Anxiety and fears about speaking are common among people who stutter. Fear is a very primitive bodily response to danger; it is fundamental to sustaining life. People need to be cautious and avoid serious dangers. Anxiety is related to fear; it is a general feeling of apprehension; a premonition of danger. An intense, excessive fear of an activity, object, or situation is known as a phobia. In phobias, the fear is out of proportion to the actual physical danger at hand. A phobia causes a person to make alterations to their life in order to avoid perceived physical or psychological dangers.
The Role of Anxiety and Fear in Stuttering: Anxiety, fear and phobias are commonly an integral part of the problem of stuttering. Speaking phobias result in limiting or restricting activities in which patients are willing to participate. As a consequence, these avoidances and restrictions handicapped their lives.
For those who stutter, patterned behavior, negative thinking and a belief system emerges which magnify to intensity of the problem. This thinking and behaving become internalized and the person who stutters begins to organize his or her life around their fears about speaking. They begin to form their self concept around the inability to speak.
Fear and anxiety can represent a bigger problem than the actual stuttering itself. The thought patterns and belief system contribute heavily to problems of relapse. The bodies response to fear and anxiety blocks access to therapy targets, particularly during moments of stress. As a result, many who stutter stop speaking, rather than risk stuttering.
The Body's Response to Fear: There are three components of fear: behavioral, cognitive, and physiological. Behavioral symptoms include such things as shakiness, throat clearing, and avoidances. Cognitive symptoms involve difficulty thinking, hypersensitive or selective stimulus focus. Physiological symptoms comprise increased heart and respiration rates, and increased blood flow to large muscle groups.
How the Response is Elicited: The emotion of fear is elicited when an event or situation is perceived to be threatening. The person becomes aware on an impending danger -- a threat to the ego or the person's sense of self.
Two factors enhance the fear response: past experiences and apprehension. Previous negative experiences in similar situations are stored vividly in memory. These emotional memories serve accentuate the memory of the event or situation. Apprehension makes the bodily systems that scan for danger more sensitive; it sets them "on edge". Apprehension heightens the impact of fear.
A Deeper Understanding: The body's response to fear is a "call to action"; the "fight or flight" response is instantly summoned into play. This primitive reflexive response, however, is contraindicated in speaking situations. Both fighting and fleeing involve activation of large muscle groups, rapid heart rate and respiration. Mediation of higher cerebral thinking is minimized. These bodily reactions are exactly the opposite of what is required to effectively manage fluency. The "fight or flight" response is rooted very deeply in our genetics and will not be extinguished. Our work then becomes a matter of learning to mediate our reactions.
Treatment of Fears and Anxiety: The overall treatment paradigm to manage the fear response is to combat it mentally. Remember it is unrealistic to expect the reflex to go away; it is primitive and still critical to our survival. One approach is to begin to make fear more tangible and objective. Our approach will be to become more knowledgeable of our fear.
Increasing Cognitive Awareness - It is human nature to want to avoid fears. But to overcome them, one must become more knowledgeable about them -- knowledgeable of both the bodily feelings and the subject of the fears.
There are three areas in which patients should learn more about their fears: (1) how their body specifically responds to fear, (2) being able to evaluate the degree of their fear response, and (3) building more tolerance to the fear response.
| (1) | Clinicians should explore with patients, the ways in which their body is specifically affected by fear. The "Body's Response to Fear" can serve as a framework to guide the client's exploration. The more detailed the exploration, the richer and more complete the understanding. This knowledge can be used to add rationality to the sensation of fear. |
| (2) | Fear is based upon perception and as such, can be measured on a perceptual scale. Have the patient assess the level of his or her fear relative to the extremes of the scale. Commonly, he or she is asked to rate their fear on a 10-point scale, with 10 signifying an immediate, unstoppable, life-threatening event and 1 defining a state near sleep. The scale helps the patient cognitively evaluate, critically compare and communicate the status of their mental and bodily response to fear. Instead of fleeing, they are using their intellect to analyze and grade their fear response. |
| (3) | The point is not to make the fear go away, but to be able to tolerate it better, so that the fear reflex is not set off. This may be approached to listening to the instructions you give to yourself in fearful situations. These instructions may not be words, but rather "impulses". The first step then is to interpret the impulses but "translating them" into words. Being able to articulate the messages is an important initial step toward modifying and changing the message, to allow the patient to respond differently. |
Conclusion
At best, the fears and anxieties associated with stuttering can be better managed; it is not reasonable to think they can be extinguished. It is difficulty for many people who stutter to comprehend that people who don't stutter are the least bit anxious or fearful of public speaking. Learning how to mediate the process by which fear and anxiety is elicited and communicating throughout the body can be an effective means of managing the response, enabling the client to function appropriate.
© Rentschler, 2001