Fluency Strategies: A Cheat Sheet to Treatment

Stuttering can be a challenging disorder for many therapists to treat. Many speech-language pathologists have never taken a specific course in stuttering and lack confidence in their treatment skills in this area. Current evidence suggests the best methods for addressing stuttering is by using a combined approach including cognitive behavioral therapy, fluency shaping, and fluency modification techniques. It’s no wonder many clinicians find this intimidating! To simplify what that means, here’s the basic breakdown of each:

Cognitive Behavioral Therapy. This involves both restructuring negative thought patterns as well as desensitizing the stuttering itself. Here are some ways to tackle this:

  1. Talk with your student about how they view and perceive their own stuttering. Discuss environments where they notice their stuttering increasing or decreasing. Encourage them to develop self-awareness/monitoring through the use of a speech journal. Allow them to reflect on their emotions including experiences of teasing, embarrassment, and/or shame.
  2. Help reduce anxieties and fears related to stuttering by making a plan for stressful situations. The plan may involve using a controlled fluency technique (see fluency shaping below), using relaxation techniques, or teaching “easier ways” to stutter to reduce tension (see fluency modification below).
  3. The goal of CBT is to shift negative thoughts and/or beliefs about their stutter to a healthier place by examining beliefs, evidence and reflection with clinician guidance. This can help reduce negative self-talk which may increase anxieties surrounding their stuttering.

Fluency Shaping. These strategies are used when an individual wants to control/minimize their stuttering.

  1. Slower rate: Slowing the rate of the word production, especially on the initial sound to reduce stuttering and allow more time for motor planning and execution.
  2. Phrasing (also known as pausing): this strategy allows the student to slow down their rate and proceed and comfortable rate of speech to reduce stuttering.
  3. Easy onsets: encourage the student to start phonating at the level of the vocal cords then stretch the first sound of the targeted word. I allow my students to name this method (e.g., turtle talk, taffy talk) something they will remember and can be used as a cue.
  4. Light articulatory contact (also known as continuous phonation): encourage soft articulation with continuous air flow. Keeping the airflow even as stop consonants are producing can help to avoid becoming “stuck” on a sound.

Fluency Modification. This aim of this category of strategies is to provide the student with ways to lessen tension during inevitable moments of stuttering.

  1. Cancellation: (1) A full cancellation is when a student experiences a stutter, they repeat the word that was stuttered and imitates the stutter (pseudo stuttering) that occurred, then relax the sound to smooth the stutter out.  (2) Simple cancellation is when a student experiences a stutter, they repeat the word in a relaxed and smooth fashion.
    • Often times when a person stutters, they struggle to “hurry up” through the stutter, building tension, to get on to the next word. These struggling behaviors get naturally reinforced in the brain as the tension/struggle behaviors become associated with the “release” when the student is finally able to move on to the next word. This strategy helps to rewire the brain so the relaxation becomes reinforced and associated with the “release” to move on to the next word.
  2. Pull out: When the student experiences a moment of stuttering, they attempt to “catch” the stutter by holding on to it (prolonging it slightly) then relaxing the tension, often through the use of a stretched sound, before finishing the word. This strategy requires a high degree of self-awareness and monitoring. A good place to begin in therapy is by first training the student to pause independently (or with visual/verbal cues that are faded) after a moment of stuttering.
  3. Preparatory set: This strategy, like the pull-out strategy, involves a high degree of self-awareness and monitoring. The student anticipates a stutter and before saying the word that will be stuttered, they use a strategy, such as an easy-onset, to produce the word more easily.

Author: Allie Laubenstein, M.S. SLP

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