Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 1 Indicators of Successful Change During Treatment CHAPTER 11

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 2 Perspectives of change Group data vs. patterns of individual changeGroup data vs. patterns of individual change Formal–informal treatmentFormal–informal treatment The multidimensional nature of changeThe multidimensional nature of change Sheehan (1980) trivial criteria = greater success Krauss-Lehrman & Reeves (1988): 75% of National Stuttering Association members surveyed felt that their therapy had been mildly or very successful even though many continued to display varying degrees of stuttering (implications for EBP?)Krauss-Lehrman & Reeves (1988): 75% of National Stuttering Association members surveyed felt that their therapy had been mildly or very successful even though many continued to display varying degrees of stuttering (implications for EBP?)

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 3 Perspectives of change (continued) Change can begin prior to Tx (Andrews & Harvey, 1981) (regression to the mean & speaker taking action)Change can begin prior to Tx (Andrews & Harvey, 1981) (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 timeBehavioral 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 CPSCooper’s (1987) suggestion of CPS Other problems (speech, language, anxiety, addiction...)Other problems (speech, language, anxiety, addiction...) Older speakers who stutterOlder speakers who stutter

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 4 Indicators 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 normal fluency breaksIncreasing normal fluency breaks Changing stuttering form-types (less effort)Changing stuttering form-types (less effort) Increasing self-monitoring—especially proprioceptive feedbackIncreasing self-monitoring—especially proprioceptive feedback

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 5 Indicators of change (continued) Improving scores on measuresImproving scores on measures Increasing naturalnessIncreasing 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

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 6 LCB scores Craig, Franklin, and Andrews (1984)—28/32 Ss who maintained fluency 10 m post-tx showed increased internality during treatment.Craig, Franklin, and Andrews (1984)—28/32 Ss who maintained fluency 10 m post-tx showed increased internality during treatment. Replicated by Craig and Andrews (1985)Replicated by Craig and Andrews (1985) De Nil & Kroll (1995)—while fluency gains maintained 2 years post-tx, no relationship between LCB scores and %SS.De Nil & Kroll (1995)—while fluency gains maintained 2 years post-tx, no relationship between LCB scores and %SS. Andrews & Craig (1988)—total LCB scores alone were of limited help in predicting treatment outcomeAndrews & Craig (1988)—total LCB scores alone were of limited help in predicting treatment outcome Type of treatment (or short, intense treatments) may not promote cognitive changes and may not be reflected in LCB scores.Type of treatment (or short, intense treatments) may not promote cognitive changes and may not be reflected in LCB scores. Individual Pawn & Origin scores more predictive?Individual Pawn & Origin scores more predictive?

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 7 LCB scores for an adult female with severe stuttering over six years of treatment. LCB scores for an adult female with severe stuttering over six years of treatment.

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 8 Self-efficacy (SESAS) scores Blood (1995)—3 high school students, 25 hr tx, 50 hrs relapse prevention, 6 & 12 m follow-up:Blood (1995)—3 high school students, 25 hr tx, 50 hrs relapse prevention, 6 & 12 m follow-up: Baseline56.3% Post-treatment77.6% Post-relapse87.3% 6m follow-up89.7% 12m follow-up86.7%

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 9 Self-efficacy (SESAS) scores (continued) Hillis (1993)—See Figure 11-1Hillis (1993)—See Figure 11-1 Langevin et al. (2006): Canada (N = 16) Netherlands (N = 25)Langevin et al. (2006): Canada (N = 16) Netherlands (N = 25) SESAS Approach ScoresSESAS Approach Scores Maintainers improved 28.1%Maintainers improved 28.1% Nonmaintainers improved 17.9%Nonmaintainers improved 17.9%

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 10 Approach scores for the self-efficacy scale for adult stutterers (SESAS) for an adult female with severe stuttering over six years of treatment.

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 11 Performance scores for the Self-Efficacy Scale for adult stutterers (SESAS) for an adult female with severe stuttering over six years of treatment.

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 12 Indicators of change Improving scores on measures Improving scores on measures Increasing naturalness (1 natural → 9) (video of Joy) Increasing naturalness (1 natural → 9) (video of Joy) Changing metalinguistics & self-talk Changing metalinguistics & self-talk Changing roles (approach, risk taking, assertiveness) Changing roles (approach, risk taking, assertiveness) The altered roles of others The altered roles of others Becoming comfortable with fluency Becoming comfortable with fluency Increased agentic behavior—problem solving Increased agentic behavior—problem solving Self-concept & self-esteem (a cornerstone of psychological change (Peck, 1978) Self-concept & self-esteem (a cornerstone of psychological change (Peck, 1978)

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 13 Indicators of change (continued) The variable of Humor The variable of Humor Mastery – Distance – Paradigm Shift Mastery – Distance – Paradigm Shift Working with Relapse (shallow–deep) Working with Relapse (shallow–deep) Transfer and maintenance Transfer and maintenance Joining a Support Group (Chapter 12) Joining a Support Group (Chapter 12)

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 14 S. Brundage and experiments with virtual reality Transfer beyond the treatment settingTransfer beyond the treatment setting Live and virtual experiences similar (affective, cognitive, physiologic measures, cortisol levels, & anxiety)Live and virtual experiences similar (affective, cognitive, physiologic measures, cortisol levels, & anxiety) Without penalty (free to explore and experiment)Without penalty (free to explore and experiment) Vary & control important factors in hierarchical manner (many possible scenarios)Vary & control important factors in hierarchical manner (many possible scenarios) Initial studies indicate generalization and empowerment with practice in virtual environmentInitial studies indicate generalization and empowerment with practice in virtual environment

Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED. 15 Your criteria for terminating treatment Children: home severity ratings (SR) of less than 2.0 and 1.0% SS during clinic (+ gradual phase- out) Children: home severity ratings (SR) of less than 2.0 and 1.0% SS during clinic (+ gradual phase- out) Adults: Adults: Bored and unenthused (Van Riper, 1973) Bored and unenthused (Van Riper, 1973) Spontaneous & natural speech? Spontaneous & natural speech? Little or no avoidance Little or no avoidance The importance of closure/speaker responsibility and dependency The importance of closure/speaker responsibility and dependency A trial or temporary break, group therapy, joining a support group A trial or temporary break, group therapy, joining a support group