Clinical Trials and Cognitive Therapy
By Susan Block, Ph.D.
Social anxiety (i.e. anxiety arising in social encounters) cannot be overlooked in the management of chronic stuttering. The evidence for a relationship between anxiety and stuttering is considerable. Adults who stutter have reported high levels of trait, state, and social anxiety on standard measurement instruments (Hancock & Craig, 1998; Kraaimaat, Janssen, & Vandambaggen, 1991). Those who stutter appear to experience higher than normal levels of anxiety, independent of speech. A recent, large-scale population study of Australians (Craig, Hancock, Tran, & Craig, 2003) found trait anxiety levels to be higher in stuttering participants than in controls.
This paper presents the results of a study in Australia in which the authors examined social anxiety and stuttering. The study examined the rate of social phobia among 32 adults who stutter, the effects of speech restructuring treatment on social anxiety, and then the effects on anxiety and stuttering of a cognitive-behavior therapy (CBT) package for social anxiety.
Thirty-two adults with chronic stuttering were randomly allocated to receive either speech restructuring (Prolonged Speech) following a CBT package for social anxiety or speech restructuring alone. Data were obtained on a variety of speech and psychological measures at pre-treatment, post-CBT, post'speech restructuring, and 12 months follow-up.
Sixty percent of the cohort were diagnosed with social phobia. Speech restructuring treatment alone had no impact on the social phobia of the cohort at 12 months follow-up. At follow-up, participants who had received CBT showed no social phobia and greater improvements than control participants on a range of psychological measures of anxiety and avoidance. However, the CBT package made no difference to the speech outcomes of those with social phobia.
Consequently, it was concluded that the CBT treatment was associated with significant and sustained improvements in psychological functioning but did not improve fluency.
This article is from the Journal of Speech, Language, and Hearing Research Vol. 51 1451-1464 December 2008. It is based on research by Ross G. Menzies, Sue O'Brian, Mark Onslow and Ann Packman of the Australian Stuttering Research Centre, The University of Sydney, Australia; Tamsen St Clare of The University of Sydney and Westmead Hospital, Sydney, Australia; and Susan Block of La Trobe University, Melbourne, Australia.
Craig, A., Hancock, K., Tran, Y., & Craig, M. (2003). Anxiety levels in people who stutter: A randomized population study. Journal of Speech, Language, and Hearing Research, 46, 1197'1206.
Hancock, K., & Craig, A. (1998). Predictors of stuttering relapse one year following treatment for children aged 9 to 14 years. Journal of Fluency Disorders, 23, 31'48.
Kraaimaat, F. W., Janssen, P., & Vandambaggen, R. (1991). Social anxiety and stuttering. Perceptual and Motor Skills, 72, 766.