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Indicators of Successful Change During Treatment

CHAPTER 11. Indicators of Successful Change During Treatment. Perspectives of change. Group data vs. patterns of individual change Formal – informal treatment The multidimensional nature of change Sheehan (1980) trivial criteria = greater success

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Indicators of Successful Change During Treatment

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  1. CHAPTER11 Indicators of Successful Change During Treatment

  2. Perspectives of change • Group data vs. patterns of individual change • Formal–informal treatment • The multidimensional nature of change Sheehan (1980) trivial criteria = greater success • Krauss-Lehrman & Reeves (1988): 75% of National Stuttering Association members surveyed felt that their therapy had been mildly or very successful even though many continued to display varying degrees of stuttering (implications for EBP?)

  3. Perspectives of change (continued) • Change can begin prior to Tx (Andrews & Harvey, 1981) (regression to the mean & speaker taking action) • The 33% rule ? For some, only one meeting! • Looking closely at success (p. 6) • Paradox: • Behavioral change first, cognitive change takes time • But cognitive change necessary for long-term behavioral change • Cooper’s (1987) suggestion of CPS • Other problems (speech, language, anxiety, addiction . . .) • Older speakers who stutter

  4. Indicators of change • Ask the client! • Recognize little victories • Decreasing frequency of stuttering (duh!) • Increasing frequency of stuttering (really?) • Increasing normalfluency breaks • Changing stuttering form-types (less effort) • Increasing self-monitoring—especially proprioceptive feedback

  5. Indicators of change (continued) • Improving scores on measures • Increasing naturalness • Changing metalinguistics/self-talk • Changing roles (risk taking, assertiveness) • The altered roles of others • Becoming comfortable with fluency

  6. LCB scores • Craig, Franklin, and Andrews (1984)—28/32 Ss who maintained fluency 10 m post-tx showed increased internality during treatment. • Replicated by Craig and Andrews (1985) • De Nil & Kroll (1995)—while fluency gains maintained 2 years post-tx, no relationship between LCB scores and %SS. • Andrews & Craig (1988)—total LCB scores alone were of limited help in predicting treatment outcome • Type of treatment (or short, intense treatments) may not promote cognitive changes and may not be reflected in LCB scores. • Individual Pawn & Origin scores more predictive?

  7. LCB scores for an adult female with severe stuttering over six years of treatment. 

  8. Self-efficacy (SESAS) scores • Blood (1995)—3 high school students, 25 hr tx, 50 hrs relapse prevention, 6 & 12 m follow-up: Baseline 56.3% Post-treatment 77.6% Post-relapse 87.3% 6m follow-up 89.7% 12m follow-up86.7%

  9. Self-efficacy (SESAS) scores (continued) • Hillis (1993)—See Figure 11-1 • Langevin et al. (2006): Canada (N = 16) Netherlands (N = 25) • SESAS Approach Scores • Maintainers improved 28.1% • Nonmaintainers improved 17.9%

  10. Approach scores for the self-efficacy scale for adult stutterers (SESAS) for an adult female with severe stuttering over six years of treatment.

  11. Performance scores for the Self-Efficacy Scale for adult stutterers (SESAS) for an adult female with severe stuttering over six years of treatment.

  12. Indicators of change • Improving scores on measures • Increasing naturalness (1 natural → 9) (video of Joy) • Changing metalinguistics & self-talk • Changing roles (approach, risk taking, assertiveness) • The altered roles of others • Becoming comfortable with fluency • Increased agentic behavior—problem solving • Self-concept & self-esteem (a cornerstone of psychological change (Peck, 1978)

  13. Indicators of change (continued) • The variable of Humor • Mastery – Distance – Paradigm Shift • Working with Relapse (shallow–deep) • Transfer and maintenance • Joining a Support Group (Chapter 12)

  14. S. Brundage and experiments with virtual reality • Transfer beyond the treatment setting • Live and virtual experiences similar (affective, cognitive, physiologic measures, cortisol levels, & anxiety) • Without penalty (free to explore and experiment) • Vary & control important factors in hierarchical manner (many possible scenarios) • Initial studies indicate generalization and empowerment with practice in virtual environment

  15. Your criteria for terminating treatment • Children: home severity ratings (SR) of less than 2.0 and 1.0% SS during clinic (+ gradual phase- out) • Adults: • Bored and unenthused (Van Riper, 1973) • Spontaneous & natural speech? • Little or no avoidance • The importance of closure/speaker responsibility and dependency • A trial or temporary break, group therapy, joining a support group

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