Echolalia, stuttering, stumbling, writer's cramp, logorrhea

Jose Antonio Garcia Higuera

Born in Madrid in 1947.

Candidate of Sciences in Psychology. 1999 National University of Education (UNED). (Diploma with honors).

Licensed psychologist. 1979 Universitad Complutense de Madrid

Degree in Mathematics. 1969 Universitad Complutense de Madrid

Accredited psychotherapist. FEAP (Spanish Federation of Psychotherapists). ASETECCS (Spanish Association of Social Cognitive Behavioral Therapy).

Introduction

Most people who stutter have no psychological problems other than those associated with their stuttering. Most of the psychological problems that people who stutter have are related to their stuttering. In other words, if people who stutter could speak fluently and smoothly, they would not have any other problems. Van Riper (1973, pp. 211, 213) said, "The neurosis, if present, is usually the result of a traumatic experience of speaking...these stuttering people were unhappy only because they stuttered." This article, which focuses on the psychological problems associated with speech disorders, attempts to illustrate, by describing the treatment chosen in this particular case, some of the mechanisms and processes that may be involved in the development of psychological problems in people who stutter.

Stuttering can cause psychological problems, which in turn can impair speech. Solving psychological problems is not always a direct consequence of improving speech. The use of cognitive behavioral therapy techniques may be a fundamental principle for achieving better health in some cases.

Stuttering leads to the fact that a person gains the experience of losing control over his body in an extremely important situation - during interpersonal communication. Loss of control over one's own body can cause situations similar to those mentioned by Van Riper (1973, p. 330). In this case, the resulting blockage is so intense that external intervention is required to eliminate it. Van Riper compares this human experience with the results obtained in experiments with dogs, which were inevitably punished. These situations have given rise to the phenomenon of learned helplessness (Abramson, 1978), which is believed to play an important role in the onset of some types of depression.

Several years ago (1908), Yerkes and Dodson established a connection between the level of activation and performance indicators. If we are “too under-activated,” that is, in an almost sleepy state, our performance will be very low. As activity increases, our performance also increases to reach its optimal level. This optimal level of performance corresponds to a certain level of activation, which depends directly on the type of task and the individual characteristics of the individual. If the process of increasing activation continued, our performance would quickly deteriorate. A person who stutters, when he tries to speak, must make more efforts to formulate and express his thoughts correctly. Applying such efforts implies an increase in activation, and accordingly, a decline in performance can easily occur. When faced with failure, the subject experiences anxiety, which in turn further increases activation. This creates a feedback loop that sets up more and more blocks and finally leads to a feeling of loss of control over one's body, making stuttering inevitable. In psychology, loss of self-control has traditionally been recognized as a leading cause of depression. In recent years, the inability to control oneself has also been identified as an important culprit in the development of anxiety disorders (Zinbarg and Barlow, 1992).

Depression and anxiety are not the only experiences that can trigger psychological disorders that affect stuttering. Control of speech is of great importance in social relationships. Long-term failures in social relationships generate feelings of frustration, guilt, hostility, and high levels of anger (Van Riper, 1973, p. 264). In addition, improper management of the resulting feelings of guilt and disappointment can disrupt interpersonal relationships, provoking additional social problems that can lead to the formation of many psychological disorders. A person who stutters may have greater difficulty than a person who does not stutter when interacting socially. Avoidance, evasion, and flight from contacts can cause serious problems in social relationships, which give rise to psychological disorders. The effort a person who stutters puts into speaking can sometimes feel overwhelming and overwhelming, and he or she withdraws from social interaction, feeling frustrated, angry, and hostile, which in turn increases existing social problems.

Quite often, when speech problems are resolved, the person’s psychological state simultaneously improves. However, this is not always the case. Sometimes improving the ability to express one's thoughts leads to changes in a person's expectations and contributes to a change in the social environment, which, in turn, can create new psychological problems. For example, in a marital relationship, the ability to express oneself freely can lead to a redistribution of power within the couple, leading to problems that were not previously so obvious. In anxiety and depression, an important role is played by existing ancient patterns in a person's worldview (Beck, 1969), which continue to operate even when they are no longer needed and even in situations where they are harmful. It is necessary to deactivate the influence of such established patterns to solve psychological problems of the individual.

Methods for solving speech problems

Based on the above reasons for the development of speech disorders, the following emerges: in order to stop stuttering when excited, you need to eliminate the root cause - the excitement itself. It is impossible to get rid of it in life, but yes, it is possible to train a competent reaction to the occurrence of this emotional state.

Stuttering when excited is a disease that has functional, personal and social aspects. For effective treatment, it is necessary to resort to comprehensive measures that include therapeutic, pedagogical and rehabilitation techniques.

Practiced methods of treatment:

• sedative medications;
• relaxing massage;
• breathing and speech exercises;
• psychological training on restructuring thinking.

To stop stuttering when nervous, you need to fulfill three basic conditions:

• learn to control breathing;
• minimize the effect of muscle contractions on speech;
• to form a normal psychological attitude towards anxiety, communication, and stuttering.

How to control your breathing

A comprehensive speech therapy program for the treatment of stuttering includes 4 blocks.

1. Relaxation of the tongue and lips.
2. Control of facial muscle contractions.
3. Normalization of breathing through the diaphragm (stomach).
4. “Stretched” pronunciation of vowels.

Soft start method:

• a small diaphragmatic breath;
• pronunciation of certain sounds on a short exhalation.

Breathing exercises are one of the best remedies for speech disorders. If you're nervous or have a difficult conversation ahead of you, find a quiet place and do a simple exercise.

1. Starting position - standing, straightened with your arms down.
2. Bend forward, lowering your head and arms.
3. Inhale quickly in a bent position.
4. Incomplete raising of the body and head, inhalation and exhalation.
5. New bend and breath.
6. The exercise is done eight times, eight approaches each.

How to behave during a conversation

Recommendations for eliminating stuttering when nervous will help you calm down.

1. When talking, keep your arms, neck, shoulder girdle and back relaxed.
2. Don't mentally focus on stuttering. For others it is not a serious problem.
3. Speech during a conversation should be slow, with an emphasis on pauses and punctuation marks. Words must be pronounced in a low voice, in a monotonous tone.
4. Don't rush when talking. Rapid speech causes shortness of breath.
5. Breathing and speech are developed by singing, tongue twisters, and reading books out loud.
6. Conscious participation in public speaking.
7. Talk to yourself in front of the mirror in a slow and quiet voice for thirty minutes every day. It is important to get used to talking and contemplating the “interlocutor” at the same time. As you talk, remember this practice and calm down.
8. Positive thinking when speaking.
9. Writing down on a piece of paper specific words on which stuttering occurs. Training their pronunciation slowly and syllable by syllable.

Case R.

R., a man about forty years old, entered treatment with only one goal - to get rid of his stuttering. At the first session, he could not even say his name, and was able to form only a few coordinated phrases. He turned to this method of therapy after failures experienced with other treatment techniques. Van Riper's approach was a specific plan that had to be followed during therapy, since it was clear that other strategies simply would not be accepted by the patient.

How does stuttering occur?

Speech disturbances during stuttering are caused by a spasmodic state of the structures that take part in the formation of speech - namely:

• language;
• soft palate;
• lips;
• muscular apparatus of the larynx.

Anti-stuttering exercises are aimed at eliminating these spasmodic contractions.

Spasms happen:

• articulation (the tongue, soft palate and lips suffer);
• vocal cords (the larynx apparatus suffers, with spasmodic contractions of its muscles a condition similar to hiccups occurs);
• respiratory - with them, breathing “gets confused”, a person cannot cope with it, a feeling of lack of air is created (although there are no objective prerequisites for complaints about such a violation).

Spasmodic contractions occur due to the fact that in the motor speech centers located in the brain, excessive excitation of the nervous structures is formed, which spreads to neighboring respiratory centers and centers responsible for emotions.

Brief clinical information

R. is the second son in a family with average income. He has three siblings. When he was a year and a half old, he fell ill. To regain his health after his illness, his father had to carry out a recommended rehabilitation program that required great effort and dedication for two years. Following this program, R. achieved sufficient recovery of well-being.

He left school due to spontaneous panic that arose when he was faced with the possible need to talk during the educational process. He found a job in a profession that did not involve regular contact with other people.

Functional diagnostics

Before starting treatment, functional diagnostics were carried out to determine the predominant behavior and factors influencing the behavioral pattern. This part of the procedure is similar to the identification phase in the approach used by Van Riper.

One day, when R. was an eight-year-old boy, he began to stutter while surrounded by his father and uncle, who also stuttered. Both men laughed at him, and his father, becoming very angry, shouted at the boy and demanded with severe reprimand that he immediately begin to speak normally. This incident determined his personality as a person who stutters. R.'s father is a powerful and authoritative person who established his own laws that apply to the whole family. The father continued to criticize the boy every time he stuttered. In other respects, R's father is a respected man who is loved by R and other family members.

When he sought treatment, his speech fluency was very poor. For example, he could not say his name. Moreover, his existing model of behavior - avoidance - made it difficult for any attempts to build a consistent discussion between the doctor and the patient.

Following the recommendations proposed by Van Riper, the treatment began with the identification phase, where we discovered the words that he was afraid of, avoided, and put off saying. Having determined which situations aggravated his stuttering, the patient discovered that lack of sleep, being too relaxed, vacations and holidays, and intimate contacts were precursors to the aggravation of his speech disorders. In order for R. to speak freely and fluently, he needed to make enormous efforts, which he was unable to do, being in an overly relaxed or tired state.

Another factor that aggravated the speech problem was the length of the phrase: pronunciation of long phrases was impossible for him. Other situations were identified that were problematic for the patient. These were: requests from other people, spoken in an aggressive tone; situations when he himself needed to make a request to other persons, the need to provide personal data, the requirement to repeat what had already been said. A problematic situation for him was the need to answer the phone, carry out a conversation in unfamiliar places, talk with unknown people. It was difficult, and often completely impossible, for the patient to carry on a conversation for more than an hour and a half.

The examined patient also had hypochondriacal syndrome and excessive aggressiveness, but getting rid of them was not accepted by R. as goals of therapy at this stage of treatment.

Predisposing causes of stuttering

Predisposing causes are those that create the basis for the appearance of stuttering. The table describes the main risk factors:

The mentioned risk factors lead to pathologies at the physical and mental level and, as a result, the child develops speech disorders.

Find out more about stuttering:

• symptoms and manifestations of the disease;
• diagnosing the problem;
• Do they give you a disability and do they take you into the army with logoneurosis?

Treatment of stuttering in patient R.

Reducing Anxiety

The first goal of cognitive behavioral therapy, as in the approach proposed by Van Riper, is to eliminate the patient's excessive anxiety. R. had so many avoidance situations that it was impossible to reduce or eliminate his excessive anxiety in his real environment. This is why a technique that Van Riper called “adaptation” was employed (1973, p. 289). In other therapeutic approaches, this method is called “massive practice” or “flooding technique”. This is a fairly simple method, during which the patient is intensively and repeatedly exposed to factors that instill fear. After a long session, the client feels tired or relaxed. In R.'s case, after an hour and a half of adaptation, he calmed down. As a consequence, in a paradoxical reaction described by Borkovec and his colleagues, the patient became extremely anxious (Borkovec and Sides 1979; Heide and Borkovec 1983). The flood session continued, and R. began to adjust to the feeling of relaxation that came over him. Until the end of the session, a state of relative calm was achieved for the patient. Without such work, R.'s further treatment would have been a failure. An increase in anxiety before relaxation occurs is commonly observed in hypochondriacal individuals (Avia, 1993).

This step in therapy was decisive. R.'s enormous anxiety about his stuttering decreased significantly, and he noted that after the therapy session the improvement in his speech that occurred was impressive. The patient's motivation to continue treatment increased significantly, and the frequency of avoidance episodes decreased sharply. This allowed R. to confront problematic situations for him on his own. For example, he incorporated long phrases into his normal speech after working on them briefly in therapy sessions. Soon he was able to have long conversations that did not impair the quality of his speech. The therapy process allowed him to demonstrate blocking of fear in everyday situations and in front of outstanding people, meeting whom was not accompanied by high levels of anxiety.

At this stage of therapy, high-level fluency and fluency of speech was achieved. However, additional successes began to be achieved much more slowly, since other psychological problems previously discovered in the patient needed to be eliminated. Overcoming hypochondriacal syndrome was chosen as the next goal of therapy.

Symptoms and forms of stuttering

Speech disorders with stuttering can be of the following nature:

• frequent repetitions of words or individual sounds;
• an increase in the time that a person spends playing sounds or syllables (the so-called prolongation);
• frequent speech stops;
• indecisiveness when reproducing sounds or syllables, which causes the rhythm of speech to deteriorate.

Depending on the nature of the speech disorder, the forms of stuttering are as follows:

• tonic – characterized by a pause when playing sounds or syllables or by stretching out a sound;
• clonic – observed when the same sounds, syllables or words are repeated several times;
• mixed - speech disorders characteristic of tonic and clonic forms of stuttering are simultaneously observed.

Depending on the cause of its occurrence, there are such forms of stuttering as:

• neurosis-like – observed in neurological disorders. Children with this type of stuttering lag behind their peers in development and begin to speak late;
• neurotic - observed against the background of stressful conditions - momentary (fear, worry) or chronic (constant psychological tension in the environment in which a person is located). The development of such children is normal. Adults with this form of stuttering speak almost without hesitation in a normal environment, but begin to stutter when a stressful situation arises.

With the neurotic form of stuttering, logophobia often occurs - fear of speaking.

Methods for correcting stuttering in children and adults directly depend on what form of pathology is observed.

The term “logoneurosis” is more logical to use when defining the neurotic form of pathology, but it is often used as a synonym for the word “stuttering”.

Other psychological problems of the patient and their overcoming

In cognitive behavioral therapy, treatment goals are clearly focused on problems that patients are able to resolve or are motivated enough to cope with. Other, equally important problems may also exist in the client, but work on eliminating them should be postponed until the course of therapy creates conditions when the client is ready to cope with them. This position does not interfere with therapy, because the patient understands that he is currently solving other problems and achieving other goals. Typically, success achieved in one problem area encourages the patient to confront the next problem and motivates him to continue therapy. If the patient interrupts treatment at a certain point, the results of therapy achieved up to that point are usually consolidated and even have an impact on other aspects of life.

Patient R. had some psychotic disorders that prevented effective and complete treatment of stuttering, primarily the hypochondriacal syndrome present in him. There were other problems, such as aggressive behavior, which came to the fore at a later stage of treatment, when the changes that had occurred in R.'s life, due mainly to the acquired fluency and fluency of speech, showed the importance of overcoming them.

Hypochondriacal syndrome

In this patient, a relaxed state, especially associated with sex, caused a significant increase in stuttering and associated anxiety. R. called his feelings “excruciating.”

In the religious education received by R., masturbation was considered a terrible sin and was seen as the cause of serious illnesses, including madness, tuberculosis, etc. When R. masturbated for the first time and experienced the relaxed state that usually follows sex, he began to fear that he would certainly acquire a terrible disease as punishment for his behavior. The fact that he realized years later that masturbation could not cause any disease, and he became a follower of agnosticism in his religious beliefs, could no longer solve anything. R. had already created and strengthened a conditioned connection between relaxation after sex and excessive anxiety, which had to be destroyed during therapy.

Treatment of hypochondriacal syndrome started with the recommendations given by Avia (1993). The main tool was the use of the body sensation exposure method. The goal of this technique is that the patient gives up his fear of his own sensations, which he interprets as illness. When these somatic symptoms of the body are perceived by the patient as normal, it is quite possible to rethink them and then interpret them as completely acceptable, normal, everyday sensations. The exposure method is used in conjunction with teaching the patient anxiety management techniques, which can quickly reduce anxiety caused by symptoms emanating from the body. Another effective way to reduce fear of your own physiological sensations is to rethink the bodily symptoms that arise and discover your body as a source of pleasure. In the case of R., this part of the treatment was completed completely, including the patient being able to accept other types of bodily sensations.

At this time, R. decided to suspend therapy. The goals of emergency treatment for his stuttering had been achieved, but the patient was not yet ready to confront other problems to get rid of the hypochondriacal syndrome.

As a result of the acquired fluency and fluency of speech, R. changed his place of work to a profession more consistent with his intellectual abilities. When changes occurred in his professional activities and other areas of life, R. had a desire to continue therapy. His efforts to implement changes in his life increased his stress, and the “torment” he felt increased in frequency and intensity. Treatment continued with the same strategies used to improve understanding and control of his own body. When R. felt that his “torment” had decreased and reached an acceptable level, he stopped therapy again.

Anger

At the beginning of therapy, the marital relationship was satisfactory, although there were episodes of violence on the part of R. with his loss of control over his own emotions and behavior. R. verbally attacked his wife, who defended herself by reproaching him for being overly restless, unclean and very aggressive. R's wife did not have sufficient tolerance for violence. From time to time, R.'s passionate and loud speech was interpreted by her as an attack.

Fluency in speech function, changing jobs, and the ability to manage anxiety provided balance in R.'s relationship with his wife. When R. began treatment, he was more dependent on his wife, a successful professional. At the time, his wife used guilt to stop R.'s attacks and reproach him after an outburst. The changes that occurred with R. increased the level of family income, and his social status became similar to that of his wife. Freedom helped him create stronger social relationships. Overall, his emerging tolerance for his own “torments” made him more resilient to his wife's reactions to violent outbursts. All these factors, as well as R.’s repeated therapy, contributed to the emergence of balance in the couple.

At this stage of treatment, R learned to deal with anger by following a program similar to that explained in Weisinger (1988). The abilities achieved in anger management allowed R. to significantly improve his relationship with his wife. R. left therapy without achieving all possible goals: the aggression was not completely controlled, and “torment” also continued to occupy the patient’s thinking. Reducing his own anger became such an important and priority for R that he sometimes neglected potential consequences in his relationships, such as divorce or the loss of the person whom he recognized as “the woman of his life.”

The problems that prompted R. to resume therapy did not affect his fluency and fluency of speech, which remained at a very high level.

Causes

Speech defects in children can be caused by multiple factors, both external and internal. If the child began to stutter from a very early age, at 2-3 years old, the origins should probably be sought in disorders of brain function. These will be congenital reasons:

• Pathologies of pregnancy. Problems with speech can be caused by intrauterine hypoxia, if for nine months the baby was pathologically lacking oxygen. The mother could have suffered serious infections while carrying the baby, and the little one could have suffered from an intrauterine infection.
• Problems during childbirth. If the birth was difficult, the baby could suffer from hypoxia during the birth process. Or the baby received a birth injury, which affected the normal activity of the brain. Often the cause of stuttering is the premature birth of a child.
• Genetics. If one of the child’s blood relatives stutters, there is a very high probability that the baby will also begin to suffer from this speech disorder. The genetic factor of stuttering is one of the main factors in determining the causes of the problem.
• Individual characteristics. If your child was born with a choleric temperament, then the likelihood that he will start to stutter is much higher than in sanguine or melancholic children. This is explained by the increased excitability and nervousness of choleric people.

Such stuttering is considered acquired:

• Psychological trauma. If a child has painfully suffered the loss of someone close to him, something has frightened him greatly, he is experiencing chronic, prolonged stress, and his speech may be impaired. Children who experience a critical attention deficit or, conversely, spoiled and capricious children may begin to suffer from stuttering. Often the psychological cause of stuttering lies in the excessive demands of parents and the preschooler’s fear of not meeting them.
• At risk are children from families in which there is an unfavorable psychological climate, scandals and quarrels often occur, parents have recently divorced, if the family allows physical punishment of the child. Children who spend a lot of time at the computer or in front of the TV are also at risk of becoming stutterers. They replace the real world with a virtual one, it becomes more difficult for them to communicate with others, and speech disorders develop.
• Physiological processes. In children under 5 years of age, the cerebral hemispheres have not fully matured and function in “test” mode; this can become a natural cause of stuttering. This speech disorder does not need correction; it goes away on its own, and quite quickly, as it grows.
• Past illnesses. Speech impairment can be a consequence of previous infectious diseases - meningitis or encephalopathy, brain injury - concussion, cerebral palsy, bruises. Sometimes the basis of stuttering is diabetes mellitus or influenza, acute respiratory viral infections and acute respiratory diseases suffered with complications.
• False stuttering. If someone in the child’s family stutters (mother, father, grandmother, grandfather, brother, etc.), the child can simply copy the speech style of a loved one. At the same time, he himself does not have any pathology. This phenomenon is called pseudostuttering.
• Attempts to transform left-handedness. Very often, children whose parents try to artificially change their preference for the left hand to the right begin to stutter. Left-handed children are more susceptible to stress; this is a feature of their psychology. If mom and dad constantly transfer the spoon and pencil from the child’s comfortable left hand to the right hand, this situation will become extremely stressful for the baby.

This episode of the program from a qualified doctor will tell you what may be the trigger for stuttering in children.

Carefully observing your child will help determine the cause of stuttering. If he begins to stutter only in a nervous or stressful situation, when he is very worried, in the presence of strangers, this may indicate an acquired stutter, neurotic, neurosis-like. With such a speech disorder, in a calm and familiar atmosphere, the baby usually pronounces everything quite normally.

If stuttering is permanent, independent of external factors (weather, the presence of strangers, the child’s excitement), then the cause of the disorder is probably malfunction of the brain, damage to the speech center.

Return to treatment for hypochondriacal syndrome

Finally, after several years of good family relationships, R. returned to continue therapy due to stress caused by previously familiar circumstances that increased his “torment.”

After a short course of training aimed at more calmly overcoming his problems, a functional diagnosis established the relationship between interruptions in his rest, the ability to manage anger and the resulting suffering. This conclusion became the basis for continuing therapeutic work, focused on the patient’s acceptance of the emerging feeling of disappointment, gaining control over the emotion of anger and a calm attitude towards “suffering.” The consequences of the rest breaks were no longer interpreted by R. as negatively affecting his feelings that would arise the next day. However, the patient's anxiety was not completely eliminated. At this time we began a controlled resurrection of the original frustrations associated with his father's earlier attacks. In cognitive behavioral therapy, childhood memories are viewed with the understanding that they are likely to have established a set of behaviors that are triggered even when they are no longer functional. These mechanisms are similar to previous settings that were mentioned by Van Riper (Van Riper 1973, p. 337). R.'s automatic response to disappointment was such a previous installation, triggered when it is necessary to solve a problem, and caused “suffering.” Rethinking the old situation and the emotions that arise from it had the goal of finding an alternative solution to the problem in order to first select and implement a new model of behavior (Arnz and Weertman, 1999; Littrell, 1999).

Self-analysis and re-examination of R.’s “suffering” led to the emergence of a feeling of guilt, directly related to his father’s scream and strict demand that he speak normally. Such paternal violence gave rise to a feeling of guilt in R. He felt that he had done something to deserve what he called "God's punishment." His father had absolute power, and appealing his opinions and decisions was not possible. R. felt a total sense of guilt because he could not do the basic things that other people do - speak freely and fluently. This situation, in turn, caused anger directed both at his father and at himself, as well as feelings generated by guilt, which he called “suffering.” Remembering these situations with maximum intensity of emotions, the current R., with his current knowledge and abilities, could tell the previous R. that he deserves neither such enormous criticism nor “divine punishment.” When he realized this, his “suffering” and destructive emotions disappeared during the session. He also realized that the masturbation he was doing had created the same style of thinking. He felt enormous personal guilt for threatening himself with illness and rewarding himself with “divine punishment.” Having understood and accepted this fact, the patient’s “suffering” practically disappeared, and if it reappeared, he already had the ability to quickly change his thinking, accepting the feelings that arose.

How to help a child, teenager, or adult who stutters?

How to help someone who stutters ? At the first consultation, the doctor will tell you whether you need logorhythmic exercises, breathing exercises, logorhythmics, speech breathing, tongue twisters for children who stutter, what are the psychological characteristics of stutterers, what is the corrective work, the work of a psychologist with children who stutter, how not to stutter when speaking . If a guy or girl stutters, it makes communication very difficult for them. And if an adult begins to stutter, then treatment should begin as soon as possible, before the pathological reflex to stuttering takes hold. Sarclinic knows how to help a child who stutters , how to stop stuttering, and how to understand that a child is stuttering. The earlier treatment is started, the greater the chances of complete relief from the disease.

Come to Sarclinic for a consultation and treatment, the doctor will try to help you cure your stuttering and logoneurosis.

Treatment of stuttering in Saratov, treatment of stuttering in Russia can be carried out in Sarklinik.

Sign up for a consultation. Reviews about the treatment. There are contraindications, consultation with a specialist is required.

Text: ® SARCLINIC | Sarclinic.com \ Sarlinic.ru Photo 1: (©) Valeriylebedev | Dreamstime.com \ Dreamstock.ru Photo 2: (©) Ruslanomega | Dreamstime.com \ Dreamstock.ru The children depicted in the photo are models, do not suffer from the diseases described and/or all coincidences are excluded.

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Comments ()

Discussion

R.'s treatment, like the treatment of most other cases, is a work in progress. The sequence of his treatment was as follows: first, efforts were aimed at overcoming stuttering, then treatment of hypochondriacal syndrome was carried out (for two years), the issue of overcoming anger and stabilizing family relationships (6 months) and, finally, returning to the problem of hypochondria (3 months) . In R's situation there are still some unresolved issues that are addressed to address the anger, but it is possible that this patient no longer needs additional support in solving his own problems.

It is noteworthy that R. acquired his social identity as a person who stutters. This identity still exists today. Sometimes R. has some blocks that proceed without concern, even if he has a conversation with important people, for example, with the general director of his company. The role of his father is very significant in the patient’s life: it aggravates R.’s stuttering and contributes to the emergence of anger.

My speech from 2012 to now

​At the moment, the attitude towards all this is neutral, since the serious problem of frequent and severe speech blockages has been solved. The difficult and terribly worrying problem is no longer there, but traces of it remain, in the form of infrequent stutters and slight freezes against the backdrop of negative memories from the past. And this is normal, if for 20 years in a row you have stumbled thousands of times in various situations when talking with someone, all this cannot just pass absolutely without a trace. But, in about 90% of the total volume of my speech, I do not have any doubts at all that I may not succeed. Accordingly, I speak at the same time absolutely freely and conveniently, naturally and comfortably. And this is a cool positive dynamic. And at these moments you don’t think about speaking at all, you just speak and that’s it. Can you speak normally? Well, so what? All the people around me manage to speak normally, but they are not happy about it, these are like completely ordinary incidents. So I’m no longer happy at these moments. I’ve gotten used to it, I’ve gotten used to it, now when speech is given “imperceptibly” (a very appropriate word!) – you don’t pay any attention to it at all. Like all other “normally speaking” people.

conclusions

Stuttering can be associated with the existence of various psychological problems. In R's case, these problems included the patient's inability to manage anger and the presence of hypochondria. Typically, all psychological problems associated with stuttering form a single chain in which the connection between the individual components is well established and secured. In R.'s case, stuttering caused a feeling of guilt, in turn, feelings of guilt provoked an increase in stuttering. Fear of possible “suffering” negatively affected his speech, while failures experienced in speaking caused “torment.” To achieve increased fluency and increased fluency, you may first need to make an effort to solve the existing psychological problem. For R, it was first necessary to break the connection between his relaxed state and the anxiety that arose in order for him to achieve improvement in his speech.

Acquiring smoothness and fluency of speech does not necessarily mean a complete solution to psychological problems. Dysfunctional attitudes must be eliminated and destructive patterns must be changed to achieve well-being in life. Another important aspect that is illustrated by the case of R. The fact is that understanding the situation does not necessarily imply solving the problem. Removal of hypersensitivity and changes in response patterns (established patterns) are often necessary. Cognitive behavioral therapy has the tools to effectively address many of these problems.

Another aspect demonstrated by R.'s case is that solving speech problems leads to global changes in the life of a person who stutters, which the patient must also learn to manage. If there are unresolved psychological problems that act as an obstacle to free conversation, then such problems may become more obvious over time or may hinder the patient's progress. This happened to R. in the aspect of managing his own anger.

The case of patient R. is unique, since his existing psychological problems were closely related to the factors underlying his stuttering. But it is also important to remember that most people who stutter do not have any special or unusual psychological problems other than those directly caused by stuttering.

August 13, 1999

You can learn about the treatment of stuttering with hypnosis on the website of psychologist and hypnotherapist Gennady Ivanov.

Causes of stuttering

This pathology can begin at any age. Often the onset of the disease is associated with serious psychoneurological shocks. Although most often the problem is identified in the earliest years. During the period when the child just begins to speak in whole words and sentences. Experts include the following in the list of causes of pathology:

• congenital weakness or underdevelopment of the articulatory apparatus;
• hereditary predisposition;
• brain damage that occurred during birth;
• sudden fears;
• rickets or malnutrition at an early age;
• traumatic brain injuries;
• severe infectious diseases;
• complications of diseases of the larynx, tongue and oral cavity.

Most of the reasons are removable. Including problems associated with disruption of the structure of the articulatory apparatus.