Characteristics associated with social anxiety in adults with developmental stuttering: A review

Main Article Content

Kim R. Bauerly, Ph.D., CCC-SLP

Abstract

People who stutter are at a greater risk for developing symptoms of social anxiety, with up to 22-60% of adults who stutter meeting the criteria for a clinical diagnosis. Negative attitudes and feelings about speaking and stuttering are reported to emerge as early as the preschool years and are suspected to be due to exposure to negative listener reactions, stereotyping and social isolation. Repeated negative experiences lead to feelings of fear, embarrassment and loss of control during speaking which over time, leads to the development of more severe difficulties with speaking and an overall apprehension to speak as they perceive themselves as an incompetent communicator. The present review aims to summarize risk factors, particularly temperament and environmental factors, that are reported to play a role in the emergence and maintenance of social anxiety in people who stutter. Another aim of this review is to summarize the features of social anxiety reported in adults who stutter, some of which, are similar to high socially anxious fluent speakers (e.g., avoidant strategies) while others are specific to stuttering (e.g., muscle tension). The clinical implications of these findings and recommendations for future research are also discussed.

Article Details

How to Cite
BAUERLY, Kim R.. Characteristics associated with social anxiety in adults with developmental stuttering: A review. Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5876>. Date accessed: 15 nov. 2024. doi: https://doi.org/10.18103/mra.v12i10.5876.
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Review Articles

References

1. Bloodstein O, Ratner NB, Brundage SB. A handbook on stuttering. vol 1. Plural Publishing; 2021.

2. Yairi E, Ambrose N. Epidemiology of stuttering: 21st century advances. Journal of fluency disorders. 2013;38(2):66-87.

3. Craig A, Tran Y. The epidemiology of stuttering: The need for reliable estimates of prevalence and anxiety levels over the lifespan. Advances in Speech Language Pathology. 2005; 7(1):41-46.

4. Guitar B. Stuttering: An integrated approach to its nature and treatment. Lippincott Williams & Wilkins; 2013.

5. Vanryckeghem M, Brutten GJ, Uddin N, Van Borsel J. A comparative investigation of the speech-associated coping responses reported by adults who do and do not stutter. Journal of Fluency Disorders. 2004;29(3):237-250.

6. De Nil LF, Brutten G. Voice onset times of stuttering and nonstuttering children: The influence of externally and linguistically imposed time pressure. Journal of Fluency Disorders. 1991;16(2-3):143-158.

7. Blood GW, Blood IM. Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Journal of fluency disorders. 2016;50:72-84.

8. Beilby J. Psychosocial impact of living with a stuttering disorder: Knowing is not enough. Thieme Medical Publishers; 2014:132-143.

9. Ezrati-Vinacour R, Levin I. The relationship between anxiety and stuttering: A multidimensional approach. Journal of fluency disorders. 2004;29 (2):135-148.

10. Langevin M, Packman A, Onslow M. Peer responses to stuttering in the preschool setting. 2009;

11. Bricker-Katz G, Lincoln M, McCabe P. A life-time of stuttering: How emotional reactions to stuttering impact activities and participation in older people. Disability and rehabilitation. 2009;31(21): 1742-1752.

12. Mulcahy K, Hennessey N, Beilby J, Byrnes M. Social anxiety and the severity and typography of stuttering in adolescents. Journal of fluency disorders. 2008;33(4):306-319.

13. Blumgart E, Tran Y, Craig A. Social support and its association with negative affect in adults who stutter. Journal of fluency disorders. 2014;40: 83-92.

14. Craig A, Tran Y. Trait and social anxiety in adults with chronic stuttering: Conclusions following meta-analysis. Journal of fluency disorders. 2014; 40:35-43.

15. Iverach L, Jones M, O’Brian S, et al. Screening for personality disorders among adults seeking speech treatment for stuttering. Journal of fluency disorders. 2009;34(3):173-186.

16. Mahr GC, Torosian T. Anxiety and social phobia in stuttering. Journal of Fluency Disorders. 1999;24(2):119-126.

17. Gabel RM, Colcord RD, Petrosino L. Self-reported anxiety of adults who do and do not stutter. Perceptual and Motor Skills. 2002;94(3):775-784.

18. Messenger M, Onslow M, Packman A, Menzies R. Social anxiety in stuttering: measuring negative social expectancies. Journal of fluency disorders. 2004;29(3):201-212.

19. Watson D, Friend R. Measurement of social-evaluative anxiety. Journal of consulting and clinical psychology. 1969;33(4):448.

20. van Dam-Baggen R, Kraaimaat F. Assessing social anxiety: The Inventory of Interpersonal Situations (IIS). European Journal of Psychological Assessment. 1999;15(1):25.

21. Turner SM, Beidel DC, Dancu CV, Stanley MA. An empirically derived inventory to measure social fears and anxiety: the Social Phobia and Anxiety Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(1):35.

22. Kraaimaat FW, Vanryckeghem M, Van Dam-Baggen R. Stuttering and social anxiety. Journal of fluency disorders. 2002;27(4):319-331.

23. Iverach L, Jones M, Lowe R, et al. Comparison of adults who stutter with and without social anxiety disorder. Journal of fluency disorders. 2018;56:55-68.

24. Tomisato S, Yada Y, Wasano K. Relationship between social anxiety and coping profile in adults who stutter. Journal of Communication Disorders. 2022;95:106167.

25. Lei X, Sasisekaran J, Nguyen-Feng VN. The experience of stuttering in everyday life among adults who stutter: The impact of trait social anxiety and the social situations. Journal of Fluency Disorders. 2024;80:106061.

26. Kagan J. Temperamental contributions to social behavior. American psychologist. 1989;44 (4):668.

27. Nigg JT. Temperament and developmental psychopathology. Journal of Child Psychology and Psychiatry. 2006;47(3‐4):395-422.

28. Lonigan CJ, Vasey MW, Phillips BM, Hazen RA. Temperament, anxiety, and the processing of threat-relevant stimuli. Journal of Clinical Child and Adolescent Psychology. 2004;33(1):8-20.

29. Rubin KH, Burgess KB, Hastings PD. Stability and social–behavioral consequences of toddlers’ inhibited temperament and parenting behaviors. Child development. 2002;73(2):483-495.

30. Rothbart MK, Sheese BE, Rueda MR, Posner MI. Developing mechanisms of self-regulation in early life. Emotion review. 2011;3(2):207-213.

31. Spence SH, Rapee RM. The etiology of social anxiety disorder: An evidence-based model. Behaviour research and therapy. 2016;86:50-67.

32. Brook CA, Willoughby T. The social ties that bind: Social anxiety and academic achievement across the university years. Journal of youth and adolescence. 2015;44:1139-1152.

33. Fox NA, Henderson HA, Marshall PJ, Nichols KE, Ghera MM. Behavioral inhibition: Linking biology and behavior within a developmental framework. Annu Rev Psychol. 2005;56:235-262.

34. Rapee RM, Coplan RJ. Conceptual relations between anxiety disorder and fearful temperament. New directions for child and adolescent development. 2010;2010(127):17-31.

35. Pérez-Edgar K, Fox NA. Temperament and anxiety disorders. Child and Adolescent Psychiatric Clinics. 2005;14(4):681-706.

36. Clauss JA, Blackford JU. Behavioral inhibition and risk for developing social anxiety disorder: a meta-analytic study. Journal of the American Academy of Child & Adolescent Psychiatry. 2012;51(10): 1066-1075. e1.

37. Fox NA, Nichols KE, Henderson HA, et al. Evidence for a gene-environment interaction in predicting behavioral inhibition in middle childhood. Psychological Science. 2005;16(12):92 1-926.

38. Biederman J, Rosenbaum JF, Bolduc-Murphy EA, et al. A 3-year follow-up of children with and without behavioral inhibition. Journal of the American Academy of Child & Adolescent Psychiatry. 1993; 32(4):814-821.

39. Anderson SE, Bandini L, Dietz W, Must A. Relationship between temperament, nonresting energy expenditure, body composition, and physical activity in girls. International journal of obesity. 2004;28(2):300-306.

40. Choi D, Conture EG, Walden TA, Jones RM, Kim H. Emotional diathesis, emotional stress, and childhood stuttering. Journal of Speech, Language, and Hearing Research. 2016;59(4):616-630.

41. Eggers K, Luc F, Van den Bergh BR. Inhibitory control in childhood stuttering. Journal of fluency disorders. 2013;38(1):1-13.

42. Karrass J, Walden TA, Conture EG, et al. Relation of emotional reactivity and regulation to childhood stuttering. Journal of communication disorders. 2006;39(6):402-423.

43. Tumanova V, Backes N. Autonomic nervous system response to speech production in stuttering and normally fluent preschool-age children. Journal of Speech, Language, and Hearing Research. 2019;62(11):4030-4044.

44. Conture EG, Kelly EM, Walden TA. Temperament, speech and language: An overview. Journal of communication disorders. 2013;46(2): 125-142.

45. Johnson KN, Walden TA, Conture EG, Karrass J. Spontaneous regulation of emotions in preschool children who stutter: Preliminary findings. 2010;

46. Zengin-Bolatkale H, Conture EG, Walden TA, Jones RM. Sympathetic arousal as a marker of chronicity in childhood stuttering. Developmental neuropsychology. 2018;43(2):135-151.

47. Ntourou K, DeFranco EO, Conture EG, Walden TA, Mushtaq N. A parent-report scale of behavioral inhibition: Validation and application to preschool-age children who do and do not stutter. Journal of Fluency Disorders. 2020;63:105748.

48. Choi D, Conture EG, Walden TA, Lambert WE, Tumanova V. Behavioral inhibition and childhood stuttering. Journal of fluency disorders. 2013;38 (2):171-183.

49. Tumanova V, Wilder B, Gregoire J, Baratta M, Razza R. Emotional reactivity and regulation in preschool-age children who do and do not stutter: Evidence from autonomic nervous system measures. Frontiers in human neuroscience. 2020;14:600790.

50. Frost A. The Relationship Between Behavioral Inhibition and Secondary Behaviors in Children Who Stutter. University of South Alabama; 2022.

51. Smith KA, Iverach L, O’Brian S, Kefalianos E, Reilly S. Anxiety of children and adolescents who stutter: A review. Journal of fluency disorders. 2014;40:22-34.

52. Rapee RM, Spence SH. The etiology of social phobia: Empirical evidence and an initial model. Clinical psychology review. 2004;24(7):737-767.

53. Rana SA, Akhtar S, Tahir MA. Parenting styles and social anxiety among adolescents. New Horizons. 2013;7(2):21.

54. Beidel DC, Turner SM. At risk for anxiety: I. Psychopathology in the offspring of anxious parents. Journal of the American Academy of Child & Adolescent Psychiatry. 1997;36(7):918-924.

55. Fyer AJ, Mannuzza S, Chapman TF, Martin LY, Klein DF. Specificity in familial aggregation of phobic disorders. Archives of general psychiatry. 1995;52(7):564-573.

56. Rapee RM. The development and modification of temperamental risk for anxiety disorders: prevention of a lifetime of anxiety? Biological psychiatry. 2002;52(10):947-957.

57. Acarturk C, Smit F, De Graaf R, Van Straten A, Ten Have M, Cuijpers P. Incidence of social phobia and identification of its risk indicators: a model for prevention. Acta Psychiatrica Scandinavica. 2009; 119(1):62-70.

58. Simon NM, Herlands NN, Marks EH, et al. Childhood maltreatment linked to greater symptom severity and poorer quality of life and function in social anxiety disorder. Depression and anxiety. 2009;26(11):1027-1032.

59. Broeren S, Muris P, Diamantopoulou S, Baker JR. The course of childhood anxiety symptoms: Developmental trajectories and child-related factors in normal children. Journal of abnormal child psychology. 2013;41:81-95.

60. Bögels SM, Brechman-Toussaint ML. Family issues in child anxiety: Attachment, family functioning, parental rearing and beliefs. Clinical psychology review. 2006;26(7):834-856.

61. Geyer EC, Fua KC, Daniel KE, et al. I did OK, but did I like it? Using ecological momentary assessment to examine perceptions of social interactions associated with severity of social anxiety and depression. Behavior therapy. 2018;49(6):866-880.

62. Lau SR, Beilby JM, Byrnes ML, Hennessey NW. Parenting styles and attachment in school-aged children who stutter. Journal of communication disorders. 2012;45(2):98-110.

63. Poulos MG, Webster WG. Family history as a basis for subgrouping people who stutter. Journal of Speech, Language, and Hearing Research. 1991;34(1):5-10.

64. Yairi E. The onset of stuttering in two-and three-year-old children: A preliminary report. Journal of Speech and hearing Disorders. 1983;48(2):171-177.

65. Starkweather CW. The epigenesis of stuttering. Journal of fluency Disorders. 2002;27 (4):269-288.

66. Carleton RN, McCreary DR, Norton PJ, Asmundson GJ. Brief fear of negative evaluation scale—revised. Depression and anxiety. 2006;23 (5):297-303.

67. Kraft SJ, Ambrose N, Chon H. Temperament and environmental contributions to stuttering severity in children: The role of effortful control. Thieme Medical Publishers; 2014:080-094.

68. Anderson JD, Pellowski MW, Conture EG, Kelly EM. Temperamental characteristics of young children who stutter. 2003;

69. Winton EC, Clark DM, Edelmann RJ. Social anxiety, fear of negative evaluation and the detection of negative emotion in others. Behaviour research and therapy. 1995;33(2):193-196.

70. Ganesh Kumar J, Athilakshmi R, Maharishi R, Maya R. Relationship between fear of negative evaluation and anxiety. The International Journal of Indian Psychology. 2015;3(1):74-80.

71. Rodebaugh TL, Weeks JW, Gordon EA, Langer JK, Heimberg RG. The longitudinal relationship between fear of positive evaluation and fear of negative evaluation. Anxiety, Stress & Coping. 2012;25(2):167-182.

72. Kocovski NL, Endler NS. Social anxiety, self‐regulation, and fear of negative evaluation. European Journal of Personality. 2000;14(4):347-358.

73. Bernard R, Hofslundsengen H, Frazier Norbury C. Anxiety and depression symptoms in children and adolescents who stutter: A systematic review and meta-analysis. Journal of Speech, Language, and Hearing Research. 2022;65(2):624-644.

74. Lowe R, Helgadottir F, Menzies R, et al. Safety behaviors and stuttering. Journal of Speech, Language, and Hearing Research. 2017;60(5): 1246-1253.

75. Menzies RG, Onslow M, Packman A, O’Brian S. Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Journal of fluency disorders. 2009;34(3):187-200.

76. St Clare T, Menzies RG, Onslow M, Packman A, Thompson R, Block S. Unhelpful thoughts and beliefs linked to social anxiety in stuttering: Development of a measure. International Journal of Language & Communication Disorders. 2009; 44(3):338-351.

77. Iverach L, O’Brian S, Jones M, et al. Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of anxiety disorders. 2009;23(7):928-934.

78. Lowe R, Guastella AJ, Chen NT, et al. Avoidance of eye gaze by adults who stutter. Journal of fluency disorders. 2012;37(4):263-274.

79. Brundage SB, Winters KL, Beilby JM. Fear of negative evaluation, trait anxiety, and judgment bias in adults who stutter. American journal of speech-language pathology. 2017;26(2):498-510.

80. Voncken MJ, Bögels SM, de Vries K. Interpretation and judgmental biases in social phobia. Behaviour research and therapy. 2003;41 (12):1481-1488.

81. Jackson ES, Gerlach H, Rodgers NH, Zebrowski PM. My client knows that he's about to stutter: How can we address stuttering anticipation during therapy with young people who stutter? Thieme Medical Publishers; 2018:356-370.

82. Jackson ES, Tiede M, Beal D, Whalen DH. The impact of social–cognitive stress on speech variability, determinism, and stability in adults who do and do not stutter. Journal of Speech, Language, and Hearing Research. 2016;59(6):1295-1314.

83. Arenas RM, Zebrowski PM. The relationship between stuttering anticipation and verbal response time in adults who stutter. Speech, Language and Hearing. 2017;20(1):1-14.

84. Wells A, Clark DM, Salkovskis P, Ludgate J, Hackmann A, Gelder M. Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy. 1995;26 (1):153-161.

85. Hinrichsen H, Clark DM. Anticipatory processing in social anxiety: Two pilot studies. Journal of behavior therapy and experimental psychiatry. 2003;34(3-4):205-218.

86. Vassilopoulos SP. Anticipatory processing plays a role in maintaining social anxiety. Anxiety, Stress, and Coping. 2005;18(4):321-332.

87. Alm PA. Stuttering and the basal ganglia circuits: a critical review of possible relations. Journal of communication disorders. 2004;37(4):325-369.

88. Jackson ES, Yaruss JS, Quesal RW, Terranova V, Whalen DH. Responses of adults who stutter to the anticipation of stuttering. Journal of fluency disorders. 2015;45:38-51.

89. Jackson ES, Rodgers NH, Rodgers DB. An exploratory factor analysis of action responses to stuttering anticipation. Journal of Fluency Disorders. 2019;60:1-10.

90. Walsh B, Usler E. Physiological correlates of fluent and stuttered speech production in preschool children who stutter. Journal of Speech, Language, and Hearing Research. 2019;62(12):4309-4323.

91. Berntson GG, Cacioppo JT, Grossman P. Whither vagal tone. Biological psychology. 2007; 74(2):295-300.

92. Berntson GG, Cacioppo JT, Quigley KS. Autonomic determinism: the modes of autonomic control, the doctrine of autonomic space, and the laws of autonomic constraint. Psychological review. 1991;98(4):459.

93. Porges SW. The polyvagal perspective. Biological psychology. 2007;74(2):116-143.

94. Bradley MM, Codispoti M, Cuthbert BN, Lang PJ. Emotion and motivation I: defensive and appetitive reactions in picture processing. Emotion. 2001;1(3):276.

95. Coan JA, Allen JJ. Handbook of emotion elicitation and assessment. Oxford university press; 2007.

96. Porges SW. Vagal tone: a physiologic marker of stress vulnerability. Pediatrics. 1992;90(3):498-504.

97. Friedman BH. An autonomic flexibility–neurovisceral integration model of anxiety and cardiac vagal tone. Biological psychology. 2007;74 (2):185-199.

98. Thayer JF, Lane RD. A model of neurovisceral integration in emotion regulation and dysregulation. Journal of affective disorders. 2000;61(3):201-216.

99. Hagenaars MA, van Minnen A. The effect of fear on paralinguistic aspects of speech in patients with panic disorder with agoraphobia. Journal of Anxiety Disorders. 2005;19(5):521-537.

100. Calkins SD. Cardiac vagal tone indices of temperamental reactivity and behavioral regulation in young children. Developmental Psychobiology: The Journal of the International Society for Developmental Psychobiology. 1997;31(2):125-135.

101. Stifter CA, Fox NA. Infant reactivity: Physiological correlates of newborn and 5-month temperament. Developmental psychology. 1990; 26(4):582.

102. Balzarotti S, Biassoni F, Colombo B, Ciceri MR. Cardiac vagal control as a marker of emotion regulation in healthy adults: A review. Biological psychology. 2017;130:54-66.

103. Mauss I, Wilhelm F, Gross J. Is there less to social anxiety than meets the eye? Emotion experience, expression, and bodily responding. Cognition and emotion. 2004;18(5):631-642.

104. Sulik MJ, Eisenberg N, Silva KM, Spinrad TL, Kupfer A. Respiratory sinus arrhythmia, shyness, and effortful control in preschool-age children. Biological psychology. 2013;92(2):241-248.

105. Sulik MJ, Eisenberg N, Spinrad TL, Silva KM. Associations between respiratory sinus arrhythmia (RSA) reactivity and effortful control in preschool‐age children. Developmental psychobiology. 2015;57(5):596-606.

106. Pu J, Schmeichel BJ, Demaree HA. Cardiac vagal control predicts spontaneous regulation of negative emotional expression and subsequent cognitive performance. Biological psychology. 2010;84(3):531-540.

107. Balle M, Tortella-Feliu M, Bornas X. Distinguishing youths at risk for anxiety disorders from self-reported BIS sensitivity and its psychophysiological concomitants. International Journal of Psychology. 2013;48(5):964-977.

108. Geisler FC, Kubiak T. Heart rate variability predicts self‐control in goal pursuit. European Journal of Personality: Published for the European Association of Personality Psychology. 2009;23 (8):623-633.

109. Eisenberg N, Fabes RA, Shepard SA, et al. Contemporaneous and longitudinal prediction of children's social functioning from regulation and emotionality. Child development. 1997;68(4):642-664.

110. Volokhov RN, Demaree HA. Spontaneous emotion regulation to positive and negative stimuli. Brain and cognition. 2010;73(1):1-6.

111. Park G, Van Bavel JJ, Vasey MW, Thayer JF. Cardiac vagal tone predicts inhibited attention to fearful faces. Emotion. 2012;12(6):1292.

112. Park G, Vasey MW, Van Bavel JJ, Thayer JF. Cardiac vagal tone is correlated with selective attention to neutral distractors under load. Psychophysiology. 2013;50(4):398-406.

113. Park G, Vasey MW, Van Bavel JJ, Thayer JF. When tonic cardiac vagal tone predicts changes in phasic vagal tone: The role of fear and perceptual load. Psychophysiology. 2014;51(5):419-426.

114. Jönsson P. Respiratory sinus arrhythmia as a function of state anxiety in healthy individuals. International journal of psychophysiology. 2007;63 (1):48-54.

115. Bowers A, Saltuklaroglu T, Kalinowski J. Autonomic arousal in adults who stutter prior to various reading tasks intended to elicit changes in stuttering frequency. International Journal of Psychophysiology. 2012;83(1):45-55.

116. Jones R, Choi D, Conture E, Walden T. Temperament, emotion, and childhood stuttering. Thieme Medical Publishers; 2014:114-131.

117. Zengin-Bolatkale H, Conture EG, Walden TA. Sympathetic arousal of young children who stutter during a stressful picture naming task. Journal of fluency disorders. 2015;46:24-40.

118. Zimmermann G. Stuttering: A disorder of movement. Journal of Speech, Language, and Hearing Research. 1980;23(1):122-136.

119. Dietrich S, Roaman MH. Physiologic arousal and predictions of anxiety by people who stutter. Journal of Fluency Disorders. 2001;26(3):207-225.

120. Brundage SB. Virtual reality augmentation for functional assessment and treatment of stuttering. Topics in Language Disorders. 2007; 27(3):254-271.

121. Bauerly KR, Mefferd A. The effects of attentional focus on speech motor control in adults who stutter with and without social evaluative threat. Journal of Fluency Disorders. 2023;77:105995.

122. Weber CM, Smith A. Autonomic correlates of stuttering and speech assessed in a range of experimental tasks. Journal of Speech, Language, and Hearing Research. 1990;33(4):690-706.

123. Peters HF, Hulstijn W. Stuttering and anxiety: The difference between stutterers and nonstutterers in verbal apprehension and physiologic arousal during the anticipation of speech and non-speech tasks. Journal of Fluency Disorders. 1984;9(1):67-84.

124. Bauerly KR, Jones RM, Miller C. Effects of social stress on autonomic, behavioral, and acoustic parameters in adults who stutter. Journal of Speech, Language, and Hearing Research. 2019;62(7): 2185-2202.

125. Bauerly KR. Attentional biases in adults who stutter before and following social threat induction. Folia Phoniatrica et Logopaedica. 2022;74(4):239-253.

126. Brundage SB, Brinton JM, Hancock AB. Utility of virtual reality environments to examine physiological reactivity and subjective distress in adults who stutter. Journal of fluency disorders. 2016;50:85-95.

127. Tumanova V, Woods C, Wang Q. Effects of physiological arousal on speech motor control and speech motor practice in preschool-age children who do and do not stutter. Journal of Speech, Language, and Hearing Research. 2020;63(10): 3364-3379.

128. Bauerly KR, Jones RM. The impact of self-reported levels of anxiety on respiratory sinus arrhythmia levels in adults who stutter. Journal of Communication Disorders. 2021;90:106084.

129. Spielberger CD, Gonzalez-Reigosa, F., Martinez-Urrutia, A.. The state-trait anixety inventory. Revista Interamericana de Psicologia/Interamerican Journal of Psychology. 1971;5

130. Dickerson SS. Emotional and physiological responses to social‐evaluative threat. Social and Personality Psychology Compass. 2008;2(3):1362-1378.

131. Kemeny ME, Gruenewald TL, Dickerson SS. Shame as the emotional response to threat to the social self: Implications for behavior, physiology, and health. Psychological inquiry. 2004;15(2):153-160.

132. Bauerly KR, Bilardello C. Resting autonomic activity in adults who stutter and its association with self-reports of social anxiety. Journal of fluency disorders. 2021;70:105881.

133. Chen J, Short M, Kemps E. Interpretation bias in social anxiety: A systematic review and meta-analysis. Journal of Affective Disorders. 2020; 276:1119-1130.

134. Coombes SA, Higgins T, Gamble KM, Cauraugh JH, Janelle CM. Attentional control theory: Anxiety, emotion, and motor planning. Journal of anxiety disorders. 2009;23(8):1072-1079.

135. Gray J, McNaughton N. The neuropsychology of anxiety. Crossref Google Scholar Article Locations: Article Location Article Location More AR articles citing this reference The Neurocognitive Bases of Human Volition Patrick Haggard. 2003;1(2):3.

136. Dickerson SS, Gruenewald TL, Kemeny ME. When the social self is threatened: Shame, physiology, and health. Journal of personality. 2004;72(6):119 1-1216.

137. Lowe R, Menzies R, Packman A, O'Brian S, Jones M, Onslow M. Assessing attentional biases with stuttering. International Journal of Language & Communication Disorders. 2016;51(1):84-94.

138. Plexico L, Manning WH, DiLollo A. A phenomenological understanding of successful stuttering management. Journal of fluency disorders. 2005;30(1):1-22.

139. Lowe R, Menzies R, Onslow M, Packman A, O'Brian S. Speech and anxiety management with persistent stuttering: Current status and essential research. Journal of Speech, Language, and Hearing Research. 2021;64(1):59-74.

140. Rodgers NH, Lau JY, Zebrowski PM. Attentional bias among adolescents who stutter: Evidence for a vigilance–avoidance effect. Journal of Speech, Language, and Hearing Research. 2020;63(10):3349-3363.

141. Tran Y, Blumgart E, Craig A. Subjective distress associated with chronic stuttering. Journal of fluency disorders. 2011;36(1):17-26.

142. Beard C, Amir N. Interpretation in social anxiety: When meaning precedes ambiguity. Cognitive therapy and research. 2009;33:406-415.

143. Gutiérrez-García A, Calvo MG. Social anxiety and threat-related interpretation of dynamic facial expressions: sensitivity and response bias. Personality and Individual Differences. 2017;107: 10-16.

144. Campbell D, Sareen J, Stein M, et al. Happy but not so approachable: the social judgments of individuals with generalized social phobia. Depression and Anxiety. 2009;26(5):419-424.

145. Stopa L, Clark DM. Social phobia and interpretation of social events. Behaviour research and therapy. 2000;38(3):273-283.

146. Amir N, Beard C, Bower E. Interpretation bias and social anxiety. Cognitive Therapy and Research. 2005;29:433-443.

147. Schoth DE, Liossi C. A systematic review of experimental paradigms for exploring biased interpretation of ambiguous information with emotional and neutral associations. Frontiers in psychology. 2017;8:244801.

148. Hirsch CR, Meeten F, Krahé C, Reeder C. Resolving ambiguity in emotional disorders: The nature and role of interpretation biases. Annual review of clinical psychology. 2016;12(1):281-305.

149. Buhlmann U, Wacker R, Dziobek I. Inferring other people's states of mind: Comparison across social anxiety, body dysmorphic, and obsessive–compulsive disorders. Journal of Anxiety Disorders. 2015;34:107-113.

150. Wenzel A, Lystad C. Interpretation biases in angry and anxious individuals. Behaviour Research and Therapy. 2005;43(8):1045-1054.

151. Kreifelts B, Brück C, Ethofer T, et al. Prefrontal mediation of emotion regulation in social anxiety disorder during laughter perception. Neuropsychologia. 2017;96:175-183.

152. Ritter J, Brück C, Jacob H, Wildgruber D, Kreifelts B. Laughter perception in social anxiety. Journal of Psychiatric Research. 2015;60:178-184.

153. Brundage SB, Hancock AB. Real enough: Using virtual public speaking environments to evoke feelings and behaviors targeted in stuttering assessment and treatment. American Journal of Speech-Language Pathology. 2015;24(2):139-149.

154. Rodgers NH, Lau JY, Zebrowski PM. Examining the effects of stuttering and social anxiety on interpretations of ambiguous social scenarios among adolescents. Journal of communication disorders. 2022;95:106179.

155. Sisskin V. Avoidance reduction therapy for stuttering (ARTs). More than fluency: The social, emotional, and cognitive dimensions of stuttering. 2018;157:186.

156. Menzies RG, O’Brian S, Onslow M, Packman A, St Clare T, Block S. An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering. 2008;

157. Beilby JM, Yaruss JS. Acceptance and commitment therapy for stuttering disorders. More than fluency: The social, emotional, and cognitive dimensions of stuttering. 2018;111:129.

158. Amster BJ, Klein ER. More than fluency: The social, emotional, and cognitive dimensions of stuttering. vol 1. Plural Publishing; 2018.

159. Cheasman C, Everard R, Simpson S. Stammering therapy from the Inside. J & R Press Limited; 2013.