NEW tips from SLP Briley: How can we desensitize to stuttering anticipation? How exactly does our body "know" a stutter is coming? (thru associative learning: cognitive and emotional cues from memory, belief, or consequences)

NEW tips from SLP Briley: How can we desensitize to stuttering anticipation? How exactly does our body "know" a stutter is coming? (thru associative learning: cognitive and emotional cues from memory, belief, or consequences) I created this image (after reading [Briley's ](https://pubmed.ncbi.nlm.nih.gov/37515980/)research about stuttering anticipation). Here is it's [PDF ](https://drive.google.com/file/d/1X095E5hgqYSvBf49AM1BQjxLvUKj_Z41/view?usp=sharing)version (printable) and [DOC ](https://docs.google.com/document/d/1nonwyd26mP7jvIfj-LuPnDp9HSNf6rr6DGYafVZoQwU/edit?usp=sharing)version (editable). This is my attempt to extract tips from SLP Briley. **Strategies for stuttering anticipation:** 1. Some judgements of anticipation are incorrect. **Intervention**: Avoid reinforcing this judgement, which people who stutter unfortunately often exhibit 2. Stuttering anticipation must be met with an adaptive reaction (i.e., subconscious) or response (i.e., conscious) in response to emotions such as anxiety) - to stabilize control of balance- which differs based on whether they promote positive or negative communicative behaviors. **Intervention**: So, identify all your subconscious responses/reactions. Followed by replacing negative reactions/responses with positive ones 3. Many people who stutter use motoric adaptations in response to stuttering anticipation, even when adaptations result in listener perceived fluency, the speech of the person who stutters is still controlled by stuttering. Reactive behaviors indicative of adapted motor plans includes adjusting breathing patterns or initiating a swallow, coughing, atypical subglottal air pressure patterns, or adding sounds or words to help initiate voice. Even “primary” and “secondary” behaviors represent different reactions and responses to anticipation (they are simply compensatory behaviors) emanating from the central involuntary block. Other responses include open stuttering, and any techniques taught in speech therapy. Modified speech patterns learned in therapy (even when deemed highly successful) still represent ***reactions and responses*** to stuttering. Techniques taught in speech therapy represent adapted motor plans. For example, Van Riper’s cancellations, pull-outs, and preparatory sets represent ways of implementing new motor plans (rather than initiating the "initial" motor plan). **Intervention**: The recommendation is to start implementing adaptive responses in response to stuttering anticipation 4. In time, sounds, words, core motor plans, and eventually, people, places, and situations, associated with stuttering would become associated with stuttering (i.e., learned). Approach-Avoidance Conflict (Sheehan) states that stuttering behaviors emerge from competing motivations to speak and to not speak. **Intervention**: Target your unique approach-avoidance conflict (rather than implementing random responses) 5. Most would agree that simple repetitions are the preferred reaction, but the presence of a repetition equates to the presence of a block. **Intervention**: Look for a more long-term effective approach **Conclusion**: Change our fluency goals. Treatment success should be effective interventions that teach how to work through stuttering anticipation, and that teach replacing a less effective reaction with a more effective response. Repeatedly stutter openly on feared words. Over time, this breaks the conditioned link between stuttering and anxiety (especially if your stuttering is anxiety-based). Of course, if your stutter is not anxiety-based, target other conditioned stimuli (that are mostly subconscious) and work on de-conditioning those instead. Create a hierarchy of feared speaking situations. Gradually expose yourself to each one *without* avoiding or using safety behaviors (e.g., switching words). Pair feared words with a pre-trained calming cue (e.g., diaphragmatic breath, progressive muscle relaxation). Over time, the association might weaken between feared word and fear of stuttering/speaking (or whatever your conditioned stimulus is you are targeting). *Emily Blunt-style*: Say feared words in exaggerated, cartoonish, or musical tones to rewire the emotional salience of feared words. Before speaking, repeat 1 or 2 personally resonant affirmations (e.g., “It’s okay to take my time”; “I can speak imperfectly and still be heard”). Goal: To build new affective associations with the act of speaking. Speak through the fear of stuttering anticipation, even if a block occurs. Over time, the absence of reinforcement might weaken the fear-response pattern. When you anticipate a stutter, pause, and do nothing. No substitutions, no avoidance, no attempt to force fluency. Simply stay with the moment. This helps teach your nervous system that the anticipation itself isn’t dangerous. Over time, this de-conditions the learned fear response. Of course, as with any strategy, it’s not about applying techniques at random rather it’s about targeting your own specific approach-avoidance conflict, so that the conditioned stimuli gradually lose their power. During a wave of anticipation, notice the urge to avoid or rush. Label it: “This is an urge.” Watch it rise and fall without acting on it. During moments of anticipated stuttering, scan your body and note physical signals (tight chest, heat or pressure, breath shifts). This builds awareness and reduces reactivity. If you feel an anticipatory pressure in your throat, chest or other place, calmly acknowledge/allow this sensation while promoting calmness, "it's ok to stutter" "this anticipatory sensation doesn't have any meaning *(it was randomly conditioned in response to trauma or panic or a lack of knowledge)*" Redirect attention from “*what if I stutter*?” to immediate sensory data (e.g., feel your feet, breath, room sounds, the listener's eyes). Brings focus away from feared future outcomes. Replace “*I must not stutter*” with “*I can handle what comes despite stuttering*”. Goal: To weaken the conditioned stimuli related to fear of stuttering/speaking. Of course, if this strategy isn’t effective for your specific stuttering experience, it’s important to first identify the conditioned stimuli that trigger your unique approach-avoidance conflict in stuttering. After which, you should use desensitization (or de-conditioning) techniques \~\~\~ *Enjoy these new strategies. I hope they will desensitize you to fear of stuttering anticipation. And take note of what works for you! If you have any questions, I'm here to help! Take your time experimenting. And reach out with any questions along the way!*