Valsalva Control Stuttering Therapy

Valsalva Stuttering Therapy is a comprehensive new approach for treating the most common form of stuttering, often referred to as “persistent developmental stuttering.” Valsalva Stuttering Therapy is based on the realization that most stuttering is caused not by a lack of ability to speak, but rather by an interference with that ability. This interference is neurological and physiological in nature, but it may be triggered by various psychological factors. In addition to addressing the psychological factors, Valsalva Stuttering Therapy promotes easy, natural speech by controlling the physiological mechanism that causes stuttering blocks.

Valsalva Stuttering Therapy offers people who stutter a new opportunity to enjoy easy, effortless speech without drugs, without electronic devices, and without unnatural-sounding speaking techniques. It is very different from the “fluency shaping,” “stuttering modification,” or “voluntary stuttering” approaches to therapy. It does not rely on “targets” or “artificial fluency” gimmicks.

Rather than focusing on controlling one's speech, Valsalva Stuttering Therapy is aimed at controlling the body’s Valsalva mechanism and reducing the urge to exert effort, so as to free the person’s own natural speaking ability. Valsalva Stuttering Therapy intentionally does not emphasize fluency, because any effort to “stop stuttering” would tend to activate the Valsalva mechanism and be self-defeating. Natural fluency cannot be forced. Instead, the goal is to make speech easier and more enjoyable, thereby allowing fluency to follow on its own.

Stuttering and the Valsalva Mechanism

The Valsalva mechanism includes the larynx in the throat and various muscles in the chest and abdomen. These are neurologically coordinated to perform Valsalva maneuvers by simultaneously squeezing to build up air pressure in the lungs. In a normal Valsalva maneuver, you hold your breath by closing your larynx tightly – a function called effort closure. Meanwhile, your abdominal and chest muscles squeeze to increase the air pressure. The more these muscles squeeze, the tighter your larynx closes to resist the increasing air pressure. The purpose is to make the trunk of the body rigid, so that effort can be exerted more efficiently. Valsalva maneuvers are normally used to help us lift, push, or pull heavy objects, or to force things out of the body (such as bowel movements). The Valsalva maneuver is also associated with the “fight or flight” response to danger.

Stuttering blocks usually occur when the person who stutters (PWS) feels the urge to use extra effort in speaking – usually in response to anxiety or because he or she anticipates that saying a word will be difficult. Anxiety about speaking may trigger a reaction of the body’s sympathetic nervous system (part of the autonomic nervous system). This reaction neurologically prepares the larynx to exert effort as part of a Valsalva maneuver, rather than to phonate the vowel sound of the word or syllable in question. The vowel sound is the natural place for effort to be exerted, because it is the part of a syllable with the most energy. Therefore, stuttering blocks occur in the brain, even before the person tries to say the word.

The PWS then gets stuck on the initial consonant of the word – either repeating, prolonging, or forcing on it – because the larynx is not prepared to phonate the vowel sound that follows. The lips or tongue may press forcefully to build up pressure in the lungs, in an attempt to force out the word by means of a Valsalva maneuver. In words that start with vowels, the result is tight closure of the larynx, either continuous or repetitive.

The PWS mistakenly believes that the initial consonant caused the block and that effort was needed to overcome it. Although exerting effort might instinctively feel like the right thing to do, it actually strengthens the block and perpetuates stuttering. The real problem is not the consonant, but the speaker’s inability to phonate the subsequent vowel sound.

There are many reasons why the urge to exert effort may have originally developed, depending on the individual. Some persons may have had neurological weaknesses or delays in the motor programming of speech as children, which caused them to feel that speech was difficult and required extra effort. Such neurological weaknesses could also make their programming of speech susceptible to interference by anxiety or other emotions. Some of these traits may have been inherited. Other individuals may have learned to use effort in response to excessive demands on their speech or because of stressful environments. Regardless of the reason, the prolonged repetition of this behavior creates strong nerve pathways that may perpetuate stuttering even after the original factors subside.

Is Valsalva Control Appropriate for You?

Valsalva Control is intended for treatment of what is often referred to as persistent developmental stuttering. These are some of its characteristics:

	“Developmental stuttering” usually begins in childhood and is not associated with brain damage. It is “persistent” if it continues into adulthood.
	It is basically a speech problem rather than a language problem. The person knows exactly what he or she wants to say, but is sometimes blocked when trying to say the words.
	The person is able to talk fluently some of the time, and stuttering severity may vary depending on the speaking situation. The person is usually able to sing, mouth words silently, whisper, speak in unison with other people, and make isolated vowel sounds without blocking.

Valsalva Control may be especially appropriate if, in addition to the above, you also experience the following:

	Sometimes you feel as if an upcoming word contains a “brick wall” that will require force to break through.
	You often get stuck on the beginning consonants of words or syllables (or on the laryngeal closure at the beginning of words that start with a vowels) and are unable to vocalize the vowel sound that follows. You find yourself repeating, prolonging, or blocking on these initial sounds.
	Sometimes you find your words being blocked by tightness in your mouth or larynx (throat), accompanied by tension in your chest or abdomen and a build-up of air pressure in your lungs.
	There also may be times when your voice doesn’t respond when you want it to.

Advantages of Valsalva Control

Valsalva Stuttering Therapy should be seriously considered as an approach to stuttering therapy because it is:

	The only approach that directly addresses the Valsalva mechanism's involvement in stuttering behavior;
	Comprehensive in that it addresses both the psychological and physiological aspects of stuttering;
	Consistent with natural-sounding speech;
	Harmless, non-invasive, and without adverse side effects; and
	Not dependent on drugs or devices.

How Long Will It Take?

The time required to achieve optimal results varies for each individual. The regular Valsalva Stuttering Therapy Program includes 25 hours of therapy over a period of approximately 18 weeks. The program specifies 10 hours of instruction and practice during the first three weeks. This is followed by individualized counseling sessions of one hour per week to help transfer skills to ordinary speaking situations. The therapy can be done either by Skype™ (subject to applicable law) or in my Philadelphia office. The regular therapy program can be followed up with optional additional sessions, on an hourly basis.

In addition to therapy sessions, participants must also do at least 30 minutes of practice every morning, plus an additional 30 minutes during the day. Participants must also practice their speaking exercises when talking with therapy partners (e.g., spouse, friends, or family), and eventually with other people.

A 15-hour Short Program, given over a period of approximately eight weeks, is available for persons whose stuttering is relatively mild or who are unable to commit to the full program. The purpose of the Short Program is to provide education and to teach basic Valsalva Control principles and skills. It does not include “transitioning” Valsalva Control to everyday speaking situations, which is a gradual process that usually requires additional, individualized therapy over a longer period of time.

Will You Be “Cured”?

Ethically responsible speech-language pathologists avoid using the term “cure” in regard to stuttering in adults. Currently there is no therapy, drug, or device that totally eliminates stuttering in all stutterers all the time. The results of any stuttering therapy will vary depending on the individual. Although clinicians will use their best efforts to help to improve your speech, the results of stuttering therapy cannot be guaranteed and therapy fees are not refundable.

The reason is that long-established nerve pathways for stuttering may be weakened, but they cannot be totally eliminated. Some vestiges of them may remain in your brain indefinitely. Therefore, don’t be surprised if they continue to cause occasional blocks, particularly when you’re stressed or excited. Nevertheless, much can be done to improve fluency and to make speech easier and more enjoyable.

Your speech should continue to improve long after formal therapy is completed. Using the skills, insights, and natural way of speaking that you have learned, you will be in a position to make further progress on your own. The more you go out and talk, the easier and more enjoyable speaking will become.

StutteringTherapist.com

Valsalva Stuttering Therapy:

A Brief Introduction

by William D. Parry, Esq., CCC-SLP

Valsalva Control is intended for treatment of what is often referred to as persistent developmental stuttering. These are some of its characteristics: