A case in which speech avoidance disappeared through a chronological mental rehearsal training program: Focusing on the process of changing thoughts, emotions, and behaviors

[Theoretical background and purpose] We observed a case in which improvement was observed in the classification of stuttering developmental phases after using a mental rehearsal method (MR method) based on the Retrospective Approach to Spontaneous Speech theory (RASS theory). This study aims to analyze the factors that lead to the progress from the fourth to the third level of the classification of stuttering developmental phases and clarify the improvement process.
[Method] The patient is a male university student in his 20s who started stuttering 5 years ago. At the first visit (Day X), his classification of stuttering developmental phases was level 4. We analyzed the progress of the "Stuttering Person`s Thoughts and Behavior Checklist," administered 10 times during intervention. This checklist consists of 89 items, including three indicators: 1) values/thoughts, 2) feelings/emotions, and 3) behavior (avoidance, ingenuity, etc.) (example item: stuttering is embarrassing, etc.), and participants were asked to convert the level to which they think each applies into a percentage and enter it. With the MR method, the aim is for all of these numbers to be 0%.
[Results] The initial average percentages for each index and the time when they reached 0% were: 1) values/thoughts: 58.5% → 0% at X+6 months, 2) emotions/feelings: 67.5% → 0% at X+7 months, 3) behavior (only four items in avoidance): 82.5% → 0% at X+10 months. This case reached the third level of the stuttering developmental phases 10 months after the start of the intervention.
[Discussion] This case progressed from the fourth to the third level of the classification of stuttering developmental phases through the process of "disappearance of negative values" → "disappearance of negative emotions" → "disappearance of avoidance" regarding stuttering. In the MR method based on RASS theory, it is suggested that not only advising the patient to eliminate avoidance but also to approach the negative values and emotions regarding stuttering is an effective step toward improvement.