Clients who stutter, especially those who experience intense emotional and cognitive stressors, can greatly benefit from learning and practicing mindfulness-related strategies.
Mindfulness is the practice of being present and fully engaged in the current moment, without judgment or distraction. It’s a popular tool in therapeutic spaces with a myriad of benefits, including reductions in stress, depression, and anxiety, as well as improved emotional regulation, attention and working memory, and overall psychological well-being.
Let’s talk about it:
What is Mindfulness?
Mindfulness is the practice of being present in the moment and fully engaged in what we’re doing or experiencing. It involves paying attention to our thoughts, feelings, and sensations without judgment, and thereby “accepting what is” rather than ignoring or shutting down the experience. By focusing on the present moment and practicing this non-judgmental awareness, we can reduce stress and anxiety, improve cognitive function, and enhance emotional regulation, while also responding more effectively to challenging situations.
By returning our attention and observation to the present and letting thoughts and judgements slip away, we can gain better insight into what’s happening and what we can do about it.
Why is Mindfulness Helpful?
The sympathetic nervous system – better known as the fight/flight/freeze response – is a survival mechanism that has been hardwired into our brains for thousands of years. When we encounter a threat, our bodies automatically release adrenaline and cortisol, preparing us to either fight the danger, run away, or quite literally freeze. In this state, we’re wrapped up in the thoughts and emotions that come from a stressful or challenging situation, and our brains are determined to figure out a way to get out. While this response was essential for our ancestors, it’s not so helpful in modern society. Today, we face more emotional, rather than physical, threats, like work stress, relationship problems, and (particularly for people who stutter) communication anxiety. However, because our brains still consider these situations as “threats”, they continue to trigger the sympathetic nervous system (and the thoughts and emotions that come with it), even though there is no real danger.
Mindfulness is an immensely powerful tool that can slow down and interrupt the sympathetic nervous system, and then shift the body towards the parasympathetic nervous system – also known as rest/digest.
When explaining mindfulness to clients, I often make the comparison between the sympathetic response we habitually find ourselves in, where we feel like we’re caught in a corner, having to react right now and move quickly (or sometimes even blacking out in extreme cases) to the parasympathetic, where we feel a little more space around us, a few more choices, and increased capacity to respond with a little more clarity to what’s happening around us.
That’s our goal when we work on mindfulness with people who stutter.
Our Brains on Mindfulness
Mindfulness is a practice that has been extensively researched in the fields of psychology, neuroscience, and medicine. Based on these studies, mindfulness has been found to:
- Activate the prefrontal cortex, which is responsible for executive functions such as attention, decision-making, and self-control.
- Reduce activity in the amygdala, which is responsible for the sympathetic response and the processing of emotional stimuli.
- Increase the thickness of the prefrontal cortex and insula, which are involved in self-awareness and sensory processing.
Mindfulness Challenges
At its core, mindfulness is paradoxical, and therefore tricky to teach: you have to feel, experience, and accept in order to let the thoughts and feelings go. If you try to be mindful, you might be trying too hard. We want to observe the thoughts without getting wrapped up in them. And most importantly, you often can’t think or analyze your way into mindfulness – since getting caught up in the thinking and analyzing is the problem we’re trying to get out of in the first place.
It can also be frustrating: the thinking parts of our brains – the areas in charge of reasoning, problem-solving, and fixing – are immensely trained and powerful, so it can be hard to shift our attention to observing and letting go.
Mindfulness is also the exact opposite of what we’re usually prone to do during stressful moments. Our sympathetic nervous systems are strong, and we can easily get triggered into the fight/flight cycle, sometimes without even realizing it – and especially if we’re habitually in this state.
Therefore, I’m always quick to emphasize that it’s a mindfulness practice, and the practice piece comes from the repeated act of shifting out focus. We’re not trying to be completely calm and zen out all the time, and we’re also not trying to stop ourselves from experiencing or being affected by what’s happening around us. Instead, the goal is to continuously practice shifting our attention gently back to noticing the present and observing what’s happening, so we can better understand how we’re feeling, what’s happening around us, and how we can navigate the situation, all without getting completely wrapped up in fight/flight experience.
So, when your clients tell you things like, “it’s so hard to focus” or “I get distracted when I try to be mindful”, that’s actually a good thing! Encourage them around the act of noticing and continuously shifting back, because that’s the whole point.
The How
Mindfulness can be seen as a very broad category encompassing a wide range of activities that can be described as “mindful”. This includes, but is not limited to, meditation (guided or unstructured), emotional freedom technique (EFT), visualization, yoga, prayer, and activities such as mindful running (without music), mindful walking, and even mindful eating and cleaning. Clients can do practically anything mindfully once they have a mastery of the basic concepts, which make it easy to apply to real-life situations.
The basics of mindfulness are:
- Bring your attention to the present, or something in the present – what’s happening around you, what you may be thinking or feeling, what you’re looking at, etc.
- Anytime your attention starts to shift, bring it back to what you’re focusing on.
That’s it! If it helps to have a bit more structure, have your clients try:
- Feeling quieter or calmer within themselves.
- Focusing on breathing: feeling the regular inhale and exhale (not changing, not fixing, not moving, just noticing).
- Doing a body scan, or noticing any places of pressure or tension (not changing, not fixing, not moving, just noticing).
- Feeling points of contact: feet on floor, legs on chair, hands on table, etc.
- Softly focusing your eyes on something in front of you.
And if their brain’s need something to do, try:
- Counting breaths up to 10: 1 on the inhale, 2 on the exhale, 3 on the inhale, etc., and then starting over once you get to 10.
- Square breathing: inhaling for 4 seconds, holding for 4 seconds, exhaling for 4 seconds, holding for 4 seconds.
- Noticing five things they see, four things they feel, three things they hear, two things they smell, and tey thing you taste.
- Repeating a word or phrase in their head or out loud.
- Guided meditations or visualizations.
As your clients do any or all of these activities, encourage them to observe if any thoughts come up and if their attention starts to shift – and when it does, gently move back to whatever they’re focusing on, for as many times as it takes until the end of the activity.
Beginner Tips
Keep time: timers can be helpful, and especially useful when your clients want to track any progress they’re making (but remember, progress may also not be linear).
Think of blue skies: when a storm comes, we know that there’s blue sky behind the rain and clouds. Similarly, when we’re practicing mindfulness, our thoughts can hard to ignore or it may feel difficult to shift our focus. However, we always know that there’s space beyond those thoughts, so keep practicing gently moving your focus back as catch yourself.
It’s not about perfection: I’ve been practicing various forms of mindfulness for years now, and there’s been many times where it’s been challenging. There was even one time within the past week where I just gave up. And that’s ok. I’m attuned to how I feel in the moment – which is the important part – and I’m ready to try again whenever the situation calls for it, because it’s a practice.
“Stopping” is a bad thing: as I mentioned above, we’re not really trying to “stop” anything from happening. The thoughts are going to come, the emotions are going to be felt, and the physical sensations are going to be there, along with whatever is happening around us. In fact, there are many instances where through mindfulness, we actually want to feel more of what’s happening – while letting go of our attachment to the thoughts and stories. So remember: it’s notice, focus, and let go…not stopping the experience.
How to Apply in Therapy
Like any strategies or behavior changes we target, I like to work on mindfulness up through the speech hierarchy. This usually means identifying one or two activities that seem accessible, and practicing them in the therapy room first (either on their own or through role-playing activities). Then, I have the client practice in different easy situations outside the therapy room, while progressing up to more challenging situations.
Helpful Apps
Headspace – great for kids and adults, and those just starting to learn about mindfulness and meditation
Insight Timer – expansive (free) library by teachers across the world, great for specific topics and concepts (e.g., mindfulness for stress, meditation for anger, etc)
Other options:
Further SLP-Specific Reading:
Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012). Acceptance and commitment therapy for adults who stutter: Psychosocial adjustment and speech fluency. Journal of fluency disorders, 37(4), 289-299.
Blood, G. W., Blood, I. M., Dorward, S., Boyle, M. P., & Tramontana, G. M. (2011). Coping strategies and adolescents: Learning to take care of self and stuttering during treatment. Perspectives on Fluency and Fluency Disorders, 21(3), 68-77.
Boyle, M. P. (2011). Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. Journal of fluency disorders, 36(2), 122-129.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological inquiry, 18(4), 211-237.
Cheasman, C. (2007). Revealing and healing—A mindfulness approach to stammering. Speaking Out, (Spring), 9-10.
De Veer, S., Brouwers, A., Evers, W., & Tomic, W. (2009). A pilot study of the psychological impact of the mindfulness-based stress-reduction program on people who stutter.
Emge, G., & Pellowski, M. W. (2019). Incorporating a mindfulness meditation exercise into a stuttering treatment program. Communication Disorders Quarterly, 40(2), 125-128.
Freud, D., Levy-Kardash, O., Glick, I., & Ezrati-Vinacour, R. (2020). Pilot program combining acceptance and commitment therapy with stuttering modification therapy for adults who stutter: A case report. Folia Phoniatrica et Logopaedica, 72(4), 290-301.
Garcia-Rubio, C., Rodríguez-Carvajal, R., Castillo-Gualda, R., Moreno-Jiménez, J. E., & Montero, I. (2021). Long-term effectiveness of a mindfulness based intervention (MBI) program for stuttering: A case study. Clínica y Salud, 32(2), 55-63.
Gupta, S. K. (2015). Mindfulness-based cognitive therapy in early adolescents who stutter. Delhi Psychiatry Journal, 18(2), 452-455.
Gupta, S. K., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. The International Journal of Indian Psychology, 3(3), 78-87.
Harley, J. (2015). Bridging the gap between cognitive therapy and acceptance and commitment therapy (ACT). Procedia-Social and Behavioral Sciences, 193, 131-140.
Harley, J. (2018). The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. American journal of speech-language pathology, 27(3S), 1139-1151.
Leary, M. R., Tate, E. B., Adams, C. E., Batts Allen, A., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. Journal of personality and social psychology, 92(5), 887.
Medina, A. M., & Mead, J. S. (2021). An exploration of mindfulness in speech-language pathology. Communication Disorders Quarterly, 42(4), 257-265.
Mongia, M., Gupta, A. K., Vijay, A., & Sadhu, R. (2019). Management of stuttering using cognitive behavior therapy and mindfulness meditation. Industrial psychiatry journal, 28(1), 4.
Plexico, L. W., Manning, W. H., & Levitt, H. (2009). Coping responses by adults who stutter: Part I. Protecting the self and others. Journal of fluency disorders, 34(2), 87-107.
