Background: Stuttering is a neurodevelopmental disorder that impacts motor system functioning and is characterized by abnormally high frequencies and/or duration of stoppages in the flow of speech. With a prevalence of 0.7-1% in the general population, we can presume that approximately 50 000 Norwegians stutter.
Although varying individually and contextually, stuttering can have a negative impact on education, career, and social life, and can significantly influence both communication and quality of life. Lack of belief in one’s ability to speak can lead to avoidance behaviors and social withdrawal. Research has shown considerable individual variation in response to a large number of stuttering therapy approaches, and treatment programs with many hours of contact do not necessarily seem to offer different outcomes to those with fewer. The present study confirms that there are multiple factors which may influence a person’s reasons for seeking stuttering therapy, their goals for therapy, and the outcomes of that therapy. To date, there is only limited empirical evidence demonstrating that issues that the individual considers personally significant are fully addressed in stuttering therapy.
Supported by Stiftelsen Dam (the Norwegian Extra Foundation for Health and Rehabilitation), this study is a wider-ranging treatment study of individualized stuttering management tailored to the participants’ personal goals and preferences. The therapy format in the present study was grounded in practice-based evidence, in considerations of ‘what makes a difference to a particular person at a particular time point?’. Following feedback from the participants regarding their therapy preferences, the elements were further categorized and systematized. The approach was subsequently entitled the Multidimensional Individualized Stuttering Therapy (MIST). The approach combines awareness-based elements from Acceptance and Commitment Therapy (ACT) with stuttering and speech modification interventions.
The MIST approach works through the combined clinician and client selection of range of factors across five areas: 1) general breathing patterns and body tension, 2) breathing patterns during speech production, 3) vocal features in speech production, 4) value and mindfulness-based strategies, and 5) general communication and/or presentation skills.
Aim: The overall aim of this thesis was to explore the extent to which the MIST approach has the potential to help people who stutter. The aim of the thesis is threefold: a) To explore individual aspects of people who stutters' motivation for treatment and improvement goals, b) to investigate the therapeutic alliance within stuttering treatment, including but not limited to the person’s belief in the treatment process and degree of motivation, and c) to evaluate the extent to which the MIST approach has a positive impact on overall speaking ability, confidence in communication, avoidance behaviors, and quality of life.
Methods: An A-B-A Single Case Research Design (SCRD) was used to address the research questions. This design provides an appropriate framework from which to evaluate the procedures used in stuttering therapy and to determine its potential. Twenty-one adults, aged between 21- 61 years, took part in a pretherapy interview. Eighteen adults went on to engage in the explorative MIST approach. The treatment lasted for two months. It comprises a total of 10 hours of face-to-face therapy time spread over four treatment sessions, with follow-ups up at 1-, 3-, 6-, and 12 months post-therapy.
Results: All participants who commenced the therapy approach completed it. Findings indicated that the majority of participants wished to focus on both physical and psychological aspects of therapy, and 95% of participants regarded the goal ‘to gain a sense of control over the stuttering’ as important. Qualitative data identified four primary areas in which participants wanted to improve: speech fluency, emotional functioning, daily life activity and participation, and understanding of their stuttering. Participants’ perspectives on their speaking ability and stuttering interference in communication were identified as central factors, particularly in social and professional settings. Analyses demonstrated significant associations between the working alliance, client motivation and treatment outcomes. When the values reflecting the quality of the working alliance were high (indicating a positive working alliance), scores reflecting treatment outcomes associated with improved speech, communication and social activity were indicating a positive change. The Multidimensional Individualized Stuttering Therapy (MIST) was associated with a significant effect on improved speaking ability, and a significant difference was found between improved speaking ability and reduced stuttering severity. The findings confirm strong associations between the speaking abilities experienced by the person who stutters, confidence in communication, avoidance related behaviours, and quality of life. When the relationship between participants’ satisfaction with MIST and therapy outcomes was investigated, strong associations were found between the participants’ levels of satisfaction and improved speaking abilities.
Conclusion: The findings in the present study indicate that the Multidimensional Individualized Stuttering Therapy (MIST) is an effective treatment approach in stuttering management, highlighting the value of incorporating personal values in flexible therapy approaches that integrate both speech changes and awareness-based skills from the ACT. As demonstrated in this study, the nature of a multi-faceted, individualized approach means that the relative weighting of different subcomponents in therapy needed to vary from individual to individual.