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Indicators of Successful Change Indicators of Successful Change During TreatmentDuring Treatment

CHAPTERCHAPTER 1111

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Perspectives of changePerspectives of change

• Group data vs. patterns of individual changeGroup data vs. patterns of individual change

• FormalFormal––informal treatmentinformal treatment

• The multidimensional nature of changeThe multidimensional nature of change

Sheehan (1980) trivial criteria = greater successSheehan (1980) trivial criteria = greater success

• Krauss-Lehrman & Reeves (1988): 75% of National Krauss-Lehrman & Reeves (1988): 75% of National Stuttering Association members surveyed felt that their Stuttering Association members surveyed felt that their therapy had been mildly or very successful even therapy had been mildly or very successful even though many continued to display varying degrees of though many continued to display varying degrees of stuttering (implications for EBP?)stuttering (implications for EBP?)

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Perspectives of change (continued)Perspectives of change (continued)

• Change can begin prior to Tx Change can begin prior to Tx (Andrews & Harvey, 1981) (Andrews & Harvey, 1981) (regression to the mean & speaker taking action)(regression to the mean & speaker taking action)

• The 33% rule ? For some, only one meeting!The 33% rule ? For some, only one meeting!

• Looking closely at success (p. 6) Looking closely at success (p. 6)

• Paradox: Paradox: • Behavioral change first, cognitive change takes time Behavioral change first, cognitive change takes time

• But cognitive change necessary for long-term behavioral changeBut cognitive change necessary for long-term behavioral change

• Cooper’s (1987) suggestion of CPS Cooper’s (1987) suggestion of CPS

• Other problems (speech, language, anxiety, addiction . . .)Other problems (speech, language, anxiety, addiction . . .)

• Older speakers who stutterOlder speakers who stutter

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Indicators of changeIndicators of change

• Ask the client!Ask the client!

• Recognize little victoriesRecognize little victories

• Decreasing frequency of stuttering (duh!)Decreasing frequency of stuttering (duh!)

• Increasing frequency of stuttering (really?)Increasing frequency of stuttering (really?)

• Increasing Increasing normalnormal fluency breaksfluency breaks

• Changing stuttering form-types (less effort)Changing stuttering form-types (less effort)

• Increasing self-monitoring—especially Increasing self-monitoring—especially proprioceptive feedbackproprioceptive feedback

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Indicators of change (continued)Indicators of change (continued)

• Improving scores on measuresImproving scores on measures

• Increasing naturalness Increasing naturalness

• Changing metalinguistics/self-talkChanging metalinguistics/self-talk

• Changing roles (risk taking, assertiveness)Changing roles (risk taking, assertiveness)

• The altered roles of othersThe altered roles of others

• Becoming comfortable with fluencyBecoming comfortable with fluency

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LCB scoresLCB scores

• Craig, Franklin, and Andrews (1984)Craig, Franklin, and Andrews (1984)——28/32 Ss who 28/32 Ss who maintained fluency 10 m post-tx showed increased internality maintained fluency 10 m post-tx showed increased internality during treatment.during treatment.

• Replicated by Craig and Andrews (1985)Replicated by Craig and Andrews (1985)

• De Nil & Kroll (1995)De Nil & Kroll (1995)——while fluency gains maintained 2 years while fluency gains maintained 2 years post-tx, no relationship between LCB scores and %SS.post-tx, no relationship between LCB scores and %SS.

• Andrews & Craig (1988)Andrews & Craig (1988)——total LCB scores alone were of total LCB scores alone were of limited help in predicting treatment outcome limited help in predicting treatment outcome

• Type of treatment (or short, intense treatments) may not Type of treatment (or short, intense treatments) may not promote cognitive changes and may not be reflected in LCB promote cognitive changes and may not be reflected in LCB scores.scores.

• Individual Pawn & Origin scores more predictive? Individual Pawn & Origin scores more predictive?

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LCB scores for an adult female with LCB scores for an adult female with severe stuttering over six years of severe stuttering over six years of

treatment. treatment. 

  

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Self-efficacy (SESAS) scoresSelf-efficacy (SESAS) scores

• Blood (1995)Blood (1995)——3 high school students, 25 hr tx, 3 high school students, 25 hr tx, 50 hrs relapse prevention, 6 & 12 m follow-up:50 hrs relapse prevention, 6 & 12 m follow-up:

BaselineBaseline 56.3%56.3%

Post-treatmentPost-treatment 77.6%77.6%

Post-relapsePost-relapse 87.3%87.3%

6m follow-up6m follow-up 89.7%89.7%

12m follow-up12m follow-up 86.7% 86.7%

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Self-efficacy (SESAS) scores Self-efficacy (SESAS) scores (continued)(continued)

• Hillis (1993)Hillis (1993)——See Figure 11-1See Figure 11-1

• Langevin et al. (2006): Canada (N = 16) Langevin et al. (2006): Canada (N = 16) Netherlands (N = 25) Netherlands (N = 25)

• SESAS Approach ScoresSESAS Approach Scores• Maintainers improved 28.1%Maintainers improved 28.1%• Nonmaintainers improved 17.9%Nonmaintainers improved 17.9%

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Approach scores for the self-efficacy scale for Approach scores for the self-efficacy scale for adult stutterers (SESAS) for an adult female with adult stutterers (SESAS) for an adult female with

severe stuttering over six years of treatment.severe stuttering over six years of treatment.

 

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Performance scores for the Self-Efficacy Scale Performance scores for the Self-Efficacy Scale for adult stutterers (SESAS) for an adult female for adult stutterers (SESAS) for an adult female

with severe stuttering over six years of with severe stuttering over six years of treatment.treatment.

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Indicators of changeIndicators of change

• Improving scores on measuresImproving scores on measures• Increasing naturalness (1 natural Increasing naturalness (1 natural →→ 9) 9) (video of (video of

Joy)Joy)• Changing metalinguistics & self-talkChanging metalinguistics & self-talk• Changing roles (approach, risk taking, Changing roles (approach, risk taking,

assertiveness)assertiveness)• The altered roles of othersThe altered roles of others• Becoming comfortable with fluencyBecoming comfortable with fluency• Increased agentic behaviorIncreased agentic behavior——problem solvingproblem solving• Self-concept & self-esteem (a cornerstone of Self-concept & self-esteem (a cornerstone of

psychological change (Peck, 1978)psychological change (Peck, 1978)

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Indicators of change (continued)Indicators of change (continued)

• The variable of HumorThe variable of Humor

• MasteryMastery – Distance – – Distance – ParadigmParadigm Shift Shift

• Working with Relapse (shallow–deep)Working with Relapse (shallow–deep)

• Transfer and maintenanceTransfer and maintenance

• Joining a Support Group (Chapter 12)Joining a Support Group (Chapter 12)

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S. Brundage and experiments with S. Brundage and experiments with virtual reality virtual reality

• Transfer beyond the treatment settingTransfer beyond the treatment setting• Live and virtual experiences similar Live and virtual experiences similar (affective, (affective,

cognitive, physiologic measures, cortisol levels, cognitive, physiologic measures, cortisol levels, & anxiety)& anxiety)

• Without penalty Without penalty (free to explore and experiment)(free to explore and experiment) • Vary & control important factors in hierarchical Vary & control important factors in hierarchical

manner manner (many possible scenarios)(many possible scenarios) • Initial studies indicate generalization and Initial studies indicate generalization and

empowerment with practice in virtual empowerment with practice in virtual environmentenvironment

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Your criteria for terminating Your criteria for terminating treatmenttreatment

• Children:Children: home severity ratings (SR) of less than home severity ratings (SR) of less than 2.0 and 1.0% SS during clinic 2.0 and 1.0% SS during clinic (+ gradual phase- (+ gradual phase- out)out)

• Adults:Adults:• Bored and unenthused Bored and unenthused (Van Riper, 1973)(Van Riper, 1973)• Spontaneous & natural speech?Spontaneous & natural speech?• Little or no avoidance Little or no avoidance • The importance of closure/speaker responsibility and The importance of closure/speaker responsibility and

dependencydependency• A trial or temporary break, group therapy, joining a A trial or temporary break, group therapy, joining a

support groupsupport group