Research results: Barry Guitar (SLP) discusses stuttering relapse

Research results: Barry Guitar (SLP) discusses stuttering relapse Research link: [https://2024.sci-hub.box/6303/6796fd44dce150123c191569017a4a01/10.1044@jshd.4303.392.pdf](https://2024.sci-hub.box/6303/6796fd44dce150123c191569017a4a01/10.1044@jshd.4303.392.pdf) For at least some stutterers, attitudes-including avoidance attitudes- seem to be important targets for modification. For these stutterers, attitudes are not automatically modified by changes in fluency. On the contrary, it might be the unchanged attitudes that modify the fluency, bringing behaviors back into line with feelings, and causing **relapse**. It is important to note that this study observed only the effects of strictly operant therapy. Thus no claim can be made for the possible efficacy of atti- tude-oriented and other nonoperant therapies. The attitudes of stutterers in Group 2 may not be amenable to change by any current therapy-either atti- tude oriented or behavioral. In addition, because avoid- ance conditioning may be involved in stuttering, avoidance deconditioning or counterconditioning (compare Starkweather, 1973) may be a useful technique in normalization of attitudes. Previous research has indicated that attitude change generally follows behavior change in operant stuttering therapy programs. This study sought to examine the longterm therapy outcome of stutterers whose communication attitudes were not substantially normalized after fluency establishment and generalization. Posttransfer attitude scores of 20 stutterers were used to classify them into one of two groups: those whose communication attitudes had been modified to show less abnormality than the mean level for normal speakers, and those whose attitudes had not. Fol- low-up interviews with the 20 stutterers one year later indicated that those whose posttransfer attitudes were not substantially normalized stuttered significantly more. Theoretical and clinical implications are discussed This study tested the hypothesis that stutterers who do not show a normal- ization of communication attitude during treatment will have a poorer long- term outcome in %SS than subjects who do show a normalization of attitude. The results obtained seem to support this hypothesis. Stutterers in Group 1, whose attitudes normalized after transfer of fluency, showed significantly less stuttering a year after treatment than stutterers in Group 2, whose attitudes did not normalize after transfer. The significance of this difference between the mean levels of %SS of the two groups is cor- roborated by the consistency of the individual scores. Only two stutterers in Group 1 had long-term outcomes greater than I%SS (1.2 and 4.4%SS) and only two stutterers in Group 2 had long-term outcomes of less than I%SS (0.1%SS for both). The relationship between normalization of attitude in treatment and long- term outcome was also reflected in the correlations between attitude and stut- tering outcome variables. Change in stuttering over the course of treatment for this group of subjects was moderately well predicted (r = +0.66), by change in Erickson scores during treatment. It is noteworthy that the better predictor of absolute level of stuttering for these subjects was the level of Erickson score after transfer, rather than amount of change in Erickson score. Although the difference in predictive value between these variables is not great (r- 0.62 vs r- 0.54), the difference does suggest that a minimal level of Erick- son score may, in an important way, be related to outcome.