Valsalva Stuttering Therapy: A Brief Introduction
by William D. Parry, Esq., CCC-SLP
Copyright © 2016 by William D. Parry
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. Furthermore, it recognizes that the interference with speech does not begin in the mouth, but rather in brain - even before the person tries to say the word being blocked. This interference may involve a freeze response, which inhibits phonation of the vowel sound - the loudest part of a word or syllable. It is usually accompanied by a strong impulse to exert effort through activation of the body’s Valsalva mechanism (named after Italian anatomist Antonio Maria Valsalva who lived from 1666 to 1723).
Valsalva Stuttering Therapy addresses the neurological and physiological core of stuttering blocks - the brain's substitution of motor programs for effort instead of phonation of vowel sounds, in response to anxiety or the anticipation of difficulty in speaking. Consequently, the larynx is not prepared to phonate the word's vowel sound, causing speech to get stuck on the consonant or glottal stop preceding the vowel sound. Because of this, speakers often feel that an upcoming word contains an obstacle, or "brick wall," even before they try to say the word.
Stuttering behaviors then occur as maladaptive struggles to overcome these internal blocks. The block is usually accompanied by a strong impulse to exert physical effort in the lips, tongue, or larynx, often involving the build-up of air pressure by the body's Valsalva mechanism in a self-defeating attempt to "force out" the word, as if it were a physical object
Because the larynx isn't ready to phonate the vowel sound, the speech mechanism hesitates or gets stuck on the consonant preceding the vowel - repeating, prolonging, or forcing on it. In words that begin with vowels, the repetitions or forcing may focus on the "glottal stop" - the brief closure of the larynx to build up air pressure to accentuate the beginning of the vowel sound. These are the behaviors called "stuttering." The harder the speaker tries to force out the word, the stronger the block becomes.
Consequently, it may be said that stuttering is best understood and treated as a specific kind of voice problem, and not as a "fluency" problem or an "articulation" problem. Once the voice problem is fixed, the stuttering behaviors will disappear on their own.
By understanding the "voice problem," Valsalva Stuttering Therapy is able to address more effectively the physiological, neurological, and psychological aspects of stuttering, teaching effective new ways to:
Rather than focusing on "controlling" one's speech, Valsalva Stuttering Therapy promotes easy, natural speech by:
Valsalva Stuttering Therapy intentionally does not emphasize "fluency" per se, because efforts to “stop stuttering” are usually self-defeating. Natural fluency cannot be forced. Instead, the goal is to free you to express yourself in an easy, effortless, and natural way, thereby allowing natural fluency to follow on its own.
Valsalva Stuttering Therapy, in its current form, has been developed through actual clinical experience, experimentation, and practice-based evidence, involving the participation of more than two hundred persons who stutter from all over the world. Individualized counseling also helps you transfer Valsalva-relaxed speech to everyday speaking situations.
The Standard Therapy Program includes 15 hours of individual online therapy sessions and daily independent practice over a period of approximately 4 months.
In order to allow the therapy sessions to focus more efficiently on your own specific needs, both programs are supplemented by the following Materials Package, which can be downloaded:
The time required to obtain optimal results will vary depending on each individual. However, the insights and skills learned from Valsalva Stuttering Therapy may enable you to achieve further progress on your own, while reducing the possibility of relapse. You can also arrange additional therapy on an hourly basis, as needed.
Basic Elements of Therapy
Valsalva Stuttering Therapy has three basic elements – education, practice, and transfer:
Is Valsalva Stuttering Therapy Appropriate for You?
Valsalva Stuttering Therapy is intended for treatment of what is often referred to as persistent developmental stuttering. These are some of its characteristics:
Valsalva Stuttering Therapy may be especially appropriate if, in addition to the above, you also experience the following:
Advantages of Valsalva Stuttering Therapy
Valsalva Stuttering Therapy should be seriously considered as an approach to stuttering therapy because it is:
The exercises in Valsalva Stuttering Therapy are designed to promote easy, effortless speech by rooting out the effort impulses that lead to stuttering blocks. Rather than teaching superficial “fluency” tricks, which tend to be ineffective in actual speaking situations, the exercises seek to permanently resolve the principle cause of stuttering: the substitution of excessive physical effort (as in a Valsalva maneuver) in place of the normal phonation of vowel sounds. The exercises accomplish these objectives in various ways, including the following:
Relaxation of the body’s Valsalva mechanism through Valsalva-relaxed breathing. The purpose of these exercises is to prevent the occurrence of Valsalva maneuvers, in which the exhaled breath is blocked in the larynx or mouth for the purpose of building up air pressure in an attempt to “force out” words. Because the muscles of the Valsalva mechanism are neurologically coordinated to act as a “team,” the relaxation of one part of the mechanism tends to relax the others. Among other things, participants are taught to relax the puborectalis and abdominal muscles while exhaling, as a way to relax the Valsalva mechanism and prevent forceful blockage of airflow. Valsalva-relaxed breathing is incorporated into all the other exercises. The puborectalis muscle, which is part of the Valsalva mechanism, can also be used to discharge “effort impulses” that result in blocks.
Reprogramming your speech mechanism. One of the therapy’s principle exercises is aimed at eliminating the tendency of phonation and articulation to interfere with one another, resulting in blocks. You are taught how to perform continuous phonation through your nose while silently articulating the words in your mouth. In this way, the articulation of consonants cannot build up air pressure and trigger Valsalva maneuvers, while the larynx is always ready to phonate the vowel sounds. This frees articulation from phonation and vice-versa and frees you from your habitual pattern of effortful speech. You then gradually allow more air through your mouth, while maintaining the same Valsalva-relaxed breathing, phonation, and articulation. Phonation and articulation are thereby gradually re-integrated in an effortless, Valsalva-relaxed way.
Valsalva-relaxed production of phonation and vowel sounds. Participants practice bringing together and adjusting the pitch of the vocal folds while exhaling Valsalva-relaxed breaths. They practice shaping the airflow in the mouth to produce the various vowel sounds, instead of pressing on the consonants (or the glottal stop, in words starting with vowels). Participants are taught to anticipate and prepare for shaping and voicing the “key vowel sound” in a word or phrase, instead of fixating on the consonants.
Valsalva-relaxed articulation. Various exercises reduce your urge to force on consonants by teaching you to view and process words as melody and movement, rather than as physical objects to be forced out of the body.
Resonant, Valsalva-relaxed speech. The final result of the therapy is easy, effortless, natural-sounding speech. But before this can be achieved, the participant must practice and master each step along the way. Each aspect of the therapy must be diligently practiced so that it becomes habitual and provides the foundation on which to build the next step. The purpose of Valsalva Stuttering Therapy is to make lasting changes in underlying speaking behavior as well as attitudes about speech. These changes must be continuously practiced so they will become second nature and hold up even in stressful situations.
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 each 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 reduce the frequency of such blocks, to help you handle them when they occur, and to make speech easier and more enjoyable.
Valsalva Stuttering Therapy has produced significant improvements in both fluency and the overall impact of stuttering in the great majority of participants, while preserving natural-sounding speech.
As with any kind of therapy, the time needed to achieve the desired results will vary, depending on each individual. In the case of Valsalva Stuttering Therapy, 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.
Last revised: 5/23/2020