1. Paul Brocklehurst PhD The Stammering Self-Empowerment Programme. C.I.C paul@stammeringresearch.org

2. Purpose This talk is for people who stutter, therapists and students. It explores the concept of non- avoidance, the extent to which non-avoidance is beneficial, and some of the practical difficulties associated with putting it into practice. Methods I will review relevant theory, including Sheehan’s Approach-avoidance conflict theory; the Johnsonian paradox: that “stammering is what we do trying not to stammer again”; and more recent research into the relationship between speech-error avoidance and stuttering. I will then consider how current therapeutic approaches relate to these theories and consider how they may be adapted/improved to take recent advances into account. Conclusion Although non-avoidance is central to many forms of therapy that are offered to people who stutter, it is likely that, often, the concept is not sufficiently understood or explained for it to be of any real benefit. There is a need for a much more sensitive consideration of what exactly it is, that people who stutter are avoiding, how such avoidance arises in the first place, and what it is that sustains it. Recent research suggests that, rather than focussing on reducing their avoidance of stuttering, people who stutter may benefit more from forms of therapy that help them to reduce their avoidance of speech errors. It is proposed that this may be achieved by a combination of cognitive therapy and techniques that encourage an increased focus on maintaining the forward flow of speech, regardless of phonological or lexical accuracy.

3. The paradox of non-avoidance “stuttering is what you do trying not to stutter” (Johnson, 1972).

4. The paradox of non-avoidance “stuttering is what you do trying not to stutter” (Johnson, 1972). “Stuttering is an anticipatory, apprehensive, hypertonic, avoidance response”

5. Approach-avoidance conflict Sheehan (1953) Two conflicting drives: – Approach –desire to communicate – Avoidance – desire to avoid unpleasant experiences associated with stuttering Roots in psycho-dynamic theory Inspired by Miller’s (1944) experiments with rats. The momentary reduction of fear during a stutter, enables the speaker to move forward again.

6. Block modification vs. Fluency shaping two seemingly incompatible approaches to therapy Block modification (non-avoidance of stuttering) – Van Riper method (cancellations & pullouts) – Sheehan’s method (the slide, the bounce) Fluency shaping (avoidance of stuttering) – Prolonged speech (e.g. Camperdown) – Rhythmic speech – Pre-formulated speech – (aspects of) McGuire & Starfish techniques

7. Sheehan – on “successful outcomes” following fluency shaping “... We suggest that the figures published on the establishment of fluency are mostly suppression figures and not ultimately recovery figures, and that the more successful the suppression, the less the chance of eventual recovery.” (Sheehan, 1984, p.150)

8. What do PWS avoid? - Historical perspective Wendell Johnson 1942;1959 In the beginning PWS avoid things that elicit negative listener responses – Speech errors and inaccuracies

9. What do PWS avoid? - Historical perspective Wendell Johnson 1942;1959 In the beginning PWS avoid things that elicit negative listener responses – Speech errors and inaccuracies Then, they avoid stuttering

10. Perhaps fluency shaping techniques stop us stuttering because they reduce our avoidance of speech errors and inaccuracies.

11. Perhaps the important underlying problem is the avoidance of speech errors and inaccuracies (rather than avoidance of stuttering).

12. Perhaps fluency shaping techniques stop us stuttering because they reduce our avoidance of speech errors and inaccuracies. Perhaps the important underlying problem is the avoidance of speech errors and inaccuracies (rather than avoidance of stuttering). Covert Repair Hypothesis (Postma & Kolk, 1993) Vicious Circle Hypothesis (Vasić & Wijnen, 2005) Variable Release Threshold Hypothesis (Brocklehurst, Lickley & Corley, 2013)

13. Insights from recent psycholinguistic research The more speakers try to speak accurately and avoid making speech errors, the more disfluent they become Fluent Accurate

14. Insights from recent psycholinguistic research The more speakers focus on the forward flow, the more fluent they become Although they might make more mistakes Fluent Accurate

15. FMPS Perfectionism self-ratings (Brocklehurst 2008)

16. People who stutter make more speech errors The Tonguetwister study Brocklehurst & Corley 2011 6144 tongue-twister recitations in each condition

17. stutterers’ utterances are more variable (Kleinow & Smith, 2000) Kinematic signals from the forehead and lower lip Spatio-temporal index- control vs. PWS

18. Intelligent avoidance

19. Sometimes it is important to speak fluently (to avoid stuttering)

20. Intelligent avoidance Sometimes it is important to speak fluently (to avoid stuttering) – At such times, we can use fluency shaping techniques

21. Intelligent avoidance Sometimes it is important to speak fluently (to avoid stuttering) – At such times, we can use fluency shaping techniques Sometimes it is important to speak accurately (to avoid errors) – At such times we can use block modification techniques.