At last week’s weekly speech class, The LOUD Crowd, I asked each of the members to share a communication challenge and a goal for improvement. Interestingly, 6/12 people reported “anxiety” as a major contributor to their speech and communication difficulties.
Anxiety, which can be described as excessive worry, apprehension or nervousness, can be experienced through physical symptoms, such as shakiness, rapid breathing or dizziness, or it can present as a specific fear, such as a fear of social settings or large crowds.
Anxiety is not unique to Parkinson’s disease, but its prevalence is cited by researchers to occur in up to 40% of patients with PD, with this rate being higher than in normal or other disease comparison populations and current evidence suggests that anxiety may not be a psychological reaction to the illness but rather may be linked to specific neurobiologic processes accompanying PD. [i]
In a fall report published by the Parkinson Alliance, 26% of respondents to a survey reported that anxiety was present prior to the diagnosis of PD, and 35% of the participants reported experiencing moderate to extreme generalized anxiety. [ii]
But what does anxiety have to do with speaking?
Several class members described anxiety as affecting their difficulty with being able to think of the words to express themselves, hence “shutting down” in conversation. Others described their difficulty as getting “tongue tied,” and in particular when leaving voice mail messages.
Coordination and thinking problems can occur to any of us when the body becomes abnormally stressed, and in addition anxiety can cause changes to breathing patterns which can contribute to voice and speech difficulty.
The relationship between anxiety and speaking has been studied in other groups of people, in particular individuals who stutter, and while the relationship between anxiety and stuttering is complex, the research has reported a high rate of social anxiety disorder among individuals who stutter. (Social anxiety disorder is defined as a prevalent and chronic anxiety disorder characterized by significant fear of humiliation, embarrassment, and negative evaluation in social or performance-based situations.)[i]
Unlike an adult who has stuttered from early childhood and possibly experienced a life time of anxiety related to speech performance, most individuals with Parkinson’s report communication skills that were within normal limits prior to their diagnosis of PD. And, in fact, some individuals with PD who are the most distressed about their speech are those who spent much of their career in professions such as sales or teaching, where their prowess in communication skills contributed to their success.
Social anxiety can become a bit of a chicken-egg dilemma, with anticipatory anxiety, that is fear of being judged negatively ahead of a situtation, adding to or worsening the problem.
Individuals with PD, who may be experiencing anxiety, should first, speak with their neurologist about their symptoms, as medication may be available which can be helpful. If social anxiety extends beyond the ability to successfully communicate, working with a psychologist can also be of benefit.
But, for those individuals, like the members of my speech class, who cited anxiety specifically as it relates to communicative effectiveness, a speech-language pathologist, knowledgeable about Parkinson’s can be of help. Improving communication skills with a broad focus, meaning, including not only speech clarity, but attention and listening, and formulation of thoughts, may help to reduce anxiety associated with speaking. Practicing communication skills in a safe, small group social setting with other individuals who also have a Parkinson’s diagnosis can also yield benefit.
I always advise new members of our weekly speech class that it is a working group. By that, I mean, we do not sit around and discuss Parkinson’s disease, rather, we come together weekly much like a Toastmasters group, focusing on all aspects of communication and garnering for each other support and honest feedback. Hopefully, the success experienced in group can transfer to everyday situations.
The LOUD Crowd meets weekly in Port Charlotte, Florida, Eligibility criteria apply, and include prior participation in one:one speech therapy treatment.
Voice Aerobics®, a 90 minute community-based class, sponsored by Neurochallenge Foundation, is offered monthly, the 4th Thursday of the month in NorthPort, Florida. This is a free class open to anyone with a diagnosis of Parkinson’s disease. Carepartners are also invited to participate.
For additional information or to contact Voice Aerobics visit: https://voiceaerobicsdvd.com/voice-aerobics-private-practice/
Citations:
[i] J Fluency Disord. 2014 Jun;40:69-82. doi: 10.1016/j.jfludis.2013.08.003. Epub 2013 Sep 2.Social anxiety disorder and stuttering: current status and future directions. Iverach L1, Rapee RM2.
[i] Richard, I. H., Schiffer, R. B., & Kurlan, R. (1996). Anxiety and Parkinson’s disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 8(4), 383-392.https://dx.doi.org/10.1176/jnp.8.4.383
[ii] Parkinson Alliance survey results Anxiety and Parkinson disease https://www.parkinsonalliance.org/wp-content/uploads/2018/10/PA-AnxietySurvey-LONG-web-2.pdf
Hi, Alec, I’m sorry to hear about your speech difficulty. It sounds as if you might be having some anticipatory anxiety. Meaning, you expect it to happen, and even before your name is called, you are already tense or anxious about speaking. If you are stationed in the states, I would suggest you contact your local VA and see if you can get a consult with a licensed speech-language pathologist. If you have not had this sort of trouble before, you may only need a few visits and a few strategies to reduce your anxiety ahead of speaking. Our minds are powerful, and sometimes they compete with our body
Help me find out what is wrong.
For example, I’m in the Army. Every Morning we do roll call. The first Sergeant will say a name, then the name of the soldier will answer with “Here First Sergeant!”
For me I get real nervous when speaking in front of people. So when it’s my turn, I have a real difficulty getting words out. Some times it takes me like 10 seconds to answer. Unable to speak. Sometimes I stutter. It’s really embarrassing.
What is going on? And how can I fix this issue?
Hello, Catherine, as you can tell from comments, many people experience anxiety with different triggers and different symptoms. It’s always best to discuss this with you physician, as medication may help. Learning a few breathing techniques may help with you symptoms as well.
Thanks for info ,my speak panic attacks last short time ,
Usually when in company
I’m a diabetic so that dosnt help
Hello Anwar, and thank you for your email.If you have access to a speech-language pathologist, I would suggest you schedule a consult. They may be able to r/o a fluency or other communication disorder which is impacting your ability to speak. The American Speech-Language and Hearing Association has a directory of therapist who are certified and accepting clients. If you live outside the United States, or do not have a provider near you, telepractice might be an option.
I am patiant of inxiety and used paraxotine tablet from 2,3 year but still i have a problem with talking and communicating myself
Parkinson’s disease (PD) is a progressive disease, so, no, you cannot “recover” from it. However, proper medication and exercise can help with management of symptoms and give you a vital life.
can you recover from PD
Hi, Travis, thank you for your email. I’m sorry to hear about your speech difficulties. The larynx is a fragile organ that conveys emotion for all of us, and it sounds as if for you, it carries some of the burdens of your past. If you can locate a speech-language pathologist near you and work with them along with a psychologist you might be able to further heal some of your pain from the past and learn techniques which can help you manage the impact of anxiety on speech production.
Ive been struggling with speech anxiety for a long time. I’ve tried to control it but it made it worse over the years ever since I was 10 through abuse of my child hood I’m 28 and still struggling with it I can’t communicate with the people I love and when I do it comes out wrong the wrong words and I get choked and I cant talk I over think things and it gets worse and worse when I want to talk about something it feels like something grabs me by the neck and my heart is trying to force the words out and it’s all wrong
Hello, and thank you for your email. I am not sure that I have online resources beyond what you have already explored, but it sounds as if you might benefit from a speech-language evaluation to determine if your anxiety is being caused by a speech impairment or if difficulty speaking fluently is creating anxiety. If you visit the American Speech-Language and Hearing Association you may be able to locate a speech-language pathologist in the country where you are located. Many therapist offer telepractice in addition to in-person treatment.https://www.asha.org/
Hey, I don’t think I have access to self help groups or other channels of diagnosis, I’m not based in the US. I have suffered with an unorderly speech impediment stemming from my anxiety. I was hoping you might have free online resources or links to some, that maybe helpful in some way thanks
Hi, Ash, and thank you for your comment. There are a variety of tools available to help you manage your anxiety and if you have not already seen a speech-language pathologist, that would be my suggestion. Your school should be able to help with co-ordinating that referral. A speech therapist can help determine if there are underlying language problems that are contributing to your speech difficulty and provide tools to help.The American Speech-Language and Hearing association maintains a member directory and can be helpful in locating a speech-language pathologist near you. https://www.asha.org/
I’m 16 and I have recently discovered that I have speech problems because of anxiety. I want to be able to socialise and have fun like other teenagers but I have trouble searching for the right word at the right time.
Hello, and thank you for your comment. I would suggest that you locate a speech-language pathologist for an evaluation. Also, you may want to discuss your anxiety with your physician who may rule out any underlying medical causes.
I have speech difficulty due to anxiety.please suggest treatment.
Anxity can have many sources, so the first thing to do would be to discuss you symptoms with your physician. If anxiety is associated primarily with speaking, than, yes, I think a speech-language pathologist can provide help with learning techniques to manage the impact of anxiety on communication.
Can it change
Thank you for your comment, Roger, and yes, you are correct tenacity is a good attribute to have when it comes to maintaining and improving communiction in the face of PD
Thanks for posting this concise information about this PD problem and the various solutions. I’ll add that it takes a consistent positive effort by the PD person to rehabilitate speech for robust, thoughtful, effective communication.