Living with the disorder of stuttering is associated with many problems other than physical speech disruptions. Other problems include experiencing negative thoughts and emotions related to communication (Vanryckeghem, Hylebos, Brutten, & Peleman, 2001), being subjected to negative stereotypes, prejudice, and discrimination (Boyle et al., 2009, Cooper and Cooper, 1996, Gabel et al., 2004, Hurst and Cooper, 1983 and Silverman and Paynter, 1990), as well as victimization and bullying (Blood & Blood, 2007). These problems may be related to increased anxiety levels found in many people who stutter (PWS; this acronym also stands for “person who stutters”) (Menzies, Onslow, Packman, & O’Brian, 2009). Some studies have shown that PWS have elevated anxiety levels compared with the general population (Craig, Hancock, Tran, & Craig, 2003). Iverach, O’Brian, et al. (2009) reported that PWS had an increased risk for meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for panic disorder, social phobia, and generalized anxiety disorder compared with matched controls. Craig, Blumgart, and Tran (2009) also found that PWS have decreased quality of life levels in the areas of vitality, social functioning, emotional functioning, and mental health status compared with matched controls. It is suggested that these psychological issues experienced by some PWS are the result of continually having negative life experiences associated with a chronic communication disorder (Iverach, O’Brian, et al., 2009).
There is evidence that negative attitudes about speech and other mental health problems are associated with impeded therapy gains (Andrews and Cutler, 1974, Guitar and Bass, 1978 and Kraaimaat et al., 1988). Even if therapy gains in speech fluency occur, there is likely to be relapse experienced by PWS after treatment ends (Craig & Calver, 1991). While there is likely a constellation of factors that is related to relapse in stuttering (Craig, 1998), recent evidence suggests that relapse is more likely to occur in individuals with mental health disorders, including anxiety, compared with individuals with no mental health disorder (Iverach, Jones, et al., 2009). Experiencing negative emotions like embarrassment about using speech control techniques has also been found to be linked with relapse (Craig & Calver, 1991). Relapse is less likely for individuals whose treatment had included cognitive and affective components compared with those who had not received this type of treatment (Hancock and Craig, 2002 and Yaruss et al., 2002). From this evidence, it appears that addressing cognitive and affective components of stuttering are related to benefits obtained during stuttering treatment as well as their maintenance following treatment.
Due to the awareness of the role of cognitive and affective components in stuttering, the need for addressing these issues in treatment has been promoted by professionals (Craig et al., 2003, Menzies et al., 2008 and Menzies et al., 2009) and adults who stutter (Plexico et al., 2005 and Plexico et al., 2009b). The need for addressing cognitive and affective aspects of stuttering in treatment has led to an interest in cognitive-behavioral therapy (CBT) for individuals who stutter (for an in depth review see Menzies et al., 2009). Although CBT has improved psychosocial functioning in some PWS (e.g., reduction in avoidance and anxiety), gains in fluency may not result from these treatments when given as a supplement to speech restructuring treatments (Menzies et al., 2008).
There is a so-called “third wave” of behavior therapy that involves approaches that are focused more on awareness, acceptance, and understanding the context of thoughts rather than challenging and changing their content (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). Mindfulness, as described in the following section, may add a valuable dimension to stuttering management beyond or supplemental to those of CBT. PWS require treatment that facilitates self-control and self-responsibility (Craig, 1998) if modified speech is desired, and the mindfulness approaches described in this paper may provide a valuable means for PWS to accomplish these goals.
