Peter M. Miller

Development of assertive responses: Clinical, measurement and research considerations

Abstract The development of assertive responses in unassertive individuals is surveyed in terms of clinical application, measurement techniques and experimental study. Case reports indicate that assertive training is an effective technique for a large variety of disorders as it enables patients to overcome deficits in inter-personal functioning. Some of the effective elements in assertive training have been identified by using analogue research designs. In most of these investigations the major focus has been on expressing hostile feelings and thoughts. However, more efforts at instigating positive responses (clinically and experimentally) are warranted. In addition, there is a need to assess the effects on ‘clinically’ unassertive subjects of techniques in which the transfer of training is programmed rather than expected.

Effects of modeling on components of assertive behavior

Abstract Unassertive psychiatric patients matched on age, diagnosis, and self-reported assertiveness were assigned to one of three conditions, with 10 subjects in each group: (1) Modeling, (2) Practice-Control, (3) Test-Retest. All subjects were videotaped (Pre- and Post- Test) while responding to five interpersonal situations requiring assertive responses. Subjects in the modeling condition were exposed to a videotaped model (four sessions) trained to respond assertively to the same five interpersonal situations. Each modeling session was followed by one practice session to the five scenes. Practice-control subjects were given four separate practice sessions to the five scenes but no modeling. Test-retest subjects recieved neither modeling nor practice. Pre- and Post-Test responces for all subjects were rated by judges on eight behaviorally defined components of assertiveness. Analyses of variance for difference scores indicated that the Modeling group improved significantly on five of the eight components of assertiveness. No differences were found between the Practice-Control and Test-Retest groups.

Effects of social stress on operant drinking of alcoholics and social drinkers

Abstract The relationship between social stress and alcohol consumption was examined in 10 alcoholics and 10 social drinkers matched on age and education. Drinking was measured via 10 minutes of operant responding whereby lever presses earned alcohol reinforcement on an FR-50 schedule. During stress conditions, subjects were exposed to simulated interpersonal encounters requiring assertive behavior. In terms of autonomie arousal, both groups were equally stressed. The no-stress condition consisted of non-threatening discussions of pleasurable spare time activities. Alcoholics significantly increased their operant responding to obtain alcohol following stress conditions while social drinkers did not.

Effects of practice, instructions, and modeling on components of assertive behavior

Abstract Unassertive psychiatric patients matched on age, years of education, diagnosis, and self-reported assertiveness were assigned to one of five conditions, with 10 subjects in each group: (1) Test-Retest, (2) Practice-Control, (3) Instructions, (4) Modeling, (5) Modeling plus Instructions. All subjects were videotaped (Pre- and Post-Test) while responding to five interpersonal situations requiring assertive responses. Pre- and Post-Test responses for all subjects were rated independently by judges on seven verbal and non-verbal components of assertiveness. Analyses of variance for difference scores followed by multiple t-test comparisons indicated that the Modeling plus Instructions group was superior or equal to the Instructions alone or Modeling alone groups on five of the seven components. Instructions alone and Modeling alone led to greatest improvement in the remaining two components. No differences were found between the Practice-Control and Test-Retest groups on any of the seven components of assertiveness. No differences (Post-Pretest) were found among the groups on a self-report measure of assertiveness.

An experimental analysis of generalization in assertive training

Abstract Unassertive psychiatric patients matched on age, diagnosis, and self-reported assertiveness were assigned to one of five conditions, with 10 subjects in each group: Test-Retest, Practice-Control, Practice-Control with Generalization Instructions, Modeling and Instructions, Modeling and Instructions with Generalization Instructions. All subjects were videotaped (Pre- and Post-Test) while responding to ten interpersonal situations requiring assertive responses. Following the Pre-test, subjects in the experimental groups received training on five of the ten situations (training scenes). On the remaining five situations subjects received no training (generalization scenes). Results indicated that the Modeling and Instructions groups effected the greatest changes on seven of the eight components for the training scenes but on only five of the eight components for the generalization scenes. No differences were found between either of the two Practice-Control groups and the the Test-Retest group. Although transfer of training effects were obtained on the generalization scenes, these effects were minimal on an independent in vivo test of generalization. Moreover, an instructional set designed to facilitate generalization to different situations was only partially effective.

The use of behavioral contracting in the treatment of alcoholism: A case report

Behavioral contracting was applied to an alcoholic and his wife in order to change reinforcement contingencies maintaining drinking behavior. A moderate drinking pattern was established and was still being maintained after a 6-month followup. The study illustrates the values of altering social contingencies in the alcoholics environment and questions the assumption that complete abstinence is a necessary treatment goal.

Assertive behavior of alcoholics: A descriptive analysis

Alcoholic and nonalcoholic psychiatric patients were compared on self-reported assertiveness and behavioral assertiveness. In addition, the relationship between the assertiveness of alcoholics and their alcohol drinking behavior was assessed. Results indicated that, while alcoholics reported themselves to be more assertive than nonalcoholics, both groups were equally nonassertive on behavioral tests measuring negative assertion (expression of anger or irritation). However, alcoholics performed significantly better than nonalcoholics on positive assertiveness (expression of positive feelings or complimentary remarks). A negative correlation was found between negative assertiveness and alcohol consumption.

Topographical components of smoking behavior

Abstract Topographical characteristics of smoking behavior were studied using three subjects in single-case research designs. Five components of smoking topography were identified and monitored: inter-puff interval; cigarette duration; puff length; puff frequency; and percentage of tobacco burned. Following baselines, subjects were given instructions to modify inter-puff interval, cigarette duration, or both. Results showed that topographical components could be reliably monitored and were sensitive to instructional manipulation. A strong functional interrelationship among components was also observed. These findings support the use of topographical components of smoking as dependent variables. It is suggested that smoking topography be routinely assessed as part of a multiple measurement approach to the evaluation of smoking control programs. The modification of the individual topographical components is also an important step in the development of controlled smoking strategies.

Contingent reinforcement of lowered blood-alcohol levels in an outpatient chronic alcoholic.

Abstract Recently. the proposition that alcohol abuse is an operant behavior and thus functionally related to its consequences has been investigated under experimental conditions. In controlled laboratory settings, in which inpatient chronic alcoholics are allowed access to alcoholic beverages, alcohol consumption has been markedly altered via operant strategies. Monetary rewards (Cohen et al ., 1971), the opportunity to participate in an enriched environment (Cohen et al. , 1971). and visits to a girlfriend (Bigelow et al., 1973) have been used as reinforcers for decreased drinking. Other investigators (Sulzer, 1965; Miller, 1972: Hunt and Azrin, 1973) have successfully applied similar contingency management techniques to alcoholics in the natural environment. However, failure to control for the influence of extraneous therapeutic variables (e.g., attention-placebo factors, job counseling) together with reliance on self-report measures of drinking behavior seriously limit the conclusiveness of these results. Objective assessment is particularly essential with operant techniques since consequent events must be systematically scheduled upon the occurrence or non-occurrence of drinking. Documentation of drinking in the natural environment is a difficult task since the alcoholic frequently consumes alcohol when he is alone. In lieu of direct observation, blood alcohol concentrations are an obvious means of objective assessment. Such data are most conveniently obtained via breath tests similar to the ones that law enforcement officers utilize to identify intoxicated motorists. The purpose of the present study was to investigate the influence of reinforcement contingencies on lowering blood alcohol concentrations obtained in an alcoholics natural environment.

Electrical aversion therapy with alcoholics: an analogue study.

Abstract Chronic alcoholic patients matched on age, education and length of problem drinking were assigned to one of three treatment conditions, with 10 subjects in each group: (1) Electrical Aversion Conditioning (high shock paired with alcohol sips); (2) Control Conditioning (very low shock paired with alcohol sips); and (3) Group Therapy (confrontation psychotherapy). Groups 2 and 3 were included to control for possible ‘attention-placebo’ and expectancy factors involved in the conditioning procedures. Subjects in each group were given instructions designed to produce high expectancy for therapeutic success. Pre-post measures of alcohol consumption and attitudes toward alcohol were obtained using an analogue ‘taste test’ assessment procedure. No statistically significant differences in reduced alcohol consumption or attitudes toward alcohol were found among the groups. Trends in the data support the contention that effects of electrical aversion may be more related to such factors as therapeutic instructions, expectancy, specificity of the procedure or experimental demand characteristics than to conditioning factors.