942141

research-article2020
CDQXXX10.1177/1525740120942141Communication Disorders QuarterlyMedina and Mead

Clinical Exchange
Communication Disorders Quarterly

An Exploration of Mindfulness in
1­–9
© Hammill Institute on Disabilities 2020
Article reuse guidelines:
Speech-Language Pathology sagepub.com/journals-permissions
DOI: 10.1177/1525740120942141
https://doi.org/10.1177/1525740120942141
cdq.sagepub.com

Angela M. Medina, PhD, CCC-SLP1

and Jean S. Mead, EdD, CCC-SLP1

Abstract
For decades, mindfulness practices have been studied and applied across professions such as health care, business,
education, law, and counseling as a means to reduce workforce stress and improve patient/client outcomes. Literature
describing applications and outcomes of mindfulness has been growing in the field of speech-language pathology. While
there is an abundance of work on treating fluency disorders as well as adult cognitive and language deficits, reports of the
successful application of mindfulness techniques in the service area domain of voice are expanding. The purpose of this
article is to describe mindfulness and how mindfulness techniques are currently being applied in the practice of speech-
language pathology with clients as well as parents and caregivers of clients. Suggested mindfulness activities and means for
measuring change in the context of speech therapy are described.

Keywords
mindfulness, meditation, speech-language pathology, counseling

An Introduction to Mindfulness brain’s structure and function thereby improving atten-

In today’s society, “mindfulness” just may be the word du
jour. It is encountered in Super Bowl commercials, Forbes
Magazine, Sesame Street, and even in songs that we hear
daily on our AirPods. But what is “mindfulness”? Kabat-
Zinn (1994) operationally defined it as an awareness that
comes from paying attention to one’s thoughts, emotions,
and physical state, on purpose, in the present moment,
and without judgment. When individuals are mindful,
they are fully present and aware of their state of being.
One can be mindful while eating, brushing their teeth, or
driving. To further illustrate, if a person is observing all
aspects of handwashing such as turning on the water, feel-
ing the water on the hands, noticing the scent of the soap,
then that person is being mindful. Simply taking a minute
to observe the sounds around in the immediate environ-
ment will force one into the present moment. Spending a
few moments each day noticing the inhalation and exha-
lation of the breath is a way to be mindful. In addition to
day-to-day mindfulness, formal mediation practices may
also cultivate mindfulness.
An immediate benefit of mindfulness is that it allows
for human beings to experience a sense of peace and calm
because rumination about the past and anxiety toward the
future cannot exist while focusing on the present moment
(Fredrickson et al., 2008; Sharma & Rush, 2014). In addi-
tion to this immediate benefit, studies have shown that
practicing mindfulness, in the long term, can alter the
tional skills, cognitive capacity, and emotional regulation
(Hölzel et al., 2011).
Given what we know about the benefits of mindfulness,
it makes sense that for many it has become a regular part of
their personal and professional lives. For instance, mindful-
ness has been applied and studied across a multitude of dis-
ciplines including health care (e.g., Raab, 2014), education
(e.g., Burrows, 2011), counseling (e.g., Brown et al., 2013),
law (e.g., Rogers, 2012), and business (e.g., Sauer & Kohls,
2011) as well as with college students (e.g., Bamber &
Schneider, 2016) and in the U.S. military (e.g., Jha et al.,
2015). Recently, mindfulness has been getting a lot of atten-
tion in speech-language pathology, which comes as no sur-
prise given its applicability to the underpinnings of speech
therapy. In terms of the areas of the speech pathology ser-
vice domain (American Speech-Language-Hearing
Association [ASHA], 2016), fluency disorders as well as
adult cognition and language have an abundance of litera-
ture calling for the application of mindfulness or
citing outcomes of mindfulness, while the area of voice is
1
Florida International University, Miami, USA
Corresponding Author:
Angela M. Medina, Department of Communication Sciences & Disorders,
Florida International University, 11200 SW 8th St, AHC3-441, Miami,
FL 33199, USA.
Email: MedinaAM@fiu.edu
2 Communication Disorders Quarterly 00(0)
growing. Each of these will be explored in the following
sections.
Fluency Disorders
The use of mindfulness practices has increased in the field
of fluency disorders over the past several years (Palasik &
Hannan, 2013). Given that its benefits have been widely
supported by the literature, it indeed may be a viable com-
plement to traditional stuttering therapy approaches
(Plexico & Sandage, 2011). For instance, Boyle (2011)
describes parallels with the goals of current stuttering
therapy approaches and mechanisms of change in mind-
fulness including behavioral exposure, improved emo-
tional regulation, changes in perceptions of thoughts, and
increased sensory-perceptual processing, attentional con-
trol, and acceptance. Potential clinical applications for
speech-language pathologists and their fluency clients are
awareness of everyday activities, body scan, awareness of
breath, changing one’s relationship with thoughts, creat-
ing an action plan for relapse, and taking action mindfully.
Echoing these parallels, Cheasman (n.d.) states that mind-
fulness has a role in speech therapy for people who stutter.
Mindfulness can facilitate cultivation of acceptance,
increase awareness of the body, and aid with stress man-
agement and relaxation (Cheasman, n.d.). Similarly,
Harley (2018) elaborates on how mindfulness-based inter-
vention can facilitate desensitization in stuttering therapy
by guiding clients through the process of exploring stutter-
ing in the spirit of curiosity versus with feelings of fear.
Although there have been several suggestions for clinical
application in the literature, research is in an emergent
stage in terms of building an evidence base for using
mindfulness as a technique to reduce stuttering frequency
as well as to reduce negative feelings and attitudes.
For instance, Acceptance and Commitment Therapy
(ACT) is a program for clients who stutter that addresses
psychosocial functioning, readiness for therapy and change,
utilization of mindfulness skills and psychological flexibil-
ity, and stuttering frequency (Beilby & Byrnes, 2012;
Beilby et al., 2012). The mindfulness component facilitates
fluency clients’ understanding of how past experiences
shape their current behaviors as well as their beliefs and
attitudes about themselves. Beilby et al. (2012) used a pre-
test/posttest study design to explore the efficacy of an
8-week group ACT program for 20 adults who stuttered.
Positive results were yielded in that statistically significant
improvements in mindfulness skills, quality of life, and
speech fluency were attained by participants. In addition to
these findings, it has been suggested that ACT can be used
to facilitate awareness of the present moment which can in
turn reduce avoidance and clients’ dwelling on past nega-
tive speaking situations (Beilby & Byrnes, 2012). Taken
together, these findings and suggestions have implications
for people who stutter and their management of the negative
“mind games” they have played about themselves and their
speech (Beilby & Yaruss, 2018, p. 123).
Similarly, Emge and Pellowski (2019) conducted a case
study in which an adult who stuttered completed a 15-week
fluency-shaping program that incorporated guided mindful-
ness meditation and breathing exercises. In comparing pre-
test and posttest data, results indicated that the participant
exhibited increased fluency, improvement in communica-
tion attitudes, and improvement in quality of life.
Gupta (2015) investigated the efficacy of using a
12-week Mindfulness-Based Cognitive Therapy (MBCT)
program to reduce anxiety and frequency of stuttering as
well as to increase mindfulness, quality of life, and com-
munication attitudes in two adolescents who stutter. Group
sessions of 90 min were held once a week and consisted of
educating participants on the basics of stuttering, self-mon-
itoring of anxiety, mindfulness meditation practice, aware-
ness of thoughts and sensations in the body, integrating
mindfulness into everyday life, and restructuring beliefs
about stuttering. Results indicated that both participants
experienced decreases in anxiety and the frequency of stut-
tering. Improvements in quality of life, overall mindfulness,
and communication attitudes were observed as well.
Although the study had a small sample, it provides prelimi-
nary evidence on the benefits people who stutter can gain
through participating in mindfulness-based therapy pro-
grams, one of which includes long-term management of
stuttering (Gupta, 2015).
In a subsequent study, Gupta et al. (2016) describe
similar outcomes using a two-group pretest/posttest
design, wherein one group of adults who stuttered partici-
pated in a cognitive behavioral therapy (CBT)-based pro-
gram that incorporated mindfulness practice and the other
group of adults who stuttered only participated in CBT.
Findings revealed that the group who participated in the
CBT plus mindfulness intervention showed greater
improvement in communication attitudes than did the
CBT-only group. However, both groups demonstrated
improvements in fluency, quality of life, anxiety, and
mindfulness measures. According to Gupta et al. (2016),
CBT plus mindfulness intervention is a viable, cost-effec-
tive option for clinicians who wish to take a holistic
approach to adult stuttering therapy.
Although there are still significant gaps in the literature
relative to the efficacy of incorporating mindfulness-based
techniques in fluency therapy, the evidence gathered thus
far is promising.
Parents of children who stutter. It has been suggested that
adults who stutter can improve coping skills through mind-
fulness (Plexico et al., 2009; Swartz et al., 2014), but it
may also be a viable technique for parents of children who
stutter. Parents are an essential part of the child’s speech
Medina and Mead
therapy program regardless of the type of therapy the child
is receiving. However, they need to be counseled as well as
guided by the clinician to facilitate fluency at home (Gui-
tar, 2013; Zebrowski & Schum, 1993). In the case of stut-
tering, the ways parents react to their child’s stuttering, in
vivo, is an aspect that is addressed clinically in many pedi-
atric-based stuttering therapy programs. For instance, a
component of the Family-Focused Treatment Approach
(Yaruss et al., 2006) involves parent-focused strategies
which require parents to modify their own communication
behaviors and decrease concerns relative to their child’s
stuttering. Similarly, the Lidcombe Program (Packman
et al., 2016) requires parents to be aware of their children’s
speech characteristics so that they can provide appropriate
verbal contingencies as well as create a positive and sup-
portive speaking environment. Another program that
includes a parental focus is Palin Parent–Child Interaction
therapy (Kelman & Nicholas, 2017), wherein much train-
ing occurs to empower the parent to acknowledge their
child’s stuttering as well as to give them the confidence to
manage it. The common thread in all of these programs is
that they require the parents’ awareness, whether it is
awareness of their own reactions and how they manage
them or awareness of their child’s stuttering behaviors and
how to offer appropriate acknowledgment and support.
Thus, mindfulness can serve as a means to facilitate par-
ents’ attention to and awareness of their own interaction
styles including attending to their child’s message and
emotions as well as their own behavioral and emotional
responses to their child’s stuttering (Harley, 2018).
Adult Cognition and Language
Work on the effects of mindfulness on neurogenic cognitive
clientele is growing; however, there still remains a large gap
in knowledge about how complementary and alternative
medicine (CAM) including mindfulness can be used in con-
junction with conventional speech therapy approaches for
individuals with neurogenic cognitive or communicative
disorders (Murray, 2008). Given that emotional issues can
inhibit outcomes more so than physical or cognitive limita-
tions, research on the efficacy of incorporating CAM into
rehabilitation programs is essential (Murray & Kim, 2004).
In a review of the literature, Murray (2008) reported that
relaxation therapy has been used with a variety of neuro-
genic client populations to manage impairments as well as
symptoms, and that there is some evidence that relaxation-
based therapies had a positive effect on aspects such as
quality of life, mood, participation in rehabilitation and
social interaction, and fatigue to name a few. Research has
also shown, thus far, that mindfulness intervention can
improve the quality of life of individuals with traumatic
brain injury (TBI). Bedard et al. (2003) conducted a pretest
and posttest study on participants with mild to moderate
3
TBI who were 1 year post injury. Aspects measured
included: quality of life, psychological processes, and func-
tion. The 10 participants who completed a 12-week inter-
vention program utilizing mindfulness-based activities (i.e.,
insight meditation, breathing exercises, guided imagery,
and group discussions) showed statistically and clinically
significant improvements in quality of life and depression.
Functioning did not improve in either the control or experi-
mental group. While improvements were not statistically
significant in all of the domains tested, the study highlights
the utility of mindfulness in improving quality of life after
all other forms of therapy for clients with TBI have been
explored (Bedard et al., 2003).
Mindfulness meditation has also yielded positive out-
comes in adults with aphasia. In Marshall et al. (2018), five
adults were assigned to the training group and three were
assigned to the control group. The training group partici-
pated in a 5-day-long meditation program that consisted of
mindfulness meditation instruction during tasks that ranged
from 10 to 30 min in duration. Findings revealed that the
training group did have increased fluency immediately fol-
lowing mindfulness meditation training. The control group
presented with higher levels of cortisol than did the training
group, which is indicative of the control group experiencing
stress-inducing thoughts during mind-wandering activities.
No statistically significant differences in attention between
the two groups. Similarly, Murray and Ray (2001) revealed
that preceding syntactic stimulation treatment with relax-
ation training a client with fluent aphasia exhibited improve-
ments in language abilities. Researchers posit that this
occurred due to the emotional aspects of aphasia such as
anxiety and frustration being managed and therefore freeing
up more cognitive resources for efficient language usage
(Murray & Ray, 2001).
Caregivers of adults with cognitive and language deficits.
Another population that may benefit from mindfulness is
caregivers of adults with cognitive and language deficits.
As described by Prigatano et al. (2005), the emotional
and behavioral functioning affected by frontal injury is
particularly distressing to family members of clients.
Data accrued thus far indicate that caregivers are not
only interested in participating in stress reduction pro-
grams (Swartz & Keir, 2007), but that they also benefit
from participation. Specifically, Swartz and Keir (2007)
surveyed 60 caregivers of patients with brain tumors by
presenting them with a list of stress reduction techniques.
Participants checked all techniques that they were inter-
ested in trying to reduce their stress including body-
focused techniques, mind–body techniques, and
skill-building techniques. Results indicated that while
exercise (73%), massage (66%), and coping skills (50%)
received the most interest, the participants also took
interest in mindfulness-based techniques such as
4 Communication Disorders Quarterly 00(0)
progressive muscle relaxation (48%), belly breathing
(47%), meditation (47%), yoga (42%), and guided imag-
ery (37%). Although it would not be appropriate to
instruct caregivers of clients in exercise and massage,
speech-language pathologists can indeed guide them in
the aforementioned mindfulness-based techniques. The
goal of incorporating these techniques would be to
improve the overall well-being of the caretaker, which
could facilitate better functional outcomes for the client
through the enhancement of the caregiver’s quality of
care and support for the client (Swartz & Keir, 2007).
There are also findings indicating that caregivers expe-
rience psychological and emotional benefits as a result of
participating in mindfulness-based programs. Through
conducting a systematic review of the literature, Li et al.
(2016) evaluated the outcomes of studies in which care-
givers of family members with various health conditions
participated in mindfulness-based stress reduction
(MBSR). The pooled outcomes of the 14 studies that met
the search criteria, which included studies on caregivers
of clients with dementia, indicated that MBSR practice
had a positive effect on caregivers’ health and psycho-
logical symptoms. In a data-based study focusing on care-
givers of clients with dementia by Waelde et al. (2004),
data were collected via pretest and posttest to measure
outcomes of the Inner Resources program. The pretest
(administered 1 week prior to the program) and posttest
(administered 1 month after participation) measured par-
ticipants’ depression, self-efficacy, anxiety, caregiving
burden, treatment adherence, subjective improvement,
and usefulness of intervention components. It was found
that after the 12 participants completed the Inner
Resources program, which consisted of 6 weekly group
sessions of meditation, yoga, guided imagery, breathing
exercises, and mantra repetition, they experienced reduc-
tions in anxiety and depression levels as well as in emo-
tional and physical symptoms while also experiencing
increases in immune functioning and ratings of self-effi-
cacy (Waelde et al., 2004).
Clientele seeking cognition-based therapy due to TBI
or aphasia may therefore also be a population who would
benefit from the inclusion of mindfulness-based tech-
niques in their individual therapy programs. Mindfulness
will allow for a holistic approach in that the emotional
aspects of the clients’ communication difficulties can be
addressed. Caretakers can be included in this part of ther-
apy, which may enable them to better care for their loved
ones with cognitive difficulties. As highlighted in the
synthesis of findings of the literature on caregivers of
clients with dementia, more randomized controlled trials
with sound methods need to be conducted to firmly
establish the efficacy of mindfulness as a technique for
reducing the negative affect experienced by caregivers
(Cooper et al., 2007).
Voice
In a taxonomy of voice interventions outlined by Van Stan
et al. (2015), direct interventions included auditory, somato-
sensory, vocal function, musculoskeletal, and respiratory
approaches, while indirect interventions included pedagogy
and counseling. The direct aspects of voice intervention
require physiological modifications to the vocal folds, con-
nective tissues, or respiratory functioning for example
whereas indirect aspects entail either teaching clients how
to modify vocal health or identifying factors that negatively
affect vocal health (Van Stan et al., 2015). All of the afore-
mentioned modifications require the client’s focused atten-
tion to be accomplished. Thus, our voice clientele may
benefit from the implementation of mindfulness in the
clinic setting regardless of whether the client is seeking
therapy for an organic, functional, or psychogenic disorder
or for transgender voice training.
Relaxation, a tenet of mindfulness, is a key element for
many direct voice interventions that aim to reduce vocal
fold tension. Confidential voice (e.g., Casper, 2000), for
example, is a therapy technique used to reduce laryngeal
and vocal fold tension by means of having the client speak
with a breathy voice. As therapy progresses, the client is
taught to increase the use of the typical voicing without
affecting airflow. Another technique called yawn-sigh
(e.g., Boone et al., 2010), addresses vocal hyperfunction
by having clients produce voiced sighs. This in turn allows
for relaxation of the vocal tract. Lax Vox is a voice therapy
strategy used to improve sustained phonation (ASHA,
n.d.), wherein the client blows air into a cup of water with-
out voice then later with voice. As a result, the vocal tract
widens and vocal fold tension is decreased. Similarly,
mindfulness is a necessary aspect of the Lee Silverman
Voice Treatment (LSVT; Ramig et al., 1994) given that
clients must learn to monitor and recalibrate the effort
required to reach their desired level of loudness.
Biofeedback, as outlined by ASHA (n.d.), is another voice
tool that is seemingly grounded in mindfulness in that it
centers on clients’ awareness of their physical state of
being in terms of respiration, bodily posture, and sensation
of vibration. By being trained to use kinesthetic, visual,
and auditory feedback to explore alterations of voice, cli-
ents can gain control of and improve vocal functioning. In
the same vein, D’Antoni et al. (1995) characterized voice
clients as being “busy, goal-oriented, high-achieving per-
sonalities” (p. 309) resulting in difficulties focusing on
vocal hygiene. By incorporating mindfulness as part of a
tactile-kinesthetic feedback program, the client can work
on awareness of the moment which will enable them to
recognize and identify these types of feedback (Borysenko,
1987; D’Antoni et al., 1995).
Transgender clientele seeking voice training is another
specific group that may benefit from the inclusion of
Medina and Mead
mindfulness in their individual therapy plans. Thornton
(2008) suggests that the speech-language pathologist’s
role in working with this population encompasses much
more than working on pitch and extends to other aspects
of communication including intonation, resonance, speech
and language, articulation, and speech rate. We have pre-
viously described how these aspects of voice therapy that
include altering the vocal tract can be enhanced through
mindfulness. The remaining non-voice aspect, speech and
language, includes training stereotypical gender speech
styles such as word choice and mannerisms (Thornton,
2008). Teaching these skills could also be complemented
by mindfulness-based techniques in that the client needs
to be aware of the nuances of gendered speech styles as
well as attend to and adjust their accuracy in attaining their
desired speech style.
Kayajian and Pickering (2017) is one of the few publi-
cations that explicitly describes the benefits of including
mindfulness in a clinical model called The College of
Saint Rose Transgender Voice and Modification Program.
The program includes mindfulness/relaxation, vocal
health and warm up, group communication skill develop-
ment, individual intervention, and gratitude. The mindful-
ness/relaxation and gratitude portions of the program not
only focus on breathing and upper body relaxation, but
they are also designed to encourage discussion about feel-
ings and self-esteem. Data collected from approximately
56 clients over a 5-year time span indicated that voice
change was attainable and that the group setting improved
clients’ self-esteem. Mindfulness, therefore, may aid voice
clients in making desired physiological as well as psycho-
logical changes.
The domain of voice undoubtedly has several aspects of
service delivery that reflect the core principles of mindful-
ness; however, an evidence base demonstrating the efficacy
of mindfulness in the voice therapy setting has yet to be
developed.
Incorporating Mindfulness Into
Therapy Sessions: A Brief “How-To”
While there are calls for more stringent research methods
and more evidence regarding mindfulness in speech-lan-
guage pathology, there is much that can be done now to
strengthen the evidence base of mindfulness in speech-lan-
guage pathology. Techniques can be applied in other areas
of speech therapy where there is a clear, appropriate fit (i.e.,
working on awareness of the articulators in articulation
therapy; inciting calm and focus with language clients;
exploring the senses like taste, smell, and touch with feed-
ing clients; and bringing awareness to the mechanics of
swallowing). Below are some suggestions for incorporating
basic mindfulness-based activities into therapy sessions as
well as for measuring outcomes of these activities.
5
Suggested Activities
Before implementation of these activities, it should be noted
that clinicians should take caution with the terminology
they choose when explaining mindfulness goals as well
when guiding clients through mindfulness activities. For
instance, the term “meditation” may have religious implica-
tions for some clients, while for others, it may carry stigma.
Thus, an introduction to mindfulness could be worded
something like this:
Today, before we start our session, I would like to spend a few
minutes with you to simply focus on our breathing, (or what we
might be hearing or physically feeling right now). Doing this
may help us feel more relaxed and peaceful as we work together
toward your goals.
Creating an ambiance. The atmosphere for cultivating mind-
fulness is important. Organization, ventilation, and reduc-
tion of clutter help promote a sense of calm. Playing soft
meditation music in the background may add to a calming
ambiance. A live plant, a scent diffuser or a scented candle
(if appropriate) might prove to be a soothing part of your
office decor. If the session gets off track, the client could be
asked to listen carefully to the music, or to gaze at the plant
or notice the scent in the room. Again, all these activities
serve the purpose of bringing a client to the present moment
where anxiety cannot coexist; thus, creating a calm and
peaceful feeling that will allow for the best possible thera-
peutic outcomes. The first two websites below offer sugges-
tions for creating a peaceful ambiance, while the final two
are links for 432 Hz meditation music:
Zero to Infinitude (https://zerotoinfinitude.com/creating-a
-perfect-atmosphere-for-meditation)
Always Well Within (https://www.alwayswellwithin.com/
blog/2018/02/17/simple-meditation-space).
Powerthoughts Meditation Club (https://www.youtube.com/
watch?v=oj6v4AsTWlo) and
Meditation and Healing (https://www.youtube.com/watch?v
=eWLVBP3VrO4)
Breathing techniques. An easy first step is to begin each ses-
sion with a couple of deep breaths. The clinician could ask
the client to join them in a deep inhale and then follow with
a prolonged exhale. Another breathing technique could be
one whereby the clinician asks the client to inhale for a
count of 4 s, sustain the breath for a count of 4 s, and then
exhale for a count of 6 s. The counting helps to keep the
mind from wandering, hence directing both client and clini-
cian to the present moment. Sometimes, simply observing
the breath as it is can produce a peaceful feeling. Clients
could be reminded throughout the session to “take a few
6 Communication Disorders Quarterly 00(0)
seconds and observe your breathing.” The following web-
sites may be used as a resource for describing breathing
techniques:
Greater Good in Action website (https://ggia.berkeley.edu/
practice/mindful_breathing)
Mindful: Healthy Mind Healthy Life (https://www.mindful.
org/a-five-minute-breathing-meditation/)
Mala Prayer (https://www.malaprayer.com/blogs/news/9-best
-breathing-techniques-for-meditation-and-mindfulness)
Movement. Oftentimes mindfulness education is paired
with yoga classes. The yoga positions and movements are
coordinated with the inhalation and exhalation of the breath
to help bring individuals into the present moment. Most
clinical settings do not provide enough space for yoga, but
clinicians could incorporate some stretching and movement
as part of the session. Simply lifting arms over the head and
slowly lowering them to the side can be beneficial. The cli-
ent could be asked to inhale while raising the arms and
exhale while lowering them. Children could be asked to
move their arms like a butterfly or bird. The following web-
sites provide additional information related to incorporating
movement as part of an emerging mindfulness practice:
The Expanding Light Retreat (https://www.expandinglight.
org/blog/yoga/the-connection-between-yoga-and-meditation)
SSM Health (https://www.agnesian.com/blog/mindfulness
-through-relaxation-and-stretching).
Yoga with Adriene: Office-break yoga. (https://www.youtube.
com/watch?v=M-8FvC3GD8c)
Guided meditation. Speech-language pathologists can guide
their clients through a relaxing visualization meditation to
help create a sense of calmness and soothing. To help clini-
cians employ guided meditation or mindfulness visualiza-
tions, a Google search for keywords such as “two-minute
meditation for creating calmness” would result in several
hits for both YouTube and written scripts. Specifically, the
following YouTube channels can be explored for guided
meditation activities:
Rosalie Yoga (https://www.youtube.com/watch?v=vLhOG
EnEedk)
The Honest Guys Meditation-Relaxation (https://www.
youtube.com/watch?v=i50ZAs7v9es)
MyLife (https://www.youtube.com/watch?v=nmFUDkj1Aq0).
There are also meditation apps such as Insight Timer
(https://insighttimer.com), Calm (https://www.calm.com),
and Headspace (https://www.headspace.com) that could be
used for guided visualizations. They provide various medi-
tations that can be downloaded on devices at no cost and
could be used therapeutically, personally, and profession-
ally by both the client and clinician.
Another way to guide clients back to the present moment is
to ask them to practice the S.T.O.P. method (Kar et al., 2014).
S.T.O.P. is an acronym which represents the following:
S: Stop. Be still and pause for a moment.
T: Take a breath.
O: Observe. Notice what is happening via sense percep-
tion. What can be heard, felt, seen?
P: Proceed. Continue the task or change it based on feel-
ings after implementing S.T.O.P.
Body scan. This activity, also known as differential relax-
ation, asks the client to focus on specific parts of the body,
acknowledging where tension may be felt/noticed, and
making a conscious effort to release the tension. On a regu-
lar basis, differential relaxation is used for fluency and
voice clients as an integral part of their therapy sessions. To
guide a voice or fluency client through a body scan, clini-
cians might say at a slowed rate with frequent pauses:
Bring your attention to your throat. How does it feel? Is it
tight? Can you tighten it up further? Hold it. Now relax it.
Relax it a little further. Feel what that feels like. How is it
different from when it was tense?
However, body scans could also be beneficial for relaxing
clients other than those who present with voice or fluency
disorders. In a soft voice, slowed rate and using frequent
pauses, the clinician may say something like:
Notice your feet. Relax all the muscles in your feet and then
move your attention up your legs. Relax those muscles (the
calves, thighs). Now focus on your abdomen and back. Release
any tension you may feel there. Let your back relax into the
chair. Now notice your neck and shoulders. Relax those
muscles. Relax your jaw, cheeks and eyes. Smooth out your
forehead and relax the top of your head.
With practice, the body scan script should not take more than
2 min. The University of Michigan Anxiety Disorders Clinic
Department of Psychiatry offers a PDF online that outlines
relaxation skills for anxiety: (https://medicine.umich.edu/
sites/default/files/content/downloads/Relaxation-Skills-for-
Anxiety.pdf). The following YouTube videos also demon-
strate effective use of the body scan technique:
Yoga by Candace (https://www.youtube.com/watch?v=dsmfI
Ayiois)
Mindfulness Meditation (https://www.youtube.com/watch?v=
VZpHM2vYa5E)
Medina and Mead
Meditation basket. The “meditation basket” (Cassity, 2016)
contains objects of various shapes, sizes, and textures that
are placed in a decorative basket. The objects may include a
feather, a coin, a cotton ball, a bell or baby rattle, or maybe
even a soft fabric scented with vanilla or coffee. The client
would be asked to draw from the basket and describe the
objects as they are experienced via sense perception (visual,
tactile, possibly auditory and/or scent). The basket of
objects, as described above, is commonplace in pediatric
clinics but the focus is more on developing language or
vocabulary. This common language therapy activity, there-
fore, could be repurposed and used to foster a sense of calm.
Cultivating gratitude. Providing clients with a moment at the
beginning or end of a session (after a couple of deep breaths)
to express gratitude for any aspect of their day or asking
them what they may be able to do to show kindness to oth-
ers, may set the tone for a more enjoyable session. Gratitude
journals may help them reflect on the good in their lives and
track their mindfulness journey. Additional information
related to the importance of expressing gratitude is avail-
able via the following websites:
Mindful: Healthy Mind, Healthy Life (https://www.mindful.
org/an-introduction-to-mindful-gratitude)
Psychology Today (https://www.psychologytoday.com/us/
blog/mindfulness-insights/201906/mindfulness-and-gratitude)
Suggestions for Measuring Change
Keeping data on clients’ progress in achieving their speech
and language goals is paramount in the clinical setting,
tracking clients’ progress relative to mindfulness practice is
no different. Some things to consider are the specific data
points to be tracked, the frequency at which data are to be
collected, and the data collection tools to be used. Data
points can include aspects like levels of stress and anxiety,
types and pervasiveness of negative emotions, ability to
concentrate, ability to cope; sense of well-being, and over-
all quality of life. As with any goal or objective, speech-
language pathologists should collect baseline data from
their clients before the mindfulness activities are imple-
mented. Baseline data on the severity of the clients’ com-
munication or swallowing disorder should be current as
well. From there, speech-language pathologists may choose
informal measures to collect data at the beginning and end
of each session or less frequently at once a session or once
a week. A simple, informal measure one can begin with is a
self-made Likert-type scale (e.g., Nemoto & Beglar, 2014).
For children, drawings of facial expressions ranging from
sad to happy, energetic to calm, and so on, can be used to
rate their current state (Hall et al., 2016). More abstract con-
cepts can be used for adults such as numerical ratings for
severity of stress, for example. Another informal measure
7
could be the clients’ use of journals to document their own
changes and then share those journal entries with the clini-
cian (e.g., Hubbs & Brand, 2005; Miller, 2014; Simmons-
Mackie & Damico, 2001). While the informal measures are
viable options for frequent tracking that is not time consum-
ing, some speech-language pathologists may opt to use
more formal, self-report measures to collect baseline and
follow-up data (e.g., O’Leary & Dockray, 2015). Published
assessments like quality of life questionnaires and self-per-
ceptions of severity that are couched in the clients’ individ-
ual communication disorders may be appropriate measures
to capture a clients’ change over a long period of time.
Disorder-specific options include, but are not limited to, the
Overall Assessment of the Speaker’s Experience of
Stuttering (Yaruss & Quesal, 2006); the Voice-Related
Quality of Life Measure (Hogikyan, 2004); and the Stroke
and Aphasia Quality of Life Scale (Hilari et al., 2009).
Final Thoughts
Preliminary research has shown that mindfulness tech-
niques taught in conjunction with traditional speech therapy
have benefits for clients who stutter and their parents, as
well as clients with cognitive deficits and their caregivers.
Researchers have suggested the application of mindfulness
in voice therapy, given the degree of awareness and atten-
tion required for many voice therapy techniques. While the
idea of incorporating the tenets of mindfulness in speech
therapy is gaining significant traction, more research is
needed to continue building an evidence base of its utility in
all of the major domains of speech-language pathology for
clientele of all ages. More continuing education opportuni-
ties on mindfulness in speech-language pathology need to
be offered so speech-language pathologists can learn spe-
cific techniques as well as how to implement them and track
their efficacy in a meaningful way. Until these things hap-
pen, there is still much that individual speech-language
pathologists can do today to make therapy plans more
mindful. The activities suggested in the previous section
may help to bring clients back to the present moment, which
will bring a sense of calm and focus to the task at hand.
These strategies are not only excellent for the client, but for
the speech-language pathologist as well. So, take the
plunge, go deep, be still and enjoy the present moment; it is
all we ever really have.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
8 Communication Disorders Quarterly 00(0)
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