Practical Thoughts Blog

It's (almost) NEVER breathing in stuttering therapy!

It's (almost) NEVER breathing in stuttering therapy!

For decades - centuries - heck, probably longer - clinicians and others have recommended various breathing exercises for people who stutter. I see it all the time on the Internet. 

Without giving away too much right up-front in this little essay, let me just say this: there is absolutely NO research evidence that changing breathing patterns actually helps people who stutter in the long term. 

I know, crazy, right?!?

Okay, let's break it down. But first, sure, because it's stuttering, we always have to allow for unique circumstances (that's why I put "(almost)" in the title), but the vast, vast majority (like 99%) of the clients I have worked with over the past 30 years have breathed just fine and did not need to do any work to improve breath support.

Well, let's say that they started out breathing just fine, until some well-meaning family member (or clinician) told them to take a breath before speaking. Some people say "Take a DEEP breath" or "Breathe with your diaphragm," but as speech-language pathologists know, that's not how people talk... We don't take deep breaths from our bellies before we talk. We take appropriately sized breaths, as needed, in the flow of communication. Typical, natural breathing patterns are quite sufficient for fluent speech.

This emphasis on changing the way people breathe does not help them be more fluent. End of story. Mostly, what it does is leave people confused, and all that attention focused on their breathing can actually make the process of talking harder. That can end up interfering with their speech even more than the stuttering does.

So what are we supposed to do?

First, let's acknowledge that deep breathing CAN be useful for relaxation, and for some people, increasing their relaxation response can help them deal with difficult situations. Note that I didn't say that it will necessarily make them more fluent in those situations, but it can make it easier to face them, and greater confidence can indirectly affect fluency. So, if a breath helps a client feel good before they enter a situation, then, sure, they can take a breath. But, they definitely should not do it in the hopes that it might make them fluent.

Second, let's acknowledge, too, that sometimes we receive clients who have already had their breathing messed up -- by this, I mean that they've been told to DO THINGS with their breathing that they probably didn't need to do. Our job with these clients is to help them get back to normal breathing - to shift their focus away from trying to do anything special with their breathing in a vain attempt to be fluent. That means that we need to undo the damage that's been done to them (again, by well-meaning individuals), so that they can do more of the things that people who don't stutter do when they talk (that is, breathe normally).

Third, and related: even without the input from misguided family members (and clinicians), sometimes speakers do mess with their breathing because they are trying to avoid stuttering. (My most difficult client EVER was a young boy who had, in essence, learned to avoid stuttering by "taking a deep breath" that had morphed into a sharp inhalation...) Note the direction of the effect, though - it was not the breathing that made stuttering hard; it was their stuttering that caused them to make breathing hard. It was an avoidance strategy, so the key to undoing the pattern was to reduce the avoidance, not to focus on the breathing (though in that one case, I had to do that, too, because the pattern was deeply entrenched.)

Fourth, if we see someone who truly has difficulty with breath support (and this would need to be verified independently from their speech fluency - we cannot use stuttering as an indicator that breath support is messed up, because stuttering is a moment when the speaker has involuntarily lost control of the speech mechanism) then we need to make a referral to an appropriate professional to ensure that the person is safe. I have seen this in cases whether the person who stutters also has cerebral palsy, for example.

Finally (for now), I would like to suggest that instead of changing people's breathing from clavicular to costal or diaphragmatic or whatever, we should focus on the reason that they may be experiencing physical tension, or the reason that they are messing with their breathing, or the reason that they are experiencing fear...

Typically, that reason is their discomfort with stuttering itself.

If we can help people learn to understand, tolerate, and ultimately accept that moment of stuttering, then they won't have the elevated tension, the desire to avoid, and the increased fear. THAT will help them far more than any practice with a different manner of breathing.

What does this mean for you, right now, on a practical level? Mostly, it means that you do not need to spend time with your students teaching them diaphragmatic breathing or belly breathing or whatever... People can use clavicular breaths and talk just fine! In fact, most people do it all the time! Why should people who stutter need to learn to breathe differently from the way other people breathe, just in an attempt to try to mask or hide their stuttering (especially when that different manner of breathing won't actually help to reduce the stuttering in the first place)?!? 

No, you can simplify their life (and yours) by leaving breathing techniques for fluency behind and focusing instead on what really matters: helping people communicate more easily and more effectively, regardless of how they breathe.

Okay, that was a rant, but it's an issue that Nina and I face all the time as stuttering specialists. So many of our clients come to us saying that they were told to breathe this way or that way by some prior clinician or family member, and we spend a lot of time trying to break the unhelpful habit of taking a breath before talking.

Now, I know that some of this will be controversial and different from what you've been told... so, please share your thoughts. Email us at info@StutteringTherapyResources.com to let us know what you think, or add comments on our social media posts on this topic.  We value the dialogue! 

(Whew! I need to take a deep breath!)

So, to summarize: 

  1. There is no research to support that changing breathing is helpful long-term for people who stutter.
  2. Our role for some clients is to undo a misdirected focus on breathing that is causing problems in their communication now. 
  3. Sometimes, breathing irregularities may be part of a person's attempt to avoid stuttering; our role is to address the reasons for the avoidance, NOT to focus on breathing. 
  4. If there are suspected medical reasons for low breath support (again, not about their stuttering), our role to is to refer to health care providers. 
  5. Finally, we need to discover why the speaker is avoiding or changing breathing patterns. This will give us the information to know how to help! 

Most important take-home: Leave the breathing therapy behind, and focus on easier communication.