Why Stuttering Occurs: The Role of Cognitive Conflict and Control

Hi everyone and welcome to the Stuttering Foundation podcast. This is Sarah McIntyre, recording from Philly in Pennsylvania. It's the summertime and it's very hot here and I'm actually welcomed by Dr. Evan Usler. Hey Evan. Yeah, hey Sarah, how's it going? It's good. We're not too far geographically from each other, huh? No. I've been meaning to come up to Philly so maybe I'll come visit you sooner or later. Sounds good. Yeah. We're going to talk shop a little bit about a theoretical article that Evan put together and he'll share a little bit more about it. But let me just introduce Dr. Usler to everyone in a brief bio context and then I'm going to toss it over to you Evan to elaborate and share whatever I'll see with like listeners to know. Dr. Evan Usler is an assistant professor at the University of Delaware. He's the director of the interpersonal neurophysiology lab where he studies the interactions between cognition, language and speech motor control. Well, welcome Evan. What else do you want us to know about you? Not much. I think though, unless that everybody knows about me the better. But I do think it's important to know that I've had a really good stutter most of my life or as far as I can remember. I do stutter less now than I have in the past. But it's still strong, it's a part of me and I think a lot of what I do as a researcher is trying to understand what happens to me in certain situations. They often say research is me search, right? And so that's certainly true for me. And so this article that I wrote was pretty much like, it was a COVID project. I had just begun my lab and I had set everything up and I was ready to go and then COVID hit. And then there was a period about 18 months where I couldn't record new data and I was a new professor so I didn't have any old data to look at. So I had to find something to do. And it gave me time to kind of think about what I think is happening. But the danger with that is I'm an end of one. And so there's always the potential of thinking that your personal experience is the same experience of everybody else. And so Sarah, I'm happy we're having this chat because I'm interested in what you think about what I wrote. Does it make sense to you or does it not make sense? I think a lot of it is intuition and so I'd really value your input when we have this conversation. Yeah. No, I'm very interested in that and I think maybe we could start by an overview a little bit for listeners on what you covered and maybe some background. But I will say ahead of time in advance right now as I was reading it, I was really intrigued and some of the things you're proposing related to why stuttering occurs and some of the questions that still remain that some of the current theories or areas of research maybe don't completely answer quite yet. We're really jiving with me as I was reading and I thought, wow, this is awesome. So could you give us a little bit of an overview first and then we'll kind of get into a little deeper? Sure, so I gave it a pretty strong title called Why Stuttering Curves and I was purposely somewhat pro-vocative by being that strong and sometimes my language is used in the article could be a little too strong for my own taste but I think sometimes you have to be willing to kind of put yourself out there. But I will say there's nothing new in this article, Sarah, there's nothing, I'm not that intelligent, there's no new theoretical idea that I have here. What I wanted to do was I wanted to synthesize the ideas of many others, many other good researchers in the field who have written about this topic over the past century. When I teach my fluency class, we use a lot of textbooks and we use a lot of scientific articles and they're all fantastic but I felt like I was missing a short superficial yet not reductionist piece of document that my students could read over, you know, maybe a weekend at the beach and understand the experience because I think of stuttering as an experience that someone goes through. There's an interesting word called phenomenology that you may have heard before and when I go to conferences I often hear that word more and more which is nice to hear but it's about what is the experience of the moment of stuttering and even more to the point, what is the moment? I think when most people talk about stuttering or the moment of stuttering, they're not necessarily thinking about what I'm thinking. Sometimes I have a different view of what that moment is and so I wanted to figure out what is that moment and how do you describe it? And what are you proposing, I guess, as a means of describing that moment? So I view stuttering behaviors as transient and voluntary, habitual, it's an inhibition in the initiation of speech and it results in overt disfluencies. I typically don't refer to typical latipical stuttering-like disfluencies, I typically don't use those words. I typically refer to them as hesitations, perseverations and procrastinations in speech and so you may think of hesitations as blocks and perseverations as repetitions but I think it makes more sense to think of it in those terms because those are behaviors that occur when our behavioral inhibition system is activated but covertly during that process we have the conscious feeling of anxiety, the conscious feeling of uncertainty so I am moving along the sequence of actions as I say this utterance or I say this sentence and there's some part of my brain that is somewhat uncertain that the next word I'm going to say is that I'll be able to say it and the analogy that I often give is imagine you're hiking in the woods and you have a goal in mind. So you're doing sequence goal-directed action so you're walking hiking towards your camp. That's your safe space in the woods but you never know what could happen. Maybe an animal might jump out on the trail and right in front of you and what happens when you perceive that threat. What typically happens is that we become behaviorally inhibited and I make the argument that the defensive distance between us and that perceived threat is going to affect the strength of that inhibition so back to the notion of me hiking and I can see the campsite in the distance so I have a goal and I'm fluent in my goal-directed action towards my goal but I perceive a bear in front of me. If the bear is somewhat in the distance then what do I do? I may kind of slow down my behaviors non-consciously I will slow down to try to resolve this what I call a cognitive conflict that has happened because now I have to reassess do I change my actions to continue towards my goal of trying to reach the campsite or do I change my goals altogether. I have to resolve this new conflict that's in front of me and I need to buy myself time before I reach that threat because I don't want that bear right in front of me. But if the bear jumps out right in front of me however all of a sudden I inhibit myself much more strongly and quickly and that's a freezing behavior that we often hear about. And so I make the comparison of walking along this trail to me saying a sentence, maybe saying my name. So to me that is the most treacherous trail that I have to speak is Sarah if I see you and I know that I don't know you that well and you don't know my name and so you're probably going to ask me my name when you meet me and I see that we're making eye contact and you start to approach me and you start to round your lips to say the minute that happens that's the bear right I see the bear in front of me and I probably have 2.5 seconds to resolve this conflict before the bear has gotten me or in other words er than okay. And so how do I resolve this conflict. Now one thing I can do is I can slow down my rate of speech that's like when you slow down on the trail like you try to figure out okay it's all about buying time because to resolve this conflict the one thing that that the body needs to do is give you more time to figure out what you're going to do and so I think that's why slowing down my speech is probably the most fluency inducing thing that I can do but sooner or later the bear is there. I can only slow down so much I can say I can put in some kind of like a buffer my name is Evan or I can put in some filler words my name is I can procrastinate like I said my name is my name I'm keeping the bear at bay that's what I'm doing I'm putting space between me and the bear I can just keep on repeating the same phrases my name is my name is my name is my name is but I can only do that for so long right before I perceive that to be silly so sooner or later I have to say Evan right but when I say Evan that conflict is often still there and the only thing that what I call the behavioral inhibition system can do is to just shut me down is to freeze my behavior because I can't slow down anymore I'm there the bear is in front of me and so when my motor system becomes frozen at the initiation of that's what I perceive to be the proximal cause of a block a prolongation could be that freezing but I was able to vocalize just before the freezing begun so now I'm kind of stuck in that vocalization yeah so hopefully that made sense there it makes sense I don't know yeah no that made sense the only thing I was thinking when you were explaining was when you were describing the pseudo experience of introducing yourself and I'm rounding my lips to say what's your name the W there and it triggers that anticipation or already that built up anticipation that you had the moment you even probably thought about that you potentially might run into someone or when you see the person that you might end up having to run into but then when you're in that moment a thought I had was giving myself more time or slowing down almost as like revving a toy car that you rev backwards and you like build up more steam to go faster and so time element I guess if I'm speaking from personal perspective results in greater magnitude I would say but and I totally agree with all the different options we then resort to whether it's buying our self more time attempts at suppression or concealment or what have you or just powering on through until that that gate opens so to speak yeah that's a great point Sarah when you are in that moment when you see the bear do you have almost two motivations do you have the motivation to escape with draw or like I've been saying to hold it off but do you also have the motivation to just get her over with just push it through right yes and whenever I feel that gate open in even a sliver even if it's not timed perfectly in the sequence of a conversation even if I'm overlapping a little bit with the introduction of the person next to me if I feel that ability to just go you're right it's either go or kind of by myself some time or you know I'm not saying I actively do this all the time presently but we all do is people who stutter we have this conflict and I think that's the road and the path to change when you chill on the conflict a little bit but it's there yeah that's what I I think the conflict for particularly people like you or me who have who are so good at doing this or who've been so duttering for so long is I think the most salient conflict is a motivational conflict and back to Neil Miller who was a psychologist in the 1940s who developed the notion that there's two main motivations to approach something or to withdraw from something and I think when Jo Shien was a doc student I assume Jo Shien was a doctoral student in the 1940s late 1940s and I can imagine him reading about this new concept of approach and avoidance motivations and thinking yes this is how to frame this conflict that's happening within me because I find it so interesting I could be wrong but I think there was a consensus from the mid 19th century to about the mid 20th century that and I gotta be careful here the proximal cause for starting behavior why this moment is happening to me right now is or has something to do with some kind of conflict within me some conflict of the self and if you read the early work of C.S. Bolumel and Frederick Brown and even you know the people in Iowa early Wendell Johnson and early Van Riper there was this just intuition this consensus that it was either a psychic conflict mental conflict psychological conflict some people even thought it was a neurological conflict even though they didn't have the neuroimaging technology to figure out what exactly parts of the brain were in conflict but I think you had these researchers who also stuttered but they had a lot of time on their hands and they just thought about it and said you know what the proximal cause has something to do with some conflict of the self and I think the the best rendition of this idea was Joshin in 1953 with his paper I can't remember what it's called I'm stuttering as an approach of life's conflict it's my favorite piece of scientific writing and all the thousands of articles I've ever read on this topic it's still my favorite and I highly encourage anybody to to to pick it up and read it because it makes so much intuitive sense to me but what was missing was in 1953 Joseph Sheen didn't have neuroimaging he didn't have they had EEG at the time but it really wasn't that practical to to use in a laboratory he couldn't empirically validate his proposition that the stirring block that moment of stuttering was the result of this conflict to approach a moment of speech but also to avoid that moment of speech and to me it's interesting and a little weird that this canonical presupposition of approach of points conflict being associated with stuttering behavior is what 70 years old and nobody had really no one has really taken it up in terms of research I mean maybe there was a paper to in the 70s that touched upon it but there really hasn't been a rigorous empirical investigation if this underlying hypothesis is true we know that Vivian Siskin as real you know she has that background with avoidance reduction therapy and it's really based on this fundamental hypothesis and it's it's wonderful work it makes perfect theoretical sense but no one has really validated it in the lab and so that's what this this paper is proposing a research program to do that I think it makes total sense because there's something about still outside of this this paper and an outside of of considering Sheen's role conflict theory and and I agree if I could meet someone dead or alive and a dinner with them I think Sheen would be at my table I don't know I don't know about you but the the whole idea that stuttering is just a neatly variable sure but that's never stuck with me in explaining as someone who stutters the trends that we have individually and then as a whole the variability and I know you speak to both of these pieces in relation to to struggle or reactivity you know I don't think it's sufficient to just say that stuttering is variable that doesn't give me a lot of of validation or answers as someone who stutters because I trend things in my head right and I want more answers I mean it is variable but it's also very predictive I mean I I can not always but I have a good sense of when that moment is happening a few words before I know exactly the situations that I have a lot of stuttering like I was just crossing the border into Canada for a vacation last week and I know when that agent at the border asked me where am I coming from and why am I there I'm going to stutter like it's like I'm seven years old again you know and I know it and my wife just thinks it's the most interesting thing because she's like I've known you for 15 years and this is the second time I've ever heard you talk like that and but the difference is is that I still trust the border I you know I might feel a little embarrassed for the five seconds after I drive away from that border agent but then it's back to regular life and so that's you know that's my progression thanks to years of therapy but it is a little tricky to talk about these topics it's I think it's easier to refer as variability it's harder to talk about it in terms of control and conflict and I think one reason is because if you assume that stuttering could be a product of cognitive control or cognitive conflict first of all in the lab how do you study cognitive conflict like it's hard enough to study you know linguistic complexity on speech motor control and that's sort of a thing but how do you quantify conflict in the brain it's really esoteric and it's really only been since about twenty fifteen that social psychology labs have been able to devise really good and validated neuro imaging paradigms that are known to evoke approach avoidance conflict most of these tasks are like nonverbal so it's seeing good pictures versus bad pictures but if you see the bad but if you choose to see a bad picture you you earn points so do you choose to see the bad picture because this points even though you really want to see a good picture that sort of a thing but what we're doing in my lab is we have verbal versions of this approach avoidance conflict and but it's intrinsically a very hard thing to do the second thing that I think is kind of troublesome is when you talk about variability when you talk about distal factors like genetics and white matter pathways and even things like language and that sort of a thing you're always not always but you're often able to kind of remove the self from those topics right and as a person who stutters it almost makes me feel good to think oh stuttering is a primarily genetic thing or it's a primary you know it's a multicultural thing it's not me it's language and genes and all that sort of thing but when you talk about cognitive conflict it makes me think well is it because I'm doing something wrong and I responsible for what I'm doing could I have fixed like I would never tell anybody oh you stutter because you have some mental conflict like that's so rude right you would never go there yeah so you do have to be careful about this and I do think that you know that may have been a reason why we haven't gone back to sheans approach avoidance conflict idea in the past but yeah hey so you know hopefully people will read the article and and please let me know if something doesn't make sense or if I've gotten something wrong I mean my wife tells me I get everything wrong all the time so I'm used to it and this article is more of a speculation of more of a presenting a hypothesis that is probably more incorrect than correct but it does set my lab up for a future research program that maybe we can validate some of these ideas it's very interesting you would still acknowledge that there is an underlying neural and genetic component for stuttering I'm just wanted to throw that out there for for listeners just to oh sure of course right most my previous work is in you know the neurodevelopment of speech and language processes in young children and how those could affect recovery and persistence I mean I know you've had Dr Bridget Walsh on your podcast you've had Dr Maniacampin Ray on your podcast see just there I know Mandi I think Mandi is fantastic but for a split second I I had this approach of violence conflict on saying Mandi and so I put in a couple of fillers just to give myself a little bit of time but anyway um and um that's that science is just it's it's really solid so this has this tells you almost nothing about these more distal factors that play a role more explaining some of the questions that that still remain from an experience perspective that that that tend to still pop up into our heads related to variability or or really just explaining that that individual conflict period of time that we have of approach avoidance and role playing yeah so we'll we probably all differ to some degree in the genetic propensity to develop stuttering behaviors when we're quite young but what I'm interested in is in this moment me talking to Sarah why am I so fluent right now or relatively fluent right now compared to when I'm crossing the border into Canada right not that Canada is a horrible place but what's the difference between those two situations right if I didn't know you if I weren't comfortable with you you would probably see that in my speech and the symptomology of that speech would be more behavioral inhibition in the form of hesitations perseverations and procrastinations in my speech and we just label it stuttering yeah and there are more components too than just the relationship with the speaker I mean even if I was to switch rooms in my house to where I usually um recording these podcasts and I might need to relocate as a side note because there's some construction beginning in a house nearby but um in any case even that that shift of it being a little bit different I can imagine would create a pause or a consideration in in in my my head or experience sure I mean we all have to navigate through life and that's often kind of constructing an ecosystem that is most favorable to our communicative uh capacity our communicative competence and so yeah there's things I do in everyday life that I've just learned to condition to make myself relatively more fluent than less fluent um now I can go overboard in that and that's when we go into true avoidance behaviors which is I don't think that's constructive right um back to the approach of one's conflict one way of resolving the conflict is to avoid and you know I take the idea of the behavioral inhibition system from a neuropsychologist called uh dr. Jeffrey Gray who was a famous neuropsychologist in the 70s and 80s and he would argue that the behavioral inhibition system activates when we feel anxious and we're anticipating doing something so we're in the moment of conflict and we're predisposed to avoid okay so back to the path where you face the bear now you you still want to go home obviously like like you want to go back to your campsite because it's where it's safe um but if the bears in front of you you this stronger motivation is going to to run away and I think that when I was younger when I was a kid that's what I did it it was just intuitive to just run away to avoid as much as possible even though I still had that approach motivation because I I did want to talk I did want to do things um but I think as I grew older I I learned over time that the conflict the conflict can be better resolved not by going all out to the avoid inside but by kind of cognitive reframing is this a bear in front of me and being in that moment of of conflict and realizing that actually that conflict is not as strong as I suppose it is and hopefully I'm not talking too long but what often happens to me now Sarah the way I stutter so when I was young I would have really good blocks like my name is really good blocks and I do think that is as I mentioned in the article I do think that is that hyper-direct pathway going from the right hemisphere to also lateral peripheral cortex just going straight to my basal ganglia and just shutting down my motor system but instead what I do now is as I approach Evan I just feel that inhibition so I know people can't see me right now but if you can see me Sarah it's more like my name is my name is I can feel that inhibition it's not it's it's not there and so I almost have to wait it out I I wait out that freeze response and so now my speech is more like my name is Evan does that do you feel that inhibition does that make sense to you I don't know if it's just me it makes sense but I think my choice in that moment is usually not to wait per se on the whole but rather to dial my my my my my my conflict degree down a bit through you know whatever it is I I'm you know a variety of things not to go down that rabbit hole to to get to that point and directly and directly of reducing how I'm thinking or perceiving or the consequences etc and I think for me it's about not putting up that stop sign which is a Vivian analogy of of of of throwing that up when and then choosing to pause or go back or whatever but rather remind myself that I that just because that stop sign is like coming up ever so slightly and I know listeners can't see me either but to still blow it to still run through it with by just starting to say the word I want to say rather than allowing stuttering to dictate the timing of that or sending me back in another direction jik jik just to to to to to to kind of go I don't know if that makes sense it makes sense to just go but I think it's difficult it's almost like you are breaking the conflict by not increasing avoidance but the opposite increasing the motivation to approach right and you have to be really brave to do that right it's like jumping into the deep end of the pool right and for me I'm in those situations when I'm like really rushed or in like emergency situations where I get out of my own head and I just need to do things next thing you know I'm pretty fluent and I think it's because I'm just pure approach motivation you know and I think the the more I'm I'm the the more I'm not focused on the self and I forget about myself that's when the approach motivation just takes over and I think for most people when we're having conversations when we're socializing it's all approach motivation but for me that conflict is there's always a risk that that conflict comes back up of course I think that's what perpetuates the the continuation or the experience of it and the frequency or magnitude I I still experience the conflict right I mean I'm I'm even like trying to put a visualization mentally into what that looks like and when it kind of just like pops up its head and says hey what's up or maybe it's just a whisper or a little numb right it's not that it yeah and I think I would imagine that that has quieted and maybe reduced or changed form over time from being this like huge thing but I think it's still going to take a lot and I I you know I can't imagine just knowing myself and my my tendency to care a lot about what others think of me just naturally I can imagine that that that will be kind of present for for quite a bit in perpetuity yeah I mean maybe I should meditate more or do yoga or we're happy but I kind of think of it as I always have like the angel and the devil on each of my shoulders right and it is interesting because scientifically the neuro correlates of approach approach motivation is typically seen in the left hemisphere and avoidance motivation and conflict is typically seen in the prefrontal cortex of the right hemisphere so you do have this left and right kind of dichotomy going but when I was a kid any social situation the devil would win out right the angel is like come on you want to socialize you want to you know be cool and and you're interested in in having conversations with people and then the devil on my right hemisphere is saying no no you're going to screw up you're going to screw up you're going to make fool yourself don't do it don't do it don't do it and think about that in terms of inhibition right so the left hemisphere could be saying you know don't worry about just do it you know how to say these words just just say it say it say it and then you have the right hemisphere saying hold up hold up stop stop break break break break break break and I think it's that conflict that dichotomy that dance between the left and right hemisphere is that causing the during behaviors happen and the quicker you resolve that conflict the quicker you move on is that correct or yeah and I think for a lot of us we do stutter less over time in certain certain situations that's certainly true for me I don't know if you have that experience Sarah but I think the way I like to describe it is if someone asked me my name if I saw the bear on the trail between the ages of five and I don't know 30 years of age like there was a 90% chance that I would not be able to say my name and I could predict I am going to stutter on heaven but for some reason through just more talking time and just increasing my approach motivation when you increase your approach motivation you decrease your avoidance motivation and the next thing you know I go into an introduction kind of situation and I think well maybe it's only 75% then I'm going to stutter maybe it's only 60% then it may be 50% and to be honest now it's probably 25% and I shouldn't think too much about it because the more I think about it that's my stuff up you know that's going to go back up to 30 right so now when you know you ask me to introduce myself I may be in a little bit of conflict but the conflict is very minimal and you just approach motivation you just kind of do it you know and you think that it is decreased in percentage likelihood in your mind because you have given yourself a higher end or sample size of realizing maybe the bear isn't as big once you get closer maybe it's actually a little bit familiar maybe maybe or no yeah with experience and I can only talk for myself but with experience you realize society is not as harmful or cruel as you supposed I really emphasize the role of self so digmo and I think as you grow up I think when everybody gets older you realize that you know you're not so much focused on the self right you have your job you have kids you have family have more important things to worry about and you realize that the person you're talking to may not be even paying attention to what you're saying like they don't care about whether or not you stutter like they're probably focused on them on themselves and their own issues right and maybe the face that they make when you sit down on your name maybe that's not a face of disgust or rejection maybe that's just a face of confusion or uncertainty because they don't know how to react and I think me understanding that society is not in control of my behavioral inhibition system I find that to be really empowering but yeah yeah and speaking for myself there I had to lean in and approach more than I wanted to or was necessarily ready to in order to see those things and to feel like it the path to approaching more and to tolerate the discomfort of that was teaching me things and and kind of chilling my my my inner thought core belief certainties that were driving my avoidance choices and you know they they don't always win out perfectly but I think leaning in and at least choosing to give it a go was what convinced me that approaching would be useful in reducing this conflict I guess yeah when you let the bear right in front of you and you stop and you can observe the bear you realize it's just kind of it's gonna walk out of your way it's just gonna continue down the path it's looking for a stick or barriers or whatever it's doing you just gonna stand you know it should be there with it and just let it let it pass it's really interesting stuff and Evan I think we could kind of go on and on about this for a while don't want to lose listeners but getting I'm going to link to the journal article so if those of you are interested feel free to give that a read and send questions our way just sending a thank you Evan for for being with us and sharing your brain with us all and and and your your your your your theories oh thank you and but I will say this is this isn't a theory and it's certainly not mine this is just my attempt to to combine a lot of different ideas from a lot of great speech scientists and researchers in the CSD field and so it's certainly not mine but I I will ask that if anybody is interested in the work that our lab does at UD feel free to um look us up on google i just write university of Delaware so tutoring or send us an email at [email protected] great and I can provide those links in the description for everyone as well well thank you Evan for being with us thank you listeners looking forward to being with with you all again next month thanks