Nominal Levels of Recovery from Stuttering Using Rational Emotive Behavior Therapy
Introduction
Rational Emotive Behavior Therapy of Stuttering (REBTS) focuses on teaching the client to become his own therapist. There are three threads in the therapy. The most important thread is motivation, the thread that distinguishes REBTS is the focusing on changing ones emotions of speech anxiety, shame, guilt, feeling of inferiority, helplessness, hopelessness, and anger associated with stuttering, and the third thread is using easy Iowa bounces as the direct speech manipulation technique. Wendell Johnson, the General Semanticist and speech pathologist suggested their use and I applied their use in voluntary stuttering, cancelling, holding onto a stutter and pulling out of it, and pre-empting the stuttering.
Motivation
Many people who stutter express their wish to not stutter, try themselves, and through various therapies recover from stuttering. Some people recover. Some recover but relapse. These are the ones who, although learn a mechanical skill of talking more flowingly with less effort, do not change their feelings toward stuttering. And some people are not fortunate to encounter the method that helps them recover before giving up on all therapy. This is sad.
I believe that if a person can talk fluently when they are alone then they can, through REBTS learn how to recover from stuttering. If when alone they can speak much better than when they are with other people, they can recover at least to that extent.
Paraphrasing Henry Ford, some people think they can recover from stuttering and some people think they cannot recover from stuttering. Both groups are right. Therefore, my first step in motivation is to convince the persons that they can recover from stuttering.
The next level in motivation is to convince that the process of recovery takes q lot of work and courage. Courage is not a lack of fear, courage is the ability (or skill) to do things like voluntary stuttering despite the fear of failure or rejection. But what is failure? According to Henry Ford it is the opportunity to do things over again, this time more intelligently.
Persistence at stuttering therapy is enhanced if, like in REBTS, we can show progress in therapy.
Managing your emotions
REBT the grandfather of all the cognitive behavioral therapies was invented by my mentor Albert Ellis. He stipulated that emotions in a situation are greatly influenced by beliefs and self-talk which we held about this situation. His ABCDE of emotions, when stated in terms of stuttering can be stated as follows: The Activating speaking situation at A triggers Beliefs (both conscious and pre-conscious) about the speaking/stuttering which together produce extreme Consequent emotions. In people who stutter, and some people who do not stutter, the extreme emotions—and these can all reside in the limbic system, especially amygdala—mess around with the fine motor control needed to produce speech. Thus, we stutter.
The first level of managing one’s emotions is to really understand and buy into the model that our beliefs and self-talk do almost totally produce our emotions. The second level of managing one’s emotions is teaching which emotions are unhealthy and which are healthy, meaning which emotions propagate stuttering and which promote recovery.
Then we learn what are the unhelpful beliefs/self-talk (what Dr. Ellis called irrational) that evoke unhealthy stuttering producing emotions. At this level we learn to detect what are our personal irrational beliefs. Once we have caught them by their tails, we tear them apart bit by bit with what we call Disputing at D. Disputing is nothing but application of logic, the scientific method of searching for evidence to validate or invalidate a belief, and keeping those that help us. (Just being pragmatic.)
The final level in managing emotions is the to observe the new emotions and beliefs about our speech and speech situation so as to emphasize how Effective (designated by E) are these new emotions and beliefs. These serve as reminders when we encounter a similar situation next time.
Reason to use easy Iowa bounces in direct speech manipulation
So, is our task done? Far from it. When we were learning to talk, we all started out with ma-ma and da-da. These were easy bounces—that had not as yet visited Ames, Iowa where Travis, Wendell Johnson, and Van Riper passed through—on the way of our learning to say mammy and daddy. But darn it, we stumbled in learning to talk: “Da-da-dy, ma-ma-ma-mammy…etc” sometimes we even might have gotten stuck in trying to master the language. Our parents might have gotten concerned, we might have gotten frustrated. Wendell Johnson might well have been right, between the concern of our parents and our own frustration we became frightened. The old flight or fight or freeze habit kicked in. Often, we froze or blocked, sometimes we fought and struggled and forced our speech, or we just fled or avoided. No matter what we did we and our caregivers labeled it as stuttering. Labeling just reinforced the habit of thinking ourselves as doomed to stuttering.
So as if this was not bad enough, we were smart and sometimes when we got stuck we observed that forcing helped to get a word out. Sometimes we breathed funny and it helped. For some of us pursing the lips helped. Or snapping the fingers. Blinking eyes was another escape from the blocks. And the list goes on. So, we used one of these aids until it stopped working. But when it stopped working it still was a habit. What psychologists call an operantly conditioned habit of secondary stuttering.
Meanwhile, our erstwhile fear was not sitting idle. We were punished by being asked in a kind voice “Just take your time dear little Gunars.” “You can do it.” Punished? Yes, punished because our caregivers expressed concern. We were smart enough to feel their apprehension and fear. Just because we might have had some gene or genes that made us a little slower at learning to talk, now we were thought of (and our smart sensitive selves bought into it) as deficient human beings. No wonder we feared speaking and stored the feared situations in our subconscious (limbic system, especially amygdala).
And then there was bullying and teasing. Which led to fear stored in amygdala.
By this time we all had built up the habit of stuttering that was like a big snowball or head of cabbage. Fear, struggle, secondary habits, shame, etc. To unravel all this, I decided to unpeel it as a cabbage, taking the outer leaves away, cutting here and there. I decided to get back to how we were when we started to stutter. Going back to easy Iowa bounces. I succeeded.
But what to do with my clients? I decided that starting with the easy Iowa bounces was promising. At the time when we used “ma-ma” and “da-da” there was no fear and no shame. So, I use REBT to teach clients courage to advertise stuttering via voluntary stuttering using easy Iowa bounces even though they initially fear to do so. Concurrently I use REBT to manage their feelings of shame and inferiority and strengthen their unconditional self-acceptance and acceptance of stuttering. This combination results in desensitization to stuttering. Now all that remains is wiping out the habit of struggled, forced speech.
Easy Iowa bounces as the Swiss army knife
Easy bounces can be used as the basis for everything. But each time they are coupled with emotion reduction exercises. The sequence of using easy bounces is as follows:
1. The therapist demonstrates easy bounces by reading from an alphabetical list (a-z) of words and having the client repeat them over Skype.
2. Assigning the client to practice easy bounces at home from the alphabetical list and a list of 10 words of most feared sounds that is generated by the client.
3. If the client cannot duplicate the easy bounces only one word is chosen and repeated fifteen times with the video and sound off and fifteen times with the camera and sound on. This is repeated as long as necessary to establish an easy way to say the words. I mean it: as long as necessary! “lo-lo-long, lo-lo-long, lo-lo-long, lo-lo-long, lo-lo-long…”
4. Then comes the preparation to do voluntary stuttering on non-feared or easy words. First with therapist only. Of course, first the anxiety reduction, desensitization, unconditional self-acceptance, and stuttering acceptance discussions using the REBT A-B-C-D-E format are used as often as necessary. The discussions are helped by the use of REBT self help form as well as the therapist’s interspersion of easy bounces in his/her speech.
5. For voluntary stuttering as well as all the following exercises homework sheets are used using a hierarchy of situations as follows:
5.1. Repetition after therapist;
5.2. Practice at home;
5.3. Practice with therapist or stutter-buddy. _____times every ______(day, week, hour)
5.4. Practice in easy casual situations. _____times every ______(day, week, hour)
5.5. Practice in non-important phone calls. _____times every ______(day, week, hour)
5.6. Practice in more stressful situations. _____times every ______(day, week, hour)
5.7. Fill out an REBTS self-help form why you can do it in stressful situations that matter.
5.8. Practice in stressful situation that matter. _____times every ______(day, week, hour)
5.9. Designate the day when you will cancel every stutter with easy bounces in every situation. _____times.
6. Steps 6 through 8 use the same hierarchy of situations as in step 5. Item 6 is the cancellation. This consists of after stuttered word take a 2-3 second pause and then repeat the word using easy bounces.
7. Introduce sound, bounce, turn it into easy bounce slow down and say the next sound. Let me repeat this: When you start to stutter or block introduce the bounce and then turn it into an easy bounce, slow it down and then proceed to the next sound.
8. I (GN) always knew when I would stutter on a word. If you do then you can pre-empt a stutter with an easy bounce.
Note that clients differ in both how fast they can learn to manage their consciously formed and their subconscious emotions and how fast they can learn the skill of easy bounces. Thus, some of them can skip back and forth among steps when talking to the therapist, because the therapist is non-threatening.
9. The ninth step is ninth heaven. 😊 Although the client on occasion still has stutters which he usually can pre-empt with easy bounces he feels minimum anxiety, shame, and feelings of inferiority.