10.12 Habit or addiction?

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In an abstract form (Map 10.12.1) we see the individual, Battos, represented as an SRS-cycle maintaining himself in his environment, and responding to contacts with this environment. The stimulation (S) can be perceived as painful, disagreeable or hostile, it can also be rewarding and friendly. Negative qualities in an environment will be avoided, a positive situation will elicit an approach- response.

Map 10.12.1 Stuttering as a learned emotional and behavioural response

Reading from left to right we distinguish

• antecedent eliciting stimuli, which provoke emotional tendencies and/or drives in the individual, indicated by [r], for an involuntary or autonomous response, such as fear and tenseness

• an emotion or motivational state usually gives rise to a behaviour or response [R] which answers the momentary needs declared by the [r]>

• the behaviour has an effect on the environment that is signalled back to the individual in the form of subsequent stimulation. When the [S] following an [R] is rewarding, such stimulation tends to increase the chances of the same [R] to occur again under similar circumstances; this would be reinforcing or habit forming. Neutral stimulation may cause the behaviour to be extinguished. Unpleasant or punishing stimulation will have the effect that [R] will not be reinforced, and that the [S] (preceding stimulus or situation) will be avoided. Such a conditioned stimulus may give rise to anxiety or apprehension that remains subconscious or is felt consciously.

Most of the behaviour associated with stuttering falls in the category of avoidance response or instrumental responses serving to relieve an immediate tension/anxiety. The emotional relief that immediately follows an avoidance-behaviour is the reward which maintains stuttering.

During therapy the stutterer should get to the point that he will not allow himself this type of short term rewards, and that he will prevent them from occurring (response prevention). There are now countless successful recoveries of stuttering on record. We have seen complete recoveries in stutterers whose affliction had received a neurological label "extra pyramidal disorder" or "focal pathology in the left temporal area". Such diagnostic errors are due to the fact that in the minds of neurologists and in the textbooks on neurology learning and conditioning are sparsely represented. The study of conditioning and learning principles leads to convincing evidence that whatever "structural" changes there had been in a stutterer's central nervous system, they had lost their influence after a learning process that led to personal growth and healing.

Since we now know that most stuttering symptoms are the result of learning or conditioning we realize that other dyskinesia's have equally been acquired by learning. The principles illustrated by the example of stuttering have a wide significance. Dyskinesia's such as facial tics, ocular spasm, spastic dysphonia, can be treated with behaviour therapy combined with cognitive therapy, preferably in the early stages of their development. In the long run the faulty tracks are ingrained more or less permanently in the neural system, and in the personality structure.

10.13 Alalia scales the stairs out of the pit of doom: a de-escalation.