       It might be helpful simply to forget about your mouth when you speak.  Instead, concentrate on relaxing your abdomen and pretend that you are speaking through your navel. 

Practice ways to relax your Valsalva mechanism while speaking. 

·        Practice abdominal breathing. 

o       Breathe from your diaphragm.  After inhaling, don't hold your breath.  Allow your larynx to remain open. 

o       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 part.

 §       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 more readily. 

o       Regularly read to yourself using continuous phonation. 

o       Learn the "Adronian 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 Adronian speech exercise requires a far more detailed description than can fit in this outline.  See Understanding & Controlling Stuttering for details. 

·        Practice daily. 

o       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.

o       Even better, follow a regular routine, including exercises in Valsalva relaxation, abdominal breathing, phonation, Adronian speech, and the "Key Suggestions for Speaking." Then gradually ease into normal, resonant speech.  (See Understanding & Controlling Stuttering for details.) 

Additional exercises to control the Valsalva mechanism.

·        Become familiar with the Valsalva maneuver, what it feels like, and what muscles are involved.

o       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. 

o       Then practice stopping the Valsalva maneuver by relaxing your abdominal muscles. 

·        Practice relaxing the Valsalva mechanism. 

o       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.

o       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. 

o       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. 

·        Practice "Voluntary Valsalva."

o       This is a different kind of "voluntary stuttering" exercise in which you intentionally duplicate the Valsalva blocks during speech.

§         One objective is to gain control of the involuntary spasms by learning how to create them and release them on purpose.  (This is just an exercise - not a technique for ordinary speech.) 

o       Instead of repeating the beginning sound of a word, as in voluntary controlled repetition ("VCR"), you will silently block on the word by doing a Valsalva maneuver. 

o       After blocking and building up air pressure, you will then release the block by relaxing your abdomen.  This will reduce the air pressure, which will tend to relax the mouth or larynx and let speech flow more freely.  Then say the rest of the word gently, without any sudden burst of air, at the same time you relax your abdomen. 

·        Purposely refrain from doing Valsalva maneuvers, even in those activities in which they normally occur. 

o       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 Understanding & Controlling Stuttering, Chapter 23, ”Principles of Valsalva Control.”) 

o       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.  

o       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. 

o       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. 

o       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. 

o       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. 

o       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 stuttering. 

·        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 our self-esteem. 

·        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. 

o       Instead our goal should be to make speech easier and more enjoyable.

o       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.

Copyright  © 2002, 2004, 2009, 2010 by William D. Parry