CBT for Stuttering: Essential Skills for Changing Thoughts and Feelings

  Communication access realtime translation (cart) is provided in order to facilitate communication accessibility and may not be totally verbatim. The consumer should check with the moderator for any clarifications of the material.   >> Amy Hansen:  Good afternoon, everyone and welcome to this Expert e-Seminar, “CBT for Stuttering: Essential Skills for Changing Thoughts and Feelings”, presented by Tim Mackesey. Tim is owner of Atlanta Area Stuttering Specialists, a full-time private practice dedicated to fluency disorders.  Tim has taught the graduate level fluency disorders course at Georgia State University.  As a nationally and state certified speech language pathologist, since 1992, he travels nationally and internationally presenting workshops on early intervention, stuttering therapy and CBT.  Tim has published several articles in peer-reviewed professional journals.  He served as a clinician at the Successful Stuttering Management Program at Eastern Washington University in 1991 and graduated from the Stuttering Workshop for Specialists at Northwestern University in 1995.  Tim has been interviewed on a number of television and radio programs related to stuttering.  He has been an expert witness in litigation that involves stuttering.  Tim is formally recognized as a Board Recognized Specialist in Fluency Disorders and a Specialist Mentor.  As a certified master practitioner of Neuro Linguistic Programming, Tim integrates numerous unique strategies into therapy and teaching.  So welcome, Tim, and thank you so much for joining us today. (Applause)   >> Tim Mackesey:  Thank you, Amy, for that huge round of applause.  And thank you so much for being on the class for those of you on the East Coast it is the afternoon.  So I want to share with you ideas and resources for helping your patients deeper than you ever have.  We have so many children, teens and adults, who stutter who have fear and avoidance.  I want you to save your questions -- I mean do type them in as they come up and I will address them at the end as time allows.  I would like to see a show of hands for all of the people who want more help for fear and avoidance with their patients.  You click on your thumbs up.  Yeah.  Wonderful.  Also I want to see a thumbs up on who did not learn this stuff in graduate school?  I don't believe.  There is a huge need.  We have children and teens and adults who are fearing stuttering, avoiding,  word changing.  They're in support groups.  The relapse and stuff is really, really important.  So we'll move on to what would be Slide No. 2, please.    Pasted Graphic 1.tiff ¬ This is the profile of a patient I had years ago and I simply could not fit any more of his issues that he had on the slide: -       word changing -       asking to be excused in the classroom -       phone avoidance -       asking his parents to order food.  -       He would say he had to go to the bathroom so he could leave class so he wouldn't have to read.  -       Putting “um” in before blocking -       eye contact aversion  - and that is defined as a subconscious or unconscious looking away from your listener at the moment of a stutter.  -       A myriad of other tricks   Just for those of you who don't know me, I had a severe stutter until age 25ish.  I did all of these things, phone avoidance, word changing.  It took me five and a half years to get through my undergraduate course because I dropped so many classes when I had to talk.  Five and a half years.  So anything on this list I have done.    At the Core of Stuttering We want to look here at the background.  Our field has been in existence 90 years-ish.  We want to look at some of the things like Joe Sheehan's Iceberg Analogy, where the symptoms you see from your patient are the tip of the iceberg - the stutters, lip tightening and eye blinks.  We know that the majority of an actual iceberg in the ocean, a majority is under the surface so Sheehan would say that the word changing, the avoidance, the fear - all those things - are under the surface.  We have to dig them up for our patients.  The struggle felt in the body.  This really talks about the fight or flight response.  During the fight or flight response, blood leaves from your torso to your arms and legs and your diaphragm muscle tightens.  You'll notice that when people have the fear of a stutter coming, perhaps if they fear words that begin with a ‘d’, you might actually notice that they take a deep breath high in the chest [inhale] and then push that stutter.  The diaphragm muscle, if it tightens, then most people who stutter are going to take the breath high in the chest.  So telling a person who stutters to take a breath before a stutter is the opposite of what will help them.  It also is very difficult to use targets when you feel fear of stuttering.  We have the Volcano Analogy and the PTSD - that is really huge.  What we're talking about here is a person who stutters can remember moments of stuttering on their timeline being laughed at in class, stuttering at the drive thru restaurant, etc.  They remember moments of stuttering and they replay them in their unconscious mind and they begin to predict future problems.  For example - I met a guy who was 40.  The reason why he came to me is he said, “I have to read in a wedding and I'm freaked out.”  He recalled when he stuttered in classrooms as a child, he recalled those moments vividly.  Because of his past trouble when he read out loud, he was coming to me at age 40 knowing he might stutter when he's 40.  So timeline is very important.     Anxiety and Stuttering I want to make clear that people who stutter don't have what's called generalized anxiety.  What we're talking about here is trait and state anxiety.  What that means is a person who stutters will develop anxiety about saying his name or going through drive thru...