We know that we are about to stutter: How Can We Address Stuttering Anticipation? (PhD researchers Jackson et al, answers this question)

We know that we are about to stutter: How Can We Address Stuttering Anticipation? (PhD researchers Jackson et al, answers this question) This is my attempt to summarize [this](https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1202&context=specedfacpub) research study that discusses: **'How to address stuttering anticipation?**' **Intro**: * Anticipation is playing a significant role in **people who stutter (PWS)**. Stuttering anticipation is endorsed by many people who stutter as a core aspect of the stuttering experience * Anticipation occurs and develops internally, for many individuals the “knowing” or “feeling” that they are about to stutter is a primary contributor to the chronicity of the disorder * Definition of anticipation: Anticipation is the cognitive sense that a moment of overt stuttering is imminent, given that speech is initiated as planned (e.g., without delaying, stalling, circumlocuting). Stuttering events begin before stuttering behaviors overtly manifest as stuttering or avoidance * Anticipation can be described as one’s awareness that something has already gone wrong in the speech–language planning or production system * During anticipation the speaker has a choice; he can choose to ignore this awareness and continue speaking in the way he originally planned, or he can react to it by delaying, stalling, or substituting or rearranging words to avoid overtly stuttering in that moment * Anticipation often leads to fight flight freeze * Over time, while anticipation and anxiety can cooccur, they remain separate but interdependent processes. That is, anticipation involves awareness on a cognitive level (e.g., knowing that something has broken down in the system), whereas anxiety is an emotional response to anticipation, which includes learned negative associations with certain sounds, syllables, or words * Speech therapists are trained to focus on the observable speech behaviors that characterize stuttering (i.e., repetitions and prolongations). Relying too heavily on observable behaviors to reduce avoidance-behaviors, can lead to an underestimation of the frequency of stuttering events and the weight of the internal experience of stuttering * Early research showed that **adults who stutter (AWS)** anticipate stuttering over 85% * More recently, in a research study, Jackson showed that AWS anticipate stuttering at least “sometimes,” and nearly 80% reported experiencing anticipation “often” or “always,” suggesting that most, if not all, AWS anticipate stuttering at least some of the time. 80% of AWS use avoidance-behaviors when anticipating stuttering * Early research showed that 45% of 10- to 11-year-olds and 38% of 8- to 9-year-olds reported anticipating "sometimes", **children who stutter (CWS)** also anticipate stuttering but less so than AWS. The vast majority of CWS anticipate stuttering at least “sometimes * AWS report that they respond to anticipation by: Stalling or hesitating while speaking, attempting to use a therapy strategy (e.g., easy or smooth speech initiation), looking away from their conversational partner, or doing avoidance-behaviors * People who stutter (PWS) describe feelings of nervousness, throat tension, and sweaty hands as “signs” that they are about to stutter **Conclusions**: * Set goals to mitigate anticipation * If anticipation leads to a negative experience of stuttering or attempts to prevent or “hide” moments of stuttering, then it follows that we should attempt to understand its place in the constellation of cognitive, affective, and behavioral factors that comprise stuttering. Although, we can be good at hiding stuttering (*e.g., sometimes we pretend not to hear what a conversational partner says to us to avoid responding and potentially stuttering*), it could lead to feeling inauthentic (“not like ourselves”) when we do so and become frustrated with ourselves when we don't say what we want to say. This is evidence that we should mitigate stuttering anticipation to reduce maladaptive anticipatory responses * Speech therapists should always ask the question (part of every stuttering assessment protocol): "*Do you know that you are going to stutter before you actually do?*" * Identify anticipation and responses to it * Move the role of 'the expert' from the speech therapist to you * Importantly, study participants characterized anticipation as being both harmful and helpful. For example, it was endorsed that anticipation can be harmful when it leads to anxiety, freezing, and avoidance, but helpful when it elicits use of a therapy strategy perceived as productive (e.g., disclosure, easy onset). Thus, a reasonable therapeutic goal is to support adaptive and minimize maladaptive responses to anticipation **In my opinion:** * I argue that we should stop using the word 'stuttering anticipation', because organisms can't anticipate behavorial responses. Say that I'm dancing at a school prom, am I able to predict that I will move my leg in 5 seconds when I'm dancing? Answer: no. But this is exactly what we do when scanning for errors. According to Yairi, no one starts with 'anticipating stuttering' at early onset. [Research](https://www.reddit.com/r/Stutter/comments/1372xp9/tips_to_improve_stuttering_anticipation_is/) states that stuttering anticipation is formed by repetitive negative thinking. So, does it help to scan for 'dancing errors' when I'm dancing at the prom? No, this will likely result in falling, just like how scanning for speech errors will likely lead to a speech block. **Conclusion**: So, I suggest to never label this 'feeling' as 'stuttering anticipation'. From now on we can label 'stuttering anticipation' as '**being nervous**'. Please write in the comments how I can rephrase this better to make us understand it more clearly * Stop perceiving 'stuttering anticipation' (or rather **nervousness**) as dangerous, a problem or to be avoided * Don't resort to the compulsions \[avoiding prosody\] \[freezing speech movements\] to reduce nervousness. So, don't justify doing compulsions just because we feel nervous, because it's not helpful to do compulsions in order to reduce being nervous * Speech therapists consider FS and SM techniques as productive behaviors. However, Jackson (2023) states that FS and SM techniques rely on one's ability to anticipate stuttering. I argue, that - since anticipation is not dangerous or true - by responding to anticipation, we likely reinforce the neuro-habit of subconscious anticipation making it a chronic problem in our mind. By immersing ourselves in anticipation we make the meaning of anticipation more true. Additionally, by relying on: *canceling and reformulating the speech plan* (caused by FS and SM techniques), we learn a habit of adopting the unhelpful attitude of avoiding speech plans. This could lead to developing 'advanced stuttering' instead of outgrowing stuttering, in my opinion * When we anticipate stuttering, we often apply stutter behaviors such as: avoiding fluency behaviors (and replacing them with avoidance or FS and SM techniques). In my opinion, in the viewpoint of outgrowing stuttering as an adult, it may be more effective to apply fluency behaviors that fluent speakers use (instead of FS-SM tools) in the anticipation of stuttering * Apply fluency behaviors that fluent speakers use such as (1) focus on prosody, (2) fluent speakers speak immediately when they have the intention to say a word (so speak on the timing of your own intention instead of waiting out speech), (3) think 4-5 words ahead instead of 1-2 words, (4) stay calm when feeling **nervous**, relax muscles and stop with **consciously** scanning or looking for errors/anticipation, and mindfully observe the **subconscious** stuttering anticipation while not perceiving it as a problem or to be avoided. The positive effect could be that we don't cancel the initial speech plan anymore and that we stop avoiding fluency behaviors (because avoidance will only enable us to perceive stuttering anticipation as more real in our mind, in my opinion) * Unlearn word switching. Substituting words may minimize 'weird looks' or 'misunderstanding' and other negative reactions, but it makes the anticipation more real in our mind 'as if we need to avoid anticipation by replacing words' * From now on, I recommend to never tell yourself again: '*It's really hard to speak when I anticipate stuttering (or when I'm nervous)*'. First of all, because it has nothing to do with the level of difficulty, and secondly if we label this speaking skill as hard to do, then we may subconsciously create unhelpful beliefs/attitudes to make it more real in our mind * "*Anticipation can be described as one’s awareness that something has already gone wrong in the speech–language planning or production system*" (Jackson), in other words: \[wrong speech plan\] > (leads to) anticipating stuttering (which is what we often tend to believe). However, [these](https://www.researchgate.net/profile/Paul-Brocklehurst) new studies from PhD researchers explain that it's the opposite: anticipation (raises the execution threshold too high) > (and leads to) \[canceling the speech plan\]. This then results in a speech block. **Conclusion**: So, don't 'fix' the anticipated wrong speech plan, because (1) the anticipation is not real and therefore cannot be fixed, and (2) relying on it and scanning for errors will only enable us to make the anticipation more true in our mind, in my opinion, as if it is 'real' (which I explain more in-depth in [this](https://www.reddit.com/r/Stutter/comments/xr6luy/tips_for_people_who_stutter_advice_on_how_to/) post) * Use mindful observation to distinguish: anticipation, **nervousness**, fight flight freeze and body tension, from one another. This could then lead to knowing or feeling stuttering might happen without needing to freeze the speech movement. Normally, we tend to do compulsions (such as freezing speech movements) to reduce anticipation anxiety which may become redundant if we distinguish anticipation anxiety from freezing * Exercise: * Step 1: Make a promise to yourself that you will stutter the same amount in every situation. The goal is to dissociate 'stuttering' from 'situations', which may lead to removing most of the unhelpful conditions (regarding situations/people) to hold back speech * Step 2: I suggest to do this exercise during the whole day (for 1 to 10 hours) at the moment when you don't speak. If you don't speak often, this exercise is for you * Step 3: In your mind think about executing speech (without actually speaking), with the goal of triggering 'freezing' from stuttering anticipation. * Step 4: If we anticipate stuttering, we should mindfully observe these unhelpful thoughts and feelings (without reducing them) * Step 5: Notice how we tense our shoulders, chest, head and other muscles when we anticipate stuttering. Terminate trying to execute speech and stop thinking about speech at all to feel completely calm again. Apply body scanning to reduce each muscle region. Then visualize executing the speech plan again (step 3) while consciously maintaining this relaxed state of unfreezing. Repeat this throughout the whole day when you are not speaking. The aim of this exercise is to tackle 'fight flight freeze' in the stutter cycle to outgrow stuttering as an adult