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A comparative outcome study for the treatment of social avoidance : does training in helping skills add… Cappe, Robin Elyse 1985

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A COMPARATIVE OUTCOME STUDY FOR THE TREATMENT OF SOCIAL AVOIDANCE: DOES TRAINING IN HELPING SKILLS ADD TO A BEHAVIOURAL STRATEGY? By ROBIN ELYSE CAPPE M.A., The University of British Columbia, 1980 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES Department of Psychology We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA February 1985 © Robin Elyse Cappe, 1985 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make i t 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 or her representatives. It i s understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date Apr, 7 /H. - i i -Abstract Traditionally, research regarding social s k i l l s training has emphasized deficits in specific s k i l l components, rather than process s k i l l s , such as being sensitive to another's behaviour. In the present study, Human Relations Training (HRT) was adapted to the treatment of socially avoidant members of the community. Training in HRT consisted of defining, modeling and practising s k i l l s of attending, empathy, self-disclosure and respect. It was expected that training in these process-like s k i l l s would encourage a focus of attention away from the self and towards the other, which in turn, may abate anxiety and foster social effectiveness. Following a stringent screening process, 52 persons (26 male, 26 female) were randomly assigned to one of three conditions: Graduated exposure plus progressive relaxation (Condition I); Graduated exposure plus progressive relaxation plus HRT (Condition II); or a Waiting l i s t condition. Subjects in the two treatment conditions received eight weekly, two-hour training sessions in groups. The results indicated that subjects in both treatment conditions improved in the predicted direction more than those in the waiting l i s t condition, as assessed by twenty of twenty-one dependent measures. Subjects in both treatment conditions improved significantly more than those in the waiting l i s t condition on self-reported well-being, global s k i l l and comfort, and functional impairment. This difference was not corroborated by objective raters. Those in the HRT condition improved significantly more than those in Condition I on several self-report measures. This improvement of HRT subjects could not be clearly attributed to an other-directed focus of attention. There was no evidence of gender differences. After three months, participants had maintained positive changes made at post assessment, but had not improved significantly since then. However, those in the HRT condition reported that they were engaging in a broader range of social activities and with greater frequency than those in Condition I. It was concluded that both treatment conditions evidenced greater improvement than those who received no treatment, as assessed by self-report measures. Further, the addition of an HRT component to a behavioural strategy proved somewhat beneficial to the well- being and social effectiveness of subjects. - iv -Table of Contents PAGE ABSTRACT i i LIST OF TABLES ' x ACKNOWLEDGMENTS : xi INTRODUCTION 1 Overview 1 Definitions 1 Populations 2 Research on Social S k i l l s Training 3 Limitations on Social Ski l l s Training Research ... 6 Research on Loneliness: Focus in Social Interactions 8 Speech and Test Anxiety 10 Self-Evaluations and Self-Focus of the Socially Anxious 11 Shyness 12 Parallels Between Social Anxiety and Loneliness .. 16 Self-Awareness Theory 17 Depression and Social Competence 18 Human Relations Training 19 Research Goals 20 Summary of Treatment Conditions 23 - V -Hypotheses 23 METHOD 24 Subject Recruitment 24 Community Recruitment 24 Telephone Interview 24 Individual Interviews 26 Screening Measures 27 Subjects 30 General Procedure 30 Dependent Measures 31 Questionnaires Used as Dependent Measures 32 Role Playing Task 35 Significant Other Ratings 39 Measures of Focus of Attention 41 Measures of Credibility and Evaluation of Treatment 41 Therapist Ratings 42 Group Assignment 42 Therapists 44 Treatment 45 Summary of Treatment Conditions 45 Treatment Procedures 46 - vi -Waiting L i s t Condition 49 Post Treatment Assessment 49 Three Month Follow-up Session 50 RESULTS 51 Overview of Analyses Conducted 51 The Unit of Analysis 51 Categorization of Dependent Measures 54 Analyses to Investigate Sex Effects 56 Testing the Hypotheses 65 Assessing Change from Pre to Post Assessment 66 Screening Measures 67 Self-Report of Functional Impairment 67 Others' Ratings 69 Therapists' Ratings 69 Significant Others' Ratings 70 Secondary Analyses 70 Focus of Attention 70 Relation Between Skill Level and Attractiveness .. 72 Credibility and Expectations 72 Three Month Follow-up Assessment 73 Treatment Drop-outs and Exclusions 75 DISCUSSION 77 Major Hypotheses 77 - v i i -Hypothesis I 77 Hypothesis II 82 Secondary Analyses 87 Relation Between Skill Level and Attractiveness .. 87 Gender Differences 88 Methodological Issues 88 Treatment Procedures 92 Clinical Observations 94 Future Research 95 Summary 98 BIBLIOGRAPHY 100 APPENDICES 114 Appendix A: Letter to Mental Health Workers 114 Appendix B: Details of Persons Screened Out by Telephone 116 Appendix C: Referrals Made Over Telephone Following Screening 119 Appendix D: Pre-Assessment Interview 123 Appendix E: Beck Depresssion Inventory 126 Appendix F: Social Avoidance and Distress Inventory 128 Appendix G: Demographics and Statistics 129 Appendix H: Self-Report of Social Interactions 132 Appendix I: Self-Report of Comfort and Skill in the Community 133 - v i i i -Appendix J: UCLA Loneliness Scale 134 Appendix K: Subjects Screened out at Interview .. 135 Appendix L: Global Skill 139 Appendix M: Global Comfort 140 Appendix N: Confederates' Ratings 141 Appendix 0: Focus of Attention: Judges 142 Appendix P: Peer Letter 143 Appendix Q: Peer Rating Form 144 Appendix R: Focus of Attention: Therapists 145 Appendix S: Credibility of Treatment 146 Appendix T: Evaluation of Treatment 147 Appendix U: General Rationale for Exposure Group. 148 Appendix V: General Rationale for S k i l l s Group .. 149 Appendix W: Client Consent Form 151 Appendix X: General Rationale for Sk i l l s Group .. 153 Appendix Y: General Rationale for Exposure Group. 155 Appendix Z: Progressive Relaxation 156 Appendix AA: Rationale for Graduated Exposure Procedure 157 Appendix BB: Graduated Exposure Procedure 158 Appendix CC: Rationale for Skil l s Component 162 Appendix DD: Attending S k i l l s 163 Appendix EE: Sensitivity Sk i l l s 166 Appendix FF: Respect Skil l s 168 Appendix GG: Self-Disclosure 170 - ix -Appendix HH: Tape Content 172 Appendix II: Cell Sizes and Drop-out Information. 173 Appendix JJ: Procedure for Condition I 174 Appendix KK: Procedure for Condition II 176 Appendix LL: Overview of Sessions 178 Appendix MM: Levinger's Model 180 Appendix NN: Relaxation Procedures 181 Appendix 00: Sk i l l s Handouts 184 Appendix PP: Post Assessment Interview 188 Appendix QQ: Follow-up Interview 190 Appendix RR: Results of t Tests 191 - X -List of Tables PAGE Table 1: Grouping of Dependent Variables 57 Table 2: Correlation Matrix of Dependent Variables ... 58 Table 3: Means of Each Dependent Variable at Each Assessment Period 59 Table 4: Summary of Sex Effects at Post Assessment ... 64 Table 5: Results of A Priori Comparisons at Post Assessment Following MANCOVAs 68 Table 6: Means of Drop-outs on Self-Report Questionnaires at Follow-up 76 - xi -Acknowledgments I would like to express my gratitude to my dissertation advisor, Dr. Lynn Alden, for her academic expertise and consistent support throughout this thesis, from its conception to completion. As a committee member, Dr. Jack Rachmari was appreciated for his straightforward assistance in helping to manage the dissertation and to maintain an accurate perspective on my p r i o r i t i e s . I would also like to thank Dr. Del Paulhus for his contributions as a committee member. Jim Frankish, Jacquie Hare, Pat Manly and Ken Reesor have my most sincere appreciation and admiration for their unyielding dedication, in the amount of time and energy they spent as therapists and in supervision of the groups. They approached this research as i f i t was their own. I would also like to thank those who acted as confederates — Mary Peng and Leslie Roseberry. Special thanks to Daniel Chernenkov. All were appreciated for their conscientiousness and f l e x i b i l i t y in dealing with scheduling idiosyncracies. I am grateful to Pat Gnissios and Cindy Jensen for their many hours spent rating videotapes. My thanks to Nancy Wiggs for typing and retyping this manu-script, while racing to meet my deadlines. Finally, I am most grateful to Lome Cappe who freely took time from his own thesis to problem-solve, support and encourage me to persist with this dissertation. 1 Introduction Overview As this study concerns intervening to minimize the postulated excessive self-focus of socially avoidant persons, pertinent literature from a variety of sources will be outlined. This introductory chapter commences with a review of the social effectiveness/dysfunction literature: several populations relevant to this study are defined and described. The literature regarding social s k i l l s training is then reviewed and critiqued. A presentation of literature concerning excessive self-focus follows. This literature is drawn from several areas of study including: loneliness, speech and test anxiety, social anxiety, and depression. Self-awareness theory is then discussed. The literature on shyness is reviewed, followed by a description of a particular type of s k i l l training. Finally, the goals and hypotheses of the present research are outlined. Definitions Several closely related, and, at times, overlapping terms are utilized in this proposal: shyness, social anxiety, social ineffectiveness, social s k i l l d e f i c i t s , social isolation, and, loneliness. All are descriptive of an individual who in his/her own or another's opinion is socially dysfunctional. Typically, shyness refers to the absence of expected social behaviours, coupled with feelings of discomfort and social avoidance; social anxiety refers to subjective discomfort; social s k i l l s deficits - 2 -and social ineffectiveness to behavioural s k i l l , and social isolation and loneliness to frequency and/or quality of interpersonal contacts. The precise definitions of these terms and the relations between them have not been well investigated. This proposal will include research relating to each of these topics. There are also similarities between speech and test anxiety and social anxiety in that all include a fear of evaluation by others, discomfort, and s e l f - c r i t i c a l thinking. As researchers of speech and test anxiety have drawn conclusions relevant to social anxiety, these two areas will be referred to as wel 1. Populations Research regarding social dysfunction has focused on a number of distinct populations. It should be noted that conclusions are often moderated by population variables. Studies have been conducted with psychiatric inpatients (e.g. Jaffe & Carlson, 1976; Bellack, Hersen & Turner, 1976; & E i s l e r , Hersen & Miller, 1974). The majority of these assume social dysfunction in this population is related to behavioural deficits and involve social s k i l l s training. Similarly, social s k i l l s training has been the primary treatment focus with outpatients, although research with this population is less extensive. Finally, a number of studies have been conducted with university populations (e.g. Hedquist & Weinhold, 1980; Rehm & Marston, 1968; Royce & Arkowitz, 1978; Rathus, 1972; McFall & Twentyman, 1973). Here, investigations - 3 -have focused on social anxiety, heterosocial (dating) anxiety/skills and assertive behaviour. Research on Social Ski l l s Training For the most part, social s k i l l s training has focused on psychiatric populations (e.g. Bellack, Hersen & Turner, 1976) and heterosexually anxious subjects (e.g. Christensen, Arkowitz, & Anderson, 1975; Royce & Arkowitz, 1978). Some research has, however, been conducted on the traditional analogue population, college students (e.g. Wright, 1976). Typically, most cli n i c a l treatment studies have examined the effectiveness of one or a combination of the following social s k i l l s training techniques: modeling, behaviour rehearsal, coaching and feedback. In general, social s k i l l training procedures have produced significant improvements in the populations studied i f behavioural ratings of laboratory role playing are utilized as the c r i t e r i a . However, several problems in the treatment literature should be noted: the issue of generalizability, the lack of differential effectiveness of different treatment interventions, and questions regarding the nature of social dysfunction. Although most studies provide evidence for improvement on laboratory measures, the clinical significance of these changes has not been well investigated. Too few studies have addressed the issue of generalizability to "real" l i f e settings (e.g. Bellack, Hersen & Turner, 1976; Shepard, 1978; and Twentyman & McFall, 1975). Those that have, often report a surprisingly low correlation between laboratory measures and - 4 -behaviour in naturalistic settings (e.g. Bellack, Hersen & Lamparski, 1979; Bellack, Hersen & Turner, 1978; & Green, Burkhurt & Harrison, 1979). As previously noted, the majority of investigations conducted have compared various types of behavioural interventions e.g. modeling vs. instructions vs. modeling plus instructions (Hersen, et a l . , 1973). For the most part, combinations of techniques have not produced significantly different results. There have, however, been some exceptions (e.g. Edelstein & Eisler, 1976; Turner & Adams, 1977). While the majority of treatment interventions have produced significant change in comparison to placebo or minimal treatment control conditions, such factors as experimental demand and expectancy effects have not been consistently equated and assessed. Thus, the active components of social s k i l l s training have not been clearly identified. While social s k i l l s training is generally effective (e.g. Jaffe & Carlson, 1976; Bellack, Hersen & Turner, 1976) i t may be no more effective than other intervention strategies. For example, Wright (1976) found no differences between systematic desensitization and social s k i l l s training in a university population. Similarly, Marzillier, Lambert and Kellett (1976) studied the effects of systematic densensitization and social s k i l l s training on outpatients. While both treatments led to significant improvements in the patients' range of social activities and social contacts, the treatments did not d i f f e r . - 5 -Royce and Arkowitz (1978) assigned socially isolated university students to one of four conditions: practice interactions, practice interactions with nine hours of social s k i l l s training, minimal treatment control, or, a waiting l i s t control. In contrast to the control groups, subjects in the two treatment groups significantly improved. However, no differences were found between the two treatment groups. Therefore, i t may be that social s k i l l s training, at least as provided to date, is no more effective than other techniques. At present, there may be l i t t l e reason to prefer the behavioural s k i l l s conceptualization of social dysfunction. Research is needed to investigate other types of interventions. For example, many practising clinicians u t i l i z e relaxation techniques in conjunction with graduated exposure ( i . e . gradually confronting and mastering situations which are increasingly anxiety-producing) without the addition of social s k i l l s training per se. Few studies have evaluated the relative efficacy of this combination. Royce and Arkowitz (1978) reported that social s k i l l s training did not add to practice dating i t s e l f . Tangentially related is the work of Marzillier et a l . (1976) and Wright (1976) both of whom reported few significant differences between subjects who received systematic desensitization and those who received s k i l l s training. However, these studies employed imaginal desensitization, rather than graduated in vivo exposure. No other evaluations of graduated exposure (either with or without - 6 -relaxation training) have been reported in the social anxiety 1iterature. Limitations of Social Skill Training Research Social s k i l l s training (as i t has been utilized) may require some modification. The nature of this modification is the focus of this research. Trower (1980) and Fischetti, Curran and Wessberg (1977) have suggested that researchers have not been assessing crucial s k i l l s for effective social behaviour. Trower (1980) has noted that research emphasizes deficits in components (e.g. eye contact, voice volume) rather than in processes (e.g. monitoring the other's behaviour, being sensitive to others' reactions). The results of his research have suggested that unskilled patients are not only deficient in absolute levels of behaviour, but also in the pattern of their behaviour. Specifically, they were less responsive to situational cues than the s k i l l e d . He concluded that training in process s k i l l s is mandatory for effective social behaviour. In a similar vein, Fischetti et a l . (1977) investigated the timing of responses of heterosocially anxious males. Their data revealed that a socially competent group did not differ significantly from a socially incompetent group in frequency of responses, but did in terms of timing of responses. The socially incompetent responded in a random fashion, whereas those who were competent, clustered their responses more systematically. Fischetti et a l . concluded that the nature of social s k i l l must encompass the accurate placement, - 7 -as well as execution of those particular behaviours. Taken together the results of these two studies suggest that s k i l l s of a different sort merit further attention and evaluation. It may be that s k i l l s training procedures would be enhanced by instruction in process s k i l l s . Morrison and Bellack (1981) have also addressed this issue. They suggest that the assumption that individuals with poor social s k i l l s are deficient or excessive in their use of specific motor responses, provides a less than adequate explanation for the complexity of interpersonal functioning. These authors stress the importance of possessing the ability to receive and process relevant interpersonal stimuli in an adequate fashion. In order to determine when and how to respond to others, one must be able to accurately "read" the social environment. This consists of assessing the norms and conventions operating at a particular moment, attending to and showing interest in one's partner, conveying sensitivity by understanding messages being sent, as well as the emotions and intentions which shape the behaviour of one's partner in any interaction (Morrison & Bellack, 1981; Argyle, 1969). These a b i l i t i e s to receive and process relevant interpersonal stimuli, have been referred to as person perception (Argyle, 1969) and social perception (Trower, 1979). As inadequate social functioning could result from either s k i l l or perceptual d e f i c i t s , Morrison and Bellack (1981) proposed that behavioural strategies consisting only of component s k i l l - 8 -training, to the exclusion of social perception s k i l l s , are not adequate for enhancing social competence. Similarly, Azrin and Hayes (1984) have acknowledged that the rules surrounding complex behaviours are not easily identified and would thus likely be d i f f i c u l t to describe and convey to c l i e n t s . These authors highlight social sensitivity, defined as the ab i l i t y to discriminate the nature and demands of a social situation, as a crucial component of social s k i l l s . As an alternative approach to social s k i l l s training, they adopted an experiential approach in which specific cues, rules and instructions were not identified for males who were learning to discriminate nonverbal indicants of social interest conveyed by females. Improvement in the development of subjects' discriminative s k i l l without provision of specific rules led the authors to conclude that social sensitivity may play an important role in s k i l l s training, and hence, categorization and labelling of specific s k i l l components before commencing training may not be necessary (Azrin & Hayes, 1984). Research on Loneliness: Focus in Social Interactions Certain research regarding loneliness may help to shed light on the means by which researchers might attempt to foster social perception. Several laboratory studies of lonely university students have investigated the effects of encouraging subjects to focus on their partner, rather than themselves. The treatment interventions examined taught other-focused behaviours. For example, Jones, Hobbs and Hockenbury (1982) examined the effects - 9 -of encouraging subjects to concentrate on one's partner in an interaction (defined as "partner attention"). Lonely and non-lonely subjects were paired into dyads and directed to interact with each other. Judges' ratings indicated that lonely persons made fewer references to their partner; discussed the partner-initiated topics less; asked fewer questions of the partner; and emitted fewer partner attention statements. In a second study, subjects received two sessions (1.5 hours) of instruction in methods designed to augment attention to their partners. Increased use of partner attention resulted in a significant decrease in self-reported loneliness and shyness, as compared with a no-contact control group and an interaction-only group. While these results are suggestive, one is hesitant to draw strong conclusions from this research, given that each cell consisted of six persons. Several laboratory studies of social attraction are relevant as well. Kupke, Hobbs and Cheney (1979) hypothesized that personal attention (defined as questions or statements concerning one's partner) is related to interpersonal attraction. Male students interacted with female students in an unstructured dyadic setting. The males were instructed to converse with the females "as they normally would" for a period of fifteen minutes. Females rated their partners on several factors, including measures of interpersonal attraction. The authors concluded that personal attention techniques may increase heterosocial d e s i r a b i l i t y . - 10 -Scott and Edelstein (1981) examined the relative efficacy of two techniques designed to improve social effectiveness: positive self-presentation and other-enhancement. Subjects were female undergraduates (not identified as socially incompetent or anxious). Other-enhancement was defined as "focusing on the other person in the conversation," communicating you like him or her and find him/her interesting. Positive self-presentation, however, concentrated on oneself. Here, one conveys "I like myself and enjoy l i f e " . Individuals in a third condition expressed l i t t l e interest in anything. Female subjects interacted with a male trained in one of these conditions. Subjects then rated the male on a series of scales including physical attractiveness, apparent self-esteem and attraction to the male. The two primary treatment interventions were equally effective in producing interpersonal attraction. Two methodological limitations warrant attention: a small sample size was used (N=27), and, several of the males were trained actors, which may have brought an air of a r t i f i c i a l i t y to the situation. Speech and Test Anxiety Investigations of test anxiety and speech anxiety also provide support for the potential usefulness of process s k i l l s training. Researchers have found that anxious subjects engage in s e l f - c r i t i c a l , self-focused thinking (e.g. Goldfried, Linehan & Smith, 1978; Meichenbaum, Gilmore & Fedoravicius, 1971). This pattern is believed to be maladaptive; self-criticism likely - 11 -increases arousal and self-focused thinking may replace task-relevant thoughts. Meichenbaum (1977) suggested that behavioural improvements were noticed in such subjects when they were taught to focus their attention on the task at hand. The same may be true for the socially anxious individual. In social interactions, a task-relevant focus might involve monitoring the other's behaviour. This ties in with the observations of Trower (1890) and Fischetti et a l . (1977). An interesting possibility is that traditional s k i l l s training, which requires the individual to focus on and evaluate molecular aspects of his/her own behaviour, actually increases self-focused, s e l f - c r i t i c a l thinking. Research indicates that training in process s k i l l s may be more effective in producing desired change. Encouraging persons who are socially deficient to attend to their partner may abate anxiety and concurrently serve so as to augment one's social competence, as this requires that one not become self-absorbed. Self-Evaluations and Self-Focus of the Socially Anxious Research in the area of social anxiety suggests that socially ineffective individuals evaluate their social behaviour in a distorted fashion. For example, Smith and Sarason (1975) reported that high anxious subjects expect to be evaluated negatively, and Clark and Arkowitz (1975) concluded that high anxious persons selectively attend to negative aspects of their performance. Similarly, Alden and Cappe (1981) found no difference in the actual behaviour of assertive and non-assertive individuals, but - 12 -did note that the non-assertive rated their social behaviour more negatively than assertive subjects. Thus, the self-orientation of the anxious individual may be disruptive to ongoing performance. Smith, Ingram and Brehm (1983) recently investigated this self-preoccupation with a socially anxious university population. Their purpose was to explore the extent to which cognitive deficits (e.g. decreased learning, memory and task performance) and/or cognitive excesses characterize anxiety states. Cognitive excesses were described as the production of and attention to self-focused patterns of negative and ruminative covert speech or thought, including self doubt, self derogation and concern about poor performance. Results of this research indicated that anxious individuals evidenced a particular type of cognitive excess, i.e., concern over evaluations by others, rather than any sort of cognitive d e f i c i t . Shyness Recently, shyness has been gaining recognition as a valid, and at times debilitating concern affecting both psychiatric in and outpatients, as well as a good portion of the general population (e.g. Pilkonis, 1977a; Buss, 1980; Zimbardo, 1977). Zimbardo's research has indicated that 80% of a population surveyed reported that they had been shy at some point in their lives and 42% referred to themselves as presently shy. Of these, 63% f e l t their shyness was a "real problem" and 86% disliked being shy. - 13 -Crozier (1979), noting that to date, emphasis has been on anxiety and behaviour, rather than on disposition, examined the evidence for a personality t r a i t of shyness. He suggests that shyness does exist as a factor which is related to, but separate from both introversion and neuroticism. This factor loads on items referring to feeling anxious and uncomfortable in particular situations; withdrawing in certain kinds of situations; experiencing feelings of self-consciousness, inhibition, preoccupation with the self and, experiencing d i f f i c u l t i e s with expression and communication s k i l l s . (Crozier, 1979). Crozier cites the work of Eysenck and Eysenck (1969) who argue that shyness correlates more highly with neuroticism than introversion. According to these authors, two separate aspects of social shyness exist: the introverted shy who does not value social participation very much, but who can engage in social activity without undue anxiety or fear; and the neurotic socially shy person who desires engaging in social activity but is prevented from doing so by fears of rejection (Eysenck & Eysenck, 1969). According to Crozier, a considerable number of factor analytic studies have isolated factors similar in item content to the neurotic shyness factor. He views the tendency to be shy as a function of both the situation and the individual's position along a dimension of shyness. Pilkonis and Zimbardo (1979) define shyness as a tendency to avoid social situations, f a i l i n g to participate appropriately in - 14 -social encounters and feeling anxious, distressed and burdened during interpersonal interactions. Shyness can result in a reduction of rewards available from others, limited social support, and deprivation of available social comparison information (Pilkonis and Zimbardo, 1979). Pilkonis further delineates shys into two categories: publicly shy (those reporting behavioural deficiencies) and privately shy persons (those focusing on internal events, such as subjective discomfort) (Pilkonis 1977a, 1977b). When required to give a speech, public shys complained of more discomfort, evidenced more speech anxiety, and gave less appealing speeches than those who were privately shy (Pilkonis, 1977b). He postulates that focusing on a structured task (giving a speech) may have distracted privately shy subjects from their self-consciousness and concern with internal events, and, in turn, led to a more comfortable performance. Pilkonis advises providing strategies for shy persons which are designed to "restructure" social situations or provide them with an agenda. Researchers and clinicians are cautioned against providing s k i l l training for a l l shy persons and instead i t is recommended that different interventions be utilized which address that nature of the public vs. private distinction. More specifically, he proposes that s k i l l s training may be more appropriate for publicly shy persons while those who are privately shy may benefit most from interventions designed to decrease their self-consciousness, - 15 -internal arousal and anxiety. Buss (1980) defines shyness as the relative absence of expected social behaviours, consisting of both instrumental (the absence or minimization of expected social behaviour) and affective (discomfort, strain and tension) components, either of which may predominate in a shy individual. As well, he distinguishes between those who become shy early in l i f e , as opposed to after the age of f i v e . The relation between shyness and several other constructs has been recently investigated. For example, Cheek and Buss (1981) examined the association between shyness and soc i a b i l i t y , the latter of which was defined as a preference or need to be with people. Self reported shyness correlated only moderately with self reported s o c i a b i l i t y , r_ = -.30, indicating that shyness is more than mere low soc i a b i l i t y . Understandably, shy persons who were sociable were judged as more tense and inhibited than shy-unsociables, as the latter would be less concerned with their social behaviour. Consequently, the authors suggest that for research purposes, investigators should assess both. Additional research has indicated that shyness correlates significantly with social anxiety, _r = .67 (Pilkonis, 1977a) and self esteem, r_ = -.62 (Pilkonis & Zimbardo, 1979); moderately with loneliness, r_ = .50 (Jones, Freemon & Goswick, 1981); and, less so with public self consciousness, r_ = .26 and private self consciousness, r = .10 (Cheek & Buss, 1981). It should, however, - 16 -be noted that these values require replication. To date, only one pair of investigators has begun to examine possible intervention strategies for modifying shyness. Brodt and Zirnbardo (1981) designed an experimental misattribution paradigm as an intervention for altering social participation among dispositionally shy females.^ Forty-five undergraduates were randomly assigned to one of three conditions: shy/misattribution paradigm, nonshy/misattribution, or shy control. Shy subjects behaved as i f they were not shy only when their arousal symptoms from an anxiety-producing source, i.e. interaction with a male, were misattributed to a non-psychological source, i.e. high frequency noise. Male confederates more accurately perceived whether subjects in the two control groups were shy (81% and 64%) but correctly identified only 40% of the women in the misattribution condition. The authors concluded that shyness is maintained by arousal, which leads to a self-focus, which in turn, leads to greater arousal, etc. Parallels between Social Anxiety and Loneliness Social psychological research on loneliness indicates that loneliness and social anxiety are related. There is evidence to suggest that the cognitions of lonely persons in some senses parallels that of the socially anxious. For example, Goswick and Jones (1981) found that lonely individuals had negative self-perceptions, were dissatisfied with themselves, and attended more to their own feelings and reactions than to those of others. - 17 -One strength in the literature on loneliness is the attention paid to the assessment of daily functioning. For example, satisfaction with social contacts has also been addressed with this population. Jones' (1981) research indicated that the more lonely the individual, the greater the diversity of people he/she interacted with; the smaller the proportion of interactions with one's family; and the greater the proportion of interactions with strangers and acquaintances. Loneliness was not related to the actual frequency of interactions. Lonely subjects, on the average, had as many interactions as subjects who were not lonely. Similarly, Cutrona (1982) reported that satisfaction with one's contacts and interpersonal relationships was a better predictor of loneliness than was frequency of social contacts. To summarize, treatment studies which address social deficits have, for the most part, been limited to laboratory analogue situations, typically employing university or psychiatric populations. The efficacy of social s k i l l s training i s , at present, uncertain in that i t may not augment the effects of other treatments. Encouraging individuals to focus on their partners in social situations may prove to be an effective strategy for treatment. Self-awareness Theory The concept of self-focused attention was introduced by Duval and Wicklund (1972) whose theory of objective self-awareness bears - 18 -directly on the issues being addressed in this proposal. Their theory assumes that one's awareness can be directed either toward oneself or towards the external environment. In subjective self-awareness, attention is focused outward -- toward others, external tasks, etc. Contrasted with this state is objective self-awareness, where one is the object of his own consciousness. The objectively self-aware person comes to evaluate himself as soon as the objective state occurs. He compares himself with internalized standards such as that of "correctness" and typically finds discrepancies between actual behaviours and ideal standards. According to Duval and Wicklund (1972) the state of objective self-awareness leads to negative self-evaluations and negative affect whenever the individual is aware of these self-contradictions. A feeling of control and mastery over the environment can only be achieved in the state of subjective self-awareness. Therefore, when one is the subject of action and directs his/her attention outwardly, a feeling of control is achieved. According to this theory, i t is possible that socially anxious or shy persons may be in a state of objective self-awareness and may benefit from encouragement toward a subjective state. One way to accomplish this might be to focus attention outward, i.e. towards others, as previously outlined. Depression and Social Competence Social competence has also been theorized as playing a - 19 -crucial role in the course of depression. For example, in investigating the interpersonal behaviours of depressed persons, Jacobson and Anderson (1982) found no difference in frequency of self-disclosures between depressed and nondepressed students, with the exception that the depressed emmitted significantly more negative self statements. Similarly, in theorizing regarding the excessive self-focused attention of depressed individuals, Lewisohn, Hoberman, Teri and Hautzinger (1984) review the effects of a heightened self-awareness and i t s negative consequences. Human Relations Training Client-centered therapy (Rogers, 1951; 1961; Carkhuff, 1969) is one school of therapy which has emphasized process s k i l l s . Early client-centered treatment techniques have led to the development of human relations training (HRT) procedures (e.g. Ivey & Authier, 1978). HRT is a form of s k i l l training in which process s k i l l s (such as attending to the other person and empathy) are systematically trained through role playing and modeling. Although the format of training is similar to that employed in traditional social s k i l l s training, the interpersonal s k i l l s taught are different. These s k i l l s require a constant, sensitive focus on the other person, similar to that suggested by Trower (1980) and Fischetti et a l . (1977). Such s k i l l s may prevent the task-irrelevant self-focus noted by Meichenbaum (1977). HRT was i n i t i a l l y utilized to train counselors. Its scope has broadened to include the training of professionals such as - 20 -nurses and teachers (Carkhuff, 1969; Kratochvil, 1969). Several studies have been conducted in which HRT was employed with socially dysfunctional psychiatric inpatients. For example, one study demonstrated that inpatients trained in HRT significantly improved in interpersonal functioning (Vitalo, 1969). Similarly, Pierce and Drasgow (1969) allotted inpatients to one of four groups receiving traditional therapy or a group trained in HRT. The greatest improvement in interpersonal functioning was evident in the HRT group. While few studies have been conducted, and these are not without methodological problems, the results of these preliminary investigations suggest that HRT might provide the type of other-focused s k i l l s which would aid socially dysfunctional individuals, and deserves further investigation. Research Goals The goals of this research were to adapt the HRT process to the treatment of socially avoidant members of the community and to compare the resulting treatment regimen to a treatment regimen of graduated exposure plus progressive relaxation. The graduated exposure regimen was selected because of earlier studies showing variants of desensitization and r e a l - l i f e practice to be equal to s k i l l s training in effectiveness (e.g. Wright, 1976; Marzillier et a l . , 1976). Further, any effective treatment strategy would eventually require dysfunctional clients to gradually confront and master the situations which make them anxious. It may be that this process of graduated exposure is alone sufficient to reduce - 21 -incapacitating anxiety and to allow the socially avoidant individual to learn those s k i l l s necessary to interact with others. The proposed research design may be viewed as a constructive research strategy (Kazdin, 1980). This particular strategy refers to the development of a treatment package in which components are added to determine i f they enhance treatment effects. The essential question being addressed with this approach i s : What can be added to this treatment to make i t more effective? (Kazdin, 1978). For the present research, a constructive strategy is appropriate as the question of interest concerns whether the addition of a s k i l l s component enhances or adds to the effects received from training in graduated exposure and relaxation procedures. A treatment regimen involving relaxation and a graduated approach to fearful social situations was compared to a combination of the HRT s k i l l s (see Appendices DD, EE, FF, GG) plus graduated exposure and relaxation techniques. The population employed in this study consisted of socially avoidant members of the community who reported functional impairment. This population may provide a better test of the interventions chosen than populations previously studied. University students are generally not as dysfunctional as other populations and psychiatric inpatients may suffer from problems in addition to social dysfunction, such as thought disorder and mood disturbances. The recruitment of a community sample is likely to - 22 -avoid these problems. The issue of generalization to daily functioning is of particular interest. Treatment effectiveness was assessed via the traditional laboratory role playing measures, as well as several newly-developed measures of daily social functioning, number and quality of social contacts, etc. Finally, i t was expected that training in process s k i l l s would encourage a focus of attention away from the self and towards the other, which in turn, may abate anxiety and foster social effectiveness. - 23 -Summary of Treatment Conditions Condition I = graduated exposure plus progressive relaxation Condition II = graduated exposure plus progressive relaxation plus HRT s k i l l s Condition III = waiting l i s t Hypotheses 1. It is predicted that subjects in Conditions I and II will improve significantly more than those in Condition III. 2. It is predicted that subjects in Condition II will evidence greater improvement than those in Condition I. a) This improvement will extend to include a greater generalization of treatment effects, as assessed by the Community Ratings measure (Appendix I) and the Functioning measure (Appendix H). - 24 -Method Subject Recruitment Community Recruitment Subjects were recruited from the community via several avenues. On several occasions, the investigator was interviewed on local radio and television programs. However, this failed to attract a substantial response to the program. An advertisement was then placed in a local newspaper for two days, followed the next day by an article describing shyness and the program being offered. This article generated over five hundred responses and the final sample consisted almost entirely of persons who had responded to i t . Mental health practitioners in the city were also approached (see Appendix A), but the few referrals received were almost invariably compounded with other serious concerns such as severe depression or alcoholism. Due to the large number of replies to the newspaper a r t i c l e , potential subjects' names and telephone numbers were recorded; each was informed that he or she would be contacted in the next day or two. Telephone Interview All individuals were informed by the investigator that several c r i t e r i a must be met before formal acceptance could be made into the program. Each was also informed of the time requirements for assessment purposes and for participation in the program i t s e l f . At this point, individuals were scheduled for a one and one-half hour interview with the investigator at the - 25 -University of British Columbia in the Department of Psychology. However, after interviewing several persons i t became apparent that telephone screening procedures were inadequate as only three of ten persons were found appropriate for the research. The procedure was thus altered to incorporate more stringent screening procedures during the telephone interview. The program was described in greater detail ( i . e . , purpose of program, scheduling details, etc.) and mention of commitment to the program was made. They were then informed that i t would be necessary to ask a series of questions to best determine appropriateness for the program. Each was informed of the necessity to f u l f i l l certain c r i t e r i a before an interview could be arranged. All consented to this screening process. Subjects who were screened out at this stage included those: who were not between twenty and f i f t y years of age; for whom shyness did not appear to be their primary problem; who were being maintained by antipsychotic medication or who were judged to be possibly psychotic; whose command of the English language was extremely poor; who reported that their shyness did not interfere with their lives or l i f e s t y l e ; who had been a psychiatric inpatient in the past; who were presently c l i n i c a l l y depressed or considering suicide or who had a history of suicidal ideation. A total of one hundred and sixty five persons were screened out during the telephone interview. Appendix B details the reasons for screening these persons. Each was referred to at least one - 26 -f a c i l i t y deemed more appropriate to address their particular concerns. Referrals were made to psychiatric outpatient departments of hospitals, psychology departments of hospitals, mental health centres, private psychologists and psychiatrists, or to the shyness program offered by the North Shore Family Services. Those considered to be appropriate at this stage were informed that the next step would involve an interview with the investigator at the university. It was clearly explained that this did not guarantee acceptance into the program as numerous other c r i t e r i a must be met in the interview situation. Individual Interviews The primary purpose of the interview was to collect data regarding social history and to further screen out inappropriate referrals not detected by telephone. A total of one hundred and eighteen persons were interviewed for one and one half hours each by the investigator. Individuals were interviewed for approximately thirty minutes, following the format outlined in Appendix C. If judged to be not acceptable for this research, subjects were not informed of this decision until a l l self-report data had been collected. In this way, i t was possible to collect data on these individuals for research purposes. Further, i t seemed insensitive to "reject" these persons after only a brief interview as i t was clear that most were highly motivated and desiring of any assistance made - 27 -available to them. Screening Measures Subjects were then required to complete three self-report measures for screening purposes. These were included to assess levels of depression, social anxiety and the degree to which their shyness interfered with social interactions. 1. Level of Depression: It was expected that shy persons would be somewhat depressed, as this is often so for those seeking therapy. However, those experiencing depression beyond the mild range, as well as those presently experiencing suicidal ideation were not accepted into the program as i t was f e l t that they would best benefit from i n i t i a l l y receiving treatment for their depression. This was judged to present a more immediate concern than shyness. Further, this program had not been designed to present coping strategies for depression and suicidal ideation, in addition to shyness. As well, there is an ethical concern that suicidal persons receive careful ongoing contact, which was beyond the constraints of the present program. Judgment regarding level of depression was determined by subjects' responses to questions in the interview concerning the presence of cognitive or biological signs of depression, suicidal history and present suicidal ideation, as well as frequency of experiencing depression. Further, a l l subjects were requested to complete the Beck Depression Inventory (BDI) (Beck et a l . , 1961; Beck & Beamesderfer, 1974), (Appendix D). The BDI was selected - 28 -because research supports i t s ' psychometric soundness. Research has indicated the BDI has a split-half r e l i a b i l i t y of r = .93 (Beck & Beamesderfer, 1974). Test-retest r e l i a b i l i t y procedures revealed that changes in Inventory scores reflected changes in clinicians' ratings of depth of depression. Research supports i t s ' concurrent validity in that the BDI correlates with c l i n i -cians' ratings and other standardized measures of depression (Beck & Beamesderfer, 1974). Construct validity was established by correlating the BDI with negative self concept, disturbed sleep patterns, masochistic dreams and pessimism, (Beck & Beamesderfer, 1974). In the present study, subjects scoring at or beyond the moderate range of c l i n i c a l depression (BDI greater than 19) or who scored high on item I were referred elsewhere for help. At present, definitions of, and, consequently, measures of social effectiveness are scarce and not entirely adequate. How-ever, some concepts related to shyness may prove useful in defin-ing this population. Subjects were requested to provide self-report information designed to assess social anxiety and discomfort as well as loneliness. 2. Social Anxiety: This was assessed using the Social Avoidance and Distress Scale (SAD) (Watson & Friend, 1969) (Appendix E). Social avoidance was defined by the authors as avoiding being with, talking to, or escaping from others for any reason, whereas social distress was viewed as the repeated experience of a - 29 -negative emotion (such as tension or anxiety) in social interactions. Test-retest r e l i a b i l i t y procedures of the SAD yielded product-moment correlations of r = .68 and r_ = .79. Research supports the validity of the SAD in that i t correlates positively with similar measures and with sensitivity to audiences; and moderately with the Taylor Manifest Anxiety Scale, and the social and evaluative parts of the Endler-Hunt S-R Inventory of Anxiousness. To be eligible for the present proposed research, subjects were required to score at least one-half standard deviation above the mean on the SAD. 3. Shyness Interference Measure: Subjects then completed a simple global measure, designed to assess their self-report of the degree to which shyness interferes with daily interactions with co-workers, supervisors, and a b i l i t i e s to make friends and acquaintances (Appendix F). This was to aid in screening out those persons who saw themselves as shy but whose shyness does not or minimally interferes with their functioning. As Zimbardo's research (1977) indicates, forty percent of persons report experiencing shyness at any given time, while eighty percent report experiencing shyness at one time or another in their l i v e s . As shyness may be a label persons readily attribute to themselves, an effort was made to adopt stringent c r i t e r i a for the purpose of excluding those for whom shyness represents only a minimal interference. - 30 -On this measure, subjects were required to score a total of at least nine out of a possible fifteen, indicative of at least moderate interference. This c r i t e r i a was chosen to aid in the selection of persons for whom shyness interferes at least moderately, i f not severely, in their daily social interactions with others. Subjects The final sample of subjects consisted of fifty-two persons, half of whom were male, and half female. Ages ranged from twenty to fifty-two; mean age was 30 years. Seventy percent had completed at least one year of university education and thirty-eight percent had a university degree. Although some (nineteen percent) were married, most (sixty-seven percent) had never dated or had not for years. Nineteen percent stated that they had no close friends. The majority of subjects described themselves as always having been shy (sixty-nine percent); half had not been encouraged or had been actively discouraged by parents from socializing and sixty percent reported that their parents socialized with their families only or not at a l l . Twenty-eight percent of the sample attributed the depression they experienced to their shyness and feelings of isolation. Appendix G provides further demographic and descriptive information regarding the sample. General Procedure Following the interview and screening process, subjects were - 31 -required to complete various self report measures. Subjects' behavioural performance was then assesssed in the laboratory via a role playing task. This was followed by the completion of additional dependent measures. Subjects were then randomly assigned to one of three conditions; informed of the commitments required for participation in the program and then signed a consent form. Subjects were informed of the place, time and date for the i n i t i a l training session, while a second assessment session was arranged with waiting l i s t subjects. Those in the two treatment conditions received training in groups, for eight weekly two-hour sessions. Following this, they were scheduled for post-treatment assessment, while waiting subjects were also assessed for their post-waiting period of eight weeks. Subjects in the two training conditions were contacted for follow-up three months later. Dependent Measures The following were used as dependent measures in the present study: a) three paper and pencil self-report inventories including: — frequency and satisfaction with social contacts ~ community ratings of s k i l l and comfort -- UCLA Loneliness Scale b) assessment of subjects during a role playing task: — subjects' self-report of their global comfort and s k i l l - 32 -~ confederates' intuitive ratings of subjects' global comfort and s k i l l , physical attractiveness, and general attractiveness — judges' ratings of subjects' global comfort and s k i l l and apparent focus of attention c) therapists' ratings of subjects' global comfort and s k i l l in the i n i t i a l and final treatment sessions. d) peer or significant others' ratings of subjects' comfort and s k i l l in various community settings. After searching the literature, i t became apparent that some dependent measures were not available and hence, needed to be constructed for the present study. To date, instruments had not been developed to provide information considered relevant for the evaluation of this research. This was especially true for obtaining information regarding subjects' daily social functioning in their natural environment. This information was considered crucial to evaluating the generalizability of any beneficial effects accrued from the interventions. Measures are more readily available to assess behaviour in laboratory settings but l i t t l e is available to aid in the assessment of daily interactions. Consequently, several dependent and one screening measure were constructed to provide information regarding the subjects' perceptions of their problem, and, as well, to provide details of their ongoing participation in social a c t i v i t i e s . Questionnaires Used as Dependent Measures - 33 -1. Frequency and Satisfaction with Social Contacts: This measure is reflective of a behavioural analysis which clinicians may conduct with their c l i e n t s . Drawing from research in the loneliness literature (e.g., Jones, 1982; & Cutrona, 1982), this instrument was designed to assess both frequency of social contacts as well as reported satisfaction with engaging in these activities (Appendix H). If changes in self-reported feelings of shyness are reflected in greater frequency and satisfaction of social contacts, this would suggest that the beneficial effects of treatment are generalizing to the subjects' daily social behaviour. Making changes in the laboratory setting is not sufficient to suggest that the interventions affected subjects' lives in a more concrete, meaningful fashion. 2. Community Ratings: In the absence of ideal objective observations of subjects in the natural environment, this instrument (Appendix I) was used for the purpose of obtaining a self-report measure of the subjects' global s k i l l and comfort in various community settings. This also provides information regarding the generalizability of treatment effects from the University setting to those in which subjects typically interact with others. 3. UCLA Loneliness Scale: Subjects were required to complete the Revised UCLA Loneliness Scale (Russell, Peplau & Ferguson, 1978; Russell, Peplau & Cutrona, 1980). Research suggests the UCLA Loneliness Scale (Appendix J) has a test-retest r e l i a b i l i t y - 34 -of jr = .73 and _r = .62 after two and seven months, respectively. Item-total correlations yielded a coefficient alpha of .96. To establish va l i d i t y , the scale has been correlated with several other loneliness measures, personality correlates, frequency of engaging in social activities and, number of friends. Research indicates that the mean score of a c l i n i c sample was two standard deviations higher than that of a college sample. Scores on this measure are not confounded with social desirability. This measure was used in this study as one question of interest concerns the relationship between loneliness and shyness. It was expected that i f subjects f e l t less shy following treatment, they might engage in more social activities and hence, experience less loneliness than before training commenced. The relationship between loneliness and other-focus is also of interest as past research has indicated that loneliness is related to self-focus (Goswick & Jones, 1981) and increasing partner attention can lead to a significant decrease in loneliness (Jones, Hobbs, & Hockenbury, 1982). After subjects completed the screening measures (the BDI, the SAD, and the Interference Measure) which were collected and scored, the three dependent measures (frequency and satisfaction with social contacts, community ratings, and the UCLA Loneliness Scale) were completed. The subject was then informed as to whether he or she was considered appropriate for the proposed search. Forty persons - 35 -were screened out at this l e v e l . Appendix K details reasons for their inappropriateness, such as not meeting c r i t e r i a on screening measures, e.g. experiencing moderate or severe depression, or, shyness not interfering with social interactions. For some, shyness presented as a problem secondary to more immediate concerns, such as substance abuse, inadequate impulse control, or delusional thinking. Each of these persons was informed as to the reasons for this decision and were given names and telephone numbers of at least three referral sources. Role Playing Task Subjects' behavioural performance was assessed in the laboratory via a role playing task. It should be noted that the validity of u t i l i z i n g these procedures for the purpose of assessing social s k i l l s , especially that of assertiveness, has been questioned recently. For example, in a series of studies, Bellack, Hersen and Turner (1978) found only limited generalizability of behaviour in role playing situations to that in naturalistic settings. In a later study, Bellack, Hersen and Lamparski (1979) obtained only moderate correlations between the behaviour of female undergraduate students in role playing situations and in the naturalistic setting. Few significant relationships were obtained for males. Similarly, a third series of studies (Bellack, Hersen & Turner, 1979) with psychiatric patients revealed that behaviour in a role playing task was not highly related to behaviour in an - 36 -interview situation or a similar in-vivo situation. However, in light of the paucity of practical, ethical strategies available to researchers for assessing the social behaviour of a socially impaired population, a decision was made to employ role playing as a means of assessment. Given the apparent limitations of role playing, this procedure was utilized with the expectation that generalizations made to behaviour in the natural environment would be extremely conservative. Further, i t was expected that more objective information regarding social behaviour in the community would be provided by the self-report and peer measures. It was explained to subjects that the purpose of this proce-dure was to help us "get an idea of what your style is like" when interacting with a stranger. They were informed that students had been hired specifically for this portion of the assessment and were then introduced to a confederate of the same sex who had been waiting in another room. In an effort to assess subjects' optimal, rather than typical performance, they were requested to get to know their partner as best they could, as i f meeting him or her for the f i r s t time. Subjects were instructed to s i t in a chair facing a video camera; the confederate was seated in a chair approximately four inches away. Chairs were angled slightly towards each other to afford eye contact, i f desired. After the equipment was readied, subjects were informed that they could begin. The investigator remained in the room in the event that any subject found the situation particularly stressful. Her back - 37 -was turned to the partners who had previously been requested to avoid interacting with her or asking questions during the role playing task. To avoid being perceived as another source of evaluation anxiety, she scored questionnaires during this period. Confederates were trained to respond to the subject in a somewhat neutral fashion. This was expected to provide a somewhat challenging task for subjects, by placing the burden of ini t i a t i o n on them. If paired with a friendly, talkative confederate, they may have manipulated the situation to l e t the confederate carry the conversation, rather than themselves. This would have provided inadequate information regarding their general level of comfort and s k i l l when experiencing shyness. Confederates were therefore trained to avoid asking questions of the subject and initiating conversation, but to reply briefly to attempts at conversation and in a neutral fashion, avoiding gestures of friendliness, such as smiling, head nodding, animated voice tone, etc. This was standardized across a l l subjects. Following the five minute role playing period, the investigator interrupted to terminate the interaction and turned off the videotape equipment. The confederate was thanked for his or her time, and ushered out of the room. The subject then evaluated his or her own global s k i l l (Appendix L) and global comfort (Appendix M) during the role playing task. In a separate room, the confederate rated the subject on these same scales, and, as well, rated the subject's attractiveness in the role playing situation (Appendix N) as - 38 -confederates' untrained, intuitive responses to the subject were of interest. An attempt was made to replicate the findings of Scott and Edelstein (1981) and Kupke, Hobbs and Cheney (1979) where effective social competence was positively correlated with physical attractiveness, as perceived by untrained raters. Further, compared with trained ratings, intuitive ratings can provide a perception unbiased by the investigator's definitions of s k i l l and comfort (Bellack, 1979). However, as these perceptions are intuitive, they are considered to be secondary in importance to judges' ratings and are not meant to substitute for the la t t e r . At a later date, the videotaped interactions were rated by two female undergraduate psychology students who served as objective judges. Blind to the hypotheses of the study and to group membership, they were trained to rate global comfort, s k i l l and focus of attention. Inter-rater agreement for s k i l l and comfort (Appendices L and M, respectively) was assessed by means of the intraclass correlation, as recommended by Haggard (1958). This procedure allows for the calculation of the correlation between ratings of two judges who are logically interchangeable. Unlike the Pearson Product-Moment Correlation, intraclass correlations take into consideration the possible utilization of different means by each judge and thus represent a relatively conservative test of inter-rater agreement (Haggard, 1958). At the termination of training, inter-rater agreement reached R= - 39 -.95. A spot check part way through independent tape ratings revealed that agreement remained adequate; = .92. Focus of attention during role playing was also assessed for the purpose of determining whether apparent focus bears any relation to treatment outcome. Focus of attention was rated by the judges, with the acknowledgement that judged focus may not reflect self-reported focus. This measure (Appendix 0) was adapted from the work of Scott and Edelstein (1981), Kupke et a l . (1979) and Jones et a l . (1982). Simple frequency counts were obtained of s e l f , neutral or other-focused statements or questions. Percentage of other-focused attention was then calculated by dividing the number of statements rated as other-focused by the total number of statements emitted by the subject. Inter-rater agreement was obtained using the Pearson Product-Moment Correlation coefficient, an appropriate st a t i s t i c for two continuously distributed variables. Inter-rater agreement averaged £ = .94, calculated over several periods. Significant Other Ratings Subjects were requested to nominate a peer or significant other to provide information regarding subjects' behaviour in the natural setting. Kazdin notes that peer ratings can serve as a form of social validation (1977). Wiggins (1980) in his discussion of the generalizability of peer ratings to criterion situations of importance, notes that peer ratings have been useful predictors of academic performance, leadership qualities, military - 40 -performance and social maladjustment in preadolescent boys. Further, Bellack (1979) acknowledges that untrained peers can provide ratings which are independent of the researcher's conception of s k i l l , and hence, better reflect the actual social impact of the subject's behaviour. He goes on to specify that an increase in s k i l l must be associated with an increase in perceived effectiveness. Peer and significant other ratings have most frequently been employed in the assessment of children's social s k i l l s where peer nominations and teacher judgments are heavily relied upon (French & Tyne, 1982). In the adult literature, peer ratings are sometimes employed as one of several methods for the assessment of social s k i l l s . For example, peer ratings have been utilized as one dependent measure in assessing the effects of practice interactions on increasing comfort and activities with others (Royce & Arkowitz, 1978; Christensen, Arkowitz, & Anderson, 1975). Conger and Conger (1982) employed peers as judges to evaluate the quality of males' heterosocial s k i l l s . Similarly, untrained female undergraduates were employed as judges by Scott and Edelstein (1981) to rate social aspects of males' role played responses. Thus, i t was f e l t that, in the present study, peers would serve to provide additional information regarding subjects' behaviour, as perceived in the natural environment. As expected, due to their shyness and isolation, a significant portion of the subjects in the present study did not have a significant other in their l i f e to nominate. Further, some - 41 -subjects strongly preferred to not involve others in their treatment or were too embarassed to inform others of their involvement with the study. In either case, these subjects were not excluded from the research as exclusion would have resulted in rejecting many subjects, seriously reducing the size and representativeness of the sample. Those who consented, were shown a copy of a letter (Appendix P) which would be mailed directly to their peer. The inventory to be completed by the peer (Appendix Q) accompanied this l e t t e r . A total of twenty-two questionnaires were returned: six, eleven, and five for Conditions I, II and III respectively. Although the data for this measure are incomplete, they were included in the analysis as they may provide some information, which is judged to be preferable to none at a l l . However, because of the small sample size, these data will be interpreted most cautiously. Measures of Focus of Attention Subjects' focus of attention while practising in the treatment sessions was of interest as a check upon whether those in Condition II actually focused more on their partners than those in Condition I. Consequently, each therapist rated half of the subjects' verbal and nonverbal focus of attention (Appendix R) while they practised the f i r s t of their two situations in sessions two, five and eight. Inter-rater agreement was not possible to establish in this situation, as rating was conducted surreptitiously while therapists gave feedback to the subject. - 42 -Measures of Credibility and Evaluation of Treatment Credibility of treatment was rated anonymously by subjects at the end of the i n i t i a l treatment session. The format employed (Appendix S) was similar to that developed by Borkovec and Nau (1972). Similarly, evaluation of treatment forms (Appendix T) were completed at the end of the final treatment session. To avoid encouraging demand characteristics, rating was again conducted anonymously. Therapist Ratings Therapists' perceptions of subjects were also of interest over the course of treatment. Consequently, therapists rated each subjects' global s k i l l (Appendix L) and comfort (Appendix M) following the i n i t i a l and final treatment sessions. Group Assignment One concern was that subjects' level of s k i l l would be confounded with treatment outcome. For practical reasons, i t was not possible to match subjects for s k i l l . Rather, a check was performed on the mean s k i l l levels for all six groups, as rated by confederates at preassessment. These mean values indicated that subjects within each of the six groups obtained very similar ratings of global s k i l l : in the graduated exposure conditions — 2.5 and 3.3; in the HRT condition --2.5 and 3.5, and in the wait l i s t condition ~ 2.8 and 3.5. This indicates that none of the groups commenced training with an advantage regarding their level of s k i l l . - 43 -Subjects were randomly assigned to one of three conditions: Condition I: Graduated exposure plus progressive relaxation plus general discussion (n=17) Condition II: Graduated exposure plus progressive relaxation plus HRT Skil l s training (n=17) Condition III: Wait l i s t control condition (n=18) Immediately following the role playing task, subjects were informed of the commitments required for participation in the program. This included: attendance at all sessions; willingness to attempt all homework assignments; and agreement to return for a post-treatment session with the investigator. Each person was then given a brief summary of the rationale and description of his or her treatment intervention (Appendices U and V). Any questions were answered and subjects were informed of the time and place of their group meetings. Those in the wait l i s t condition received a copy of the rationale given to those in Condition II (Appendix V) and the purpose of a control was explained to them. In addition to a post-treatment session, these subjects agreed to attend an additional brief assessment session, after the eight week waiting period had terminated. Subjects were then required to sign a consent form (Appendix W). Fi n a l l y , they were told to expect a telephone call two or three days before their group commenced, to remind them of the date. Each person was then given the investigator's telephone number in the event that they had further questions or decided not - 44 -to participate in the program. Therapists Two male and two female graduate students in cl i n i c a l or counselling psychology were hired as therapists. Therapists were paired up; each pair consisting of one male and one female, one junior and one senior therapist. To control for therapist effects, each pair led one group in each of the two treatment conditions. All therapists participated in 12 weekly group training sessions, totalling approximately twenty-five hours. Training included instruction and memorization of: rationales for each of the treatment conditions (Appendices X and Y); progressive relaxation training as adapted by Bernstein and Borkovec (1973) which was presented in a specific, structured format (Appendix Z); rationale for (Appendix AA) and development of graduated exposure procedures (Appendix BB). The rationale for s k i l l s training (Appendix CC) was also learned by therapists, followed by instruction in each of the four HRT S k i l l s : attending (Appendix DD), empathy (Appendix EE), respect (Appendix FF), and self-disclosure (Appendix GG). Each of these s k i l l s was introduced, defined, and practised by therapists. Training terminated when knowledge, method of presentation and dealing with general procedures were standardized at a satisfactory level across therapists. In addition, once treatment commenced, each session was - 45 -audiotaped for the purposes of supervision by the investigator and to ensure that treatment modes were not contaminated (Appendix HH). The investigator met with each pair of therapists weekly for one to two hours for purposes of supervision. Treatment Summary of Treatment Conditions As previously noted, subjects were assigned to one of three conditions. Instead of running one group per condition, two smaller groups were run as i t was expected that shy persons would find the task of participating in a large group aversive and demanding, an expectation that was realized. It was hoped that this procedure would limit the number of dropouts from treatment. One set of treatment groups commenced in late August, 1983; the second set began in mid-October, 1983, following the completion of the i n i t i a l set. Each group met for a period of eight weeks. All groups met in the same room at the University of British Columbia, at the same time of day, on a different day of the week. Ten persons were to be assigned to each group, i.e., twenty per condition. A final N of fifty-two was obtained, seventeen in each of the treatment conditions and eighteen in the waiting l i s t condition. Appendix II details the numbers per cell as well as an explanation of the eight persons from the original sixty who were not included in the research. Once a sufficient number of subjects had been acquired, the - 46 -f i r s t of the two sets of groups commenced. As this f i r s t set was receiving their treatment, interviewing continued to obtain subjects for the second set. Treatment Procedures Treatment procedures, as well as the amount of time spent on each topic were standardized across each of the four treatment groups. Detailed outlines of the procedures which were followed by therapists in each session are provided in Appendices JJ and KK for Conditions I and II , respectively. Appendix LL provides a brief summary of procedures for the eight sessions. Rationales for the overall treatment plan were provided for subjects in both conditions (Appendices X and Y). Each component of treatment was introduced with a specific rationale (Appendices Z, AA, and BB). In order to provide a simple frame of reference, subjects in both conditions were introduced to Levinger's model of the development of relationships (Levinger, 1977; Levinger & Snoek, 1972; Hinde, 1979) which postulates that three levels exist in the growth of any relationship (Appendix MM). Condition I: To reduce their generally high level of anxiety, subjects were instructed in progressive relaxation techniques as developed by Jacobsen and adapted by Bernstein and Borkovec (1973). Part of each session was spent inducing relaxation in the group members together, beginning with sixteen muscles, then proceeding to seven, four, four with counting instructions, and, - 47 -f i n a l l y , to counting alone and differential relaxation in the final session. Each time a new procedure was introduced, handouts were provided for subjects (Appendix NN) to fa c i l i t a t e home practice. Subjects agreed to practise relaxation s k i l l s twice daily, for fifteen to twenty minutes. At the beginning of each session, a period of time was spent discussing home practice and dealing with any problems that arose. The second part of the session consisted of training in graduated exposure procedures (Appendices Y, AA and BB). Rather than receiving a standardized hierarchy, each subject was required to develop his own hierarchy of exposure assignments. This was expected to increase relevancy and therefore heighten the efficacy of this component. To ensure that hierarchies proceeded in a graduated fashion and remained pragmatic, therapists supervised in their development. Each subject was encouraged to proceed through his or her hierarchy at their own pace, so as to avoid creating undue anxiety before mastering each step. Subjects were paired into dyads during the sessions and practised two new situations per week. During practice, they were encouraged to use their relaxation s k i l l s . Therapists provided support and redirected subjects to their relaxation in response to questions regarding or requests for social s k i l l s "tips" or procedures. The purpose of this was to consciously avoid any discussion or direction regarding social s k i l l s in this particular treatment condition. The aim was to keep this condition uncontaminated regarding social - 48 -s k i l l s . Each subject practised these two situations in vivo between sessions, and reported back to the group regarding his or her progress. Once subjects were able to complete each step in vivo while experiencing only minimal anxiety, they were encouraged to attempt the next step on the hierarchy. Subjects were encouraged to revise their hierarchies i f necessary, by reassigning new numerical values of anxiety, dropping situations which were no longer relevant or of concern, or by inserting easier steps in between two d i f f i c u l t situations. Finally, the latter portion of the session for subjects in Condition I consisted of a general discussion regarding shyness. This was rather simple to execute, as subjects often had questions regarding the topic or wished to discuss their opinions concerning several newspaper articles which had been printed regarding shyness. Therapists were not directive at this point, and simply allowed subjects to discuss their feelings and opinions with other group members. Condition II: Subjects in this condition also received training in progressive relaxation and graduated exposure techniques. Instead of a general discussion they were instructed in HRT s k i l l s , via the microcounselling method outlined by Ivey (1978), not unlike that typically employed by researchers in the social s k i l l s and assertion f i e l d s . At the beginning of each of four of the eight sessions, a new s k i l l was introduced to the group (Appendices DD, EE, FF, and GG) and defined. Therapists then - 49 -modelled Level one, two and three responses, discussed these with group members, and each s k i l l was then practised. The s k i l l s included attending, empathy, respect and self-disclosure. While practising their two situations each week in the group and in vivo, subjects used the new s k i l l which had been introduced. During practice, therapists gave group members feedback on their use of the s k i l l s . To f a c i l i t a t e recall and practising s k i l l s between sessions, subjects were given handouts on each of the four s k i l l s (Appendix 00). Each session included a discussion of subjects' progress in using the s k i l l s while practising in vivo. Wait-List Condition Subjects in the wait l i s t conditions commenced their training following an eight week delay, during which subjects in Conditions I and II were receiving training. Each of the two wait l i s t groups began immediately following the termination of the two treatment groups, i.e., in mid-October, 1983 and January, 1984. Training was conducted by the investigator, and was very similar to that of Condition I I , presented in a somewhat less structured fashion. Post Treatment Assessment All subjects participated in an individual interview with the investigator. This forty-five minute session was conducted from one to seven days following the termination of training. An interview was conducted (Appendix PP), subjects completed the - 50 -three screening measures: BDI (Appendix D), the SAD (Appendix E), and the Interference Measure (Appendix F); the three dependent measures: frequency and satisfaction with social contacts (Appendix H), community ratings (Appendix I) and UCLA Loneliness Scale (Appendix J ) . They then repeated the role playing task and completed accompanying measures of global s k i l l (Appendix L) and global comfort (Appendix M). Finally, any questions were answered. Three Month Follow-Up Session 0 Three months after the termination of treatment, subjects were contacted by the investigator and asked to come in for a forty-five minute follow up session. Only those in Conditions I and II were contacted; twenty-eight out of a possible thirty-four agreed to participate. Procedure for this session was identical to that of the post-treatment session, with the exception of a different interview format (Appendix QQ). - 51 -Results Overview of Analyses Conducted This chapter begins with a brief discussion addressing the choice of a unit for statistical analysis regarding this research. An explanation follows concerning how the various dependent measures were grouped together for multivariate analyses of covariance (MANCOVAs), which were utilized to analyze data pertaining to the two major hypotheses of the study. Data from multivariate analyses designed to assess pre to post change are presented. To further investigate the major hypotheses, the results of these MANCOVAs are presented in conjunction with data from a priori comparisons. A discussion of secondary analyses follows, including: (a) the investigation of subjects' focus of attention both in the laboratory setting and in training sessions and (b) the assessment of differences between treatment conditions regarding credibility and expectancy of treatment. A discussion of analyses conducted on three month follow-up interviews is presented, followed by data regarding treatment drop-outs and exclusions. Unit of Analysis The issue of adopting the appropriate unit of experimental analysis is a problem for researchers investigating a particular effect on a dyad or group of persons or objects. For instance, concern has been raised about studies on the efficacy of classroom curriculum (e.g. Campbell & Stanley, 1963; Lindquist, - 52 -1953; Raths, 1967); developmental researchers studying mother-child and child-child interactions (e.g. Allison & Liker, 1982; Kraemer & Jacklin, 1979; Maccoby & Jacklin, 1980); and agricultural experts (e.g. Cox, 1958). In certain situations, i t has been recommended that the group, rather than the individual, be considered the appropriate unit for analysis. Typically, these situations include groups to which members are not randomly assigned, e.g. students or teachers in the classroom (Hovland, 1949; Glass and Stanley, 1970; Lumsdaine, 1963). Similarly, the group is often the preferred unit i f one individual affects the responses of other group members, e.g. the influence of a disruptive student on others (Peckham et a l . , 1969; Raths, 1967); of a mother's behaviour on her child (Martin, Maccoby, Baron, Jacklin, 1981); or, of one plant's growth on others surrounding i t (Raths, 1967). In the present study, precautions were taken to minimize differences between the two groups within each of the three conditions. These included: counterbalancing therapists across conditions, standardizing environmental conditions and procedures; and extensively screening to prevent disruptive persons from participating in the study. As is outlined in the method chapter, a total of two hundred and thirty one persons were screened out after being interviewed by telephone or in person. Of serious concern was that an atypical event or person could have had an effect (unknown to the investigator) on all the members of a - 53 -particular group. As a final check, a series of Jt-tests was utilized to investigate any group differences. Additionally, F_-tests were used to compare group variances. Both series of tests were performed between the two groups within each of the three conditions. These analyses were conducted on each of the dependent and screening measures, at both pre and post assessment (see Appendix RR). Because a series of t-tests is likely to produce a high number of significant results due to chance alone, i t was expected that this would provide a particularly stringent test for any differences between the two groups. Similarly, a significance level of .05 was chosen to allow for obtaining significant results due to chance. If few of the t-tests are significant, then the individual may be considered as the unit of analysis, whereas i f a sizeable number prove to be significant, then the group should be seriously considered as the unit for analysis. Within each of the three conditions, the two groups differed significantly on only eight of 118 possible t-tests, five of which occur between the two groups comprising the wait l i s t condition (see Appendix RR). More s p e c i f i c i a l l y , within the wait l i s t condition, one group scored consistently higher than the other on the five variables. However, this finding is not of concern as these differences are attributable to variables other than those related to the group effect or treatment. Since subjects in the - 54 -wait l i s t condition had no contact with each other from preassess-ment to postassessment, a particular group effect of any sort could not have occurred. Given that significant findings appeared on only three dependent variables between the two groups comprising the treatment conditions (when six would be expected by chance alone), i t can be argued that the two groups within each condition were similar enough so as to permit utilization of the individual as the basis for the unit of analysis. Further, a comparison of group variances revealed that only four of a possible 118 were significantly different, again allowing for the pooling of variances. Categorization of Dependent Measures According to method of observation, twenty-one dependent variables were grouped together for multivariate analyses of covariances (MANCOVAs). Four categories of variables include: (a) screening measures: i.e. self report of depression, social anxiety and the degree to which shyness interferes with one's interactions. It should be noted that the three screening measures were analyzed and treated similar to other categories of dependent measures in this study. However, screening measures should not be confused with or regarded as being dependent measures. Screening subjects and accepting only those who score in an extreme range is li k e l y to result in regression toward the mean on secondary testing. Because data from the two treatment conditions could be - 55 -compared with that from the wait l i s t conditon, i t was expected that the latter could provide a check for whether regression toward the mean occurred at a second testing period. If regression had occurred, i t would be evidenced by apparent improvement in wait l i s t subjects from pre to post waiting period, as assessed by the screening measures. To summarize, although screening measures are unlike dependent measures, they were included for analysis in the present study due to the availability of a wait l i s t condition for comparison purposes. When interpreting the results, one should bear this in mind. (b) self report of functional impairment in the laboratory and  community settings: consisting of self-report of comfort and s k i l l in the laboratory and natural settings; self-report of frequency and satisfaction of engaging in social a c t i v i t i e s , and self-report of loneliness. (c) others' ratings: consisting of ratings of objective judges as well as confederates; intuitive ratings during the role-playing task in the laboratory setting. (d) therapists' ratings: of subjects' s k i l l and comfort in the i n i t i a l and final treatment sessions. These were distinguished because they were collected only for the two treatment groups. Two additional dependent measures: significant others' ratings of subjects' s k i l l and comfort in various community settings, were analyzed separately. As this grouping of variables consisted of only two measures, univariate procedures were - 56 -considered more appropriate than multivariate procedures for this particular analysis. The categorization of these screening and dependent variables is detailed in Table 1. Table 2 provides a correlation matrix, containing intercorrelations between all dependent variables at preassessment, across all subjects. A summary of mean scores and standard deviations for each dependent variable, at each time period (pre, post and follow-up) is provided in Table 3. Analyses to Investigate Sex Effects Past research has indicated that gender plays an important factor in the realm of social effectiveness. However, at this time, the nature of this role is rather equivocal in its effects. For example, Pilkonis (1977b) documented findings that shy males had poorer eye contact, and spoke, smiled, and nodded less than shy females. Further, public self-consciousness correlated more highly with shyness in males than females. In fact, Pilkonis reported that, compared with females, significantly more males label themselves as shy (1977a). However, Cheek and Buss (1981) found no significant gender differences in their investigations of shyness. Other areas of social effectiveness have found differences in behaviour due to gender. For example, assertiveness has, for the most part, been accepted as situation specific. In addition to individual differences in assertive behaviour, i t has been documented that males and females are assertive in different sorts of situations (Gambrill & Richey, - 57 -Table 1 Grouping of Dependent Variables Dependent Variable Abbreviation A. Questionnaire and Screening Data Beck Depression Inventory BDI Social Avoidance and Distress Scale SAD Interference with social interactions TOTINT B. Self Report of Functional Impairment Self report of comfort during role playing RPSC Self report of s k i l l during role playing RPSS Self report of comfort in community settings TOTCOM Self report of s k i l l in community settings TOTSKL Self report of frequency of engaging in activities TOTACT Self report of satisfaction with social activities TOTFRE Number of different activities engaged in TOTCAT UCLA Loneliness Scale Score TOTLON C. Others' Ratings Role playing, judges' ratings of comfort RPJC Role playing, judges' ratings of s k i l l RPJS Role playing, confederates' ratings of comfort RPCC Role playing, confederates' ratings of s k i l l RPCS Role playing, confederates' ratings of general attractiveness RPCGA Role playing, confederates' ratings of physical attractiveness RPCPA D. Therapists' Ratings (only for Conditions I and II) Female therapists' ratings of comfort RPTAC Female therapists' ratings of s k i l l RPTAS Male therapists' ratings of comfort RPTBC Male therapists' ratings of s k i l l RPTBS E. Significant Other or Peer Ratings Peer ratings of comfort in the community RPPC Peer ratings of s k i l l in the community RPPS - 58 -Table 2 Correlation Matrj\x_ot\ Dependent Variables 1 2 3 4 5 6 7 8 9 10 11 1. BDI .34 .31 -.08 -.20 -.49 -.18 .00 -.10 -.01 .04 2. SAD .34 -.35 .42 -.48 -.38 -.28 -.41 -.34 -.02 3. TOTINT -.37 -.16 -.37 -.27 -.19 -.20 -.16 .01 4. RPSC .38 .29 .09 -.11 -.04 .07 .01 5. RPSS .13 .07 .12 .21 .22 -.01 6. TOTCOM .61 .04 .16 .02 -.01 7. TOTSKL .31 .22 .04 -.11 8. TOTACT .59 .52 .02 9. TOTFRE .90 .27 10. TOTCAT .30 11. TOTLON 12. RPJC 13. RPJS 14. RPCC 15. RPCS 16. RPCGA 17. RPCPA 18. RPTAC 19. RPTAS 20. RPTBC 21. RPTBS 22. RPPC 23. RPPS 12 13 14 . 15.. 16 17 18 19 20 21 22 23 -.04 -.10 -.07 -.19 -.11 .14 -.02 .02 -.47 -.11 .10 -.02 -.05 -.18 -.26 -.23 -.32 .13 .05 -.02 -.38 -.14 -.28 -.22 .10 -.01 -.05 -.04 .05 .24 .14 .15 -.40 -.19 -.11 -.01 .26 .30 .28 .27 .07 -.16 .17 .13 .28 .05 .18 .17 .36 .38 .42 .52 .31 -.14 .08 .10 .14 .23 .19 .12 .02 .02 .07 .11 .13 -.20 .11 .04 .32 .00 .15 .06 -.16 -.05 .11 .07 .23 .08 .04 .15 .37 .23 .04 -.12 .03 .07 .17 .16 .14 .04 .12 .10 .15 .17 -.05 -.11 .14 .17 .30 .22 .41 .12 -.10 .06 .21 .21 .03 -.10 .18 .13 .35 .26 .41 .22 -.08 .11 .19 .23 .06 -.06 .09 .10 .12 .08 -.09 .00 .06 .20 .11 -.08 .07 -.09 .81 .53 .58 .28 -.18 .05 .17 .01 .06 .40 .55 .67 .69 .41 -.10 -.14 .03 .08 .10 .33 .44 .89 .55 .06 -.08 .04 .10 .27 .15 .18 .59 .07 .04 .09 .10 .28 .06 .11 .43 .04 .06 .24 .30 .17 .11 -.12 -.02 -.24 .06 -.10 -.13 .63 .28 .28 -.03 -.05 .36 .46 .23 .14 .62 .06 .08 -.11 -.16 - 59 -Table 3 Means of Each Dependent Variable at Each Assessment Period M e a n s Dependent Condition Pre Assessment n Post Assessment n Follow -up n Measure BDI Condition I 12.00 (5.30) 17 6.47 (4.76) 17 6.59 (4.12) 16 Condition II 12.59 (5.39) 17 4.00 (3.32) 17 3.81 (4.13) 12 Condition III 11.17 (4.73) 18 9.67 (5.43) 18 Overall Mean 11.90 (5.07) 52 6.77 (5.09) 52 5.24 (4.30) 28 SAD Condition I 21.94 (4.59) 17 15.00 (5.66) 17 14.76 (7.05) 16 Condition II 19.94 (4.19) 17 11.24 (6.04) 17 10.00 (5.27) 12 Condition III 21.28 (3.46) 18 20.83 (4.37) 18 Overall Mean 21.06 (4.10) 52 15.79 (6.63) 52 12.45 (6.61) 28 TOTINT Condition I 11.12 (2.45) 17 6.71 (3.51) 17 . 6.65 (2.87) 16 Condition II 11.47 (3.12) 17 . 5.13 (3.01) 17 4.69 (3.38) 12 Condition III 9.94 (1.80) 18 10.00 (2.20) 18 Overall Mean 10.83 (2.54) 52 7.35 (3.51) 52 5.70 (3.24) 28 RPSC Condition I 1.59 ( .62) 17 3.06 (1.09) 17 3.06 ( .85) 16 Condition II 2.06 (1.09) 17 3.29 ( .92) 17 3.92 ( .90) 12 Condition III 2.28 ( .96) 18 2.44 (1.10) 18 Overall Mean 1.98 ( .94) 52 2.92 (1.08) 52 3.43 ( .96) 28 RPSS Condition I 1.65 ( .79) 17 2.94 ( .97) 17 2.88 (1.20) 16 Condition II 2.00 ( .87) 17 3.35 (1.00) 17 3.42 (1.08) 12 Condition III 1.89 (1.08) 18 2.22 (1.06) 18 Overall Mean 1.85 ( .92) 52 2.83 (1.10) 52 3.11 (1.17) 28 TOTCOM Condition I 27.35 (5.16) 17 33.00 (4.68) 17 32.69 (6.50) 16 Condition II 27.88 (4.28) 17 37.29 (4.50) 17 38.00 (6.47) 12 Condition III 28.22 (4.18) 18 29.72 (4.76) 18 Overall Mean 27.83 (4.48) - 52 33.27 (5.53) 52 34.96 (6.90) 28 - 60 -Table 3 continued Dependent Condition Pre Assessment n Measure TOTSKL Condition I 27.71 (5.10) 17 Condition II 28.35 (4.40) 17 Condition III 29.39 (4.22) 18 Overall Mean 28.50 (4.54) 52 TOTACT Condition I 16.00 (11.08) 17 Condition II 11.76 (7.97) 17 Condition III 13.39 (6.60) 18 Overall Mean 13.71 (8.72) 52 TOTFRE Condition I 14.53 (7.49) 17 Condition II 15.53 (6.37) 17 Condition III 17.11 (6.47) 18 Overall Mean 15.75 (6.74) 52 TOTCAT Condition I 4.24 (1.86) 17 Condition II 4.47 (1.94) 17 Condition III 4.94 (1.92) 18 Overall Mean 4.56 (1.89) 52 TOTLON Condition I .57.06 (5.73) 17 Condition II 57.12 (3.31) 17 Condition III 58.33 (4.58) 18 Overall Mean 57.52 (4.59) 52 RPJC Condition I 1.82 ( .81) 17 Condition II 2.35 (1.50) 17 Condition III 2.44 (1.25) 18 Overall Mean 2.21 (1.23) 52 M e a n s Post Assessment n Fol1ow -up n 34.29 (5.02) 17 33.56 (7.05) 16 37.94 (5.24) r 17 37.92 (7.84) 12 29.06 (4.80) 18 33.67 (6.16) 52 35.43 (7.59) 28 19.35 (9.60) 17 18.56 (9.27) 16 24.53 (15.78) 17 25.09 (13.85) 12 11.11 (3.88) 18 18.19 (11.98) 52 21.36 (11.69) 28 20.82 (8.17) 17 18.94 (7.65) 16 27.24 (10.21) 17 25.92 (9.91) 12 18.56 (6.75) 18 22.13 (9.09) 52 21.93 (9.21) 28 5.71 (1.49) 17 5.44 (1.63) 16 6.82 (1.91) 17 6.25 (2.01) 12 5.39 (1.69) 18 5.96 (1.78) 52 5.79 (1.81) 28 56.59 (4.64) 17 54.63 (4.60) 16 56.29 (3.58) 17 54.59 (5.38) 12 58.17 (3.57) 18 57.04 (3.97) 52 54.61 (4.86) 28 2.52 (1.12) 17 3.06 (1.18) 16 3.06 (1.20) 17 3.00 ( .85) 12 2.67 (1.14) 18 2.75 (1.15) 52 3.04 (1.04) 28 - 61 -Table 3 continued Dependent Condition Pre Assessment n Measure RPJS Condition I 2 . 2 4 ( . 9 0 ) 17 Condition I I 2 . 7 1 ( 1 . 5 7 ) 17 Condition I I I 2 . 8 3 ( 1 . 2 9 ) 18 Overall Mean 2 . 6 0 ( 1 . 2 9 ) 52 RPCC Condition I 2 . 8 2 ( 1 . 1 9 ) 17 Condition I I 2 . 4 7 ( 1 . 3 3 ) 17 Condition I I I 2 . 9 4 ( 1 . 4 7 ) 18 Overall Mean 2 . 7 5 ( 1 . 3 3 ) 52 RPCS Condition I 2 . 9 4 ( 1 . 3 9 ) 17 Condition I I 2 . 8 8 ( 1 . 2 7 ) 17 Condition I I I 3 . 0 0 ( 1 . 4 1 ) 18 Overall Mean 2 . 9 4 ( 1 . 3 3 ) 52 RPCGA Condition I 4 . 4 1 ( 1 . 0 0 ) 17 Condition I I 4 . 6 5 ( 1 . 0 6 ) 17 Condition I I I 4 . 9 4 ( 1 . 3 5 ) 18 Overall Mean 4 . 6 7 ( 1 . 1 4 ) 52 RPCPA Condition I 4 . 7 1 ( 1 . 3 6 ) 17 Condition I I 4 . 5 9 ( 1 . 4 2 ) v 17 Condition I I I 5 . 1 1 ( 1 . 5 3 ) 18 Overall Mean 4 . 8 1 ( 1 . 4 3 ) 52 R P T A C Condition I 2 . 7 6 ( . 5 6 ) 17 Condition I I 2 . 5 3 ( . 8 0 ) 16 Overall Mean 2 . 6 4 ( . 7 0 ) 3 3 RPTAS Condition I 3 . 0 0 ( . 7 9 ) 17 Condition I I 2 . 9 4 ( 1 . 1 2 ) 16 Overall Mean 2 . 9 7 ( . 9 5 ) 33 M e a n s Post Assessment n Fol1ow -up n 3 . 4 7 ( 1 . 2 8 ) 17 3 . 6 3 ( 1 . 2 6 ) 16 3 . 5 9 ( 1 . 2 3 ) 17 3 . 7 5 ( . 9 7 ) 12 3 . 1 7 ( 1 . 4 7 ) 18 3 . 4 0 ( 1 . 3 2 ) 52 3 . 6 8 ( 1 . 1 2 ) 28 4 . 0 0 ( 1 . 0 6 ) 17 4 . 0 0 ( 1 . 3 2 ) 16 3 . 9 4 ( 1 . 1 1 ) 17 4 . 0 0 ( 1 . 1 3 ) 12 3 . 5 6 ( 1 . 6 2 ) 18 3 . 8 3 ( 1 . 2 9 ) 52 4 . 0 0 ( 1 . 2 2 ) 2 8 4 . 0 0 ( 1 . 3 2 ) 17 4 . 3 8 ( 1 . 2 6 ) 16 4 . 2 3 ( 1 . 0 3 ) 17 4 . 4 2 ( 1 . 0 8 ) 12 3 . 6 7 ( 1 . 5 3 ) 18 3 . 9 6 ( 1 . 3 1 ) 52 4 . 3 9 ( 1 . 1 7 ) 28 5 . 3 5 ( 1 . 0 6 ) 17 5 . 4 4 ( . 8 1 ) 16 5 . 1 2 ( 1 . 1 1 ) 17 5 . 4 2 ( 1 . 1 6 ) 12 5 . 1 1 ( 1 . 0 8 ) 18 5 . 1 9 ( 1 . 0 7 ) 52 5 . 4 3 ( . 9 6 ) 2 8 4 . 8 8 ( 1 . 3 6 ) 17 5 . 0 6 ( 1 . 3 4 ) 16 4 . 5 3 ( . 8 7 ) 17 4 . 0 8 ( 1 . 2 4 ) 12 5 . 2 2 ( 1 . 2 6 ) 18 4 . 8 8 ( 1 . 2 0 ) 52 4 . 6 4 ( 1 . 3 7 ) 2 8 3 . 1 8 ( 1 . 0 7 ) 17 3 . 3 5 ( . 7 0 ) 16 3 . 2 7 ( . 9 1 ) 3 3 3 . 4 7 ( 1 . 2 3 ) 17 3 . 6 9 ( . 8 7 ) 16 3 . 5 8 ( 1 . 0 6 ) 33 - 62 -Table 3 continued Dependent Condition Pre Assessment n Measure RPTBC Condition I 3.06 ( .75) 17 Condition II 2.71 ( .99) 16 Overall Mean 2.82 ( .81) 33 RPTBS Condition I 3.18 ( .64) 17 Condition II 2.88 ( .99) 16 Overall Mean 2.97 ( .77) 33 RPPC Condition I 29.00 (3.95) 6 Condition II 29.09 (5.61) 11 Condition III 29.20 (6.53) 5 Overall Mean 29.09 (5.18) 22 RPPS Condition I 28.83 (4.49) 6 Condition II 32.73 (7.72) 11 Condition III 30.60 (8.79) 5 Overall Mean 31.18 (7.13) 22 M e a n s Post Assessment n Fol1ow -up n 3.29 (1.10) 17 4.29 ( .92) 16 3.82 (1.13) 33 3.47 (1.18) 17 4.12 ( .70) 16 3.79 (1.02) 33 33.33 (2.58) 6 32.00 (6.90) 6 34.91 (3.91) 11 35.40 (4.48) 10 32.20 (3.77) 5 33.86 (3.59) 22 34.13 (5.55) 16 32.00 (3.16) 6 30.50 (6.31) 6 36.91 (5.77) 11 36.70 (5.54) 10 32.40 (5.37) 5 34.55 (5.44) 22 34.38 (5.43) 16 - 63 -1975; Hollandsworth & Wall, 1977). Because of these findings, sex differences were investigated in the present study. If treatment outcome is dependent on gender, the data should be analyzed separately for males and females, to control for this confound and better understand the nature of the results of treatment. To investigate this possibility, a 3 x 2 (Conditions x Sex) multivariate analysis of covariance was performed on each of the four sets of variables, with preassessment scores as the covariates (see Table 4). Main effects for sex were not significant on: screening measures, £ (3, 41) = .78, N.S.; functional impairment measures, £ (8, 31) = 1.29, N.S.; and therapists' ratings, £ (4, 22) = .43, N.S.; using Wilks' Lambda Criterion.* Main effects for sex were significant on the fourth set of variables, i e . others' ratings, £ (6, 35) = 2.85, JJ< .04. Planned comparisons revealed that males were perceived as post assessment by untrained confederates as more skilled than females. The results of several two way ANCOVAs (Sex x Conditions) revealed that a significant main effect for sex was obtained on significant other ratings of comfort, £ (1, 15) = 4.90, £ < .05, indicating that females were seen as more comfortable than males. These results should be interpreted most cautiously, due to the small sample size. 1. The significance of all MANCOVA analyses were assessed with Wilks' Lambda Criterion. - 64 -Table Summary of Sex Effects Grouping of Dependent  Variables I. Screening data Sex Effects Sex x Condition II. Functional Impairment Sex Effects Sex x Condition III. Others' Ratings Sex Effects Sex x Condition IV. Therapists' Ratings Sex Effects Sex x Condition Significant Others' Ratings Comfort Ratings Sex Effects Sex x Condition Skill Ratings Sex Effects Sex x Condition 4 at Post Assessment 3,41 .78 .514 6,82 .48 .818 8,31 1.29 .284 16,62 .68 .803 6,35 2.85 .023 12,70 .86 .588 4,22 .43 .783 •4,22 .23 .917 1,15 4.90 .043 2,15 2.36 .128 1,15 4.29 .056 2,15 1.22 .323 - 65 -Sex x Condition interaction effects were not significant on any of the four sets of dependent variables when pre scores were covaried out from post assessment scores (see Table 4). Although main effects for gender were significant on one set of variables, as well as significant other ratings, a decision was made to combine the data for males and females for several reasons: in this study, confederates' ratings were of less interest than other dependent variables; cell sizes for significant other ratings were so small that they must be interpreted with caution; and, only one dependent measure was significant, which would be expected by chance. Combining data for males and females under the appropriate circumstances increases statistical power as a function of increase in cell size. Testing the Hypotheses Hypothesis I stated that subjects in Conditions I and II would improve significantly more than those in Condition III. Hypothesis II stated that those in Condition II would improve significantly more than those in Condition I. The data were analyzed using multivariate procedures, as recommended by Huck et a l . (1974), Kaplan and Litrownik (1977) and Bray and Maxwell (1979). As compared with univariate analyses, multivariate procedures adjust for an increase in Type I error rates attributable to correlated dependent variables. In u t i l i z i n g a series of univariate tests, the probability of finding a significant difference by chance alone increases as the total - 66 -number of dependent variables increases (Huck et a l . , 1974). To test the specific hypotheses, multivariate analyses of covariance were performed on the postassessment data, with pretest scores designated as the covariates. Covariance procedures are preferred to repeated measures as they adjust for differences between the groups on pretest scores, and hence, are considered to be more powerful s t a t i s t i c a l l y (Huck et a l . , 1974). Assessing Change from Pre to Post Assessment For the purpose of assessing pre to post change, a single factor (conditions) multivariate analysis of covariance (MANCOVA) was performed on each of the four sets of dependent variables, with pre scores as covariates. Again, because sex effects were found to be mostly insignificant, data for males and females were combined. The research indicated that subjects' scores changed in the predicted direction on twenty of twenty-one variables, indicating improvement. MANCOVAs were followed by a priori comparisons which were utilized because: rather than seeking to explain any group differences, specific hypotheses were being tested and, relative to post hoc measures, a priori constrasts are more efficient s t a t i s t i c a l l y (Marascuilo & Levin, 1983). For most dependent variables two contrasts were conducted: one contrasting subjects in Conditions I and II with Condition III (as related to Hypothesis I) and a second contrasting subjects in Condition I with Condition II (as related to Hypothesis II). - 67 -Screening Measures A significant conditions effect emerged, _F (6, 88) = 5.64, £ = .000. A priori comparisons (see Table 5) revealed that subjects in Conditions I and II improved significantly more than those in Condition III on the Beck Depression Inventory, J: (26.06) = 3.72, £ 4, .005; Social Avoidance and Distress Scale, t (45.56) = 5.51, £ ^ .0005; and self report of interference of shyness, t (44.71) = 5.44, £ ^ .0005. Further, subjects in Condition II improved significantly more than those in Condition I on the Social Avoidance and Distress Scale, _t (32) = 1.73, £ = .05 and interference of shyness, _t (32) = 1.78, £ = .05.1 Self Report of Functional Impairment The three conditions differed significantly on measures of self reported functional impairment, F_ (16, 58) = 2.31, £ <^  .01. As assessed by a priori comparisons, subjects in Conditions I and II improved more than those in Condition III on self report of: comfort during role playing, _t (38) = -2.13, £ .025; s k i l l during role playing, Jt (38) = -3.02, £ .005; comfort in community settings, Jt (33.30) = -3.96, £ ^ .0005; s k i l l in community settings, _t (36.91) = -4.79, £ ^ .0005; frequency of engaging in social a c t i v i t i e s , Jt (42.55) = -3.94, £ ^ .0005; number of different social activities engaged i n , t (35.50) = -2.52, £ ^ .01; and satisfaction with a c t i v i t i e s , _t (44.50) = -2.56, £ ^ .01. 1. All values were assessed using one-tailed tests. - 68 -Table 5 Results of A Priori Comparisons At Post Assessment Following MANCOVAS Performed on Three Categories of Dependent Variables Contrast Dependent Variable CI CII vs. III CI vs. CII df t value £ df t value P Screening Measures BDI 26.08 3.72 .005 32 1.65 .106 SAD 45.56 5.51 .0005 32 1.73 .05 TOTINT 44.71 5.44 .0005 32 1.78 .05 Self Report of Functional Impa irment RPSC 38.00 -2.13 .025 32 - .90 .374 RPSS 38.00 -3.02 .005 32 -1.05 .299 TOTCOM 33.30 -3.96 .0005 32 -2.44 .025 TOTSKL 36.91 -4.79 .0005 32 -1.55 .130 TOTACT 42.55 -3.94 .0005 32 -1.66 .10 TOTFRE 44.50 -2.56 .01 32 -2.06 .05 TOTCAT 35.50 -2.52 .01 32 -1.89 .05 TOTLON 39.71 .43 .672 32 - .73 .468 Therapists' Ratings RPTAC 32 -1.40 .10 RPTAS 32 -1.69 .10 RPTBC 32 -3.36 .005 RPTBS 32 -2.81 .01 - 69 -Subjects in Condition II improved significantly more than those in Condition I on measures of self-reported comfort in community settings, t (32) = -2.44, £ <^  .025; satisfaction with a c t i v i t i e s , _t (32) = -2.06, £ ^ .05; and on number of different social activities engaged i n , Jt (32) = -1.89, £ .05, and, to a lesser extent, on frequency of engaging in social a c t i v i t i e s , Jt(32) = -1.66, p = .10.2 No other analyses were significant. Others' Ratings The results of MANCOVA performed on others' ratings indicated that, when pretest scores were covaried out from posttest scores, group differences were not significant, F_ (12, 76) = .90, N.S. Therapists' Ratings Therapists' ratings of subjects' behaviour was conducted only for those in Conditions I and II, as data of interest from subjects in Condition III concerned the pretest and postassessment periods only. A MANCOVA which covaried out scores from the in i t i a l session from scores obtained at the final session, indicated that the groups improved di f f e r e n t i a l l y , F_ (4, 24) = 2.83, £ ^ .05. Male therapists rated subjects in Condition II as significantly more comfortable, t (32) = -3.36, £ <f .005 and skil l e d , t (32) = -2.81, £ <f .01 than those in Condition I. However, female therapists perceived less significant differences between the two groups of subjects in terms of comfort, _t (32) = -1.40, p < .10, or s k i l l , t (32) = -1.69, p .10. 2. As assessed by one-tailed tests. - 70 -Significant Others' Ratings As this category of dependent variables consisted of only two measures, a single factor (conditions) analysis of covariance (ANCOVA) was performed on each variable. Results indicated that group differences on both comfort and s k i l l in the community setting as rated by significant others were not significant, F_ (2, 18) = 1.27, N.S., and F (2, 18) = 1.76, N.S., respectively. It should be noted that cell size was particularly small on this variable, n = 6, 11 and 5, hence, analyses should be interpreted with caution. Further, given that only certain subjects could nominate a significant other, these data are regarded as selective. Secondary Analyses Focus of Attention It was hypothesized that the s k i l l s component of Condition II would act to decrease subjects' focus on themselves in a social interaction. Hence, analyses were performed to determine whether subjects in Condition II did, in fact, focus upon their partner in the role playing situation more than those in Condition I. To investigate subjects' focus of attention while practising during training sessions, two 2 x 3 (Conditions x Sessions) ANOVAs were conducted. One was performed for verbal focus of attention, another for nonverbal. The results indicated that verbally, there was a significant main effect for conditions, £ (1, 42) = 6.95, £ < .05 and for sessions, F_ (2, 42) = 8.69, £ <^  .01. Tukey's - 71 -method as recommended by Glass and Stanley (1970) was used to determine the means between which significant differences existed. The results indicated that the mean of Condition II was greater than Condition I, £ (2, 42) = -7.1, £ 4 .05, with a 99% confidence interval ranging from -7.62 to -6.58. In terms of the effects of sessions, the mean of session eight was significantly greater than that of session two, £ (3, 42) = -14.88, £ ^ .01, with a 99% confidence interval ranging from -16.1 to -13.66. Further, the mean of session eight was significantly greater than session f i v e , q (3, 42) = -14.88, £ <. .01, with a 99% confidence interval ranging from -16.1 to -13.66. Session two did not differ significantly from session f i v e , j} (3, 42) = 0, N.S. The results of the analysis for nonverbal data indicated that there was a main effect for sessions, £ (2, 42) = 4.64, £ <^  .05. Tukey's method indicated that the mean of session five was significantly greater than session two, £ (3, 42) = -8.63, £ <^  .01, with a 99% confidence interval of -9.85 to -7.41. The mean of session eight was significantly greater than that of session two, q (3, 42) = -12.5, £ <" .01, with a 99% confidence interval of -13.72 to -11.28. The mean of session five was not significantly different from that of sesion eight, £ (3, 42) = -3.88, N.S. Subjects' apparent focus of attention was also assessed during the role playing task. A 3 x 2 (Conditions x Sex) analysis of covariance, using scores obtained on preassessment as - 72 -covariates revealed that the main effect for conditions was not significant, £ (2, 33) = .00, N.S. Sex effects were also nonsignificant, £ ( l , 33) = 2.11, N.S., nor was the Condition x Sex interaction, £ (2, 33) = .36, N.S. Similarly, an ANCOVA (Conditions x Sex) performed on follow-up data with post-assessment scores as covariates, revealed nonsignificant main effects for conditions, £ (1, 18) = .02, N.S.; sex, £ (1, 18) = .01, N.S.; or sex x conditions, £ (1, 18) = .69, N.S. Relation between Skill Level and Attractiveness Pearson Product-Moment Correlations performed between objective ratings of s k i l l and general attractiveness revealed that these two variables are moderately related, r_ = .41, .49 and .41, for preassessment, post, and follow-up. Credibility and Expectations Subjects in the two treatment conditions did not differ in their perception of how logical their respective treatments seemed to them, t_ (38) = -.48, N.S., or in their level of confidence that their respective treatments would be successful in helping them feel more comfortable and socially effective, t (38) = -.52, N.S.3 However, ratings in the final session of treatment indicated that subjects in Condition II f e l t significantly more comfortable in recommending their treatment to a friend who experiences 3. All credibility and expectations ratings were assessed using two-tailed tests. - 73 -discomfort in social situations, _t (30) = -2.88, £ £ .01. Those in Condition II also f e l t that their group leaders were significantly more knowledgeable, t (30) = -3.21, £ ^ .01. Finally, there was a trend for subjects in Condition II to perceive their group leaders as more warm/friendly, _t (30) = -1.89, £ ^ .10. Pairs of therapists were judged by the investigator to be equally warm, J: (62) = -.79, N.S. However, one pair was judged to be significantly more skilled than the other, t (62) = -2.58, £ < .001. Three Month Follow-up Assessment Examination of Table 3 indicates that, for the most part, changes which had occurred from pre to post assessment, had been maintained at three month follow-up. Analyses similar to those conducted for assessing pre to post change were utilized to determine subjects' status after three months' time. Sex effects: A 2 x 2 (Conditions x Sex) MANC0VA was performed on scores obtained at follow-up on each of the three sets of dependent variables. (Therapists' ratings were not applicable at follow-up). Post assessment scores were designated as the covariates. Results indicated that there was some evidence for a nonsignificant trend for sex differences between males and females on screening measures, F_ (3, 24) = 2.54, £ ^ .10. More spec i f i c a l l y , males were somewhat more depressed at follow-up than females, t (16) = 2.22, £ ^ .025. However, main effects for - 74 -sex were not significant on self-report of functional impairment, £ (8, 9) = 1.12, N.S., others' ratings in the laboratory and community settings, £ (6, 13) = .94, N.S., or on significant others' ratings of comfort, £ (1, 7) = 1.17, N.S. or s k i l l , £ (1. 7) = 1.26, N.S. Further, Sex x Conditions interactions were also not significant at follow-up on: screening measures, £ (3, 24) = .17, N.S.; self-report of functional impairment, £ (8, 9) = 1.37, N.S.; others' ratings, £ (6, 13) = 1.68, N.S.; or significant others' ratings of comfort, £ (1, 7) = .87, N.S. or s k i l l , £ (1, 7) = .08, N.S. Again, data from significant others' ratings should be interpreted with caution because of the small number of subjects and should be regarded as merely suggestive. Conditions Effects: In an effort to assess whether further change had occurred since post assessment, post scores were covaried out from scores obtained at follow-up. Data for males and females were grouped together. Results from single factor MANCOVAs indicated that further improvement had not occurred since post assessment on: screening measures, F_(3, 26) = .46, N.S.; self report of functional impairment, £ (8, 11) = 1.04, N.S., or others' ratings, £ (6, 15) = 1.12, N.S. Subjects responded to a series of questions during post assessment and three month follow-up interviews (Appendices PP and QQ, respectively). A test of independent proportions was conducted on their responses to several questions. At three months' time, a greater proportion of subjects in Conditions II reported c l i n i c a l l y significant changes than did subjects in - 75 -Condition I, z. = 1.74, £ { .05. Further, at post assessment, subjects from Condition II reported engaging in more frequent and/or a broader range of social activities than subjects in Condition I, z_ = 3.02, £ ^ .01. This difference was generally maintained at three months' time, z_ = 1.5, £ ^ .10. Treatment Drop-outs and Exclusions At three month follow-up, self-report questionnaires were sent to four individuals who had dropped out during treatment to determine their present status; three subjects completed the forms. Two additional individuals who had not dropped out of treatment, but who were not included in the final analyses (see Appendix II) were not contacted; one had moved to Australia, the other was diagnosed as neurologically impaired and was undergoing a series of tests. Table 6 compares the means and standard deviations of the three drop-outs on seven dependent measures with the combined means and standard deviations of subjects in Conditions I and II on the same measures, at post assessment and three month follow-up. T_-tests were not conducted due to the inequality of the sample sizes. However, examination of this table reveals that there are few notable differences between drop-outs' status and that of the treated subjects at both time periods. - 76 -'A V Table 6 Means of Drop Outs on Self-Report Questionnaires at Follow-Up Dependent Mean of Combined mean Combined mean Measure Drop-Outs of CI and CII at of CI and CII at (n = 3) Post Assessment Follow-up (n = 34) (n = 33) BDI 6.00 (6.24) 5.24 (4.04) 5.24 (4.30) SAD 15.00 (7.55) 13.12 (5.85) 12.45 (6.61) TOTINT 4.67 (4.16) 5.92 (3.26) 5.70 (3.24) TOTLON 61.33 (5.51) 56.44 (4.11) 54.61 (4.86) TOTACT 16.33 (5.77) 21.94 (12.69) 21.36 (11.69) TOTFRE 26.00 (8.00) 24.03 (9.19) 21.93 (9.21) TOTCAT 5.67 (1.53) 6.27 (1.70) 5.79 (1.81) TOTCOM 34.33 (5.51) 35.15 (4.59) 34.96 (6.90) TOTSKL 33.00 (7.55) 36.12 (5.13) 35.43 (7.59) - 77 -Discussion Major Hypotheses  Hypothesis I Hypothesis I stated that subjects in Conditions I and II would improve significantly more than those in the waiting l i s t condition. The results indicated that subjects' scores in the two treatment conditions changed in the predicted direction more than those in the control condition on twenty of twenty-one dependent measures. These differences reached statistical significance on the screening data (self-report of depression, social anxiety and interference of shyness) and functional impairment measures (self-report of comfort and s k i l l during role playing and community settings, and, frequency, satisfaction and number of different social activities engaged in ) . Self-reported loneliness did not change. The improvement of subjects in Conditions I and II is likely due to factors other than statistical regression. If regression toward the mean had been a major contributor to the results, subjects in the waiting l i s t condition would also have shown significant improvement from pre to post assessment, especially on the three screening measures. This did not occur. There were no significant differences between conditions on judges' and confederates' ratings during laboratory role playing. Inspection of the data revealed that, as compared with treated subjects, fewer waiting l i s t subjects improved on judges' ratings. Fifty-three percent of subjects in Condition I and sixty-five o - 78 -percent in Condition II improved on global comfort, while only twenty-one percent of waiting l i s t subjects improved. Similarly, seventy-one percent of subjects in Condition I and sixty-five percent from Condition II improved on global s k i l l , while only f i f t y percent of waiting l i s t subjects improved. Those figures are based on frequency counts of improvements of at least one point on a five-point scale. However, although subjects in the waiting l i s t condition improved less than treated subjects on the laboratory task, these differences between conditions were not significant. These results are different from those found in past social s k i l l s training research. Some previous studies found that subjects in a waiting l i s t condition improved as much as subjects who received training. For example, Wright (1976) found a no treatment control condition improved as much on observers' ratings in the natural environment as did treated subjects. More recently, in a study of shyness, Glass and Furlong (1984) found that significant improvement occurred across five conditions, including the waiting l i s t , with no significant differences between the five conditions. In summary, the treatment strategies did produce changes in the well-being and behaviour of socially avoidant individuals, as assessed by self-report measures. However, this differential improvement over time was not entirely corroborated by laboratory role playing measures. - 79 -Significant changes occurred only on self-report measures. One issue concerns how much weight should then be placed on self-reported change. Self-report measures have a number of strengths. They provide information regarding the subjects' perceptions, emotions and behaviours which are often unavailable or not available to direct observation. The subject is in a unique position to report on his own thoughts, feelings and overt behaviours. Because he can report on his behaviour in a wide variety of natural settings, a comprehensive overview of performance is afforded (Kazdin, 1980). Self-report measures are easy to administer and often function as screening devices for treatment outcome studies. Finally, self-report data can be instrumental in research, as many psychological concerns are defined by what clients report or feel (Kazdin, 1980). Self-report measures for the assessment of social s k i l l s have some limitations as well: items and terms are subject to individual interpretation; varied formats across measures yield inequitable data; and, psychometric adequacy can vary (Bellack, 1979). In the present study, self-report data proved useful and • there is no obvious reason to doubt i t s ' accuracy. Subjects were motivated to receive help. They appeared to respond honestly to the investigator's questions. Thus, there was no reason to suspect their written responses on questionnaires were not truthful. However, i t should be noted that measures of community - 80 -functioning were contructed for this study. Therefore, data regarding their psychometric properties is unavailable, and i t is not possible to ascertain whether these instruments were adequate. As discussed, there was a lack of correspondance between objective and self-report measures in this study. Margolin (1978) argues that the relative independence of methods of assessment does not necessarily invalidate the measurement procedures. She suggests that they may not be measuring a unitary dimension. Extending her reasoning to shyness, i t may be that the self-report and laboratory role playing assessment measures "tap" different dimensions of shyness and should not be expected to correspond. Similarly, in their discussion of fear and avoidance, Rachman and Hodgson (1974) introduced the concept of dischordance, referring to measures of various response systems which do not correlate significantly at a particular point of time. They note that physiological and subjective measures of emotional states often lack concordance. These authors suggest that therapeutic dischordance is more likely to occur when emotional arousal is relatively mild, when one is in a state of high demand, or i f the therapuetic technique employed is a high demand treatment. It may be that in the present study, subjective changes occurred in advance of objective changes. It is possible that experiencing less shyness and discomfort takes some time to translate into changes in behaviour which becomes noticeable to others. - 81 -The only dependent measure on which subjects evidenced no change was the UCLA Loneliness Scale. No subject improved more than a few points in self-reported loneliness. Russell et a l . (1980) reported an overall mean of 36.00 on the scale, with a standard deviation of 10.00. In the present study, the mean was two standard deviations higher (this corresponds to the mean of Russell et al.'s c l i n i c a l sample). However, the standard deviation of the present sample was approximately 4.00 at both pre and post assessment reflecting a very limited dispersion of scores. The fact that subjects' feelings of loneliness remained unchanged from pre to post assessment bears consideration. This is likely not due to any defects of the measure i t s e l f , which appears to be psychometrically sound. Rather, i t is probable that subjects considered to be both shy and lonely, continued to experience loneliness, even i f they reported feeling less shy or socially avoidant at post assessment. One can become more socially active and feel more comfortable in interpersonal situations, but loneliness may continue to persist and require more than three months to begin to dissipate. In fact, Cutrona (1982) has suggested that, regardless of frequency of social contacts, feelings of loneliness endure i f subjects experience dissatisfaction with friendships. In another study, two-thirds of a sample of lonely college students were s t i l l lonely seven months after i n i t i a l assessment (Cutrona, Russell and Peplau, 1979). The - 82 -results of the present study are different from those of Jones, Hobbs, and Hockenbury (1982) who found that after only one and one-half hours of encouragement in partner attention, subjects reported experiencing significantly less loneliness. However, this was an analogue study, with university students who were not as isolated and distressed as subjects in the present study. It should also be noted that Jones et a l . utilized the Loneliness Scale to screen subjects and as a dependent measure. Hence, regression to the mean might have occurred. Also, cells consisted of only six subjects. Hypothesis II Hypothesis II stated that subjects in Condition II (HRT) would improve significantly more than those in Condition I (relaxation and exposure) and that this change would generalize to measures of functional impairment. This was partially borne out in that subjects in the HRT condition improved more than those in the graduated exposure and progressive relaxation condition on two screening measures and significantly more on three of the self-report functional impairment measures: satisfaction with social a c t i v i t i e s , diversity of a c t i v i t i e s ; and comfort in social settings. Subjects in the HRT condition were rated by male therapists as significantly more comfortable and skilled than those in Condition I. Female therapists rated them as somewhat more comfortable and s k i l l e d . Although subjects maintained improvements made at post - 83 -assessment, further significant change did not occur between post assessment and three months' follow-up, with one exception. When interviewed, subjects who had received HRT reported that they had made significantly more changes in their social lives and were participating in a wider range and greater frequency of a c t i v i t i e s . Thus, the addition of training in process-oriented s k i l l s produced c l i n i c a l l y significant changes in that these persons became more socially active and began to take the i n i t i a t i v e in arranging social events. Given that training was relatively brief for such an extremely shy sample, i t is encouraging to note that improvements were maintained. It should be noted that although subjects did make some s t a t i s t i c a l l y and c l i n i c a l l y significant changes as a result of the training, they remained somewhat socially avoidant or shy. At follow-up, a sizeable portion of the subjects continued to experience some shyness. However, most reported that i t no longer presented an obstacle for them and that they were less concerned about their shyness. It was hypothesized that process-oriented s k i l l s might result in a shift of attentional focus from the subjects themselves to their partners. Several analyses were conducted to attempt to confirm whether subjects in the HRT conditon did, in fact, focus their attention on their partners during the interaction. While practising during training sessions, subjects in the HRT condition focused significantly more on their partners verbally, but not - 84 -nonverbally. These findings are not unexpected as the subjects who had HRT were instructed to focus their attention on their partners, i.e. to draw them out and attend to their behaviour. Across conditions, therapists' ratings indicated that subjects focused significantly more on their partners over time, both verbally and nonverbally. This may be interpreted as reflective of an improvement in their social effectiveness. However, these differences did not generalize to behaviour in the role playing situation. That i s , at post assessment, subjects in Condition II did not appear to focus their attention on their role play partners significantly more than did subjects in Condition I. The experimental instructions, i.e. get to know the other person, may have been sufficiently demanding that most persons would be likely to focus on the other. This may have obscured differences between the two groups. Thus, i t was not possible to establish a link between focus of attention in the laboratory setting and change in community functioning. Future research should include the assessment of focus of attention in community settings. This would be of value in determining whether improvements made by HRT subjects were mediated by an other-directed focus of attention or other factors. The results obtained in this study are different from those obtained by Jones et a l . (1982) who found a significant difference in focus of attention between lonely and non-lonely students on a laboratory task. Lonely students emitted fewer partner references - 85 -than those who were not lonely. Rather than a five minute inter-action designed to get to know the partner, Jones et al.'s subjects were asked to discuss for fourteen minutes what attracted them to persons of the opposite sex. Thus, the difference in results between the two studies may be that focusing on one's partner for five minutes is a relatively simple task which becomes more challenging after a longer period of time. If required to interact for about fifteen minutes, i t is possible that subjects who learned the HRT s k i l l s might focus on their partners more than Condition I subjects. Alternative explanations for the greater improvement of HRT subjects must also be considered. The data revealed no differences between subjects on expectations from the two treatment conditions, or on perceived credibility of treatment. This rules out the alternative explanation that expectancy or treatment credibility accounted for the greater change in HRT subjects. After training was completed, however, HRT subjects were more willing to recommend this treatment to a friend and rated their group leaders as more knowledgeable and warmer than did Condition I subjects. It is likely that the greater satisfaction with HRT is attributable to the intervention i t s e l f , rather than the therapists, as the latter were counterbalanced across conditions. Thus, although subjects had similar expectations of the two treatment interventions, they were more satisfied with the HRT procedure. During post assessment - 86 -interviews, those who had received HRT expressed significantly greater satisfaction with treatment, while the majority of those in Condition I stated that they had hoped for more direction in terms of what to say and how to behave. Similarly, all four therapists confirmed this preference for working with the HRT s k i l l s . Thus, treatment satisfaction may have increased HRT subjects' attempts to socialize. A third possible explanation for the improvement of HRT subjects concerns therapists' level of s k i l l . As a check on treatment, the investigator rated therapists' s k i l l and warmth from audiotapes of sessions. Although the investigator perceived the therapist pairs as equally warm, one pair was judged to be more s k i l l e d . However, therapists were counterbalanced across conditions and such differences should have been equally distributed in the two treatment conditions. Subjects did not rate the therapist pairs as different in this way, which also suggests that differences between pairs is not of great importance. Fourth, assessment revealed that subjects in both conditions began with equivalent levels of s k i l l s . Therefore, i n i t i a l s k i l l differences provide an unlikely explanation for Condition II subjects' greater change. A f i f t h alternative explanation pertains to the possible influence of demand characteristics. However, i f demand characteristics had been in operation, one might expect that HRT subjects would have attempted and engaged in - 87 -a greater number of homework tasks that Condition I subjects. This did not occur. Subjects in both training conditions attempted and completed an equivalent number of homework tasks. At post assessment, HRT subjects reported feeling somewhat more comfortable, but not more skilled than Condition I subjects. The most significant gain made by HRT subjects was their increased social in i t i a t i o n and participation. This could not be attributed to significant differences in i n i t i a l s k i l l l e v e l , expectations, or demand characteristics between the two training conditions. Perhaps the addition of the HRT component beyond relaxation and exposure provided a useful and relevant tool which could be relied upon in social situations. This in turn might have motivated subjects to become more socially active participants in their natural environment and increase their level of comfort. Secondary Analyses Relation Between Skill Level and Attractiveness Another objective of this thesis was to determine whether a gain in global s k i l l would be associated with a parallel increase in perceived attractiveness, as rated by confederates. Although the confederates perceived subjects as more skilled following training, this was not accompanied by increased ratings of attractiveness. Subjects were perceived equally as attractive at post assessment as at pre assessment. These results do not corroborate with those obtained by Scott and Edelstein (1981) who found that an increase in s k i l l was associated with an increase in - 88 -perceived physical attractiveness. One major difference between this study and that of the present study is that Scott and Edelstein paired subjects with opposite sex partners, while same sex partners were used in the present research. It may be that, as subjects become more sk i l l e d , their behaviour is perceived as more attractive by persons of the opposite sex, whereas physical attractiveness may be a more stable and less relevant component of same sex interactions. Gender Differences Past research has established that men and women differ in behaviours reflecting shyness (e.g. Pilkonis, 1977a) and assertiveness (e.g. Gambrill and Richey, 1975). In the present study, males and females did not differ significantly on screening or dependent measures with one exception: males were perceived by confederate as more skilled than females at post assessment. Insufficient data were available to interpret gender effects on significant other ratings. In this study, males and females were equally dysfunctional and responded similarly to treatment. Methodological Issues The methodological issues of greatest import concern laboratory measures of assessment, especially the role playing situation. There were no significant differences between subjects in the three conditions on laboratory mearsures of role playing. As discussed in the Introduction, the usefulness of role playing tasks as accurate measures of interpersonal behaviour has been - 89 -questioned. F i r s t , behaviour in role playing situations has been shown to have only limited generalizability to behaviour in naturalistic settings with both inpatient populations (e.g. Bellack, Hersen and Turner, 1978; Bellack, Hersen and Turner, 1979) and student populations (Bellack, Hersen and Lamparski, 1979). One cannot assume that the behaviour of socially avoidant persons while getting to know a collaborator in the laboratory environment closely parallels behaviour in various community settings. Second, subjects in all conditions reported that i t was much easier to engage in the task the second time. Thus practice effects might have contributed to ratings of subjects' s k i l l and comfort and obscured treatment effects. However, i t should be noted that a greater percentage of subjects in the training conditions, as opposed to the waiting l i s t , improved their role playing scores from pre to post assessment. Therefore, the influence of practice effects is insufficient to explain a l l the changes observed. Third, the rating scales must also be examined. Some investigators recommend global ratings rather than judging a series of discrete behaviours, such as voice volume and eye contact (e.g. Curran, 1982; Glass and Furlong, 1984). Global ratings were utilized in this study for several reasons. Along a practical vein, global judgments are less time consuming to train and rate. Further, the relevance of particular units likely - 90 -varies across a variety of settings (Curran, 1982; Kazdin, 1980). Thus, i t can be d i f f i c u l t to discern which components to assess (Bellack, 1979). Finally, i t was assumed that these perceptions more closely parallel the sort of judgments which we make of others in interpersonal situations (Bellack, 1979). Global rating scales are also used by those who perceive social effectiveness as consisting of complex behaviours. For example, Fischetti, Curran and Wessberg (1977) see interpersonal behaviour as an interactive process and note that discrete behaviours often ignore parameters such as timing and sequencing of behaviours. On the other hand, there are also disadvantages to using global ratings. For example, the specific components involved in making global ratings are not always clear (Kazdin, 1980). Bellack (1979) noted that extraneous factors such as global s k i l l and attractiveness can influence ratings of global anxiety. Curran (1982) suggested that global categories of s k i l l be analyzed to determine which discrete behaviours influence ratings. It is not possible in the present study to explain which of these factors were reflected in ratings of global s k i l l . Similar problems affect the therapist and confederate ratings. While these global ratings can provide useful data, information is again lost regarding individual components of behaviour (Kazdin, 1980). That i s , those behavioural components which contribute to improved performance in subjects remain unknown. Further, therapists rated subjects in the i n i t i a l and - 91 -final sessions of training, and therapists may have responded to demand characteristics inherent in this process. Therapists are also susceptible to their own biases regarding any subjects or particular treatment condition. Bellack (1979) suggested that confederates' untrained ratings of subjects are independent of the investigator's interpretation of social effectiveness and more accurately reflect subjects' social behaviour. However, the basis for these impressions is even less clear than that for trained judges (Bellack, 1979). Although confederates were unaware of the research hypotheses, at post assessment, they sometimes recalled having role played with certain individuals. Perhaps they assumed that subjects had made improvements over time and thus rated subjects as more skilled and comfortable at post assessment. However, the waiting l i s t condition should also be subject to bias of this sort. Thus, this is not an entirely satisfactory explanation. Significant other ratings were used to provide a perspective on the subjects in their naturalistic environement (Kazdin, 1980). Unfortunately, only a few significant others completed these ratings, so data were insufficient to draw conclusions. Interestingly, some subjects perceived a self-reported change in their shyness that was not corroborated by their significant others. In the i n i t i a l interview, a sizeable number of subjects expressed frustration that their friends did not perceive them as shy and dismissed these feelings when expressed by subjects. - 92 -Significant others who do not observe shyness in their friends before training are unlikely to note change following training. Another possibility is that progress undergone by subjects is not readily recognized by their peers. It may be that the opinions and perceptions we form of our friends and family members remain stable and inflexible to modification. In fact, Kazdin (1980) notes that such ratings are particularly subject to biases. Another possibility is that subjects f e l t they had made changes, but these were of an internal nature and not objectively noticeable to others. However, i t seems likely that recognition of positive changes by significant others would have beneficial implications for subjects. Thus, this issue deserves further study. Also, the opinion of others, i f accurate, is desirable from a research point of view. One procedural improvement for future research may be to interview significant others directly. Treatment Procedures The treatment procedures should be reviewed to assess whether training was adequate. At post assessment and three month follow-up, a significant portion of subjects expressed a desire for longer treatment duration. Most were just beginning to master the s k i l l s and feel comfortable in the group when training terminated. This recommendation was echoed by the therapists. Perhaps twelve to sixteen (as opposed to eight) two hour sessions would prove more beneficial. This may be especially true for subjects in the HRT condition. One observation was that the concepts of empathy - 93 -and respect could not readily be absorbed and applied comfortably in one weeks' time. In fact, developing such s k i l l s often requires months of training for helping professionals. One might expect avoidant subjects to require even more training time. Another factor to consider is that a l l shy persons may not benefit from one particular treatment strategy or package. Distinctions have been made among shy persons on the following dimensions: Skilled vs. deficient in s k i l l s (e.g. Crozier, 1979; Pilkonis, 1977a); anxious vs. prone to cognitive distortions; privately vs. publicly shy (Pilkonis, 1977b); early vs. late onset; and sociable vs. unsociable (Cheek and Buss, 1981). Shy persons who differ along dimensions such as these might respond differentially to particular treatment strategies. However, data from this study do not support this hypothesis. For example, skilled and unskilled subjects benefitted equally from training. Similarly, post assessment revealed no differences between subjects of early vs. late onset of shyness. Similarly, other researchers indicate that in terms of outcome, few differences exist between strategies (e.g. Glass and Furlong, 1984). Perhaps the next step might be to refine existing treatment strategies. In terms of the present research, this might involve strengthening graduated exposure procedures, as this component of treatment may not have been presented as adequately as the other components. These could be incorporated into the homework assignments in a more structured fashion. For example, one - 94 possibility would be to more closely scrutinize the progress of each subject as they worked on their hierarchies. Although each subject did report on their weekly progress, time constraints limited therapists' a b i l i t y to do this f u l l y . Another possibility might be to pair up subjects for completing homework assignments between sessions. Another possibility would be to have a therapist or volunteer accompanying each subject as they progress through their hierarchy of situations outside of the training schedule. Clinical Observations Numerous c l i n i c a l observations were made in working with this sample. The following represents a summary of the most notable of these observations. This sample of subjects was judged to be severely impaired. Most reported that their shyness was "holding them back in many ways," i.e. in making friends, dating and in progressing with their careers. Subjects described themselves as easily embarassed, self-conscious, uneasy with the opposite sex or in groups, anxious, wanting to hide and remaining quiet in the presence of others. Several were concerned that their children were becoming shy. Although most subjects reported that they had always been shy, others attributed their shyness to traumatic events, e.g. being abused, one's birth order, being discouraged from socializing, frequent moves as a child, or a physical imperfection. It was interesting that almost a l l persons interviewed were judged by the investigator as adequately socially - 95 -skilled on a one to one basis. However, when placed in the group situation, they were seen as much less s k i l l e d , which suggests that conditioned anxiety was inhibiting their performance. The majority of subjects expressed satisfaction with training interventions. Relaxation procedures and being in a group were cited as the most appreciated factors, while fourteen percent reported that the role playing was not useful. Half of the HRT subjects attributed their change to the s k i l l s component. Four persons, a l l from Condition I, requested a referral for further help with their shyness. As a therapist, i t was striking how impaired these people were and how painful i t was for them to work on their hierarchies. Avoidance was a topic frequently discussed in all three conditions. As previously noted, the HRT s k i l l s proved to be more d i f f i c u l t to convey than anticipated. However, in spite of their orientations, all therapists expressed a preference for instructing the HRT condition. This may be because of the s k i l l s themselves. Alternatively, when subjects requested direction, i t was preferable to be able to provide a s k i l l rather than directing them back to their relaxation. Finall y , a l l therapists expressed a certain amount of dissatisfaction with the rigidity of the structure of the sessions which was due to research constraints. This was not unexpected, but i t was f e l t that standardization was a priority for this research. Future Research - 96 -As previously discussed, research regarding social effectiveness is presently hampered by less than adequate assessment tools. Future research must address this issue. Particular concerns requiring investigation include the development of practical, reliable and valid objective measures for assessment in the laboratory setting. At present, investigations rely heavily upon objective data, but laboratory assessments are far from adequate. The continued development of unstructured, unobtrusive situations which closely resemble naturalistic settings hold promise for objective assessment. Researchers must develop more knowledge of which factors constitute and are reflected in molecular unit vs. global judgments utilized for rating social effectiveness. For example, i f subjects are judged as more comfortable at post assessment, i t would be advantageous to understand which factors contributed to this improvement. Finally, the design of self-report and objective tools for assessing ongoing social functioning in the community setting would be advantageous for research in this area. Measures must demonstrate r e l i a b i l i t y and v a l i d i t y . Alternative research designs would prove beneficial in ruling out hypotheses to explain the results obtained in this study. For example, once a treatment package has been established as effective in overcoming social inadequacy, a dismantling strategy (Kazdin, 1980) would be of interest to aid in the isolation of specific components of treatments which are most effective. At - 97 -this time, the effects of the individual components of relaxation, graduated exposure and HRT on overall treatment outcome are unknown. Factorial designs would also be instrumental in allowing for the simultaneous investigation of several factors. These factors might include variations of treatment, therapist characteristics such as experience, number of training sessions and perhaps subject demographics, such as age. Experience with this study suggests that number of training sesions might be particularly useful to determine the optimal number needed to maximize treatment outcome. Similarly, investigating variations of treatment would be useful. For example, the unstructured, individualized graduated exposure procedure used in this study could be compared with providing a standard, structured hierarchy for all subjects. Finally, the issue of the unit of statistical analysis bears further consideration. In this study, differences between the groups comprising each condition were minimal. If cl i n i c a l research concerning social s k i l l s effectiveness continues to proceed in group format, rather than on an individual basis, research is required to investigate any differences which may arise between groups within any given treatment conditions. The chief concern is that within one group, one individual or factor may somehow affect a l l other members of that group. This is of particular concern i f : subjects have not been screened thoroughly; therapists are not counterbalanced across conditions; - 98 -subjects have not been randomly assigned; and extraneous or environmental factors such as place and time of group meetings have not been standardized. Summary Extremely shy subjects who participated in treatment received either relaxation training and graduated exposure or relaxation training, graduated exposure, plus training in other-focused s k i l l s . Subjects in both these conditions improved significantly more than untreated subjects. Those who received the other-focused treatment improved more on screening measures and self-reported social functioning in the community, as compared with subjects receiving relaxation and graduated exposure alone. Differences were made primarily in self-report measures. HRT subjects also reported more c l i n i c a l l y significant l i f e changes as a result of treatment. Methodological limitations temper the conclusions. The role playing task may not have provided an adequate measure of subjects' typical interpersonal behaviour. Further, an insufficient number of subjects were able to nominate significant others for providing information regarding subjects' community functioning. After three months, HRT subjects continued to report c l i n i c a l l y significant changes in that they remained more socially active. 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A comparison of systematic desensitization and social s k i l l acquisition in the modification of a social fear. Behavior Therapy, 1976, 7_, 205-210. Zimbardo, P.G. Shyness: What i t i s . What to do about i t . Reading, Mass: Addison- Wesley, 1977. - 114 -Appendix A Letter to Mental Health Workers/Agencies Are you shy? Do you feel uncomfortable in a number of social situations? Do you feel your shyness causes problems for you at work or making friends? We are beginning a research project investigating shyness. The purpose of this project is to understand the factors that create anxiety and shyness and to begin to identify techniques which will help shy people reduce their anxiety. We are looking for shy individuals to volunteer to participate in a treatment research project. The programme consists of an intake interview and eight two hour group meetings. During the intake interview we will describe the programme in detail and determine whether this programme might be interesting and helpful to you. We will also ask you about your shyness, what causes i t and so on. We hope to develop a picture of shyness and social isolation that will help us create better programmes to reduce anxiety. The group meetings focus on how to overcome shyness. We find that anxiety makes shy people self-conscious and interferes with their ability to talk and feel comfortable during interactions. Sometimes they feel they can't think clearly so they can't handle interactions as well as they might. Often shy people begin to avoid certain social interactions to reduce their discomfort. Unfortunately, this often makes things worse. The f i r s t part of the programme involves teaching different techniques for remaining calm during interactions. With daily practice, most individuals can learn to become more relaxed. This calming helps them interact with others better. The next part of the programme involves carefully analyzing situations which create anxiety. We will help you develop a plan to approach problem situations systematically and thoughtfully, using your relaxation techniques to reduce anxiety. The third part of the programme involves group discussion and support. Often shy people do not get enough support from friends in their attempts to overcome anxiety. The group can provide this. Taking the opportunity to discuss your shyness with other shy people often provides new ways of looking at a problem. This group discussion also provides a place where you can talk openly and meaningfully with others. Just knowing you are not alone makes a great difference to most people. Because the purpose of the project is to evaluate the group programme we will ask you to complete some questionnaires about shyness and to provide us with feedback about which techniques were most help ful in your daily interactions. In order to - 115 -determine how effective the treatments are, we will need a comparison group who temporarily do not participate in treatment. Some people will be assigned to a waiting condition. They will be asked to complete the questionnaire, but hold off on treatment until the f i r s t group is finished. Then they will enter treatment. You may be asked to be in this waiting group. Of course, a l l the information collected is kept s t r i c t l y confidential and will be destroyed once the project is over. We do not talk with outsiders about the programme. Thus, complete anonymity is assured. You are free to withdraw from the project at any time. If you are shy and are interested in hearing more about this project, please call Dr. Lynn Alden at 228-2198. If you know someone who is shy, please draw this to their attention. Fi n a l l y , many shy people are anxious about taking part in a shyness group. They are worried that they won't be able to talk in a group. If this is true for you, feel free to give us a call and discuss the project. Most shy people find i t isn't as d i f f i c u l t as they fear. And i t may be a f i r s t step toward reducing your anxiety. - 116 -Appendix B Details of Persons Screened out over the Telephone Reason £ Depression 25 Did not meet age c r i t e r i a 18 Telephone number not in service 16 Distance from UBC was a factor 16 Shyness did not interfere notably with , l i f e and interactions 10 Telephoned for a friend or relative 8 Taking holidays during group 7 Moved; not able to contact 6 Taking antipsychotic medication 6 Generalized anxiety a problem rather than shyness 5 No longer interested in program when contacted 5 Shift work or hours conflicts with group time 5 Had been psychiatric inpatient or diagnosed as schizophrenic 5 Hung up on telephone when contacted 4 Spoke of multiple psychological problems 4 Poor impulse control/agressive and hostile 3 Agoraphobic 3 Hearing Impaired 3 Suicidal (presently) 3 Present y abusing drugs/alcohol 2- 117 -Other (e.g. physical concerns, psychological) Not able to reach after multiple attempts at contact - 118 -Referrals Made over Telephone Following Screening Referral Source n Psychology Dept. in a hospital 13 North Shore Family Services Shyness Program 11 Private psychologist 3 Private psychiatrist 14 Other 11 - 119 -Appendix C Pre-Assessment Interview Tell me about your shyness What types of situations are the worst for you? Are any situations better for you? When did you become shy? How did i t start? (prompt with school periods) How has your shyness affected your l i f e : Has i t caused any problems for you at work? How does i t affect your friendships? Making friends Keeping in touch with friends Where did you meet them How many close friends do you have? How long have you known them? How often do you see them? Who sets up getting together? .  Has shyness affected you in dating situations? - 1 2 0 -How often do you go out with men/women? Is there anything you can do to help you cope with your shyness? Make i t a l i t t l e easier for you? Demographic Information * * * Current Medical Problems - receiving treatment for them? Prescribed Medications (what, dosage, reason, prescribing doctor/ vis i t s ) Street drugs (frequency, what drugs) Alcohol consumption * * * How did you find about these groups (this study)? Have you sought treatment before for this problem? Any other? - 121 -With whom? How did i t go? What kinds of things did you do? Are you s t i l l going? (why stop)? Is aware that you are coming here? (inform him/her) * * * Many shy people feel depressed at times. Does this happen with you? When? How often? How depressed do you become? Have you ever f e l t depressed enough to k i l l yourself? Tell me about that. Have you thought about how you would do this? Did you have the ? How often do you think about k i l l i n g yourself? What situations/events seem to trigger these thoughts? - 122 -Have you ever tried to commit suicide in the past? Tell me about i t . * * * What led you to come here? What would you like to get out of this group? Do you have any concerns about the group? Anything you'd like to ask me? * * * Summarize Our Expectations for these groups: 1. Attend all sessions 2. Participate actively 3. Homework assignments (Weekly practice exercises) 4. Confidentiality - 123 -Appendix D Beck Depression Inventory (BDI) |A. 0 I do not feel sad 1 I feel blue or sad 2a I am blue or sad all the time and I can't snap out of i t 2b I am so sad or unhappy that i t is quite painful 3 I am so sad or unhappy that I can't stand i t B. 0 I am not particularly pessimistic or discouraged about the future la I feel discouraged about the future 2a I feel I have nothing to look forward to 2b I feel that I won't ever get over my troubles 3 I feel that the future is hopeless and that things cannot improve C. 0 I do not feel like a failure 1 I feel that I have failed more than the average person 2a I feel I have accomplished very l i t t l e that is worthwhile or that means anything 2b As I look back on my l i f e a l l I can see is a lot of failure 3 I feel I am a complete failure as a person (parent, husband, wife) D. 0 I am particularly dissatisfied la I feel bored most of the time lb I don't enjoy things the way I used to 2 I don't get satisfaction out of anything anymore E. 0 I don't feel particularly guilty 1 I feel bad or unworthy a good part of the time 2a I feel quite guilty 2b I feel bad or unworthy practically all the time 3 I feel as though I am very bad or worthless F. 0 I don't feel that I am being punished 1 I have a feeling that something bad may happen to me 2 I feel I am being punished or will be punished 3a I feel I deserve to be punished 3b I want to be punished G. 0 I don't feel disapponted in myself la I am disappointed in myself lb I don't like myself 2 I am disgusted with myself 3 I hate myself H. 0 I don't feel I am any worse than anybody else - 124 -2 I am c r i t i c a l of myself for my weakness or mistakes 2 I blame myself for everything that happens I. 0 I don't have any thoughts of harming myself 1 I have thoughts of harming myself but I would not carry them out 2a I feel I would be better off dead 2b I feel my family would be better off i f I were dead 3a I have definite plans about committing suicide 3b I would k i l l myself i f I could J . 0 I don't cry any more than usual 1 I cry more now than I used to 2 I cry all the time now. I can't stop i t 3 I used to be able to cry but now I can't cry at al l even though I want to K. 0 I am no more irritated now than I ever am 1 I feel annoyed or irritated more easily than I used to 2 I feel irritated all the time 3 I don't get irritated at all at the things that used to ir r i t a t e me L. 0 I have not lost interest in other people 1 I am less interested in other people now than I used to be 2 I have lost most of my interest in other people and have l i t t l e feeling for them 3 I have lost a l l my interest in other people and don't care about them at all M. 0 I make decisions about as well as ever 1 I try to put off making decisions 2 I have great d i f f i c u l t y in making decisions 3 I can't make any decisions at all any more N. 0 I don't feel I look any worse than I used to 1 I am worried that I am looking old or unattractive 2 I feel that there are permanent changes in my appearance and they make me look unattractive 3 I feel that I am ugly or repulsive looking 0. 0 I can work about well as before la It takes extra effort to get started to doing something lb I don't work as well as I used to 2 I have to push myself very hard to do anything 3 I can't do any work at all P. 0 I can sleep as well as usual - 125 -1 I wake up more tired than I used to in the morning 2 I wake up 1-2 hours earlier than usual and find i t hard to get back to sleep 3 I wake up early every day and can't get more than 5 hours si eep Q. 0 I don't get any more tired than usual 1 I get tired more easily than I used to 2 I get tired from doing anything 3 I get too tired to do anything R. 0 My appetite is no worse than usual 1 My appetite is not as good as i t used to be 2 My appetite is much worse now 3 I have no appetite at a l l now S. 0 I haven't lost much weight, i f any, lately 1 I have lost more than 5 pounds 2 I have lost more than 10 pounds 3 I have lost more than 15 pounds T. 0 I am no more concerned about my health than usual 1 I am concerned about aches and pains or upset stomach or constipation 2 I am so concerned with how I feel or what I feel that i t ' s hard to think of much else 3 I am completely absorbed in what I feel U. 0 I have not noticed any recent change in my interest in sex 1 I am much less interested in sex than I used to be 2 I am much less interested in sex now 3 I have lost interest interest in sex completely - 126 -Appendix E Social Avoidance and Distress Inventory (SAD) The following questions are concerned with your beliefs, feelings, and actions. Decide whether each statement is more true or false as applied to your personally and ci r c l e either true (T) or false (F) after each. Work quickly, giving your f i r s t reaction to each If a statement is sometimes true and sometimes false, is more typical of you personally. statement, decide which T . I feel relaxed even in unfamiliar social situations T F 2. I try to avoid situations which force me to be very sociable T F 3. It is easy for me to relax when I am with strangers T F 4. I have no particular desire to avoid people. T F 5. I often find social occasions upsetting. T F 6. I usually feel calm and comfortable at social occasions. T F 7. I am usually at ease when talking to someone of the opposite sex. T F 8. I try to avoid talking to people unless I know them well. T F 9. If the chance comes to meet new people, I often take i t . T F 10. I often feel nervous or tense in casual get-togethers in which both sexes are present. T F 11. I am usually nervous with people unless I know them wel1. T F 12. I usually feel relaxed when I am with a group of people. T F 13. I often want to get away from people. T F 14. I usually don't feel uncomfortable when I am in a group of people I don't know. T F 15. I usually feel relaxed when I meet someone for the f i r s t time. T F 16. Being introduced to people makes me tense and nervous. T F 17. Even though a room is full of strangers, I may enter i t anyway. T F 18. I would avoid walking up and joining a large group of people. T F 19. When my superiors want to talk to me, I talk willingly. T F 20. I often feel on edge when I am with a - 127 -group of people. T F 21. I tend to withdraw from people. T F 22. I don't mind talking to people at parties or social gatherings. T F 23. I am seldom at ease in a large group of people. T F 24. I often think up excuses in order to avoid social engagements. T F 25. I sometimes take the responsibility for introducing people to each other. T F 26. I try to avoid formal social occasions T F 27. I usually go to whatever social engagements I have. T F 28. I find i t easy to relax with other people. T F - 128 -Appendix F Interference of Shyness with Social Interactions (TOTINT) How much does your shyness Not interfere with your abil i t y to: at all Much a) interact with co-workers 0 1 2 3 4 or fellow students b) make friends/acquaintancs 0 1 2 3 4 c) interact with supervisors 0 1 2 3 4 or teachers - 129 -Appendix G Demographics and Statistics of the Sample 70% had at least one year of university education. 23% were students presently. 21% were employed as professionals. 15% were employed in trade or labour occupations. 19% were married; 73.1% had never married. 67% had never dated or had not for years. 19% had no close friends. 98% reported that their shyness interfered with socializing with coworkers Mean number of drinks per week (where one drink = one-half ounce of pure ethyl alcohol) = 4.5. 13.5% were abstinent. 69% described themselves as having always been shy; 92% were shy by their twelfth birthday. Mean number of si blings is 2.5 42% were second born children. 11.5% were abused physically as children (self-reported). 23% were abused physically and/or emotionally. 57% had at least one shy parent (self-reported). 50% were not encouraged or were discouraged from socializing by parents. 60% had parents who socialized not at a l l or only with their - 130 -farm* l i e s . 30.8% could not attribute their shyness to any source, i.e., they did not know why they were shy; 11.5% attributed i t to emotional abuse or being teased when young; 13.5% attributed i t to being discouraged from socializing. 100% reported that their shyness interfered with making friends. 98.1% reported that their shyness interfered (or did while unmarried) with dating. 19% had no means of coping with their shyness; 17.3% coped by avoiding people; 15.4% utilized relaxation or cognitive behavioural strategies; 11.5% coped by forcing themselves into situations; 9.6% coped with the aid of alcohol. 13.5% used street drugs (almost exclusively marijuana and/or hashish); 84% did not use street drugs (self-reported). 7% had sought treatment for their shyness in the past. 42% had received professional help for other problems (e.g., marital or sexual 9.6%; anxiety 5.8%; depression 3.8%; school-related concerns or problems 7.7%). Of these, 13.5% had sought help from a psychiatrist. 1.9% were continuing to go for treatment during the program. 28% attributed the depression they experienced to shyness/ i solati on/1oneli ness. 21% experienced depression at least once a week; 21% experienced depression once a month. 42.3% had experienced suicidal ideation in the past; 11.5% of the - 131 -sample had made suicidal plans in the past; 21.2% had been suicidal only once; 5.8% attributed their suicidal ideation to their shyness; 3.8% had made suicide attempts in the past. - 132 -Appendix H Self-Report of Social Interactions (TOTACT, TOTFRE, TOTCAT) A. Social Situations Please indicate how often you have participated in the following activities: How satisfying was it? (Please cir c l e the appropriate number) No. of Times a l i t t l e much Phoned a friend in the last 2 weeks Spoken with or shared an activity with a family member in the last 2 weeks Initiated a conversation with a stranger in the last 2 weeks Gone to a club, church or con-ference in the last 2 weeks Gone out with a friend in the last 2 weeks Asked for a date or accepted one in the last 2 weeks Shared activity with rnate/partner in the last 2 weeks Invited friends over in past 2 weeks Gone to a party or a large social gathering in last month Socialized with co-workers in past 2 weeks 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 4 5 4 5 4 5 4 5 4 5 4 5 4 5 4 5 4 5 4 5 - 133 -Appendix I Self-Report of Comfort and Ski l l in the Community Setting (TOTCOM, TOTSKL) Below is a l i s t of people we come in contact with on a daily basis. Please rate: 1) How comfortable you feel interacting with this person(s). Choose a number from 1 to 5 where: 1 - very uncomfortable, anxious 2 - uncomfortable 3 - somewhat comfortable/somewhat uncomfortable 4 - comfortable 5 - very comfortable and relaxed 2) How skilled you feel you are when interacting with this person(s) Choose a number from 1 to 5 where: 1 - very unskilled 2 - unskilled 3 - somewhat skilled/somewhat unskilled 4 - skilled 5 - very s k i l l e d . I can keep the interaction flowing quite smoothly Comfort (1-5) Sk i l l (1-5) 1. Co-workers/colleagues 2. Your superior/boss 3. Family members 4. Acquaintances 5. Friends . 6. Persons with whom you are intimately involved 7. Strangers 8. Persons in authority positions; e.g., doctor, bank manager, etc. 9. Large groups of people you know ' 10. Large groups of people you don't know - 134 -Appendix J UCLA Loneliness Scale (TOTLON) Indicate how often you feel the way described in each of the following statements. CIRCLE one number for each. 1. I feel in tune with the people around me 2. I lack companionship 3. There is no one I can turn to 4. I do not feel alone 5. I feel part of a group of friends 6. I have a lot in common with the people around me 7. I am no longer close to anyone 8. My interests and ideas are not shared by those around me 9. I am an outgoing person 10. There are people I feel close to 11. I feel l e f t out 12. My social relationships are superficial 13. No one really knows me well 14. I feel isolated from others 15. I can find companionship when I want i t 16. There are people who really understand me 17. I am unhappy being so withdrawn 18. People are around me but not with me 19. There are people I can talk to 20. There are people I can turn to never rarely sometimes often 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 - 135 -Appendix K Details of Subjects Screened Out at the Individual Interview Level As many subjects had multiple problems, this data is presented individually, rather than summarizing for the group. However, i t should be noted that twenty-six of forty persons were screened out due to clinical depression. Subject number Reason for Screening 1 Moderately depressed. BDI = 27 2 No show twice; cancelled once 3 Moderately depressed. BDI = 25 4 Moderately depressed. BDI = 29 5 Not shy enough 6 Sexual identity issues and suicidal ideation 7 Low SAD score 8 Moderately depressed. BDI = 29; Spent fourteen years in prison; two psyciatric hospitalizations; past suicidal attempt 9 Moderately depressed. BDI = 23; shyness did not interfere with l i f e significantly 10 Mildly agoraphobic and unassertive 11 Shyness only minimally interfered with l i f e ; past suicide attempt 12 Moderately depressed. BDI = 28; vague violent fantasies 13 Walked out of interview - 136 -14 Moderately depressed. BDI = 27 15 Physical disability prevented abil i t y to practice relaxation exercises 16 Age 57; Mild suicidal ideation. BDI = 19 17 Ativan 6 mg.; highly suspicious, impulse control 18 Language barrier 19 Shyness did not interfere enough with l i f e 20 Bipolar disorder; in manic phase 21 Age 18; moderately depressed. BDI = 21; emotionally labile 22 Felt he had no problem with shyness. Sent by a friend 23 Moderately depressed. BDI = 21 24 Refused to complete questionnaires; referred to self as "schizy" 25 Moderately depressed. BDI = 25; heavy daily drug use 26 Shyness interfered only minimally with l i f e 27 Moderately depressed. BDI = 22. Continuous suicidal ideation 28 Librium 50 mg., problems controlling aggression and domineering behaviour 21 Moderately depressed; BDI = 25 22 Alcohol abuse; generalized anxiety; impulse - 137 -control 23 Shyness interfered only minimally with l i f e 24 Moderately depressed. BDI = 24 25 Shyness interfered only minimally with l i f e 26 Severely depressed. BDI = 30 27 Possible suicide risk 28 Severely depressed. BDI = 38; two past suicidal attempts; possible delusions 29 Moderately/severely depressed. BDI = 29 30 Moderately depressed. BDI = 23; suspicious 31 Sexual identity issues -- incestuous with nine siblings 32 Reluctant to participate. Reported problems accepting structure and authority. 33 Moderately depressed. BDI = 25; alcohol abuse; marital dischord. 34 Extremely poorly groomed and unclean 35 Severely depressed. BDI = 34 36 Severely depressed. BDI = 38; name phobic; emotionally labile 37 Shyness interfered only minimally with l i f e ; reported psychotic-like experiences; mild paranoid ideation 38 Moderately depressed. BDI = 22 39 Moderately depressed. BDI = 28 - 138 -40 Moderately depressed. BDI = 25; multiple problems - 139 -Apendix L Global Skill (RPSS, RPCS, RPJS) 1 lack s k i l l 2 of average s k i l l 3 4 5 very skilled 1 = Noticeably lack s k i l l . Attempts to relate may be marked by long pauses. Doesn't interact easily with other person. 3 = Of average s k i l l . Tends to keep interaction going. May be a series of short pauses, nervous laughter, etc. 5 = Top s k i l l . Keeps interaction going quite smoothly. (May be 1 or 2 breaks or a few nervous laughs.) - 140 -Appendix M Global Comfort (RPSC, RPCC, RPJC) I 2 3 4" 5 distinctly somewhat comfortable uncomfortable comfortable and relaxed 1 = Noticeably uncomfortable. Poor eye contact. Quiet, uneasy. 3 = Somewhat comfortable/somewhat uncomfortable. A number of periods of discomfort and tenseness. 5 = Comfortable and relaxed, given the situation. Appropriate eye contact. Calm and poised. - 141 -Appendix N Confederates' Ratings (RPCGA and RPCPA) 1. How physically attractive do you find this person? I 2 3 4" 5 5 T extremely extremely unattractive attractive 2. How attractive do you find this individual on an overall basis? 1 2 3 4" 5 5 T extremely extremely unattractive attractive - 142 -Apendix 0 Focus of Attention: Judges' Ratings includes: statements displaying interest and approval toward other questions of the other statements that refer directly to the partner statements that refer directly to the partner's attitudes, activities, experiences comments referring to partner referring to the partner's preceeding statements using the pronoun "you" in a statement or question frequency count includes: statements relating to the subject's personal feelings, expriences, past events, opinions expression of statement toward self frequency count frequency count - 143 -Appendix P Peer Letter Dear Through a program offered by the Dept. of Psychology at the University of British Columbia, we are presently offering to help people in overcoming their shyness. has volunteered to participate in this program. To help us evaluate the program, we have asked each participant to nominate one individual to provide us with some information concerning him/her as you perceive them in the community. has given us your name and his/her consent to contact you for this purpose. We are asking you to take less than 5 minutes to complete the enclosed questionnaire. A stamped, self-addressed envelope is enclosed for your convenience in returning it when completed. After the program has concluded, we shall contact you once again to ask you to complete the same questionnaire. Again, the purpose is to evaluate whether our program has been effective. Please note that your responses will be kept strictly confidential. Only those working on the study will have access to them. Your friend or relative will not be privy to this information and is aware of this. If you have any questions whatsoever, please do not hesitate to contact me at' Thank you so much for your time. Sincerely, Robin Cappe, M.A. Dept. of Psychology University of British Columbia - 144 -Appendix Q Peer/Significant Other Rating Form (RRPS and RPPC) Below is a l i s t of people we come in contact with on a daily basis. Please rate: 1) How comfortable you feel your friend/relative is when interacting with this person(s). Choose a number from 1 to 5 where: 1 - very uncomfortable, anxious 2 - uncomfortable 3 - somewhat comfortable/somewhat uncomfortable 4 - comfortable 5 - very comfortable and relaxed 2) How skilled you feel your friend/relative is when interacting with this person(s). Choose a number from 1 to 5 where: 1 - very unskilled 2 - unskilled 3 - somewhat skilled/somewhat unskilled 4 - skilled 5 - very s k i l l e d . Comfort (1-5) Skill (1-5) 1. Co-workers/Colleagues 2. His/her superior/boss 3. Family members 4. Acquaintances 5. Friends 6. Persons with whom he/she is initmately involved 7. Strangers 8. Persons in authority positions e.g., doctor bank manager, etc. 9. Large groups of people he/she knows 10. Large groups of people he/she doesn't know - 145 -Appendix R Focus of Attention: Therapists' Ratings Verbal 1 Doesn't attempt to draw partner out or to get to know them. Speaks almost totally of self and own feelings, expriences, or, of neutral topics. Focuses on partner some of the time. Speaks of self or neutral topics about 50% of the time. Attempts to draw out partner get to know them, asks questions, makes statements display-ing interest in partner or in partner's experiences or attitudes. Nonverbal 1 2 Body is oriented away from partner. Poor eye contact. Body is somewhat oriented toward other or shifts in orientation. Makes eye contact about half the time. Body is oriented toward partner. Appropriate eye contact. May be nodding head when other speaks - 146 -Appendix S Credibility of Treatment Ratings How logical does this type of treatment seem to you? 1 2 3 4 5 6 7 8 9 10 How confident are you that this treatment will be successful in making you feel more comfortable and socially effective? 1 2 3 4 5 6 7 8 9 10 - 147 -Appendix T Evaluation of Treatment Ratings 1. How comfortable would you be in recommending this treatment to a friend who is uncomfortable in social situations? 1 2 3 4 5 6 7 8 9 10 2. How knowledgeable do you feel the group leaders were? 1 2 3 4 5 6 7 8 9 10 3. How warm/friendly do you feel the group leaders were? 1 2 3 4 5 6 7 8 9 10 - 148 -Appendix U General Rationale for Exposure Group Most shy people become anxious in social situations. This anxiety makes them self-conscious and interferes with their ability to talk and feel comfortable. Sometimes they feel they can't think or react calmly and so they don't handle the situation as well as they might. Often shy people begin to avoid social interactions to some extent. The only situations they encounter may be those that are forced on them. Unfortunately, this often means they are faced primarily with d i f f i c u l t situations which make them anxious. This treatment programme is designed to handle these problems. The f i r s t part of the programme will teach you how to deeply relax through a procedure called progressive relaxation training. Progressive relaxation involves following a series of relaxation and deep breathing exercises. It also teaches you how to quiet your mind from worries and s e l f - c r i t i c a l thoughts. With daily practice, most individuals can learn to relax more deeply than they usually do. The next part of the treatment programme involves taking a very close look at situations which produce anxiety. We will try to understand what situations are more or less d i f f i c u l t for you and to develop a plan to systematically and gradually approach these situations. This gradual approach increases your chances of remaining calm and relaxed so that you can think clearly about the interaction. If you remain calm in the situation, you break the link between the situation and anxiety. The third part of this treatment involves group discussion and support. Often shy people do not get enough support from friends for their attempts to overcome anxiety. The group can provide t h i s . Taking the opportunity to discuss your shyness with other shy people often provides new ways of looking at a problem. This group discussion also provides a place to practise talking openly and meaningfully with others. Just knowing that you are not alone makes a great diffrence to most people and can be very reassuring. - 149 -Appendix V General Rationale for SKILLS Group There's been a lot of research on shyness and social anxiety. What's been found is that most shy people become anxious in social situations. This anxiety often makes them self-conscious, that i s , they begin to focus on their own tension and their own fears about how others are responding to them. Unfortunately, this self-consciousness has several negative effects. F i r s t , i t creates even more anxiety so that the person can't think or react calmly. Second, i t interferes with their ability to pay attention to the other person, and an essential part of relating to others is this ab i l i t y to focus on the other person, to draw him out, carefully tracking what he/she is saying. Often the anxiety and self-consciousness are painful enough to cause shy people to avoid social interactions to some extent. The only situations they may encounter are those which are forced on them. Unfortunately, this often means that they are faced primarily with d i f f i c u l t situations which makes them very anxious. This group is designed to handle the problems of excessive anxiety, a lack of attention to the other person (due to self-consciousness and self-preoccupation), and avoidance of social interactions. The f i r s t part of the programme will teach you how to deeply relax through a procedure called progressive relaxation training. Progressive relaxation involves following a series of relaxation and deep breathing exercises. It also teaches you how to quiet your mind from worries and s e l f - c r i t i c i a l thoughts. With daily practice, most individuals can learn to relax more deeply than they usually do. The second thing we want to do is to discuss the behaviours or s k i l l s that help a person focus on others. Essentially what we find is that the people others like to be with are those who are genuinely interested in others. Such people focus their attention on the other person, they listen carefully to what he is saying and how he is feeling. With practice most people can learn how to communicate that they are genuinely interested in others and learn how to draw other people out and make them feel comfortable. We will be discussing how this is accomplished. By learning to focus on others, we divert our attention from our own anxiety and self-consciousness. This helps us to feel less anxious. The third part of the programme involves taking a very close - 150 -look at situations which produce anxiety. We will try to understand what situations are more or less d i f f i c u l t for you and to develop a plan to systematically and gradually approach these situations. This gradual approach increases your chances of remaining calm and relaxed so that you can think clearly about the interaction. If you can remain calm in the situation, you can use the interpersonal s k i l l s we have discussed to communicate your interest in the other person and to make him/her feel comfortable. Finally, this programme involves group discussion and support. Often shy people do not get enough support from friends for their attempts to overcome anxiety. The group can provide th i s . Taking the opportunity to discuss your shyness with other people often provides new ways of looking at a problem. This group discussion also provides a place to practise talking openly and meaningfully to others. Just knowing you are not alone makes a great difference to most people and can be very reassuring. - 151 -Appendix W Client Consent Form This project is evaluating several different treatment programmes for extreme shyness. Because this is a research project as well as a treatment programme there are several things you should know. Because we don't know at this time which treatment works best with which individuals, we are assigning people at random to a programme. You may be assigned to any of our treatment procedures. In order to determine how effective the treatments are, we will need a comparison group who do not participate in treatment. Some people will be assigned to a waiting condition. They will be asked to complete the evaluation measures, but hold off on treatment until the f i r s t group is finished. Then they will enter treatment. You may be asked to be in this waiting group. In order to evaluate the treatment, we will ask you to complete the questionnaires again after treatment. We will also talk with you to get your impressions on whether the programme made any changes in your l i f e . Part of the evaluation procedure involves participating in roleplaying to t e l l us whether our programmes are getting the important concepts across. We will ask you to complete the evaluation a third time, six weeks after treatment has ended. Of course, all information collected is kept s t r i c t l y confidential and is destroyed once the study is over. We do not talk with outsiders about the programme or it s participants. Thus, complete anonymity i s assured. It is important that you also agree to keep all information about the other people in your group completely confidential. Then we can all feel comfortable discussing our feelings openly. The programme will consist of eight sessions of 1 1/2 - 2 hours. In order to benefit from treatment we feel i t is essential that you attend all 8 sessions. However, you may withdraw at any point i f you so decide. Withdrawing from this study will have no effect on other treatment or services provided by any agency or physician. If these conditions are agreeable to you, and you wish to participate in the treatment evaluation research, please sign below. - 152 (Counsellor) (Client) (Date) - 153 -Appendix X General Rationale for SKILLS Group There's been a lot of research on shyness and social anxiety. What's been found is that most shy people become anxious in social situations. This anxiety often makes them self-conscious, that i s , they begin to focus on their own tension and their own fears about how others are responding to them. Unfortunately, this self-consciousness has several negative effects. F i r s t , i t creates even more anxiety so that the person can't think or react calmly. Second, i t interferes with their abi l i t y to pay attention to the other person, and an essential part of relating to others is this a b i l i t y to focus on the other person, to draw him out, carefully tracking what he/she is saying. Often the anxiety and self-consciousness are painful enough to cause shy people to avoid social interactions to some extent. The only situations they may encounter are those which are forced on them. Unfortunately, this often means that they are faced primarily with d i f f i c u l t situations which makes them very anxious. This group is designed to handle the problems of excessive anxiety, a lack of attention to the other person (due to self-consciousness and self-preoccupation), and avoidance of social interactions. The f i r s t part of the program will teach you how to relax deeply through a procedure called progressive relaxation training. Progressive relaxation involves following a series of relaxation and deep breathing exercises. It also teaches you how to quiet your mind from worries and s e l f - c r i t i c a l thoughts. With daily practice, most individuals can learn to relax more deeply than they usually do. The second thing we want to do is to discuss the behaviour or s k i l l s that help a person attend to and focus on others. Essentially what we find is that the people others like to be with are those who are genuinely interested in others. Such people focus their attention on the other person, they listen carefully to what he is saying and how he is feeling. With practice, most people can learn how to communicate that they are genuinely interested in others and learn how to draw other people out and make them feel comfortable. By learning to focus on others, we divert our own attention away from our anxiety. This helps us to feel less self-conscious and we don't have to worry about what to say next. We will be discussing how this is accomplished. The third part of the program involves taking a very close look at situations which produce anxiety. We will try to understand what situations are more or less d i f f i c u l t for you and to develop a plan to systematically and gradually approach these situations. This gradual approach increases your chances of - 154 -remaining calm and relaxed so that you can think clearly about the interaction. If you can remain calm in the situation, you can use the interpersonal s k i l l s we have discussed to communicate your interest in the other person and to make him/her feel comfortable. Finally, this program involves group discussion and support. Often shy people would like more support from friends for their attempts to overcome anxiety. The group can provide t h i s . Taking the opportunity to discuss your shyness with other shy people often provides new ways of looking at a problem. This group discussion also provides a place to practise talking openly and meaningfully with others. Just knowing you are not alone makes a great difference to most people and can be very reassuring. - 155 -Appendix Y General Rationale for Graduated Exposure Group There's been a lot of research on shyness and social anxiety. What's been found is that shy people don't differ all that much in what they do in social situations. But they do differ in how they experience i t and what they feel in these situations. Most of the differences are due to anxiety. Most shy people become anxious in social situations. This anxiety makes them self-conscious and interferes with their abi l i t y to talk and feel comfortable. Sometimes they feel they can't think or react calmly and so they don't handle the situation as well as they want to. Often shy people begin to avoid social interactions to some extent. The only situations they encounter may be those that are forced on them. Unfortunately, this often means that they are faced primarily with d i f f i c u l t situations which make them very anxious. This program is designed to handle these problems. The f i r s t part of the program will teach you how to deeply relax through a procedure called progressive relaxation training. Progressive relaxation involves following a series of relaxation and deep breathing exercises. It also teaches you how to quiet your mind from worries and s e l f - c r i t i c a l thoughts. With daily practice, most individuals can learn to relax more deeply than they usually do. The next part of the program involves taking a very close look at situations which produce anxiety. We will try to understand what situations are more or less d i f f i c u l t for you and to develop a plan to systematically and gradually approach these situations. This gradual approach increases your chances of remaining calm and relaxed so that you can think clearly about the interaction. If you can remain calm in the situation, you break the link between the situation and anxiety. The third part involves group discussion and support. Often shy people would like more support from friends for their attempts to overcome anxiety. The group can provide this. Taking the opportunity to discuss your shyness with other shy people often provides new ways of looking at a problem. This group discussion also provides a place to practise talking openingly and meaningfully with others. Just knowing you are not alone makes a great difference to most people and can be very reassuring. - 156 -Appendix Z Progressive Relaxation 1. Provide rationale 2. Remove constricting clothing: shoes, glasses/contacts, watches etc. 3. Go to washroom i f necessary 4. Try not to move unnecessarily 5. No talking — there will be time for questions later 6. Dimming the lights 7. Close lights **** 8. Go through procedure **** Terminating Relaxation: 9. Summarize muscle groups working up from arms and legs 10. Check for any residual tension 11. Relaxation pattern-global state, blending etc. approx 30 sec. 12. Counting up from 1 to 10 13. Silence for approx. 30 sec. to enjoy deep relaxation 14. Terminate counting from 4 to 1 15. May feel as i f you've had a brief nap Questioning: 16. Trouble relaxing any particular muscle groups (or trouble tensing) 17. Did anything I say make i t more d i f f i c u l t to relax? Home Practice: 18. Repeat learning analogy -- stress importance of practice 19. Every day, twice a day for 15 to 20 minutes 20. At least 3 hours in between periods of relaxation 21. In quiet room; on bed with pillow or large comfy chair 22. Minimal interruptions 23. Practice sessions when no time pressure 24. Suggest times for relaxation: before work, lunch, coffee breaks, before dinner, after dinner, before r e t i r i n g , etc. Misc. Stuff remember to work in breathing instrns. from chest on "ing" words for patter, noticing, focusing etc. FOUR (feet & legs) THREE (arms and hands) TWO (head & neck) ONE (open eyes) - 157 -Appendix AA Rationale for Graduated Exposure Procedure We've just gone over progressive relaxation and you're beginning to learn how to control your relaxation level. What we want to do now is closely examine the situations that produce anxiety for you and begin to systematically approach these situations while using the relaxation s k i l l s . We will begin with situations that don't produce much discomfort, and when we can comfortably deal with these, we'll go on to a situation which produces somewhat more anxiety. This procedure is referred to as graduated exposure. Shy people often become anxious in a situation even though they have the abili t y to handle i t well. This situation automatically triggers anxiety. Have you ever found this? That you know what you'd like to say but just can't get i t out because you're anxious? By remaining calm in a situation, you can break this link between the situation and your feelings of anxiety. In this way, a situation which used to produce fear and tension now becomes neutrally toned, that i s , less likely to produce automatic fear and tension. The technical term for this is counter-condi tioning. If you can remain relaxed in these situations, you will be able to think and react more clearly to the other person. Your natural s k i l l s will come through. How does this sound to you? - 158 -Appendix BB Graduated Exposure Procedure 1. F i r s t , we want to take a very close look at situations that produce anxiety. List the situations that make you anxious, (provide sheet) (after this has been done) — 2. Write down details that make the situation better or worse for you. Next, we will arrange them from least anxiety provoking to most anxiety provoking. a. F i r s t , select the situation(s) which cause the greatest anxiety. These are labelled LEVEL 100 situations. b. Second, select the situation(s) which cause the least anxiety. These are labelled LEVEL 10 situations. c. Now, go back to your situations and select one (those) which produces siightly more anxiety than the LEVEL 10 situations. You should notice a step up in anxiety from LEVEL 10 situations. These are labelled LEVEL 20. d. Now, select those which cause more anxiety than the LEVEL 20s. Choose one or more situations which represent a step upward in anxiety. These are LEVEL 30s. e. Continue this until a l l the situations are placed at some level (ensure equal distribution of situations along the entire continuum). 3. We now have a hierarchy of situations from the least anxiety provoking to the most anxiety provoking. Let's discuss our hierarchies and what we've discovered. -- What is your lowest level? — Your highest level situation? -- What do you notice about these situations? Are any themes common to them? Any people or situations that are common to them? 4. Now, begin with one of the easier situations. Choose one that you are highly likely to encounter this week. — Describe i t to the group. -- Let's practice that situation. a. Break up into twos. One of you will play the other person. Practise how you will approach the situation. Be sure to use your relaxation. b. So, f i r s t relax -- focus on your breathing. c. Think about the situation and practise handling i t . d. How did you feel? Were you relaxed? e. Now, the next person practise that situation. Rotate positions. f. Now, come back into the group and let's discuss how the practise went. 5. Try the f i r s t 2 situations this week, and, using your relaxation and focusing on breathing, remain calm in the situation and let yourself handle the interaction. - 159 -Observe what happens and let's discuss i t next week. - 160 -Potential Trouble Spots with G.E. Procedure 1. Can't come up with s i t s : try to prompt them with places; persons; a c t i v i t i e s , ect. Also helps to think of the last time they were anxious. 2. Exposes self to s i t & becomes anxious: How do you feel about the fact that this happened? Reinforce that they simply need more practice. Most important ~ help them to construct a less anxiety-provoking s i t , e.g., i f s i t was a 30, construct a 25. CAUTION: Take care not to reinforce avoidance of the s i t . i.e., not a good idea to encourage them to avoid the s i t as this simply reinforces the anxiety. 3. Forgetting homework: Here, what you want to do is find out what's going on i f this happens more than once. Then, what can we do to make i t easier for you to remember to bring with you? You may need to prompt them but the idea is to give responsibility to cl i e n t . 4. Not doing homework, i.e., exposure: Again, what's going on to account for this? e.g. disinterest, boredom, hierarchy not demanding enough, or more l i k e l y , too anx. provoking. You may need to check into each of these as client may be unwilling to provide negative feedback, e.g. bored. Also she/he may be unwilling to directly state that she/he is too anxious to expose self to situations. 5. Missed sessions: Subjects will be told and will agree to come to a l l sessions. This will occur previous to commencement of groups. It is likely that one session may be missed. Subject can catch up from: brief review at beginning of session, team up with another group member at coffee break who can " f i l l " them in; one group leader may want to spend a SHORT period of time at end of session with them. If more than one session is missed, refer to #4. 6. Listing sits that they are not likely to encounter: Therapists should remember to "check out1 each person's hierarchy in session 2 when i t is constructed. This should be done in a surrepitious manner, as you go around to each group member, i.e. this should be done on a 1:1 basis, not as a group. If you are unsure, ask them i f they feel they are likely to encounter situation in the next week or, any week. 7. "Unusual" designation of anxiety levels: Most typical case would be underestimating anxiety level of a particular situation. Here, i t would help to suggest that most other people "may see that as an 80 rather than as a 20". How do you feel about that? Try to encourage them to reconsider. It would even help to provide them with a rationale as to why you are encouraging them in this direction, e.g., we want you to be able to master a given situation and this is best done i f we ensure that you will not be overcome with anxiety at any l e v e l . This way, we "build in" success. - 161 -8. Inappropriate hierarchy: Examples we suggested last week concerned such issues or sits as marital problems; intimate relationships; serious issues with close friends, family, etc. Here, the main point is that this situation/topic is beyond the scope of this group. Be very careful about making a referral. 9. Subject is resistant/late/noncompliant: This may be one case where you want to deal with the subject on an individual basis, rather in the group. I would suggest that only one therapist talk with the subject to avoid a "two against one situation". Again, the basic questions are what's going on/what's this about? What do you think you can/should do? What can we do? Obviously, to be dealt with in a supportive, rather than confronting fashion. 10. Extremely avoidant subject: Consider cutting off the top of the hierarchy. Then construct a series of situations which are much easier to handle and e l i c i t anxiety level which is less overwhelming. This, like a l l other issues/problems, etc. is to be dealt with in a matter-of-fact manner, e.g. whenever you have a group of people, you will find that everybody goes at a different pace. It's unproductive to compare yourself with others and better to focus on your own progress. - 162 -Appendix CC Rationale for Skil l s Training Component of Condition II Now we'd like to consider the interpersonal behaviours or s k i l l s that help a person focus their attention on the other person. This will decrease your self-consciousness or preoccupation and make i t easy for others to relate to you. As we discussed, we find that the people others like to be with are those who are genuinely interested in others, who are warm and supportive to others, and who take steps to draw the other person out. This interpersonal style can be broken down into four separate components. F i r s t , such people focus their ATTENTION on the other person, rather than on themselves. They listen carefuly to what the other is saying and they communicate their interest in what he/she is saying. They'encourage others to talk. Second, such people are SENSITIVE to the feelings or emotions of the other person. They are careful to notice the other's emotional response to what's going on, and they reflect back their awareness of how the other person is feeling. Third, such people have a RESPECT for the other person's feelings and opinions, and communicate a respect for him/her as a person. They communicate in a warm, supportive fashion, not as cold, disinterested, or preoccupied. Fourth, they track the other person's comments and are sensitive to when and HOW TO TALK ABOUT THEMSELVES. They are sensitive to the balance of the interaction and know how much to talk. You'll notice that doing all of these things will help you to focus your attention on the other person and will thereby reduce your self-preoccupation. What we'd like to do is discuss each of these four factors in more detail and then give you a chance to practise these behaviours so you can see how they might be adapted to handle the situations that make you feel anxious. - 163 -Appendix DD Attending Ski l l s This involves attending to the other person. It's communicating that you are listening and have heard the other person. It involves drawing them out and encouraging them to talk. You might think that attending to another person is easy, that everyone already knows how to listen fully to what the other person is saying and notices everything happening with that person. In fact, fully attending to another is not a common behaviour. Pay attention at the next group discussion and notice how often one person doesn't really hear another; listen to how many disagreements are the result of each side not attending to the other person. There are several aspects to attending: 1. Physical attending: Physical attending means adopting a posture of involvement with the other person. This includes: facing the other squarely -- this says "I am available to you." maintaining good eye contact — looking directly at the other person. maintainng an "open" posture — not crossing arms and legs, remaining relatively relaxed. This says "I am comfortable with you." Maintaining this posture communicates that you want to interact with the person. 2. Psychological attending: Listening is the core of attending. Listening involves: Listening to the other person's verbal behaviour. The good listener not only hears the words and sentences but also listens for feelings. The good listener asks him/herself: "What is he really saying? What does she really mean? How is she feeling about that?" Listening to the other person's nonverbal behaviour. Tune into his/her facial and body expression. Is he/she relaxed or tense? Happy or sad? Angry or upset? - 164 -People communicate with their bodies and faces as well as their words. One study indicates that 70% of the message is carried by nonverbal behaviours. Notice carefully the other person's nonverbal message 3. Encouraging the other person to talk; Drawing him/her out; showing your interest in discussing the topic he/she has introduced. By encouraging the other person to talk, you are communicating that you want to hear what he/she has to say, that he/she is important. This can be done several ways: a. nonverbally: through your nods, through looking interested. b. with l i t t l e words: through saying "yes"; "mm-hmm". c. by summarizing what he has said: (paraphrasing) --through communicating what is said by repeating back a phrase or sentence telling him what you've heard. In general, all of these things encourage the other person to continue to relate to you. You show your interest by drawing the other person out by continuing to discuss the topic he/she has introduced. - 165 -Attending Level 1 The individual's nonverbal behaviours communicate l i t t l e  interest in the other person. He displays poor eye contact, fidgeting, is turned away from the other. His verbal behaviour shifts attention from the other person. He changes topics abruptly or frequently, interrupts the other person, or talks excessively about his own ideas or s e l f . Level 2 The individual attends somewhat to the other person, but his nonverbal and verbal behaviour show that he is not fully focused on the other. He may avoid eye contact somewhat, or appear tense or s t i f f . He may change topic occasionally or focus on irrelevant statements. He may display some l i t t l e words to encourage the other person to continue, but doesn't appear fully interested in the other. Level 3 The individual attends fully to the other person. His nonverbal behaviour communicates warmth and interest: good eye contact, comfortable posture, faces other squarely, attentive gestures etc. His verbal behaviour encourages the other person to continue talking. He uses l i t t l e words (umm-hmm), nods, reflection, or summarization to communicate his interest in and understanding of the other person. - 166 -Appendix EE Sensitivity (Empathy). One key element in relating to others is developing a sensitivity to the feelings, or emotions of the other person. Most people feel better understood and more comfortable when the other person conveys a concern for the sensitivity to how they are feeling. This is true in professional as well as personal situations. It is true when the other person is angry or happy. Having someone take notice of our feelings makes us feel they understand and care about us. Sensitivity involves two aspects: 1. Noticing the other person's emotions. 2. Letting them know you understand what they are feeling. * * * * 1. Noticing the other's emotional response: When you are interacting with another person, ask yourself how that person is feeling. Notice what he/she says and how he/she looks. Verbal and nonverbal behaviour. Try to get inside their world and look at the world from their frame of reference. How would you feel in that situation? 2. Letting them know you understand their feelings. Briefly reflect back (mention) the feelings you notice. For example: You're so frustrated about that. You sound somewhat sad about this. If you can't t e l l what they're feeling: You can state the matter as a question: Are you feeling frustrated about this? You can request some cl a r i f i c a t i o n : I can't t e l l exactly how you're feeling about that. It is important not to fake understanding. Genuineness is important in relating to others. People can t e l l i f you really understand them. Perhaps try, I'm not following you. What are you really saying here. It's important to learn to stay at the other person's level of emotion. If they are speaking formally, reflect back just a bit of emotion. If they are speaking very emotionally, l e t them know you realize the extent of their feelings. - 167 -Sensitivity Level 1 The verbal and behavioural expressions of the person do not  attend to or distract significantly from the other person's feelings and experiences. The person is noticeably insensitive to even the most obvious feelings of the other person. Level 2 The verbal and nonverbal expressions of the person subtract  emotion from the other person's communication. The person is somewhat aware of obvious feelings on the part of the other person, but what he says and does distort the feelings of the other or shifts attention to his own feelings and ideas. Level 3 The person responds with sensitivity to the feelings of the other person. His words and behaviours are at the same level of affect as those of the other person and encourages the other person to continue to express himself. The person accurately notices the other's feelings and communicates this to the other person. - 168 -Appendix FF Respect Interactions go better when you can communicate a respect for the other person's feelings and opinions, when you communicate that you respect him as a person. Communicating respect is especially important when disagreements occur or when the other person is angry or upset. What does i t mean to respect someone? How do you communicate respect? respect their opinion, even i f you disagree with i t . Hear i t out, acknowledge i t s ' strengths and acknowledge the other has a right to his/her beliefs. respect their feelings, even i f you disagree with them. Don't dismiss, b e l i t t l e or t e l l the other person they shouldn't feel the way they do. A person has the right to his own feelings. respect their suggestions, think about them and acknowledge their strengths, even i f you have reservations. Express doubts positively and label them as your own opinions. nonverbal signs of respect involve being warm and supportive, interested in what the other person says, rather than cold, disinterested, or preoccupied with your own emotions or thoughts. - 169 -Respect Level 1 The verbal and nonverbal behaviour of the person communicates a lack of respect for the other person. Feelings, opinions, and suggestions are ignored or dismissed without consideration. The person is cold, disinterested or preoccupied. Level 2 The verbal and nonverbal behaviour of the person communicates 1it t l e respect for the other person's feelings, opinions, and suggestions. The person may grudgingly acknowledge the other's statements, but not be warm and supportive, or note the strengths in the other's experiences or statements. Level 3 The verbal and nonverbal behaviour of the person conveys clear respect for the other person. The person tunes into the other's feelings, opinions, and suggestions and notes their positive aspects. He communicates warmth and support. Even i f he disagrees, he acknowledges the other's right to his own view of matters. - 170 -Appendix GG Self-Disclosure Its important to track the other person's comments and to be sensitive to when and how to talk about yourself. Talking about oneself is important in relating to others. This is referred to as self-disclosure. It's through mutual and self-disclosure that two people develop more personal relationships. It isn't enough to just talk about yourself when you feel like i t . One must also be sensitive to when to talk about yourself, how much to talk about yourself, and how personally to self-disclose. Let's take each of these steps. 1. What clues t e l l you when to talk about yourself?-— when there is a break in the conversation ~ when the other person looks at you or conveys interest (either directly or indirectly) in your opinion. 2. How much should one talk? ~ be sensitive to the balance of the interaction. Encourage the other person to talk at least half the time. Be careful, however, to avoid asking them a series of questions about themselves without any self-disclosure on your part. 3. How does one know how intimately to self-disclose? In general, match your level of self-disclosure to the other person's level. Unless you know the other person well, intimate self-disclosure can make them uncomfortable. However, no self-disclosure, no talking about yourself at a l l , conveys a lack of interest in others or an unwillingness to become more personally involved with the other person. The most comfortable interactions occur when two people match on self-disclosure. Track the other person's comments. Is he/she talking intimately? Superficially? - 171 -Self-Disclosure Level 1 The person either: (1) remains detached from the other person and discloses nothing at all about his own feelings or personality even when the other attempts to draw him our, or, (2) he dominates the interaction or (3) is insensitive to the balance or amount of talking or level of intimacy of the other person. Level 2 The person provides brief and superficial information about himself. The conversation i s somewhat out of balance in terms of the amount of talking both people do (one talks quite a bit more) or in terms of level of intimacy at which they are talking (one is more intimate than the other). Level 3 The person freely volunteers information about his personal ideas, attitudes, and feelings. He matches the amount and depth of self-disclosure to that of his partner. - 172 -Appendix HH Tape Content Session Condition Therapists Content: 6 five-minute segments I 2 3 4 RELXN . _ G.E. _ SKILLS OTHER Therapist: Warmth 1 2 3 4 5 Ski l l s 1 2 3 4 5 Therapist: Warmth Skills 1 2 - 3 4 5 1 2 3 4 5 - 173 -Appendix II Cell Sizes and Information Regarding Dropouts n Condition I Group I Group II Condition II Group I Group II Condition III Group I Group II Drop-Outs Condition I: Group I: Group II: Condition II: Group I: Group II: Total 9 8 TT 9 8 TT 8 10 ~IB~ Three drop outs. One due to hours of new job. One because of high anxiety level; one became involved in union strike action One drop-out and two not included in research. One not included in research as he attended only sessions One dropped out due to illness; another not included in research — subject only attended 4 sessions due to confusion/neurological problems, eight persons not included in research - 174 -Appendix JJ Procedure for G.E. Condition plus Discussion Session I introductions: therapists and then group leaders taping sessions group exercise general rationale Levinger model ratinale for relaxation demonstration relaxation f.u. to relaxation: questions, problems, etc. Homework info re: relxn rationale for graduated exposure & f.u. questions explanation for developing hierarchies pass out sheets for hierarchy info ss rate cr e d i b i l i t y of treatment leave on a positive note after subjects leave, therapists rate s k i l l — anxiety Homework — I6~muscle group relaxation work on hierarchies Session II ~ discuss relaxation homework repeat 16 gp. relaxation work on hierarchies: putting i t together practise 1st 2 sits general discussion Homework ~ IB-"mus. group relaxation 1st 2 steps on hierarchy Session III ~ discuss relaxation homework demonstrate 7 muscle group discuss g.e. homework practise next 2 sits on hierarchy general discussion Homework — 7 muscle group relaxation next 2 steps on hierarchy Session IV ~ discuss relaxation homework demonstrate 7 muscle group again discuss g.e. homework practise next 2 sit s on hierarchy general discussion - 175 -Homework ~ 7 muscle group relaxation next 2 steps on hierarchy Session V — discuss relaxation homework demonstrate 4 muscle group relaxation discuss g.e. homework practise next 2 sits on hierarchy general discussion Homework — 4 muscle group relaxation next 2 steps on hierarchy Session VI ~ discuss relaxation homework demonstrate 4 muscle group relaxation with recall discuss g.e. homework practise next 2 sits on hierarchy general discussion Homework ~ 4 muscle group next 2 sits on hierarchy Session VII — discuss relaxation homework demonstrate recall with counting procedure discuss g.e. homework practise next 2 sits on hierarchy general discussion Homework recall with counting finish hierarchy Session VIII ~ discuss relaxation homework demonstrate counting; differential relaxation discuss g.e. homework general discussion: what you've learned, how have you changed, where do you plan to go from here in terms of your shyness rate credibility of treatment closing: summary of past 7 sessions; conclude after subjects leave therapists rate anxiety and s k i l l Amount of Time to Spend on Treatment Components Introduction; review of last week's information 10 minutes Report on and discussion of homework 30 minutes Relaxation Procedures 20 minutes Practising graduated exposure situations 35 minutes General discussion 20 minutes Closing 5 minutes 120 minutes - 176 -Appendix KK Procedure for Other-Focus Condition Session I introductions: therapists and then group leaders taping sessions group exercise general rationale Levinger model rationale for relaxation demonstrate relaxation f.u. to relaxation: questions, problems, etc. Homework info re relaxation rationale for s k i l l s dimensions explanation for developing hierarchies pass out sheets for hierarchy info ss rate credibility of treatment leave on a positive note after subjects leave, therapists rate -- s k i l l -- anxiety Homework ~ HPmuscle group relaxation work on hierarchies Session II ~ discuss relaxation homework repeat 16 muscle group relaxation work on hierarchies: putting i t together demonstrate attending practise 1st 2 sits Homework — 16 muscle groups 1st 2 sit s : practise doing them and attending Session III ~ discuss relaxation homework demonstrate 7 muscle group relaxation discuss g.e. homework demonstrate sensitivity/empathy practise next 2 sits Homework 7 muscle group relaxation practise next 2 sits on hierarchy: sensitivity Session IV ~ discuss relaxation homework demonstrate 7 muscle group again discuss g.e. homework (also how did sensitivity go?) present respect dimension practice next 2 sits - 177 -Homework ~ THmuscle group practice next 2 sits with respect Session V ~ discuss relaxation homework demonstrate 4 muscle group relaxation discuss g.e. homework (with respect) present self-disclosure practise next 2 sits Homework ~ 4 muscle group practise next 2 sits with self-disclosure Session VI ~ discuss relaxation homework demonstrate 4 muscle group with recall discuss g.e. homework practise next 2 s i t s . Pull together attending, empathy, respect and self-disclosure Homework ~ 4 muscle group with recall next 2 sits on hierarchy Session VII ~ discuss relaxtion homework demonstrate recall with counting procedure discuss g.e. homework practise next 2 sits with a l l dimensions in mind (attending, etc.) Homework recall with counting next 2 sits on hierarchy Session VIII ~ discuss relaxation homework demonstrate counting; differential relaxation discuss g.e. homework general discussion: what have you learned, how have you changed, where do you plan to go from here in terms of your shyness rate cr e d i b i l i t y of treatment closing: summary of past 7 sessions; conclude after subjects leave, therapists rate anxiety and s k i l l Amount of Time to Spend on Treatment Components Introduction; review of last week's information 10 minutes Report on and discussion of homework 30 minutes Relaxation Procedures 20 minutes Practising graduated exposure situations 35 minutes Presentation of Sk i l l s 20 minutes Closing 5 minutes 120 minutes I - 178 -i Appendix LL Overview of Sessions Session Condition I Homework I Introductions-group exercise 1. 16 muscle group Overview of treatment/rationales relaxation Present Levinger model 2. I n i t i a l steps Rationale for relaxation on hierarchy Develop hierarchies Condition II Homework Introductions-group exercise 1. 16 muscle group Overview of treatment/rationales relaxation Present Levinger model 2. Ini t i a l steps Rationale for relaxation on hierarchy Demonstrate relaxation/fol1ow-up Develop hierarchies II Discuss relaxation hmwk 1. 16 muscle group ' Discuss relaxation hmwk 1. 16 muscle group Repeat 16 muscle gp. relax'n relaxation Repeat 16 muscle gp. relax'n relaxation Discuss G.E. hmwk 2. Next 2 steps Discuss G.E. hmwk 2. Next 2 steps General discussion on hierarchy Present S k i l l s : attending on hierarchy Discuss relaxation hmwk 1. 7 muscle group Discuss relaxation hmwk 1. 7 muscle group Demonstrate 7 muscle gp. relax'n relaxation Demonstrate 7 muscle gp. relax' 'n relaxation Discuss G.E. hmwk 2. Next 2 steps Discuss G.E. hmwk 2. Next 2 steps General discussion on hierarchy Present S k i l l s : sensitivity on hierarchy (empathy) Discuss relaxation hmwk 1. 7 muscle group Discuss relaxation hmwk 1. 7 muscle group Repeat 7 muscle gp. relax'n relaxation Repeat 7 muscle gp. relax'n relaxation Discuss G.E. hmwk 2. Next 2 steps Discuss G.E. hmwk 2. Next 2 steps General discussion on hierarchy Present S k i l l s : respect on hierarchy Discuss relaxation hmwk 1. 4 muscle group Demonstrate 4 muscle gp. relax'n relaxation Discuss G.E. hmwk 2. Next 2 steps General Discussion on hierarchy Discuss relaxation hmwk 1. 4 muscle group Demonstrate 4 muscle gp. relax'n relaxation Discuss G.E. hmwk 2. Next 2 steps Present S k i l l s : self-disclosure on hierarchy - 179 -Session Condition I Homework VI Discuss relaxation hmwk 1. 4 muscle group Demonstrate 4 muscle gp. & recall and recall Discuss G.E. hmwk 2. Next 2 steps General discussion on hierarchy Condition II Homework Discuss relaxation hmwk 1. 4 muscle group Demonstrate 4 muscle gp. & recall and recall Discuss G.E. hmwk 2. Next 2 steps Practise S k i l l s : pull a l l 4 on hierarchy steps together VII Discuss relaxation hmwk Demonstrate recall and counting procedure Discuss G.E. hmwk General discussion 1. Recall with counting 2. Finish hierarchy Discuss relaxation hmwk Demonstrate recall and counting procedure Discuss G.E. hmwk Present S k i l l s 1. Recall with counting 2. Finish hierarchy VIII Discuss relaxation hmwk Demonstrate counting; differential relax'n General discussion Rate credibility of treatment Summary of past 7 sessions Conclude Discuss relaxation hmwk Demonstrate counting; Discuss G.E. hmwk Rate Credibility of treatment Summary of past 7 sessions Conclude - 180 -Appendix MM Levinger's Model In order to provide a simple frame of reference, subjects in both treatment conditions were provided with Levinger's model of the development of relationships (Levinger, 1977; Levinger and Snoek, 1972; Hinde, 1979). Levinger postulates that three levels exist in a relationship (Appendix I ) . Zero Contact: At this l e v e l , two persons are unaware that each other exists. Usually, they meet by accident. Level I - Awareness: Person X becomes aware of person Y. Although an interaction has not yet occurred between them, each person may have impressions of, or limited information regarding the other. Level II - Surface Contact: X and Y interact. This can occur as a result of: a. attraction - physical or perceived similarity b. external situational pressures c. estimates of probable costs. At this l e v e l , individuals usually reveal limited information about themselves — the format is relatively superficial. Conversations might involve attitudinal comparisons as the parties assess degree of similarity between them. This level represents what we commonly label the "acquaintance" le v e l . Level III - Mutuality: The relationship at this point extends beyond one based on externally-structured roles. It is characterized by deeper and more honest exchanges and self-disclosing. At this l e v e l , a relationship can range from a basic level of mutuality to an almost total overlap, i.e., interdependence. The relationship is mutual to the extent that the partners possess shared knowledge of each other, and assume responsibility for promoting each other's outcomes. Private norms are thus developed for regulating their association, and, consequently, the relationship emerges as personal, uniquely tailored, and intimate. - 181 -Appendix NN Relaxation Procedures: 16 Muscle Groups Muscle Groups 1. Dominant lower arm: make a f i s t 2. Dominant biceps: push elbow down against floor or arm of chair 3. Nondominant lower arm: make f i s t 4. Nondominant biceps: push elbow down against floor or arm of chair 5. Upper face: l i f t eyebrows as high as possible 6. Central face: squint eyes tightly and wrinkle up nose 7. Lower face: bite teeth together and pull back corners of mouth 8. Neck: pull chin down towards chest and prevent i t from touching chest 9. Chest, shoulders, upper back: take deep breath, hold i t , at same time pull shoulder blades .together 10. Abdomen: make stomach hard 11. Dominant upper leg: tighten large muscle on top and smaller ones underneath 12. Dominant calf: pull toes upward toward head 13. Dominant lower leg: turn foot inward and curl toes at same time 14. Nondominant upper leg: tighten muscle on top and underneath 15. Nondominant calf: pull toes upward toward head 16. Nondominant lower leg: turn foot inward and curl toes at same time - 182 -7 Muscle Group Relaxation DOMINANT ARM: Make a f i s t and press the elbow in (arm should be bent). NONDOMINANT ARM: same as above. FACIAL MUSCLES: Raise eyebrows, squint eyes, wrinkle up nose, bite down, and pull corners of the mouth back NECK: Tense as in 16 group procedure CHEST, SHOULDERS, UPPER BACK, ABDOMEN: Take a deep breath, hold i t , pull shoulder blades back, and at the same time make the stomach hard DOMINANT LEG: Tense muscles of upper leg, turn foot inward, and point toes NONDOMINANT LEG: as above. - 183 -4 Muscle Group Relaxation BOTH HANDS AND ARMS: Bend at elbows, make fi s t s and either l i f t arms off floor or dig in at elbows. FACE AND NECK: Pull chin towards chest but don't touch chest. Raise eyebrows, squint eyes, wrinkle up nose, bite down, pull corners of the mouth back CHEST, SHOULDERS, BACK AND ABDOMEN: Take deep breath, hold i t , pull shoulder blades back, make stomach hard. BOTH LEGS: Tense muscles of upper leg, point toes and turn leg inward. - 184 -Appendix 00 Skills Handouts Attending Behaviours This involves communicating that you are listening and have heard the other person. It involves drawing them out and encouraging them to talk. Attending includes: a) Physical attending: Being involved with the other person in a nonverbal sense: ~ face the other squarely ~ make good eye contact ~ "open" posture -- don't cross arms and legs -- remain relatively relaxed Maintaining this posture communicates that you want to interact with the other person. b) Psychological attending: Listening is the core of attending. -- listen to the other person's verbal behaviour, i.e. listen for words ~ listen for feelings — What is he/she really saying? What does he/she really mean? — listen to the other person's nonverbal behaviour, i.e. tune into his/her facial and body expressions c) Encourage the other person to talk; draw him/her out nonverbally — with head nods, looking interested — with little words, e.g. "yes", "mm-hmm" -- summarize, paraphrase by repeating back a phrase or sentence - 185 -Sensitivity/Empathy One key element in relating to others is developing a sensitivity to the feelings, or emotions of the other person. Most people feel better understood and more comfortable when the other person conveys a concern for and sensitivity to how they are feeling. This is true whether the other feels angry or happy. Sensitivity involves two aspects: 1. Noticing the other's emotional response: When you are interacting with another person, ask yourself how that person is feeling. Try to get inside their world. How would you feel in that situation? Notice verbal and nonverbal behaviour: what they say; how they look. 2. Letting them know you understand their feelings: Briefly reflect back the feeling you notice. If you can't t e l l what they're feeling, ask a question or request some cl a r i f i c a t i o n . It is important to be genuine and to avoid faking understanding as others can t e l l i f you really understand them. Try to stay at the other person's level of emotion. - 186 -Respect Interactions go better when you communicate a respect for the other person's feelings and opinions. This conveys that you respect him/her as a person. It is important to convey respect when disagreements occur or when the other person is angry or upset. How to Communicate Respect 1. respect their opinion even i f you disagree with i t . Hear i t out, acknowledge i t s strengths. He/she has a right to their beliefs. 2. respect their feelings, even i f you disagree with them. Don't dismiss or b e l i t t l e them for the way they f e e l . 3. respect their suggestions, think about them and acknowledge their strengths, even i f you have reservations. Express doubts positively and label them as your own opinion. 4. nonverbal signs of respect involve being warm and supportive, interested in what the other person says, rather than cold, disinterested, or preoccupied with your own emotions or thoughts. - 187 -Sel f-Disciosure This involves tracking the other person's comments and being sensitive to when and how to talk about oneself. Through mutual self-disclosure two people develop more personal relationships. One must be sensitive to WHEN to talk about oneself, HOW MUCH to talk and HOW PERSONALLY to self-disclose. When to talk about yourself when there is a break in the conversation when the other person looks at you or conveys interest in your opinion How much to talk be sensitive to the balance of the interaction encourage the other to talk at least half the time but avoid asking them a series of questions about themselves without any self-disciosure on your part How intimately to self-disclose match your level of self-disclosure to the other person's le v e l . Are they speaking on an intimate or superficial level? intimate self-disclosure can make others uncomfortable unless you know them wel1. however, not talking about yourself at al l conveys an unwillingness to become more personally involved with the other person. - 188 -Appendix PP Post Assessment Interview How did you find the groups? What did you find useful: What was not useful? (Why not?) How are you feeling about your shyness now? What specific changes did you make as a result of the program? What do you plan to do about your shyness in the future? - 189 -Any additional comments or questions? - 190 -Appendix QQ Three Month Follow-up Interview 1. How have you been feeling about your shyness since the group ended? 2. Have you made any changes in your lifestyle/social l i f e since the group finished? 3. How often do you practice the -- relaxation? -- graduated exposure? — s k i l l s ? 4. Do you have future plans regarding your shyness? 5. Have you received any counselling/been in a group since the shyness group finished? If so, with whom? For what problem/purpose? 6. In retrospect, was the course useful? If so, how has i t you/your shyness? - 191 -Appendix RR Results of t Tests Performed Between  Groups Within Condition I at Pre Assessment Group I Group II (n=9) (n-8) Dependent M S.D. M S.D. t-value df P Measure BECK 12.44 4.45 11.50 6.41 .36 15 .727 SAD 22.33 4.90 21.50 4.50 .36 15 .729 TOTINT 11.44 2.79 10.75 2.12 .57 15 .576 RPSC 1.44 .53 1.75 .71 -1.02 15 .325 RPSS 1.33 .50 2.00 .93 -1.88 15 .107 TOTCOM 27.11 4.34 27.63 6.26 - .20 15 .851 TOTSKL 29.33 4.53 25.88 5.36 1.44 15 .170 TOTFRE 12.89 8.46 16.38 6.26 - .95 15 .355 TOTLON 56.00 6.52 58.25 4.83 - .80 15 .437 RPJC 1.78 .67 1.88 .99 - .24 15 .814 RPJS 2.11 1.17 2.38 .52 - .61 11.30 .557 RPCC 2.56 1.51 3.13 .64 -1.33 11.05 .325 RPCS 2.56 1.59 3.38 1.06 -1.23 15 .228 RPCGA 4.33 1.12 4.50 .93 - .33 15 .744 RPCPA 4.44 1.33 5.00 1.41 - .83 15 .418 RPTAC 3.00 .50 2.50 .54 1.99 15 .065 RPTAS 3.00 .71 3.00 .93 0.00 15 1.000 RPTBC 3.22 .83 2.88 .64 .95 15 .361 RPTBS 3.44 .53 2.88 .64 2.01 15 .063 TOTACT 14.67 9.96 17.50 12.75 - .51 15 .615 TOTCAT 3.78 2.11 4.75 1.49 -1.08 15 .295 - 192 -Results of t Tests Performed Between  Groups Within Condition I at Post-Assessment Group I Group II (n=9) (n-8) Dependent Measure M S.D. M S.D. t-value df £ BECK 6.00 4.80 7.00 4.99 - .42 15 .680 SAD 15.56 6.56 14.38 4.81 .42 15 .682 TOTINT 6.67 2.87 6.75 4.33 - .05 15 .963 RPSC 3.11 1.17 3.00 1.07 .20 15 .841 RPSS 3.00 .71 2.88 1.25 .26 15 .800 TOTCOM 34.22 4.30 31.63 4.98 1.15 15 .266 TOTSKL 33.78 4.35 34.88 5.94 - .44 15 .668 TOTFRE 20.11 9.12 21.63 7.50 - .37 15 .716 TOTLON 55.56 4.80 57.75 4.46 - .97 15 .346 RPJC 2.78 .97 2.25 1.28 .96 15 .350 RPJS 3.56 1.01 3.38 1.60 .28 15 .782 RPCC 4.22 .83 3.75 1.28 .91 15 .377 RPCS 3.78 1.20 4.25 1.49 - .72 15 .480 RPCGA 5.22 .97 5.50 1.20 - .53 15 .605 RPCPA 4.44 1.51 5.38 1.06 -1.45 14 .167 RPTAC 3.67 .71 2.63 1.19 2.23 15 .042 RPTAS 3.78 .67 3.13 1.64 1.05 9.03 .322 RPTBC 3.67 .87 2.88 1.25 1.54 15 .145 RPTBS 3.67 .87 3.25 1.49 .72 15 .485 TOTACT 17.44 10.48 21.50 8.67 - .86 15 .402 TOTCAT 5.33 1.94 6.13 .64 -1.16 9.92 .274 - 193 -Results of t Tests Performed Between Groups Within Condition II at Pre -Assessment Group I Group II (n=9) (n-8) Dependent M S.D. M S.D. t-value df £ Measure BECK 14.11 6.21 10.88 3.98 1.26 15 .227 SAD 21.67 3.81 18.00 3.93 1.95 15 .070 TOTINT 12.56 1.94 10.25 3.85 1.59 15 .133 RPSC 1.44 .73 2.75 1.04 -3.04 15 .008 RPSS 2.00 .87 2.00 .93 0.00 15 1.000 TOTCOM 25.67 4.33 30.38 2.67 -2.65 15 .018 TOTSKL 27.44 4.90 29.38 3.82 - .90 15 .384 TOTFRE 16.00 6.87 15.00 6.19 .31 15 .758 TOTLON 57.89 3.30 56.25 3.33 1.02 15 .324 RPJC 2.22 1.48 2.50 1.60 - .37 15 .716 RPJS 2.33 1.66 3.13 1.46 -1.04 15 .315 RPCC 2.11 1.27 2.88 1.36 -1.20 15 .249 RPCS 2.56 1.13 3.25 1.39 -1.14 15 .274 RPCGA 4.44 1.24 4.88 .84 - .83 15 .420 RPCPA 5.11 1.36 4.00 1.31 1.71 15 .108 RPTAC 2.56 .73 2.50 .93 .14 15 .892 RPTAS 3.33 .50 2.63 1.51 1.27 8.37 .250 RPTBC 2.33 .87 3.13 .99 -1.76 15 .099 RPTBS 3.00 .87 2.75 1.17 .51 15 .620 TOTACT 13.33 8.94 10.00 6.85 .85 15 .407 TOTCAT 4.44 2.07 4.50 1.93 - .06 15 .955 - 194 -Results of t Tests Performed Between  Groups Within Condition II at Post Assessment Group I Group II (n=9) (n-8) Dependent Measure M S.D. M S.D. t_-value df BECK 4.00 3.94 4.00 2.73 0.00 15 1.000 SAD 11.33 7.14 11.13 5.00 .07 15 .946 TOTINT 5.11 3.48 5.25 2.38 - .09 15 .926 RPSC 3.11 1.05 3.50 .76 - .86 15 .402 RPSS 3.33 .87 3.38 1.19 - .08 15 .935 TOTCOM 38.78 5.36 35.63 2.73 1.50 15 .155 TOTSKL 40.00 4.98 35.63 4.78 1.84 15 .085 TOTFRE 30.44 11.67 23.63 7.41 1.42 15 .177 TOTLON 56.22 3.27 56.38 4.14 - .08 15 .933 RPJC 3.11 1.45 3.00 .93 .19 15 .856 RPJS 3.56 1.13 3.63 1.41 - .11 15 .912 RPCC 3.44 1.24 4.50 .76 -2.09 15 .054 RPCS 4.00 1.12 4.50 .93 -1.00 15 .335 RPCGA 5.22 .97 5.00 1.31 .40 15 .694 RPCPA 4.67 .71 4.38 1.06 .67 15 .510 RPTAC 3.22 .67 3.50 .76 - .81 15 .433 RPTAS 3.56 1.01 3.86 .69 - .67 14 .512 RPTBC 4.67 .71 3.88 .99 1.91 15 .075 RPTBS 4.33 .71 3.88 .64 1.39 15 .184 TOTACT 26.67 17.84 22.13 13.88 .58 15 .571 TOTCAT 7.00 1.94 6.63 2.00 .39 15 .700 - 195 -Results of t Tests Performed Between Groups Within Condition III at Pre Assessment Group I Group II (n=9) (n=8) Dependent M S.D. M S.D. _t-value df Measure BECK 12.50 4.81 10.10 4.63 1.07 16 .299 SAD 22.75 2.92 20.10 3.54 1.70 16 .108 TOTINT 10.63 2.00 9.40 1.51 1.49 16 .157 RPSC 2.13 .99 2.40 .97 - .59 16 .561 RPSS 2.00 1.20 1.80 1.03 .38 16 .708 TOTCOM 25.75 3.78 30.20 3.49 -2.60 16 .020 TOTSKL 29.13 5.06 29.60 3.69 - .23 16 .820 TOTFRE 15.63 6.00 18.30 6.90 - .87 16 .400 TOTLON 59.75 5.29 57.20 3.82 1.19 16 .252 RPJC 2.13 1.13 2.70 1.34 - .97 16 .346 RPJS 2.63 1.51 3.00 1.16 - .60 16 .558 RPCC 2.88 1.36 3.00 1.63 - .17 16 .864 RPCS 2.88 1.36 3.10 1.52 - .33 16 .748 RPCGA 4.88 1.55 5.00 1.25 - .19 16 .852 RPCPA 5.13 1.73 5.10 1.45 .03 16 .974 TOTACT 13.63 5.26 13.20 7.79 .13 16 .897 TOTCAT 4.63 1.85 5.20 2.04 - .62 16 .545 - 196 -Results of t Tests Performed Between Groups Within Condition III at Post Assessment Group I Group II (n=9) (n-8) Dependent M S.D. M S.D. t^-value df 2 Measure BECK 10.13 4.89 9.30 6.08 .31 16 .759 SAD 21.75 3.20 20.10 5.18 .79 16 .443 TOTINT 10.50 1.77 9.60 2.50 .86 16 .404 RPSC 1.88 .84 2.90 1.10 -2.18 16 .045 RPSS 1.88 .84 2.50 1.18 -1.26 16 .224 TOTCOM 29.13 4.16 30.20 5.37 - .46 16 .648 TOTSKL 29.13 5.00 29.00 1.56 .05 16 .958 TOTFRE 14.38 5.26 21.90 6.05 -2.78 16 .014 TOTLON 58.88 3.64 57.60 3.60 .74 16 .468 RPJC 2.75 1.39 2.60 .97 .27 16 .790 RPJS 2.50 1.41 3.70 1.34 -1.84 16 .084 RPCC 3.38 1.77 3.70 1.57 - .41 16 .685 RPCS 3.25 1.58 4.00 1.49 -1.03 16 .317 RPCGA 4.75 1.04 5.40 1.08 -1.30 16 .214 RPCPA 5.13 1.25 5.30 1.34 - .28 16 .780 TOTACT 10.63 3.85 11.50 4.06 - .46 16 .649 TOTCAT 4.38 1.19 6.20 1.62 -2.66 16 .017 

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