Exploring the ‘Anticipation Effect’ in Stuttering

Nathan Rattansey

For people who stutter (PWS), the following scenario — or some variation of it — is all too familiar. You are standing in line at Starbucks. You know exactly what you’re going to order: Pumpkin Spice Latte. Grande. For most people, the entire ordeal is straight forward enough. However, from past experiences you have struggled to say your order with any fluency. Maybe it’s getting past the hard-plosive P sound in Pumpkin, the series of blocks you’ve experienced before on ‘Grande’ — or when the smiling barista asks: ‘Can I get a name for the order?’ As you shuffle your feet along a slow conveyor belt of dread towards the front of the line, your mind is in high gear, conjuring up ways on how you are going to approach saying your order with pristine fluency…

The above scenario captures the moment — or series of moments — leading up to when we have to speak but foresee our stutter derailing our fluency. This phenomenon is called the ‘anticipation effect’ and has been observed by two studies from the Journal of Fluency Disorders. Both studies provide us with a larger picture detailing how PWS experience anticipation in speech disruption.

How is Anticipation Possible?

In the first study by Garcia-Barrera and Davidow titled ‘Anticipation in Stuttering: A theoretical model of the nature of stutter prediction’, the authors believe we all have an internal monitoring system housed in our frontal lobes that is believed to play a role in error monitoring and predicting errors in our speech production.

negative emotions are often accompanied by certain autonomic responses PWS often stutter on the same words and sounds—and our monitoring system keeps track of these problem words and errors over time. In our interactions, we might encounter certain feedback from our environment, for example our barista giving us a confused look, or laugh when we stutter on our name. As a result, we might feel negative emotions such as anxiety or embarrassment. These negative emotions are often accompanied by certain autonomic responses (such as an increased perspiration and heart rate), and our monitoring system records the overall interaction as a ‘negative’ memory based on the negative emotions and consequences we experienced.

Over time as we stutter on the same words, there is a greater association forged between these negatively stored memories of how we stuttered on that word, and the perceived negative consequences that we experienced in these speaking encounters. In future interactions where we are asked to introduce ourselves, our internal monitoring system reflects back on those negative memories where we stuttered on our name creating the anticipation effect: the expectation that we are about to have a stuttering moment.

What Do People Do When They Anticipate a Moment of Stuttering?

Returning to our Starbucks scenario: what do we do in the moment or moments leading to when we anticipate stutter? Do we trudge along and stutter bravely through the interaction? Do we expertly use our techniques that our speech language pathologist taught us to overcome our blocks? Or do we politely excuse ourselves from the line, apologize to the person behind us, and leave the coffee shop entirely?

The study by Jackson et al., ‘How People Respond to the Anticipation of Stuttering?’, provides us with a fascinating look into the different responses people have when they anticipate a stutter. The authors surveyed thirty people, ages 18-50, asking them open-ended questions as to how they respond when they anticipate a stuttering moment.

Many PWS experience anticipation as a barrier towards their ability to manage stuttering Some PWS reported using ‘avoidance strategies’, such as word substitution, fillers or avoiding a social situation to hide or escape from an impending moment of stuttering. Other participants used ‘self-management strategies’ that involved speaking techniques such as involved using their learned speech therapy techniques, changing their speaking volume, or maintaining eye contact. Finally, some participants reported that they would continue speaking even if they anticipated a stutter, choosing to stutter openly to face their fear of sounding ‘different’. Unfortunately, participants also reported feeling anxiety, a loss of control and reduced confidence when faced with anticipation. Here, the participants cited anticipation as a barrier towards their ability to manage stuttering, with some people feeling that it reduced their participation in social settings.

The Anticipation Effect: What Can We Learn?

For researchers, more work clearly needs to be performed to explore how our internal monitoring system works, its relationship with other neural parts of our brain, and how this system operates across different social situations. For speech language pathologists, the study by Jackson et al. offers an insightful look into the more nuanced, covert ways in which stuttering affects a speaker. In the absence of a block or repetition, PWS often switch and substitute words to preserve the illusion of fluency—and this type of behaviour might be an issue to address in therapy.

For PWS it is possible that anticipating a stutter can be used proactively. When we do feel a stutter coming on we can use our trusty therapy techniques, take a moment to gather ourselves—and continue speaking in the way that we would like. However, if the ability to anticipate is wound up in past negative memories causing us anxiety, and crippling our ability to speak, then the real question is: can we overcome these moments of anticipation by ‘over-writing’ our memory banks with positive experiences and in turn, create positive memories?

Anticipation: A Call To Be Brave

PWS will have to be more understanding of listeners as well PWS often tend to place an unusual amount of pressure on themselves, to speak fluently instead of being themselves and stuttering openly. If PWS can change the ways in which we perceive a reaction or experience as a negative one, maybe they can make important strides in changing negatively stored memories. Ironically, it may also require PWS to be more understanding to their listeners who often respond to stutterers with confusion, amusement, impatience, and even mock ridicule and laughter.

This is not to downplay the shame and embarrassment PWS when faced with these types of reactions from listeners, nor does it excuse this type of behaviour from listeners. Instead, it is an acknowledgement that most listeners simply lack the awareness and emotional intelligence to navigate an interaction with someone who stutters. If we approach every interaction with this mindset, maybe we can move away from viewing a negative reaction as an indictment on our character, our intelligence, and ultimately our self-worth.

All the scientific literature aside, I view the anticipation effect as a gentle reminder of the difficult choice we have to make in every speaking encounter. It is a choice where we choose to be brave enough to be ourselves, whether that means stuttering openly, using our techniques, or employing a speaking plan that we are comfortable with that doesn’t undermine what we truly want to say. So, the next time you’re in Starbucks, on the phone, introducing yourself at school or at work, and you anticipate a stuttering moment—the rush of anxiety, the tightening in your throat: I hope you move forward courageously and allow yourself, to be yourself. Pumpkin Spice Latte. Grande.

Nathan Rattansey is a person who stutters. He is CSA Board Member committed to raising awareness around stuttering and the unique challenges people with communication disorders have to overcome. (Special thanks to EG who helped review this article).
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