Assertion training: A review of the literature

BEHAVIOR THERAPY 8, 953-971

(1977)

Assertion Training" A Review of the Literature RICHARD G . HEIMBERG, D A N I E L MONTGOMERY, CHARLES H . MADSEN,

JR., AND JUDITH S. HEIMBERG Florida State University

Assertion training has come into prominence as a clinical technique. However, research has not kept pace with its growing popularity. This review emphasizes the following areas: the concept of assertive behavior, self-report and behavioral assessment of changes in assertive behavior, clinical applications, and experimental research. Differences in the application of assertion training to normal and psychiatric populations are outlined, and future directions are discussed. Customarily, " A s s e r t i o n Training" refers to a combination of behavioral techniques employed to remediate interpersonal problems. Recently, we have witnessed a dramatic increase in assertion training, and today it might conservatively be described as a " m o v e m e n t . " Unfortunately, research has not kept pace with the growing number of enthusiastic converts, and a professional innovation is now being marketed as a panacea to an unsuspecting public. Empirical studies are needed to (a) compare the effectiveness of assertion training with other techniques currently employed in the treatment of interpersonal concerns, (b) isolate the effective components o f treatment, and (c) test treatments and components on a variety of populations and problems. Assertion training research should be designed with the objective o f enabling therapists to deliver empirically, theoretically, and ethically sound treatment programs to clients. This paper focuses on the (a) concept of assertive behavior, (b) measurement of assertive behavior, (c) applications o f assertion training to various client populations, (d) current research, and (e) directions for future research.

THE CONCEPT OF ASSERTIVE BEHAVIOR Assertive behavior, defined as "the proper expression of any emotion other than anxiety toward another person" (Wolpe, 1973, p. 81), was r e c o m m e n d e d primarily for persons suffering from interpersonal anxiety. Reprint requests should be sent to Richard G. Heimberg, Department of Psychology,

Florida State University, Tallahassee, FL 32306. 953 Copyright© 1977by Associationfor Advancementof BehaviorTherapy. All rightsof reproductionin any form reserved,

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Subsequent definitions still fail to provide precise operational definitions: "the act of declaring oneself, of stating this is who I am, what I think and feel; it characterizes an active rather than passive approach to life" (Fensterheim, 1972b, p. 161). Rimm and Masters (1974) define assertive behavior as interpersonal behavior involving the relatively direct expression of feeling in a socially appropriate manner. Popular definitions of assertive behavior have invoked the concept of "rights": "behavior which enables a person to act in his own best interests, to stand up for himself without undue anxiety, to express his honest feelings comfortably, or to exercise his own rights without denying the rights of others" (Alberti & Emmons, 1974, p. 2). Alternatively: "that type of interpersonal behavior in which a person stands up for her legitimate rights in such a way that the rights of others are not violated" (Jakubowski-Spector, 1973, p. 76). But what are the rights spoken of? From where do they come? Does everyone have the same rights? Clearly, the concept of interpersonal rights places assertive behavior within a value-oriented moralistic framework. Assertive behavior is viewed as " g o o d " because the rights of everyone concerned are protected. Nonassertive and aggressive behaviors are viewed as " b a d " because the rights of one of the involved parties are ignored or violated. Other definitions of assertive behavior stress the effects of the behavior on the environment. For example, assertive behavior may be defined as behavior that is performed in order to maximize the reinforcement value (the algebraic sum of positive and negative factors) of a social interaction f o r all p e r s o n s involved. A person might act assertively by expressing praise, warmth, or affection or by engaging in behaviors that protect him or her from manipulation by others (Hersen, Eisler, & Miller, 1973; Hewes, 1975; Lazarus, 1971, 1973). However, the process of matching appropriate assertive behaviors to problematic situations often poses difficulties for clients and trainers Mike. With Goldfried and D'Zurilla (1969) and Goldfried and Goldfried (1975) we suggest that assertive behavior be conceptualized as "effective social problem solving" and that the thrust of assertion training be directed toward helping clients select the most "effective response" from their available alternatives. ASSESSMENT IN ASSERTION TRAINING Great emphasis has been placed on the development of self-report inventories of "assertiveness." The 11 inventories developed vary greatly in the amount of effort devoted to validation: the Wolpe-Lazarus Assertiveness Schedule (Wolpe & Lazarus, 1966), the Lazarus Assertive Inventory (Lazarus, 1971), the Rathus Assertiveness Schedule (Rathus, 1973b),

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the Conflict Resolution Inventory (McFall & Lillesand, 1971), the College Self-Expression Inventory (Galassi, DeLo, Galassi, & Bastien, 1974), the Adult Self-Expression Scale (Gay, Hollandsworth, & Galassi, 1975), the Constriction Scales (Bates & Zimmerman, 1971), the Assertive Inventory (Gambrill & Richey, 1975), the Lawrence Assertive Inventory (Lawrence, 1970), the Action Situation Inventory (Friedman, 1969), and the Interpersonal Situation Inventory (Goldsmith & McFall, 1975). Several behavioral measures assess changes in assertive behavior in analog social situations (Eisler, Miller, & Hersen, 1973; Goldstein, Martens, Huben, Van Belle, Schaaf, Wiersma, & Goedhard, 1973; Goldsmith & McFall, 1975; McFall & Marston, 1970; Wagner, 1968a, 1968b; Weinman, Gelbart, Wallace, & Post. 1972). Generally, a subject is presented with an introductory narrative, a prompt from a role-playing antagonist, and a signal that he should respond. Responses are then recorded on audio- or videotape and rated retrospectively. Interrater reliability is generally .90 or higher and equal to that of live ratings (Eisler, Hersen, & Agras, 1973). One such instrument, the Behavioral Assertiveness Test (Eisler, Miller, & Hersen, 1973), was administered to male psychiatric patients who also completed the Wolpe-Lazarus Assertiveness Schedule. Ratings of videotaped responses were made of several behaviors thought to be related to judgments of assertiveness: (a) duration of looking at the antagonist, (b) frequency of smiles, (c) duration of reply, (d) latency of response, (e) loudness of speech, (f) fluency of speech, (g) compliance, (h) requests for a change of behavior on the part of the antagonist, (i) affect, and (j) a rating of overall assertiveness. Subjects were then divided into High Assertiveness and Low Assertiveness groups on the basis of overall ratings. The two groups differed on five behavioral measures (latency of response, loudness of speech, compliance, requests for new behavior, and affect) and on Wolpe-Lazarus scores. The remaining behavioral measures failed to discriminate between groups, but have been successfully employed in other studies (Eisler, Hersen, Miller, & Blanchard, 1975: Hersen, Eisler, & Miller, 1974). This viable operational definition of assertive behavior has served as the basis for several research studies, but the small size of the sample and the lack of crossvalidation limit the generalizability of these findings. Several investigators have employed interactions with confederates to assess behavior change. Conversations with a friend of the experimenter (Bander, Steinke, Allen, & Mosher, 1975), simulated social situations (Curran, 1975; Curran & Gilbert, 1975), and conversations with strangers (Goldsmith & McFall, 1975: Gutride, Goldstein, & Hunter, 1973) have been used with a variety of populations. Observations of verbal and nonverbal behaviors are generally conducted in addition to global ratings

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of anxiety or skill. Subjects have been prepared for the interaction by some experimenters (e.g., Curran, 1975) and not prepared by others (e.g., Gutride et al., 1973). Behavioral measures have been devised to assess generalization. The most frequent approach has been to measure changes on items not included in training. A behavioral role-playing test is administered pretreatment, training proceeds on half of the items, and the role-playing test is readministered. Performance on the "untrained" scenes yields an analog measure of generalization (Goldsmith & McFall, 1975: Hersen et al., 1974; Kazdin, 1974; McFall & Lillesand, 1971; Young, Rimm, & Kennedy, 1973). A different method has been used to assess withinsubject generalization. The subject responds to a series of antagonists not involved in prior training (Edelstein & Eisler, 1976). Deception has been widely employed in the assessment of generalization. One method involves a telephone call placed to subjects' homes from a "magazine salesman," " b o o k club representative," or "volunteer worker" who makes unreasonable requests of the subjects (Kazdin, 1974; McFall & Lillesand, 1971; McFall & Marston, 1970). Subjects' responses are tape-recorded and rated. Although results with the telepone call were originally thought to be promising, additional research findings have been generally nonsignificant. Another measure of generalization involved the analysis of psychiatric patients' responses to being underpaid for research participation (Hersen et al., 1974). A similar manipulation employed experimental credit with college students (Friedman, 1969). Ethical considerations concerning deception render such manipulations inadvisable for inclusion in future research. McFall and Twentyman (1973) propose that researchers inform subjects that they will be observed unobtrusively during or after treatment, without specifying the precise time or place. Subjects may consent to be observed without that precise knowledge. Many self-report instruments have been developed. Whereas testretest reliability, concurrent validity, and construct validity have been reported for most self-report measures, such data have rarely been reported for behavioral measures. Although items on some self-report inventories have been empirically determined, others have simply been drawn from existing sources (e.g,, the Wolpe-Lazarus Assertiveness Schedule). Primary criteria for inclusion were face validity and appeal to authority. Item analyses have been reported for only one instrument (Rathus, 1973b). Many inventories contain redundant, irrelevant, or unnecessary items. The roles of response set, social desirability, etc. have yet to be evaluated. Similar criticisms apply to the behavioral measures. Excepting those developed by McFall and his colleagues (Goldsmith & McFall, 1975; McFall & Lillesand, 1971; McFall & Marston, 1970: McFall & Twenty-

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man, 1973; Twentyman & McFall, 1975), most are elaborated versions of items from self-report inventories. Little effort has been made to assess differences among situations in discriminative power. Considering the situation-specific nature of social behavior (Hersen & Bellack, 1977), subjects should not be expected to have equal difficulty in all situations. Furthermore, performance on behavioral tests has not been shown to relate systematically to behavior in the natural environment. Additional areas of importance concern the development of in vivo measures of treatment effects and measures of generalization that avoid the ethical issue of deception. Added effort should be made to specify the partictdar behavioral changes to be accomplished, the environments in which new behaviors are to occur, and the stimulus persons with whom subjects and clients will interact. CLINICAL APPLICATIONS OF ASSERTION TRAINING Assertion training has focused on the treatment of interpersonal anxiety. Some report assertion training as part of the treatment of pervasive anxiety (Cautela, 1966); others have achieved short-term success as part of a broader behavioral program (Balson, 1971; Goldstein, 1971; Katz, 1971; Piaget & Lazarus, 1969). Obsessive-compulsive disorders. Obsessive-compulsive disorders have been treated by the use of graded tasks (Walton & Mather, 1963), while chronic crying (Rimm, 1967) and psychophysiological disorders (Barnard, Flesher, & Steinbrook, 1966; MacPherson, 1972) have been eliminated with treatments involving behavior rehearsal. Chronic alcoholism has responded to a treatment involving focused instructions and feedback, although follow-up indicated a return to previous patterns (Eisler, Hersen, & Miller, 1974). Maladaptive interpersonal behaviors. Maladaptive interpersonal behaviors have been successfully treated with assertion training. Pedophilia and homosexuality have been treated by programs focusing on nonsexual anxieties (Edwards, 1972; Stevenson & Wolpe, 1960) and heterosexual anxiety has been treated with graded approach (Burgess, 1969), behavior rehearsal and modeling (D'Zurilla, 1969; Geisinger, 1969; Neuman, 1969). Marital and family crises have been similarly treated (Eisler & Hersen, 1973; Fensterheim, 1972a). Aggressive and explosive behaviors. Aggressive and explosive behaviors have been successfully treated by behavior rehearsal and contingency contracting (Wallace, Teigen, Liberman, & Baker, 1973); instructions and feedback (Eisler, Hersen, & Miller, 1974); modeling, instructions, and response practice (Foy, Eisler, & Pinkston, 1975); and rehearsal, modeling, instructions, and feedback (Frederiksen, Jenkins, Foy, & Eisler, 1976).

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Chronic psychiatric patients. Chronic psychiatric patients have been taught necessary skills for independent functioning through behavior rehearsal (Bloomfield, 1973; Nydegger, 1972; Serber, 1972) and modeling, instructions, and feedback (Edelstein & Eisler, 1976; Hersen, Turner, Edelstein, & Pinkston, 1975). Follow-ups of up to 2.5 years have indicated satisfactory adjustment (Nydegger, 1972). EXPERIMENTAL INVESTIGATIONS OF ASSERTION TRAINING Experimental studies have been concentrated in three areas: (a) analog investigations designed to assess the effectiveness of assertion training or isolate the principal effective components, (b) demonstrations of the effectiveness of group assertion training, and (c) studies comparing the effectiveness of assertion training to that of other behavior therapy methods. The principal target behaviors have been assertive behavior, general social skills, and heterosexual anxiety.

Analog Investigations College students. McFall and Marston (1970) compared a semiautomated behavior rehearsal procedure, with or without performance feedback, to placebo therapy and assessment-control conditions. Self-report and behavioral measures, pulse rate, and a telephone call from a "magazine salesman" indicated the superiority of behavior rehearsal. Performance feedback tended to add to the effectiveness of the rehearsal procedure. Overt rehearsal, modeling, and coaching were compared with covert rehearsal, modeling, and coaching and an assessment control (McFall & Lillesand, 1971). Treatment groups proved superior to the control group on self-report and behavioral measures. Covert rehearsal tended to be superior to overt rehearsal, but no differences were found in a subsequent study (McFall & Twentyman, 1973). McFall and Twentyman (1973) also compared various combinations of covert rehearsal, modeling, and coaching. Subjects receiving covert rehearsal plus coaching showed greater improvement than other subjects while modeling did not produce additional effects. Three other studies have been reported comparing the effectiveness of various techniques in the treatment of nonassertive college students. Young et al. (1973) investigated the effectiveness of modeling and modeling plus verbal reinforcement. Subjects in both modeling groups were superior to those in two control conditions in response to trained situations. The modeling-only group surpassed the no-treatment group in generalization to untrained situations while the modeling plus reinforcement group did not. Self-report measures also yielded mixed results. Reinforcement did not appear to add to the effectiveness of modeling in

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this study. However, the reinforcement procedures were general and poorly specified. Subjects were neither given instruction concerning the responses to be imitated nor were they informed which aspects of their own responses earned praise. Covert modeling (imagined scenes in which the model behaves assertively) and covert modeling plus model reinforcement (imagined model's behavior results in favorable consequences) have resulted in significant improvement while control conditions produced little change (Kazdin, 1974). The modeling plus model reinforcement subjects showed greater assertiveness at post-test and follow-up than the modeling without model reinforcement subjects. The additive effects of modeling and role-playing on nonassertive behavior have been investigated (Friedman, 1969). Modeling and/or roleplaying subjects performed more assertively on a behavioral test than subjects who received "nonassertive" readings. The combination of modeling and role-playing was superior to all other treatments except unstructured role-playing. Self-report measures did not discriminate between groups. Psychiatric patients. Analog studies have been employed using psychiatric patients as subjects (Eisler, Hersen, & Miller, 1973; Hersen, Eisler, Miller, Johnson, & Pinkston, 1973; Hersen et al., 1974). Eisler, Hersen, and Miller (1973) compared a modeling treatment (exposure to a videotaped model followed by response practice) to response practice alone and no treatment. Modeling was found to be more effective than the control conditions in modifying several behavioral components of assertiveness. Modeling subjects spoke longer, louder, and with more affect, requested more new behaviors, and were rated as more assertive on the Behavioral Assertiveness Test (Eisler, Miller, & Hersen, 1973) than control subjects. Contrary to the findings of McFall and Marston (1970) with college students, response practice (behavior rehearsal without performance feedback) was not sufficient to induce behavior change. A second investigation (Hersen, Eisler, Miller, Johnson, & Pinkston, 1973) compared modeling, focused instructions, and the combined treatment with two control conditions. All treatment groups performed better than controls at post-test, and modeling plus instructions subjects were superior on ratings of five of seven behavioral components of assertiveness. These results are supported by controlled case studies (Edelstein & Eisler, 1976; Foy et al., 1975) that found modeling and instructions superior to modeling alone for modifying withdrawn or aggressive behavior in psychiatric patients. Prior results were substantiated in that practice alone was not sufficient to produce behavioral changes (Eisler, Hersen, & Miller, 1973). There was no difference between groups in self-reported assertiveness. Special instructions for generalization (i.e., application of new learning to untrained scenes and daily life) have been added to the

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modeling plus focused instructions treatment package but did not increase its effectiveness (Hersen et al., 1974). Goldstein et al. (1973) investigated the effects of modeling on "independent" behavior. An initial study compared "independence" modeling to "dependence" modeling and a no-modeling control. Independence modeling increased independent responding for all subjects, while dependence modeling increased dependent responding for females only. These investigators also found no difference between modeling, instructions, or the combination in producing behavior change. This finding contradicts that of Hersen, Eisler, Miller, Johnson, and Pinkston (1973) who found modeling and instructions to be superior. Differences in findings are difficult to interpret because of variations in experimental procedure. Hersen, Eisler, Miller, Johnson, and Pinkston (1973) employed models presented on videotape rather than audiotape, had more treatment sessions, and assessed more behaviors. The combination of modeling, focused instructions, and response practice appears to have excellent treatment potential. An interpersonal skills training program (behavior rehearsal, modeling, coaching, recorded response playback, and corrective feedback) has been compared to control groups in the modification of inadequate social behavior in psychiatric patients (Goldsmith & McFall, 1975). Training focused on the development of many different classes of social behavior including the initiation of conversations, self-disclosure, and coping with rejection. After three 1-hr training sessions, skill-training subjects performed significantly better on a series of self-report and behavioral measures. An 8-month follow-up indicated a trend toward reduced recidivism in the skill-training group, Two studies investigated the effects of various techniques on the abilities of psychiatric patients to express anger. Two types of behavior rehearsal were compared with a neutral roleplay condition (Wagner, 1968b). In one treatment group, anger expression was reinforced by submissive responses emitted by a roleplaying confederate. In the other, anger expression was punished by verbal retaliation. The behavior rehearsal plus reinforcement subjects increased in their expression of anger as measured by a behavioral test while the other groups did not. Wagner (1968a) also compared behavior rehearsal (with or without therapistadministered reinforcement) to an assessment-control group. Both rehearsal groups showed increases in anger expression but they did not differ from each other. However, the practice of training subjects to express a greater intensity of anger is ethically questionable unless such training also includes methods of coping with this intensity and/or other interpersonal skills such as negotiation. Although studies differ in the measurements employed, the design, and

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the amount of treatment administered, general conclusions can be drawn: With college students, almost any training procedure has produced marked behavioral changes when compared to placebo or no-treatment controls; self-report measures have demonstrated less change, probably due to the limited amount of treatment administered in analog studies; and behavior rehearsal, coaching, and modeling have been the most effective components, Modeling adds little to the effectiveness of the combination of behavior rehearsal and coaching (McFall & Twentyman, 1973), but it has been shown to be an effective independent treatment (Kazdin, 1974; Young et al., 1973). Studies with psychiatric patients support these main conclusions, but there have been differences concerning modeling and behavior rehearsal. Modeling has been found to be instrumental in producing behavior change in psychiatric patients, and the combination of modeling, focused instructions, and response practice would appear to be the most powerful with this population. Rehearsal alone was not sufficient to produce behavior change in several investigations (Eisler, Hersen, & Miller, 1973; Hersen, Eisler, Miller, Johnson, & Pinkston, 1973; Hersen et al., 1974), while it was sufficient to do so with college students (McFall & Marston, 1970). The differences in the results of studies with these two populations may be a result of their respective levels of functioning. College students may possess the requisite skills to call upon several response alternatives in a given situation. Thus, behavior rehearsal and coaching may be all that is necessary to induce behavioral changes. Psychiatric patients (whose behavioral repertoires are poorly developed or have been placed on "institutional" extinction) may not possess this skill. Therefore, modeling would assume a more central role, and simple response practice would be less effective when employed in isolation.

Investigations of Assertion Training in Groups Lomont, Gilner, Spector, and Skinner (1969) compared an assertion training group to an insight therapy group. Subjects were given 45 hr of treatment by experienced therapists. While no self-report or behavioral measures of assertiveness were employed, assertion training subjects showed a greater decrease in the sum of MMPI clinical scales than did subjects receiving insight therapy. Group assertion training has also been compared with relationship therapy on self-reported assertiveness, selfacceptance, and anxiety (Percell, Berwick, & Biegels, 1974). Following eight sessions, assertion training subjects reported greater increases in assertiveness and self-acceptance and a greater decrease in anxiety than relationship-therapy subjects. Group assertion training has also been applied to the treatment of inappropriate expression of anger (Rimm, Hill, Brown, & Stuart, 1974).

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Thirteen male volunteers were treated in an assertion training group or a placebo therapy group. Assertion training consisted of behavior rehearsal, modeling, and feedback concerning eight potentially anger-provoking situations. After treatment, assertion training subjects rated themselves as less "uptight" and angry than did control subjects. They were rated by observers as more comfortable and assertive than controls. Self-report measures showed no difference between groups. The preceding studies were conducted with only one group per treatment condition. This confounds therapist or group composition variables with treatment effects and makes the interpretation of results hazardous. The following studies employed multiple groups per treatment which diminishes the chances for confounding. However, few studies to date have utilized statistical designs that can safely partition error variance due to differences among groups within conditions. A group assertion training procedure using behavior rehearsal, videotaped modeling, videotaped feedback, group and trainer feedback, bibliotherapy, and homework assignments was compared to an attention control procedure (Galassi, Galassi, & Litz, 1974). Assertion training subjects were superior to controls on several self-report and behavioral measures. Gains were maintained at a 1-yr follow-up (Galassi, Kosta, & Galassi, 1975). There were two groups per condition. One assertion training group and one control group were pretested; other groups were evaluated only at post-test. On the behavioral measures, several differences between groups within conditions were apparent, presumably due to pretesting effects. Two studies investigating the effectiveness of group assertion training with female college students have been conducted (Rathus, 1972, 1973a). In each, nine groups received assertion training, discussion, or no treatment. In the first experiment (Rathus, 1972), assertion training subjects reported a greater increase in assertive behavior and a greater decrease in general fear than no-treatment subjects. The second (Rathus, 1973a) evaluated an assertion training program that included the use of videotaped assertive models and directed response practice. Assertion training subjects improved significantly in self-reported assertiveness over the course of treatment while other subjects did not change. These results are difficult to interpret. Behavioral measures were not employed, and the author was the therapist for all groups. Groups were composed of females selected from the author's classes. Structured Learning Therapy (SLT) (Goldstein, 1973) consists of a combination of videotaped modeling, role-playing, and social reinforcement and has been applied to the treatment of interpersonal deficits in psychiatric patients. One study investigated the role of SLT, group psychotherapy, and patient status (chronic vs acute) in the development

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of several social bebaviors (Gutride et al., 1973). Subjects met in groups of five to eight, three times weekly for 4 weeks. During treatment, one-half of the subjects also participated in dynamic group psychotherapy. A comprehensive series of self-report and behavioral measures indicated that: (a) SLT resulted in an increase in a wide range of social behaviors, (b) SLT plus group therapy was less effective than SLT alone, and (c) patients of acute status showed greater improvement than chronic patients. Transfer training (onsite reminders and social reinforcement for appropriate behaviors during ward meals) has been shown to add to the effectiveness of SLT (Gutride, Goldstein, Hunter, Carrol, Clark, Furia, & Lower, 1974). Most investigations of group assertion training suffer from methodological problems. Some employed only one group per condition (Lomont et al., 1969; Percell et al., 1974; Rimm et al., 1974), while others utilized a single therapist in all conditions (Rathus, 1972, 1973a). As with analog studies, group assertion training has generally been found to be superior to no treatment (Gutride et al., 1974; Rathus, 1973a), but comparisons to discussion or placebo treatments are less clear. There is insufficient evidence to substantiate the therapeutic claims of the popular assertion literature.

Comparative Studies Lazarus (1966) compared behavior rehearsal, nondirective therapy, and advice giving in the treatment of 75 clients with interpersonal problems. Of the behavior rehearsal clients, 86.5% were improved after treatment as compared to 44% of clients receiving nondirective therapy and 32% of clients given advice. Twenty-seven unimproved clients from the nondirective therapy or advice conditions then received behavior rehearsal; 81% were subsequently rated as improved. Lazarus was the therapist for all clients and made all ratings of improvement. Assertion training and systematic desensitization were compared in the treatment of interpersonal and phobic disorders in chronic schizophrenics (Serber & Nelson, 1971). Neither treatment, alone or in combination, was effective in producing behavioral changes. A treatment labeled socioenvironmental therapy (SET) was compared to systematic desensitization and relaxation training in the modification of nonassertive behavior and social anxiety in chronic schizophrenics (Weinman et al., 1972). SET consisted of weekly group activities, informal social gatherings, and staff-delivered prompts to encourage social interaction. Older subjects receiving SET showed the greatest increase in assertiveness on a behavioral test while no change was demonstrated for younger subjects. Group behavior rehearsal (with modeling and feedback) was compared with Mainord's (1973) Social Learning Therapy and a placebo treatment

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(Hedquist & Weinhold, 1970). After 6 weeks of treatment, subjects in both treatment conditions reported more occurrences of assertive behavior in their daily lives than control subjects, but this difference was no longer significant at a 6-week follow-up. This and other comparative studies provide little additional evidence for the effectiveness of assertion techniques.

Assertion Training and Heterosocial Problems Martinson and Zerface (1970) found a program of semistructured interactions with female volunteers to be more effective than individual counseling or no treatment in reducing fears of dating and increasing dating frequency. Additional investigations have indicated that a "practice dating" procedure in which randomly paired dating partners exchanged feedback about each other's behavior was effective in producing similar effects (Christensen & Arkowitz, 1974; Christensen, Arkowitz, & Anderson, 1975). Social skills training seems to be an effective method for the treatment of dating problems (Bander et al., 1975; MacDonald, Lindquist, Kramer, McGrath, & Rhyne, 1975; Twentyman & McFall, 1975). A program of behavior rehearsal, modeling, and coaching was compared to an assessment control (Twentyman & McFall, 1975). At post-test, treatment subjects reported less avoidance of heterosocial situations and a greater increase in frequency and duration of interaction with females than control subjects. They were also rated as more skillful and showed less reactivity of pulse rate during a behavioral test. Subjects treated by group behavior rehearsal were rated superior to control subjects in dating skill (MacDonald et al., 1975), and behavioral counseling (rehearsal, feedback, and information counseling) was superior to two control conditions in the reduction of self-reported dating anxiety (Bander et al., 1975). In the latter study, the addition of systematic desensitization did not increase the effectiveness of the behavioral treatment package. A program of instructions, behavior rehearsal, and feedback was compared to systematic desensitization, relaxation training, and no treatment in the group treatment of dating anxiety (Curran, 1975). Skill training and desensitization produced increases in ratings of skill and decreases in ratings of anxiety in a simulated dating interaction. Curran and Gilbert (1975) later compared a skill-training program to desensitization and a minimal-contact control. Both treatments resulted in greater reductions in self- and other-rated anxiety than the control condition but did not differ from each other. Skill training produced greater improvements in rated social skill than all other treatments. Treatments consisting of modeling, rehearsal, and self-observation (videotape playback) have been found to be more effective than modeling

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plus role-playing, modeling alone, or control conditions in the modification of minimal dating behavior (Melnick, 1973). Self-observation subjects were rated as being more appropriate, more pleasant, and less anxious and as displaying more "masculine assertiveness" than control subjects in response to analog behavioral tests. Differences between treatments including self-observation and those without self-observation were less marked, and no difference was found among groups for self-reported anxiety or dating frequency. Results of studies which apply assertion techniques to the modification of heterosocial behavior in college males parallel those of investigations concerned with the modification of nonassertive behavior. Assertion techniques have been found to be more effective than individual counseling (Martinson & Zerface, 1970), placebo treatment (Bander et al., 1975; MacDonald et al., 1975), and no treatment (Twentyman & McFall, 1975). With one exception, assertion training and systematic desensitization have been equally effective in increasing dating skills (Curran, 1975; Curran & Gilbert, 1975). For a more detailed analysis of attempts to modify heterosocial behavior, see Curran, 1977. SUMMARY AND CRITIQUE OF EXPERIMENTAL RESEARCH (1) With all populations investigated to date, assertion training has produced behavioral changes superior to those produced by placebo or no-treatment conditions. (2) Self-reports of anxiety and assertiveness have not been consistently modified by treatment manipulations, particularly in analog studies in which the amount of treatment has been extremely limited. (3) Behavior rehearsal, coaching, and modeling have been found to be effective techniques with college populations. However, there is some question of a "ceiling effect." Modeling did not add to the effectiveness of behavior rehearsal and coaching in one study (McFall & Twentyman, 1973) but has been effective as a primary treatment (Kazdin, 1974; Young et al., 1973). (4) Comparisons of overt and covert rehearsal suggest that both may effect significant changes in the assertive behavior of college students (McFall & Lillesand, 1971; McFall & Twentyman, 1973). (5) Response rehearsal alone has not proven sufficient to modify nonassertive behavior in psychiatric patients (Eisler, Hersen, & Miller, 1973) although it has been effective with college students (McFall & Marston, 1970). (6) The combination of modeling, focused instructions, and response practice appears to be an effective treatment for nonassertive behavior in psychiatric patients. In all clinical and experimental studies reported (Edelstein & Eisler, 1976: Foy et al., 1975: Goldstein et al., 1973: Hersen,

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Eisler, Miller, Johnson, & Pinkston, 1973), this treatment package has produced behavioral changes superior to baseline or no-treatment conditions. With one exception (Goldstein et al., 1973), the package has produced results superior to other treatments. (7) Group assertion training requires further validation. Methodological problems have hampered adequate assessment. (8) Comparisons between assertion training and other therapy techniques have revealed little difference in treatment effectiveness. Lazarus and Serber (1968) have indicated that systematic desensitization and other techniques are less appropriate for the treatment of interpersonal concerns than assertion training, but this statement has yet to receive empirical support. Several methodological problems remain to be corrected before further research can accurately answer pressing questions. Problems are evident in the areas of treatment specification, subject selection, experimental control, and statistical design. Treatments have been designed on the basis of a priori judgments of what is important. It has been the exception for an experimenter to conduct necessary preliminary studies to validate a treatment program. Situations selected for treatment intervention have not been given sufficient emphasis. Goldsmith and McFall (1975) conducted interviews with psychiatric patients in an effort to compile a list of relevant situations for their training program, and Twentyman and McFall (1975) interviewed college females to determine the relevant behaviors for inclusion in their treatment of shy males. Without such preliminary work, negative results may just as validly be attributed to irrelevant content as ineffective treatment. Short treatments generally produce small changes, and analog measures (particularly self-report) may not be sufficiently sensitive to detect these changes. Valid treatments might be discarded because the effects of their abbreviated administration are too small to be detected. Maintenance of behavioral change has not received adequate attention. Of the studies reviewed, 55% report no follow-up data, and an additional 26% report follow-ups of less than 1 month. A small change in behavior can be of vast importance in analog research, but, without follow-up assessment, the interest in such demonstrations is academic. Subject selection procedures have varied widely, and this variation may have contributed to discrepant findings. Behavioral pretesting as a means of subject selection has been underutilized, and insufficient attention has been paid to the selection of subjects who closely approximate the clinical population of interest. Differential screening criteria make comparisons of results dubious. For instance, in one study of heterosocial behavior (Melnick, 1973), subjects were accepted if they dated less than t w i c e a w e e k or dated m o r e often but felt uncomfortable. In another investigation

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(Twentyman & McFall, 1975), only subjects reporting less than o n e date in the p r e v i o u s m o n t h plus a score of I S D below the mean on a survey of heterosocial avoidance were included. Several studies have used only one group per treatment condition. A partial solution has been to employ multiple groups per condition. While this reduces the probability of contamination, subjects' scores have been analyzed individually, and all variance in scores has been attributed to treatment effects. Variance due to group composition and therapist variables have been combined with between-groups variance, yielding a spuriously powerful F test. Myers (1972) proposes that subjects' scores be analyzed within a hierarchically designed analysis of variance. This separates error variance due to subject and group variation and allows a test for the significance of groups-within-treatment effects. Should this F be nonsignificant at an appropriate level (Myers, 1972, suggests .25), the error terms can be pooled, thus permitting the more powerful analysis of individual subjects' scores to be completed. If the F is significant, the groups error term can be used in the analysis of variance, yielding a weaker but more precise analysis of treatment effects.

FUTURE DIRECTIONS A potentially fruitful area of research is the empirical evaluation of effectiveness with diverse groups and under diverse circumstances. The possibility of "booster" sessions should be investigated, and the "ideal" number of sessions for group treatment for specific problems empirically determined. Relative effectiveness and economy of group and individual approaches to assertion training need to be assessed. These techniques have been applied less often to nonclinical groups who are lacking in particular interpersonal skills (a notable exception is the recent upsurge of assertion training groups for women; JakubowskiSpector, 1973). Particular groups who find themselves quickly thrust into new life situations could be taught the skills necessary to make the transition smoothly (elderly persons, the recently divorced, prison inmates preparing to reenter mainstream society, and so forth). There has not been much investigation of the impact of assertion training on others. For example, Eisler, Miller, Hersen, and Alford (1974) found positive changes in wives' behavior after their husbands received assertion training, but we do not know when or what changes will occur most often as a result of assertion training. Until such data are available, assertion trainers should consider the broad context of their clients' social systems in the development of treatment strategies.

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