Action Before Outcomes: In Praise of the New Ground-Breaking Study in Understanding Change in Adults Who Stutter

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Perhaps I have not read enough of the available academic research done on stuttering to date, or that which I have read has not been as accessible as Knowledge Without Action Means Nothing: Stakeholder Insights on the Behaviors that Constitute Positive Change for Adults Who Stutter conducted by Dr. Naomi Rodgers and Dr. Hope Gerlach-Houck. As I read furiously, I already knew they were on the precipice of a significant breakthrough for the pursuit lasting change in stuttering. It spelled out in a well-curated study how I, myself, transformed my relationship with stuttering and continue to solidify self-acceptance. I couldn’t believe what I was reading. 

In the study, these two leading speech-language pathologists (SLPs) sought to answer the question that many adults who stutter (AWS) pursue for most—if not—all of their lives: If an AWS was making positive changes to living with stuttering, what would they be doing?Doing is the key, as in what actions are we (AWS) choosing to do from moment to moment or daily that cultivates healthy change that lasts. 

The clarity with which the authors unveiled their intentions and execution of the study is thoughtful, taking into consideration controversial opinions and assumptions that often undercut the credibility of studies focused on the “how-to” of change in stuttering. For example, they use anti-ableism constructs like phrasing “positive changes to living with stuttering” instead of a stigmatized label such as “stuttering management.” 

Further, I thought it was particularly interesting how they prioritized actions before outcomes given the significant focus on outcome-oriented therapy strategies. I found this theme interesting because making progress—whatever that means to you—depends on breaking down the desired outcomes into their component parts and taking digestible actions until you reach the desired endThis was my experience of change.

As I’ve written about, I’ve spent the last four years in deep exploration of why what I did this time in my effort to change my relationship with stuttering worked—reaching lasting change and self-acceptance. Yes, these once unattainable states are a subjective experience and each person responds differently to the same actions, but I believe unequivocally that the process we who stutter must pass through is more similar than unique. Although this belief would be rather controversial to say in an academic publication, I know it to be true because the findings of this study are nearly identical to how I made positive change last. 

Let me explain the similarities and differences between their findings and mine. 

A Comparative Analysis

For my introspective analysis, I adapted a four-phase process of change from the trauma research of Dr. Peter Levine in his book Waking the Tiger: Healing Trauma to explore and explain how I journeyed to self-acceptance and change. The four phases were foundation, surge, reinforcement, and enough, which translate to Dr. Levine’s intended outcomes of awareness, action, perspective, and social connection. Here is my interpretation of Dr. Levine’s process for healing trauma shown with my adapted process for stuttering:

FoundationThe creation of a safe base for launching into and retreating from my new life.10 Months
SurgeA period of sustained disciplined focus on confronting my fears, cultivating new habits, and climbing out of the traumatic state of stuttering. ~2 Years
ReinforcementAn effort to strengthen and solidify the new habits, and transition my default reactions into opportunities to stutter~7 Years
EnoughThe point when I stutter almost without hesitation, thought, or a maladaptive reaction—the new habits become automatic.~10 Years

[i] The length of time it took me to work through each phase, which is specific to my journey. Each person who stutters takes the time it takes to journey through the phases.

Dr. Rodgers and Dr. Gerlach-Houck relied upon the five-stage continuum of behavior change developed by Dr. James Prochaska called the transtheoretical model. The trans- what? I tripped up on it too and had to do some Googling. Readiness for change is the key and the stages exist on a continuum as a “dynamic cognitive progression.” Here are the five stages of change:

The graphics and charts are eerily similar, yet not at all a coincidence. The reason—there are certain actions AWS can and must do or try to discover what will catalyze positive change, and larger, cross-cultural and demographics studies need to be conducted to prove the usefulness of applying the stages of change to transformative plans for we who stutter.


The results of the study are further proof that Dr. Rodgers and Dr. Gerlach-Houck are on the cusp of a strategic breakthrough for the execution of change in living with stuttering. Their analysis identified three overarching themes that synthesized the range of behaviors that constitute positive changes to living with stuttering for adults:

  • Noticing and adjusting physical behaviors involved in speaking, to the extent that it is personally important to do so;
  • Developing neutral or positive thoughts and feelings about stuttering;
  • Participating more fully in social and professional activities, even if the person stutters or thinks they may stutter. 

In other words, AWS stay present and feel the moment of stuttering, exercise choice in how they respond, do not negatively judge their performance, and do or say what they want when they want regardless of how stuttering might impact it. These global themes nearly mirrored the results of my self-assessment. My global themes were:

  • Cultivating felt-awareness;
  • Confronting moments of stuttering to refine and limit physiological reactivity through exposure to fear/shame;
  • Strategic perspective on behavior change journey;
  • External perception of stuttering transitions to near indifference;
  • Social fluency.

I needed to feel how I stuttered for the first time, take aggressive action to counter debilitating fears and shame, understand the compounding nature of change over a sustained period of time, reinforce an I-don’t-care-what-others-think-about me self-perception, and, eliminate all social anxiety. While I will leave the in-depth analysis of my self-study to my upcoming book, I find it incredibly validating to see that Dr. Rodgers and Dr. Gerlack-Houck arrived at very similar findings after collecting and examining data from 11 other AWS and 12 SLPs. 

Viewing these global themes together allows an AWS to get a preview of common outcomes that their pursuit of change couldproduce aside from increased stuttering efficiency and decreased physical effort when speaking. This is the part of living with stuttering that has fascinated me since I was a child struggling to grasp how to escape its life impeding nature—reducing the existential wonder of what was possible if I were to stutter forever. And, it shines a spotlight on the stigmatizing caveat that each person who stutters travels a very different journey to positive change and cannot or should not pursue these common outcomes using the same or similar actions because they will react differently in the same situations. This study is a monumental step in the right direction of beginning to change this journey-stalling narrative. 

They Considered Almost Everything 

Reviewing the organizing and basic themes further showed the promise of this study’s findings. After reading Table 3, the reader is sees that they considered almost every variable when drawing conclusions from the data. 

Global 1: For cultivating behavioral awareness and adjustment while speaking, the themes read as though AWS should learn the fundamentals of habit change and how to apply them to individual moments of stuttering to lessen cognitive and physiological reactivity. Violet’s profound claim epitomizes this point perfectly, “…you know that the physical struggle of stuttering is the thing that’s bothering you the most.” The way stuttering sounds must take a backseat to how it feels. 

The reason I recommend learning habit change methods is because of the need to break down our hierarchies of fear into small, digestible actions, which is alluded to and stated multiple times throughout the study. Applying these methods occurs through self-reflection combined with self-coaching, two of the basic themes noted in the first global theme. 

Global 2How does an AWS make stuttering less and less of a negative experience? By changing their definition of success, developing a progressive openness facing fears, desensitizing to the totality of their moments of stuttering (before, during, and after), making stuttering a part of their identity, and formulating their own understanding of their stuttering and sharing it with others. In doing so (which is obviously easier said than done), the AWSs begins to see their thoughts and feelings of stuttering as neutral or positive, which, for me, can even result in a state of having moments where I forget that I stutter while openly stuttering. 

However, there were two critical points in these basic themes that warrant more attention. First, an AWS’ shift in self-assessing their variability of moods based on their severity of stuttering. This was one of my key propellers of positive change in that over time and through many exposures to feared situations, I changed my internal narrative of “wow, I’m really struggling here…” to “It’s just this moment/today…tomorrow is a fresh start.” Shedding this reactivity ended the compounding struggle and subsequent rumination, allowing me to confront the next moment of stuttering without the thoughts and trauma from that which preceded it. 

The second was kind of a throw-in to the section: “For some people who stutter, one way of reducing stuttering-related shame was to focus more on other parts of themselves outside of stuttering, such as hobbies, values, and other identities.” This is the buried gem of the entire study.

Positive change in stuttering is identity change. Every action we take towards positive change is a vote towards who we wish to become, to quote best-selling author and habit change guru James Clear. If the goal is to make stuttering a part of our whole identity, we cannot focus all of our attention on it while trying to implement change. Coupling the pursuit of positive change in stuttering with another activity of your choosing that you like to do, such as a hobby or career, and concurrently doing them probably accelerates all of the other findings in this study and helps make the changes last. Given that my journey to self-acceptance hues so closely to the findings of this study, I highly recommend additional research on this potential life-changing combination for catalyzing positive change

Global 3: Living without social friction is the incomprehensible existence we who stutter long for as we repeatedly fail to achieve it…until we start doing something about it. As George said, “I’m finding that until you try things in the normal course of daily life, challenge yourself that way, it’s hard to really see the results that you want to see.” We have to make real attempts and examine what happens. An attempt is an action taken, not simply imagined or desired. Asking what might the first step towards—talking about stuttering more, saying one more thing in a group discussion, or making a phone call—look like? Cue the significance of understanding habit change I mentioned in global theme 1. 

Becoming socially fluent while stuttering is a true step-by-step process that in time feels like it happens all at once, and I appreciate that this reality gets so much real estate in this study. How does one who stutters know when they achieved social fluency? The answer lies in the very last basic theme—when you’re able to make life decisions independent of how stuttering might impact them. This is another buried gem and an outcome that showed me when I could ease up on the breakneck pace of my own pursuit of behavior change with stuttering. 

Conclusion: Where Can We Go from Here?

I am ecstatic inside that Dr. Rodgers and Dr. Gerlach-Houck even conducted this study with the intention of their findings being incorporated into individualized change plans for AWS. This is an initial building block—using change instead of therapy further redirects AWS towards taking positive actions, removing the possibility that we may hesitate to begin therapy again since we’ve likely experienced at least one or many therapeutic failures in our efforts to change. Chasing fluent speech is not a therapeutic actionsince the only possible outcome is avoidance of the inevitable.

Another building block could be adding questions that broaden the scope of the study to include a holistic view on where the pursuit of positive change in stuttering fits into the participant’s life. Simply, what else are they also doing when they pursue change, that could or probably has an impact on their success. For example, as I went through three years of Avoidance Reduction Therapy for stuttering, I also changed careers, learned to swim, became a triathlete, met the love of my life, studied stoic philosophy, and began a daily reading and journaling practice. How can we zoom out to see everything that is propelling and catalyzing positive change, and then use the momentum to drive change forward, forever? 

A natural follow up question that readers, SLPs, and AWS are probably wondering is how long with it take to actualize and achieve positive change? Or, how long does each stage of change take? Yes, the answer is again subjective and is difficult to deduce within the parameters—and unwritten rules—of academic publications. I totally understand the constraints and potential professional blowback. But, a longitudinal study of AWS could yield news insights into the duration of effort it takes to make breakthrough change. In my own after action analysis I shared above, it took me about 10 full years to reach a relapse-proof self-acceptance and a default to open stutter; however, keep in mind that I didn’t know what I was doing while I was making these transformative changes. It was only after I passed through the stages that I realized why the actions and journey I took led to the outcomes I never thought possible. 

Lastly, how can AWS incorporate the findings of this study into their work with SLPs? See what I did there—the responsibility and readiness for change begins with we who stutter. Change cannot be forced, recommended, or something you have to think about. Mine began when I was reached out my hand for help. Since change is also not something you do on your own, why not seek to fully collaborate with SLPs who want to meet us where we are. Dr. Rodgers and Dr. Gerlach-Houck advocate for this by saying: 

Clients and SLPs should collaborate to develop individualized therapy plans, composed of actions and outcomes that are personally meaningful. It is equally important to have a shared understanding of the intent, or why the client is participating in various activities, which can help clients connect what they are doing in the therapy room to their preferred outcomes. This can promote their understanding of, and agency in, the change process.

We who stutter must take a leading, active role in our own change. This presents an opportunity to reverse the unfounded responsibility that SLPs bear for our success in therapy, and allow them to coach us through our journeys of change using evidence-based methods that we devise together. 

Thank you, Dr. Rodgers and Dr. Gerlach-Houck, for the ground-breaking work that you are doing for the stuttering community. A monumental step in the right direction!

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