Stress Management

Rule No 1: Don’t sweat the small stuff. Rule No 2: it’s ALL small stuff. And if you can’t fight and you can’t flee, flow. --- Robert Eliot, a cardiologist at the University of Nebraska




Stuttering is to a large extent * stress-related. It therefore follows that the person who stutters will have to manage his tension levels in order to increase his control over his speech.

In the previous four chapters we looked at a speech technique which reduces speech tension. In this chapter, the focus will be on ways to reduce base-level tension.


What is tension?

We all know what being tense feels like – those clammy palms as you await your turn to do an oral examination, the accelerated pulse rate, the lump in the throat ... We have several names for these responses: ‘nerves’, pressure, excitement, panic, stress, tension. But what exactly IS tension?

Canadian biologist Hans Selye, the world-renowned authority on tension, has described tension as the rate at which we live at a given moment. All living beings are subject to a measure of tension, and any intense experience – whether pleasant or not – temporarily increases that tension. This means that in terms of tension, a painful blow and a passionate kiss can have the same effect.


Fight or flight

Tension is often the result of the body’s response to a real or perceived THREAT. This ‘fight or flight’ response, as it is also known, is a mechanism which is activated to release the additional energy required to counter the threat.

Prehistoric man could survive a threat by either fighting or fleeing. Both options require a lot of energy. The ‘fight or flight’ response serves to activate a complicated biochemical process in which chemicals such as adrenaline are released. This causes blood sugar levels to rise and metabolic processes to speed up – a chain reaction leading to an increase in pulse rate, blood pressure and muscular activity. This last feature is of special significance for people who stutter (PWS). An increase in muscular activity may also affect the vocal cord muscles.

The fact is that we no longer live in prehistoric times. Every day people encounter problems that can’t be solved by fighting or running away the way our predecessors used to. Nowadays threats come in many different guises: a rush-hour traffic jam when you are late for an appointment; unemployment; a difficult love affair; or the death of a loved one. However our bodies respond to these threats in the same primitive manner, accelerating the pulse rate and releasing energy. At the same time our bodies cannot use that energy in the way it was meant to be used - we don’t ram into the car in front of us when we are caught in a traffic jam, and most of us don’t resort to violent crime when we lose our jobs.


Chronic stress

If these fight-or-flight responses occur frequently, the ensuing tension may become chronic and cumulative. Too much tension causes stress, which in turn can cause physiological as well as psychological problems. We know that an excess amount of tension can influence the PWS’s speech; but stress is also implicated in many other ailments and psychological conditions such as depression, anxiety and feelings of hopelessness and helplessness.


Threat and change

Threat, real or imagined, is an important factor in stress. CHANGE can also be perceived as a threat. Change involves unfamiliarity and uncertainty, the underlying question being: ‘Will I be able to cope with the new situation?” This explains why tension may arise not only from new circumstances such as marriage, moving to a new city or accepting a new job, but also from less defined transitions such as social, political or demographic change.

To understand stuttering one has to understand the nature of stress. Only then does it become clear why an authority figure can induce tension in many PWS as well as fluent speakers: an authority figure represents a potential or actual threat. The authority figure wields power which can be used to your disadvantage.

Uncontrolled tension can devastate the PWS’s speaking ability, and even the best fluency technique in the world may not be of much help if one’s base-level tension (see the chapter 'A Possible Cause of Stuttering' for an explanation of this term) is excessive.

This also applies to people who, in addition to stuttering, also have severe social, psychological or other problems that keep their base-level tension so high that speech treatment is of no use. They should first attend to their underlying, stress-inducing problems. According to Dr Martin Schwartz, base-level tension contributes up to 70% of vocal cord tension, whereas speech tension contributes 30%. This shows the importance of stress management for people who stutter.


Subconscious stress – the case of the unhappy husband

Stress sometimes manifests itself subconsciously. The person may not be aware of how high his base-level tension is. PWS should therefore study their own stress patterns. If you want to manage your stress, you first have to be able to recognise it.

Schwartz used an interesting case to illustrate how the subconscious can diverge from conscious experience:

A young married client of his was devoted to his wife. The feeling was not mutual; she was always criticising and reprimanding him about one thing or another. In spite of this he always praised her whenever he could – he was hopelessly in love with her and blind to her shortcomings. He did not benefit at all from Schwartz’s airflow therapy. One day his wife told him that she had been involved in a relationship with another man for the past year and wanted a divorce.

The poor husband was deeply distressed, shocked and bewildered – and never stuttered again! Schwartz explains this as follows: In his subconscious the patient was well aware of his marital problems, although he consciously denied it. His unhappy marriage maintained his high base-level tension, but when his wife left, it dropped substantially. The result: a profoundly unhappy, but fluent speaker!

Spontaneous (but infrequent) cures such as this which seem to result from a sudden, lasting drop in base-level tension have also been reported by others:

A pensioner told how he was cured after watching a TV programme in which a recovered stutterer described his experiences. According to his own explanation, the pensioner identified himself with the recovered stutterer to such an extent that he himself was cured. (P Faber, Achtergronden van stotteren en spreekangst, 1979)


Stress is relative 

Also remember that stress is to some extent relative and subjective. An individual may find a particular situation stressful, whereas somebody else does not experience stress at all in similar circumstances. It all depends on the individual’s personality, experiences, value system, etc.


‘Bad days’ and stress

Base-level tension can rise inexplicably. Such normal variations in tension – which tend to impact on a PWS’s fluency – could have several causes, eg subconscious processes. Some experts explain that even the weather, humidity, temperature, age and the day of the week can affect tension. Eg. office workers have reported feeling more tense on a Wednesday than a Friday (before the weekend!).

Your immediate environment can also affect your tension. Many people attribute stress to the rushed nature of city life, but it has been established that even country life, which is supposed to be so peaceful, causes far more stress than previously believed. The comparative lack of recreational facilities such as cinemas etc in the countryside is part of the reason for this phenomenon.


‘Good’ tension

Tension isn’t necessarily inherently harmful. Some amount of tension is normal. It provides the energy we need to tackle new challenges. Without it, life would be dreary and aimless. The goal should therefore be to control and not eliminate tension. Fortunately much research has already been done in finding ways to control stress, some of which are discussed below. These strategies should become part of your stress management toolbox. Use this toolbox in a flexible way according to your circumstances


Strategies to counter stress


Identify the cause of the stress

In some cases it would be appropriate to first establish the cause of the stress, before working on the speech dysfluency to which it is linked.

The stuttering self-help group of which I was a member was once approached by a young female student with a severe stutter. It became quite obvious that she was under a lot of stress. What was not known at the time was that she was experiencing terrible problems at home – including sexual abuse by her father. Naturally these underlying problems had to be addressed before anything could be done about her stutter.


Get control of your life

People who feel in control of a situation or of their lives in general seem to be less susceptible to stress. This feeling often goes hand in hand with the knowledge that help will be available if needed. People with a network of family or friends have the security of knowing where to find support when they need it. Such social support can play an important role in resisting stress.


A positive and flexible attitude

Living presents us with many challenges that have to be faced one after the other. Coping with each individual problem requires a flexible approach and mastery of a variety of life skills.


Acceptance, relativism and humour

Sometimes it is better to take a tolerant or fatalistic view of a situation, or to accept the problem, perhaps in terms of religious beliefs.

Research has shown that deeply religious people are less susceptible to stress. They do not take all their problems to heart. They see things in perspective and reconcile themselves with a higher will.

There are also times when it’s better to see the funny side of life instead of taking it all too seriously. When under stress, always ask yourself: Is this really important enough to worry about?

The answers to this question will depend on your value system, ie what you consider important in life. In this context let me describe a view of success which I value. Success is not necessarily determined by your money or career. A successful person is part of the world’s solution, instead of its problems; somebody who does something towards making the world a better place. Neither is success limited to major achievements; success can also mean making the most of just another routine day.


Type B behaviour

Experts distinguish between two types of behaviour, ie Type A and Type B.

Type A behaviour is characterised by the tendency to want to do too much in the available time, whereas Type B people have a more relaxed attitude. Try to rid yourself of Type A behaviour by, for instance, slowing down your meals, conversations, driving or reading. Stop if you find yourself rushing through essential but monotonous routine activities.


Frequent holidays / leave days, entertainment and other recreational activities

But watch out for the type of holiday that only increases tension because of long distances travelled, family conflicts, etc.


Diet and vitamins

Beware of the excessive use of coffee and tea (both contain caffeine), sugar (especially refined sugar), chocolates and carbonated soft drinks. Consider switching to the decaffeinated versions, or to herb teas. It is important to adhere to these restrictions: the above-mentioned substances tend to increase base-level tension significantly.

Prof Schwartz recommends a daily vitamin and mineral supplement to reduce tension. The supplement consists of vitamin B complex, vitamin C (prepared from rose hip) and dolomite tablets (calcium and magnesium). These substances have a mildly calming effect. Take the daily dosage in consultation with your doctor.

These supplements do not work for everybody – but some have reported significant improvement in their fluency as a result.


A healthy lifestyle: adequate sleep, sport and exercise

Adequate sleep allows the nervous system to recover, and physical activity absorbs the excess energy released by the fight-or-flight stress response. Just keep in mind that highly competitive sport can actually increase tension!


Relaxation techniques

A wide selection of relaxation techniques is available today, and numerous books have been written on how to use them. People don’t always respond in the same way to relaxation techniques, and you should look for one that works for you.

The body appears to be capable of a natural relaxation response that is in many ways the reverse of the stress response. This relaxation response can be produced in different ways, including progressive muscle relaxation exercises, ‘Eastern’ meditation techniques (where you focus on a specific word or sentence with the aim of relaxing the mind), bio-feedback, massage and rhythmic breathing.

Prof Schwartz recommends what he calls the Bathtub Exercise. It’s a combination of relaxation exercises done in the bath, and combines psychological ‘focused mind’ relaxation with progressive muscle relaxation and the relaxing effect of the warm water:

Get into a hot bath, lie down and make yourself comfortable, perhaps by placing a small towel so that it supports your head and neck. (PS this exercise can also be done in bed.) Ensure that the lighting is subdued, eg light a candle. (Make arrangements to ensure that you are not disturbed. You could also use earplugs to eliminate noise.) Hold your breath to the count of eight and gently exhale through your nose. Continue breathing easily through your nose, and every time you breathe out, focus all your attention on a single thought: ‘Relax’.

You will soon feel far more relaxed. Don’t worry if other thoughts interfere with your concentration on the word ‘relax’. However, try your best to focus on this word.

Now you can move on to the different parts of your body. Start with your feet. Every time you exhale, think: ‘Relax my feet’, ‘Relax my calves’, and continue in this way until your entire body is relaxed. Finally try to achieve a state of complete mental and physical rest, and to find an internal centre of peace, a ‘room of silence’ deep within yourself.

At the end of the exercise, try to ‘wake up’ step by step. Slowly count to five and with each count, think about another part of your body waking up. (This is a shortened version of the Schwartz Bathtub Exercise.)

A full stomach inhibits the relaxation response, so do this exercise before eating! If you have enough time, you should follow this relaxation exercise with visualisation or a series of affirmations (see the chapter 'The Power of Visualisation') as you lie in the bath.


Deconditioning

Most stress has been learned, and can therefore be unlearned. If you always get tense when in a shop (even when not speaking), you can try to weaken this conditioned response, ultimately eliminating it. Deconditioning techniques exist to tackle this, eg. purposely delaying the moment when your tension will increase – see the section on conditioning and deconditioning in the chapter 'Some Other Techniques and Approaches'.


Knowledge and awareness

Knowing yourself and your environment will help you to avoid stress. Knowledge is like a road map with which you can anticipate probable future twists and turns. For example, someone who is asked to deliver a speech, should prepare that speech so well that he has complete understanding of the subject matter. In this way he will, in his own mind, become an authority figure, with a psychological advantage over his audience. Being well prepared will give him added confidence and reduce the so-called ‘stress of uncertainty’. Also learn to identify the first signs of localised tension early enough to do something about it. A stiff jaw or teeth-clenching indicates a build-up of facial tension – neutralise it by slackening and relaxing your jaw.


Managing stress in the workplace

Use the following strategies to manage or avoid stress in the workplace:


Prioritise

When you have so much work that you don’t know where to begin, prioritise and complete the tasks one by one, instead of trying to do everything at once.


Vary your workload

Try to get a balance between challenging and routine work. Too much of either causes stress.


Avoid unpleasant results

Cover yourself by following the correct procedures; keep others informed of your position; develop contingency plans and create ‘escape routes’ in case things go wrong.


Time, duties and responsibilities

If possible, organise your available time and delegate and divide your duties and responsibilities.


A last word on stress and stuttering

Stress control does have its limits for the PWS. Used in isolation it is of limited help in managing stuttering. Combined with a fluency technique, however, it is a powerful weapon in lowering your base-level tension to below your stuttering threshold, so that you can apply your fluency technique successfully.

You may well ask, ‘But how is stress control linked to the psychological side of stuttering and its management?’ From the information in this chapter it should be clear that the psyche and the issue of stress are inextricably intertwined. In the following chapters, therefore, the focus will be on psychological ways of dealing with stuttering, the ultimate aim always being to reduce general tension as well as localised vocal cord tension.

Firstly, however, let’s look at a much neglected aspect of stuttering, namely the actual, physical forming of speech sounds. It is so much easier to apply a fluency technique if you know what your speech organs are doing when you stutter, and what those organs SHOULD be doing in order to speak more fluently.

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Footnote: * Note the words 'to a large extent'. Stress doesn't 'cause' stuttering. If that were true, there would hardly be any fluent speakers around. In order to understand the effect of stress on stuttering, one has to differentiate between GENERAL and LOCAL tension. Stuttering is caused by excessive LOCAL tension on the vocal cords of that part of the population whose cords are ultra sensitive to tension.

If the difference between general and local tension is kept in mind, it follows that you may stutter even though you do not feel very stressed. This happens because the local tension on your vocal cords - your 'speech tension', as Dr Schwartz calls it - has exceeded your speaking threshold, while your general tension levels - 'base-level tension', as it is called by Schwartz - are quite low.

Conversely, you may not stutter even when you are in high stress. This would be the case where your speech tension is below your threshold, whereas your base-level tension is quite high. Please refer to the very important Figure 1 in the chapter 'A Possible Cause of Stuttering' (or check it out HERE ) which clearly explains the relationship between speech tension, base-level tension and threshold.

Though speech tension and base-level tension are different concepts, they impact on one another. If you are stuttering badly, it may increase your general stress levels; and if you are under stress, it will most probably also make your speech worse because the margin of fluency between your speech tension and base-level tension reduces.

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