Stuttering and Anxiety: Understanding the Connection & What Helps
Quick summary
- What it is. Anxiety about speaking is common in stuttering and usually develops in response to living with stuttering and difficult speaking experiences (Iverach & Rapee, 2014; Alm, 2014).
- What it is not. Anxiety does not cause stuttering; stuttering has neurodevelopmental roots (Chang et al., 2025).
- Why it can spike. Anticipation raises arousal, which tightens breathing and voice and increases self-focus, making speech starts harder (van Lieshout et al., 2014).
- How common. Reviews report about 22–60% of adults who stutter meet criteria for clinically significant social anxiety (Bauerly et al., 2024; Iverach & Rapee, 2014).
- What helps. CBT or ACT with graded exposure; speech approaches target mechanics and may help indirectly; some digital apps and software is available (Menzies et al., 2019; Khoshnam et al., 2023).
Estimated read time: 7–8 min • Last updated: 25 August 2025
What is Stuttering-Related Anxiety
People who stutter often notice a strong link between their stutter and feelings of anxiety. It’s common to feel nervous about speaking, especially after difficult speaking experiences. Reviews indicate that anxiety itself does not cause stuttering; rather, anxiety commonly develops in response to living with stuttering and challenging speaking situations (Iverach & Rapee, 2014; Alm, 2014).
Over time, repeated negative reactions or difficult moments can lead to real anxiety around speaking. In practice, stuttering can fuel stress or nervousness, and that stress can make stuttering moments more likely or more intense—creating a feedback loop of fear and stutter. Can Anxiety Cause Stuttering?No. Stuttering has neurodevelopmental roots. Anxiety can increase tension, shift attention inward, and raise time pressure, which can make stuttering more frequent or intense; but anxiety does not cause stuttering (Chang et al., 2025). Treating anxiety helps many people approach speaking more freely, but it does not create or remove a stutter on its own.
Why Do I Stutter More When I’m Nervous?Anticipation and fear raise arousal. Arousal tightens breathing and voice and increases self-focus. That makes starting and moving through speech harder, which can lead to more struggle. Tough moments then reinforce the expectation of a tough next time. This cycle is maintained by fear of negative evaluation, avoidance of situations, and “safety behaviors” like word substitution or rushing. Laboratory work shows that cognitive stress can disrupt speech-motor control in people who stutter in exactly these ways (van Lieshout et al., 2014).
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Social Anxiety and Stuttering
Many people who stutter also experience social anxiety—fear or worry about speaking in public or social situations. Estimates vary, but reviews report that roughly 22–60% of adults who stutter meet criteria for clinically significant social anxiety (Bauerly et al., 2024; Iverach & Rapee, 2014). This often starts early. Negative reactions from listeners—teasing, impatience, interruptions—can build shame and avoidance. Over time, these experiences teach the person that talking is risky, reinforcing fear and escape behaviours (Iverach & Rapee, 2014). Social anxiety in stuttering can look like dread of phone calls or presentations, overestimating others’ negative reactions, and avoiding conversations or opportunities.
Importantly, studies suggest that reducing anxiety alone (for example, with general relaxation or medication) does not automatically reduce stuttering frequency; the two domains often need to be addressed together (Alm, 2014).
Importantly, studies suggest that reducing anxiety alone (for example, with general relaxation or medication) does not automatically reduce stuttering frequency; the two domains often need to be addressed together (Alm, 2014).
What Can Help with Anxiety About Stuttering
Cognitive-behavioural therapy (CBT)
CBT targets fear of judgment and avoidance. It uses thought work and step-by-step exposure to feared situations (for example, making brief calls or asking short questions in meetings). Randomised trials show that internet-delivered CBT designed for people who stutter (iGlebe) reduces social anxiety with outcomes comparable to clinic CBT, maintained at 12 months (Menzies et al., 2019). Reviews also support CBT for stuttering-related social anxiety (Lowe et al., 2021).
Acceptance and Commitment Therapy (ACT)
This approach can help you notice anxiety and unhelpful thoughts, then speak anyway in small, meaningful steps. Instead of trying to eliminate anxiety first, you learn to unhook from thoughts like “I’ll mess up,” make room for the feelings with a slow out-breath and softer posture, and focus on what matters to you at work, school, or home. You might learn to name the thought, take one slow breath out, do one short speaking action you value, then note what helped for next time. Early research in adults who stutter shows ACT can reduce avoidance and struggle, especially when paired with speech goals (Khoshnam et al., 2023).
Exposure ladders and everyday practice
Build a small ladder of tasks from easier to harder. Start with one tiny step (for example, a 10-second voicemail or one short question at a counter). Keep sessions brief and frequent. After each step, note anxiety before and after and one idea for next time. Graded exposure helps reduce fear even if stuttering occurs (Lowe et al., 2021; see also Scheurich et al., 2019).
Fluency-Shaping Therapy
Fluency-shaping techniques teach a modified speech pattern (for example, easy onsets, continuous phonation, or prolonged speech) to reduce stuttering frequency. These target speech mechanics rather than anxiety directly; however, better control of speech can indirectly lower fear and avoidance for some people.
Stuttering Modification Therapy
This classic approach teaches ways to move through stutters with less struggle (for example, easing out of blocks or using lighter, more controlled stutters). Facing moments of stuttering directly can reduce fear and build confidence, and is often paired with psychological strategies to address avoidance (Lowe et al., 2021).
You can find a guide to the differences between Fluency Shaping and Stuttering Modification therapy here.
You can find a guide to the differences between Fluency Shaping and Stuttering Modification therapy here.
Digital Tools and Programs
The following online programmes and software may be of use in helping people who stutter manage anxiety:
- iGlebe: This is an internet CBT program designed for adults who stutter. It delivers self-guided CBT modules that target stuttering-related social anxiety (think: a structured online course that teaches the same skills you would learn in clinic). In a randomised non-inferiority trial, iGlebe produced similar improvements in social anxiety to face-to-face CBT, and gains were maintained at 12-month follow-up (Menzies et al., 2019). The same team are developing a version of iGlebe for teenagers - called iBroadway. You can find information and a link to request to test this new program here: www.uts.edu.au/research/centres/australian-stuttering-research-centre/our-research/participate-research
- Scenari-Aid: This is a free online simulation tool where people can practice speaking in video scenarios (like a job interview, phone call, or social gathering) in a safe way. It aims to build confidence and fluency by allowing users to record and replay themselves in realistic situations. While formal research on Scenari-Aid’s effectiveness is limited, many speech therapists suggest it as a way to desensitize the fear of speaking. In one case report, a user described how Scenari-Aid helped him practice stuttering more naturally in interviews.
- withVR: A virtual reality platform designed for people who stutter to practice feared speaking situations in immersive environments (e.g. classroom presentations, meetings, interviews). Early research shows VR exposure can help reduce social anxiety in stuttering, offering a safe step between clinic and real life. While still in early stages of study, withVR is an example of how VR can support exposure therapy by letting people rehearse situations that usually trigger high stress. Used in some speech therapy clinics.
Practical Next Steps
Working with professionals and trusted tools
- For anxiety, evidence supports CBT and ACT, often with graded exposure. When in-person help is hard to access, digital options have emerging support: iGlebe (adult internet-CBT) or Scenari-Aid for video-based rehearsal.
- A speech-language therapist can tailor fluency-shaping or stuttering-modification strategies to your goals.
Summary
Anxiety and stuttering often go hand-in-hand, but they have a two-way relationship. Anxiety doesn’t create a stutter, but stuttering can create anxiety. Understanding this helps people target the root of the problem. A variety of evidence-based strategies – from speech therapy to cognitive therapy to digital tools – can help break the cycle. With the right support and practice, many stutterers learn to speak more comfortably, even in the situations that once caused fear.
Sources
Alm, P. A. (2014). Stuttering in relation to anxiety, temperament, and personality: Review and analysis with focus on causality. Journal of Fluency Disorders, 40, 5–21. https://pubmed.ncbi.nlm.nih.gov/24929463/
Bauerly, K. R., et al. (2024). Characteristics associated with social anxiety in adults who stutter. Frontiers in Psychology, 15, 1400564. https://pmc.ncbi.nlm.nih.gov/articles/PMC11626403/
Carey, B., O’Brian, S., Onslow, M., Packman, A., & Menzies, R. (2010). Randomized controlled non-inferiority trial of telehealth delivery of the Camperdown Program for adults who stutter. Journal of Speech, Language, and Hearing Research, 53(3), 887–898. https://pubmed.ncbi.nlm.nih.gov/20643705/
Chang, S.-E., Garnett, E. O., et al. (2025). Stuttering: Our current knowledge, research opportunities, and future directions. Brain Sciences. https://pmc.ncbi.nlm.nih.gov/articles/PMC11977836/
Chard, I., Van Zalk, N., & Picinali, L. (2023). Virtual reality exposure therapy for reducing social anxiety in stuttering: A randomized controlled pilot trial. Frontiers in Digital Health, 5, 1061323. https://pubmed.ncbi.nlm.nih.gov/36845336/
Gunn, J., Menzies, R., et al. (2019). Evaluation of Internet cognitive behavioural therapy (iBroadway) for social anxiety in adolescents who stutter: A Phase I trial. Behaviour Change, 36(2), 124–143. https://www.cambridge.org/core/journals/behaviour-change/article/evaluation-of-internet-cognitive-behaviour-therapy-icbt-for-social-anxiety-in-adolescents-who-stutter-a-phase-i-trial/0A0E303E390E53DE33BFCA9795C4984A
Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 40, 69–82. https://pubmed.ncbi.nlm.nih.gov/24929468/
Khoshnam, S., Gharraee, B., & Ashouri, A. (2023). Comparing cognitive-behavioural group therapy and mindfulness-acceptance group therapy in adults who stutter: Randomised clinical trial. Advanced Biomedical Research, 12, 26. https://pmc.ncbi.nlm.nih.gov/articles/PMC10086645/
Lowe, R., Menzies, R., et al. (2021). Speech and anxiety management with persistent stuttering: Current status and essential research. Journal of Speech, Language, and Hearing Research, 64(1), 307–324. https://pmc.ncbi.nlm.nih.gov/articles/PMC8608149/
Menzies, R. G., O’Brian, S., et al. (2019). Internet CBT (iGlebe) vs. in-person CBT for social anxiety in adults who stutter: Randomised controlled trial with 12-month follow-up. Journal of Fluency Disorders, 61, 36–51. https://pubmed.ncbi.nlm.nih.gov/30584689/
O’Brian, S., Onslow, M., Packman, A., & Jones, M. (2013). Maintenance of treatment gains after a randomised controlled trial of the Camperdown Program for adults who stutter. Journal of Speech, Language, and Hearing Research, 56(6), 1606–1615. https://pubmed.ncbi.nlm.nih.gov/23913213/
Scheurich, J. A., Beidel, D. C., & Vanryckeghem, M. (2019). Exposure therapy for social anxiety disorder in people who stutter: Multiple-baseline design. Journal of Fluency Disorders, 59, 21–32. https://pubmed.ncbi.nlm.nih.gov/30578977/
van Lieshout, P., Ben-David, B., Lipski, M., & Namasivayam, A. (2014). The impact of threat and cognitive stress on speech motor control in people who stutter. Journal of Fluency Disorders, 40, 93–109. https://pubmed.ncbi.nlm.nih.gov/24929470/
Bauerly, K. R., et al. (2024). Characteristics associated with social anxiety in adults who stutter. Frontiers in Psychology, 15, 1400564. https://pmc.ncbi.nlm.nih.gov/articles/PMC11626403/
Carey, B., O’Brian, S., Onslow, M., Packman, A., & Menzies, R. (2010). Randomized controlled non-inferiority trial of telehealth delivery of the Camperdown Program for adults who stutter. Journal of Speech, Language, and Hearing Research, 53(3), 887–898. https://pubmed.ncbi.nlm.nih.gov/20643705/
Chang, S.-E., Garnett, E. O., et al. (2025). Stuttering: Our current knowledge, research opportunities, and future directions. Brain Sciences. https://pmc.ncbi.nlm.nih.gov/articles/PMC11977836/
Chard, I., Van Zalk, N., & Picinali, L. (2023). Virtual reality exposure therapy for reducing social anxiety in stuttering: A randomized controlled pilot trial. Frontiers in Digital Health, 5, 1061323. https://pubmed.ncbi.nlm.nih.gov/36845336/
Gunn, J., Menzies, R., et al. (2019). Evaluation of Internet cognitive behavioural therapy (iBroadway) for social anxiety in adolescents who stutter: A Phase I trial. Behaviour Change, 36(2), 124–143. https://www.cambridge.org/core/journals/behaviour-change/article/evaluation-of-internet-cognitive-behaviour-therapy-icbt-for-social-anxiety-in-adolescents-who-stutter-a-phase-i-trial/0A0E303E390E53DE33BFCA9795C4984A
Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 40, 69–82. https://pubmed.ncbi.nlm.nih.gov/24929468/
Khoshnam, S., Gharraee, B., & Ashouri, A. (2023). Comparing cognitive-behavioural group therapy and mindfulness-acceptance group therapy in adults who stutter: Randomised clinical trial. Advanced Biomedical Research, 12, 26. https://pmc.ncbi.nlm.nih.gov/articles/PMC10086645/
Lowe, R., Menzies, R., et al. (2021). Speech and anxiety management with persistent stuttering: Current status and essential research. Journal of Speech, Language, and Hearing Research, 64(1), 307–324. https://pmc.ncbi.nlm.nih.gov/articles/PMC8608149/
Menzies, R. G., O’Brian, S., et al. (2019). Internet CBT (iGlebe) vs. in-person CBT for social anxiety in adults who stutter: Randomised controlled trial with 12-month follow-up. Journal of Fluency Disorders, 61, 36–51. https://pubmed.ncbi.nlm.nih.gov/30584689/
O’Brian, S., Onslow, M., Packman, A., & Jones, M. (2013). Maintenance of treatment gains after a randomised controlled trial of the Camperdown Program for adults who stutter. Journal of Speech, Language, and Hearing Research, 56(6), 1606–1615. https://pubmed.ncbi.nlm.nih.gov/23913213/
Scheurich, J. A., Beidel, D. C., & Vanryckeghem, M. (2019). Exposure therapy for social anxiety disorder in people who stutter: Multiple-baseline design. Journal of Fluency Disorders, 59, 21–32. https://pubmed.ncbi.nlm.nih.gov/30578977/
van Lieshout, P., Ben-David, B., Lipski, M., & Namasivayam, A. (2014). The impact of threat and cognitive stress on speech motor control in people who stutter. Journal of Fluency Disorders, 40, 93–109. https://pubmed.ncbi.nlm.nih.gov/24929470/
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