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UBC Theses and Dissertations

Client anxiety level and the treatment of the unassertive individual Safran, Jeremy David 1978

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CLIENT ANXIETY LEVEL AND THE TREATMENT OF THE UNASSERTIVE INDIVIDUAL by JEREMY DAVID SAFRAN B.A.(Hons) Simon F r a s e r U n i v e r s i t y , 1974 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES Department o f P s y c h o l o g y We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA March, 1978 /e"VTeremy D a v i d S a f r a n , 1978 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of Brit ish Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of P s y c h o l o g y The University of Brit ish Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 D a t e A p r i l 10, 1978. i ABSTRACT The present i n v e s t i g a t i o n was conducted to evaluate the hypo-thesis that i n the context of assertion t r a i n i n g , c l i e n t anxiety w i l l i n t e r a c t with treatment modality i n such a fashion that high anxiety i n d i v i d u a l s w i l l benefit more from a c o g n i t i v e l y oriented treatment than t r a d i t i o n a l s k i l l s t r a i n i n g procedures, whereas low anxiety i n d i v i d u a l s w i l l obtain equivalent therapeutic gain from the two treatment approaches. Twenty-eight male and female college undergraduates seeking assertion t r a i n i n g were dichotimized into low and high anxiety cate-gories on the basis of the discomfort scale of Gambrill and Richey's Assertion Inventory. Subjects within both categories were then ran-domly assigned to two treatment conditions: behavioural s k i l l s t r a i n i n g (ST), and cognitive behaviour modification (CBM). The ST condition included components of i n s t r u c t i o n , modelling, s o c i a l feed-back, and behavioural rehearsal. The CBM procedure was derived o r i -g i n a l l y from the s e l f - i n s t r u c t i o n a l t r a i n i n g procedure employed by Meichenbaum i n the treatment of test anxiety. I t included components of d i d a c t i c presentation, t r a i n i n g i n the discrimination and systema-t i c observation of self-statements, t r a i n i n g i n the modification of maladaptive cognitive processes, and the implementation of cognitive coping strategies and task-relevant self-statements. Both treatment conditions were run i n a group format and consisted of s i x , two hour sessions. A l l subjects were assessed p r i o r to and a f t e r treatment on s e l f - r e p o r t and behavioural measures of assertion and anxiety. i i Experimental support was obtained for a modified version of the o r i g i n a l hypothesis. While high anxiety subjects tended to benefit more from CBM than from ST i n the phenomenal realm, t h i s trend was reversed on the behavioural measures where ST was more e f f e c t i v e . Results of the study are explained i n terms of a t h e o r e t i c a l analysis of the nature of anxiety, and implications for future treatment pro-grammes are discussed. i i i TABLE OF CONTENTS Page A b s t r a c t i L i s t o f T a b l e s i v L i s t o f F i g u r e s v Acknowledgements y i I n t r o d u c t i o n 1 H i s t o r i c a l Review and C r i t i q u e 1 A s s e r t i o n T r a i n i n g : A P a r a d i g m i n T r a n s i t i o n 11 C o g n i t i v e B e h a v i o u r M o d i f i c a t i o n 15 C o g n i t i v e B e h a v i o u r M o d i f i c a t i o n and A s s e r t i o n T r a i n i n g 21 A n x i e t y L e v e l as a M o d e r a t o r V a r i a b l e 24 Method 32 Treatment C o n d i t i o n s 32 S k i l l s T r a i n i n g 33 C o g n i t i v e B e h a v i o u r M o d i f i c a t i o n 34 S u b j e c t Assignment 38 T h e r a p i s t s 38 Assessment 39 Dependent Measures 39 B e h a v i o u r 39 S e l f - R e p o r t 40 R e s u l t s 42 D e s c r i p t i v e D a t a 42 R e l i a b i l i t y and V a l i d i t y o f B e h a v i o u r a l R a t i n g s 47 N o n s p e c i f i c F a c t o r s 53 F a c t o r i a l A n a l y s i s of V a r i a n c e 54 A n a l y s i s of S i m p l e E f f e c t s ( S t a t i s t i c a l ) 56 A n a l y s i s o f S i m p l e E f f e c t s ( G r a p h i c ) 57 D i s c u s s i o n 66 R e f e r e n c e s 73 A p p e n d i c e s 81 i v LIST OF TABLES Page T a b l e 1. Means and S t a n d a r d D e v i a t i o n s o f D i s c o m f o r t S c o r e s on t h e A s s e r t i o n I n v e n t o r y T a b l e 2. Comparison o f C u r r e n t Sample w i t h N o r m a t i v e Sample T a b l e 3. Means and S t a n d a r d D e v i a t i o n s f o r Low and H i g h A n x i e t y B e h a v i o u r a l A s s e r t i o n C a t e g o r i e s on B e h a v i o u r a l Measures 43 44 49 T a b l e 4. Means and S t a n d a r d D e v i a t i o n s f o r Low and H i g h S e l f - P e r c e i v e d A n x i e t y D u r i n g R o l e P l a y C a t e g o r i e s on B e h a v i o u r a l Measures T a b l e 5. C o r r e l a t i o n M a t r i x f o r B e h a v i o u r a l Measures T a b l e 6. C o r r e l a t i o n M a t r i x f o r Group S a t i s f a c t i o n Items T a b l e 7. P l a n n e d O r t h o g o n a l C o n t r a s t s 50 51 55 58 V LIST OF FIGURES Page F i g u r e l a . Graphed I n t e r a c t i o n o f Treatment C o n d i t i o n x A n x i e t y L e v e l on Tennessee S e l f Concept S c a l e 61 F i g u r e l b . Graphed I n t e r a c t i o n o f Treatment C o n d i t i o n x A n x i e t y L e v e l on S o c i a l A v o i d a n c e and D i s t r e s s S c a l e . 62 F i g u r e l c . Graphed I n t e r a c t i o n o f Treatment C o n d i t i o n x A n x i e t y L e v e l on Eye C o n t a c t 63 F i g u r e 2b. Graphed I n t e r a c t i o n o f Treatment C o n d i t i o n x A n x i e t y L e v e l on Body E x p r e s s i o n 64 F i g u r e 2c. Graphed I n t e r a c t i o n o f Treatment C o n d i t i o n x . A n x i e t y L e v e l on G l o b a l A n x i e t y 65 v i ACKNOWLEDGEMENTS There were a number of i n d i v i d u a l s involved i n the preparation of t h i s manuscript to whom I am indebted. F i r s t I would l i k e to express my gratitude to those who served as therapists i n the groups: Steve Holliday, Betsy Spaulding, Cathy Bond, Kathy Douglas, Marcia Spetch, L o r i Edmonton, and Robin Cappe, i n p a r t i c u l a r . My gratitude i s also extended to Park Davidson for consulting on a number of c r i t i c a l issues and for c h a i r i n g the committee. Both Bob Knox and Les Greenberg served as committed members and were h e l p f u l i n t h e i r own ways. I would also l i k e to express my gratitude to Ralph Hakstian for h i s patient s t a t i s t i c a l consultation, and f i n a l l y to Lynn Alden who was involved i n the project from i t s conception and who influenced the evolution of the f i n a l product i n more ways than one. 1 INTRODUCTION H i s t o r i c a l Review and C r i t i q u e V a r i o u s forms o f s o c i a l a n x i e t y have been r e c o g n i z e d and t r e a t e d c l i n i c a l l y s i n c e t h e c o n c e p t i o n o f contemporary p s y c h o t h e r a p y ( F i n i c h e l , 1945). S a l t e r ( 1 9 4 9 ) , however, i s c r e d i t e d by t h e c u r r e n t b e h a v i o u r a l t r a d i t i o n w i t h p i o n e e r i n g the f i e l d o f a s s e r t i o n t r a i n i n g w i t h h i s pub-l i c a t i o n o f C o n d i t i o n e d R e f l e x Therapy (1949). I t was h e r e t h a t he d e s c r i b e d the dynamics o f and t e c h n i q u e s f o r the c l i n i c a l management o f what he termed t h e " i n h i b i t o r y p e r s o n a l i t y " , the i n d i v i d u a l who i s c h a r a c -t e r i z e d by a h i g h l e v e l o f a n x i e t y and a c o r r e l a t e d f u n c t i o n a l i n a d e -quacy i n i n t e r p e r s o n a l s i t u a t i o n s . F o l l o w i n g S a l t e r , Wolpe r e a s o n e d t h a t f u n c t i o n a l i n a d e q u a c y o f t h i s t y p e i s o f t e n t h e consequence o f an u p b r i n g i n g by " p a r e n t s who bound by c o n v e n t i o n and c o n f o r m i t y , t r a n s m i t s t o i c and a s c e t i c h a b i t s o f s e l f -c o n t r o l t o t h e i r c h i l d r e n i n t h e name of b r e e d i n g , manners, good t a s t e , and r e f i n e m e n t . " I t was m a i n t a i n e d t h a t d e v e l o p m e n t a l e x p e r i e n c e s o f t h i s s o r t l e d t o t h e s u p p r e s s i o n o f i n n e r f e e l i n g s , a p r o c e s s w h i c h "may l e a d t o a c o n t i n u i n g i n n e r t u r m o i l , w h i c h may produce s o m a t i c symptoms and even p a t h o l o g i c a l changes i n p r e d i s p o s e d o r g a n s - p s y c h o s o m a t i c i l l n e s s e s " (Wolpe, 1969). T h i s i n h i b i t o r y r e s p o n s e was c o n t r a s t e d by S a l t e r w i t h the e x c i t a -t o r y r e s p o n s e , w h e r e i n t h e i n d i v i d u a l ' s f e e l i n g s a r e o u t w a r d l y e x p r e s s e d . The e x c i t a t o r y r e s p o n s e was renamed by Wolpe, a s s e r t i o n , a term he f e l t was more a p p r o p r i a t e , s i n c e a n x i e t y i s a l s o a form o f e x c i t a t i o n . He r e a s o n e d t h a t t h e d i r e c t , a s s e r t i v e e x p r e s s i o n o f f e e l i n g s was 2 a response antagonistic to the anxiety response, and as such would act as a r e c i p r o c a l l y i n h i b i t i n g agent. It was maintained furthermore, that the assertive response i t s e l f would be reinforced i n an operant fashion as a r e s u l t of the decrement i n anxiety and increase i n comfort experienced. Although forms of assertion t r a i n i n g have been employed c l i n i c a l l y f o r the l a s t two decades, systematic, c o n t r o l l e d research i n the area i s a r e l a t i v e l y recent development. McFall and Marston (1970), enumerated three primary factors responsible for retarding t h i s development: (1) the complexity of c l i n i c a l procedures and m u l t i p l i c i t y of treatment components obscure an understanding of e f f e c t i v e therapeutic components and m i l i t a t e against experimental r e p l i c a t i o n ; (2) the target population i s heterogeneous; (3) there i s d i f f i c u l t y obtaining v a l i d and r e l i a b l e behavioural measures i n the area. While phobia studies y i e l d the oppor-tunity for behavioural avoidance t e s t s , test anxiety presents the oppor-tunity f o r simulated test taking s i t u a t i o n s , and the e f f i c a c y of speech anxiety treatment can be evaluated through simulated public addresses, i t i s far more d i f f i c u l t to f a i t h f u l l y r e p l i c a t e the stimulus s i t u a t i o n s problematic f o r the unassertive i n d i v i d u a l i n the laboratory. Despite these problems, i n recent years a number of c o n t r o l l e d i n v e s t i g a t i o n s on as s e r t i o n t r a i n i n g have been conducted. In the f o l -lowing pages, a s e l e c t i v e review of t h i s research i s presented p r i m a r i l y for purposes of h i g h l i g h t i n g c e r t a i n s a l i e n t methodological, assessment, and conceptual issues. 3 McFall and h i s colleagues are responsible for e s t a b l i s h i n g a program of research which has done much to lay the groundwork for a systematic approach to assertion t r a i n i n g . The research strategy adopted has been termed by them a "constructive strategy", i n contrast to Lang's d i s -mantling strategy (Lang, 1969). The decision was made to examine the therapeutic e f f i c a c y of therapeutic components i n i s o l a t i o n , beginning with what they perceived to be the most basic component, and progres-s i v e l y augmenting i t with a d d i t i o n a l components, while evaluating the extent to which therapeutic e f f i c a c y was incremented. With t h i s i n mind, a decision was made i n the i n i t i a l study (McFall & Marston, 1970) to devise an analog procedure to examine the r e l a t i v e e f f i c a c y of basic behavioural rehearsal versus behavioural rehearsal with feedback. In the basic behavioural rehearsal condition, subjects responded to prerecorded s i t u a t i o n s requiring assertive responses. The rehearsal with feedback.condition supplemented the f i r s t procedure by playing the subject's recorded response back to him. The two treatment conditions yielded s i g n i f i c a n t l y better r e s u l t s than the control and attention placebo conditions for s e l f - r e p o r t , behavioural, and p h y s i o l o g i c a l measures (pulse r a t e ) . A follow-up mea-sure, c o n s i s t i n g of a persuasive sales p i t c h delivered over the t e l e -phone, demonstrated s i g n i f i c a n t l y better performance of the combined treatment groups on only one of a number of c r i t e r i a rated. Thus the f i r s t study i n the s e r i e s tended to support the hypothesis that simple behavioural rehearsal i s more e f f e c t i v e than no treatment and an i n s i g h t placebo i n improving assertion, but f a i l e d to demonstrate that the addi-t i o n of a feedback component has much incremental value. 4 I n a second s t u d y ( M c F a l l & L i l l e s a n d , 1971), t h e b e h a v i o u r a l r e h e a r s a l w i t h f e e d b a c k package was supplemented w i t h two new components: t h e r a p i s t c o a c h i n g and s y m b o l i c m o d e l i n g . Two t r e a t m e n t c o n d i t i o n s were c o n t r a s t e d w i t h an assessment p l a c e b o c o n t r o l on s e l f - r e p o r t and b e h a v i o u r a l measures: (1) c o v e r t r e h e a r s a l + t h e r a p i s t c o a c h i n g + s y m b o l i c m o d e l i n g and (2) o v e r t r e h e a r s a l + f e e d b a c k + t h e r a p i s t c o a c h i n g + s y m b o l i c m o d e l i n g . Once a g a i n a s i g n i f i c a n t d i f f e r e n c e i n e f f i c a c y was d e m o n s t r a t e d between t h e two t r e a t m e n t c o n d i t i o n s and the c o n t r o l c o n d i t i o n , but n o t between t r e a t m e n t c o n d i t i o n s . There was, however, a t r e n d f o r t h e c o v e r t r e h e a r s a l c o n d i t i o n t o be more e f f e c t i v e t h a n the o v e r t m o d e l i n g c o n d i -t i o n . T h i s e v i d e n c e , however, was confounded by t h e f a c t t h a t t h e c o v e r t r e h e a r s a l o m i t t e d the f e e d b a c k component p r e s e n t i n t h e o v e r t r e h e a r s a l c o n d i t i o n . The a u t h o r s r e a s o n e d t h a t t h e o v e r t r e h e a r s a l + f e e d b a c k t r e a t m e n t may a c t u a l l y have had an i n h i b i t i n g o r d e b i l i t a t i n g e f f e c t upon s u b j e c t s ' p e r f o r m a n c e . A t e l e p h o n e f o l l o w - u p measure once a g a i n f a i l e d t o c o n v i n c i n g l y d e m o n s t r a t e the s u p e r i o r i t y o f e i t h e r o f the t r e a t m e n t p r o c e d u r e s o v e r t h e c o n t r o l c o n d i t i o n . The n e x t f o u r s t u d i e s i n t h e s e r i e s ( M c F a l l & Twentyman, 1973) were c o n d u c t e d t o c l a r i f y and f u r t h e r e l a b o r a t e on t h e f i n d i n g s o f the f i r s t two s t u d i e s . Semi-automated t a p e s were once a g a i n employed t o c r e a t e s t a n d a r d i z e d a n a l o g p r o c e d u r e s . Among the f i n d i n g s y i e l d e d by t h i s s e r i e s o f s t u d i e s were: (1) b e h a v i o u r a l r e h e a r s a l and c o a c h i n g ( t h e r a p i s t i n s t r u c t i o n ) had a d d i t i v e and i n d e p e n d e n t e f f e c t s upon a s s e r -t i v e b e h a v i o u r ; (2) s y m b o l i c m o d e l i n g f a i l e d t o s i g n i f i c a n t l y enhance t r e a t m e n t e f f i c a c y o v e r b e h a v i o u r a l r e h e a r s a l . T h i s was t r u e o f b o t h 5 p u r e l y a u d i o m o d e l i n g and a u d i o - v i s u a l m o d e l i n g . I t was a l s o t r u e f o r a v a r i e t y o f m o d e l i n g c o n d i t i o n s , i n c l u d i n g t a c t f u l v s . n o n t a c t f u l models, and m o d e l i n g w i t h v i c a r i o u s r e i n f o r c e m e n t v s . m o d e l i n g w i t h o u t r e i n f o r c e -ment. T h i s f a i l u r e t o d e m o n s t r a t e t h e v a l u e o f m o d e l i n g as a t h e r a -p e u t i c p r o c e d u r e may be due t o a number of f a c t o r s w h i c h w i l l be d i s c u s s e d s u b s e q u e n t l y . (3) There was no d i f f e r e n c e i n e f f i c a c y between c o v e r t r e h e a r s a l and o v e r t r e h e a r s a l once t h e f e e d b a c k component was e l i m i n a t e d , t h u s f u r t h e r s u b s t a n t i a t i n g t h e h y p o t h e s i s t h a t f e e d b a c k may have a d e t r i m e n t a l e f f e c t upon p e r f o r m a n c e ; (4) d e s p i t e a f a i l u r e t o c o n v i n c i n g l y d e m o n s t r a t e t r a n s f e r o f t r a i n i n g e f f e c t s t h r o u g h t e l e p h o n e f o l l o w - u p s i n t h e f i r s t t h r e e s t u d i e s , some s u c c e s s was a c h i e v e d t h r o u g h a more s e n s i t i v e f o l l o w - u p measure employed i n the f o u r t h s t u d y . A l t h o u g h v a r i o u s a u t h o r s have spoken about t h e n o n v e r b a l b e h a v i o u r s a s s o c i a t e d w i t h a s s e r t i o n ( S e r b e r , 1972; A l b e r t s & Emmons, 1974), none o f t h e s t u d i e s r e v i e w e d t o t h i s p o i n t have a c t u a l l y p a i d e x p l i c i t a t t e n -t i o n t o t h e r o l e o f t h e s e component b e h a v i o u r s i n a s s e r t i o n t r a i n i n g o r employed them i n an assessment c o n t e x t . E i s l e r , M i l l e r , and H e r s e n (1973) a t t e m p t e d to s p e c i f y e m p i r i c a l l y i n a p s y c h i a t r i c p o p u l a t i o n , what com-ponent b e h a v i o u r s a r e a s s o c i a t e d w i t h a s s e r t i v e b e h a v i o u r . S u b j e c t s were i n s t r u c t e d t o r o l e p l a y r e s p o n s e s t o f o u r t e e n s t a n d a r d i n t e r p e r s o n a l s i t u a t i o n s and were r a t e d by t r a i n e d j u d g e s on n i n e b e h a v i o u r a l d i m e n s i o n s presumed t o be a s s o c i a t e d w i t h a s s e r t i o n . They were a l s o r a t e d f o r g l o b a l o v e r a l l a s s e r t i o n and d i c h o t o m i z e d i n t o low and h i g h a s s e r t i v e c a t e g o r i e s on t h i s b a s i s . H i g h a s s e r t i v e s u b j e c t s were d i s c r i m i n a t e d from low a s s e r t i v e s u b j e c t s on seven r a t e d d i m e n s i o n s . These were: l a t e n c y o f r e s p o n s e , l o u d n e s s , d u r a t i o n of r e s p o n s e , c o m p l i a n c e , r e q u e s t s f o r new b e h a v i o u r , and a f f e c t . An i n i t i a l t r e a t m e n t s t u d y ( E i s l e r , H e r s e n , and M i l l e r , 1973) e v a l u a t e d t h e e f f e c t i v e n e s s o f a m o d e l i n g p r o c e d u r e on e i g h t components o f a s s e r t i v e b e h a v i o u r r a t e d f r o m v i d e o t a p e d r e s p o n s e s t o f i v e i n t e r -p e r s o n a l s i t u a t i o n s . S u b j e c t s i n t h e t r e a t m e n t c o n d i t i o n were exposed t o v i d e o t a p e d a s s e r t i v e models f o r f o u r s e s s i o n s . These s u b j e c t s were found t o improve s i g n i f i c a n t l y more t h a n s u b j e c t s i n a p r a c t i c e c o n t r o l c o n d i t i o n , and a t e s t - r e t e s t c o n t r o l c o n d i t i o n on f i v e o f t h e e i g h t d i m e n s i o n s r a t e d : d u r a t i o n o f r e p l y , r e q u e s t s f o r new b e h a v i o u r , a f f e c t , l o u d n e s s , and o v e r a l l a s s e r t i o n . H e r s e n , E i s l e r , J o h n s o n , and P i n k s t o n (1973) e v a l u a t e d the r e l a t i v e e f f i c a c y o f m o d e l i n g , i n s t r u c t i o n s , and m o d e l i n g p l u s i n s t r u c t i o n s , i n i n c r e a s i n g a s s e r t i v e b e h a v i o u r i n an u n a s s e r t i v e p s y c h i a t r i c p o p u l a t i o n . S u b j e c t s were once a g a i n v i d e o t a p e d w h i l e r e s p o n d i n g t o f i v e s t a n d a r d i n t e r p e r s o n a l s i t u a t i o n s , and r a t e d a l o n g seven b e h a v i o u r a l d i m e n s i o n s : d u r a t i o n o f l o o k i n g , d u r a t i o n o f r e p l y , l o u d n e s s o f s p e e c h , c o m p l i a n c e c o n t e n t , r e q u e s t s f o r new b e h a v i o u r , a f f e c t , and o v e r a l l a s s e r t i v e n e s s . T reatment c o n s i s t e d o f f o u r s e p a r a t e t r i a l s o f r e s p o n d i n g t o the s t a n -d a r d i n t e r p e r s o n a l s i t u a t i o n s i n t e r s p e r s e d between t h e p r e t e s t and t h e p o s t t e s t . The e x a c t p r o c e d u r e and i n s t r u c t i o n s were v a r i e d i n a c c o r d a n c e w i t h t h e t r e a t m e n t c o n d i t i o n . I n a d d i t i o n t o the t h r e e t r e a t m e n t c o n d i t i o n s , a p r a c t i c e c o n t r o l group was s i m p l y i n s t r u c t e d " T h a t ' s o.k., but t r y t o do b e t t e r n e x t t i m e " , f o r e a c h o f t h e f o u r t r i a l s , w h i l e a t e s t - r e t e s t c o n t r o l group o m i t t e d t h e f o u r t r i a l s . M o d e l i n g p l u s i n s t r u c t i o n s p r o v e d s i g n i f i c a n t l y more e f f e c t i v e t h a n 7 any other conditions On three of seven rated dimensions, equally e f f e c -t i v e to i n s t r u c t i o n alone on one, and equally e f f e c t i v e to modeling alone on one. The two remaining dimensions, loudness and compliance, were most s i g n i f i c a n t l y affected by i n s t r u c t i o n s alone and modeling alone, respectively. E i s l e r , Hersen, M i l l e r , and Blanchard (1975) reasoned that research studies as a rule neglect to consider important variables which a f f e c t assertion i n r e a l l i f e , and incorporated three such variables as factors i n the i n v e s t i g a t i o n : kind of a s s e r t i o n (negative or p o s i t i v e ) , sex of other, and f a m i l i a r i t y of other. Employing a p s y c h i a t r i c population and the same basic assessment procedures used i n previous studies, they discovered a complex pattern of i n t e r a c t i o n s between these v a r i a b l e s and assertion. They concluded that the c l i n i c i a n ' s treatment programme must be based upon a thorough assessment of the p a r t i c u l a r pattern of a s s e r t i o n weaknesses and strengths evidenced by c l i e n t s . The discrepancy between college and p s y c h i a t r i c patients popula-tions with respect to the value of modeling may be a t t r i b u t a b l e to more than one f a c t o r . One p o s s i b i l i t y i s that subjects i n a college popula-t i o n are l e s s impaired p r i o r to treatment. The appropriate assertive responses may already be a v a i l a b l e i n the behavioural repetoire, and are r e a d i l y enough e l i c i t e d through coaching and established through behavioural rehearsal. If t h i s i s the case, the a d d i t i o n a l information conveyed through modeling procedures may be unnecessary. Evidence sug-gesting that i n college populations cognitive i n h i b i t i n g factors play a major r o l e i n unassertiveness w i l l be discussed subsequently. I f , however, modeling possesses d i s i n h i b i t i n g properties as well as information 8 conveying functions (Bandura, 1969), t h i s explanation would appear to be le s s than adequate. A second p o s s i b i l i t y to be considered i s the differences i n assess-ment methodologies employed i n the studies reviewed. While E i s l e r and colleagues evaluated changes i n various global and component behavioural dimensions, the McFall i n v e s t i g a t i o n s l i m i t e d the behavioural assessment s p e c i f i c a l l y to a measure of compliance. No s t y l i s t i c or p a r a l i n g u i s -t i c factors were considered. A l o g i c a l examination of the difference between modeling and coaching as techniques f o r conveying information reveal that a major c h a r a c t e r i s t i c of modeling i s i t s p o t e n t i a l to con-vey more information to d i f f e r e n t sensory modalities simultaneously, r e l a t i v e to simple verbal i n s t r u c t i o n s . Thus while one can to some extent describe the appropriate response content and convey some informa-t i o n about the fashion i n which the response should be delivered through verbal i n s t r u c t i o n , modeling has the advantage of conveying precise i n -formation about both content and as many s t y l i s t i c factors as the ob-server i s capable of attending to and processing at one time. I f , however, the only dimension evaluated by the assessment instrument i s whether or not the subject complied, any a d d i t i o n a l information conveyed to the subject i s superfluous. In such a case i t would not be sur-p r i s i n g to f i n d that supplementing verbal i n s t r u c t i o n with modeling did not appear to improve performance. The appropriate r e s o l u t i o n of an assessment issue as fundamental as t h i s i s pr e r e q u i s i t e for as s e r t i o n t r a i n i n g research to take a meaning-f u l d i r e c t i o n . Although evaluating subject responses e x c l u s i v e l y along the dimension of compliance may si m p l i f y assessment procedures, the 9 c l i n i c a l r e l e v a n c e o f s t u d i e s e m p l o y i n g s u c h p r o c e d u r e s i s q u e s t i o n a b l e . Development o f a p p r o p r i a t e b e h a v i o u r a l assessment methodology i n t h i s c o n t e x t i s dependent upon th e p r i o r s p e c i f i c a t i o n i n c o n c r e t e terms o f what c o n s t i t u t e s a s s e r t i v e b e h a v i o u r . There i s a g r o w i n g tendency i n the l i t e r a t u r e , r e c o g n i z e d by Heimberg, Montgomery, Madsen, and Heimber (1977) t o r e c o n c e p t u a l i z e a s s e r t i v e b e h a v i o u r i n terms o f s o c i a l l y e f f e c t i v e b e h a v i o u r . P r o c e d u r e s f o r s p e c i f y i n g and a s s e s s i n g s o c i a l l y e f f e c t i v e o r competent r e s p o n s e s have been d e v e l o p e d , and a r e r e l e v a n t i n t h i s c o n t e x t ( G p l d f r i e d & D ' Z u r i l l a , 1969). A second i s s u e w a r r a n t i n g e x a m i n a t i o n i s t h e f i n d i n g t h a t r e s p o n s e f e e d b a c k a p p a r e n t l y has no t h e r a p e u t i c v a l u e , and i f a n y t h i n g , i s d e t r i m e n t a l i n i t s e f f e c t s . T h i s f i n d i n g has been c o r r o b o r a t e d by M e l n i c k and S t o c k e r (1977) who f ound t h a t n e i t h e r t h e a d d i t i o n of r e s -ponse r e c o r d i n g p l a y b a c k o r knowledge o f r e c o r d i n g p r o v e d t o be s i g -n i f i c a n t l y more e f f e c t i v e t h a n b a s i c b e h a v i o u r a l r e h e a r s a l i n i n c r e a s i n g a s s e r t i o n . An i m p o r t a n t c o n s i d e r a t i o n i n i n t e r p r e t i n g t h e s e r e s u l t s i s t h a t t h e r e l e v a n t s t u d i e s have been a n a l o g i n n a t u r e . The f a c t t h a t s u b j e c t s do n o t improve p e r f o r m a n c e as a r e s u l t o f l i s t e n i n g t o a u d i o p l a y b a c k o f t h e i r own r e s p o n s e cannot be e x t r a p o l a t e d t o i n f e r t h a t c l i e n t s do not b e n e f i t f r o m t h e r a p i s t f e e d b a c k i n a t h e r a p e u t i c c o n t e x t . There a r e a w e a l t h o f f a c t o r s i n a t h e r a p e u t i c s i t u a t i o n w h i c h may s e r v e t o c a t a l y z e the e f f e c t o f f e e d b a c k p r o c e d u r e s . These i n c l u d e t h e r a p i s t empathy, warmth, s u p p o r t , and perahps most i m p o r t a n t , s p e c i f i c f e e d b a c k w h i c h s e r v e s t o d i f f e r e n t i a l l y r e i n f o r c e a p p r o p r i a t e and i n -a p p r o p r i a t e r e s p o n s e c o n t e n t . Thus, though a d m i r a b l e i n terms o f e x p e r i -m e n t a l r i g o u r , t h e e c o l o g i c a l v a l i d i t y o f the s t u d i e s i n q u e s t i o n i s 10 d u b i o u s a t b e s t . W h i l e the s h o r t c o m i n g s i n h e r e n t i n t h e r a p y a n a l o g s t u d i e s i s c e r -t a i n l y not a new r e v e l a t i o n f o r p s y c h o l o g i s t s ( B e r n s t e i n & P a u l , 1971), s t u d i e s i n v e s t i g a t i n g t h e e f f i c a c y o f a s s e r t i o n t r a i n i n g f o r c o l l e g e s t u d e n t s i n a c l i n i c a l c o n t e x t have been l i m i t e d i n number. T h i s i s p a r t i c u l a r l y s u r p r i s i n g i n l i g h t o f t h e c u r r e n t p o p u l a r i t y o f a s s e r t i o n t r a i n i n g groups on c o l l e g e campuses. gathus (1972) compared a s s e r t i o n t r a i n i n g t o a t t e n t i o n p l a c e b o and assessment c o n t r o l groups i n the t r e a t m e n t o f f e m a l e c o l l e g e under-g r a d u a t e s . E x e r c i s e s i n the a s s e r t i o n t r a i n i n g group were d e r i v e d from S a l t e r ' s " e x c i t a t o r y e x e r c i s e s " . F i n d i n g s were e q u i v o c a l . T r e a t e d s u b j e c t s d e m o n s t r a t e d e q u i v a l e n t knowledge o f a p p r o p r i a t e r e s p o n s e to a t t e n t i o n p l a c e b o s u b j e c t s , and s i g n i f i c a n t l y g r e a t e r knowledge t h a n assessment o n l y s u b j e c t s . A s s e r t i v e b e h a v i o u r i t s e l f was n o t e v a l u a t e d . A second s t u d y ( R a t h u s , 1973) i n c o r p o r a t e d the use o f v i d e o t a p e d a s s e r -t i v e models i n t o t h e t r e a t m e n t c o n d i t i o n . S u b j e c t s i n the a s s e r t i o n t r a i n i n g group r e p o r t e d s i g n i f i c a n t i n c r e a s e s i n a s s e r t i v e b e h a v i o u r , w h i l e s e l f - r e p o r t o f n o n - t r e a t e d s u b j e c t s remained unchanged. I n a d e -quate assessment methodology and ambiguous i n t e r p r e t a t i o n o f r e s u l t s l i m i t s t h e v a l u e o f t h e s e two s t u d i e s . G a l a s s i , G a l a s s i , and L i t z (1974) e v a l u a t e d the e f f i c a c y of an a s s e r t i o n t r a i n i n g group u s i n g v i d e o t a p e d m o d e l i n g and f e e d b a c k , be-h a v i o u r a l r e h e a r s a l , and group and t h e r a p i s t f e e d b a c k . F o l l o w i n g t r e a t -ment s u b j e c t s r e p o r t e d and d e m o n s t r a t e d g r e a t e r a s s e r t i v e b e h a v i o u r t h a n a t t e n t i o n p l a c e b o s u b j e c t s and m a i n t a i n e d t h e s e g a i n s a t one y e a r f o l l o w -up ( G a l a s s i , K o s t a , & G a l a s s i , 1975). 11 I n g e n e r a l , i n v e s t i g a t i o n s of a s s e r t i o n t r a i n i n g i n group s e t t i n g s have been c h a r a c t e r i z e d by i n a d e q u a t e assessment m e t h o d o l o g y , e q u i v o c a l r e s u l t s , and i n s u f f i c i e n t s p e c i f i c a t i o n o f t r e a t m e n t p r o c e d u r e s . W e l l s t r u c t u r e d t r e a t m e n t s e s s i o n s , w i t h e x p l i c i t s e s s i o n by s e s s i o n t h e r a -p i s t manuals, w o u l d p r o v i d e a compromise between the c l i n i c a l l y i r r e l e -v a n t a n a l o g s t u d y and t h e i n a d e q u a t e l y c o n t r o l l e d c l i n i c a l s t u d y . A s s e r t i o n T r a i n i n g : A P a r a d i g m i n T r a n s i t i o n R e c e n t l y i t has been s u g g e s t e d t h a t c o g n i t i v e b e h a v i o u r m o d i f i c a -t i o n t e c h n i q u e s (CBM) may be u s e f u l i n the t r e a t m e n t o f u n a s s e r t i v e i n d i v i d u a l s (Lange & J a k u b o w s k i , 1976; Schwartz & Gottman, 1976), T h i s s u g g e s t i o n may be seen as r e f l e c t i n g t h e o c c u r r e n c e o f a number o f d i f -f e r e n t e v e n t s . 1. The l a s t decade has w i t n e s s e d a s h i f t i n t h e b e h a v i o u r a l p a r a -digm from a p u r e l y b e h a v i o u r a l c o n c e p t u a l i z a t i o n of human f u n c t i o n i n g and change, where c o g n i t i v e e v e n t s were c o n s i d e r e d t o l i e o u t s i d e o f t h e domain o f an e m p i r i c a l s c i e n c e , t o an expanded c o n c e p t u a l framework w h i c h has a t t e m p t e d t o r e i n t e g r a t e t h e i n v e s t i g a t i o n o f c o g n i t i v e c o n c e r n s w i t h i n i t s c o r p u s . T h i s s h i f t i s h e r a l d e d h i s t o r i c a l l y by Homme's now c l a s s i c paper where he c o i n e d t h e term c o v e r a n t s t o r e f e r t o c o g n i t i v e e v e n t s , " t h e o p e r a n t s o f the mind" (Homme, 1965). 2. A p a r a l l e l s h i f t i s t a k i n g p l a c e i n c o n c e p t i o n of the e t i o l o g y o f u n a s s e r t i v e n e s s . A l t h o u g h t h e e t i o l o g y and t r e a t m e n t dynamics f o r u n a s s e r t i v e n e s s were o r i g i n a l l y c o n c e p t u a l i z e d p r i m a r i l y i n c l a s s i c a l c o n d i t i o n i n g terms ( S a l t e r , 1949; Wolpe, 1969), o v e r t h e y e a r s a number o f d i f f e r e n t h y p o t h e s e s have been advanced. 12 Curran (1977) l i s t s the major e t i o l o g i c a l concepts as: (a) s k i l l s d e f i c i t , (b) conditioned anxiety, and (c) f a u l t y cognitive evaluative appr a i s a l . The s k i l l s d e f i c i t hypothesis maintains that the primary basis for unassertiveness l i e s i n the absence of an appropriate behavioural repetoire and that the associated anxiety a r i s e s i n reaction to t h i s behavioural inadequacy. This behavioural inadequacy may take d i f f e r e n t forms. An i n d i v i d u a l may l a c k i n f o r m a t i o n about what c o n s t i t u t e s the appropriate content f o r an a s s e r t i v e response. He may also lack i n -formation about s t y l i s t i c factors which are involved i n the d e l i v e r y of an assertive response. The response may thus be marred by p a r a l i n g u i s t i c behaviours which are incongruous with an otherwise assertive verbal content (Goldfried & Davison, 1976; Serber, 1972). The conditioned anxiety hypothesis maintains that s o c i a l anxiety and r e s u l t i n g i n h i b i t i o n of a s s e r t i v e behaviour a r i s e from the associa-t i o n of previously neutral s o c i a l cues with the response of anxiety. An important c o r o l l a r y of t h i s p o s i t i o n i s that anxiety can become a condi-tioned response to the cue of s o c i a l i n t e r a c t i o n s , regardless of the adequacy.of the i n d i v i d u a l ' s behavioural repetoire. The cognitive evaluative hypothesis states that cognitive evalua-t i v e factors are p r i m a r i l y responsible for unassertive behaviour. Various cognitive s t y l i s t i c f a c t o r s such as u n r e a l i s t i c expectations from one-s e l f , negative s e l f - e v a l u a t i o n s , and i n s u f f i c i e n t self-reinforcement, r e s u l t i n the production of anxiety and the i n h i b i t i o n of assertive be-haviour. Goldfried and Davison (1976) discuss two a d d i t i o n a l e t i o l o g i c a l 13 f a c t o r s : (a) u n r e a l i s t i c expectations and (b) moral and e t h i c a l concerns. In the f i r s t case the i n d i v i d u a l may have u n r e a l i s t i c expectations about the l i k e l y s o c i a l consequences of assertive behaviour. Anxiety may thus be generated by the inaccurate a n t i c i p a t i o n of hurt, discomfort, or anger i n other persons. The v a r i a b l e of moral and e t h i c a l concerns ref e r s to the i n d i v i d u a l who i s raised to believe that i t i s wrong to assert oneself and stand up f o r one'a r i g h t s i n many s o c i a l s i t u a t i o n s , and thus experiences anxiety engendered i n a n t i c i p a t i o n of doing so. 3. This broadening i n conceptualization of the dynamics of unasser-tiveness, although p a r t i a l l y a function of a more general s h i f t i n o r i e n -t a t i o n from a purely behavioural bias towards a more c o g n i t i v e l y oriented psychology, may also r e f l e c t a s h i f t i n target population r e s u l t i n g from the demands of empirical research. Just as the t r a d i t i o n of small animal phobias research evolved p a r t i a l l y to expedite the process of ex-perimental evaluation (Bernstein & Paul, 1971), a target population of s o c i a l anxious undergraduates i n many circumstances has come to replace a t r u l y c l i n i c a l population with problems of greater severity as a sub-j e c t of experimental concern. I t may be that c o g n i t i v e l y oriented interventions are more appropriate f o r the r e l a t i v e l y verbal, i n t e l l i g e n t college undergraduate for whom the absence of knowledge of appropriate assertive responses i s a l e s s important e t i o l o g i c a l component than i t i s for the c l i e n t t y p i c a l l y seen i n private p r a c t i c e . Some support f o r t h i s conjecture i s provided by Schwartz and Gottman (1976), who conducted a task analysis of unassertive behaviour i n a college sample. They found that although low as s e r t i v e subjects performed 14 l e s s a d e q u a t e l y t h a n moderate and h i g h a s s e r t i v e s u b j e c t s i n r o l e p l a y s o f s o c i a l s i t u a t i o n s , t h e y e v i d e n c e d no d i f f e r e n c e s i n h e a r t r a t e , o r knowledge o f competent s o c i a l r e s p o n s e . They d i d , however, r e p o r t g r e a t e r s e l f p e r c e i v e d t e n s i o n , more n e g a t i v e s e l f - s t a t e m e n t s , and fewer p o s i t i v e s e l f - s t a t e m e n t s t h a n moderate and h i g h a s s e r t i v e s u b j e c t s . 4. A f o u r t h f a c t o r b e h i n d t h e i n c r e a s i n g i n t e r e s t i n the a p p l i c a -t i o n o f c o g n i t i v e l y o r i e n t e d t e c h n i q u e s t o u n a s s e r t i v e p o p u l a t i o n s r e -f l e c t s the r i s e i n c o n c e r n f o r t h e i s s u e o f g e n e r a l i z a t i o n and maintenance o f t h e r a p e u t i c g a i n s . As p r e v i o u s l y n o t e d , a t t e m p t s t o demonstrate t r a n s f e r o f t r a i n i n g e f f e c t s f o r a s s e r t i o n t r a i n i n g have been l e s s t h a n i m p r e s s i v e ( M c F a l l &. M a r s t o n , 1970; M c F a l l & L i l l e s a n d , 1971; M c F a l l & Twnetyman, 1973). P r o p o n e n t s o f c o g n i t i v e l y o r i e n t e d b e h a v i o u r a l t e c h n i q u e s have r e p e a t e d l y emphasized the u t i l i t y o f c o g n i t i v e c o p i n g s t r a t e g i e s f o r t h i s p u r p o s e ( G o l d f r i e d , 1973; G o l d f r i e d & T r i e r , 1974; S u i n n & R i c h a r d s o n , 1971) and t h e r e i s a g r o w i n g body o f e v i d e n c e t h a t i n t e r v e n t i o n s o f t h i s t y p e promote g r e a t e r maintenance and g e n e r a l i z a t i o n t h a n t r a d i t i o n a l b e h a v i o u r a l t e c h n i q u e s . Meichenbaum and Cameron (1974) f o u n d t h a t a s t r e s s i n n o c u l a t i o n t r e a t m e n t i n v o l v i n g components o f s e l f - i n s t r u c t i o n a l t r a i n i n g and r e l a x a -t i o n t r a i n i n g p r o d u c e d g r e a t e r g e n e r a l i z a t i o n o f f e a r r e d u c t i o n i n m u l t i -p h o b i c p a t i e n t s t o n o n d e s e n s i t i z e d s t i m u l i t h a n d i d t r a d i t i o n a l d e s e n s i -t i z a t i o n . G l a s s , Gottman, and Shmurak (1976) e v a l u a t e d the r e l a t i v e e f f i c a c y o f s e l f - s t a t e m e n t m o d i f i c a t i o n v e r s u s c o a c h i n g and r e h e a r s a l i n the t r e a t m e n t o f m i n i m a l d a t i n g m a l e s . They f o u n d t h a t the c o g n i t i v e t e c h n i q u e p r o d u c e d g r e a t e r t r a n s f e r o f t r a i n i n g e f f e c t s t o u n t r a i n e d 15 r o l e - p l a y i n g s i t u a t i o n s t h a n d i d the c o a c h i n g and r e h e a r s a l . A l t h o u g h f a i l u r e t o d e m o n s t r a t e t r a n s f e r o f t r a i n i n g e f f e c t s f o r a s s e r t i o n t r a i n i n g may r e s u l t p a r t i a l l y from assessment problems ( i . e . , d e s i g n i n g m e a n i n g f u l and s e n s i t i v e t r a n s f e r o f t r a i n i n g m e a s u r e s ) , c o n c e r n f o r t h i s i s s u e i s w e l l w a r r a n t e d , e s p e c i a l l y c o n s i d e r i n g the e v i d e n c e t h a t d e f i c i t s i n a s s e r t i v e b e h a v i o u r a r e s i t u a t i o n s p e c i f i c i n n a t u r e ( E i s l e r , H e r s e n , M i l l e r , & B l a n c h a r d , 1975). C o g n i t i v e B e h a v i o u r M o d i f i c a t i o n The l a s t decade has w i t n e s s e d an i n c r e a s i n g a c c e p t a n c e o f c o g n i -t i v e l y o r i e n t e d t e c h n i q u e s by b e h a v i o u r t h e r a p i s t s . The i m p a ct o f t h i s t r e n d was w e l l r e c o g n i z e d i n t h e f i r s t p u b l i s h e d i s s u e o f B e h a v i o u r  Therapy w h i c h c o n t a i n e d t h r e e s e p a r a t e t h e o r e t i c a l a r t i c l e s by Beck, Ulman, and B e r g i n , a l l a t t e m p t i n g t o i n t e g r a t e t h i s t r e n d w i t h the b e h a v i o u r a l t r a d i t i o n . I n e v a l u a t i o n o f the s i g n i f i c a n c e o f t h i s s h i f t B e r g i n s t a t e d : I n g e n e r a l t h e d e s c r i p t i o n s o f t e c h n i q u e s , the t h e o r e t i c a l i n t e r p r e t a t i o n s o f p a t h o l o g y , and the r a t i o n a l e f o r t h e r a p e u t i c p r o c e d u r e s l o o k p r o -m i s i n g and i n t e r e s t i n g ; however, c o n s i d e r a b l y more s u b s t a n c e must be p r o v i d e d b e f o r e the message i s p e r s u a s i v e . ( B e r g i n , 1970). S i n c e t h a t time a p r o f u s i o n o f a r t i c l e s have been p u b l i s h e d o u t l i n i n g and e v a l u a t i n g c o g n i t i v e l y o r i e n t e d t h e r a p e u t i c p r o c e d u r e s f o r the t r e a t m e n t o f a v a r i e t y o f c l i n i c a l p r o b l e m s . The two t h e r a p i e s w h i c h have r e c e i v e d t h e most e x p e r i m e n t a l a t t e n t i o n a r e r a t i o n a l e m o t i v e t h e r a p y and s e l f - i n s t r u c t i o n a l t r a i n i n g . The development o f E l l i s ' r a t i o n a l e m o t i v e t h e r a p y (RET) h i s t o r i c a l l y 16 p r e c e d e d the i n c o r p o r a t i o n o f c o g n i t i v e c o n c e r n s w i t h i n t h e b e h a v i o u r a l t r a d i t i o n , and i t has i n f l u e n c e d t h e subsequent development o f o t h e r c o g n i t i v e t e c h n i q u e s . E l l i s ' c e n t r a l t h e s i s i s t h a t p e o p l e i n the f i n a l a n a l y s i s become p s y c h o l o g i c a l l y and e m o t i o n a l l y d i s t u r b e d n o t be-cause o f e v e n t s o c c u r r i n g i n t h e i r e n v i r o n m e n t , but r a t h e r because o f the f a s h i o n i n w h i c h t h e y p e r c e i v e them. The f o c u s o f RET t h e n i s upon m a l a d a p t i v e c o g n i t i o n s . E l l i s m a i n t a i n s t h a t human b e i n g s have an i n -n a t e p r o p e n s i t y t o c o g n i z e i n " i r r a t i o n a l " terms w h i c h p r e c i p i t a t e un-h a p p i n e s s and p s y c h o l o g i c a l m a l a d a p t i v e n e s s . The f u n c t i o n o f t h e r a t i o n a l e m o t i v e t h e r a p i s t i s t o e d u c a t e the c l i e n t t o t h i n k i n a more r a t i o n a l f a s h i o n . T h i s i s a c c o m p l i s h e d by t e a c h i n g him t o r e c o g n i z e t h e i r r a -t i o n a l b e l i e f s w h i c h l i e a t the b a s i s o f h i s p r o b l e m and t o r e p l a c e them w i t h more r a t i o n a l b e l i e f s . E l l i s d e s c r i b e s a number o f commonly h e l d i r r a t i o n a l b e l i e f s . These i n c l u d e s u c h p r e m i s e s a s , " t h e i d e a t h a t i t i s a d i r e n e c e s s i t y f o r an a d u l t t o be l o v e d by e v e ryone f o r e v e r y t h i n g he does", and " t h e i d e a t h a t one s h o u l d be t h o r o u g h l y competent, i n t e l l i g e n t , and a c h i e v i n g i n a l l p o s s i b l e r e s p e c t s " . The a p p r o a c h i s c h a r a c t e r i z e d by a r a t h e r f o r c e f u l a t t e m p t t o c o n v i n c e the c l i e n t t h a t m a l a d a p t i v e e m o t i o n s do i n d e e d a r i s e from i r r a t i o n a l p r e m i s e s , b u t as Meichenbaum (1976) n o t e s , we must d i s t i n g u i s h here between e s s e n t i a l components o f t h i s t h e r a p e u t i c t e c h n i q u e , and E l l i s ' own c h a r a c t e r i s t i c s t y l e . G o l d f r i e d ( G o l d f r i e d , D e c e n t e c e o , & Weinberg, 1974) has a t t e m p t e d to c o n c e p t u a l i z e RET i n terms o f l e a r n i n g p r i n c i p l e s and t o m o d i f y some o f the i m p l e m e n t a t i o n p r o c e d u r e s t o r e n d e r i t more c l i n i c a l l y v i a b l e . S y s t e m a t i c R a t i o n a l r e s t r u c t u r i n g i s c o n c e p t u a l i z e d as a s e l f - c o n t r o l 17 t e c h n i q u e , "whereby a n x i e t y p r o v i d e s t h e i n d i v i d u a l w i t h t h e s i g n a l t o r a t i o n a l l y r e e v a l u a t e t he r e a s o n f o r t h e u p s e t " ( G o l d f r i e d e t a l . , 1974). D o l l a r d and M i l l e r ' s (1950) c o n c e p t i o n o f c u e - p r o d u c i n g r e s p o n s e s i s i n v o k e d as a l e a r n i n g t h e o r y b a s i s f o r E l l i s ' b a s i c n o t i o n t h a t e m o t i o n a l r e s p o n s e s r e s u l t f r o m a c o g n i t i v e l a b e l l i n g o f the s i t u a t i o n , r a t h e r t h a n the s i t u a t i o n i t s e l f . G o l d f r i e d deemphasizes the c o n f r o n t a t i v e n a t u r e o f E l l i s ' a p p r o a c h and o u t l i n e s p r o c e d u r e s f o r e v o l v i n g a common c o n c e p t u a l framework w i t h t he c l i e n t . E l l i s ' f o c u s upon the r a t i o n a l a n a l y s i s o f m a l a d a p t i v e b e l i e f s i s , however, r e t a i n e d and t h e p r e s e n t a -t i o n and subsequent d i s c r e d i t i n g o f common u n r e a s o n a b l e a s s u m p t i o n s forms an i n t e g r a l component o f the t h e r a p y . I t i s t o be n o t e d , however, t h a t G o l d f r i e d a d v o c a t e s h a v i n g t h e c l i e n t g e n e r a t e h i s own arguments about th e u n r e a s o n a b l e n e s s o f t h e s e a s s u m p t i o n s i n o r d e r t o f a c i l i t a t e a t t i -t i d e change. R a t i o n a l r e e v a l u a t i o n i s t a u g h t t o c l i e n t s as an a c t i v e c o p i n g s k i l l f o r d e a l i n g w i t h a n x i e t y . The most e x t e n s i v e l y r e s e a r c h v a r i a t i o n w i t h i n t h e g e n e r a l c l a s s o f c o g n i t i v e r e s t r u c t u r i n g t e c h n i q u e s i s Meichenbaum's s e l f - i n s t r u c t i o n a l t r a i n i n g . Meichenbaum f i r s t became i n t e r e s t e d i n t h e r o l e o f s e l f -i n s t r u c t i o n s i n c o g n i t i o n , f o l l o w i n g h i s o b s e r v a t i o n t h a t s c h i z o p h r e n i c s c o u l d be t r a i n e d t o m o d i f y t h e i r b e h a v i o u r by e n g a g i n g i n o v e r t s e l f -s t a t e m e n t s m o d e l l e d on c o g n i t i o n s v e r b a l i z e d by t h e e x p e r i m e n t e r (Meichenbaum, 1976). On a t h e o r e t i c a l l e v e l , s e l f - i n s t r u c t i o n a l t r a i n i n g has been l i n k e d t o t h e work o f L u r i a , who s u g g e s t e d t h e e x i s t e n c e o f t h r e e s t a g e s i n th e development o f i n t e r n a l i z e d s e l f c o n t r o l o f b e h a v i o u r . I n i t i a l l y , a c h i l d ' s a c t i o n s a r e c o n t r o l l e d by t h e v e r b a l i n s t r u c t i o n s o f e x t e r n a l 18 a g e n t s . I n t h e n e x t d e v e l o p m e n t a l s t a g e the c h i l d b e g i n s t o c o n t r o l h i s own p e r f o r m a n c e by o v e r t l y v e r b a l i z i n g some of t h e s e i n s t r u c t i o n s . The f i n a l s t a g e i s one o f i n t e r n a l i z a t i o n o f s e l f - i n s t r u c t i o n s ( L u r i a , 1964). S e l f - i n s t r u c t i o n s a r e t h u s seen as s e r v i n g a g u i d i n g s e l f - c o n t r o l f u n c t i o n . They a r e c o n c e p t u a l i z e d as a f o r m o f i n t e r n a l d i a l o g u e w h i c h t y p i c a l l y o p e r a t e s a t an a u t o m a t i c s y m b o l i c l e v e l t o d i r e c t a t t e n t i o n , p e r c e p t i o n , and f i n a l l y b e h a v i o u r . More r e c e n t l y , Meichenbaum a r t i -c u l a t e d a t h r e e s t a g e c o g n i t i v e - b e h a v i o u r a l system c o n s i s t i n g o f cog-n i t i v e s t r u c t u r e s , i n n e r d i a l o g u e , and b e h a v i o u r . The c o g n i t i v e s t r u c -t u r e i s c o n s i d e r e d t o be a c e n t r a l e x e c u t i v e p r o c e s s o r w h i c h o r g a n i z e s and d e t e r m i n e s t h e p a t t e r n s of thought i n w h i c h t h e i n d i v i d u a l engages. The i n t e r n a l d i a l o g u e may i n a sense be seen as a r i s i n g i n i n t e r a c t i o n between c o g n i t i v e s t r u c t u r e s and b e h a v i o u r s . The i n d i v i d u a l e v a l u a t e s e n v i r o n m e n t a l e v e n t s and h i s own b e h a v i o u r s i n c o n t e x t o f e x i s t i n g c o g n i t i v e s t r u c t u r e s . T h i s e v a l u a t i o n and r e s u l t i n g e m o t i o n s and s e l f i n s t r u c t i o n s appear t o be what c o n s t i t u t e t h e i n n e r d i a l o g u e . A c c o r d i n g t o Meichenbaum i f t h e r a p e u t i c change i s t o o c c u r , the c e n t r a l c o g n i t i v e s t r u c t u r e must i n e v i t a b l y be m o d i f i e d . T h i s change, he m a i n t a i n s , may be i n i t i a t e d a t t h e l e v e l o f e i t h e r the c o g n i t i v e s t r u c t u r e i t s e l f , t he s e l f - s t a t e m e n t s , o r the b e h a v i o u r a l l e v e l (Meichenbaum, 1977). He s u g g e s t s t h a t a major d i s t i n c t i o n between RET and s e l f - i n s t r u c t i o n a l t r a i n i n g i s t h a t RET f o c u s e s on t h e f i r s t l e v e l , w h i l e s e l f - i n s t r u c t i o n a l t r a i n i n g f o c u s e s on the second. A l o g i c a l s c r u t i n y o f a c t u a l i m p l e m e n t a t i o n p r o c e d u r e s r e v e a l s a s t r o n g p a r a l l e l between the two. B o t h s t r a t e g i e s f o c u s upon the a n a l y s i s 19 and a l t e r a t i o n o f d y s f u n c t i o n a l t hought p a t t e r n s ; b o t h employ d i d a c t i c i n s t r u c t i o n s , g r a d u a t e d p e r f o r m a n c e t a s k s , and m o d e l i n g o f a p p r o p r i a t e c o v e r t p r o c e s s e s . The p r i m a r y d i f f e r e n c e a p p e a r s t o be one o f f o c u s . Whereas E l l i s a t t e m p t s t o a l t e r c o g n i t i o n s d i r e c t l y t h r o u g h r a t i o n a l c o n f r o n t a t i o n , Meichenbaum p r o v i d e s t h e c l i e n t w i t h an a l t e r n a t i v e c o n -c e p t u a l framework and a t e c h n i q u e he can employ t o m o d i f y h i s own c o g -nitions (i.e., self-instructing I n the appropriate fashion). S u b j e c t s treated with therapies i n c o r p o r a t i n g p r i n c i p l e s of RET and/or s e l f - i n s t r u c t i o n a l t r a i n i n g have c o n s i s t e n t l y r e p o r t e d s i g n i f i -c a n t l y l e s s s u b j e c t i v e a n x i e t y t h a n no t r e a t m e n t c o n t r o l s . T h i s has been d e m o n s t r a t e d i n the t r e a t m e n t o f speech a n x i e t y ( K a r s t & T r e x l e r , 1970; T r e x l e r & K a r s t , 1972; Meichenbaum, G i l m o r e , & F e d o r a v i c i u s , 1971), t e s t a n x i e t y (Meichenbuam, 1973; H o l r o y d , 1976), and p h o b i a s (Meichenbaum & Cameron, 1974; W i l l i a m s o n & B r e n d e r , 1973; W e i r , N e l s o n , & Odam, 1975). E v i d e n c e o f improvement i n t h e b e h a v i o u r a l r e a l m has been l e s s c o n s i s t e n t . Thus, Meichenbaum (1971) and K a r s t and T r e x l e r (1972) have d e m o n s t r a t e d b e h a v i o u r a l improvement i n speech a n x i o u s c l i e n t s . A s t u d y by K a r s t and T r e x l e r (1970) f a i l e d i n t h i s r e s p e c t . Meichenbaum (1972) and H o l r o y d (1976) have b o t h d e m o n s t r a t e d im-provement o f grade p o i n t a v e r a g e i n t e s t a n x i o u s s u b j e c t s t r e a t e d w i t h s e l f - i n s t r u c t i o n a l t r a i n i n g . S a r a s o n ( 1 9 7 3 ) , u s i n g a m o d e l i n g s e l f -i n s t r u c t i o n a l a p p r o a c h , improved performance of h i g h t e s t a n x i o u s i n d i -v i d u a l s on anagrams. These s u c c e s s e s a r e c o n g r u e n t w i t h t h e w e a l t h o f e v i d e n c e i m p l i c a t i n g a t t e n t i o n a l f a c t o r s and c o g n i t i v e s t y l e s i n t e s t a n x i e t y (Wine, 1970). F i n d i n g s r e g a r d i n g t h e r e d u c t i o n o f a v o i d a n c e b e h a v i o u r i n p h o b i c 20 subjects have once again been mixed. Cognitive coping strategies involving the anticipation of the relevant stressor have been found to decrease avoidance behaviour in snake phobics (Williamson & Brender, 1973). A cognitive restructuring strategy focusing exclusively on the reconceptualization of the problem behaviour in nonanxiety producing terms has been demonstrated to reduce avoidance behaviour in snake phebiGH (Weir, Nelson, & Odam, 1975), but not i n individuals who are phobic of dead animals (D'Zurilla, Wilson, & Nelson, 1973). This dis-crepancy may be accounted for by the difference in c l i n i c a l severity and degree of circumscription of the two phobia types. Meichenbaum's multi-component stress innoculation package involving components of self-instructional training, relaxation training, and graded behavioural assignments, successfully reduced avoidance behaviour in subjects phobic of rats and snakes. The success of this programme relative to the sim-p l i f i e d cognitive restructuring procedure previously mentioned provides some evidence for the therapeutic u t i l i t y of a more comprehensive coping s k i l l s oriented treatment (Goldfried, 1971). Evidence for the efficacy of cognitive interventions on a physio-logical level is more limited. Trexler and Karst (1972) found no signi-ficant changes in finger sweat print indices of anxiety after RET, and Weir, Nelson, and Odam (1975) failed to demonstrate changes in heart rate in clients undergoing cognitive restructuring. Schwartz and Gottman (1976) found that heart rate did not differentiate between assertive and unassertive individuals, despite the fact that unassertive individuals perceived themselves as more tense than their assertive counterparts. 21 A number of studies have yielded favourable information on the e f f i c a c y of cognitive interventions when the e f f e c t s of therapeutic non-specifics are c o n t r o l l e d f o r . Holroyd (1976) has demonstrated s e l f -i n s t r u c t i o n a l t r a i n i n g with test anxious subjects to be s i g n i f i c a n t l y more e f f e c t i v e than group mediation attention placebo control and a sys-tematic d e s e n s i t i z a t i o n group on s e l f - r e p o r t and behavioural measures. Therapeutic gains were maintained at a one month follow-up. Speech anxious subjects receiving s e l f - i n s t r u c t i o n a l t r a i n i n g have evidenced greater improvement on s e l f report and behavioural measures than attention placebo subjects discussing neutral subjects, i n both s e l f - r e p o r t and behavioural realms at post assessment and a three month follow-up (Meichenbaum, Glimore, & Fedoravicius, 1971). Trexler and Karst (1972) report equivalent improvement from RET and relaxation procedures with speech anxious c l i e n t s . In the treatment of phobics, Meichenbaum and Cameron (1974) has found that multiphobic c l i e n t s receiving stress innoculation show greater benefit than c l i e n t s r e c e i v i n g systematic d e s e n s i t i z a t i o n on s e l f - r e p o r t and behavioural measures. In addition they experience greater generalization of treatment to nondesensitized phobic s t i m u l i Cognitive Behaviour Modification and Assertion Training Two recent studies have s p e c i f i c a l l y evaluated CBM procedures i n the treatment of unassertive i n d i v i d u a l s with encouraging r e s u l t s . Wolfe and Fodor (1977) evaluated the r e l a t i v e e f f i c a c y of t r a d i t i o n a l assertion s k i l l s t r a i n i n g , s k i l l s t r a i n i n g with r a t i o n a l emotive therapy, 22 and consciousness r a i s i n g procedures i n the treatment of unassertive women. While both s k i l l s t r a i n i n g and s k i l l s t r a i n i n g with r a t i o n a l emotive therapy conditions proved superior to consciousness r a i s i n g and a no treatment control on behavioural measures of assertion, there were no s i g n i f i c a n t differences between the f i r s t two conditions i n t h i s respect. Supplementing basic s k i l l s t r a i n i n g with an RET component did however decrease s e l f - r e p o r t of anxiety during role playing s i t u a t i o n s . No treatment e f f e c t s were found on s e l f - r e p o r t e d assertion or on s e l f -reported s o c i a l anxiety. Alden, Safran, and Weideman (1977) compared a CBM intervention combining components of both s e l f - i n s t r u c t i o n a l t r a i n i n g and r a t i o n a l emotive therapy to a more t r a d i t i o n a l s k i l l s t r a i n i n g approach i n the treatment of unassertive male and female college undergraduates. They found both treatments to be approximately equivalent i n potency and s i g n i f i c a n t l y more e f f e c t i v e than a no contact control group on s e l f -report measures of anxiety, assertion, and i r r a t i o n a l b e l i e f s , and be-havioural ratings of assertion, aggression, anxiety, and various com-ponent behaviours. It i s i n t e r e s t i n g to note that both of these studies f a i l e d to f i n d s i g n i f i c a n t differences between the two treatment approaches i n many respects. While caution i n i n t e r p r e t a t i o n Of r e s u l t s i s warranted i n the second study because of the omission of an attention placebo c o n t r o l , the f i r s t study did demonstrate therapeutic s u p e r i o r i t y for both cogni-t i v e and behavioural interventions over a consciousness r a i s i n g group. One hypothesis advanced to explain t h i s apparent therapeutic equivalence (Alden et a l . , 1977) i s that both procedures produce therapeutic change 23 through the same e f f e c t i v e mechanism. Bandura's theory of s e l f - e f f i c a c y , for example, s p e c i f i e s that therapeutic interventions which appear to be d i f f e r e n t i n implementation may nevertheless f a c i l i t a t e change through a unitary mechanism which involves strengthening perceptions of personal effectiveness (Bandura, 1977). In the two studies c i t e d , i t may be the case that c l i e n t s i n both behavioural and cognitive treatment conditions were provided with coping s k i l l s (overt behavioural i n one case and covert cognitive s t r a -tegies i n the second) to employ i n s o c i a l s i t u a t i o n s where they had previously seen themselves as inadequate or powerless). A second and compatible hypothesis derives from Mandler's theory of anxiety (Handler, 1966). He s p e c i f i e s that the subjective f e e l i n g of anxiety a r i s e s from the experience of helplessness and cognitive d i s o r -ganization p r e c i p i t a t e d by the i n t e r r u p t i o n of an organized response sequence. When the i n d i v i d u a l has a cognitive schema for a n t i c i p a t i n g the anxiety provoking s i t u a t i o n and a plan of action for dealing with i t , the response sequence remains Uninterrupted, and the plan i s c a r r i e d through to completion. The i n d i v i d u a l can thus engage i n purposeful behaviour and the experience of helplessness and anxiety i s avoided. In the same vein, Meichenbaum contends that the coping strategies employed i n stress innoculation t r a i n i n g enable the i n d i v i d u a l to convert the experience of learned helplessness to one of learned helpfulness (Meichenabum, 1974). In the assertion t r a i n i n g context, i t i s thus possible that both s k i l l s t r a i n i n g and CBM procedures provide the i n d i v i d u a l with coping strategies which allow the response sequence to be completed. 24 A n o t h e r p o t e n t i a l element r e s p o n s i b l e f o r t h e s e f i n d i n g s o f t h e r a -p e u t i c e q u i v a l e n c e i s the p o s s i b i l i t y t h a t c o g n i t i v e and b e h a v i o u r a l t r e a t m e n t s were d i f f e r e n t i a l l y e f f e c t i v e f o r c e r t a i n i n d i v i d u a l s and not f o r o t h e r s , and t h a t t h e s e d i f f e r e n c e s were o b s c u r e d by t h e u t i l i z a t i o n o f a g g r e g a t e d a t a i n t h e a n a l y s e s . I n o t h e r words, r e a l and c l i n i c a l l y i m p o r t a n t d i f f e r e n c e s between i n t e r v e n t i o n s may be d i s g u i s e d by t h e i m p o s i t i o n o f a u n i f o r m i t y myth on t h e p o p u l a t i o n o f u n a s s e r t i v e c l i e n t s ( C o l b y , 1964; K e i s l e r , 1966). A n x i e t y L e v e l as a M o d e r a t o r V a r i a b l e To summarize some o f t h e major p o i n t s i n the p r e c e d i n g pages: 1. A l t h o u g h a s s e r t i o n t r a i n i n g t e c h n i q u e s have been employed c l i n i c a l l y f o r t h e l a s t two decades, i t i s o n l y w i t h i n t h e l a s t s i x o r seven y e a r s t h a t t h e f i e l d has been s u b j e c t e d t o r i g o u r o u s e x p e r i m e n t a l e v a l u a t i o n . 2. W h i l e e v i d e n c e f o r t h e e f f e c t i v e n e s s o f a s s e r t i o n t r a i n i n g has been a c c u m u l a t e d , much o f t h i s e v i d e n c e comes from a n a l o g s t u d i e s , w i t h l i m i t e d c l i n i c a l r e l e v a n c e . 3. E x p e r i m e n t a l p r o g r e s s w i l l be f a c i l i t a t e d by the development o f m e a n i n g f u l assessment p r o c e d u r e s and t h e employment of c l e a r l y s p e c i f i e d t r e a t m e n t t e c h n i q u e s i n c l i n i c a l s t u d i e s . 4. F o r a v a r i e t y o f r e a s o n s , t h e t r e a t m e n t o f u n a s s e r t i v e i n d i v i d u a l s w i t h c o g n i t i v e b e h a v i o u r a l m o d i f i c a t i o n t e c h n i q u e s i s becoming p o p u l a r . 5. P r e l i m i n a r y e v i d e n c e e x i s t s t h a t c o g n i t i v e t e c h n i q u e s a r e e f f e c t i v e i n t h e t r e a t m e n t o f u n a s s e r t i v e i n d i v i d u a l s . 25 6. While there i s some evidence that the supplementing s k i l l s t r a i n i n g procedures with r a t i o n a l emotive therapy decreases s i t u a t i o n a l anxiety ( Wolfe & Fodor, 1977), no c l e a r pattern of d i f f e r e n t i a l e f f i c a c y between the two procedures has emerged. 7. Some hypotheses have been advanced as to the mechanisms through which both cognitive and s k i l l s t r a i n i n g procedures function i n the treatment of unassertive i n d i v i d u a l s , but the precise nature of these " e f f e c t i v e components" has not been c l a r i f i e d e m p i r i c a l l y . There i s a growing awareness among researchers ( K e i s l e r , 1966; Strupp, 1968) that global research questions such as "Is systematic d e s e n s i t i z a t i o n e f f e c t i v e ? " , or "Is cognitive r e s t r u c t u r i n g useful?" have been r e l a t i v e l y unproductive from the standpoint of both the re-searcher and the c l i n i c i a n . Research questions of t h i s sort are subject to the "uniformity myth" o r i g i n a l l y l a b e l l e d by Colby (1964), that "patients at the s t a r t of treatment are more a l i k e than they are d i f -ferent". This mistaken assumption of c l i e n t population homogeneity i s the same f a l l a c y which retarded research on schizophrenia u n t i l the strategy was adopted of searching for schizophrenic subcategories which were homogeneous with respect to important c h a r a c t e r i s t i c s (Herron, 1962). The suggested strategy of grouping c l i e n t s with respect to charac-t e r i s t i c s presumed to be of importance has d i r e c t relevance to both the research and the c l i n i c i a n . The c l i n i c i a n requires information regarding what s p e c i f i c techniques to employ with c l i e n t s of d i f f e r e n t c h a r a c t e r i s t i c s , or as Paul (1967) has a r t i c u l a t e d : "What treatment by whom i s most e f f e c t i v e for t h i s i n d i v i d u a l with what s p e c i f i c problem and under what set of circumstances?" 26 For the researcher, a f a i l u r e to incorporate the awareness of c l i e n t heterogeneity with respect to important c h a r a c t e r i s t i c s into the experimental design can r e s u l t i n e i t h e r misleading conclusions or the more innocuous s i t u a t i o n where r e s u l t s are simply not i l l u m i n a t i n g . There are both t h e o r e t i c a l and empirical grounds to implicate anxiety l e v e l as a p o t e n t i a l moderator va r i a b l e i n the treatment of the unassertive i n d i v i d u a l . On a t h e o r e t i c a l l e v e l , Lazarus and A v e r h i l l (1972) d i s t i n g u i s h between f r i g h t and anxiety reactions. Fright emotions are r e l a t i v e l y stimulus bound. In instrumental fear, a threat i s perceived and so i s the p o s s i b i l i t y of normal problem solving behaviour. It can, however, be e a s i l y transformed into anxiety as the s i t u a t i o n increases i n complexity or becomes more immediate or l e s s manageable. The experience of anxiety i s characterized by a cognitive disorganization, an i n a b i l i t y to construe the s i t u a t i o n i n meaningful and task relevant terms. Fright reactions, they contend, might well be reduced through d e s e n s i t i z a t i o n or habituation. But as the degree of anxiety increases, r e f l e c t i n g a greater degree of cognitive disorganization, a more cogni-t i v e l y oriented cognitive reconstructive approach may be required. Thus i t can be extrapolated that to the extent that a t r a d i t i o n a l s k i l l s t r a i n i n g approach lacks a cognitive r e s t r u c t u r i n g component, i t s benefits may be decreased with high anxiety c l i e n t s . Gambrill and Richey (1975) have marshalled evidence that i n fact the dynamics of unassertive behaviour are not unitary i n nature, and that unassertive c l i e n t s are heterogeneous with respect to s u b j e c t i v e l y experienced anxiety l e v e l i n interpersonal s i t u a t i o n s . 27 They report that subjects, on the basis of a s e l f - r e p o r t inventory where ratings were obtained f o r both degree of discomfort and response p r o b a b i l i t y f or a given assertive behaviour, f e l l i nto three d i s t i n c t categories. Some respondents consistently repotted high discomfort ratings coupled with low p r o b a b i l i t y of response ratings. These subjects were seen by them as c o n s t i t u t i n g the population we normally conceived of as unassertive. A second subcategory of subjects tended to report low ratings of discomfort i n conjunction with high ratings of response p r o b a b i l i t y . This constitutes the population we would normally consider a s s e r t i v e . A t h i r d category of subjects consistently reported high l e v e l of d i s -comfort together with high p r o b a b i l i t y of performance. These i n d i v i d u a l s are l a b e l l e d anxious-performers. Gambrill and Richey argue that the existence of these subcategories may have d i f f e r e n t i a l treatment implications. While t r a d i t i o n a l s k i l l s t r a i n i n g approaches may be more e f f e c t i v e for the high anxiety-low p r o b a b i l i t y of performance category, i t may well be the case that the anxious-performers may be more amenable to an approach focusing upon modification of coverants or mental operations rather than focusing upon the s p e c i f i c verbal and nonverbal components of assertion. A fourth category of c l i e n t s might conceivably e x i s t who are charac-t e r i z e d by low anxiety l e v e l , paired with low p r o b a b i l i t y of assertive response. In a population of t h i s sort i t may well be that any attempt to deal with i n h i b i t o r y mental processes i s superfluous and that a s p e c i f i c behavioural s k i l l s t r a i n i n g approach i s most appropriate. 28 More evidence regarding the heterogeneity of unassertive i n d i v i d u a l s i s provided by Alden and Safran (1977), who demonstrated that even within a sample of college undergraduates seeking help for assertion problems, the degree to which cognitive factors played a role was v a r i a b l e . There i s also some preliminary evidence on a treatment l e v e l to suggest that c l i e n t anxiety l e v e l has therapeutic implications. Pechacek (Meichenbaum, 1976).employing a CBM procedure (with com-ponents of rela x a t i o n , image rehearsal, and modification of s e l f talk) i n the treatment of smokers found an i n t e r a c t i o n between the treatment and c l i e n t ' s i n i t i a l l e v e l of anxiety. Casas (1975) compared the e f f i c a c y of Goldfried's r a t i o n a l re-struc t u r i n g technique (1974) versus s e l f - c o n t r o l d e s e n s i t i z a t i o n i n the treatment of speech anxious c l i e n t s and found that the CBM technique led to minimal changes. A post hoc an a l y s i s , however, indicated that subjects who were high on anxiety l e v e l were the greatest b e n e f i c i a r i e s of r a t i o n a l r e s t r u c t u r i n g procedures. S i m i l a r l y , Meichenbaum (1971) i n his study of s e l f - i n s t r u c t i o n a l t r a i n i n g f o r speech anxiety, noted a r e l a t i o n s h i p between anxiety l e v e l and e f f i c a c y of treatment. Sarason (1973) divided one hundred and twenty female students into high and low anxiety groups on the basis of his Test Anxiety Scale (TAS). Subjects i n both categories were randomly assigned to three conditions. In the performance only condition, the experimenter solved three problem anagrams while subjects watched. The experimenter i n the performance-v e r b a l i z a t i o n condition verbalized about his responses while solving the anagram (e.g., " I ' l l move the A i n front of the N", "Maybe L w i l l give me a s t a r t " ) . In the perfOrmance-verbalization-principles condition 29 the experimenter supplemented the manipulation of the l e t t e r s with ver-b a l i z a t i o n s of general problem solving p r i n c i p l e s employed as well as task f a c i l i t a t i v e r e f l e c t i o n s about h i s performance (e.g., "I want to be sure not to get stuck on j u s t one approach to the l e t t e r combinations", "At times i t looks l i k e a hopeless group of l e t t e r s , but I'm sure I ' l l h i t on something"). Sarason found that low TAS subjects outperformed high TAS subjects i n the performance only, and performance-verbalization conditions. There was, however, a s i g n i f i c a n t anxiety x condition i n t e r a c t i o n with high TAS subjects outperforming low TAS subjects i n the v e r b a l i z a t i o n of p r i n c i p l e s condition. A study by Sarason (1972) implicates anxiety l e v e l as a moderator var i a b l e i n an unexpected fashion. An experimental programme to teach s o c i a l s k i l l s to j u v e n i l e delinquents divided the boys into high test anxious and low test anxious groups. Subjects were then administered one of two experimental conditions: (a) subjects observed models who coped e f f e c t i v e l y with interpersonal problems s a l i e n t to the boys, and then rehearsed the observed behaviours; (b) the same procedure was sup-plemented with videotaping of the models and the boys. It was found that the group which responded most poorly to t r e a t -ment was the high test anxious-modeling-videotape group. Subsequent interviews with the boys indicated that high test anxious boys observing the videotapes of themselves and the models confirmed t h e i r evaluation of themselves as inadequate and, i t might be i n f e r r e d , t h i s confirmation of negative s e l f statements i n h i b i t e d performance. Studies with s o c i a l l y anxious i n d i v i d u a l s have shown that they 30 a r e more s e n s i t i v e t o s o c i a l f e e d b a c k and more l i k e l y t o p e r c e i v e n e u t r a l f e e d b a c k as b e i n g n e g a t i v e t h a n n o n a n x i o u s i n d i v i d u a l s ( S m i t h , 1972; S m i t h "& S a r a s o n , 1975). Taken t o g e t h e r , t h e s e f i n d i n g s s u g g e s t the p o s s i b i l i t y t h a t t r u l y a n x i o u s c l i e n t s w i t h f a u l t y c o g n i t i v e e v a l u a t i v e p r o c e s s e s t a k i n g the f orm o f a s y s t e m a t i c b i a s towards m i s p e r c e i v i n g t h e i r own b e h a v i o u r s as s o c i a l l y i n c o m p e t e n t , may n o t be a b l e t o b e n e f i t f r o m the new i n f o r m a t i o n o b t a i n e d from b e h a v i o u r a l changes. I n o t h e r words, the c o g n i t i v e s t r u c -t u r e s they have d e v e l o p e d r e g a r d i n g t h e m s e l v e s i n i n t e r p e r s o n a l s i t u a -t i o n s may be r e s i s t a n t t o change r e s u l t i n g from b e h a v i o u r a l i n f o r m a t i o n . The a n x i e t y e x p e r i e n c e d r e s u l t s from an e x i s t i n g c o g n i t i v e schema, i n w h i c h any b e h a v i o u r s a r e t a k e n as f u r t h e r c o n f i r m a t i o n o f t h e i r own s o c i a l i n e f f e c t i v e n e s s . Thus a l t h o u g h b e h a v i o u r a l i n t e r v e n t i o n s may be e f f e c t i v e i n m o d i f y i n g p e r c e p t i o n o f s e l f - e f f i c a c y i n some i n d i v i d u a l s , t h e r e may be o t h e r i n d i v i d u a l s who r e q u i r e an i n t e r v e n t i o n d i r e c t e d s p e c i f i c a l l y a t m o d i f y i n g the f a s h i o n i n w h i c h i n f o r m a t i o n f r o m s o c i a l s i t u a t i o n s i n c o n s t r u e d . The p r e s e n t s t u d y was d e s i g n e d to e v a l u a t e the h y p o t h e s i s t h a t t h e r e i s a r e l a t i o n s h i p between s u b j e c t i v e e x p e r i e n c e o f a n x i e t y p r i o r t o t r e a t m e n t and t h e form o f t r e a t m e n t ( c o g n i t i v e o r s k i l l s t r a i n i n g ) w h i c h i s most e f f e c t i v e . More s p e c i f i c a l l y , i t was h y p o t h e s i z e d t h a t a c o g n i t i v e t r e a t m e n t s t r a t e g y would be more e f f e c t i v e t h a n a s k i l l s t r a i n i n g i n t e r v e n t i o n i n t h e t r e a t m e n t o f h i g h l y a n x i o u s u n a s s e r t i v e s u b j e c t s . For t h e low a n x i e t y s u b j e c t s i t was h y p o t h e s i z e d t h a t t h e r e would be no s i g n i f i c a n t 31 differences i n e f f i c a c y of the two treatments. No hypotheses were formulated as to the r e l a t i v e e f f i c a c y of the two interventions, c o l l a p s i n g across l e v e l s of anxiety, or as to the degree of improvement of treated subjects r e l a t i v e to nontreated or minimally treated subjects, since both of these issues have been addresse i n previous studies. The hypotheses were thus e x c l u s i v e l y of an i n t e r a c t i o n a l nature, and for t h i s reason, assessment only and attention placebo co n t r o l groups were not included i n the study. 32 METHOD T h i r t y - s i x male and female UBC undergraduates were r e c r u i t e d to p a r t i c i p a t e i n an assertion t r a i n i n g programme. The programme was ad-v e r t i z e d through notices posted around the u n i v e r s i t y campus and b r i e f announcements made i n classes. P o t e n t i a l subjects were t o l d that the programme was offered for i n d i v i d u a l s who f e l t they they had d i f f i c u l t y i n interpersonal s i t u a t i o n s and would l i k e to learn to express t h e i r feelings and b e l i e f s more comfortably. They were informed that the group would be offered free of charge i n return for t h e i r co-operation i n the evaluative procedure. A l l subjects volunteering p a r t i c i p a t e d i n an i n i t i a l assessment procedure to screen out any i n d i v i d u a l s who were evaluated to be inap-propriate for the research-treatment programme, eit h e r because of psychological i n s t a b i l i t y or absence of c h a r a c t e r i s t i c s which would make them appropriate candidates for assertion t r a i n i n g . A t o t a l of s i x subjects dropped out during the i n t e r v a l between the i n i t i a l recruitment and the f i n a l post assessment. Four of these l e f t p r i o r to the commencement of the treatment programme because of scheduling c o n f l i c t s and two dropped out a f t e r the commencement of treatment. (One of these sustained a back i n j u r y , while the other found that his schedule was busier than he had o r i g i n a l l y anticipated.) Treatment Conditions There were two treatment conditions. Each condition involved a t o t a l of s i x two hour sessions, and was held at weekly i n t e r v a l s . 33 S k i l l s T r a i n i n g ( S T ) . S u b j e c t s i n t h i s c o n d i t i o n were t a u g h t v e r b a l and n o n v e r b a l b e h a v i o u r s b e l i e v e d t o be i m p o r t a n t i n a s s e r t i o n . I t was a s t r u c t u r e d t r e a t m e n t programme i n v o l v i n g components o f i n s t r u c t i o n , m o d e l i n g , s o c i a l f e e d b a c k , and b e h a v i o u r a l r e h e a r s a l . T h e r a p i s t s were p r o v i d e d w i t h a manual w h i c h s p e c i f i e d t h e p r o c e d u r e t o be f o l l o w e d on a s e s s i o n by s e s s i o n b a s i s . The f i r s t s e s s i o n began w i t h a g e n e r a l i n t r o d u c t i o n and o r i e n t a t i o n t o a s s e r t i o n t r a i n i n g . I t was emphasized t h a t p e o p l e a r e not b o r n a s s e r t i v e o r u n a s s e r t i v e and t h a t a s s e r t i v e b e h a v i o u r I s a s k i l l w h i c h can be l e a r n e d l i k e any o t h e r s k i l l . F o l l o w i n g t h e o r i e n t a t i o n , c l i e n t s t o o k t u r n s d i s c u s s i n g the problems w h i c h had b r o u g h t them t o the group. They were t h e n i n s t r u c t e d t o m o n i t o r p r o b l e m a t i c s i t u a t i o n s o v e r t h e n e x t week and the s e s s i o n was a d j o u r n e d . The n e x t f o u r s e s s i o n s were b r o k e n down i n t o two p o r t i o n s . I n th e f i r s t p o r t i o n c l i e n t s were t a u g h t s t o c k r e s p o n s e s t o a s s e r t i o n s i t u -a t i o n s and n o n v e r b a l b e h a v i o u r s a s s o c i a t e d w i t h a s s e r t i o n (Lange & J a k u b o w s k i , 1976; S e r b e r , 1972). These t e c h n i q u e s and n o n v e r b a l b e h a v i o u r s were d e s c r i b e d and m o d e l l e d by t h e t h e r a p i s t s and c l i e n t s were t h e n i n s t r u c t e d t o r e h e a r s e t h e s e s k i l l s . Feedback on p e r f o r m a n c e was p r o -v i d e d by b o t h t h e t h e r a p i s t s and t h e o t h e r c l i e n t s . ( P r i n c i p l e s u n der-l y i n g t h e v a r i o u s t e c h n i q u e s were e x p l a i n e d t o the c l i e n t s , i n t h e hope t h a t t h e s e s k i l l s w ould i n t i m e g e n e r a l i z e and t h a t the a s s e r t i v e b e h a v i o u r would n o t be c o n f i n e d t o a s i m p l e r e p r o d u c t i o n o f s t o c k r e s -ponses.) The second p o r t i o n o f t h e s e s s i o n s p r o v i d e d the c l i e n t s w i t h an o p p o r t u n i t y t o r e h e a r s e a l t e r n a t i v e r e s p o n s e s t o s o c i a l s i t u a t i o n s w h i c h 34 they had found problematic between sessions. Modeling, coaching, and feedback procedures were employed i n t h i s context as well. In the s i x t h and f i n a l session, the s k i l l s and p r i n c i p l e s learned i n the preceding sessions were summarized and c l i e n t s were then asked to specify areas i n which they f e l t they had improved, as well as areas which they f e l t warranted attention i n the future. Throughout the programme, the importance of p r a c t i c i n g the s k i l l s between sessions was emphasized. Cognitive Behaviour Modification (CBM). The roots of t h i s treatment procedure were derived from the therapist manual employed by Meichenbaum i n the treatment of test anxious college students (Meichenbaum, 1972). It involved components of d i d a c t i c presentation, t r a i n i n g i n the d i s c r i -mination and systematic observation of self-statements, t r a i n i n g i n the modification of maladaptive coverants, and the implementation of coping str a t e g i e s and task-relevant self-statements. A session by session manual s i m i l a r i n form to that employed i n the s k i l l s t r a i n i n g condition was provided for the therapists. The f i r s t session commenced with a general introduction and o r i e n -t a t i o n to assertion t r a i n i n g . Here i t was emphasized that a l l i n d i v i -duals know how to behave a s s e r t i v e l y i n s o c i a l s i t u a t i o n s , but that the anxiety produced by maladaptive cognitions i n h i b i t s a s s ertive behaviour. Following the d i d a c t i c presentation and o r i e n t i n g r a t i o n a l e , c l i e n t s were asked to speak about the p a r t i c u l a r problems which had prompted them to j o i n the group. They were then asked to monitor problematic assertion s i t u a t i o n s between meetings and the session was adjourned. During the next four sessions, c l i e n t s were taught to become more 35 aware of the subjective f e e l i n g s and cognitions experiences during prob-lematic s i t u a t i o n s . Emphasis was placed upon employing subjective ex-periences of anxiety and p h y s i o l o g i c a l symptoms associated with anxiety, such as increased breathing and heart rate, and increased p e r s p i r a t i o n , as cues that maladaptive cognitions or negative self-statements were occurring. Once they were able to i d e n t i f y t h e i r own negative s e l f -statements, c l i e n t s were taught to replace them with more adaptive s e l f -statements. A standard procedure was modelled and rehearsed, whereby the sub-j e c t i v e experience of discomfort would cue the u t i l i z a t i o n of a cogni-t i v e coping strategy. This involved: 1. Monitoring the subjective experience of anxiety. 2. I d e n t i f y i n g the negative self-statements. 3. S e l f - i n s t r u c t i n g not to panic, but rather to breathe slowly, to relax, and not to f e e l compelled to act immediately. C l i e n t s were encouraged not to f e e l overwhelmed.by problematic s i t u a t i o n s , but rather to think of them as opportunities to employ the coping s k i l l s they has rehearsed i n the therapy sessions. A. Implementing the adaptive self-statements modelled and rehearsed i n therapy sessions. These included a number of strategies compiled for the programme: a. Task relevant. This strategy consisted of focusing upon be-havioural a l t e r n a t i v e s which might p o t e n t i a l l y be employed to deal with the immediate s i t u a t i o n , instead of ruminating upon possible disasterous repercussions. b. Externally oriented. This cognitive strategy involved refocusing 36 attention from anxiety provoking s e l f - r e f e r r i n g ruminations to the other people i n the s i t u a t i o n . C l i e n t s were trained to become aware of the extent to which Other people are experiencing discomfort or confusion i n a s o c i a l s i t u a t i o n , rather than to automatically a t t r i b u t e confidence or c r i t i c a l intentions to them. The underlying p r i n c i p l e for the strategy comes from ob-servations that anxious i n d i v i d u a l s are characterized by rumi-native, s e l f - r e f e r r i n g c r i t i c a l thought (Wine, 1970) and obser-vations i n p i l o t work that s o c i a l l y anxious i n d i v i d u a l s tend to underestimate t h e i r own s o c i a l s k i l l s and to overestimate the s k i l l s of others. c. Challenging. The challenging strategy involved r a t i o n a l l y ex-amining the negative self-statements to evaluate the extent to which they are r e a l i s t i c . d. P o s i t i v e . P o s i t i v e self-statements were somewhat s i m i l a r to challenging statements, but were distinguished by the i n s t r u c -t i o n to focus upon the p o s i t i v e c h a r a c t e r i s t i c s which are possessed by the i n d i v i d u a l , and to r e c a l l s i t u a t i o n s where s o c i a l i n t e r -actions has been negotiated e f f e c t i v e l y . e. Exaggerating negative self-statements. This was presented to c l i e n t s as a technique to aid them i n seeing the i n v a l i d i t y of some of the negative s e l f - a t t r i b u t i o n s and catastrophizing cognitions, by exaggerating the negative self-statements to the point where they become transparently absurd. It was also em-ployed as a means of obtaining a greater awareness of maladaptive cognitions which were not immediately obvious. For example: i n 37 a s i t u a t i o n where a c l i e n t was not a b l e t o p i n p o i n t a n e g a t i v e s e l f - ^ s t a t e m e n t when t h i n k i n g o f the s i t u a t i o n i n r e t r o s p e c t , t h e t h e r a p i s t might i n s t r u c t him: "Even i f y o u ' r e not aware o f a n e g a t i v e s e l f - s t a t e m e n t when t h i n k i n g o f t h e s i t u a t i o n i n r e t r o -s p e c t , what i s t h e most n e g a t i v e , a n x i e t y p r o d u c i n g t h o u g h t a p e r s o n might be t h i n k i n g i n t h i s s i t u a t i o n ? " f . R e i n f o r c i n g s e l f - s t a t e m e n t s . Emphasis was p l a c e d here on the itnperfcanee e f e e v e r t l y r e w a r d i n g o n e s e l f f a r any t h e r a p e u t i c g a i n s , no m a t t e r how s m a l l . The impetus f o r e m p l o y i n g t h i s p r o -c e d u r e stems from t h e c l i n i c a l o b s e r v a t i o n t h a t c l i e n t s o f t e n r e t a r d t h e i r own p r o g r e s s by f a i l i n g t o n o t i c e r e a l , b u t s m a l l , s t e p s towards t h e i r o b j e c t i v e s w h i c h a r e t a k i n g p l a c e . The r e s u l t can be a c o u n t e r t h e r a p e u t i c p e r c e p t i o n o f f a i l u r e , where i n r e a l i t y some p r o g r e s s has been made. A second o r i g i n o f t h e p r o c e d u r e i s i n the o b s e r v a t i o n t h a t d e p r e s s e d and s o c i a l l y a n x i o u s i n d i v i d u a l s a r e o f t e n c h a r a c t e r i z e d by a low f r e q u e n c y o f s e l f - r e i n f o r c e m e n t (Rehm, 1977). These s i x c o g n i t i v e s t r a t e g i e s were p r e s e n t e d t o the c l i e n t s as examples o f s e l f - s t a t e m e n t s t h e y m i g h t employ t o m o d i f y t h e i r c o g n i t i o n s i n an a d a p t i v e f a s h i o n . I t was emphasized t h a t the s t r a t e g y t y p e s had been b r o k e n down i n t o c a t e g o r i e s p r i m a r i l y t o f a c i l i t a t e t e a c h i n g and r e c a l l , and t h a t i n f a c t , a t any p o i n t i n time t h e y c o u l d employ one of t h e s t r a t e g i e s o r any c o m b i n a t i o n o f them. They were f u r t h e r i n s t r u c t e d t o become aware o f and t o r e c o r d t y p e s o f n e g a t i v e s e l f - s t a t e m e n t s w h i c h were p a r t i c u l a r l y c h a r a c t e r i s t i c o f them, as w e l l as a d a p t i v e s e l f - s t a t e -ments w h i c h t h e y f o u n d t o be p a r t i c u l a r l y e f f e c t i v e . 38 Although various adaptive self-statements were modelled by thera-p i s t s i n the group, c l i e n t s were encouraged to develop t h e i r own s e l f -statements and to express them i n words which were meaningful to them. As i n the s k i l l s t r a i n i n g condition, the importance of p r a c t i c i n g newly acquired s k i l l s i n vivo between sessions was emphasized. The f i n a l session, once again, was p r i m a r i l y devoted to summarizing the key p r i n c i p l e s which had emerged and to having c l i e n t s . i d e n t i f y progress which had been made, problem areas l e f t to work on, and s p e c i f i c procedures for promoting maintenance and ge n e r a l i z a t i o n of therapeutic gain. Subject Assignment The treatment groups were run i n s i x sections: three ST sections and three CBM sections. This d i v i s i o n into sections was designed to optimize the c l i e n t to therapist r a t i o , as i t was f e l t that having more than s i x members to a group would d i l u t e treatment e f f e c t s . A f t e r the i n i t i a l assessment, subjects were categorized into high and low anxiety groups. The median score (101) on the discomfort scale from the Gambrill and Richey Assertion Inventory provided the c r i t e r i o n f o r d i -chotomization. Subjects within each anxiety group were then randomly assigned to ei t h e r the ST or the CBM treatment condition. Subsequently, subjects within each treatment condition were randomly assigned to one of three sections, subject to the constraint of scheduling problems. The f i n a l sample siz e a f t e r subject a t t r i t i o n was 30. Therapists Each section was led by two co-therapists. Therapists were s i x 39 p s y c h o l o g y g r a d u a t e s t u d e n t s and two p s y c h o l o g y honours s t u d e n t s w i t h c l i n i c a l e x p e r i e n c e r a n g i n g from two months t o one and o n e - h a l f y e a r s . A l l t h e r a p i s t s p a r t i c i p a t e d i n a two month t r a i n i n g workshop d i r e c t e d by a Ph.D. c l i n i c a l p s y c h o l o g i s t . I n a d d i t i o n , t h e y were s u p e r -v i s e d on a s e s s i o n by s e s s i o n b a s i s , u s i n g a u d i o r e c o r d i n g s of t h e r a p y s e s s i o n s t o p r o v i d e a b a s i s f o r c l i n i c a l s u p e r v i s i o n and t o e n s u r e t h a t s e s s i o n s were p r o c e e d i n g as p l a n n e d . The a u t h o r s e r v e d as a t h e r a p i s t i n one ST s e c t i o n and one CBM s e c t i o n i n o r d e r t o o b t a i n f i r s t hand e x p e r i e n c e o f any t h e r a p e u t i c o r r e s e a r c h - p r o c e d u r a l p r o b l e m e n c o u n t e r e d i n a c t u a l t h e r a p y s e s s i o n s , w h i l e the Ph.D. l e v e l p s y c h o l o g i s t s e r v e d as a t h e r a p i s t i n one o f the CBM s e c t i o n s . An a t t e m p t was made t o b a l a n c e t h e r a p i s t s between c o n d i -t i o n s w i t h r e s p e c t t o l e v e l s o f e x p e r t i s e . D i f f e r e n c e s i n t r e a t m e n t e f f i c a c y due t o i n d i v i d u a l t h e r a p i s t s were a s s e s s e d i n d e p e n d e n t l y . Assessment A p r e - t h e r a p y assessment s e s s i o n was h e l d one t o two weeks p r i o r t o t h e commencement o f t r e a t m e n t , w h i l e p o s t - t h e r a p y assessment was c o n d u c t e d one week a f t e r t r e a t m e n t had c o n c l u d e d . Dependent Measures B e h a v i o u r a l . A l l s u b j e c t s r o l e p l a y e d n i n e i n t e r p e r s o n a l s i t u a t i o n s c a l l i n g f o r a s s e r t i v e r e s p o n s e s w h i c h were based upon i t e m s i n the G a m b r i l l and R i c h e y A s s e r t i o n I n v e n t o r y and t h e M c F a l l C o n f l i c t R e s o l u -t i o n I n v e n t o r y . As N e i t z e l , M a r t o r a n o , and M e l n i c k (1977) have o b s e r v e d , a c o n s i s t e n t s h o r t c o m i n g o f a s s e r t i o n t r a i n i n g programmes i s a f a i l u r e t o t r a i n 40 c l i e n t s to deal with noncompliant responses to t h e i r own assertion. A s p e c i f i c concern i n the present study was one of devising an assessment instrument s e n s i t i v e enough to d i f f e r e n t i a t e between i n d i v i d u a l s with well established assertive behaviour and i n d i v i d u a l s with response re-petoires of a more f r a g i l e nature. Galassi and Galassi (1976) report that v a r i a t i o n s i n r o l e playing procedures have important implications f o r r e s u l t s obtained and that compliance rate i n unassertive subjects increases markedly when subjected to successive s o c i a l demands rather than a si n g l e request. For these reasons, experimenters were instruc t e d to follow subject responses i n each s i t u a t i o n with a standard set of responses, prolonging the i n t e r a c t i o n u n t i l e i t h e r three a s s e r t i v e responses were obtained or the subject complied. It was reasoned that an assessment procedure of t h i s type would provide a better simulation of r e a l s o c i a l s i t u a t i o n s where responses are i n t e r a c t i o n a l i n nature, rather than d i s c r e t e . These i n t e r a c t i o n s were videotaped and subsequently rated by two psycho-logy graduate students along seven dimensions: eye contact, voice volume, body expression, anxiety, aggression, compliance, and global assertion. The two raters p a r t i c i p a t e d i n a t r a i n i n g workshop and were provided with a r a t i n g manual. S e l f - r e p o r t . a. Fear thermometer. Aft e r each r o l e playing s i t u a t i o n , subjects were instructed to rate on a ten point scale, the degree of anxiety experienced during that i n t e r a c t i o n . b. S o c i a l Avoidance and Distress Scale. This instrument provides a single index of d i s t r e s s i n s o c i a l s i t u a t i o n s (Watson & Friend, 1969). 41 The Assertion Inventory (Gambrill & Richey, 1975). This inventory includes a s e l f - r e p o r t index of both response p r o b a b i l i t y and degree of discomfort for f o r t y assertion s i t u a t i o n s . Tennessee Self Concept Scale ( F i t t s , 1965). This instrument has been standardized on a general population sample of 626 i n d i v i d u a l s , and provides a multidimensional assessment of s e l f concept. It i n -cludes a t o t a l P score of o v e r a l l self-esteem, and eight subscales which were established i n i t i a l l y on the basis of face v a l i d i t y of items of which they are composed. The eight subscores are: i d e n t i t y , s e l f - s a t i s f a c t i o n , behaviour, p h y s i c a l s e l f , moral-ethical s e l f , personal s e l f , family s e l f , and s o c i a l s e l f . A group s a t i s f a c t i o n questionnaire was administered at post-assess-ment only. This contained f i v e items r e l a t i n g to perceived warmth, empathy, and competence of therapists. It was administered to evaluate the extent to which d i f f e r e n t i a l demand c h a r a c t e r i s t i c s were operating between conditions, as well as to evaluate the pre-sence of therapist x treatment i n t e r a c t i o n s . 42 RESULTS . . D e s c r i p t i v e Data On the A s s e r t i o n I n v e n t o r y p r i o r t o t r e a t m e n t , t h e mean s c o r e on d i s c o m f o r t f o r a l l s u b j e c t s combined was 105.25 and the s t a n d a r d d e v i -a t i o n was 18.33. The mean s c o r e and s t a n d a r d d e v i a t i o n on r e s p o n s e p r o b a b i l i t y were 113.04 and 14.80, r e s p e c t i v e l y . T a b l e 1 p r o v i d e s com-p a r i s o n s w i t h the s c o r e s o f 313 males and fe m a l e s sampled from a C a l i -f o r n i a g e n e r a l c o l l e g e p o p u l a t i o n and a sample o f 19 C a l i f o r n i a women who were a s s e s s e d p r i o r t o p a r t i c i p a t i o n i n a s i x week a s s e r t i o n t r a i n i n g programme ( G a m b r i l l & R i c h e y , 1975). The aver a g e s u b j e c t i n t h e c u r r e n t s t u d y tended t o r e p o r t g r e a t e r d i s c o m f o r t t h a n h i s c o u n t e r p a r t i n t h e g e n e r a l sample (95.61) and a p p r o x i m a t e l y e q u i v a l e n t d i s c o m f o r t t o the avera g e s u b j e c t s e e k i n g a s s e r t i o n t r a i n i n g ( 1 0 7 . 7 ) . P r o b a b i l i t y o f a s s e r t i v e r e s p o n s e t e n d e d t o be l e s s t h a n i t was f o r b o t h s u b j e c t s f r o m t h e g e n e r a l c o l l e g e p o p u l a t i o n (104.3) and the a v e r a g e s u b j e c t s e e k i n g a s s e r t i o n t r a i n i n g ( 1 0 4 . 8 ) . T a b l e 2 d i v i d e s the s u b j e c t s i n t o f o u r c a t e g o r i e s b o t h p r i o r t o and f o l l o w i n g a s s e r t i o n t r a i n i n g . These were e s t a b l i s h e d by G a m b r i l l and R i c h e y (1975) on the b a s i s o f the norms f o r t h e g e n e r a l c o l l e g e p o p u l a -t i o n and a r e c o n s t i t u t e d by f o u r d i f f e r e n t c o m b i n a t i o n s o f d i s c o m f o r t and r e s p o n s e p r o b a b i l i t y : (1) h i g h d i s c o m f o r t - l o w r e s p o n s e p r o b a b i l i t y ( l a b e l l e d u n a s s e r t i v e ) , (2) h i g h d i s c o m f o r t - h i g h r e s p o n s e p r o b a b i l i t y ( l a b e l l e d a n x i o u s p e r f o r m e r ) , (3) low d i s c o m f o r t - l o w r e s p o n s e p r o b a b i l i t y ( l a b e l l e d d o e s n ' t c a r e ) , (4) l o w d i s c o m f o r t - h i g h r e s p o n s e p r o b a b i l i t y ( l a b e l l e d a s s e r t i v e ) . 43 Table 1 Means and Standard Deviations of Discomfort and Response P r o b a b i l i t y Scores on the Assertion Inventory Mean Mean Response Discomfort S.D. P r o b a b i l i t y 1 S.D. Current Sample 28 General College Sample* 313 * C l i n i c a l Sample 19 105.25 95.61 107.7 18.33 19.93 22.37 113.04 104.30 104.8 14.79 15.70 22.55 from Gambrill and Richey (1975) Response p r o b a b i l i t y i s an inverted scale, with 1 i n d i c a t i n g high response p r o b a b i l i t y and 5 i n d i c a t i n g low response p r o b a b i l i t y . T a b l e 2 G e n e r a l C l i n i c a l Sample ( G a m b r i l l & R i c h e y , 1975) Response P r o b a b i l i t y D i s c o m f o r t Low (105+) H i g h (104-) T o t a l s j ' • I \ ! • I j H i g h i u n a s s e r t i v e a n x i o u s -• ' . | p e r f o r m e r , (96+) ! I l l (35%) 35 (11%) ; 146 (46%) Low i doesn't c a r e a s s e r t i v e (95-) 55 (18%) 112 (36%) !167 (54%) T o t a l s 166 (53%) 147 (47%) c o n t i n u e d 45 Table 2 continued Comparison of Current Sample and C l i n i c a l Sample (Gambrill & Richey, 1975) Before Before Current Sample C l i n i c a l Sample (Gambrill & Richey, 1975) Response P r o b a b i l i t y j Response P r o b a b i l i t y Discomfort Low (105+) High (104-) Totals j Low (105+) High (104-) Totals High (96+) 18(64%) 3(11%) 21(75%) j 9(47%) 5(26%) 14(23%) Low (95-) 5(18%) 2(7%) 7(25%) ! 0 5(26%) 5(26%) Totals 23(82%) 5(18%) 9(47%) 10(53% A f t e r After High (96+) 7(25%) 2(7%) 9(32%) j 2(11%) 3(16%) 5(27%) Low (95-) 3(11%) 16(57%) 19(58%) J 1(5%) 13(38%) 14(73%) Totals 10(36%) 18(64%) i 3(16%) 16(84%) 46 I n t h e p r e s e n t s t u d y , p r i o r t o t r e a t m e n t , a g r e a t e r p r o p o r t i o n o f the s u b j e c t s (64%) f e l l i n t o t h e u n a s s e r t i v e c a t e g o r y t h a n d i d i n t h e g e n e r a l sample ( 3 5 % ) . F u r t h e r m o r e , they exceeded the p r o p o r t i o n o f sub-j e c t s f a l l i n g i n t o t he u n a s s e r t i v e c a t e g o r y p r i o r t o t r e a t m e n t i n t h e c l i n i c a l sample ( 4 7 % ) . A f t e r t r e a t m e n t , t h i s p r o p o r t i o n was r e d u c e d t o 25% i n t h e c u r r e n t s t u d y and t o 11% i n the G a m b r i l l and R i c h e y s t u d y (an a p p r o x i m a t e l y e q u i v a l e n t r e d u c t i o n ) . The p r o p o r t i o n o f s u b j e c t s f a l l i n g i n t o t h e a s s e r t i v e c a t e g o r y i n the g e n e r a l p o p u l a t i o n was 36%. P r i o r t o t r e a t m e n t , t h e p r o p o r t i o n o f s u b j e c t s f a l l i n g i n t o t h i s c a t e g o r y was 18% i n t h e c u r r e n t s t u d y and 53% i n t h e c l i n i c a l sample. F o l l o w i n g t r e a t m e n t , the p r o p o r t i o n o f sub-j e c t s i n t h i s c a t e g o r y was i n c r e a s e d t o 64% i n t h e c u r r e n t s t u d y and 84% i n G a m b r i l l and R i c h e y ' s c l i n i c a l sample, t h u s b o t h e x c e e d i n g t h e p r o p o r -t i o n o f " a s s e r t i v e " s u b j e c t s i n t h e g e n e r a l sample. P r i o r t o t r e a t m e n t , 11% o f t h e c u r r e n t sample were what G a m b r i l l and R i c h e y l a b e l " a n x i o u s performers." ( i . e . , h i g h r e s p o n s e p r o b a b i l i t y p a i r e d w i t h h i g h d i s c o m f o r t ) . T h i s i s e q u i v a l e n t t o t h e p r o p o r t i o n o f " a n x i o u s p e r f o r m e r s " f ound i n t h e g e n e r a l p o p u l a t i o n , b u t l e s s t h a n t h a t f ound i n t h e c l i n i c a l sample p r i o r t o t r e a t m e n t . The d i s c r e p a n c y h e r e between t h e two c l i n i c a l p o p u l a t i o n s may be a c c o u n t e d f o r by t h e f a c t t h a t G a m b r i l l and R i c h e y ' s c l i n i c a l sample i s composed e n t i r e l y o f women. I n t h i s c u l t u r e , a s s e r t i v e b e h a v i o u r may t r a d i t i o n a l l y be l e s s a c c e p t a b l e f o r women t h a n f o r men and t h u s a s s o c i a t e d w i t h more d i s c o m -f o r t f o r f e m a l e s . F o l l o w i n g t r e a t m e n t , t h i s p r o p o r t i o n was r e d u c e d t o 7% i n t h e c u r r e n t sample and 16% i n the female c l i n i c a l sample. F i n a l l y , t he p r o p o r t i o n o f s u b j e c t s p r i o r t o t r e a t m e n t i n t h e 47 "doesn't care" category was 18% i n the present study and 0% i n Gambrill and Richey's sample. This compares with 18% found i n the general popu-l a t i o n . Following treatment, the proportion was reduced to 11% i n the present study and remained v i r t u a l l y the same, at 1% i n Gambrill and Richey's sample. It i s l i k e l y that the reduction i n t h i s proportion resulted from an increase i n p r o b a b i l i t y of response. The fact that the proportion of "doesn't care" subjects seeking treatment i n the present study equalled the proportion i n the general population sample i s noteworthy. It suggests the p o s s i b i l i t y that some subjects sought assertion t r a i n i n g as much out of i n t e r e s t ' s sake than r e a l discomfort i n s o c i a l s i t u a t i o n s . R e l i a b i l i t y and V a l i d i t y of Behavioural Ratings A randomly selected subset of videotaped s i t u a t i o n s were rated independently by both raters to provide the basis for a r e l i a b i l i t y assess-ment. Pearson r_ c o r r e l a t i o n s were computed and r e l i a b i l i t y c o e f f i c i e n t s for the seven behavioural dimensions were: eye contact, r_ = .88; body expression, r_ = .90; voice volume, r_ = .90; anxiety, r_ = .83; aggression, _r = .79; a s s e r t i o n , ±_ = .93; and compliance, r_ = 1.00. The behavioural dimensions employed i n the current study were selected on the basis of empirical findings regarding behaviours associated with a s s e r t i o n i n p s y c h i a t r i c patients ( E i s l e r , M i l l e r , & Hersen, 1973), as well as from suggestions i n the l i t e r a t u r e regarding appropriate behavioural targets for assertion t r a i n i n g ( A l b e r t i & Emmons, 1974; Bower & Bower, 1976). To date, however, there has been minimal success i n e m p i r i c a l l y e s t a b l i s h i n g behavioural dimensions which w i l l d i s t i n g u i s h 48 between s o c i a l l y s k i l l e d and s o c i a l l y u n s k i l l e d i n d i v i d u a l s i n a non-p s y c h i a t r i c p o p u l a t i o n (Glasgow & A r k o w i t z , 1975). I n o r d e r t o e s t a b l i s h t h e v a l i d i t y o f t h e c u r r e n t b e h a v i o u r a l measures, s u b j e c t s were c a t e g o r i z e d i n t o low and h i g h a s s e r t i v e g r o u p s , on t h e b a s i s o f b e h a v i o u r a l r a t i n g s o f a s s e r t i o n p r i o r t o t r e a t m e n t . The median (2.65) was used as a c u t t i n g p o i n t . These groups were sub-s e q u e n t l y c o n t r a s t e d , u s i n g one-way ANOVAs on the s i x r e m a i n i n g be-h a v i o u r a l measures. The two groups were f o u n d t o be s i g n i f i c a n t l y d i f f e r e n t on f o u r o f t h e s i x b e h a v i o u r a l measures: c o m p l i a n c e , !F(1,26) = 7.87, 2. < .01; eye c o n t a c t , _F(1,26) = 26.05; body e x p r e s s i o n , F ( l , 2 6 ) = 20.04; p < .001; and a n x i e t y , F ( l , 2 6 ) = 22.65, £ < .001. V o i c e volume and a g g r e s s i o n d i d n o t d i s t i n g u i s h between t h e two groups (see T a b l e 3 ) . I n a d d i t i o n , s u b j e c t s were d i v i d e d i n t o h i g h and low a n x i e t y groups on t h e b a s i s o f extreme s c o r e s on s u b j e c t i v e r a t i n g s o f d i s c o m f o r t d u r i n g r o l e p l a y i n g s i t u a t i o n s p r i o r t o t r e a t m e n t . These two groups were c o n -t r a s t e d w i t h one way ANOVAs and were found t o be s i g n i f i c a n t l y d i f f e r e n t on t h e f o l l o w i n g b e h a v i o u r a l measures eye c o n t a c t , F ( l , 1 9 ) = 1 1 . 6 7 , p < .01; body e x p r e s s i o n , F ( l , 1 9 ) = 6.20, p_ < .05; a n x i e t y , F ( l , 1 9 ) = 8.20, P_ < .01; and a s s e r t i o n , F_(l,19) = 8.44, p_ < .01. C o m p l i a n c e , v o i c e volume, and a g g r e s s i o n f a i l e d t o d i s t i n g u i s h between t h e two s e l f - r e p o r t a n x i e t y groups (see T a b l e 4 ) . T a b l e 5 c o n t a i n s t h e c o r r e l a t i o n m a t r i x f o r t h e seven b e h a v i o u r a l measures. The c o r r e l a t i o n s between g l o b a l a s s e r t i o n and b o t h v o i c e volume and a g g r e s s i o n a r e c o n s p i c u o u s l y low (.17 and .30, r e s p e c t i v e l y ) . I n c o n t r a s t , the c o r r e l a t i o n s o f t h e r e m a i n i n g b e h a v i o u r a l measures w i t h 49 Table 3 Means and Standard Deviations for Low and High Anxiety Behavioural Assertion Categories on Behavioural Measures Low Assertion High Assertion Variable Mean S.D. Mean S.D. F Assertion 2. 06 0. 39 3. 06 0. 34 51. 46***** Compliance 2. 47 0. 45 2. ,86 0. 25 7. 87** Anxiety 2. ,11 0. 53 2. ,95 0. 38 22. , 65***** Aggression 3. ,29 0. .50 3. .50 0. 43 1. .47 Eye Contact 2. ,14 0. ,41 2. .81 o. 26 26. ,06***** Body Expression 2. .02 0. ,49 2, .78 0. 41 20. ,04***** Voice Volume 2. .53 0, .44 2, .78 0. 35 2, .74 £ < .05 £ < .01 p_ < .005 **** p_ < .001 p_ < .0001 50 T a b l e 4 Means and S t a n d a r d D e v i a t i o n s f o r Low and H i g h S e l f - P e r c e i v e d A n x i e t y D u r i n g R o l e P l a y C a t e g o r i e s on B e h a v i o u r a l Measures V a r i a b l e LOw A n x i e t y Mean S.D. H i g h A n x i e t y Mean S.D. A s s e r t i o n C o m p l i a n c e A n x i e t y A g g r e s s i o n Eye C o n t a c t Body E x p r e s s i o n V o i c e Volume 2.95 2.87 2.98 3.47 2.81 2.77 2.82 0.53 0.22 0.39 0.39 0.21 0.36 0.37 2.19 2.60 2.23 3.19 2. 18 2.14 2.66 0.66 0.14 0.74 0.57 0.55 0.73 0.43 8.44**** 2.67 8.20** 1.67 11.67*** 6.20* 0.80 p < .05 ** p < .01 *** p_ < .005 **** p_'< .001 k k k k k £ < .0001 T a b l e 5 C o r r e l a t i o n M a t r i x f o r B e h a v i o u r a l Measures' C o m p l i a n c e Eye C o n t a c t Body E x p r e s s i o n V o i c e Volume A n x i e t y A g g r e s s i o n A s s e r t i o n C o m pliance Eye C o n t a c t Body E x p r e s s i o n V o i c e Volume A n x i e t y A g g r e s s i o n A s s e r t i o n .59 .44 .83 .18 .05 .14 .53 .84 .94 .26 • 16 .17 .04 -.27 -.10 .63 .84 .86 .17 .86 .30 N = 28 52 g l o b a l a s s e r t i o n a r e q u i t e h i g h ( r a n g i n g from .63 t o . 8 6 ) . B o t h v o i c e volume and a g g r e s s i o n c o r r e l a t e p o o r l y w i t h t h e r e m a i n i n g b e h a v i o u r a l measures as w e l l ( v o i c e volume r a n g e s from .05 t o .26, w h i l e a g g r e s s i o n r a n g e d f r o m .04 t o .27). The above a n a l y s e s p r o v i d e some s u p p o r t f o r t h e c o n s t r u c t v a l i d i t y o f the b e h a v i o u r a l measures. The f a c t t h a t v o i c e volume c o n s i s t e n t l y f a i l e d t o d i s t i n g u i s h between groups d e s p i t e i t s s u c c e s s i n t h i s r e s p e c t w i t h a p s y c h i a t r i c p o p u l a t i o n ( E i s l e r , M i l l e r , & H e r s e n , 1973), s u g g e s t s t h a t i t s v a l u e as a dependent measure may be l i m i t e d t o a more h i g h l y i m p a i r e d p o p u l a t i o n . The i m p o r t a n c e o f d i s t i n g u i s h i n g between a s s e r t i o n and a g g r e s -s i o n has been c o n s i s t e n t l y emphasized i n t h e l i t e r a t u r e ( H o l l a n d s w o r t h , 1977; A l b e r t i , 1977). The c u r r e n t i n v e s t i g a t i o n , h o w e v e r , has f a i l e d t o d i s t i n g u i s h between i n d i v i d u a l s who a r e r a t e d as low and h i g h a s s e r t i v e s i n t h i s r e s p e c t . T h i s f a i l u r e may r e f l e c t t h e i n s e n s i t i v i t y o r i n a p p r o p r i a t e n e s s o f t h e g u i d e l i n e s employed t o e v a l u a t e a g g r e s s i o n (Appendix V) i n t h e p r e s e n t s t u d y , o r the f a c t t h a t t h e c u r r e n t sample was not c h a r a c t e r i z e d by much v a r i a n c e i n a g g r e s s i v e b e h a v i o u r . The o b s e r v a t i o n s o f group l e a d e r s t h a t few group members tended t o behave v e r y a g g r e s s i v e l y i s c o m p a t i b l e w i t h the l a t t e r h y p o t h e s i s . An i m p o r t a n t q u a l i f i c a t i o n i n i n t e r p r e t a t i o n of t h e above f i n d i n g s i s t h a t a l l o f t h e s u b j e c t s were s e e k i n g a s s e r t i o n t r a i n i n g and t h e r e s u l t i n g d i s t r i b u t i o n o f c r i t e r i o n s c o r e s employed f o r c a t e g o r i z a -t i o n i s c o n s e q u e n t l y skewed towards the u n a s s e r t i v e end. I t i s w o r t h n o t i n g , however, t h a t even w i t h i n t h i s t r u n c a t e d d i s t r i b u t i o n , t h e 53 b e h a v i o u r a l measures p o s s e s s e d some d i s c r i m i n a t i n g u t i l i t y . N o n s p e c i f i c F a c t o r s D u r i n g p o s t a s s e s s m e n t a f i v e i t e m group s a t i s f a c t i o n q u e s t i o n -n a i r e was a d m i n i s t e r e d t o p r o v i d e some e v a l u a t i o n f o r t h e p r e s e n c e of d i f f e r e n t i a l t h e r a p e u t i c n o n s p e c i f i c f a c t o r s w i t h i n c o g n i t i v e and s k i l l s t r a i n i n g g r oups. S u b j e c t s r e s p onded t o t h e f o l l o w i n g q u e s t i o n s on a f i v e p o i n t s c a l e , a n c h o red on one end w i t h "not v e r y " and t h e o t h e r end w i t h " e x t r e m e l y " : 1. How s k i l l e d were y o u r c o - l e a d e r s as t h e r a p i s t s ? 2. How warm do you f e e l y o u r l e a d e r s were to w a r d s group members? 3. How u n d e r s t a n d i n g were y o u r l e a d e r s o f group members' problems and f e e l i n g s ? 4. How s a t i s f i e d were you w i t h y o u r group? 5. How l i k e l y i s i t t h a t you w i l l use t h e t e c h n i q u e s you have l e a r n e d ? One way ANOVAs were employed t o c o n t r a s t c o g n i t i v e and s k i l l s t r a i n i n g t r e a t m e n t c o n d i t i o n s on t h e b a s i s o f r e s p o n s e s t o t h e f i v e q u e s t i o n s . There were no s i g n i f i c a n t d i f f e r e n c e s between the two t r e a t m e n t c o n d i t i o n s on q u e s t i o n s 1, 4, and 5. Thus s u b j e c t s i n c o g n i t i v e and s k i l l s t r a i n i n g c o n d i t i o n s p e r c e i v e d t h e i r t h e r a p i s t s as e q u a l l y s k i l l f u l , were e q u a l l y s a t i s f i e d w i t h t h e i r g r o u p s , and had e q u a l i n t e n t i o n s o f u s i n g t h e t e c h n i q u e s t h e y had l e a r n e d . S u b j e c t s i n s k i l l s t r a i n i n g groups saw t h e i r t h e r a p i s t s as s i g n i f i c a n t l y warmer, F_(l,24) = 5.25, p_ < -05, and more u n d e r s t a n d i n g , J£(l,24) = 5.65, p_ < .05, t h a n d i d s u b j e c t s i n t h e c o g n i t i v e c o n d i t i o n . 54 Since therapists were not crossed with treatment conditions, i t i s d i f f i c u l t to evaluate the r e l a t i v e influences on t h i s discrepancy of i n d i v i d u a l therapist differences versus c h a r a c t e r i s t i c s inherent i n the treatment modalities. The subjective experiences of the group leaders themselves suggested a tendency to f e e l more comfortable and confident implementing s k i l l s t r a i n i n g rather than cognitive pro-cedures, which they perceived to be l e s s structured or procedurally les s clear-cut. This factor may have resulted i n increased confidence and hence increased demonstration of warmth and empathy. A second possible f a c t o r i s that the format of the s k i l l s t r a i n i n g condition provided more opportunity for d i r e c t therapist feedback to c l i e n t s on s p e c i f i c behaviours; whereas the cognitive therapists, f or methodological reasons, were not allowed to provide s p e c i f i c behavioural feedback and coaching. It was not uncommon i n supervision sessions for therapists to report that a c l i e n t had appeared to become f r u s t r a t e d when such feedback was not forthcoming. Table 6 contains the c o r r e l a t i o n matrix for the f i v e items on the group s a t i s f a c t i o n questionnaire. A l l items are s i g n i f i c a n t l y p o s i t i v e l y correlated with the exception of the f i n a l item which correlates s i g n i f i c a n t l y with general s a t i s f a c t i o n . The item which correlates highest with general s a t i s f a c t i o n i s perception of thera-p i s t competence, while the item which correlates highest with inten-t i o n to use the techniques i s general s a t i s f a c t i o n . F a c t o r i a l Analysis of Variance Two subjects were randomly dropped from the high anxiety x s k i l l s T a b l e 6 C o r r e l a t i o n M a t r i x f o r Group S a t i s f a c t i o n Items T h e r a p i s t T h e r a p i s t T h e r a p i s t G e n e r a l I n t e n t i o n to S k i l l Warmth U n d e r s t a n d i n g S a t i s f a c t i o n Use Techniques T o t a l 1 T o t a l 2 T h e r a p i s t S k i l l ,34 .54 19 ,66 78 T h e r a p i s t Warmth ,73 ,38 ,00 .48 T h e r a p i s t U n d e r s t a n d i n g ,33 .04 .54 .73 G e n e r a l S a t i s f a c t i o n ,35 73 79 I n t e n t i o n t o Use T e c h n i q u e s T o t a l 1 T o t a l 2 .54 ,22 ,80 T o t a l 1 = t o t a l s c o r e w i t h q u e s t i o n 5 i n c l u d e d T o t a l 2 = t o t a l s c o r e w i t h q u e s t i o n 5 e x c l u d e d 56 t r a i n i n g t r e a t m e n t c o n d i t i o n p r i o r t o a n a l y s i s i n o r d e r t o ap p r o a c h p r o p o r t i o n a l i t y o f c e l l s f o r f a c t o r i a l ANOVA (Weiner, 1970). The f i n a l N was t h u s 28, w i t h an n o f 7 s u b j e c t s p e r c e l l . Adequacy of i n i t i a l random assignment o f s u b j e c t s was a s s e s s e d v i a 2 x 2 ( t r e a t -ment x a n x i e t y ) ANOVAs on t h e p r e assessment s c o r e s . These a n a l y s e s r e v e a l e d t h a t p r i o r t o t r e a t m e n t t h e r e were no s i g n i f i c a n t main e f f e c t s f o r t r e a t m e n t c o n d i t i o n , and no s i g n i f i c a n t t r e a t m e n t c o n d i -t i o n x a n x i e t y l e v e l i n t e r a c t i o n s . S i n c e adequacy o f i n i t i a l random a s s i g n m e n t had been c o n f i r m e d s t a t i s t i c a l l y , a l l subsequent a n a l y s e s were con d u c t e d on p o s t a s s e s s -ment s c o r e s , once a g a i n e m p l o y i n g 2 x 2 AVOVAs. A n a l y s i s o f P o s t S c o r e s a. S e l f - r e p o r t measures. There were no s i g n i f i c a n t main e f f e c t s f o r t r e a t m e n t c o n d i t i o n s on any o f t h e s e l f - r e p o r t measures. T r e a t -ment x a n x i e t y i n t e r a c t i o n s a p proached s i g n i f i c a n c e on s e l f c o n c e p t , F ( l , 2 4 ) = 3.12, £ < .10. b. B e h a v i o u r a l measures. None o f t h e b e h a v i o u r a l d i m e n s i o n s r a t e s y i e l d e d s i g n i f i c a n t t r eatment, main e f f e c t s . The t r e a t m e n t x a n x i e t y i n t e r a c t i o n was s i g n i f i c a n t f o r body e x p r e s s i o n , J / ( l , 2 4 ) = 4.03, £ < .05, and approached s i g n i f i c a n c e f o r g l o b a l a n x i e t y , F ( l , 2 4 ) = 3.21, £ < . 10. A n a l y s i s o f S i m p l e E f f e c t s ( S t a t i s t i c a l ) S i n c e a p r i o r i h y p o t h e s e s were f o r m u l a t e d as t o t h e n a t u r e o f t h e i n t e r a c t i o n s , a n a l y s e s o f s i m p l e e f f e c t s on p o s t assessment s c o r e s were c o n d u c t e d v i a a s e r i e s o f t w o - t a i l e d p l a n n e d o r t h o g o n a l c o n t r a s t s 57 between c o g n i t i v e and s k i l l s t r a i n i n g t r e a t m e n t c o n d i t i o n s f o r (1) low a n x i e t y s u b j e c t s and (2) h i g h a n x i e t y s u b j e c t s (see T a b l e 7 ) . 1. There were no s i g n i f i c a n t d i f f e r e n c e s f o r low a n x i e t y sub-j e c t s between the two t r e a t m e n t c o n d i t i o n s on any o f t h e dependent measures. 2. F o r h i g h a n x i e t y s u b j e c t s , t h e f o l l o w i n g p a t t e r n o f r e s u l t s was found. a. S e l f - r e p o r t measures. S u p e r i o r e f f i c a c y o f c o g n i t i v e o v e r s k i l l s t r a i n i n g i n t e r v e n t i o n s approached s i g n i f i c a n c e on t h e f o l l o w i n g s e l f - r e p o r t measures: S o c i a l A v o i d a n c e and D i s t r e s s , £(.24) = 1.86, _£• < .10, and Tennessee S e l f Concept t o t a l s c o r e , £(24) = 1.84, p_ < .10. b. B e h a v i o u r a l measures. On t h r e e o f t h e seven b e h a v i o u r a l measures employed, h i g h a n x i e t y s u b j e c t s b e n e f i t t e d more from t h e s k i l l s t r a i n i n g p r o c e d u r e t h a n t h e c o g n i t i v e p r o c e d u r e . T h i s d i f -f e r e n c e was s i g n i f i c a n t f o r g l o b a l a n x i e t y , £(24) = 2.26, £ < .05, body e x p r e s s i o n , £(24) = 2.74, £ < .01, and approached s i g n i f i c a n c e f o r eye c o n t a c t , £(24) = 2 . 1 4 , £ < .10. A n a l y s i s o f S i m p l e E f f e c t s ( G r a p h i c ) Due t o t h e c o n s t r a i n t s o f o r t h o g o n a l i t y imposed by t h e p l a n n e d c o n t r a s t s p r o c e d u r e , s t a t i s t i c a l c o m p a r i s o n o f c e l l means was l i m i t e d t o two c o n t r a s t s : low a n x i e t y - s k i l l s v e r s u s low a n x i e t y - c o g n i t i v e and h i g h a n x i e t y - s k i l l s v e r s u s h i g h a n x i e t y - c o g n i t i v e . T h i s s e t o f con-t r a s t s was c o n s i d e r e d t o be most d i r e c t l y r e l e v a n t t o t h e o r i g i n a l h y p o t h e s i s . F u r t h e r c l a r i f i c a t i o n o f the n a t u r e o f the i n t e r a c t i o n s , however, can be o b t a i n e d by v i s u a l i n s p e c t i o n o f t h e graphed i n t e r a c t i o n s . T a b l e 7 . P l a n n e d O r t h o g o n a l C o n t r a s t s Low A n x i e t y High A n x i e t y V a r i a b l e S k i l l s M SD C o g n i t i v e M SD S k i l l s M SD C o g n i t i v e M SD S e l f - R e p o r t G a m b r i l l D i s c o m f o r t F r e q u e n c y Fear Thermometer S o c i a l A n x i e t y S e l f Concept 69.71 11.76 84.14 20.55 34.86 10.49 8.86 9.62 G l o b a l B e h a v i o u r R a t i n g s C o mpliance .2.79 A s s e r t i o n A g g r e s s i o n A n x i e t y 2.86 3. 73 2.86 82.14 18.83 92.57 15.05 37.86 10.25 6.57 3.78 351.14 22.95 341.71 33.73 .29 .66 ,27 ,61 2.83 2.84 3.56 2.93 .37 .58 .42 .43 1.33 .96 .53 .65 .66 .22 .04 .66 .27 102.00 22.44 92.57 14.79 108.14 12.74 101,86 15.77 34.57 8.16 12.57 7.28 319.71 30.85 346.14 16.43 43.57 13.07 6.00 3.79 2.86 3. 16 3.76 3.16 .38 .43 .35 .46 2.69 2.66 3.43 2.58 ,41 .77 .77 .42 1.01 .72 1.58 1.86* 1.84* .87 1.50 1.26 2.26** c o n t i n u e d OO T a b l e 7 c o n t i n u e d Low A n x i e t y High A n x i e t y S k i l l s C o g n i t i v e S k i l l s C o g n i t i v e V a r i a b l e M SD M SD _t M SD M SD _t Component B e h a v i o u r R a t i n g s Eye C o n t a c t 2.50 .48 2.69 .71 .57 2.93 . 10 2.57 .43 2.14* Body E x p r e s s i o n 2.56 .66 2.59 .43 . 10 3.09 .43 2.33 •52 2.74*^ V o i c e Volume 2.21 •55 2.61 .47 1.46 2.81 .38 2.87 .27 .33 £ < -10 £ < .05 *** £ < .01 60 On the s e l f - r e p o r t measures: S o c i a l Anxiety and Dis t r e s s , and Self Concept, s e l f - r e p o r t remains approximately constant i n the cognitive condition across both l e v e l s of anxiety. In the s k i l l s condition, however, high anxiety subjects tend to report greater discomfort associated with a s s e r t i o n , greater s o c i a l anxiety j and lower s e l f concept than low anxiety subjects (see Figure 1). Inspection of Figure 2 reveals a d i f f e r e n t i n t e r a c t i o n pattern for the behavioural ttieaaures. On measures of ey© contact, the superior e f f i c a c y of s k i l l s t r a i n i n g for high anxiety subjects cannot be at t r i b u t e d to decreased performance i n cognitive subjects, since eye contact i n t h i s treatment condition remains constant across both l e v e l s of anxiety. The contributing f a c t o r here i s an actual improve-ment i n performance of s k i l l s t r a i n i n g subjects when anxiety l e v e l i s high. S i m i l a r l y on both body expression and global anxiety, although low anxiety subjects do tend to benefit more than high anxiety sub-j e c t s from the cognitive treatment, a major contributor to the i n t e r -a ction i s t h i s same increment i n performance of s k i l l s t r a i n i n g sub-j e c t s when anxiety l e v e l i s high. 61 S k i l l s Cognitive Low High Anxiety Level Figure l a . Figure 2 63 Figure 2a. o •r-l CO CO cu u p. X w >, O m 2.5 S k i l l s Cognitive 2.0' Low High Anxiety Level Figure 2b. Figure 2c. 66 DISCUSSION A b r i e f summary of the experimental r e s u l t s i s as follows. Col-lapsing across high and low anxiety conditions, no s i g n i f i c a n t differences i n e f f i c a c y were found between s k i l l s t r a i n i n g and cognitive treatments. When, however, low and high anxiety subjects were considered indepen-dently, some i n t e r e s t i n g differences emerged. For low anxiety subjects, s k i l l s t r a i n i n g and cognitive interventions were found to be equivalent i n therapeutic e f f i c a c y . Differences i n t h i s respect, however, emerged for high anxiety subjects. These i n d i v i d u a l s reported a greater reduction i n s o c i a l anxiety and a greater improvement i n s e l f concept when treated with cognitive procedures than they did when treated with t r a d i t i o n a l s k i l l s t r a i n i n g procedures. This pattern, however, was reversed on the behavioural measures, where s k i l l s t r a i n i n g procedures were s i g n i f i c a n t l y more ef-fe c t i v e than the cognitive treatment i n reducing behavioural ratings of global anxiety, body expression, and eye contact, for high anxiety subjects. There i s , however, evidence for a modified version of t h i s hypo-thesi s . C l i e n t anxiety l e v e l does appear to function as a moderator with consequent implications for the treatment of unassertive i n d i v i d u a l s . The r e s u l t s of the present study suggest that with low or moderate anxiety c l i e n t s there i s a consistency between modification i n pheno-menal and behavioural realms. This consistency, however, breaks down for high anxiety c l i e n t s f or whom behavioural changes are not neces-s a r i l y accompanied by changes i n s e l f concept or subjective anxiety. 67 T h i s l a c k o f c o n s i s t e n c y may p a r t i a l l y be a c c o u n t e d f o r i n terms o f a f a u l t y c o g n i t i v e - e v a l u a t i v e model of u n a s s e r t i v e n e s s ( C u r r a n , 1977). F o r such c l i e n t s , s e l f - e v a l u a t i o n a l p r o c e s s e s may d i s t o r t s o c i a l r e a l i t y i n a s e l f - c r i t i c a l f a s h i o n ( S m i t h & S a r a s o n , 1975) and the e x i s t i n g c o g n i -t i v e s t r u c t u r e may n o t accomodate t o new e v i d e n c e r e g a r d i n g p e r s o n a l competence from the b e h a v i o u r a l r e a l m . F o r t h e s e c l i e n t s i t may be e s s e n t i a l f o r p u r p o s e s o f f a c i l i t a t i n g p e r c e p t u a l change, t o i n t e r v e n e d i r e c t l y a t t h e c o g n i t i v e l e v e l . B e h a v i o u r a l change i n the absence of p r e p a r a t o r y c o g n i t i v e m o d i f i c a t i o n may p r o v e t o be i n s u f f i c i e n t t o sub-s t a n t i a l l y a l t e r c o g n i t i v e s t r u c t u r e s . What emerges as p a r t i c u l a r l y i n t e r e s t i n g i n t h e c u r r e n t s t u d y i s the f i n d i n g t h a t the p r e s e n c e o f a h i g h a n x i e t y l e v e l a p p e ars t o have f u n c t i o n e d as a two edged b l a d e , d e c r e a s i n g the e f f i c a c y o f s k i l l s t r a i n i n g p r o c e d u r e s i n t h e phenomenal r e a l m , y e t a t the same ti m e i n -c r e a s i n g the b e n e f i t s o b t a i n e d from s k i l l s t r a i n i n g b e h a v i o u r a l l y . The r e l a t i v e s u p e r i o r i t y o f s k i l l s t r a i n i n g i n t h e b e h a v i o u r a l r e a l m f o r h i g h a n x i e t y s u b j e c t s can be c o n c e p t u a l i z e d i n two ways. On one hand, the c o g n i t i v e t r e a t m e n t may be seen as l a c k i n g i n v i t a l com-ponents e x i s t i n g i n t h e s k i l l s t r e a t m e n t w h i c h a r e p r e r e q u i s i t e f o r b e h a v i o u r a l change. I n t h i s sense the v a l u e o f c o a c h i n g , m o d e l i n g , and b e h a v i o u r a l r e h e a r s a l f o r p r o d u c i n g s p e c i f i c b e h a v i o u r a l change has once a g a i n been r e a f f i r m e d . On t h e o t h e r hand, the tendency f o r h i g h a n x i e t y s u b j e c t s t o b e n e f i t more t h a n l ow a n x i e t y s u b j e c t s from s k i l l s t r a i n i n g on b e h a v i o u r a l measures o f g l o b a l a n x i e t y , eye c o n t a c t , and body e x p r e s s i o n s u g g e s t s i r o n i c a l l y t h a t h i g h a n x i e t y a c t u a l l y f u n c t i o n e d as a f a c i l i t a t i n g 68 v a r i a b l e i n t h e s k i l l s t r a i n i n g t r e a t m e n t . T h i s f a c t , a l t h o u g h c o n t r a r y t o i n i t i a l e x p e c t a t i o n s , i s n o t i n c o n s i s t e n t w i t h e v i d e n c e from o t h e r s t u d i e s t h a t under c e r t a i n c o n d i t i o n s h i g h a n x i e t y s u b j e c t s may a c t u a l l y o u t p e r f o r m low a n x i e t y s u b j e c t s (Wine, 1970; S a r a s o n , 1976) and becomes more i n t e l l i g i b l e i n l i g h t o f b o t h t h e o r e t i c a l and e m p i r i c a l e v i d e n c e t h a t a n x i e t y , o r more a c c u r a t e l y , h i g h a r o u s a l , may f u n c t i o n i n b o t h d e b i l i t a t i n g and f a c i l i t a t i n g ways ( A l p e r t & Haber, 1960). The e x p e r i -ence of a n x i e t y i s n o t i n and o f i t s e l f d e b i l i t a t i n g . I t i s r a t h e r t h e " w o r r y i n g " component o f a n x i e t y , o r t h e i n w a r d d i r e c t i o n o f a t t e n t i o n i n a t a s k i r r e l e v a n t , r u m i n a t i v e , s e l f - c r i t i c a l f a s h i o n , w h i c h i m p a i r s p e r f o r m a n c e (Wine, 1970). E a s t e r b r o o k (1959) has d e m o n s t r a t e d t h a t a n x i e t y a r o u s a l a f f e c t s a t t e n t i o n by n a r r o w i n g t h e range of cue u t i l i z a t i o n . As l o n g as a t t e n -t i o n i s d i r e c t e d i n w a r d s i n a s e l f c r i t i c a l and e v a l u a t i v e f a s h i o n , the e f f e c t i v e u t i l i z a t i o n o f i m p o r t a n t t a s k r e l e v a n t cues i s p r e c l u d e d . I f , however, a t t e n t i o n can be r e d i r e c t e d outward i n a t a s k r e l e v a n t f a s h i o n , t h e i n t e n s i f i e d a t t e n t i o n a l f o c u s c h a r a c t e r i s t i c o f t h i s s t a t e can f a c i l i t a t e a more e f f e c t i v e u t i l i z a t i o n o f a p p r o p r i a t e c ues. I n the p r e s e n t s t u d y , t h e c o g n i t i v e t r e a t m e n t was p a r t i a l l y de-s i g n e d t o d e a l w i t h p r e c i s e l y t h i s component o f a n x i e t y a r o u s a l . Thus s u b j e c t s were i n s t r u c t e d s p e c i f i c a l l y (see A p p e n d i x I I I ) t o r e d i r e c t a t t e n t i o n i n a t a s k r e l e v a n t f a s h i o n and were t a u g h t v a r i o u s c o g n i t i v e s t r a t e g i e s f o r t h i s p u r p o s e . Why t h e n was t h e s k i l l s t r a i n i n g t r e a t m e n t more e f f e c t i v e i n t h i s c o n t e x t ? One h y p o t h e s i s i s t h a t t h e emphasis upon s p e c i f i c v e r b a l and n o n v e r b a l b e h a v i o u r s p r o v i d e d s u b j e c t s w i t h a v e r y t a n g i b l e a t t e n t i o n a l 69 focus. The cognitive procedures for a t t e n t i o n a l r e d i r e c t i o n , although t h e o r e t i c a l l y appropriate, were simply not characterized by the same tang e a b i l i t y as the concrete behavioural procedures. Regardless of t h i s f a c t , the cognitive treatment did appear to be more e f f e c t i v e i n improving s e l f - r e p o r t for high anxiety subjects. A number of p o s s i b i l i t i e s may account for t h i s . F i r s t l y , improved be-havioural performance, for reasons already described, does not neces-s a r i l y guarantee a change i n subjective experience. The fact that no s i g n i f i c a n t treatment x anxiety i n t e r a c t i o n emerged on the s e l f - r e p o r t of anxiety during r o l e playing s t i u a t i o n s seems to support t h i s suppo-s i t i o n . Subjects may perform quite competently by objective standards and s t i l l perceive themselves as i n e f f e c t i v e . Secondly, the p o t e n t i a l r e a c t i v i t y of the s e l f - r e p o r t measures for subjects i n the cognitive treatment must be considered. I t i s possible that the cognitive treatment which focused i n t e n s i v e l y upon the r o l e of s e l f - c r i t i c a l cognitions i n the i n h i b i t i o n of assertive behaviour may have i n t e n s i f i e d demand c h a r a c t e r i s t i c s to respond p o s i t i v e l y on s e l f -report instruments dealing with t h i s very issue. This hypothesis, however, appears le s s convincing i n l i g h t of the fact that for low anxiety subjects, no differences were found on s e l f -report measures between s k i l l s and cognitive groups. Another important issue warranting consideration i s that of main-tenance of therapeutic gains. As Heimberg, Montgomery, Madsen, and Heimberg (1977) have pointed out, assertion t r a i n i n g studies have a poor track record insofar as the implementation of follow-up assessments i s concerned. 70 The present hypotheses regarding the r e l a t i o n s h i p between anxiety l e v e l and treatment modality e f f i c a c y are a l l i n f e r r e d on the basis of a postassessment conducted at one time point, scheduled very soon a f t e r the termination of treatment. If we conceive of phenomenal and behavioural realms as i n t e r -dependent and exerting r e c i p r o c a l influence through the dimension of time, any conclusions drawn on the basis of one time point are premature, and at best, incomplete.. The p o s s i b i l i t y that high anxiety subjects re-c e i v i n g s k i l l s t r a i n i n g w i l l i n time modify t h e i r cognitions i n response to perceptions of changed behaviour and modifications i n s o c i a l reactions to that change, and that these same subjects receiving cognitive behavioural modification w i l l i n time modify t h e i r behaviours i n accordance with t h e i r new s e l f concepts cannot be ruled out, and indeed, warrants serious consideration. A study designed to s p e c i f i c a l l y assess the pattern of i n t e r -r e l a t i o n s h i p s between cognitive and behavioural changes over time analysis would be valuable i n t h i s respect. Caution i n overinterpretation of the current study i s warranted for a number of a d d i t i o n a l reasons. The l i m i t e d sample size necessitated the assignment of subjects to high and low categories on the basis of a median s p l i t , rather than extremes of the d i s t r i b u t i o n . This q u a l i f i e s the extent to which subjects can be considered t r u l y "high" and "low" anxiety c l i e n t s . In addition, l i m i t e d sample siz e resulted i n attenua-t i o n of s t a t i s t i c a l power. On one hand i t can be argued that t h i s l i m i -t a t i o n increased the p r o b a b i l i t y of beta type error and that the current pattern of r e s u l t s would have been more convincingly demonstrated with an 71 i n c r e a s e d sample s i z e . The p o s s i b i l i t y , however, t h a t r e s u l t s incom-p a t i b l e w i t h t h e c u r r e n t c o n c l u s i o n s were o b s c u r e d by t h i s f a c t o r cannot be r u l e d o u t . Because of the absence o f c o n t r o l g r o u p s , i t cannot be c o n c l u s i v e l y i n f e r r e d t h a t t h e r a p e u t i c g a i n i n the c u r r e n t s t u d y r e s u l t e d from t r e a t -ment i n t e r v e n t i o n s . The t h e r a p e u t i c e f f i c a c y o f b o t h s k i l l s t r a i n i n g and c o g n i t i v e p r o c e d u r e s have, however, been d e m o n s t r a t e d r e p e a t e d l y , and t h e g e n e r a l q u e s t i o n of t h e r a p e u t i c g a i n i s not d i r e c t l y germaine t o t h e s p e c i f i c i n t e r a c t i o n a l q u e s t i o n s a d d r e s s e d i n t h e c u r r e n t i n v e s t i g a t i o n . Comparison o f s u b j e c t s c o r e s on the A s s e r t i o n I n v e n t o r y w i t h n o r -m a t i v e d a t a c o l l e c t e d on g e n e r a l and c l i n i c a l p o p u l a t i o n s i n d i c a t e s t h a t on a s e l f - r e p o r t b a s i s , p r i o r t o t r e a t m e n t s u b j e c t s i n the c u r r e n t i n v e s t i g a t i o n c l e a r l y f e l l t owards t h e u n a s s e r t i v e end of t h e continuum. The p r o p o r t i o n a l r e d u c t i o n i n " u n a s s e r t i v e " i n d i v i d u a l s r e s u l t i n g from t r e a t m e n t was a p p r o x i m a t e l y e q u i v a l e n t t o t h a t f o u n d i n G a m b r i l l and R i c h e y ' s c l i n i c a l sample, w h i l e the p r o p o r t i o n a l i n c r e a s e i n " a s s e r t i v e " i n d i v i d u a l s was h i g h e r ( G a m b r i l l and R i c h e y , 1975). I n summary, the r e s u l t s o f the p r e s e n t s t u d y s u g g e s t t h a t c l i e n t a n x i e t y l e v e l has i m p o r t a n t i m p l i c a t i o n s f o r the t r e a t m e n t o f t h e unas-s e r t i v e i n d i v i d u a l . A l t h o u g h h i g h a n x i e t y c l i e n t s do b e n e f i t f r o m b a s i c s k i l l s t r a i n i n g p r o c e d u r e s , i t i s a d v i s a b l e t o supplement such t e c h n i q u e s w i t h i n t e r v e n t i o n s aimed s p e c i f i c a l l y a t m o d i f y i n g c o g n i t i v e e v a l u a t i v e s t y l e s , i n o r d e r t o e n s u r e t h e r a p e u t i c g a i n a t t h e phenomenal l e v e l . I t has been s u g g e s t e d by Wolpe ( 1 9 6 9 ) , t h a t d e s e n s i t i z a t i o n p r o c e -d u r e s s h o u l d be employed p r i o r t o a s s e r t i o n t r a i n i n g , when c l i e n t s a r e 72 characterized by ah inordinate amount of s o c i a l anxiety. This suggestion r e f l e c t s an underlying assumption that i n the context of assertion t r a i n i n g , anxiety i s i n some sense a "cognitive excess", which should be "done away with" i n order to f a c i l i t a t e a c q u i s i t i o n of assertive behaviour. The current findings suggest that i t may prove valuable to reconceptualize anxiety as a subjective experience r e f l e c t i n g a maladap-t i v e cognitive s t y l e . Therapeutic interventions should thus be geared not only towards "decreasing the quantity" of anxiety, but perhaps more importantly, towards helping the c l i e n t to r e i n t e r p r e t h i s experience of s o c i a l r e a l i t y . 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Teaching the nonverbal components of assertive t r a i n i n g . Journal of Behaviour Therapy and Experimental Psychiatry, 1972, 3, 179-183. Smith, R.E. S o c i a l anxiety as a moderator va r i a b l e i n the a t t i t u d e -s i m i l a r i t y - a t t r a c t i o n r e l a t i o n s h i p . Journal of Experimental  Research i n Personality, 1972, j), 22-28. Smith, R.E. & Sarason, I.G. S o c i a l anxiety and the evaluation of negative interpersonal feedback. Journal of Consulting and  C l i n i c a l Psychology, 1975, 43, 429. Strupp, H.H. Overview and developments i n psychoanalytic therapy: i n d i v i d u a l treatment. In J . Marmon (Ed.) Modern psychoanalysis  and perspectives, 1968. Suinn, R.M. & Richardson, F. Anxiety management t r a i n i n g : a non-s p e c i f i c behaviour therapy program f or anxiety control. Behaviour  Therapy, 1971, 2, 498-510. 80 T r e x l e r , L.D. & K a r s t , T.D. RET, p l a c e b o , and no t r e a t m e n t e f f e c t s on p u b l i c s p e a k i n g a n x i e t y . J o u r n a l o f Abnormal P s y c h o l o g y , 1972, 79, 60-67. Watson, D. & F r i e n d , R. Measurement o f s o c i a l e v a l u a t i v e a n x i e t y . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1969, ^33, 448-457. Wein, K., N e l s o n , R., & Odom, V. The r e l a t i v e c o n t r i b u t i o n s o f r e a t t r i b u t i o n and v e r b a l e x t i n c t i o n t o the e f f e c t i v e n e s s o f c o g n i t i v e r e s t r u c t u r i n g . B e h a v i o u r Therapy 1975, £, 459-474. We i n e r , B . J . S t a t i s t i c a l p r i n c i p l e s i n e x p e r i m e n t a l d e s i g n . McGraw H i l l Book Co., 1971. W i l l i a m s o n , P.M. & Brenden, W. C o g n i t i v e c o p i n g s t r a t e g i e s and m o d e l l i n g i n t h e t r e a t m e n t o f snake p h o b i a . P r o c e e d i n g s , 8 1 s t A n n u a l C o n v e n t i o n APA, 1973, 537. Wine, J . T e s t a n x i e t y and d i r e c t i o n o f a t t e n t i o n . P s y c h o l o g i c a l B u l l e t i n , 1971, 76; 92-104. W o l f e , J . & F o d o r , I . M o d i f y i n g a s s e r t i v e b e h a v i o u r i n women: A co m p a r i s o n o f t h r e e a p p r o a c h e s . B e h a v i o u r Therapy, 1977, j3, 567-574. Wolpe, J . The p r a c t i c e o f b e h a v i o u r t h e r a p y . New Y o r k ; Pergamon P r e s s , 1969. Wolpe, J . & L a z a r u s , A. B e h a v i o u r t h e r a p y t e c h n i q u e s . New Y o r k : Pergamon P r e s s , 1966. 81 APPENDIX I SKILLS GROUPS SESSION' I . You w i l l need: sentences - for the EXERCISE on assert ion/mmasscrtioii/aggrcssion. 1 . Introduction of co-leaders, introduction of group raewberri. 2 . .Brief discussion of goals of group. (Two or three sentences s t a t i n g that the ;--oal of. this jjroup i s to learn and practice assertion s k i l l s . ) 3. juricf iJiscussion of c o n f i d e n t i a l i t y . ("Wu generally find that everyone vou.1 tl prefer to keep anything discussed i n our sessions con f.i<k:nt l a i . 'I'llat way we a l l can f e e l free to discuss anything. Is this acceptable to everyone?") A. i lention of taping of sessions. (This should sound routine and matter-of-fact.) ("We w i l l be taping the .sessions. .We do this so we don't have to take notes. Also, our supervisor may l i s t e n to some tapes. This i s a routine procedure.) If anyone asks, tapes are erased a f t e r you l i s t e n to them. 5. Discussion of deposit, reason f o r , etc. (As we - mentioned to you e a r l i e r , v;c aire asking everyone to 'give a deposit pledging that they w i l l attend a l l 6 group sessions. WE have found i n the past that i f someone drops out in the middle of the group, i t disrupts the group for others. What i s your reaction to this.? ......... Of course t h i s deposit i s returned a f t e r the l a s t session. ) 6 . Rationale for s k i l l s t r a i n i n g . (See r a t i o n a l e sheet.). 7. EXERCISE DEL'lilING TERMS. a. Begin with reason for exercise. (...so we a l l . r e c o g n i z e what responses are a s s e r t i v e , which are unassertive, and which are aggressive.) \). define a s s e r t i v e , unassertive, and aggressive;. c. EXERCISE read sentences i n book and have group members discuss whether the statement i s assertive, unassertive, or aggressive. have them state what about the statement ma Ices i t what i t i s . (eg. tone of voice, content, i s • putting someone clown, i s apologetic e t c ) . We have found that unassertive people often, view assertive statements as aggressive. You must use your authority to point out incorrect answers to the group and to discuss why statements are a s s e r t i v e , not aggressive. S. GO ROL'i-ll) the group. Have each member t e l l what* brings him to the group, his goals. • a. Have them i d e n t i f y the s i t u a t i o n s with which they have problems, (who,when, where, what i s going on.) 82 b. Have them talk about what they do in these s i t u a t i o n s now. Have tlicin specify what they want to do in these s i t u a t i o n s . (If they can . Some unassertive people just don't know what to do, so the; answer in global, vague•terms.) c. You should be making.notes about the s i t u a t i o n s they want to work on. d. This i s the time to foster group s o l i d a r i t y and discussion.. Your goal i s to get group members to talk and to f e e l comfortable with each other. When someone brings up a problem, get the group to respond to him . Such statements us "Does anyone else have a u i n i l n r d i f f i c u l t y . ?" and "Who else wants to work on assertion with professors?" are useful. The biggest mistake a young therapist can make here i s to talk too much.' If you t a l k , the.group won't. Your job i s to get them to talk. Don't be made anxious by some pauses, learn to accept pauses quic t l y . . Point out commonalities and differences in t h e i r problems. Be a l e r t to nonverbal cues (eg. s h i f t i n g i n c h a i r s , f a c i a l experssions) that indicate that someone wants to chime i n . Encourage t h i s . If some.don't talk, c a l l on them by name or look at them and get them involved in the discussion. e. Reward s e l f - d i s c l o s u r e or even attempts at same. Say such things as "good", you've i d e n t i f i e d on s i t u a t i o n to work on. That's the f i r s t . I I step . f. . This i s very threatening to some people. lie supportive, acknowledge that i t i s . d i f f i c u l t ( i f anyone mentions i t ) , but push a l i t t l e for s e l f - d i s c l o s u r e . If they don't talk now, they may remain- quiet the whole group. 9'. If you have, time,' again go over r a t i o n a l e . 10. FlifA'L CO-ROUND. We end a l l our groups by going, around and having everyone, tel.! the group what iie i s ' thinking, and f e e l i n g . 'One co-leader .should begin this and the. other end i t . The f i r s t leader should model giving positive and negative comments about the group (keep i t b a s i c a l l y p o s i t i v e however). The l a s t lea'der" "hould terminate the session and remind of time for next session. 11. Homework: for this session,, keep track of assertion s i t u a t i o n s encountered between now and next session. Mention how important i t is to have s i t u a t i o n s • to discuss next time. author: L.E. Alden 83 SESSION I I . Weed: At l e a s t s i x s t o c k s i t u a t i o n s ( s i t u a t i o n s c a l l i n g f o r a s s e r t i v e n e s s j t h a t ' : can L i e a p p r o p r i a t e l y h a n d l e d by empathic a s s e r t i o n . 1. Repeat r a t i o n a l e b r i e f l y . 2 . P r e s e n t Lmpntltic a s s e r t i o n . a. d e f i n e ten.;. b. r o l e - p l a y two s t o c k s i t u a t i o n s 'usin;-;, e m p a t i i i c a s s e r t i o n . c. Have group s p l i t i n t o p a i r s (be s u r e no one i s l e f t o u t ) and p r a c t i c e u s i n g empathic a s s e r t i o n i n the p r o b l e m s i t u a t i o n you j u s t modeled. C o - l e a d e r s s h o u l d r o t a t e around.dyads and g i v e f e e d b a c k on use o f t h e technique.. G i v e a n o t h e r s t o c k s i t u a t i o n . (.1. come back i n t o group and d i s c u s s how t h i s f e l t , problems e t c . 3. P r e s e n t Repeated a s s e r t i o n . a. d e f i n e term b. r o l e - p l a y two s t o c k s i t u a t i o n s u s i n g r e p e a t e d a s s e r t i o n . c. HAVE group s p l i t i n t o p a i r s .and p r a c t i c e u s i n g r e p e a t e d a s s e r t i o n i n the l a s t s i t u a t i o n you modeled. Have p a i r s p r a c t i c e a n o t h e r s t o c k s i t u a t i o n . d. Come b a d ; i n t o group and d i s c u s s how t h i s f e l t and problems e t c . A.' C O -Round f o r s i t u a t i o n s t h a t have o c c u r r e d f o r c l i e n t s ( h i r i n g the week. a. '..'hen ' c l i e n t comes up w i t h s i t u a t i o n t h a t has been p r o b l e m m a t i c , have him and a n o t h e r c l i e n t r o l e - p l a y the s i t u a t i o n , u s i n g ( i f p o s s i b l e ) empathic o r r e p e a t e d . a s s e r t i o n . ' Go over s i t u a t i o n . b. iiave group g i v e feedback on r o l e - p l a y i n g and make s u g g e s t i o n s . c. P r a c t i c e u n t i l c l i e n t f e e l s s a t i s f i e d . d. Go t o e v e r y group member. 5. homework: P r a c t i c e u s i n g e m p a t h i c and r e p e a t e d a s s e r t i o n t h i s week i f p o s s i b l e , 6. F i n a l go-round to d i s c u s s f e e l i n g s about the group. io:. : i n . ,'.'eed: 6 s t o c k s i t u a t i o n s a p p r o p r i a t e f o r . b a s i c a s s e r t i o n and n o n - v e r b a l f e e d b a c k . 1. I'resent t h e n o n - v e r b a l cues t h a t convey u n a s s e r t i v e n e s s . E x p r e s s how . i m p o r t a n t t h e s e u o n v e r b a l s a r e . ( R e s e a r c h has shown t h a t o v e r 50% o f the'message r e c e i v e d by a l i s t e n e r conies from the n o n v e r b a l a s p e c t s of your b e h a v i o r . ) 2 . . U o n v e r b a l s to be c o v e r e d . a. eye c o n t a c t - l o o k l i s t e n e r d i r e c t l y i n the eye . (iJot a f r o z e n g l a r e , l o o k away o c c a s i o n a l l y , j u s t not too much.) b. voice, volume- keep v o i c e l o u d and f i r m . c. body e x p r e s s i o n - don't f i d g e t . d. f a c i a l e x p r e s s i o n - keep p l e a s a n t , r e l a x e d l o o k on f a c e . ( I f p o s s i b l e b r i n g i n m i r r o r , so c l i e n t s can see f a c e . ) 84 c. v o i c e t o n e - p l e a s a n t , m a t t e r - o f - f a c t . ( M a t t e r - o f - f a c t a s p e c t i s q u i t e i m p o r t a n t . I f c l i e n t i s a n x i o u s , he w i l l make the o t h e r p e r s o n a n x i o u s . P r a c t i c e smooth, non-anxious s t y l e . ) 3. C o - l e a d e r s a c t out u n a s s e r t i v e and a s s e r t i v e s t y l e s . 4. nave group d i v i d e i n t o dyads. G i v e them a s t o c k s i t u a t i o n , t o use. Have them . r o l e - p l a y . Then have o t h e r member of dyad o r c o - l e a d e r g i v e feed-back, 'on n o n - v e r b a l s . 5. Oo a n o t h e r s i t u a t i o n . 6. .1.1. an hour i s not up, p r e s e n t B a s i c a s s e r t i o n . i f the. f i r s t hour i s up, go on t o Homework and p r e s e n t b a s i c a s s e r t i o n i n s e s s i o n 4. Vollow-same s t e p s a s . f o r s e s s i o n 2 i n p r e s e n t i n g t e c h n i q u e . 7. Homework d i s c u s s i o n - go around and f i n d out what a s s e r t i o n s i t u a t i o n s a r o s e f o r c l i e n t s d u r i n g the week. D i s c o v e r how they h a n d l e d them. R o l e - p l a y p r o b l c m m a t i c s i t u a t i o n s . 3. homework: a s s i g n c l i e n t s t o pay a t t e n t i o n t o t h e i r n o u v e r b a l s t h i s week. 9. F i n a l go-round. SLSSiOd IV. ( I f you d l d i v ' t f i n i s h B a s i c a s s e r t i o n l a s t week, do i t t h i s week and I l a n g . n e x t ) Need:, s i t u a t i o n s a p p r o p r i a t e f o r "I. l a n g u a g e " . 1. D e f i n e I l anguage. (Sec e n c l o s e d s heet ). 2. Model 2 s i t u a t i o n s u s i n g I l anguage. 3. Break i n t o dyads and r o l e - p l a y 2 s i t u a t i o n s . 4. Come back i n t o group and d i s c u s s how i t went. ( r e a s s u r e t h a t i t g e t s e a s i e r w i t l i p r a c t i c e ) . 5. Homework d i s c u s s i o n - d i s c u s s a s s e r t i o n s i t u a t i o n s t h a t a r o s e f o r c l i e n t s d u r i n the week.. R o l e - p l a y problcmmat i c s i t u a t i o n s . 6. Homework as s i g n m e n t : a s s i g n p r a c t i c i n g i language during, the' week. 7. F i n a l go-round. 85 Session V. Need: Stock s i t u a t i o n s for escalating assertion. 1. Define escalating assertion. 2. Model escalating assertion. 3. Break into dyads and ro l e - p l a y s i t u a t i o n s . 4. Discuss how this went. 5. Homework discussion. - How did homework go? What assertion s i t u a t i o n s arose during the week? 6. F i n a l go round. Session VI. Need: Situations for HELP ME technique. 1. ' Define HELP ME technique. 2. Model HELP ME technique 3. Break into dyads and role-play s i t u a t i o n s . 4. Discuss how this went. 5. B r i e f review of the techniques presented i n the group. 6. Homework discussion. How did the week go? 7. What things have you learned i n this group? What situations are you s t i l l concerned with? Discuss and role-play. What behaviors w i l l you keep working on? 8. F i n a l go-round Remind about post assessment. 86 SKILLS ilATIONAT,l'', • The g o a l of t h e s e groups a r e f o r each of us to l e a r n how to behave In a more a s s e r t i v e manner. l.'e a r c vi s i n g _the term " a s s e r t i o n " to mean " e x p r e s s i n g one's f e e l i n g s am! o p i n i o n s . i n . a d i r e c t and a p p r o p r i a t e f a s h i o n " . A s s e r t i o n can be c o n t r a s t e d w i t h u n a s s e r t i v e n e s s , or " i n h i b i t i n g one's o p i n i o n s , or. e x p r e s s i n g them i n a vague, a p o l o g e t i c manner". A s s e r t i o n can a l s o be c o n t r a s t e d w i t h a g g r e s s i v e n e s s , o r " e x p r e s s i n g o n e s e l f i n an. a n g r y , s a r c a s t i c manner w i t h o u t r e g a r d f o r the o p i n i o n s and f e e l i n g s of o t h e r s . " A l l o f us want to. e x p r e s s o u r s e l v e s d i r e c t l y . However, when we a r e i n v o l v e d i n a s i t u a t i o n c a l l i n g f o r d i r e c t e x p r e s s i o n , we become t e n s e , a n x i o u s ; v.'.e f e e l u n c o m f o r t a b l e . T h i s d i s c o m f o r t r e s u l t s ' from not knowing e x a c t l y what to say o r what to do. 17e d e s p e r a t e l y s e a r c h f o r the a p p r o p r i a t e words and behaviors,. DOES THIS S0UMD FAMILIAR? (Get feedback . from group .) V.'c b e l i e v e t h a t a s s e r t i v e n e s s , i s a l e a r n e d s k i l l . .You l e a r n how to behave i n an a s s e r t i v e manner. Mo one i s b o r n a s s e r t i v e or u n a s s e r t i v e . L e a r n i n g how to be a s s e r t i v e i s l i k e l e a r n i n g how to r e a d . F i r s t , you l e a r n the words, th e n you p r a c t i c e . u s i n g them u n t i l you are. c o m f o r t a b l e u s i n g them. In our group, we w i l l f i r s t l e a r n what a s s e r t i v e b e h a v i o r i s . We w i l l examine t e c h n i q u e s f o r h a n d l i n g s i t u a t i o n s a s s e r t i v e l y . Then,'we w i l l p r a c t i c e u s i n g these t e c h n i q u e s i n s i t u a t i o n s where we want t o e x p r e s s o u r s e l v e s . C l i n i c i a n s have drawn up a l i s t o f t e c h n i q u e s f o r h a n d l i n g s i t u a t i o n s d i r e c t l y . We w i l l be p r e s e n t i n g and p r a c t i c i n g t h e s e t e c h n i q u e s . . AMY DISCUSSION ABOUT THIS? ( ( g e t group f e e d b a c k ) ) When you f i r s t use t h e s e a s s e r t i o n t e c h n i q u e s you may f e e l u n c o m f o r t a b l e or tense.. T h i s d i s c o m f o r t comes from the u n f a m i l i a r i t y of the new b e h a v i o r s . They don't " f e e l r i g h t " . As we p r a c t i c e t h e s e 'techniques i n our group and as you use the t e c h n i q u e s o u t s i d e the group,, they w i l l grow i n c r e a s i n g l y f a m i l i a r and you w i l l f e e l more c o m f o r t a b l e u s i n g them. T i l l s b r i n g s us t o the i m p o r t a n c e of t r y i n g out these s k i l l s i n between our. s e s s i o n s h e r e . You have to p r a c t i c e these s k i l l s r e p e a t e d l y so they become a u t o n o m a t i c and you f e e l c o m f o r t a b l e w i t h them-. I f you don't t r y out t h e s e t e c h n i q u e s between s e s s i o n s , you w i l l soon f o r g e t them. V.'c w i l l be asking, you t o t r y out t h e s e t e c h n i q u e s and t o r e p o r t back to us on how t i l i n g s went o u t s i d e the group. T h i s i s e s s e n t i a l . HOW DO- YOU FELL ABOUT THIS? ' ( ( O c t r e a c t i o n s ) ) You p r o b a b l y s h o u l d w r i t e down what o c c u r s d u r i n g the week and b r i n g , your n o t e s i n t o s e s s i o n s to d i s c u s s . Here are some l i t t l e n o t ebooks f o r you to vise to r e c o r d a s s e r t i o n s i t u a t i o n s you e n c o u n t e r durinj.-. the week. l:e have found t h a t p e o p l e have d i f f i c u l t y remembering e x a c t l y what heppened i n th e s e s i t u a t i o n s i f they don't write i t down soon a f t e r i t o c c u r s . HOW DO YOU FEEL. ABOUT RECORDING MOTES BETWEEN GROUP SESSTORS? APPENDIX I I : ASSERT ICt: TEC : IiKItWs 87 Enpathetic a s s e r t i o n conveys some s e n s i t i v i t y to the other person as well as.one's f e e l i n g s or. needs. Erapathctic. asser-t i o n involves making a statement that conveys recognition of the. other-person's s i t u a t i o n or feeli n g s and is followed by another statement which stands up for the speaker's r i g h t s . For example: When two people are ta l k i n g while a meeting i s going on : •'You may not r e a l i z e i t , but your t a l k i n g i s s t a r t i n g to make i t d i f f i c u l t f o r me to hear. Would you keep it. down.'1 When having some d e l i v e r i e s made: "I r e a l i z e i t ' s hard to say exactly when-the truck w i l l come, but I'd l i k e some estimate of the time." liRCKEK RECORD (Repeated Assertion) Broken record involves repeating the same message i n a calm fashion. This technique is useful when someone won't.take no.for an answer and keeps pressuring you. For example: When someone pressures you to have a second helping 'No thank you, I don't want another helping." (Oh, come on. I t ' s good.) '•Yes, i t ' s quite good, but I don't want another serving. 1' "Don't you l i k e i t ? ) "Yes, I r e a l l y l i k e i t , but I don't w:;nt another serving." 3. j ^ \ L A r a . ' ' • E s c a l a t i n g assertion i s employed when someone becomes p r o g r e s s i v e l more demanding and h o s t i l e when making demands on you. E s c a l a t i n g a s s e r t i o n involves s t a r t i n g with a basic, assertive response. When the other person f a i l s to respond, you should gradually become more firm .(though not aggressive) in your response. For example: When two women are in a bar and a man repeatedly' pesters them: "That's nice of you to o f f e r a drink, but we came here to t a l k . " (Oh, come on, have a drink.) "Ko thank you. We want to ta l k to each other." (bey come on.) "This i s the t h i r d and l a s t time I am going to t e l l you that we don't want your company. Please leave." CONTENT-PROCESS SHIFT 88 . . . . i s an e f f e c t i v e way of dealing with s i t u a t i o n s wherein somebody d i r e c t s an i n s u l t i n g remark at you, or becomes ex-c e s s i v e l y angry without apparent reason. • Respond by comment-ing on what the person i s doing rather than defending y o u r s e l f . For example: "Well i t looks as i f you made a mess of things again." ANSWER: "You r e a l l y seem i r r i t a b l e today. Is something bothering you?" I.jyJiANOTAGE - c o n s i s t s of s t a t i n g the e f f e c t that a person's behavior has upon you (and how i t makes you f e e l ) instead of "you-language" which blames other people and makes them f e e l defensive. For example: Somebody inte r r u p t s you and you say: "When you do that i t makes rue f e e l as i f I'm not being heard, and that's f r u s t r a t i n g . " For example: Somebody i n s u l t s you and you say: "When you i n s u l t me l i k e that i t maker, me think that you disrespect me, and that hurts." APPENDIX H I MANUAL FOR SELF-INSTRUCTIONAL TRAINING 89 Session I. 1) Co-lenders introduce themselves ' 2) have c l i e n t s introduce themselves 3) structure session; eg. "Today we're going to s t a r t off by discussing some procedural d e t a i l s . Then we'11 talk a l i t t l e b i t about what assertive behaviour i s and what our goals for the group are. Then we'll go around and give everybody a chance to talk about what problems bring you here, what concerns you have, and what you're interested in working on". 4) Discuss c o n f i d e n t i a l i t y 5) Mention taping 6) Discussion of Deposit 7) Define Assertion, Non-assertion, and.Aggression. Use examples i f necessary. Pause to see i f group i s with you. F i n i s h off with some statement l i k e : "In this group we're going to examine why i t i s d i f f i c u l t to be a s s e r t i v e a l l the time, what prevents us from expressing our f e e l i n g s honestly and d i r e c t l y when we want to? Why i s i t that we have d i f f i c u l t y standing un for our r i g h t s ? . . . and we'll learn various ways of handling these problems.... ways of becoming more honest and comfortable with other people and with outselves". 8) Do assertion exercise: "Since we're going to be using the. terms ass e r t i o n , agression and nonassertion a l o t , i t ; s important that'we a l l share a common understanding of what i t i s exactly we're t a l k i n g . about ". Use t h i s exercise to a) evolve common framework b) modify any shared i r r a t i o n a l b e l i e f s which appear to be shared by group members. c.) diagnose in your own minds any s p e c i f i c problems that group members have. i F i n i s h by turning i t over to group'. "Is- there any tiling unclear, etc?". 9) Go around group to discuss s p e c i f i c presenting problems. Ob jec t i v e s : a) obtain information b) encouraging discussion and group s o l i d a r i t y c) e l i c i t i n g statements about expectations, b e l i e f s , negative self-statements, ruminations, self-concepts, etc. Encourage s p e c i f i c i t y , i . e . , deal with s p e c i f i c s i t u a t i o n s . Use state-ments such as, "how does i t make you f e e l when that happens"; "what do you think he/she thinks of you"; "how anxious do you f e e l " ; "what makes you f e e l most anxious"; "what makes you f e e l better"; "why do you f e e l angry". Avoid drawing conclusions and l e c t u r i n g at this 90 point. Encourage group discussion. He .sensitive to non-verbals. Use questions such as, "who has the same problems"; "who has the same f e e l i n g s in s i t u a t i o n s l i k e t h i s " ; "who has the same sort of worries". - Encourage and reward s e l f d i s c l o s u r e . - E s t a b l i s h an atmosphere immediately where th i s type of behavior i s acceptable - If a group member is not t a l k a t i v e or has d i f f i c u l t y , be supportive and acknowledge that i t might be d i f f i c u l t at f i r s t . - Use c l i n i c a l judgment, This may be.a time to get into the f e e l i n g s that make i t d i f f i c u l t to talk or make him/her self-conscious. - Shape the discussion. Plant the seeds for the s e l f - i n s t r u c t i o n r a t i o n a l e . Underscore key phrases, e.g., "so you f e c i incompetent. You f e e l they're, InuRhinK nt you". 10) Begin to convey cognitive r a t i o n a l e (following Michenbaum's procedure) I. 1.1.) Assignment a) Record a s s e r t i o n s i t u a t i o n s + s e l f statements " L i s t e n with 3rd ear" to self-statements. Write down what makes i t easier and what makes i t more d i f f i c u l t to become aware of self-statements. b) Hand out monitoring sheets * c) Emphasize importance of doing work between sessions. Get feedback  from group, ( i t ' s important to resolve t h i s issue as soon as p o s s i b l e ) . 12) Go-around. Where i s everybody at. Therapists model. Session I 1) Welcome group 2) Is there any unfinished business from l a s t time. 3) Convey: Expectation b e l i e f s f e e l i n g s behaviour self-statements Rationale. II (from G o l d f i e l d ) . M Discussion of l a s t week's exercixe. (Deal here with the process of self-monitoring rather than the s p e c i f i c s ) . e.g. "How did things go over the week. What was i t l i k e for you l i s t e n i n g to self-statements with a t h i r d ear?" a) Discuss what sorts of things seemed to f a c i l i t a t e monitoring, b) c) It may be appropriate here to use "learning to drive car" analogy to convey notion of.automaticity of self-statements. I l l cb) Convey the notion of using p h y s i o l o g i c a l signs, and f e e l i n g s as cues to examine negative self-statements. (This i s conveyed as a technique .to. use, but i t i s also the beginning of the cognitive: r e l a b e l l i n g process where cues with negative connotations are r e l a b e l l e d as f a c i l i t a t i v e . 5) Go around group. Discuss s p e c i f i c s of homework. a) encourage s p e c i f i c i t y . b) use either covert imagery or role playing to e l i c i t negative .self-statements. c) reward c l i e n t s for v e r b a l i z i n g negative self-statements. 91 6) . Ask group Lo r e i t e r a t e sonic of the nog. s-s which arose, or which they're aware of i n their own experience. (Write these down). 7) . Homework: a) continue monitoring f a i t h f u l l y . b) become aware of breathing and other p h y s i o l o g i c a l signs in problematic s i t u a t i o n s . c) -babel anxiety l e v e l from 1-10 at beginning of incidents and record at i n t e r v a l s . When does anxiety increase? decrease? 8) F i n a l go around Session III.. 1) unfinished business. 2) Go-around discuss week's experiences with s p e c i f i c reference to a) success of monitoring e f f o r t s b) awareness of p h y s i o l o g i c a l signs c) l a b e l l i n g of anxiety l e v e l E l i c i t statements about changes in experience as a r e s u l t of s e l f -monitoring and changes in recorded anxiety l e v e l , ci) hand out negative s-s from l a s t week. 3) Decision point. If group i s s t i l l having trouble becoming aware of negative s-s, spend more time on this process. If not - proceed. 4) Begin introduction of coping s t r a t e g i c s . (see T.V). Hopefully c l i e n t s w i l l have mentioned that recorded anxiety l e v e l sometimes dropped af t e r they began examining s-s. (Psychological Hei.senberg uncertainty principle.). Use t h i s to . i l i us t r a te that they're not helpless victims of circumstances and that the very act of looking.at th e i r own mental processes begins to modify them. If c l i e n t s report an e l e v a t i o n in anxiety l e v e l , employ a u t i l i z a t i o n technique, i . e . , "good, you've noticed that the way in which you employ your a t t e n t i o n a l c a p a c i t i e s can r e a l l y change your experiences. Now we're going to f i n d out which ways are most p r o f i t a b l e for you". 5) Go-around. Do homework. Use rol e • p l a y i n g and covert imagery techniques. a) for each i n d i v i d u a l , a f t e r neg. s-s have been e l i c i t e d , begin e l i c i t i n g incompatible self-statements from i n d i v i d u a l and from group. Modify any statements which you think are i n -appropriate. Supplement statements offered with coping and task-relevant statements. I)) Have group' members "tr y on" coping s k i l l s overtly in role playing s i t u a t i o n s . Then fade to covert usage:. Use c o v e r t coping imagery. 6) F i n i s h off wi th discussion. Have group members generate coping s t a t e -ments (both ones which have been used in group and additions. (These are to be written down and presented to group under appropriate modific-ations next week). If group members can't generate necessary coping s-s, give them coping and taks^relevant s-s-. 7) Discuss r e i n f o r c i n g self-statements 8) Homework: a) continue monitoring b) l a b e l anxiety c) use coping s k i l l s -d) note and record which statements are most e f f e c t i v e i n which s i t u a t i o n s . 92 Scission LV • 1) Unfinished business 2) Hand out l i s t of self-statements. Reiterate coping and task-relevant s ta temen ts. 3) Describe externally oriented statements (sec V). 4) Co around. -Do homework. See i f there arc any problems.' " be prepared for people to report lack of success. This i s cue to explain to c l i e n t s that they should not be. discouraged.. Rather they should set an objective of developing a greater awareness of s l i g h t changes in experience ins.tead of expecting overnight success. To the extent that'they are able to see small changes i n their experience, the experiment i s a success. 5) Continue using, covert imagery and r o l e playing to e l i c i t negative M-H. Have c l i e n t s " t r y on" coping, task relevant, and ex t e r n a l l y oriented s-s when appropriate.-6) NOTE,: Some people may report an i n a b i l i t y to change negative s-s. "I'm aware of. the negative things I say, but they're a l l true". For these people assign as homework the task of exaggerating negative s-s. They are not to use p o s i t i v e s-s over the week. ' Rather, exaggerate, observe and record r e s u l t s . Encourage an experimental a t t i t u d e . •7) Homework: a) continue monitoring b) practice using copings task relevant, and ex t e r n a l l y or i en ted s-s. c) monitor which s-s are most e f f e c t i v e , when? d) Important to write down any idiosymeratic 4- s-s. which are p a r t i c u l a r l y e f f e c t i v e . o) . encourage experimental a t t i t u d e . 8) F i n a l Go-around. Session V. 1) unfinished business 2) deal with any problems which emerged in homework. 3) Review techniques which have been used 4) Describe challenging p o s i t i v e s-s. ( I t ' s quite probable that these have already emerged spontaneously) . 5) Go-around. Deal with s i t u a t i o n s that arose thru the week. Use the various techniques. 6 ) If there's time have c l i e n t s s p l i t into p a i r s , role play trying '. various s o l f - s ta temen ts covertly. 7) Homework: a) continue monitoring b) continue employing techniques 8) F i n a l go-around. 93 S e s s i o n . V I . 1) U n f i n i s h e d b u s i n e s s 2) more c o g n i t i v e r e s t r u c t u r i n g 3) have c l i e n t s d i s c u s s t h e i r e x p e r i e n c e s and where they s t h e m s e l v e s g o i n g i n f u t u r e . EXAMPLES OF RATIONALES 94 iLh ' i ] Cognitive- l\a Li ona.l.e. (Note: I t ' s important to pause and break this up. by going to group for feedback. Don't le c t u r e . This i s only an example. Modify, abbreviate and t a i l o r i t for the group). "As I l i s t e n to you talk about your problems, I'm aware of some diffe r e n c e s , but I also hear a l o t of common themes. 1 ) . It seems common to. experience s i t u a t i o n s where you know what you'd l i k e to say or do, but you find i t d i f f i c u l t , because you f e e l anxious, tense or angry. (Discuss with group i f appropriate). 2) . A l o t of us have had the experience of somebody saying or doing something which bothers us, or c a l l s for a response, but wc find that we get so tense, anxious, or angry, that we j u s t blank out. Oftentimes wc know exactly what we should have said afterwards and kick ourselves because then i t ' s too late (pause for recognition of experience). This i s the f i r s t thing we'd l i k e to focus on. Unassertive behaviour doesn't a r i s e in a vacuum. We f i n d - i t d i f f i c u l t to be a s s e r t i v e because wc f e e l tense, or uncomfortable, or anxious. Our f e e l i n g s a f f e c t the way we behave. The other common thread I become aware of i s that a lot of us speak about the thoughts that go on in our heads in these s i t u a t i o n s . (Use examples from group, e.g., "Benjamin, you're t e l l i n g yourself that people w i l l think you're f o o l i s h " . " E t h e l , you're saying, I'm so nervous i t must show". "Clyde, you're saying, what i f he thinks I'm some kind'of a f o o l " . [ Note: by phrasing cognitions in terms of "you're t e l l i n g y o u r s e l f " , "you're saying", you're a n t i c i p a t i n g the s e l f - i n s t r u c t i o n , s e l f - v e r b a l i z a t i o n r a t i o n a l e ] ) . These thoughts which go on in s i d e our heads, (what you might c a l l negative se.l f-s ta temen ts) ,. seem to accompany f e e l i n g s of anxiety and discomfort, and this makes i t d i f f i c u l t for us to be ourselves and behave a s s e r t i v e l y . (Go to group i f appropriate). Now sometimes we're more aware of how we're f e e l i n g , and what's going on inside our heads, than we are at other times. (Possibly refer back to examples from group). Our f i r s t goal in this group i s to develop our s k i l l s to become aware of what we're f e e l i n g , and what sorts of things are going on inside our heads when we have problems being assertive. To become aware of .when we're t e l l i n g ourselves things l i k e " I ' l l never be able to do i t " , "What i f I look l i k e a fool",, etc. 95 Expectations b e l i e f s - f e e l i n g s - behaviour -East time wc ended by talking a l i t t l e b i t about the way i n which the things we t e l l ourselves, our negative self-statements, i n h i b i t a ssertive behaviour. We find that our b e l i e f s and expectation a f f e c t the way we behave. Let me give you an example. Two people are going to the same party. Now neither'of them really'knows what to expect but, . one person believes that he's going to have a miserable time. He's not r e a l l y looking forward to going, because he assumes that he probably won't know anybody there, and that h e ' l l probably f e e l uncomfortable and kind of awkward, and end up spending most of the evening by himself. The second.person i s o p t i m i s t i c . He t e l l s himself that he may run into some old friends, but that even i f he doesn't h e ' l l have the opportunity to meet some i n t e r e s t i n g people and possibly make some new frie n d s . Now l e t ' s examine what happens when these 2 attend the party.. Our friend with the negative expectations a r r i v e s and finds that lie's r i g h t . lie doesn't know many people there. He expects to f e e l awkward and uncomfort-able - assumes that people may not l i k e him, and so he ends up being tense and withdrawn and his behaviour makes people avoid him. The second person on the other hand, because he has p o s i t i v e expectations i s more f r i e n d l y and open. He ends up meeting people and enjoying himself. So we have two people going to the same party and both have shaped what experiences they have there in d i f f e r e n t ways by the expectations and b e l i e f s they have. It's important for t h i s reason to become aware of the b e l i e f s , expect-ations, and self-statements which a f f e c t our fee l i n g s and guide our behavior. I I I . Automatic Nature of Self-statements Tt may be d i f f i c u l t at f i r s t to always be aware of our negative s e l f -statements. This i s because our expectations and the things we t e l l ourselves about s i t u a t i o n s are b u i l t up over a long period of time. Thus i t gets to the point where they become automatic. How many of you have had the experience of learning how to drive a standard transmission (or s k i i n g , or whatever) - (pause for recognition of experience). Remember what i t was l i k e at f i r s t ? You were aware of every, movement you made. You had to keep track of the c l u t c h , the brakes, the steering wheel, the accelerator, and the cars in front of you and behind you a l l at the same time. Remember how complicated i t seemed? How much of that complicated process arc you aware of now? etc... If you wanted to become . aware of a l l these things now, you'd have to make a conscious e f f o r t . It's p r e c i s e l y the same way with our negative self-statements. Introduction to Coping Strategies O.K. We've a l l reached the point now where we're developing some s k i l l at becoming aware of our f e e l i n g s , mental processes, and s e l f -statements, and i n t e r e s t i n g l y enough, some of you noted (draw on examples from group i f possible) that the simple act of becoming aware of what you're t e l l i n g yourself and what's' in t e i r f e r r i n g with assertive behaviour, makes i t a l i t t l e easier to act a s s e r t i v e l y . This, you see, i s r e a l l y the f i r s t step. 96 I t ' s one of s t e p p i n g back and g a i n i n g some p e r s p e c t i v e on what's g o i n g on. N o r m a l l y we're so busy r u m i n a t i n g about a l l of the h o r r i b l e , c a t a s t r o p h i c t h i n g s t h a t m ight happen, t h a t we're not aware of a l o t of the t h i n g s w h i c h a r e g o i n g on around us. We're not aware t h a t the p e r s o n we're t a l k i n g t o may be j u s t as n e r v o u s as we a r e , or t h a t maybe he/she i s j u s t as busy w o r r y i n g about whether wc l i k e him, as we a r e about him. By b e g i n n i n g to t a k e . a s t e p back and l o o k a t . y o u r n e g a t i v e s-s o b j e c t i v e l y , you b r e a k the a u t o m a t i c p r o c e s s , and g a i n some freedom from t h i s s t r a i n . When you f e e l a n x i o u s or u n c o m f o r t a b l e , i n s t e a d of pani.ci.ng and b e i n g overwhelmed, s t a r t l o o k i n g a t these f e e l i n g s as a c u e , a cue t h a t y o u ' r e t e l l i n g y o u r s e l f c e r t a i n t h i n g s . Say to y o u r s e l f something l i k e -O.K., I'm f e e l i n g u n c o m f o r t a b l e and a n x i o u s . What s h o u l d I do?. A l r i g h t . There* a no r e a s o n t o p a n i c . I can h a n d l e t h i s . I'm p r e p a r e d . T h i s i s e x a c t l y the s o r t of t h i n g we spoke about i n the group. T h i s f e e l i n g 1B a cue; - n cue to UHQ my c o p i n g s k i l l s . Lnba.l my a n x i e t y nnd watch i t change. O.K. Now s t e p back and take a deep b r e a t h . T h e r e , I f e e l b e t t e r a l r e a d y . I t ' s w o r k i n g . E t e r n a l l y o r i e n t e d S-S We've spent some time now d e v e l o p i n g our s k i l l s t o become aware of tl i e t h i n g s g o i n g on i n s i d e o f u s , the i n t e r n a ] d i a l o g u e s w h i c h make i t d i f f i c u l t to behave a s s e r t i v e l y . We've a l l p r a c t i c e d u s i n g v a r i o u s t e c h n i q u e s t o h a n d l e t h e s e s i t u a t i o n s . Something w h i c h has come up r e p e a t -e d l y ( h o p e f u l l y i t has i f you've taken c a r e t o e l i c i t i t and u n d e r s c o r e i t ) i s t h a t when we're p r e o c c u p i e d w i t h what's g o i n g on i n s i d e our heads, i t ' s i m p o s s i b l e t o r e a l l y s e e , h e a r , u n d e r s t a n d , and be r e c e p t i v e to what's g o i n g on o u t s i d e . We've a l l had the e x p e r i e n c e of b e i n g so nervous o r a p p r e h e n s i v e t h a t we don't r e a l l y h ear o r u n d e r s t a n d what the o t h e r p e r s o n i s s a y i n g . Or have any of you ev e r had the e x p e r i e n c e of t r a v e l l i n g i n a f o r e i g n country,, or t r y i n g to l e a r n a n o t h e r language. When yo u ' r e r e a l l y s t r a i n i n g to u n d e r s t a n d , i t ' s e x t r e m e l y d i f f i c u l t , but when you s i t back and r e l a x , you can make out the words. One of the t i l i n g s we're g o i n g to f o c u s on today i s ....... Ad,-.ip L i v e S o . l f - S La i.emen Ls 97 Coping statemenLs OK L'm f e e l i n g uncomfortable and anxious. WhaL should I 'do?' A l l r i g h t , there's no reason, to panick. I can handle 't h i s . I'm prepared. This i s exactly the- sort of tiring we spoke about i n the group. This f e e l i n g i s a cue - a cue to use my loping s k i l l s . Label my anxiety and watch i t change. OK now stop back and take a deep breath. There 1 f e e l better already. I t ' s working. Task relevant Now what.is i t I have to do? What does 'the s i t u a t i o n c a l l for? No reason to get anxious. No need to worry. What do I r e a l l y want to say i n th i s s i t u a t i o n ? What am I r e a l l y feeling? That's better. Now I'm in touch with what I want. No reason to f e e l small or over-whelmed. Externally oriented There. Wait a minute. Slow down. I'm getting so worked up - so overwhelmed by my own negative s e l f talk that I'm not r e a l l y paying attention to him/her. Let's look at t h i s r a t i o n a l l y , /lie's probably f e e l i n g j u s t as uncomfortable as I am./ He's probably insecure. /He. thinks I don't respect him. /He thinks I'm not l i s t e n i n g / . What can I do to make i t easier for both of us?/. etc. Challenging Now l e t ' s look at this r a t i o n a l l y . I know I'm f e e l i n g uncomfortable, or insecure r i g h t now, but I'm getting c a r r i e d away. /I'm not t o t a l l y incompetent/. I'm not that unattractive/. Nobody's even looking at me./ It doesn't matter i f I don't do this p e r f e c t l y . Nobody w i l l hold i t against me. What would be so t e r r i b l e i f I ... Pos i t i v e I'm being too hard on myself. I may not be the most attractive/competent/ i n t e l l i g e n t person i n the world but I'm OK ... Remember the time ... Exaggerating Negative s e l f statements When you f i n d yourself using negative s e l f statements and you f i n d i t d i f f i c u l t to change them, try exaggerating the negative self-statements. Keep doing that u n t i l you can see 1) the e f f e c t i t lias on you and 2) how u n r e a l i s t i c they are. -Rein forcing s e l f - s t a temen ts When you've used a coping s k i l l , i t ' s important to r e i n f o r c e yourself for doing i t . Even i f i t hasn't been completely successful, i t ' s important to r e a l i z e that you've developing the a b i l i t y to react d i f f e r e n t l y to these s i t u a t i o n s and that every small step i s important. 98 I t ' s w o r k i n g . I can c o n t r o l how I. f e e l . Wait u n t i l I t e l l my group about t h i s . I am i n c o n t r o l . I made more out of my f e a r 'than i t ' s w o r t h . My dam i d e a s , t h a t ' s the problem. When I c o n t r o l them I c o n t r o l my f e a r . I t ' s g e t t i n g b e t t e r each time I use the p r o c e d u r e . I d i d i t . Required s k i l l s for Self Instruct ional Training gg 1) Conveying rationales - f a m i l i a r i t y with r a t i o n a l e s - importance of engaging in dialogues. Be c a r e f u l not to lecture 2) Conducting i n i t i a l discussion in f i r s t session witli the aim of e l i c i t i n g statements which a n t i c i p a t e the s e l f - i n s t r u c t i o n a l t r a i n i n g , r a t i o n a l e technic]ucs: a) underscoring b) empathic r e f l e c t i o n c) rephrasing f e e l i n g s in terms of self-statements 3) General .techniques for e l i c i t i n g negative self-statements: a. covert.imagery b. role playing c. having c l i e n t play r o l e of others d. general r a t i o n of moving from s p e c i f i c s i t u a t i o n to f e e l i n g s to negative self-statements 4) F a m i l i a r i t y with various incompatiable self-statements a. coping b. task-relevant c. externally oriented d. challenging e. p o s i t i v e f. exaggeration technique g. s e l f - r e i n f o r c i n g 5) Techniques for implementing incompatible self-statements a. moving from overt to covert usage b. using coping imagery C l i n i c a l s i t u a t i o n s 100 1) C l i e n t says "I don't talk to myself" - denies using negative s e l f statements. 2) C l i e n t reports an i n a b i l i t y to modify negative self-statements. 3) C l i e n t s f a i l to do homework. A) C l i e n t s report f a i l u r e experiences. 5) C l i e n t c r i e s . 6) C l i e n t c r i t i c i z e s therapist or challenges authority. 7) C l i e n t i s very untalkative. Feels nervous and uncomfortable i n groups. 8) . Group engages i n nervous laughter. 9) C l i e n t speaks very quickly and tangentally - seems to sidestep r e a l issue 10) C l i e n t asks i f S-I approach i s l i k e the "power of p o s i t i v e thinking". 11) C l i e n t says: . "OK, so I'm aware of the negative things I say to myself. So what?" 12) C l i e n t says: "I've always found that spending a l o t of time introspecting makes things worse." 1.3) Wh en using technique of having c l i e n t imagine what the other says, c l i e n t responds "I've always found that putting myself i n other people's heads j u s t gets me i n trouble. 14) 2 c l i e n t s s t a r t arguing with one another. 15) C l i e n t s give s p e c i f i c s k i l l s feedback. APPENDIX IV 101 Adaptive Self-Statements The following statements are examples of the types of things you can say to yourself i n order to combat the negative self-statements (the cognitive processes) which i n h i b i t assertive behaviour. These statements are only guidelines. I t i s important to experiment and use statements phrased i n your own language; statements which are e s p e c i a l l y e f f e c t i v e - f o r you. I t ' s also extremely important to use these statements with f e e l i n g , rather than to j u s t parrot them or say them mechanically. Although i t may seem at f i r s t as i f i t would take too long to use t h i s type of s e l f -statement when you are a c t u a l l y i n a problem s i t u a t i o n , remember that i t takes a l o t less time to say something i n t e r n a l l y or to think i t than to read i t or to say i t out loud. Also, one of the most common mistakes that people make i s to believe that they don't have time to think about the s i t u a t i o n before they respond; to l e t  themselves f e e l pressured. There's always time to step back and gain some perspec-t i v e on what's going on. P r a c t i c e these self-statement techniques at f i r s t i n le s s threatening s i t u a t i o n s , and work your way up to more problematic ones. Remember that i t ' s le s s important to be completely s a t i s f i e d with the way you deal with pro-blem s i t u a t i o n s f i r s t time around, that I t i s to become aware of the small changes i n experience that occur as a r e s u l t of the techniques y o u ' l l be using. Don't t a l k yourself into b e l i e v i n g that you're f a i l i n g , by s e t t i n g unreasonable objectives for yourself. This i s j u s t another kind of negative self-statement. Reward yourself for making small steps. You can use the extra space provided to write down any s p e c i a l adaptive s e l f -statements you've found, which are p a r t i c u l a r l y e f f e c t i v e for you. 1) Coping statements OK I'm f e e l i n g uncomfortable and anxious. What should I do? A l l r i g h t , there's no reason to panic. I can handle t h i s . I'm prepared. This i s exactly the sort of thing we spoke about i n the group. This f e e l i n g i s a cue - a cue to use ray coping s k i l l s . Label my anxiety and watch i t change. OK now step back and take a deep breath. There I f e e l better already. I t ' s working. 2) Task relevant Now what i s i t I have do do? What does the s i t u a t i o n c a l l for? No reason to get anxious. No need to worry. What do I r e a l l y want to say i n t h i s situation? What am I r e a l l y feeling? That's better. Now I'm i n touch with what I want. No reason to f e e l small or overwhelmed. 3) Focusing on the other There. Wait a minute. Slow down. I'm getting so worked up - so overwhelmed by my own negative s e l f t a l k that I'm not r e a l l y paying attention to him/her. Let's look at t h i s r a t i o n a l l y . /He's probably f e e l i n g j u s t as uncomfortable as I am. /He's probably insecure. /He thinks I don't respect him. /He thinks I'm not l i s t e n i n g / . What can I do to make i t easier for both of us?/, etc. 102 A d a p t i v e S e l f - S t a t e m e n t s ( c o n t ' d ) 4) C h a l l e n g i n g Now l e t ' s l o o k a t t h i s r a t i o n a l l y . I know I'm f e e l i n g u n c o m f o r t a b l e o r i n s e c u r e r i g h t now, b u t I'm g e t t i n g c a r r i e d away. /I'm n o t t o t a l l y incom-. • p e t e n t / . I'm n o t t h a t u n a t t r a c t i v e / . Nobody's even l o o k i n g a t me./ I t doesn't m a t t e r i f I don't do t h i s p e r f e c t l y . Nobody w i l l h o l d i t a g a i n s t me. What woul d be so t e r r i b l e i f I 5) P o s i t i v e I'm b e i n g too h a r d on m y s e l f . I may n o t be t h e most a t t r a c t i v e / c o m p e t e n t / i n t e l l i g e n t p e r s o n i n t h e w o r l d b u t I'm OK.... Remember th e t i m e . . . . ( r e c a l l p a s t s u c c e s s e s ) . 6) E x a g g e r a t i n g N e g a t i v e s e l f s t a t e m e n t s When you f i n d y o u r s e l f u s i n g , n e g a t i v e s e l f s t a t e m e n t s and you f i n d i t d i f f i -c u l t t o change them, t r y e x a g g e r a t i n g t h e n e g a t i v e s e l f - s t a t e m e n t s . Keep d o i n g t h a t u n t i l y ou can see 1) t h e e f f e c t i t has on you and 2) how u n r e a l i s -t i c t h e y a r e . 7) R e i n f o r c i n g s e l f - s t a t e m e n t s When you've used a c o p i n g s k i l l , i t ' s i m p o r t a n t t o r e i n f o r c e y o u r s e l f f o r d o i n g i t . Even i f i t h a s n ' t been c o m p l e t e l y s u c c e s s f u l , i t ' s i m p o r t a n t t o r e a l i z e t h a t y o u ' r e d e v e l o p i n g t h e a b i l i t y t o r e a c t d i f f e r e n t l y t o these, s i t u a t i o n s and t h a t e v e r y s m a l l s t e p i s i m p o r t a n t . e.g.. I t ' s w o r k i n g . I can c o n t r o l how I f e e l . W a i t u n t i l I t e l l my group about t h i s . I am i n c o n t r o l . I made more out o f my f e a r t h a n i t ' s w o r t h . My damn i d e a s , t h a t ' s t h e problem. When I c o n t r o l them I : c o n t r o l my f e a r . I t ' s g e t t i n g b e t t e r each t i m e I use t h e p r o c e d u r e . I d i d i t . APPENDIX V RATING MANUAL 103 B a s i c D i s t i n c t i o n Between V e r b a l C o n t e n t and N o n v e r b a l Components o f Communication  V e r b a l c o n t e n t r e f e r s t o what the i n d i v i d u a l s a y s . Thus, f o r example, i f someone a s k s an i n d i v i d u a l i f he can borrow h i s c a r f o r the e v e n i n g , the r e s p o n s e : "No, you c a n ' t , I need i t t o n i g h t " , might be the v e r b a l c o n t e n t of the communica-t i o n . The way i n w h i c h t h i s i s s a i d , on t h e o t h e r hand, i s the n o n v e r b a l p o r t i o n of the c o m munication. These n o n v e r b a l s may i n c l u d e such components as eye c o n t a c t , body e x p r e s s i o n , v o i c e volume, v o i c e t o n e , f a c i a l e x p r e s s i o n and v e r b a l f l u e n c y . They s t r o n g l y i n f l u e n c e what the i n d i v i d u a l a c t u a l l y conveys to the l i s t e n e r and t h e f a s h i o n i n w h i c h h i s r e s p o n s e i s I n t e r p r e t e d . General Description of S c a l e s 1. C o m p l i a n c e T h i s s c a l e i s a s s e s s e d s o l e l y on the b a s i s of the v e r b a l c o n t e n t of the s u b j e c t ' s communication. I f he has n o t e x p r e s s e d h i s f e e l i n g s o r t u r n e d down what he c o n s i d e r s t o be an u n r e a s o n a b l e r e q u e s t he i s r a t e d as a 1 on the s c a l e . I f he does so o n l y p a r t i a l l y o r i n d i r e c t l y , or i f he o f f e r s an e x c u s e i n s t e a d o f e x p r e s s i n g h i s f e e l i n g s , he i s s c o r e d 2 on t h e s c a l e . I f t h e s u b j e c t d i r e c t l y and h o n e s t l y e x p r e s s e s h i s f e e l i n g s , he i s s c o r e d 3. The f a s h i o n i n w h i c h he does t h i s i s i r r e l e v a n t . Thus i t i s p e r m i s s a b l e t o appear a n g r y o r n e r v o u s , and s t i l l be s c o r e d a 3. 2. Eye C o n t a c t Eye c o n t a c t i s an i m p o r t a n t component of n o n v e r b a l communication. To communicate a s s e r t i v e l y and e f f e c t i v e l y i t i s e s s e n t i a l t o be a b l e t o m a i n t a i n eye c o n t a c t . O f t e n t i m e s , p e o p l e who a r e f e e l i n g n e r v o u s , a n x i o u s o r unsure of t h e m s e l v e s , w i l l l o o k down o r away when they a r e t a l k i n g . T h i s d e t r a c t s from the e f f e c t i v e n e s s o f t h e i r c o m m u n i c a t i o n , and makes them appear to l a c k c o n f i d e n c e i n what t h e y a r e s a y i n g . To s c o r e 1 on the s c a l e , the s u b j e c t must be l o o k i n g down o r away over h a l f t h e t i m e . I f the s u b j e c t makes eye c o n t a c t , but l o o k s away a t t i m e s , s c o r e 2. S c o r e 3 i f the s u b j e c t makes d i r e c t , a p p r o p r i a t e eye c o n t a c t . I t i s p e r -m i s s a b l e to l o o k away b r i e f l y and o c c a s i o n a l l y . P e o p l e n o r m a l l y s h i f t t h e i r eyes around to some e x t e n t . 104 3. Body E x p r e s s i o n There a r e b a s i c a l l y 3 t h i n g s t o l o o k f o r h e r e : (a) t e n s e n e s s o r r i g i d i t y , e.g., hands c l a s p e d t i g h t l y , arms of c h a i r c l u t c h e d , s h o u l d e r s hunched f o r w a r d , o r h e l d t i g h t l y e r e c t i n an awkward f a s h i o n . (b) f i d g e t i n g o r n e r v o u s g e s t u r e s , e.g., l e g s s w i n g i n g , j e r k y o r e x c e s s i v e hand movements, e x c e s s i v e head n o d d i n g , s q u i r m i n g o r w r i g g l i n g i n c h a i r , t w i t c h i n g of f i n g e r s . (c) f a c e d i s t o r t i o n s , r a i s i n g eyebrows, e t c . To s c o r e 1, s u b j e c t must appear e x t r e m e l y t e n s e o r r i g i d , o r c o n s i s t e n t l y make n e r v o u s movements w h i c h a r e q u i t e n o t i c e a b l e . To s c o r e 2, s u b j e c t s i s somewhat t e n s e o r r i g i d , o r makes p e r i o d i c , s m a l l n e r v o u s g e s t u r e s . Mya l o o k somewhat awkward. To s c o r e 3, s u b j e c t must appear g e n e r a l l y n a t u r a l and r e l a x e d , w i t h few n e r v o u s g e s t u r e s . To s c o r e 4, s u b j e c t i s v e r y r e l a x e d w i t h o u t any n e r v o u s o r d e t r a c t i n g g e s t u r e s . (NOTE: I t i s n o t uncommon to f i n d b o t h r i g i d i t y and n e r v o u s movements i n t h e same s u b j e c t ) . 4. V o i c e Volume The i m p o r t a n t c r i t e r i o n h e r e i s a u d i b i l i t y . There i s a good range of v a r i -a b i l i t y i n n o r m a l v o i c e volume, t h u s i t i s i m p o r t a n t not t o compare the s u b j e c t t o o t h e r s u b j e c t s , but r a t h e r t o an a b s o l u t e c r i t e r i o n . I f t h e v o i c e i s g e n e r a l l y low and a c t u a l l y i n a u d i b l e a t t i m e s , s c o r e 1. S c o r e 2 i f v o i c e tended t o s o f t , b u t a u d i b l e . S c o r e 3 i f v o i c e i s a u d i b l e , a p p r o p r i a t e and w e l l m o d u l a t e d . The n e x t t h r e e s c a l e s (5, 6 and 7) a r e g l o b a l r a t i n g s and s h o u l d be e v a l u a t e d by c o m b i n i n g v e r b a l and n o n v e r b a l components t o o b t a i n a g e n e r a l i m p r e s s i o n . 5. A n x i e t y S c o r e 1 i f s u b j e c t a p p ears t o be q u i t e u n c o m f o r t a b l e . Cues: a c o n s p i c u o u s l a c k of v e r b a l f l u e n c y , e x c e s s i v e s q u i r m i n g , s h i f t i n g i n c h a i r , poor eye c o n t a c t , q u a v e r i n g of v o i c e , n e r v o u s l a u g h t e r , g i g g l i n g , e x c e s s i v e f i d g e t t i n g , hand w r i n g i n g , t e n s e n e s s , n e r v o u s p a u s e s , h e s i t a t i o n , t w i t c h i n g of f a c e , eyebrows r a i s i n g , f a c i a l d i s t o r t i o n s . 105 Score 2 i f subject displays some discomfort. Any of the cues mentioned above may be present here i n a less pronounced and exaggerated sense. Thus, subject may be somewhat tense, f i d g e t t y , d i s f l u e n t , etc. Score 3 i f subject i s generally comfortable and relaxed. Score 4 i f subject i s very relaxed and i n con t r o l of the s i t u a t i o n . 6. I r r i t a b i l i t y and Brusqueness We are r e f e r r i n g here to a general s t y l e which makes the subject appear somewhat arrogant, brusque, s a r c a s t i c or i r r i t a b l e . Score 1 i f the subject demonstrated i r r i t a b i l i t y or anger i n voice, or makes sa r c a s t i c comments, or t i l t s head backwards and talks down nose i n an arrogant fashion, or sspe&ks i n an abtrupt, clipped f a i h i e n . Score 2 i f there i s some i n d i c a t i o n of arrogance i n voice tone, response content, or general manner. Score 3 i f subject has s l i g h t edge i n voice tone. Score 4 i f subject i s calm, matter of fact and pleasant. 7. Assertion This i s the l a s t scale to be rated and should combine a l l of the dimensions previously mentioned to form a general impression. A r a t i n g of 4 on th i s scale indicates that the subject was able to turn down a request or express his feeli n g s i n a d i r e c t , honest and appropriate fashion. He demonstrated respect for himself and his own f e e l i n g s , but at the same time, demonstrated respect for the other. I t i s important for t h i s reason that the response i s reasonably calm and nonaggressive. Content and nonverbals should indicate a minimal amount of anxiety, h e s i t a t i o n , anger, i r r i t a t i o n or brusqueness. It should appear to be an e f f e c t i v e response. To score 3, content should be b a s i c a l l y d i r e c t and as s e r t i v e , but may be flawed by somewhat anxious nonverbals, a lack of smoothness, some i r r i t a t i o n , etc. To score 2, subject makes an attempt at assertion, but f a l l s short because of his indirectness, hesitance, anxiety, aggression or apologetic fashion. To score 1, subject must f a i l to express his f e e l i n g s , or turn down an unreasonable request. 1 0 6 1. Compliance complete compliance: does not turn down request or express feeli n g s Eye Contact APPENDIX VI Behavioural Ratings only p a r t i a l l y or i n -d i r e c t l y turns down request or expressed fee l i n g s or j u s t i f i e s with excuse turns down request or expresses f e e l i n g s (Aggression i s per-missable conspicuously avoids eyes of experimenter over ha l f the time Body Expression 1 body extremely tense or r i g i d or continuous f i d g e t t i n g or nervous gestures with hands or head. Quite noticeable movements. makes eye contact, but unassertive glances away appropriate, d i r e c t eye contact body somewhat tense, r i g i d or periodic nervous gestures, small movements appropriate, natural and relaxed very relaxed, with-out any nervous or detracting ges-tures Voice Volume low and inaudible at times audible but soft voice appropriate, audible and well modulated 5. Anxiety displays a good deal of discomfort i n content and/ or nonverbals some discomfort displayed i n content and non-verbals 3 4 nonanxious, relaxed, very relaxed, comfortable, matter and i n control of fact of the s i t u -a t i o n 107 I r r i t a b i l i t y and Brusqueness i r r i t a b l e voice tone snotty head movements (talking down nose, head back, clipped statements, brusque some edge on voice somewhat brusque s l i g h t l y arrogant s l i g h t edge i n voice tone calm, matter of fa c t and pleasant Assertion nOn assertive compliant or does not express fe e l i n g s content asser-t i v e , but flawed by s l i g h t l y an-attempts at asser-tions but not smooth. Hesitant. Vague or apologetic xious or aggres-or excessively si c e nonverbals aggressive. Aggres-sive or nervous nonverbals smooth, firm e f f e c t i v e as-s e r t i o n , ex-presses fee l i n g s i n a d i r e c t , honest, approp-rate fashion 108 APPENDIX VII Group S a t i s f a c t i o n Questionnaire Please answer the following questions by c i r c l i n g e i t h e r 1, 2, 3, 4, or 5. 1. How s k i l l e d were your co-leaders as therapists? 1 2 3 4 5 not very average extremely 2. How warm do you f e e l your leaders were towards group members? 1 2 3 4 5 not very average extremely 3. How understanding were your leaders of group members' problems and feelings? 1 2 3 4 5 not very average extremely 4. How s a t i s f i e d were you with your group? 1 2 3 4 5 not very average extremely 5. How l i k e l y i s i s that y o u ' l l use the s k i l l s / t e c h n i q u e s that you learnt i n the group? 1 2 3 4 5 not very somewhat extremely 

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