OVERCOMING ANTICIPATORY STRESS
The consistent use of Air Flow brings total fluency. Patients are delighted
with an easy-to-use technique that handles stuttering effortlessly. And
following the twelve-to-fifteen week period of Basic Training, the habit
is both automatic and strong. Many patients think that continued application
of the technique will eventually secure permanent fluency.
But it is not always that simple. Patients' use of technique is frequently
compromised by the extreme stress associated with certain sound, word and
situation fears. These fears, which formerly had been directly responsible
for the locking of the vocal cords, now produced the same locking in an
indirect fashion - by completely filling the patient's conscious awareness
and preventing attention to the technique. The result is inevitable: the
patient stutters, which, in turn, raises stress further, leading to still
more difficulty. Early success is reversed by a tenaciously persistent
array of anticipatory stresses.
In order to secure their fluency, patients need to be able to handle
these stresses consistently. Indeed, it is the elimination of these speaking
fears and scanning behaviors, rather than the initial fluency produced
by mastering the Air Flow Technique, that signals the permanent result.
These fears will not abate by themselves, however, and merely wishing them
away won't work. They need conscious attention - a deliberate, planned
strategy - and sometimes they take months to overcome. Of course, everyone
has his own personal methods for dealing with stress, but here are a couple
we have found to be particularly effective in dealing with anticipatory
stress in stutterers.
Systematic Desensitization. Developed by psychologists to help patients
overcome situation fears, systematic desensitization involves creating
a hierarchy of examples of a stress situation (from low to high), and then
slowly and successfully negotiating the patient through each step to gradually
build confidence. For example, if a patient reported a fear of job interviews,
he or she would be advised to interview first for jobs that held no interest
for them. The rationale was that there would be virtually no stress associated
with the interview. After initial success, the patient would be encouraged
to interview for positions for which they might have an interest. The hierarchy
is obvious: the least desirable position would be interviewed for first,
the most desirable one would be reserved for last. And after a week or
two, if the hierarchal steps were chosen properly, the fear of job interviewing
should be extinguished.
I found this procedure to be very effective in eliminating anticipatory
stress in stutterers. An example shows the process in detail. Several years
ago I treated a man from New Jersey who, in spite of a severe stutter,
had managed to develop a successful automobile dealership. Now, at forty,
he seriously wished to marry and have a family. But he always stuttered
severely when meeting women socially.
He suffered from an interesting if not altogether unusual hierarchal
affliction: the prettier the woman, the greater the stress and the more
He confided this dilemma to me one morning as we sat in my office. The
description of his fear hierarchy prompted an idea. I suggested that he
and I visit a series of bars. I would choose the bars and he would engage
in a systematic desensitization while we bar-hopped. He agreed to the proposal.
At the appointed time and location, in a somewhat disreputable part
of town, we entered a bar, and I pointed to a "bag lady" sitting disconsolately
in a corner. My patient, when told to approach her with an offer of a drink,
balked, saying that this was not a stressful situation since the woman
was unattractive. My response was that this was a fine place to begin.
He approached the woman, bought a drink and offered it to her. The conversation
was brief and the technique excellent. No stuttering occurred.
At our next location we encountered a fiftyish woman of obvious means
but with a clear addiction to alcohol. She had already had several drinks
and was intoxicated as my patient sidled up to her to engage in conversation.
Again the technique was employed and again fluent speech ensued. Later
I pointed out that this woman was far more attractive than the one he had
spoken with just twenty minutes earlier and that, as a result, we should
proceed to the next step.
A taxi ride to the other side of town brought us to a favorite after-work
spot frequented by secretaries and young executives who worked in the many
office buildings in the neighborhood. We chose as our next "victim" a woman
in her late thirties who, while sober and moderately attractive, was not
too eager to speak with my patient since she was looking for a friend.
He persisted, however, and found that he could still attend to technique
in spite of the fact that the disinterest shown by her had been misinterpreted
by him as rejection and had caused an elevation of his Base Level Stress.
He reported later that he had been "on the edge" but had managed to hold
on to technique.
I decided not to proceed further up the hierarchy and chose, instead,
another woman about the same age who seemed both unincumbered by the expectation
of meeting someone and more self-contained. My patient found in her an
immediate conversation partner and spoke at length. After the conversation
he reported that his stress was again low. I noted to him that this woman
was very attractive and he acknowledged this with a smile.
In the next bar he soloed, that is, as soon as we had selected our person,
I left and it was his task to both initiate conversation and sustain it
with perfect technique. I chose a remarkably attractive woman and left.
Twenty minutes later my patient skipped out of the bar in obvious delight
and as he approached, pulled a slip of paper from his pocket, a slip bearing
a phone number which she had given him.
I suggested that the night was young and that he continue to mass practice
in as many of bars he could find until his fear was completely gone. This
he agreed to do, and in the course of the next several days, he extinguished
a lifelong fear. Two and a half year later I attended his wedding.
The same hierarchal procedure can be applied to deal with word or sound
fears. A common example is the difficulty some stutterers have saying their
name. The reason is obvious: one cannot word substitute one's name and
it is often the first thing said in a conversation, where the peak of the
stress is greatest. Many stutterers remember sitting in a classroom on
the first day as the teacher went around the room having the students say
their names. As their turn approached, the stress mounted to horrific proportions
and the result was always a stutter.
With such a history it is no wonder that some patients, in order to
avoid stuttering on their name, either always spell it or never leave home
without a business card. One patient went so far as to have his name changed
to one which he could say easily, only to discover that the stress had
now shifted and he could not say his new name.
The solution to this problem of saying a feared word such as one's name
is to first practice saying it with perfect technique a thousand times.
Employing a leisurely pace, and practicing approximately a half hour a
day, four days will produce the required number of repetitions. Following
this, the patient is encouraged to repeat his name with perfect technique
to the closest person he knows, whether it be a spouse, parent or best
friend. Twenty five repetitions per day for a week suffices and he is to
increase, on a daily basis, the number of people with whom this practice
The hierarchal concept is at work here since the patient starts first
with the easiest, least fearsome, person and then progresses to more and
more difficult ones.
The next step is to use lists of 800 numbers to make calls. When the
operator responds, he is required, with perfect technique, to say his name
and hang up. This may appear rude, but I have always justified it as the
operator's momentary minor inconvenience against the patient's life.
The next step is to begin mentioning one's name in ongoing conversations.
A number of strategies have been developed. For example, a patient would
talk about a hard-of-hearing elderly grandparent who could not comprehend
speech over the telephone. In the course of telling the story the patient
would say the following: "I would repeatedly say, this is John Smith and
yet he still wouldn't recognize his own grandson". Whether or not John
Smith really had a hard- of-hearing grandfather is immaterial; the fact
was he was practicing saying his name in conversation.
I've had patients call hotels to find out if someone with their name
was registered, have had patients page themselves at airports, have had
them call information for their phone numbers - one patient even made up
a fictitious company name which was in fact his own and used this to describe
a wonderful stock investment he had heard about. Of course, this ruse worked
only with strangers!
For some, the extinction of word or sound fears occurs rapidly; for
others it is a long, arduous process. There seems to be great variability
in the number of successful experiences required for a person's subconscious
to become convinced that there is no longer any need to look ahead for
feared words or sounds. Some individuals are highly suggestible: a few
instances are all that are required for persuasion. While others have anticipatory
stresses that linger for weeks or months before finally slipping into the
abyss of extinction.
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