JSLHR
Research Article
Safety Behaviors and Stuttering
Robyn Lowe,a Fjola Helgadottir,b Ross Menzies,a Rob Heard,a
Sue O’Brian,a Ann Packman,a and Mark Onslowa
Purpose: Those who are socially anxious may use
safety behaviors during feared social interactions to
prevent negative outcomes. Safety behaviors are
associated with anxiety maintenance and poorer
treatment outcomes because they prevent fear extinction.
Social anxiety disorder is often comorbid with stuttering.
Speech pathologists reported in a recent publication
(Helgadottir, Menzies, Onslow, Packman, & O’Brian, 2014a)
that they often recommended procedures for clients that
could be safety behaviors. This study investigated the
self-reported use of safety behaviors by adults who stutter.
Method: Participants were 133 adults who stutter enrolled
in an online cognitive-behavior therapy program. Participants
completed a questionnaire about their use of potential
F
or many who stutter, the condition is associated
with mental health problems (Blumgart, Tran, &
Craig, 2010; Iverach, O’Brian, et al., 2009; Menzies
et al., 2008). The most prevalent mental health condition
associated with stuttering is social anxiety disorder. Within
clinical populations, up to two thirds of adults who stutter
meet the criteria for a diagnosis of social anxiety disorder
(Iverach, O’Brian, et al., 2009; Menzies et al., 2008; Stein,
Baird, & Walker, 1996). The presence of such mental health
disorders is associated with impaired treatment efficacy
(Iverach, Jones, et al., 2009). In the Iverach, Jones, et al.
(2009) study, the participants who stuttered who had one
or more mental health disorders failed to maintain their
speech treatment benefits at 6 months posttreatment.
Social Anxiety Disorder
Social anxiety disorder is one of the most prevalent
mental health conditions, affecting between 8% and 13%
of the general population (Kessler et al., 2005; Ruscio
a
The University of Sydney, Australia
b
The Vancouver CBT Centre, Canada
Correspondence to Mark Onslow: mark.onslow@sydney.edu.au
Editor: Julie Liss
Associate Editor: Hans-Georg Bosshardt
Received February 9, 2016
Revision received August 1, 2016
Accepted December 5, 2016
https://doi.org/10.1044/2016_JSLHR-S-16-0055
1246 Journal of Speech, Language, and Hearing Research • Vol. 60 • 1246–1253 • May 2017 • Copyright © 2017 American Speech-Language-Hearing Association
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safety behaviors when anxious during social encounters.
Correlations were computed between safety behaviors
and pretreatment scores on measures of fear of negative
evaluation and negative cognitions.
Results: Of 133 participants, 132 reported that they used
safety behaviors. Many of the safety behaviors correlated
with higher scores for fear of negative evaluation and
negative cognitions.
Conclusions: Adults who stutter report using safety
behaviors, and their use is associated with pretreatment
fear of negative evaluation and unhelpful thoughts about
stuttering. These results suggest that the negative effects
of safety behaviors may extend to those who stutter, and
further research is needed.
et al., 2008). The condition involves extreme and excessive
fear of being humiliated, embarrassed, and negatively
evaluated in social situations where there is potential for
scrutiny by others. Severe cases can involve high levels of
avoidance, leading to social isolation and failure to partici-
pate in many occupational, social, and interpersonal activi-
ties (American Psychiatric Association, 2013). However,
not all social situations can be avoided, and those with
social anxiety disorder can experience extreme discomfort
and distress in unavoidable social or performance-based
situations (American Psychiatric Association, 2013). It has
intrigued cognitive theorists that those with social anxiety
disorder are repeatedly exposed to feared social situations
without the anticipated disastrous consequences, yet their
fears persist.
Social Anxiety Disorder and Safety Behaviors
According to contemporary cognitive theorists, anxi-
ety is maintained with social anxiety disorder in part by
safety behaviors (Clark, 1999; Clark & Wells, 1995; Rapee
& Heimberg, 1997; Salkovskis, 1991). Safety behaviors are
cognitive processes or behaviors used by those who are
socially anxious as an attempt to prevent negative social
consequences (Clark 1999; Salkovskis, 1991). Examples
of common safety behaviors used during social situations
by those with social anxiety disorder include mentally
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
rehearsing sentences before talking and avoiding eye con-
tact (Clark & Wells, 1995; Marks, 1969; Ohman, 1986;
Wells & Clark, 1997; Wells et al., 1995).
There are several means by which safety behaviors
are thought to maintain social anxiety disorder. Perhaps
most important, the use of safety behaviors can prevent the
disconfirmation of fears and negative beliefs (Salkovskis,
1991; Wells & Clark, 1997). For example, avoiding eye
gaze is typically motivated by unwillingness to be drawn
into conversations due to fear of saying something inap-
propriate or fear of not having anything worthwhile to
contribute. The feared outcome is negative evaluation from
others that will lead to consequences such as humiliation
or loss of a sense of self-worth. The consequence of using
safety behaviors is that fears are not challenged and anxiety
is likely to persist (Salkovskis, 1991; Wells & Clark, 1997).
For example, avoiding eye gaze may lead to the intended
outcome of not being included in conversations. As a result,
there may be no opportunity to challenge the fear that
conversing with others will have negative consequences.
However, safety behaviors can increase the likelihood that
the feared outcome will occur; avoiding eye gaze may create
an impression of being unfriendly and reticent to engage
with others, leading to negative social evaluation (Clark
& Wells, 1995). Further, the absence of a feared event or
outcome is attributed to the use of the safety behavior. The
behavior then continues to be used, and the cycle of anxi-
ety maintenance continues (Salkovskis, 1991; Wells &
Clark, 1997; Wells et al., 1995).
Research generally confirms that safety behaviors are
involved in maintaining anxiety for those with anxiety
disorders (Helbig-Lang & Petermann, 2010). Consistent
evidence has shown a reduction of anxiety and superior
outcomes when participants with social anxiety eliminate
safety behaviors during exposure tasks (Furukawa et al., 2009;
Kim, 2005; McManus et al., 2009; McManus, Sacadura,
& Clark, 2008; Morgan & Raffle, 1999; Taylor & Alden,
2010, 2011; Wells et al., 1995).
For example, in an experimental study, Wells et al.
(1995) reported that for adults with social anxiety disorder,
instruction to eliminate safety behaviors during an exposure
task was associated with greater reductions in anxiety and
negative beliefs when compared with the use of safety behav-
iors. In another example, Morgan and Raffle (1999) com-
pared standard cognitive-behavior therapy (CBT) with CBT
plus instruction to eliminate safety behaviors for patients
with social anxiety disorder. Those patients instructed to
eliminate safety behaviors demonstrated a greater reduction
of social anxiety than the standard treatment group. In a
similar way, Kim (2005) compared three groups of partici-
pants with social anxiety disorder. The first group was
instructed to decrease safety behavior use combined with
a cognitive rationale, the second group was instructed to
decrease safety behavior use combined with an extinction
rationale, and the third group underwent exposure only.
Both groups instructed to decrease safety behavior use
reported less anxiety and fewer beliefs in feared outcomes
than the exposure-alone group. The results of these studies
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provide support for cognitive models that suggest safety
behaviors maintain anxiety with social anxiety disorder
(Clark & Wells, 1995; Rapee & Heimberg, 1997; Salkovskis,
1991).
Safety Behaviors and Stuttering
Given the negative impact of anxiety and mental
health disorders on the capacity of clients who stutter to
maintain treatment gains, it is essential to explore factors
that may maintain anxiety with people who stutter. Many
who stutter are concerned about how they will be perceived
by others if they are heard to stutter (Cream, Onslow,
Packman, & Llewellyn, 2003; Menzies et al., 2008; St Clare
et al., 2009). Therefore, they may engage in certain behav-
iors to try to avoid stuttering or to avoid the negative con-
sequences of stuttering. Common avoidance behaviors
identified in studies include avoidance of situations, topics,
specific words, and even eye contact (Corcoran & Stewart,
1998; Crichton-Smith, 2002; Mahr & Torosian, 1999; Martens
& Engel, 1986; Plexico, Manning, & DiLollo, 2005;
Vanryckeghem, Brutten, Uddin, & Van Borsel, 2004).
Avoidance has been suggested to be a coping strategy
used in an attempt to provide relief from the emotional con-
sequences of stuttering (Guitar, 1976, 2006; Vanryckeghem
et al., 2004) and to conceal stuttering (Van Riper, 1982).
For instance, Vanryckeghem et al. (2004) investigated the
number, frequency, and type of behaviors used to cope with
the expectation and occurrence of stuttering. Participants who
stutter reportedly used significantly more coping responses
than participants who do not stutter. The groups differed with
the type and frequency of coping responses they used. For the
people who stutter, the coping responses most often used
were “substituting one word for another,” “pausing before
trying to say a feared word,” and “repeating an interjected
syllable such as ‘ah’ or ‘the’ before saying a feared word.”
In another study, Jackson, Yaruss, Quesal, Terranova,
and Whalen (2015) asked participants who stutter to describe
the types of behaviors they used in anticipation of stuttering
and to prevent stuttering. The three most common strategies
included (a) avoidance, which was defined as “an attempt
to hide or escape from an impending moment of stuttering”
(Jackson et al., 2015, p. 42); (b) self-management strategies,
such as using techniques learned in speech treatment, or
other strategies, including changing speech rate, breathing,
and pausing; and (c) approach strategies, such as continuing
with the planned sentence or utterance without using
avoidance or other strategies. Participants also reported
experiencing anxiety and physical tension when they antici-
pated stuttering.
In addition to self-report, Systemic Functional Lin-
guistic analysis of spoken language during conversational
exchanges has shown that adults who stutter tend to use
linguistic strategies to reduce conversational interaction (Lee,
Van Dulm, Robb, & Ormond, 2015; Spencer, Packman,
Onslow, & Ferguson, 2005, 2009). According to these
reports, adults who stutter may “withhold from conversa-
tional interactions, as a means of coping with any negative
Lowe et al.: Safety Behaviors and Stuttering 1247
emotional responses associated with such exchanges” (Lee
et al., 2015, p. 549).
It appears that speech-language pathologists (SLPs)
may even recommend that clients engage in some activities
or tasks that could, in effect, be safety behaviors (Helgadottir,
Menzies, Onslow, Packman, & O’Brian, 2014a). In the
Helgadottir et al. (2014a) study, SLPs who specialized in the
treatment of stuttering provided a list of behaviors they
used or had seen used during routine clinical practice for
the management of anxiety. Two clinical psychologists
identified those behaviors that were considered to be poten-
tial safety behaviors for those who stutter, which resulted
in a list of 34 items. Participants were 169 community and
private SLPs who responded to an online survey in which
they were asked to indicate the behaviors, from the 34 items
listed, they encouraged their clients to use in order to man-
age anxiety. Many indicated that they routinely recommended
that their clients use various strategies from the list. For
example, 92% reported recommending that their clients
rehearse the opening line of telephone calls prior to making
them, 81% reported recommending seeking safe speaking
partners in socially threatening situations, and around half
reported recommending that their clients avoid difficult
words (57%) and avoid any unnecessary talking (51%).
The Present Study
Those who stutter may use safety behaviors in an
attempt to cope with the anticipation of stuttering or when
they are anxious. It is well established that safety behaviors
hamper the extinction of fear and maintain anxiety for those
who are socially anxious. In light of these findings, it is
essential to continue to explore the use of safety behaviors
with stuttering. This study therefore was an investigation
of the use of safety behaviors by adults who stutter when
anxious in social situations. The aim was to explore the
relationship between the use of safety behaviors and fear
of negative evaluation and negative cognitions.
Method
Participants
Participants were 133 adults who stutter who were
involved in one of several treatment research projects that
incorporated CBTpsych, an online treatment program de-
scribed in detail by Helgadottir, Menzies, Onslow, Packman,
and O’Brian (2009, 2014b). CBTpsych was designed to
treat the social anxiety experienced by adults who stutter.
Participants were not required to have a formal diagnosis of
social anxiety disorder. Participants were notified about
CBTpsych through advertisements displayed on the web-
site of the Australian Stuttering Research Centre, The
University of Sydney, or through SLPs or psychologists
who were informed about the program at national and
international conferences, workshops, and professional
interest groups.
Participants ranged in age from 18 to 68 years (mean
age 37 years). They completed a self-report questionnaire
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that asked about the onset of stuttering, if they had stuttered
in the previous week, and whether they had ever received
a formal diagnosis and/or treatment for stuttering from an
SLP. All participants reported that they stuttered and the
majority (90%; n = 119) reported having been diagnosed
as stuttering by an SLP. Participants who did not report hav-
ing a formal diagnosis of stuttering were accepted into the re-
search studies investigating the online treatment program if
their responses to all questions were indicative of stuttering.
The decision was made by an SLP experienced with assessing
and treating adults who stutter. Most of the participants
(83%; n = 111) reported the onset of their stuttering to be at
or before the age of 10 years, 14% (n = 18) reported the on-
set to be between 11 and 20 years of age, 1.5% (n = 2) re-
ported onset to be beyond 20 years of age, and 1.5% (n = 2)
did not report an age of onset.
Ten percent (n = 13) of the participants reported
they had received psychological or psychiatric treatment
during the previous 6 months, and 8.3% (n = 11) reported
taking medication prescribed for anxiety. Participants were
drawn from 17 countries; the majority were from Australia
(71%; n = 95), followed by the United States (6%; n = 8),
Canada (6%; n = 8), New Zealand (4%; n = 5), and the
United Kingdom (2%; n = 3); two each from Finland,
India, and Singapore; and one each from Brazil, China,
Denmark, France, Israel, Nigeria, Scotland, and Spain.
Description of CBTpsych
The CBTpsych program involves no contact with cli-
nicians; however, the faces and voices of two clinical psy-
chologists provide information and feedback to the user
throughout the program. The novelty of this program is
that it provides individualized feedback to users based
on their responses to questionnaires administered before
treatment and throughout the program. The measures
target emotional and behavioral responses and negative
cognitions. Feedback is based on well-established clinical
procedures for CBT. The program consists of seven mod-
ules, and users must complete each module in order to
progress.
Questionnaires
The questionnaires reported in this study represent
a subset of the questionnaires completed by the participants
throughout the CBTpsych program. The Fear of Negative
Evaluation scale (FNE; Watson & Friend, 1969) and the
Unhelpful Thoughts and Beliefs About Stuttering (UTBAS;
St Clare et al., 2009) questionnaire were completed by par-
ticipants at the start and the completion of the CBTpsych
program. Participants’ pretreatment scores were used in the
analyses for the current study.
FNE
The FNE is a 30-item self-report measure that assesses
the expectation and fear of negative social evaluation.
Respondents indicate “true” or “false” to statements such
as “I am often afraid that I may look ridiculous or make a
fool of myself” and “I am afraid that others will not approve
of me.” Higher scores on the FNE denote greater fear of
negative evaluation from others. The FNE has demonstrated
good reliability (Oei, Kenna, & Evans, 1991). The total score
was used in the analyses for the present study.
UTBAS
The UTBAS is a self-report measure used to identify
negative and irrational thoughts and beliefs common to
people who stutter. The measure has 66 items, for exam-
ple, “people will laugh at me” and “people will think I’m
incompetent because I stutter.” In the CBTpsych program,
participants are requested to indicate the frequency of
thoughts from the 66 items, which are scored 1 = never have
the thought, 2 = rarely have the thought, 3 = sometimes
have the thought, 4 = often have the thought, and 5 = always
have the thought. The responses are summed to provide a
total frequency of negative thoughts about stuttering.
The total score was used in the analyses for the present
study. The UTBAS has demonstrated high test–retest re-
liability along with internal consistency (St Clare et al.,
2009).
Safety Behavior Questionnaire
The third module of the CBTpsych program provides
education about the use and consequences of safety behav-
iors. Examples of safety behaviors and case studies are
provided. Following the educational component, a list of
27 potential safety behaviors is presented and participants
are requested to indicate “the safety behaviors you use when
you get anxious in speaking situations.” That is, partici-
pants are requested to indicate the safety behaviors they
routinely use during speaking situations. A radio button is
aligned with each safety behavior, and participants are
instructed to select the button next to the safety behavior if
they use that behavior when anxious during speaking situa-
tions. The list of safety behaviors was adapted from that
developed by Helgadottir et al. (2014a). The responses are
then used by the program to create an individualized model
of social anxiety and to design personal experiments and
exposure activities. Participants are requested to select at
least one of the items on the list to proceed in the program.
The items include such behaviors as “avoid difficult words,”
“mentally rehearse sentences,” “keep answers short,” and
“practice your speaking technique before a speaking situ-
ation” (see Table 1). This questionnaire was administered
only once, and the results are used in this study.
Data Analysis
The data for analysis were the total number and spe-
cific safety behaviors reported to be used by each partici-
pant. A point-biserial correlation coefficient was computed
to assess the relationship between the reported use of
each behavior and participant scores on the FNE and
the UTBAS.
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Results
Questionnaire Results
Mean scores for participants at the start of the
CBTpsych treatment program were 21 (SD = 8.2) for the
FNE and 180 (SD = 55.3) for the UTBAS.
Of the 133 participants, 132 indicated that they used
at least one behavior from the list of safety behaviors pre-
sented in the CBTpsych program. All 27 safety behaviors
on the list were reportedly used. The frequency and percent-
ages of participants’ reported use of each safety behavior
are shown in Table 1. The most frequently reported safety
behaviors were “try to avoid difficult words,” “rehearse
sentences mentally before saying them,” “keep your answers
short,” “choose safe or easy people to talk to in socially
threatening situations,” and “try to avoid difficult syllables.”
Correlations
Point-biserial correlation coefficients were computed
to find associations between the safety behaviors and par-
ticipants’ total score for the FNE and the UTBAS. Around
half of the behaviors significantly correlated with the total
score for the FNE scale, and around two thirds of the
safety behaviors significantly correlated with the total score
for the UTBAS. The results and significance values are
displayed in Figure 1. The safety behaviors that were signifi-
cantly correlated with fear of negative evaluation were also
correlated with unhelpful thoughts and beliefs about stutter-
ing. These results suggest that the use of safety behaviors
was associated with more fear of negative evaluation and
a higher frequency of negative thoughts about stuttering.
Discussion
Safety Behaviors and Stuttering
This study investigated the use of safety behaviors
as reported by adults who stutter when anxious in social
situations. It further explored the association between
safety behavior use and scores on measures of fear of nega-
tive evaluation in social situations and negative cognitions
associated with stuttering. The results of this study showed
that all but one of the participants reported that they use
behaviors that could, in effect, be safety behaviors when
anxious in speaking situations. For many of the behav-
iors, their use was correlated with scores on the FNE and
the UTBAS. To be specific, safety behavior use was asso-
ciated with higher scores on measures of fear of negative
evaluation and unhelpful thoughts about stuttering. The
results of this study suggest that safety behavior use by
adults who stutter may result in the same negative effects
that are known to occur with those who have social anxi-
ety disorder.
Cognitive theorists suggest that for those with social
anxiety disorder, safety behaviors prevent fear extinction
and therefore maintain anxiety (Clark, 1999; Clark &
Wells, 1995; Rapee & Heimberg, 1997; Salkovskis, 1991).
It could be the case that some behaviors used by people
Lowe et al.: Safety Behaviors and Stuttering 1249
 Table 1. Number and percentage of participants reporting use of each safety behavior.

Safety behavior n %

1 If you feel like you’re are having a bad day, skip unnecessary talking. 76 57.1
2 Avoid topics that make you anxious. 45 33.8
3 Keep your answers short. 81 60.9
4 Choose something else in order to avoid saying something difficult. 68 51.1
5 Rehearse answering the phone out loud. 33 24.8
6 Pretend to be interested in something. 53 39.8
7 Try to control yourself beforehand. 56 42.1
8 Try to avoid eye contact. 60 45.1
9 Let your partner do the talking. 58 43.6
10 Rehearse answering the phone in your head before picking up. 38 28.6
11 Choose safe or easy people to talk to in socially threatening situations. 80 60.2
12 Try not to draw attention to yourself. 73 54.9
13 Choose safe or easy people to talk to immediately before an important speaking situation. 54 40.6
14 Try to avoid difficult syllables. 80 60.2
15 Point to things instead of talking 42 31.6
16 Encourage listeners to speak more (e.g., by asking lots of questions). 48 36.1
17 Use regrouping technique when you start to stutter. 42 31.6
18 Tell people that you stutter before you start to talk. 28 21.9
19 Allow others to order for you. 43 32.3
20 Overpractice difficult words. 33 24.8
21 Say relax to yourself when you feel anxious. 58 43.6
22 Try to take deep breaths. 59 44.4
23 Rehearse the opening line of a telephone call before making a call. 72 54.1
24 Practice speech technique immediately before an important speaking situation. 71 53.4
25 Try to avoid difficult words. 102 76.7
26 Try to speak slowly when you get anxious. 64 48.1
27 Rehearse sentences mentally before saying them. 84 63.2

Note. List of behaviors adapted from “Safety Behaviors and Speech Treatment for Adults Who Stutter,” by F. D.
Helgadottir, R. G. Menzies, M. Onslow, A. Packman, and S. O’Brian, 2014, Journal of Speech, Language, and Hearing
Research, 57, pp. 1308–1313. Copyright © 2014 by American Speech-Language-Hearing Association. Adapted with
permission.

Figure 1. Correlations between reported safety behavior use and questionnaires.

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who stutter when they are anxious in social situations could An Alternative View of Safety Behaviors
be safety behaviors. That is, people who stutter may use
Rachman, Radomsky, and Shafran (2008) present an
certain behaviors in an attempt to avoid or reduce the risk
alternative view of safety behaviors, suggesting that their
of negative consequences during social interactions. This
use may be therapeutic in the early stages of treatment for
could have implications for the maintenance of anxiety
anxiety disorders. Early and limited use of safety behaviors
for those who stutter. For example, in this study one of
may enhance patients’ willingness to engage in treatment
the most frequently reported behaviors was “try to avoid
procedures (Hood, Antony, Koerner, & Monson, 2010;
difficult words.” If a person who stutters avoids words
Milosevic & Radomsky, 2008, 2013). Further, the use of
that may be stuttered, they either need to choose a different
safety behaviors does not appear to prevent fear extinction
word or change what is to be said. However, by avoiding
with some phobias (Milosevic & Radomsky, 2008, 2013;
words that may be stuttered, the person does not learn that
Rachman, Shafran, Radomsky, & Zysk, 2011). This view
feared outcomes such as negative evaluation may not occur
of safety behaviors could be pertinent to stuttering. That
or may not be as severe as predicted. In this way, such behav-
is, safety behaviors could be helpful in the initial stages
iors have the potential to maintain anxiety by preventing
of treatment for stuttering because they may help clients
the unlearning of fear. Further, it is possible that the use of
to enter situations to practice speech treatment techniques.
safety behaviors may be a factor underpinning the failure
For instance, in the early stages of treatment, it might help
to maintain speech treatment benefits reported by Iverach,
clients to mentally rehearse sentences before saying them
Jones, et al. (2009). It is essential now to investigate the effects
and to practice their fluency technique to gain control of
of using certain behaviors on stuttering severity and anxiety.
stuttering before talking or entering a speaking situation.
This study did not ask participants to indicate the
Further research is clearly required.
frequency of safety behavior use. Therefore, the relationship
One such avenue for future research will be to explore
between the frequency of use of safety behaviors and scores
whether the use of some behaviors during the initial stages
on the FNE and the UTBAS in this study cannot be deter-
of speech treatment prevent fear extinction and impede
mined. However, it is clear that their use is associated with
the progress of treatment. Such research could also explore
more fear and negative thoughts and cognitions. Further,
whether some behaviors for clients who stutter help or hin-
it cannot be deduced from this study whether the behaviors
der treatment processes and outcomes. As reported by
reportedly used by adults who stutter maintained their
Helgadottir et al. (2014a), speech pathologists in that study
anxiety. An important line of inquiry for future research
recommended that their clients use certain behaviors that
will be to investigate whether eliminating such behaviors
are considered by psychologists to be safety behaviors. Be-
is associated with lower scores on the FNE and the UTBAS
haviors such as rehearsing fluency-enhancing strategies before
and on measures of anxiety and social anxiety specifically.
talking may, however, be helpful for those who stutter to
It will also be important to explore whether safety behaviors
gain or maintain control of their stuttering. Indeed, some
are characteristic of those who stutter who have a formal
behaviors reported in the present study, such as “Practice
diagnosis of social anxiety disorder or whether they are used
speech technique immediately before an important speaking
more generally by those who stutter.
situation” and “Rehearse the opening line of a telephone
call before making a call,” were not correlated with FNE
Safety Behaviors and Speech Treatment or UTBAS scores. It is clear that the issue of safety behavior
use by those who stutter is a complex issue that requires
Given that the presence of one or more mental health
further exploration.
disorders has been shown to be associated with poor treat-
Safety behaviors are clearly associated with anxiety
ment outcome (Iverach, Jones, et al., 2009), an important
maintenance and poorer treatment outcomes with anxiety
consideration is whether the use of safety behaviors by
disorders. It is essential to continue to investigate the use
adults who stutter is a critical component of such outcomes.
of safety behaviors by people who stutter.
One of the most researched and established treatment
approaches for adult stuttering is speech restructuring
(Onslow & Menzies, 2010). This involves teaching clients
Acknowledgment
a novel speech pattern to control stuttering. Clients initially
learn the fluency technique in a supportive environment, This research was supported by the National Health and
Medical Research Council, Program Grant 633007 (awarded to
such as with the SLP in the clinic. When an acceptable
the Australian Stuttering Research Centre, The University of
sounding fluency technique has been achieved, clients then Sydney), and the Faculty of Health Sciences, The University of
learn to use the technique in their everyday speaking situa- Sydney.
tions. Using safety behaviors, such as avoiding difficult
words, keeping answers short, avoiding difficult syllables,
and avoiding unnecessary talking, can reduce opportunities References
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