Relapse and outcomes

Question 0

What four domains were found to be responsible for treatment outcomes?

Answer 0

Individual related factors
Therapy related factors
Environment related factors
Behaviour and personality related factors

Question 1

What is relapse?

Answer 1

Relapse is when the client can no longer self manage their fluency and decisions are being made around their stutter.

Inevitable for 30- 40% of adolescents and adults within 6 months of treatment.

When the client can no longer self-manage their fluency and decisions are being made around their ‘stutter’ Generally goes with an increase in %SS, but must also consider impact on participation and QOL.

Question 2

What causes relapse?

Answer 2

Every therapy has potential to help stutterer accept role as a normal speaker
 Need to desensitize the stutterer from their stutter – association between stuttering and the negative emotion needs to be broken
 Avoidance behaviours and fear reactions need to be eliminated for successful treatment

Question 3

What determines the likelihood of relapse?

Answer 3

Risk factors include:

• Severity before treatment
• Less successful treatment outcome
• High levels of fear post treatment
• Feelings of helplessness post treatment (external locus of control)

Question 4

What is the difference between regression and relapse?

Answer 4

Regression = some slippage in fluency that includes variations in stuttering across time and situations.  Variations in ability to monitor & use fluency skills, temporary setbacks

 Relapse = pronounced and persistent return to pretreatment levels of stuttering.
 Not viewed as sign of failure but time to identify issues and take action in correcting them
 Increase confidence & make changes more robust

Question 5

What does the best treatment include to prevent relapse?

Answer 5

Speech  restructuring  
Relaxation  &  anxiety  management  
Cognitive  restructuring  
Rational  thinking  
Positive  affirmations    
Acceptance  &  disclosure  
Hence,  whilst  there  is  no  one-‐shoe-‐fits-‐all  approach,  a  holistic  approach  that  manages  the  stuttering  moment  as  a  skill  deficit,  plus  manages  ‘the  person’  and  their  associated  feelings  and  constructs  seems  to  provide  the  best  outcomes

Question 6

What factors can be responsible if the outcome is less than desired?

Answer 6

Treatment
Clinician
Client

Likely to be a combination of these.

Question 7

What are the six themes associated with the successful management of stuttering?

Answer 7

1. Support from others.
2. Successful therapy.
3. Self- therapy and behavioural change.
4. Cognitive change.
5. Utilisation of personal change.
6. High levels of determination and motivation