Comparing the effectiveness of cognitive behavioral group therapy and mindfulness and acceptance group therapy for adults who stutter: A randomized clinical trial


Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran


Background: Considering the importance of psychological interventions for adults who stutter (AWS), the present study compared the effectiveness of Cognitive Behavioral Group Therapy (CBGT) and Mindfulness and Acceptance Group Therapy (MAGT), in combination with Speech Therapy (ST) in AWS.
Materials and Methods: A randomized clinical trial was conducted with 36 AWS in Tehran and Alborz provinces in Iran from September-2019 to September-2020. Participants were assigned to CBGT + ST and MAGT + ST groups. Outcomes variables, the fear of negative evaluation scale (FNE) and the social avoidance and distress scale (SAD), were measured at four stages: (1) pretest, (2) after MAGT/CBGT, (3) after ST, and (4) at 6-month follow-up.
Results: The results of repetitive measure-analysis on variance showed that CBGT + ST and MAGT + ST were significantly effective (P = 0.001 and P = 0.003) on SAD. The same analysis showed that CBGT + ST was significantly effective (P = 0.001) on FNE. The results of Analysis of Covariance showed that there was no significant difference between CBGT + ST and MAGT + ST on SAD but CBGT + ST was more effective than MAGT + ST at stage 3 (P < 0.05) on FNE.
Conclusion: Data indicated that CBGT + ST and MAGT + ST were both effective for SAD of AWS. Regarding FNE, unlike MAGT + ST, CBGT was effective either alone or in combination with ST for AWS. Further studies are needed to confirm the results of this study.


Bloodstein O, Ratner NB, Brundage SB. A Handbook on Stuttering. San Diego, CA: Plural Publishing; 2021.  Back to cited text no. 1
Carter A, Breen L, Yaruss JS, Beilby J. Self-efficacy and quality of life in adults who stutter. J Fluency Disord 2017;54:14-23.  Back to cited text no. 2
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. J Fluency Disord 2020;63:105748.  Back to cited text no. 3
Karahan Tığrak T, Kulak Kayıkcı ME, Kirazlı MÇ, Tığrak A. Emotional and behavioural problems of children and adolescents who stutter: Comparison with typically developing peers. Logoped Phoniatr Vocol 2021;46:186-92.  Back to cited text no. 4
Kikuchi Y, Umezaki T, Sawatsubashi M, Taura M, Yamagu-Chi Y, Murakami D, et al. Experiences of teasing and bullying in children who stutter. Int Arch Commun Disord 2019;2:23937.  Back to cited text no. 5
Zamprogno MP, Mandrá PP, Gonçalves TC, Jorge TM. Experiences of violence at school from the stuttering patients' perspective. Rev CEFAC 2020;22:e6020.  Back to cited text no. 6
Menzies RG, Packman A, Onslow M, O'Brian S, Jones M, Helgadóttir FD. In-clinic and standalone Internet cognitive behavior therapy treatment for social anxiety in stuttering: A randomized trial of iGlebe. J Speech Lang Hear Res 2019;62:1614-24.  Back to cited text no. 7
Brundage SB, Winters KL, Beilby JM. Fear of negative evaluation, trait anxiety, and judgment bias in adults who stutter. Am J Speech Lang Pathol 2017;26:498-510.  Back to cited text no. 8
Bergmann PL. Social Anxiety, Fear of Negative Evaluation and Safety Behavior among those that Stutter and those that do not Stutter; 2019.  Back to cited text no. 9
Mahr GC, Torosian T. Anxiety and social phobia in stuttering. J Fluency Disord 1999;24:119-26.  Back to cited text no. 10
Craig A, Tran Y. Fear of speaking: Chronic anxiety and stammering. Adv Psychiatr Treatment 2006;12:63-8.  Back to cited text no. 11
Carpenter JK, Andrews LA, Witcraft SM, Powers MB, Smits JA, Hofmann SG. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety 2018;35:502-14.  Back to cited text no. 12
Kocovski NL, Fleming JE, Rector NA. Mindfulness and acceptance-based group therapy for social anxiety disorder: An open trial. Cogn Behav Pract 2009;16:276-89.  Back to cited text no. 13
Kocovski NL, Fleming JE, Hawley LL, Huta V, Antony MM. Mindfulness and acceptance-based group therapy versus traditional cognitive behavioral group therapy for social anxiety disorder: A randomized controlled trial. Behav Res Ther 2013;51:889-98.  Back to cited text no. 14
Kocovski NL, Fleming JE, Blackie RA, MacKenzie MB, Rose AL. Self-help for social anxiety: Randomized controlled trial comparing a mindfulness and acceptance-based approach with a control group. Behav Ther 2019;50:696-709.  Back to cited text no. 15
Harley J. The role of attention in therapy for children and adolescents who stutter: Cognitive behavioral therapy and mindfulness-based interventions. Am J Speech Lang Pathol 2018;27:1139-51.  Back to cited text no. 16
Klein ER, Amster BJ. Cognitive behavioral therapy (CBT) for people who stutter. In: More than Fluency: The Social, Emotional, and Cognitive Dimensions of Stuttering. San Diego, CA: Plural Publishing; 2018. p. 85-110.  Back to cited text no. 17
Kakamad KK. The effect of cognitive behavioral therapy in reducing social anxiety among adult stutters. Technium Soc Sci J 2021;20:540-5.  Back to cited text no. 18
Scheurich JA, Beidel DC, Vanryckeghem M. Exposure therapy for social anxiety disorder in people who stutter: An exploratory multiple baseline design. J Fluency Disord 2019;59:21-32.  Back to cited text no. 19
Brown M. Exploring the Therapy Experience of Adults who Stutter as it Relates to Inclusion of Cognitive Therapy Components in Stuttering Therapy 2021.  Back to cited text no. 20
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.  Back to cited text no. 21
Beilby JM, Byrnes ML, Yaruss JS. Acceptance and commitment therapy for adults who stutter: Psychosocial adjustment and speech fluency. J Fluency Disord 2012;37:289-99.  Back to cited text no. 22
de Veer S, Brouwers A, Evers W, Tomic W. A pilot study of the psychological impact of the mindfulness-based stress reduction program on persons who stutter. Eur Psychother 2009;9:39-56.  Back to cited text no. 23
Freud D, Levy-Kardash O, Glick I, Ezrati-Vinacour R. Pilot program combining acceptance and commitment therapy with stuttering modification therapy for adults who stutter: A case report. Folia Phoniatr Logop 2020;72:290-301.  Back to cited text no. 24
Hart AK, Breen LJ, Beilby JM. Evaluation of an integrated fluency and acceptance and commitment therapy intervention for adolescents and adults who stutter: Participant perspectives. J Fluency Disord 2021;69:105852.  Back to cited text no. 25
Beilby JM, Yaruss JS. Acceptance and commitment therapy for stuttering disorders. In: More than Fluency: The Social, Emotional, and Cognitive Dimensions of Stuttering. San Diego, CA: Plural Publishing; 2018. p. 111-29.  Back to cited text no. 26
Watson D, Friend R. Measurement of social-evaluative anxiety. J Consult Clin Psychol 1969;33:448-57.  Back to cited text no. 27
Oei TP, Kenna D, Evans L. The reliability, validity and utility of the SAD and FNE scales for anxiety disorder patients. Pers Individ Dif 1991;12:111-6.  Back to cited text no. 28
Groth-Marnat G. Handbook of Psychological Assessment. New Jersey: John Wiley and Sons; 2009.  Back to cited text no. 29
Shooshtari MH, Davari-Ashtiani R, Shahrivar Z, Shabani A, Semnani Y, Kaviani H, et al. Structured clinical interview for DSM-IV (SCID Persian translation and cultural adaptation). Iran J Psychiatry 2007;2:46-8.  Back to cited text no. 30
Riley G. Stuttering Severity Instrument for Children and Adults: Pro-ed; 1994.  Back to cited text no. 31
Farazi, Tehrani G, Kolaee K, Shemshadi, Rahgozar. The effect of a combination of cognitive therapy and speech in stutterers (Persian). J Thought Behav Clin Psychol 2014;9:37-46.  Back to cited text no. 32
McColl T, Onslow M, Packman A, Menzies R, editors. A Cognitive Behavioral Intervention for Social Anxiety in Adults who Stutter. Proceedings of the 2001 Speech Pathology Australia National Conference; 2001.  Back to cited text no. 33
Fleming JE, Kocovski NL. Mindfulness and Acceptance-based Group Therapy for Social Anxiety Disorder: A Treatment Manual Second Edition. Unpublished Manuscript; 2014.  Back to cited text no. 34
Craig A. Treating Stuttering in Older Children, Adolescents and Adults. A Guide for Clinicians, Parents and those who Stutter. Gosford, NSW: Feedback Publications; 1998.  Back to cited text no. 35