Avoidance Reduction Therapy

1. Avoidance Reduction Therapy Vivian Sisskin

3. Terminology Stuttering � a disorder of fluency Disfluency � interruptions in the forward flow of speech. May include core stuttering behaviors, open stuttering, voluntary stuttering. Trick/crutch � something one does to avoid showing oneself as a stutterer. Open stuttering � a stage in therapy. The behavior that results from moving forward into a feared word rather than using an avoidance. Voluntary stuttering � stuttering on purpose on nonfeared words in order to show yourself as a stutterer.

4. Premises Physiological/genetic factors play a role in stuttering. The desire to conceal disfluency or hide identification as a person who stutters leads to avoidance behavior. Avoidance behaviors create much of the �handicap� of stuttering: struggle, fear of stuttering/speaking, shame/guilt, embarrassment, low self-esteem, etc. Avoidance behaviors may be physical, linguistic or attitudinal.

5. Premises (continued) Avoidances may be at the sound, word, situational or relationship level. Avoidance behaviors serve to maintain and perpetuate the problem through principles of learning Avoidance behaviors can mask disfluency, causing the problem to resemble an iceberg.

6. The iceberg of stuttering

7. Avoidance behavior explained in terms of conflict theory Approach-avoidance conflict The Conflict Hypothesis: the organism stops when competing approach and avoidance gradients reach an equilibrium The Fear Reduction Hypothesis: The occurrence of stuttering reduces the fear that elicited it, resulting in the release of the block. Increasing the approach drive will reduce the conflict.

8. Role Conflict: The Self-Role Conflict: stuttering varies according to how the stutterer views himself in his role as a speaker and how the listener is perceived. The Role-Role Conflict: Experience of speaking fluently some of the time leads to expectations for fluency, leading to more stuttering. Enacting the role of a stutterer reduces the conflict.

9. Goals of therapy To eliminate struggle, avoidance and fear of speaking. To develop a comfortable, forward-moving speech pattern, which may include some disfluency. To be able to spontaneously say what you want, when you want to say it, without the negative feelings associated with revealing yourself as a stutterer.

10. Positive outcomes are measured in the following areas: Increase in fluency (Fluency is achieved as a by-product of reducing avoidance). Decrease in fear of speaking or of stuttering. Improved oral communication skills. Increase in self-acceptance.

11. Therapy concepts: Behavior: Identifying avoidance behaviors and negative attitudes Monitoring and reducing avoidance behaviors Open stuttering Voluntary stuttering Stuttering modification Oral communication skills Managing relapse Adjusting to fluency

12. Therapy concepts (continued) Attitudes: Understanding the nature of stuttering and the factors that maintain and perpetuate it Fear reduction: Establishing a hierarchy; approaching feared situations; revealing oneself as a stutterer; taking the role of a stutterer. Accepting oneself as a stutterer: confronting; tolerating; welcoming; embracing; accepting.

13. By-products of therapy Fluency By-product of lack of avoidance, conflict, holding back, struggle Control Choosing the way you stutter: smooth, comfortable, forward-moving. Breathing Struggle and fear interfere with ability to breathe normally Relaxation Fear reduction increases relaxation