Not everyone experiences an improvement in their stuttering when speaking alone. In some, stuttering simply disappears, in others, it only decreases, and in some cases, it does not change at all. There is merely a tendency for it to decrease because social pressure generally provokes emotions in people who stutter. For some individuals, however, simply speaking alone or even thinking about their stuttering is enough to trigger emotions strong enough to disintegrate speech, without the need for a listener. Some people, upon producing even the first instance of disfluency, enter a psychological state of intense anxiety. This is a symptom similar to post-traumatic stress disorder or social phobia when they have contact with the trigger stimulus. The second point, as mentioned earlier, is the development of motor behaviors in speech that hinder fluency, which can occur in any context, including when speaking alone. This is seen, for example, when a person who stutters exerts extreme effort to pronounce a syllable at the beginning of a word—when, in reality, this effort itself is harming fluency. This can also trigger stuttering when anxiety or social pressure is not present.