(69) Incorporating the ACT Framework into Therapy with Clients Who Stutter

Abstract: The field of communication disorders has a long history of counseling clients using psychotherapy techniques. Acceptance and Commitment Therapy (ACT) (Michise & Palasik, 2017; Palasik & Hannan, 2013; Hayes, Strosahl, & Wilson, 2012; Harris, 2009; Luoma, Hayes, & Walser, 2007; Hayes, Strosahl, & Wilson, 1999) is a mindfulness-based psychotherapy approach that assists clients in living a valued-based life through the development of psychological flexibility. Clients who stutter can cultivate psychological flexibility in order to cope with and manage their stuttering by experiencing the six core principles of ACT – 1) contact with the present moment, 2) acceptance and willingness, 3) thought defusion, 4) self as context, 5) defining values, 6) committed action. By incorporating these principles into therapy, clinicians can guide their clients in practicing willingness to come in contact with all thoughts and feelings that may arise during a moment of stuttering. Additionally, clients can learn to talk about their stuttering using less judgmental language, essentially defusing thoughts while looking at their stuttering from an outside perspective. This process can help clients to define their individual values and create committed actions, which allow them to live by their values – regardless of whether they stutter. 

Summary of Presentation: Considerable evidence exists to support the use of cognitive behavioral therapies in the treatment of clients who stutter (Blood, 1995; Botterill, 2011; Menzies et. al, 2009; Mustofa, 2010). Historically, however, speech-language pathologists have reported feeling poorly prepared – both clinically and academically – to work with people who stutter (Brisk, Healey & Hux, 1997; Kelly et. al, 1997). Therefore, continuing education courses that are both evidence-based and experiential in nature are essential to increase clinical competence and confidence.

Acceptance and Commitment Therapy (ACT) (Harris, 2009; Hayes, Strosahl, & Wilson, 1999; Hayes, Strosahl, & Wilson, 2012; Luoma, Hayes, & Walser, 2007) is considered the third-wave to cognitive behavioral therapy. ACT assists clients in living a valued-based life through the development of psychological flexibility. Clients can cultivate psychological flexibility by experiencing the six core principles of ACT – 1) contact with the present moment, 2) acceptance and willingness, 3) thought defusion, 4) self as context, 5) defining values, and 6) committed action. By incorporating these principles into therapy, clinicians can guide their clients in practicing willingness to come in contact with all thoughts and feelings that may arise during a moment of stuttering. Additionally, clients can learn to talk about their stuttering using less judgmental language, essentially defusing thoughts while looking at their stuttering from an outside perspective. This process can help clients to define their individual values and create committed actions, which allow them to live by their values – regardless of whether they stutter.

ACT has generated a wealth of empirical research as a psychological clinical treatment in a variety of disciplines. For example, ACT has been used to treat a variety of anxieties (Block & Wulfert, 2000; Dalrymple & Herbert, 2007; Zettle, 2003), to treat psychological challenges with chronic pain (Bach & Hayes, 2002; Dahl, Wilson, Luciano, & Hayes, 2005; Gaudiano, Miller, & Herbert, 2007; Twohig & Woods, 2004; Vowles & McCracken, 2008; Wicksell, Melin, & Olsson, 2007), to treat obesity (Lillis, Hayes, Bunting, & Masuda 2009; Tapper et al., 2009), and to help individuals who struggle with substance abuse (Hayes, et al., 2004; Luoma, Kohlenberg, Hayes, Bunting, & Rye, 2008; Twohig, Shoenberger, & Hayes, 2007).

Despite the variety of health and mental health related disciplines who use ACT for clinical treatment, limited research to date has utilized ACT with clients who stutter. Beilby, Byrnes, and Yaruss (2012) integrated ACT into group therapy with twenty adults who stuttered. This study used ACT in two-hour group therapy sessions for eight weeks. Beilby et al. (2012) incorporated the six core principles of ACT with stuttering modification techniques. The results showed that “participants experienced significant reductions in the adverse impact of stuttering on their lives (OASES), an increase in their readiness for change (SOC), an improvement in their mindfulness skills (MAAS and KIMS), and a reduction in overall frequency of stuttering (%SS)” (p. 296).

The importance of the Beilby et al. (2012) study was that it encouraged the use of a psychotherapy approach to teach clients who stutter how to increase their awareness of thoughts from a neutral and nonjudgmental perspective. This differs from classic cognitive behavior therapy, which assumes “that clinical improvement depends on changing cognitions” (Springer, 2012, p. 205). In other words, ACT does not demand that success is determined by cognitively restructuring, but rather by opening up an individual’s awareness and willingness skills to all thoughts through contact with the present moment and by developing less judgmental thoughts through the creation of options-based language. Furthermore, Beilby et al. (2012) opened the doors to the clinical application of ACT in the field of fluency and fluency disorders.

During this two-hour experiential session, the presenter will guide parrticipants through exercises to help them better understand each core principle of ACT. Furthermore, clinical examples using ACT with individuals who stutter (Michise & Palasik, 2017; Palasik & Hannan, 2013) will be discussed in an effort to provide functional activities that participants can use to complement their current clinical practices.