Phonation and Valsalva-Stuttering Blocks

Valsalva-Stuttering Blocks Revisited

In persistent developmental stuttering (the most common form of stuttering in adults and teenagers), the actual �block?occurs in the brain before the person who stutters even tries to say the word. The block is an error in the neurological motor programming of the larynx to phonate the vowel sound of a specific word or syllable.

Before any bodily movement can occur, the brain must first create a motor program to determine when and how muscles are to be activated. The same is true for speech. A neurological process called prephonatory tuning must prepare the appropriate muscles in the larynx to bring the vocal folds together at the proper time to vibrate as airflow passes between them. The vibrating vocal folds create a buzzing noise. The buzz is turned into specific vowel sounds by the shape of the oral cavity, as determined by the position of the lips and tongue.

When the person who stutters comes to the word or syllable in question, the brain does not program the larynx to phonate the vowel sound. Instead, the larynx is programmed for effort closure ?the function that it performs during a Valsalva maneuver. For that reason, we will call these blocks �Valsalva-stuttering blocks.?nbsp; The vowel sound is the natural place for motor programming for effort to occur, because it is the part of the syllable that is loudest and therefore has the most energy.

In effort closure, the entire larynx closes tightly ?including both the vocal folds and the false vocal folds above them ?to keep air from escaping. The purpose is to build up air pressure in the lungs to stiffen the trunk of the body, so that physical effort can be exerted more efficiently. Often the person who stutters will feel tightness in the throat as well as the abdominal muscles. Even if the larynx does not actually close, it still is not ready to play its part in saying the vowel.

The rest of the speech mechanism ?the lips and tongue ?must now wait until the larynx is ready to phonate the vowel sound. The person�s speech gets stuck on the consonant or glottal stop that precedes the vowel, resulting in repetitions, prolongations, hesitations, and/or forceful closures of the mouth or larynx. This creates a false impression that the initial sound is causing the problem.

It should be noted that a stutterer�s lips and tongue usually have no trouble articulating words on their own, when they don�t have to wait for the larynx to phonate. For example, a person who stutters is almost always fluent when there is no phonation, as in whispering, or when phonation is continuous, as in the �Humdronian Speech Exercise?or singing.

The person who stutters may feel as if the feared word contains an insurmountable obstacle ?often described as a �brick wall??that requires force to overcome. The PWS may be overwhelmed by a seemingly uncontrollable urge to use physical effort to force the word out ?as in a Valsalva maneuver. This may instinctively feel like the right thing ?the only thing ? to do. But the more the speaker builds up air pressure to break through the perceived block, the stronger the block becomes.

The Block Is an Illusion

In reality, there is no obstacle or �brick wall.? It is an illusion, with no substance or power of its own. Its only power comes from you.

You yourself create the obstacle by exerting effort in trying to force through it. That is the essence of a Valsalva maneuver. The blockage of the upper airway automatically becomes stronger to resist the air pressure that you build up in your lungs. The purpose is to stiffen the trunk of the body to help you exert physical effort more efficiently. This maneuver is totally inappropriate for speech. You may feel as if you are being conscientious by �trying hard,?but you are creating the very obstacle that you are struggling against.

A well-known example of this principle is the Chinese finger trap. A person inserts an index finger into each end of a woven bamboo tube and then tries to free them. The instinctive reaction is to pull the fingers outward, but the harder the person pulls, the tighter the tube becomes. The victim ends up trapping himself by his own effort in trying to escape.

Stuttering Blocks and Anxiety

Valsalva-stuttering blocks are associated with varying degrees of anxiety, as illustrated in the following diagram. The degree of anxiety may affect a block�s resistance to therapy.

Low-Anxiety Blocks High-Anxiety Blocks

	Low-anxiety blocks involve the habitual activation of the Valsalva mechanism during speech, based on erroneous expectations of difficulty. They are the kind of blocks that are most readily reduced or eliminated by practicing basic Valsalva Control techniques.
	High-anxiety blocks involve involuntary reactions of the sympathetic nervous system to situations associated with fearful memories. Controlling these blocks is more difficult and requires various methods of desensitization in addition to Valsalva Control.

The �Speech Alarm System?/span>

As discussed in The Neurological Triggering of Stuttering Blocks, the triggering of stuttering blocks is similar to the sympathetic nervous system�s �fight-flight-freeze?response to fearful stimuli. The purpose of this response is to keep us safe by causing our bodies to react instantly and automatically to potential danger. This reaction is initiated by the almond-shaped amygdalae ?the parts of the brain in which fearful memories are stored. (There is one amygdala in each hemisphere.)

The amygdalae�s sensitivity to stimuli may vary, depending on the situation. For example, if you were strolling through a safe, quiet neighborhood during the day, your amygdalae would probably be on a low alert level, allowing you to think pleasant thoughts and enjoy yourself. In contrast, if you had to walk through a crime-infested neighborhood at night, your amygdalae would probably be on high alert for muggers. Any movement in the shadows might cause them to send an alarm ?triggering the release of stress hormones through your brain and body.

Likewise, the triggering of stuttering blocks may vary greatly, depending on the speaking situation. We might better understand this variance if we view it in terms of a ?b>Speech Alarm System.?/span>

We will visualize the Speech Alarm System as having the following color-coded �Alert Levels?

	RED = Extreme;
	ORANGE = High;
	YELLOW = Moderate;
	BLUE = Low; and
	GREEN = Clear.

As you enter speaking situations, you may habitually set the sensitivity of your �Speech Alarm System?based on your memories, thoughts, expectations, attitudes, and beliefs about the difficulty or danger of the speaking situation and/or the words you anticipate saying.

The following is a hypothetical example of how the Speech Alarm System might work. This process may be conscious, unconscious, or semi-conscious. It may seem to you as being so necessary, automatic, and inevitable that you feel you have no choice in the matter.

	You approach a speaking situation thinking, �I am a stutterer. Therefore, speech is difficult for me.? Already your Alert Level starts at BLUE.
	Then you think, �In the past I have usually stuttered in this type of speaking situation, or when speaking to this person. Therefore, I will probably stutter this time also.?This moves your Alert Level up to YELLOW.
	Next you think, �It is very important that I make a good impression. Therefore, I must try hard not to stutter.? Your Alert Level is now at ORANGE.
	On top of all this, you think, �I have blocked a lot on words that start with �p?(or any other type of word on which you have had trouble). Therefore, I must try especially hard not to stutter on p-words.?nbsp; At this point, your Alert Level has shot all the way up to RED.

Your amygdalae are now on Extreme Alert for the dreaded �p-words?(or whatever other type of word you might fear). As you come to a �p-word,?your amygdalae send out an alarm: �Danger! Danger!?nbsp; This triggers your sympathetic nervous system to initiate the fight-flight-freeze response, which floods your brain and body with stress hormones.

These hormones cause your larynx to be neurologically programmed to do effort closure instead of phonating the vowel sound of the specific word or syllable. (Doing effort closure as part of a Valsalva maneuver is an instinctive way to prepare your body for physical action.) The stress hormones also shut down the thinking part of your brain, causing you to forget everything you may have learned in speech therapy. You instinctively revert back to your old, established struggle or avoidance behaviors ?as if no other choices are possible. All the while, the stress hormones are urging you to �Force! Force!??as if you were in real danger and needed to fight off a mugger.

But there is no mugger. It is only a word. You are safe. Your Speech Alarm System has given you a false alarm. Because speaking situations present no real dangers, all of its alarms are false alarms.

The Speech Alarm System is actually unnecessary and counter-productive. Nevertheless, you keep using it because, on some psychological level, it helps you feel safe. You might feel naked and exposed ?and perhaps even terrified ?without it. Exerting effort in response to the alarms set off by your amygdalae has the immediate short-term effect of reducing your anxiety. Over the long term, however, responding to these false alarms perpetuates your fears and stuttering behaviors.

Stuttering Blocks and the �Speech Alarm System?/span>