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Cognitive Behavioural Therapy for Stuttering

Updated: Jul 1


A girl in a cognitive behavioural therapy for stuttering


This blog covers the benefits of Cognitive Based therapy (CBT)- techniques for the treatment of stuttering. Stuttering is a communication disorder that affects speech fluency.


What is Stuttering?


Stuttering is an interruption in the natural flow of speech, characterized by repetitions, prolongations, or blocks in speech sounds. Stuttering is a speech disorder that not only involves speech disfluencies but also leads to various psychological and personal problems due to social anxiety, fear, reduced self esteem and frustration in those affected.


Stuttering can present in early childhood and it can be either transitory, disappears spontaneously by the age of 18 months without any speech therapy, or persistent, where a child continues to stutter in further years of life.


The male to female ratio in school children and adults is about 3:1.

There is considerable amount of evidence pointing at the impact of stuttering in adolescent individuals leading to feelings of social anxiety, frustration, and helplessness that usually accumulate over years leading to coping behaviors leading to restraining lifestyle.


What are the causes of Stuttering?


The underlying cause of stuttering remains a topic of ongoing research, but a combination of genetic, neurological, and environmental factors are believed to contribute to its development.

  • Some evidence suggests that a family history of stuttering might increase the likelihood of an individual developing the disorder.

  • Neurologically, differences in brain structure and function have been observed in people who stutter, particularly in areas associated with speech production and motor control.

  • Environmental factors, such as stressful situations or a rapid pace of speech development during early childhood, can also play a role in triggering.


What are the features of Stuttering?


Stuttering manifests in various ways, and its severity can vary from person to person. Few common symptoms of stuttering are:

  • Repetitions of sounds, syllables, words, or phrases, such as "b-b-b-ball,"

  • Prolongations, where a sound is stretched out, as in "ssssun,"

  • Blocks, where speech is momentarily halted,


The psychological manifestations of stuttering can be divided into different subtypes such as cognitive, behavioral, physiological and affective.


Cognitive symptoms include:


Typical Cognitive Distortion

The individual is focused on the fact that they stuttered on a certain word, rather than the fact that they communicated the message with relative fluency.


Self-Focused Attention

The individual is focused on getting across the message as fluently as possible, becoming completely oblivious to the negative impact it is having on the communication with the partner.


Behavioral symptoms include:


Escape and avoidance-

The individual avoids certain words and situations.


Taking control

The individual doesn't allow the partner to take part in the communication.


Physiological symptoms include

These involve typical reactions to fear such as:

  • Trembling,

  • Shivering,

  • Palpitations,

  • Increased muscular tension,

  • Sweating,

  • Blushing, etc.


Affective symptoms may vary from person to person.


Typical emotions associated with stuttering are:-


  • Fear and anxiety- 

Fear is a strong force that can have an impact on your decision making skills, it can activate a fight or flight response. Flight response often leads you to avoid situations and fight response leads to irrational decision making.These feelings often arise from the fact that the individual who stutters doesn't know when and where they might stutter, it can be anywhere a job interview, a social gathering, a restaurant, a classroom presentation, leading to constant anxiety.


  • Social anxiety:-

It is the feeling of being judged by other individuals leading to feelings of inferiority, self consciousness, depression, humiliation, and embarrassment.

The constant feeling of anxiety and fear can trap the individual in a vicious cycle leading to constant feeling of frustration and depression, directed towards themselves, their life partners, or impatient listeners.


  • Stress-

A person who stutters feels constant stress as to when and where they might stutter leading to feeling overwhelmed and avoiding certain situations.


  • Shame and guilt-

The individual feels ashamed of their inability to communicate effectively and feels guilty about not being a good conversational partner.


All these feelings have a negative impact on individuals who stutter and they often end up avoiding situations where they become the focus, meet new people, have to take the leading role, have to speak in front of large groups of people, and many day to day situations. It can have a negative impact on an individual's education, job achievements, personal relationships and overall life.




Few tips for stutterers to manage their anxiety


If you are a stutter you must often feel overwhelmed with the anxiety that comes when you are exposed to social settings or unexpected situations. Those with the disorder fear being humiliated in front of others, leading to an overestimated fear of negative consequences. Here are few basic tips that you can easily incorporate in your life to manage your anxiety:-


  • Breathing exercises to help you regulate your breath and relax.


  • Taking help from a speech therapist to engage in effective communication.


  • Recording yourself can help you recognise the words that you stutter at, it also helps you trace your progress.


  • Taking part in various help groups, where you can take part in discussions and you can practice your language and speech skills with fellow stutterers.


  • You can consult a speech therapist to receive CBT, it is by far the most effective treatment approach for stuttering. It revolves around identifying and controlling unhealthy thoughts and beliefs that have a negative impact on the life of stutterers.




Intervention strategies used at Sounderic for treatment of Stuttering


Few of the mostly commonly employed intervention techniques to help individuals overcome with stuttering are:



Cognitive based therapy for stuttering


In CBT the speech therapist focuses not only the stuttering pattern of a client but also on a major determinant the resources a client has access to. The speech therapist aims to pin-point the cognitive symptoms that an individual suffers from along with working on their strengths and weaknesses, covering the psychological aspects of stuttering as well.


It's very important for you to understand that CBT doesn't exclude the use of fluency techniques.


What is the framework of CBT for stuttering?


The speech therapist covers various different problems in every session, and there is often a specific pattern followed by the therapist.


In the first session the client is informed regarding CBT, including the aim, content and how it will be implemented. The aim of CBT isn't to help cure the stuttering, instead it is to help them develop better understanding of their problems and focus on their resources to overcome the challenges they face in everyday life.


In the following sessions the speech therapist helps the client identify their dysfunctional thoughts by the help of DTR schemes, and to slowly substitute them with more functional and realistic thoughts.


Few dysfunctional thoughts include, ‘Stuttering makes me weak’, ‘Individuals who stutter are subjected to ridicule’, ‘I am not as good as other people’, ‘Stuttering is something to be embarrassed of’.


The aim of the speech therapist is to help the client:-

  • Easily recognize their dysfunctional thoughts.

  • Via homework, practice alternative behavior patterns along with new cognitive approach, like facing their fear in various circumstances they would usually avoid.

  • Understand and interpret the comments made by others in respect to their stuttering.

  • Gain confidence and have a better hold on their emotions when they stutter in social settings.


Why choose Sounderic for CBT for stuttering?


I cannot emphasize enough on the importance of a speech therapist for proper implementation of cognitive based therapy in overcoming stuttering.


  • Cognitive based therapy is a technique that has predefined goals and format, it thereby helps both the client and the speech therapist focus on specific checklists.


  • This technique is based on collaborative therapy, where both the speech therapist and client work together thereby helping in personal development as well.


  • Our speech therapists focus not only on the clients problem, the client's resources are also taken into consideration when client based therapy is being planned.


  • While providing CBT, our therapists help the clients focus on effective communication and developing confidence, rather than curing their stuttering.


  • Cognitive based therapy is focused on increasing awareness regarding stuttering, and helping the client feel more comfortable and confident in handling challenges in unexpected situations.


A very important factor that is taken into consideration by our speech therapists while providing CBT, that is often side tracked in other therapies for stuttering, is, behavioral aspects of stuttering. The therapist help the clients identify existing coping skills and also help them develop new coping skills, helping them develop self-reliance and confidence to tackle challenges in life.



Things you need to incorporate in your day to day life for better life quality.


Acceptance- 

It's very important for an individual to accept their stuttering, before they expect society to understand or accept it. It helps the person interact with confidence, sure it can still be annoying sometimes but it won't embarrass them as easily, instead it motivates them to take on bigger challenges and overcome them. 



Tell people about your stuttering- 

In a research paper published in 2017, it was found that people who disclose their stuttering are often more confident, social, outgoing, polite, comfortable and more intelligent than those who don't self-disclose their condition. 


Find humor in stuttering- 

I understand it's easier said than done, however, finding of humor towards stuttering may be an indicator of acceptance towards stuttering


Here are few comedians who stutter:-

I have added links to their videos to help you feel more confident and have a open conversation regarding stuttering and humor.


Nina G- 

She is America's only female stutterer. 

Watch Nina G - https://youtu.be/gak_gtgbqBE ( in this video she talks about how to talk to someone who stutters)


Jody Fuller- 

Jody is comic, writer, soldier who was posted thrice for duty in Iran, he also stutters. 

Watch Jody-


Practice- 

In our practice, one of the most common challenges an individual who stutters faces are job interviews and presentations either at work or school. During these situations, the verbal skills of an individual are at full display. It is stressful for anyone, and it is more stressful for someone who stutters. 


Practice is the key to mastering one's verbal skills. One must practice confidently speaking about their abilities and skills along with their condition, for a successful interview or presentation. Speaking about one's condition not only maintains a transparency with the interviewer but also portrays self confidence. 


Always remember-

“Acceptance is a very powerful thing. Finding peace with stuttering is to stutter with grace.” - Sarah D'Agostino








Sounderic provides online speech therapy sessions for children with various communication disorders. We would love to help you. Get in touch with us on WhatsApp at +919644466635 or schedule a consultation with us at https://www.sounderic.com/service-page/speech-language-consultation-for-kids?referral=service_list_widget



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