An Integrated Fluency and Psychosocial Treatment for Adults Who Stutter: Addressing Stuttering and Self-Efficacy

"The fACTS (fluency + Acceptance & Commitment Therapy for Stuttering) Program". The fACTS Program is an integrated fluency and psychosocial treatment for adolescents (aged 16+) and adults who stutter that aims to address stuttering frequency and self-efficacy by targeting the biological, cognitive/affective, and social components of stuttering simultaneously. The fACTS Program will be administered by qualified speech pathologists, all of whom are familiar with Acceptance and Commitment Therapy philosophies and experienced in working with adolescents and adults who stutter. All speech pathologists administering the fACTS Program will receive a comprehensive "fACTS Program" manual developed by the primary researcher, as well as a comprehensive half-day training workshop. The "fACTS Program" manual will contain weekly session materials (e.g., handouts, homework activities etcetera) and an overview of the targets to be covered each session. Participants (i.e., adolescents [aged 16+] and adults who stutter) will take part in eight (8) intervention sessions. These sessions may be conducted weekly or fortnightly in either individual or group sessions, depending on participant availability and preference. Sessions will be conducted face-to-face at the Curtin University Stuttering Treatment Clinic, in private metropolitan community clinics in Australia, or online via video-conferencing services. Each treatment session will utilise a combination of behavioural fluency techniques (i.e., fluency enhancement or stuttering modification strategies; individualised and selected by each participant based on their personal preference) and Acceptance & Commitment Therapy* targets (i.e., covering all aspects of psychological flexibility). Participants will practice their chosen behavioural fluency techniques whilst participating in the planned Acceptance & Commitment Therapy activities each week. *Acceptance and Commitment Therapy is a new wave of behavioural psychotherapy. Psychological flexibility at the heart of Acceptance and Commitment Therapy rests on the interplay between six processes - mindfulness, acceptance, defusion, self-as-context, values clarification, and committed action. Psychological flexibility promotes positive experiential living guided by an individual's core values by alleviating some of the tension and struggle associated with persistent developmental stuttering disorders. To ensure treatment fidelity, each speech pathologist administering the program will complete a standard checklist at the conclusion of each session. This checklist will include items related to the structure of the session, the Acceptance and Commitment Therapy processes targeted, and the behavioural fluency techniques practiced. Checklists will be reviewed by the primary researcher. All externally provided treatment sessions will be audio or video-recorded, and 20% of the sessions will be selected at random to be analysed by an independent observer to ensure adherence to the intervention protocol.