involve psychological issues,” she says. “There’s not a lot of data
to support that.”
In fact, two studies by Beck and University of Memphis
speech and language pathologist Walter Manning in the Journal
of Fluency Disorders find that stutterers are no more likely than
the general population to have personality disorders. Although
rates of anxiety are higher among those who stutter, their
anxiety is situation-specific and related to social evaluation,
rather than to high levels of trait anxiety, says Beck. “That
makes sense as we think about this — your anxiety is going
to be pretty much focused around things that are garnering
negative social attention” — such as stuttering, he says.
Manning, who has many years of experience treating
people who stutter, echoes Beck’s views. “Decades of research
indicate that people who stutter are normal in many respects
— including psychological aspects — except when they try to
communicate with others. They experience anxiety, often at
high levels. ... It would be unusual for a person who stutters not
That’s why addressing the anxiety is an important part of
treatment. Although there is no consensus on the most effective
treatment for stuttering, the most common modality is speech
therapy, often with cognitive therapy to address anxiety.
In traditional speech therapy for stuttering, a counseling
component focuses on modifying client reactions to his or her
stuttering. Traditional treatment protocols involve attempting
to alter features of stuttering as the person begins to stutter.
Clients are taught to speak in a more relaxed mode; they are
taught to attempt to “glide” or “slide” through blocks once they
begin, and they are taught to stutter on purpose in order to
face their disorder more directly and purposefully. Treatment
also often involves group therapy and taking part in support
groups, such as those offered through the National Stuttering
Webster and his HCRI team have updated their treatment
methods over the years through trial and error, collecting data
on what works. Participants in his 12-day intensive program
start by practicing particular speech sound combinations, and
then once they have mastered those sounds, they practice them
with other program participants.
The next step is making hundreds of telephone calls
practicing their newly learned speech skills, calling local
businesses and asking questions like, “What time do you
close?” before going on to have lengthier phone conversations
with friends, family and business colleagues, says Webster.
Practice and desensitization continue with trips to the mall to
speak with store clerks, with a clinical staff member present to
monitor the client’s speech and give feedback.
“We think anxiety is a consequence of having gone out and
stuttered and the adverse social learning that has taken place,”
Once participants master the skills and can transfer them
in a variety of situations, “fears begin to simply drain away,” he
says. “If you’ve made several hundred telephone calls, you’re
not going to be afraid to go into the garage and have your car
serviced, you’ll be able to go into job interviews.”
Webster’s team continues to innovate. They recently
developed an iPhone app called Voice Monitor that gives
patients feedback on their speech, thereby helping them learn
how to control their voices.
Maguire prescribes dopamine-blocking medication for
his adult patients, which he said can be done in conjunction
with speech therapy. Although there are no FDA-approved
medications for stuttering, researchers have had some success
in trials of dopamine-blocking drugs. Maguire has tested
olanzapine and risperadone and found positive results in his
own lab. These results were included in a 2012 review article he
co-authored that appeared in the Journal of Experimental and
Clinical Medicine, “Overview of the Diagnosis and Treatment of
He often refers patients to speech therapy as well as to self-
help and support groups through organizations such as the
National Stuttering Foundation. He would like to conduct
a study comparing medication alone versus combining
medication with speech therapy.
Beck would like to see more research done that focuses on
better understanding the link between anxiety and stuttering.
While stuttering causes performance anxiety, the anxiety itself
could be a barrier to treatment.
“If someone’s social anxiety is really high, they may not have
as motivated a speech therapy outcome,” she explains. “We don’t
know at this point. In my mind, that would be kind of a natural
next step growing out of our understanding of anxiety and
Julie Cohen, PhD, is a clinical psychologist and writer in Boston.
• Wu J. C., Maguire G., Riley G., Lee A.,
Keator D., Tang C. Increased dopamine activity
associated with stuttering. Neuroreport
• Lu C., Chen C., Ning N., Ding G., Guo T.,
Peng D., Yang Y., et al. The neural substrates
for atypical planning and execution of
word production in stuttering. Exp Neurol
• Manning, W. & Beck, J. G. (2013). The role
of psychological processes in estimates of
stuttering severity. Journal of Fluency Disorders,