Category: Comorbidity - Anxiety and Other

PS15- #B62 - Exposure Therapy for the Treatment of SAD in Adults Who Stutter: A Multiple Baseline Design

Sunday, Nov 19
9:00 AM – 10:00 AM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Social Anxiety | Comorbidity | Exposure

Social anxiety disorder (SAD) is a debilitating disorder, and it is estimated that approximately half of adults who stutter meet criteria for SAD. The temporal relationship between anxiety and stuttering suggests that stuttering may engender anxiety, as adults who stutter, but not young children who stutter, demonstrate increased levels of anxiety relative to peers. Previous versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) precluded a diagnosis of SAD among individuals whose anxiety was related to stuttering; however, due to increased recognition of the significant and problematic prevalence of social anxiety symptoms among individuals who stutter, the DSM-5 now allows for a comorbid diagnosis in cases in which the fear, avoidance, or distress is unrelated or excessive to the stuttering. Cognitive-behavioral therapy (CBT) has shown promise in this area, but exposure, the essential ingredient for successful CBT for SAD, has been understudied and underemphasized in treatment for this population. The current study utilized a multiple baseline across participants design to evaluate the effectiveness of an exposure therapy protocol developed to target fears specific to the population of people who are comorbid for SAD and stuttering. Six participants were treated with ten individual sessions of intensive exposure therapy, which entailed speaking in front of a small audience. Individuals who stutter vary in their level of anxiety surrounding extemporaneous speech versus reading aloud, and they often substitute or avoid certain sounds and words that are associated with their stuttering behavior. Hence, the exposure task included both extemporaneous speech and reading, and incorporated all potential anxiety-provoking sounds. Relative to baseline conditions, there were substantial improvements in participants’ self-reported daily ratings of social anxiety (individual reductions ranged from 15% to 58%) and amount of additional social interaction (individual increases ranged from 5 to 106 minutes) as a function of the exposure therapy. There were significant reductions from pre- to post-exposure therapy in social anxiety, t(5) = 5.87, p = .002, as assessed by the Social Phobia and Anxiety Inventory, and in negative emotional reaction to speaking, t(5) = 4.03, p = .01, as assessed by the Speech Situation Checklist. These findings underscore the importance of the assessment and treatment of SAD among adults who stutter, and suggest that the integration of care between psychologists and speech-language pathologists may prove beneficial for this population. 

Jennifer A. Scheurich

Clinical Psychology Doctoral Student
University of Central Florida
Winter Park, Florida

Deborah C. Beidel

Pegasus Professor of Psychology & Medical Education
University of Central Florida

Martine Vanryckeghem

Professor, Board Certified Fluency Specialist, ASHA Fellow
University of Central Florida