Anxiety and Stuttering

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I think most people who stutter agree: 

We don’t stutter because we are anxious or nervous

…but stuttering may make us anxious! 

In this post, I’ll outline some research about the connection between anxiety and stuttering. I’ll also share opinions of people who stutter and researchers in the field of speech language pathology. 

The relationship between stuttering and anxiety 

Some research suggests people who stutter have a higher rate of social anxiety (Blumgart, Tran, Craig, 2010Kraaimaat, Vanryckeghem, Van Dam-Baggen et., al 2002) and are more likely to meet the DSM-V diagnosis of social anxiety than matched controls (Ivarich, O’brian, Jones, Block, Lincoln, Harrison, Hewat, Menzies, Packman, Oslow, 2009a ).  

Symptoms of social anxiety disorder include:

  • Intense fear and avoidance of performance-based social situations, in which judgement by others may occur (Ivarich et al, 2015) .
  • Feelings of humiliation and embarrassment as well as physiological sensations, like blushing, trembling, and sweating while engaging in these situations (Ivarich et al 2015). 

Sound familiar?

Many people who stutter also avoid and feel uncomfortable while engaging in social situations for fear of stuttering and negative listener evaluation! 

So, the obvious question is: 

Is stutterers’ anxiety just another aspect of the stuttering experience or is it a separate, distinct disorder?   

Researchers and people who stutter haven’t quite reached a consensus on this point. 

Dr. Rozz Menzies is an Australian researcher in psychology, who has contributed to many studies, indicating high instances of anxiety and personality disorders in people who stutter.

He believes there could very well be a high number of stutterers who also have true social anxiety disorders.  

In this interview, he explains that an anxiety disorder doesn’t occur in a vacuum, but is directly related to a person’s life’s experiences, including a stutterer’s experience stuttering (Menzies, 2013).  

Though related to stuttering, Menzies believes stutterers’ anxiety should be recognized as its own distinct disorder and should be treated as such.  
 
Other Australian researchers, with whom Menzies has worked (Ivarich, 2015) have suggested psychologists and speech language pathologists collaborate to help more people who stutter. 
 
Researcher in the field of speech language pathology, Walter Manning, doesn’t quite agree with Menzies’ interpretation of his team’s  research findings.  

Dr. Manning’s gut – and extensive personal experience both as a person who stutters and working with those who stutter — tells him that people who stutter aren’t more prone to psychological disorders than those in the general population (Manning, 2013)

It makes intuitive sense to Manning and others that people who stutter are more anxious than those in the general population… and that this anxiety is directly linked to stuttering in many cases.

He doesn’t think an added pathology should be layered on top of stuttering.  

He also doesn’t believe psychologists are needed in most cases of stuttering-related anxiety, as speech language pathologists who specialize in stuttering treatment do a significant amount of counseling in therapy sessions. It is well within their scope of practice to ameliorate stuttering-related anxiety (Manning, 2013) .  

 Feeling anxious about stuttering is normal  

Others agree:

Anxiety is a natural reaction to the stuttering experience.  

In a StutterTalk episode, Dr. Chris Constantino and guest Dr. Michael Boyle point out:  

Speech language pathology graduate students report feeling high levels of anxiety while completing assignments requiring them to go out into the community and pretend to stutter. (These assignments are meant to afford students a glimpse into the stuttering experience.)

When asked why these students feel anxious, they say: 

They are afraid of what others will think of them.  

And why are they so sure society will judge them negatively? Because a strong stigma is attached to stuttering.  

Us and them.  

In his conversation with Dr. Boyle, Chris Constantino points out that Boyle never uses the word anxiety to describe stutterer’s negative feelings surrounding speaking.  

Implicit in the diagnosis of anxiety is the view that something is wrong with the person holding the diagnosis.  

But Boyle isn’t implying that anything is wrong with anxious stutterers. He is not pathologizing this experience at all.  

Instead, Boyle reasons, stutterers’ negative feelings are related to their self-stigma or their internalization of the societal stigma of stuttering, which suggests fluent speech is preferable to stuttered speech and that people who stutter are shy and nervous.  

In other words: 

Stutterers who feel anxiety don’t necessarily have a problem that needs fixing. Society has the problem! 

Constatino and Boyle are no doubt alluding to the social model of disability.

The social model of disability differs from the medical model, which implies something is wrong with the “disabled” person. And this thing that’s wrong needs to be diagnosed and cured ( Constantino, 2018.)  

The social disability model, by contrast, states that the problem begins in society, in this case, with society’s expectation of fluency (Constantino, 2018.) This model states that it is society’s responsibility to accommodate the so-called disabled person’s differences.  

Reducing social stigma 

So, if reduced social stigma leads to less self-stigma, which likely leads to less anxiety about listener reactions, it would make sense that reducing social stigma would, over time, improve stutterers’ plight.  

After all, with no one telling young stutterers that stuttering is bad, children and adolescents who stutter won’t grow up thinking stuttering is bad.  

But, how do you reduce social stigma? 

By talking about it.  

Self-disclosure, or talking about stuttering, has been linked to positively changing others’ attitudes about stutterers (Boyle, Dioguardi, Pate, 2016.)  

This is likely because seeing a person who stutters talking confidently about stuttering challenges society’s view that stutterers are nervous, shy, and self-concious.

Talking about stuttering with a positive, confident, non-apologetic attitude is key in self-disclosure (American Institute for Stuttering, 2018; Byrd, Croft., Gkalitsiou, Croft, Hampton, 2017 .) (Apologizing for your stuttering, on the other hand, has not been shown to be effective (Byrd, et. al, 2017).) 

Reducing self-stigma: 

But society’s opinions about stuttering won’t change overnight.  

Instead of putting all our efforts into changing other people’s views about stuttering, people who stutter can reduce their internalization of social stigma related to stuttering (Boyle, 2013).  

Instead of believing society’s views about stuttering – that stutterers are nervous, that stuttering is bad, that fluency is preferable – people who stutter can hold more constructive views about stuttering.  

Plus– as Dr. Constantino points out– you are part of society! If you change your views about stuttering, you are starting to chip away at society’s view.  

Boyle outlines three main ways to reduce self-stigma, or to help those who stutter resist internalizing society’s beliefs about stuttering.  

  • Join a self-help support group like the National Stuttering Association. Peer support plays a huge role in changing our stigma-related stuttering views.  
  • Self-disclosure isn’t only helpful in changing society’s view of stuttering. Being open about stuttering and talking more about this part of our lives makes us feel more confident and comfortable in our own skin and in our role as people who stutter. If you are more comfortable with yourself, you’ll care less about how others view you. Not surprisingly, research suggests a correlation between being open about stuttering and higher quality of life (Boyle, Milewski, Beita-Ell, 2018.)
  • Challenge and test negative self-stigmatizing thoughts through cognitive behavioral therapy.  Are you really incapable of ordering food from a drive through or asking a question in class? Test this view and see! You may stutter while doing these things — but you can likely do them!

Anxiety after treatment 

Researcher and pioneer in the field of stuttering, Joseph Sheehan once mentioned that sometimes, people who stutter feel like giants in chains.  

They think they could live exceptional lives, but stuttering is holding them back. They blame their downfalls on stuttering.  

But, as Dr. John Klein points out in a StutterTalk podcast with Eric Jackson: 

When you have reached some degree of acceptance of your speech, when you are comfortable stuttering and no longer feel anxiety because of it…. 

you will be like everybody else, with the same fears, same pressures, same insecurities. 

You may get to a point where you say what you want and do what you want despite stuttering, without even thinking about stuttering. But you may still feel anxiety. Because lots of people who don’t stutter feel anxiety.  

All in all 

In general, I think stutterers who feel anxiety surrounding their stuttering can drastically reduce these anxious feelings. They can meet others who stutter, people who may be further along on their journey towards accepting stuttering.

And they can find a speech language therapist who really understands the experience of stuttering, a therapist who can guide them on a journey of acceptance and help them give themselves permission to stutter. 


Articles related to Anxiety and Stuttering:

Self-Disclosure: A Powerful Tool for the Stutterer

Finding the Perfect Speech Therapist for Stuttering

4 Ways Stuttering Support Groups Could Improve Your Life


Resources

[American Institute for Stuttering]. (2018, November 12). Dr. Michael Boyle: Disclosing Stuttering (video file). Retrieved from this link  

Boyle, M. (July 2015) The Normal Anxiety of Stuttering (Ep. 535) (C. Constantino, Interviewer.) Retrieved from: https://stuttertalk.com/the-normal-anxiety-of-stuttering-from-the-world-congress-in-portugal-with-michael-boyle-ep-535/

Boyle, M. P., Diogarde, L., Pate, J. E. (2016) A comparison of three strategies for reducing the public stigma associated with stuttering. Journal of Fluency Disorders, 50; 44-58

Boyle, M. P., Milewski, K. M., Beita-Ell, C. (2018). Disclosure of stuttering and quality of life in people who stutter. Journal of FLuency Disorders, 58; 1-10

Blumgart, E., Tran, Y, Craig, A., 2010. Social anxiety disorder in adults who stutter.   Depression and Anxiety, 7; 687-92.

Constantino, C. (2018). What Can Stuterers Learn from the Neurodiversity Movement. seminars in Speech and Language; 39(04): 382-396

Iverach, L., Jones, M., O’Brian, S., Block, S., Lincoln, M., Harrison, E., et al. (2009b). Screening for personality disorders among adults seeking speech treatment for stuttering. Journal of Fluency Disorders, 34, 173–186. 

Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harison, E., Hewat, S., Menzies, R., Packman, A., & Onslow, M. (2009). Prevalence of Anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 23, 928-934 

Iverach, L., Rapee, R. M. (2015). Social anxiety disorder and stuttering,: Current Status and Future Directions; Journal of Fluency Disorders, 40; 69-82

Ivarich, L., Jones M., Lowe, R., O’Brian S., Menzies, R. G., Packman A., Onslow M. (2018). Comparison of adults who stutter with and without social anxiety disorder. Journal of Fluency Disorders, 56, 55-68 

Klein, J. (2010, February 25). Anxiety and Stuttering (Ep. 182) (E. Jackson, Interviewer). Retrieved from http://stuttertalk.com/self-help-support-groups-for-stuttering-ep-446/ 

Kraalmaat, F. W., Vanryckeghem, M., & Van Dam-Baggen, R. (2002). Stuttering and social anxiety. Journal of Fluency Disorders, 27, 319-331.

Menzies R., Manning W., (2013). Research Update: Personality Disorders and Preschool Stuttering Treatment (Ep. 408). Retrieved from: http://stuttertalk.com/tag/rozz-menzies/ .

Anxiety and Stuttering

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