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Practical Thoughts Blog

Is it true that prolonged speech is the best type of fluency therapy?

Is it true that prolonged speech is the best type of fluency therapy?

Prolonged speech is a commonly used treatment approach for adolescents and adults who stutter. Basically, it involves helping people learn to change the way they speak, beginning with very slow speech production (e.g., saying just one syllable per second when reading a passage) and then gradually increasing to a more natural speaking rate. Prolonged speech has been shown to improve fluency for many people who stutter, and it is often held up as the only evidence-based approach for instantiating fluency in those who stutter (even though this isn't actually true).

Because of this, people often ask me if they should start prolonged speech with their older clients who stutter. Here is one thought I often offer in my response: when thinking about evidence-based therapy for those who stutter, it is useful to first ask about what aspect of the overall stuttering disorder you are seeking to treat.

The answer to this question will depend entirely on each individual client's needs, and it will dictate whether it is appropriate to use a speaking strategy such as prolonged speech with your client.

As I said, prolonged speech and other fluency-enhancing therapies have evidence supporting their use for increasing speech fluency. For clients who seek to increase fluency, then this might be an appropriate way to go. (Though keep in mind that prolonged speech therapies are not a panacea...that's a topic for another post.)

What prolonged speech does not help with is the rest of the stuttering disorderthe emotional and cognitive reactions to stuttering, functional communication difficulties, and adverse impact on the speaker's life.

Of course, if we could get people to be completely fluent, then there would no longer be anything to cause negative reactions, etc., but it doesn't seem to be as straightforward as that. Even people who are successful in fluency-enhancing therapy still report difficulties in communication, etc.

Therefore, for most clients, there needs to be more than just fluency-enhancing therapy, because the person is likely to have needs beyond simply increasing speech fluency.

For some people, addressing the broader aspects of stuttering might involve cognitive-behavioral therapies (CBT), as well as mindfulness therapies and acceptance-based approaches such as acceptance and commitment therapy (ACT). Desensitization is also a strong component of many therapies, as is treatment designed to help people who stutter learn to manage moments of stuttering more effectively so that any stuttering that remains is less disruptive to their communication. There is good and growing evidence in support of all of these approaches.

Thus, the point I want to make is that just because there is a lot of evidence in favor of prolonged speech for helping people increase fluency, this does not mean that prolonged speech is all you need to learn. I would advocate for a comprehensive approach to therapy that addresses the entire stuttering disorder, based on each client's individual and unique needs. (Determining those needsalso the topic for another postcomes from your comprehensive evaluation that examines not only how much the person is stuttering but also how much stuttering affects their lives as a whole.)

The bottom line is this: only by approaching the stuttering disorder in a comprehensive way (focused not just on fluency and not using an approach that is narrowly defined for only the speech behavior) can we help people overcome the burden of stuttering. You can find more information about CBT and ACT and other comprehensive approaches to therapy in Stammering Therapy From the Inside.