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Practical Thoughts Blog

The "Deep Breath" Dilemma

The "Deep Breath" Dilemma

This question, from one of our social media followers brings up a frequent dilemma that many SLPs face as they work with students who stutter. 

Too often, people tell children who stutter that they ought to “take a deep breath” in an attempt to control their stuttering. Sometimes, this message comes from well-meaning caregivers, and other times, from ill-informed speech-language pathologists. Interestingly, it’s not always clear whether the advice is designed to help children calm down (relaxation methods often involve breathing changes) or to specifically change the way they breathe in an attempt to affect their speech.

(See related blog post, “It’s (almost) never breathing in stuttering therapy!”)

Either way, the advice is misguided, because it (a) sends incorrect and simplistic messages about what helps people speak more easily and (b) actually teaches  an unnatural speaking pattern that makes it harder for them to say what they want to say. Put simply, taking a deep breath does nothing to help students speak more easily.

Regardless of how children receive this unhelpful advice, the bottom line is that we often find ourselves needing to undo the harmful lessons that our students who stutter have learned. This can be difficult, because atypical breathing patterns can rapidly become part of a student’s stuttering or avoidance behaviors. That is, unnecessary deep breaths can function as “secondary behaviors” that students use in an attempt to hide or prevent or mask stuttering, and the result is that they stutter and breathe in an atypical way.

How to unwind “deep breaths”

Fortunately, there is much that we can do to help students return to more typical breathing (and speaking) patterns, as we shift their focus from trying to hide their stuttering to speaking naturally and authentically. 

Step 1: Teach Students about the Speech Machine

The first step is to ensure that students have a solid understanding of the process of speech production. That is, they need to understand both the anatomy and the physiology of speaking. As shown in our activity book, “Go To Guide™: GETTING STARTED in Stuttering Therapy,” we spend a significant amount of time in therapy teaching students about how they speak. We want them to learn not just about the parts of the body involved in speaking (the “Speech Machine”) but also how those parts work—and work together—to produce speech.

Not surprisingly, this involves teaching students that they do not need to take a deep breath (or do anything else with their breathing) before speaking. They don’t need to use diaphragmatic breathing or belly breathing or any other type of breathing pattern. They just need to allow their bodies to take the air that they need without interfering with an otherwise automatic process.

If students have already been taught unnatural breathing patterns, we explain directly (at a level that is appropriate for their age and abilities), that sometimes other people will advise students to take a deep breath because they want to help. It’s nice that they want to help, but they don’t understand that this advice is not actually helpful!  Why would they tell students to try something that doesn’t actually help? Because they’ve never tried it themselves! 

Step 2: Invite Students to Become Speech Detectives

We often encourage our school-age and older students to watch how other people breathe when they talk. We can guarantee that they will never find another person who actually takes a deep breath before they talk during regular conversation. (They might do so before yelling or before singing a long lyric, but they don’t do it before speaking in everyday situations.) By becoming Speech Detectives, they can learn more about what other people do when they talk. They will learn that others do not interfere with natural breathing patterns as they speak. They allow their bodies to take the air they need…and if they need more air, they take another breath. As students observe others, they can see the difference in what they have been taught to do, and they can see the value in “unlearning” the unhelpful habit of inhaling deeply when speaking.

Step 3: Become Mindful about Breathing

Next, we help students develop and enhance their proprioceptive skills for recognizing their own breathing patterns. This step is critically important, because it helps students increase their awareness of when they are engaging in less natural breathing patterns. As they become more mindful of their breathing, they will be better prepared to change their breathing patterns as they return to more natural ways of breathing. Again, we describe several activities for helping children increase their mindfulness about speaking in our Go-To Guide.

Step 4: Practice Naturalness

Finally, after students can more easily recognize when they are taking unnecessary breaths, we support them as they practice taking regular breaths in their speech. If they take an unnecessarily deep breath, they can pause and allow themselves to let that extra air go, then restart their sentence with a regular breath. This is just like any other behavioral type of practice that a student might engage in. The difference, however, is that we want students to keep their focus not on their breathing but on saying what they want to say.

Recall that unnatural breathing patterns are often taught (and learned) as attempts to avoid stuttering. If we want students to return to natural breathing patterns, we have to simultaneously help them know that it is okay to stutter and that they don’t need to do anything (with breathing or any other aspect of speaking) to try to avoid or hide their stuttering. We want them to speak authentically and freely, regardless of whether or how much they might stutter. 

Note that later in therapy, after students have unlearned the unhelpful breathing patterns, we might return to communication strategies that can help students speak more easily, but we don’t want to conflate unnatural speech techniques that seek fluency (like deep breathing) with helpful communication strategies that increase ease of speaking. (Examples of such communication strategies can be found in School-Age Stuttering Therapy: A Practical Guide.)

Step 5: Be Patient

All of this work will take time. It’s an odd and frustrating aspect of secondary characteristics — they seem to be quite easy for students to learn but extremely difficult for students to unlearn. So, be prepared to take your time, approach the behavior in a step-by-step fashion, and give students ample opportunity to learn that what they say is valuable and worthy of being said, even if it happens to contain stuttering. They don’t ever have to mask or hide their stuttering by doing something unnatural like taking a deep breath or changing their breathing patterns.

Over time, these messages will help students become more accepting of themselves and of their speech differences, and this will help to communicate more easily and more authentically—and that can and should be the ultimate goal of stuttering therapy.