title: Stuttering, emotions, and heart rate during anticipatory anxiety: a critical review.
abstract: Persons who stutter often report their stuttering is influenced by emotional reactions, yet the nature of such relation is still unclear. Psychophysiological studies of stuttering have failed to find any major association between stuttering and the activity of the sympathetic nervous system. A review of published studies of heart rate in relation to stressful speech situations indicate that adults who stutter tend to show a paradoxical reduction of heart rate compared with nonstuttering persons. Reduction of heart rate has also been observed in humans and mammals during anticipation of an unpleasant stimulus, and is proposed to be an indication of anticipatory anxiety resulting in a "freezing response" with parasympathetic inhibition of the heart rate. It is suggested that speech-related anticipatory anxiety in persons who stutter is likely to be a secondary, conditioned reaction based on previous experiences of stuttering.
  
  
  OBJECTIVE
  The reader will be able to: (1) describe how the autonomic nervous system is modulated by emotional responses; (2) explain how anticipatory fear often results in inhibition of heart rate due to parasympathetic activation; (3) discuss why emotional reactions in persons who stutter may be secondary to negative experiences of speech problems.
authors.affiliation: Department of Clinical Neurosciences, Division of Psychiatry, Lund University, Lund, Sweden. Per.Alm@psykiatr.lu.se
authors.forename: Per A
authors.initials: PA
authors.lastname: Alm
mesh_terms: D000818:Animals; D001007:Anxiety / Q000150:complications* / Q000503:physiopathology; D001341:Autonomic Nervous System / Q000503:physiopathology*; D004644:Emotions; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D013342:Stuttering / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology*