Why are SLPs often so focused on: genetics/neurology underpins stuttering? (in your own words)

Why are SLPs often so focused on: genetics/neurology underpins stuttering? (in your own words) I agree with SLPs when they say stuttering has a neurological/genetic underpinning. After reading hundreds of research studies, my takeaway is that most contemporary theories of stuttering view it as the product of both neurobiological and psychological factors. In other words, there’s strong evidence for a genetic or neurological vulnerability at onset, and psychological processes — i.e., approach–avoidance "cognitive" conflict — help shape how stuttering appears and persists. That two-sided view (biology + psychology) is widely accepted, and I appreciate how the wording of many SLPs highlights the genetic/neurology side. Again: I absolutely agree that stuttering has a genetic/neurological underpinning. No one is debating otherwise. However, this mindset of SLPs often lead to dismissing or overlooking the main question that is more focused on the other side namely the approach–avoidance conflict (see attached image.. I mostly disagree with their interpretation in the image — my view is closer to Brocklehurst, PhD’s contemporary (2025) perspective). https://preview.redd.it/iseumo7sxdrf1.jpg?width=3118&format=pjpg&auto=webp&s=e8b79997ab34066d933d1045cea6a6d71e656219 Now. In my experience when I was still a child, I didn't stutter with my mum in one week (but I did stutter a lot with my dad), but the next week I stuttered significantly with my mum (again, without an anticipatory fear or other triggers), and, instead, I spoke fluently with my dad. So: At first glance, there is no reasonable explanation for this cessation that alternated weekly (using your own words). (because I was not aware of any fear or other stimuli that would possibly trigger my stuttering) Now, let's look at other situations in which we actually ARE consciously aware of anticipatory fear (e.g., speaking fluently with my dad, then switching environment resulting in stuttering on a feared word/situation), in such an example we might argue that the amygdala triggers the approach–avoidance conflict (in which the subconscious prevents/suppresses the execution of the speech motor plan/program). But if this is true, the main question is now: Why does the subconscious brain eventually allow the execution of the speech plan — eventually (e.g., after 2 s) — without having reduced any anticipatory fear? What I mean is that this classic model: fear -> triggers stuttering, is incomplete. (this model based on the approach-avoidance conflict, misses pieces, agreed?) So. What exactly is this release threshold (in which the subconscious brain releases the speech plan for execution)? And why does this release threshold fluctuate from word to word or on a millisecond timeframe, speaking from an approach–avoidance conflict perspective? Why does the brain need to reduce anticipatory fear (that it perceives as a problem/error) anyway to execute the speech plan? Put simply: Why does the subconscious brain "need" to avoid those errors (i.e., conditioned stimuli) specifically to regulate the execution of the speech plan? For example, in time, through repeated sensitization, even a low amount of anticipatory fear can trigger the approach–avoidance conflict to execute the speech plan — resulting in totally unnecessary stuttering-like disfluencies. A label for this phenomena could be: "poorly fine-tuning of the release threshold in which the subconscious brain excessively regulates the execution of the speech plan (i.e., a conditioned reflexive response; conditioned suppression) (resulting in the outward manifestations we see as stuttering, but only if we continue speaking anyway during this 'cognitive conflict')." In my lifetime, I've experienced many stuttering remissions and relapses. So if we start looking at it from the perspective of the approach–avoidance conflict, what is the underlying mechanism here exactly? Authority stress or fear of stuttering could lead the subconscious brain to excessively regulate the execution of the speech plan (resulting in more stuttering events). However, authority stress and "fear of stuttering" could also lead to the opposite effect (less stuttering) in which the subconscious brain loosens its speech plan execution regulation. This depends on how the subconscious brain evaluates (and treats) those conditioned stimuli. For example, in my stutter experience, I usually don't stutter during authority stress, whereas my stuttering might return when speaking to comfortable people (because I have this overall, general expectation looming over me that it's OK to stutter with my family, that they expect it, and that I don't have to resolve the approach–avoidance conflict to execute speech). My point is, the statement "fear exacerbates stuttering" is, in my opinion, a misconception. Fear is simply a conditioned stimulus that can either lead the subconscious brain to loosen or excessively regulate the execution of the speech plan. So, by default, I argue that negative stimuli can either increase or decrease stuttering (see the example I gave about authority stress); similarly, positive stimuli can either increase or decrease it. For example, if a PWS (person who stutters) is happy/excited to speak more formally/appropriately/measured (i.e., a positive emotion), it can still lead to excessively regulating speech execution. Because, if one "desires/expects/needs" to speak more formally while they feel they're not formal enough, the positive emotion might result in excessively regulating speech execution. So, in the end, being happy about speaking more formally or appropriately can ultimately trigger a "cognitive conflict" to execute the speech plan. Being happy to speak more formally/appropriately (i.e., a positive emotion) is ultimately linked to a fear of judgment/fear of social rejection (i.e., an unconditioned, innate stimulus). I argue that almost all (if not all) conditioned stimuli to execute speech, are ultimately linked to this unconditioned fear of judgements/social rejection. So, in short, I think the core unconditioned fear — the fear of social rejection (or judgements) — is by default very subtle rather than intense - too subtle to notice during reallife stuttering events in daily life. It doesn’t act like a lion-in-the-room survival alarm kind of fear; instead it functions as a low-level regulatory protection mechanism that, after sensitization, can cause the subconscious to excessively regulate the execution of the speech plan. I think that could explain why desensitization approaches (voluntary stuttering, graded exposure, acceptance work) can significantly resolve the approach-avoidance conflict in a subset of people who stutter (but not all PWS). At the same time, many SLP techniques that include desensitization mainly target the “fear of stuttering” and therefore may miss the many other conditioned stimuli that trigger approach–avoidance conflict and excessive speech-plan regulation. If SLPs broadened the target to include those additional conditioned stimuli, I think therapy could help a wider range of people and lead to more stuttering remissions and subconscious fluency (over controlled fluency). I’d really appreciate your perspective — what do you think about this, from an approach-avoidance perspective?