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Cited by 30Stuttering Research and TreatmentAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesVoice and Speech Disorders

What works for whom? Multidimensional individualized stuttering therapy (MIST)

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Sønsterud, Hilda, Halvorsen, Margrethe Seeger, Feragen, Kristin Billaud, Kirmess, Melanie, Ward, David·2020·Journal of Communication Disorders
DOI 10.1016/j.jcomdis.2020.106052
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Abstract

PURPOSE: This study reports outcomes from a stuttering therapy approach that combines value and awareness-based elements from Acceptance and Commitment Therapy (ACT) with those of stuttering and speech modification interventions. The approach, entitled Multidimensional Individualized Stuttering Therapy (MIST), includes a combined clinician and client selection of factors across five areas: 1) general breathing patterns and body tension, 2) breathing patterns during speech production, 3) vocal features in speech production, 4) value and mindfulness-based strategies, and 5) general communication and/or presentation skills. The aims of this study were to evaluate whether the MIST a) reduces the impact of stuttering and stuttering severity, and b) has a positive impact on speaking ability, confidence in communication, avoidance-behavior, and quality of life. METHOD: Eighteen adults, age 21-61 years took part in an A-B-A multiple case study design. Participants underwent a pre-clinic assessment phase, followed by 10 h of therapy over four sessions administered by an experienced speech-language therapist. Outcome measures examined both psychosocial and behavioral aspects of therapy three-, six- and twelve-months post-therapy. RESULTS: Most participants chose elements from at least four of the five areas of focus. There was a significant reduction in the impact of stuttering at both 6- and 12-months post-therapy, with moderate (d = .71) to very large (d = 1.06) effect sizes. A strong association was found between overall satisfaction with MIST and improved speaking abilities. Moderate to strong associations were also found between experienced speaking abilities, confidence in communication, reduction in avoidance behaviors and improved quality of life. DISCUSSION: Findings indicate that MIST can be effective in managing adult stuttering. The findings highlight the importance of shared decision making and personal considerations using flexible therapy approaches that integrate stuttering and speech modification interventions with value and awareness-based skills. The nature of a multidimensional individualized approach, as shown in this study, highlights the importance of adjusting the relative weighting of different subcomponents according to each individual's needs and goals. CONCLUSION: MIST was shown to be efficacious in clinical settings and effective in real life settings. Findings were promising, despite a relatively small sample, and replication by other SLPs and with larger samples is warranted.

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  • The original MIST study confirmed that there are many factors that can influence treatment outcomes (e.g., degree of personal motivation, considerations of usefulness of therapy elements, and quality of the working alliance), and this complexity poses challenges when managing confounding elements in different therapy programs.

    “The original MIST study confirmed that there are many factors that can influence treatment outcomes (e.g., degree of personal motivation, considerations of usefulness of therapy elements, and quality of the working alliance), and this complexity challenge when managing confounding elements in different therapy programs.”

    From Multidimensional Individualized Stuttering Therapy Outcomes At 24 Months Post Clinic: An Embodiment and Awareness Perspective. (2025) · cites this paper as Sønsterud et al., 2020

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  • OASES-A total impact mean scores at 6 months post-therapy for both the experimental group and the control group in the Menzies et al. study were similar to those of the MIST study.

    “OASES-A total impact mean scores at 6 months post-therapy for both th experimental group and the control group in this study were similar to those of the MIST study (S ø nsterud et a 2020).”

    From Multidimensional Individualized Stuttering Therapy Outcomes At 24 Months Post Clinic: An Embodiment and Awareness Perspective. (2025) · cites this paper as Sønsterud et al., 2020

  • The MIST approach was co-designed with people who stutter to enable measurement of evaluation and level of satisfaction on therapy elements considered useful at an individual- and context-sensitive level.

    “The MIST approach was co-designed with who stutter to enable measurement of evalua tion nd level of satisfaction on therapy elements considered useful at an individualand context-sensitive level (S ø nsterud et 2020).”

    From Multidimensional Individualized Stuttering Therapy Outcomes At 24 Months Post Clinic: An Embodiment and Awareness Perspective. (2025) · cites this paper as Sønsterud et al., 2020

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Cited by

Sorted by citations

Authors
Sønsterud, H., Halvorsen, M. S., Feragen, K. B., Kirmess, M., & Ward, D.
Affiliations
  • University of Oslo (NO)
  • Oslo University Hospital (NO)
  • University of Reading (GB)
Corresponding author
Sønsterud, Hilda
ORCID
Venue
Journal of Communication Disorders
Publisher
Elsevier BV
Published
2020-11
Volume
88
Pages
106052
ISSN
0021-9924 (ISSN-L)
DOI
10.1016/j.jcomdis.2020.106052
OpenAlex
W3091765434
Cited by
30
References
9
Citations by year
2026: 5 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 9 · 2021: 2 · 2020: 1
FWCI
1.69
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Communication Disorders (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders
  • Dam Foundation
  • Norwegian Extra Foundation for Health and Rehabilitation
Topics
  • Social Sciences › Psychology › Clinical Psychology › Stuttering Research and Treatment
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Physiology › Voice and Speech Disorders
Keywords
stuttering treatment, acceptance and commitment therapy, shared decision-making, personalized treatment, breathing pattern, body tension, voice characteristics, mindfulness, communication confidence, avoidance behavior, quality of life, adults who stutter, client satisfaction
MeSH terms
Adult, Humans, Middle Aged, Quality of Life, Speech, Speech Therapy, Stuttering, Treatment Outcome, Young Adult, Acceptance and Commitment Therapy

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