Research study: PTSD and stuttering. Your thoughts?

Research study: PTSD and stuttering. Your thoughts? **Research** [**link**](https://www.researchgate.net/publication/329280362_Stammering_and_Post-Traumatic_Stress_-Some_food_for_thought): "Stammering and Post-Traumatic Stress -Some food for thought" (2016) The PTSD paper, has a lot of parallels with how I’m thinking about stuttering. Brocklehurst stated: >"I also think that the current focus on the importance of genetic factors in the onset of stammering may have contributed to a tendency for researchers and clinicians to underestimate the importance of life-events in its onset. " and >"Whether or not that predisposition manifests as stammering, and whether or not that stammering persists almost certainly depends on environmental factors, which may sometimes include trauma" See the image below. In the fish-diagram (based on Brocklehurst's statements), do you see the many conditioned stimuli? My point is, in reallife, when we stutter, there are likely various conditioned stimuli at play at the time of speech execution (which we are often not aware of). Agreed? See the image, so this fish diagram explains that, if the total evaluation of all the conditioned stimuli are NET negative. Then an error is perceived by the subconscious brain, that it treats as to be avoided - to execute speech which triggers an approach-avoidance or "cognitive" conflict. \~\~ **Question 1**: Can you resonate with this? Your thoughts? In Paul's PTSD research, he mentioned the freeze response. As you guys probably know, in common daily usage the word freezing is often used as: "halting of the speech muscles" (which is on the outward manifestation level) There is also another description for "freezing", in scientific terms, the amaygdala can be activated 2-ways: 1) CeN activation (rapid, global full-body **freezing**. This is what Brocklehurst mentioned in his PTDS study and how Paul think it doesn't resonate with a stuttering block; because we can usually move all our speech articulators just fine during a block, just not that particular speech movement \[initial motor program\] to make that specific sound) 2) BLA activation (associative, **selective suppression of the motor program** rather than a full-body freeze; allowing affective evaluations to bias motor selection and basal-ganglia gating) In conclusion, so in the context of stuttering, a CeN-type full-body freeze is generally unlikely as the primary mechanism; however, the BLA-mediated selective suppression of speech planning and basal-ganglia gating is a more plausible neural substrate for the kinds of variable, context-dependent speech blocks we observe (e.g., we might be mostly fluent if we speak alone but we might significantly stutter with people.. even if we are totally comfortable with them). So, the real question we should ask is: **Why do most PWS (people who stutter) not recognize this amygdala-selective suppression loop, at the moment of stuttering especially when they are not aware of any conscious anticipatory fear?** Answer from a scientific point of view: \- Amygdala ≠ full emotion experience: amygdala activation alone is not the same as conscious feeling of fear \- The amygdala reliably shows differential responses to threat-relevant stimuli even when those stimuli are not consciously perceived. So physiological/behavioral effects can follow unseen stimuli. \- Startle potentiation, and expectancies can be conditioned to masked fear-relevant stimuli (snakes, spiders, fearful faces). (without subjective awareness) \- Amygdala that can transmit low-spatial-frequency threat signals rapidly and without the cortex’s conscious identification. (a mechanism for “unseen” fear processing i.e., nonconscious amygdala sensitivity) \- BLA encode “salience” and the specific reward or punishment outcome predicted by a stimulus which is crucial to decide whether an action should be executed (action suppression). \~\~ **Question 2**: Your thoughts? In the PTSD study by Brocklehurst, he mentions "the vicious circle". In the attached image, below the fish diagram Paul explains how the vicious circle of stuttering can persist, even if the underlying neurological factors have mostly disappeared. I agree with Paul's statement, in that, I think that factors that predispose us to stuttering onset are not the same factors that prevent us from achieving stuttering remission and subconscious fluency. **Can you resonate?** In the PTSD study by Brocklehurst, Paul mentions "Communication failure". In the attached image (at the right-side of the fish diagram, in the first grey square), you can see Paul's viewpoint: >Any negative experience (e.g., being error-prone, hypersensitive \[trait\], traumatic events, ear problems, or listeners ignoring you etc etc \[sensitization\]), can lead to our subconscious brain perceiving communication failure resulting in a NEED to excessively regulate the execution of the speech plan (resulting in totally unnecessary stuttering). https://preview.redd.it/3mxd78v3cfrf1.png?width=2746&format=png&auto=webp&s=d970631d8b3f0eeb3e518789b693f4df4f5b7577 **Question 3**: Can you resonate with this? \~\~ In the PTSD study, Paul stated: "such experiences are likely to lead to social rejection". For your information, paul considers this "fear of social rejection/judgements" as the innate, unconditioned stimulus (i.e., that we are born with). For example, a baby may start crying if a mother leaves (i.e., in response to the fear of social rejection). For clarification: Paul (and also I) do not believe that stuttering (i.e., the outward manifestations) is a conditioned response. The subconscious brain which is suppressing the motor program is not the conditioned response (This is often confused by both SLPs and people who stutter). Take for example: If a person is happy to speak more formally (resulting in excessively regulating the execution of the speech plan). Technically we could argue: But this is bad, because speaking formally is ultimately linked to a FEAR of social judgements/rejection. However, in our daily life, there are 100s and 1000s of other conditioned stimuli (such as "speaking more formally) which are ultimately linked to a fear of social rejection/judgements. We simply do not WANT to eliminate this fear, so in a sense, it's not a fear-problem, rather an associative-problem or a conditioned response-problem.  (i.e., our coping strategies and SLP techniques fail to effectively extinguish the conditioned stimuli). As Paul states: Quote by Brocklehurst (PhD): >"Most stutterers would assert that a rise in the release threshold as positive (i.e. good) because it makes speech easier, and a fall in the release threshold as negative (or “bad”) because it makes speech more difficult (i.e., a cognitive distortion). But I think this is a perception that we need to change in ourselves. Argument: Because it is unhelpful to impose positive and negative value-judgements on the conditioned response. Essentially, when it is finely tuned, both the rises and the falls of the release threshold are good (positive). Because the rises help us to speak when it is adaptive to speak, and the falls help us to stay silent when it's adaptive to stay silent. Conclusion: So, we don’t want to extinguish this conditioned reflex, we just want to fine-tune it so that it works in our favour. After all, it is usually a good thing to stay silent (to block) when speech is likely to elicit hostile listener responses or social rejection. Staying silent (blocking) can sometimes save our lives. Our problem is simply a problem of fine-tuning the CR (conditioned response)." --> End Quote \~\~ Paul considers the conditioned response as: **Conditioned response**: Excessively regulating the execution of the speech plan (for example: excessive suppression of the speech plan execution even during low amounts of anticipatory fear (i.e., stimulus generalization). Which then results in the poorly fine-tuning of their release threshold i.e., every subtle stimulus may start triggering their cognitive conflict, to release the speech plan for execution to say the planned syllable/sound. Put simply: the CR (or conditioned response) refers to the excessive error-avoidance i.e., in which the subconscious brain relies on the NEED to avoid i.e., reduce, certain stimuli until a certain level of threshold is achieved - for the motor program to be executed) \~\~ **Question 4**: Your thoughts?