- Email: [email protected]
Information and opinions about behavior modification
J. Behav. Ther.&I?.xp. Psychiat. Rinted in Great Britain.
Vol. 12, No. 3, pp. 1894%.
1981.
00057908/81/03018948 0 1981 Pa8amon
SOZ.CWO Press Ltd.
INFORMATION AND OPINIONS ABOUT BEHAVIOR MODIFICATION LARRY D. YOUNG Section on Medical Psychology, Bowman Gray School of Medicine
and JANA N. PATTERSON Department of Psychology, University of Mississippi Summary-Previous research ha8 suggested that the general population views behavior modification as an “appropriate” therapy for certain problems but it has not assured that these attitudes are based on an accurate conceptualization of behavior modification. In the present investigation, students and non-psychology faculty were assessed regarding their knowledge about and their attitudes toward several aspects of behavior modification. Attitudes toward behavior modification generally were favorable. Although greater knowledge as measured by a very simple task was associated with more favorable attitudes toward behavior modification, the overall level of information was very low. The significance of positive attitudes based on distorted information was discussed and concern8 for behavioral clinician8 were highlighted.
The history of behavior modification has been puncuated with controversy regarding the morality and ethics of employing behavior change technology. Although A Clockwork Orange (Burgess, 1963) and similar fictional works presented behavior modification in a negative light, many behavior therapists have voiced greater concern over its negative portrayal in the news media (cf., Bandura, 1975; Franks and Wilson, 1975). Turkat and Feuerstein (1978) surveyed The New York Times for a period of over 4 yr and found that half of the articles discussing behavior modification contained substantial misinformation (e.g. identification of brainwashing or psychosurgery with behavior modification). Woolfolk, Woolfolk and Wilson (1977) reported that college students evaluated a procedure labelled “behavior modification” significantly less favorably than they did the same procedure when it bore the label “humanistic education”. This suggests that descriptive and explanatory terminology may be more important in effecting negative responses than are the procedures themselves, although this possibility has not been tested directly. A second investigation (Turkat, Harris and Forehand, 1979) assessed the perceptions and
reactions of college students to the term “behavior modification” and to the implications of behavior modification. Respondents reported that behavior modification was appropriate for use with certain problems and populations but not with others. The investigators concluded, therefore, that behavior modification was not viewed as threatening nor was it regarded as “good”. Because of several methodological problems which exist with the Turkat et al. article, however, the generally benign conclusion that the public does not regard behavior modification negatively cannot be accepted without further investigation. A central difficulty was the failure to demonstrate that the students’ definition of behavior modification bore any resemblance to the investigators’ definition. Secondly, no distinction was made in the survey between the use of behavior modification and the use of psychological therapies in general. Such a lack of distinction makes it unclear whether, for example, disagreement with the use of behavior modification to change homosexual behavior is attributable to a generalized belief in the inappropriateness of changing homosexual behavior regardless of the means, or to a belief in the inappropriateness of behavior modification for changing that behavior.
Requests for reprints should be addressed to Larry D. Young, Section on Medical Psychology, Bowman Gray School of Medicine, Winston-Salem, NC 27103. 189
190
LARRY D. YOUNG and JANA N. PATTERSON
The present study represents an attempt to clarify some of these issues as well as to broaden the scope of the conclusions by sampling from three different populations. Turkat et al. (1979) surveyed only college students who had not taken psychology courses in an attempt to reduce bias. The current investigation sampled college students in an introductory psychology course during the first week of the semester, prior to any exposure to principles of behavior modification. Other students’ attitudes were assessed at the conclusion of their first semester of (introductory) psychology. Finally, in an attempt to sample from a population with broader exposure to media accounts of behavior modification, increased social consciousness, and a more thoroughly reasoned ethical stance, several faculty members were asked to give their opinions of behavior modification. METHOD Subjects Four hundred and seventy-five male and female undergraduate students at the University of Mississippi participated in the study. One hundred and sixty-five of these answered a questionnaire during the last 2 weeks of the semester and the remaining 310 participated during the first week of the subsequent semester. All were students in a required introductory psychology course and, as such, are probably representative of the University population. All received course credit for participation. Id addition, 120 questionnaires were mailed to members of the non-psychology faculty at the University of Mississippi. Forty-nine of these were anwered and returned for a return rate of 40%. A half dozen additional faculty members returned their questionnaires unanswered but with letters explaining that they did not know enough about behavior modification to provide informed answers. To compare the responses of persons not primarily involved with psychology with those of persons who were, members of two other groups were asked to complete the questionnaire. One group consisted of the psychology faculty at the University; the other, of members of a professional organization supportive of behavior modification. A total of 18 completed questionnaires were obtained from these two groups. Procedure Students were asked to complete questionnaires which assessed their knowledge, beliefs, and opinions of behavior modification practices. The questionnaire was divided into three sections conceptually. In the first section, respondents provided estimates of their own degree of knowledgeability regarding behavior modification, listing the sources.of their information, and identifying from a list of psychological
terms those techniques which they considered to be “Behavior Mcdification”. In the second section, respondents rated the “appropriateness” of the use of “Behavior Modification” for 10 different problems or groups. They also were asked to rate the appropriateness (a) of “either shock therapy or sensory deprivation” with 5 of these problem areas or groups, and (b) of “psychotherapy” with 5 of these conditions. The final section requested respondents to give their attitudes and opinions regarding several facets of “Behavior Modification”. Because only descriptive personal information was requested, all responses were anonymous. All faculty members also were asked to complete the questionnaire anonymously. No follow-up prompts to increase the return rate from faculty were made.
RESULTS
Responses of the students Students were asked to indicate the relative amount and source of the information they possessed regarding behavior modification. The proportion of students describing themselves as Very Informed, Informed, Poorly Informed and Very Poorly Informed was 10, 35, 46 and 9070,respectively. Although students who labelled themselves Informed reported slightly more sources of information than did those who labelled themselves Poorly Informed, the groups did not differ significantly in the number of sources which they indicated. At the beginning of the questionnaire, students were presented with a recognition task in which they were to identify from a list of psychological terms techniques which would be considered procedures of behavior modification. Table 1 presents .the proportion of all students identifying particular procedures as behavior modification techniques. A substantial proportion of the respondents incorrectly identified mind control drugs, brainwashing, sensory deprivation, electroconvulsive therapy, psychoanalysis, and psychotherapy, as behavior modification procedures. Likewise, students generally failed to identify correctly the behavioral procedures. Only positive and negative reinforcement were identified correctly by the majority of students. It is of interest that the self-labelled Informed and Very Informed did not differ from the Poorly Informed and Very Poorly Informed in their overall performance
INFORMATION Table 1. Proportion of all students who identified each technique as a “behavior modification technique” (N = 462)* Procedure Positive reinforcement* Negative reinforcement* Sensory deprivation Psychotherapy Electroconvulsive therapy Mind control drugs Psychoanalysis Brainwashing Cognitive restructuring* Neutral reinforcement Systematic desensitization* Thought-stopping* Transactional analysis Psychosurgery Overcorrection* EST Time out* Rolfing
Percentage of students 13 68 64 63 56 53 48 47 40 32 32 29 27 26 25 11 11 8
*Behavioral techniques are marked with an asterisk.
on the recognition task (mean number correctly identified = 9.1 vs 9.0). Self-labelled knowledgeability appears to bear little relationship to a very simple performance-based measure of knowledgeability. Table 2 presents data about the opinions of all students regarding three types of intervention: behavior modification, shock therapy or sensory deprivation, and “psychotherapy”, in several different conditions and populations. Students generally regarded behavior modification as “Very” or “Somewhat Appropriate” in treating all the listed populations, including normal children and homosexuals. These latter results are in contrast with those of Turkat et al.
Students generally regarded the more punitive procedures (shock therapy and sensory deprivation) as less appropriate (all Ps < 0.05) than behavior modification for treating ail conditions, including those that are socially stigmatized (e.g. prisoners and child molesters). The percentage of students endorsing the appropriateness of behavior modification and the percentage endorsing the appropriateness of psychotherapy
191
did not differ significantly at any category of appropriateness or for any of the populations. In an effort to determine whether students made any differentiation between the two classes of intervention for the treatment of the various conditions mentioned above, the percentage of students giving identical ratings in either of the two extreme categories (Very Appropriate or Very Inappropriate) was determined. Since only 10% of the students gave identical extreme ratings for the same condition, the data suggest that some degree of differentiation was being made. However, the differentiation between behavior modification and general psychotherapy is less clear-cut than between behavior modification and punitive procedures. The proportion of students endorsing various opinions about behavior modification is presented in Table 3. The data indicate that most students believe that behavior modification is both desirable and effective (separate components of “Appropriate”) for increasing desired behavior and for decreasing undesired behavior. Behavior modification was not generally regarded as unethical or dehumanizing. It was thought to enhance human potential and to affect human dignity positively. Although students were divided regarding the impact of behavior modification on the personal freedom of a particular individual, most expressed the belief that it has positive effects on human freedom in general. Nonetheless a plurality believed that it should be subjected to somewhat greater legal restriction than is currently the case. Students regarded behavior modification as more appropriate for serious than minor problems. Finally, a majority indicated that the quality of their own lives could be improved by behavior modification. Self-defined level of. knowledgeability affected only one question. The Informed regarded behavior modification as less unethical than did the more Poorly Informed, x2 (1) = 5.23, < 0.05. In contrast to the minimal effects observed for self-defined level of information, several differences were noted between groups which were classified either as High or Low Information by their respective performance on the recognition
Normal children Homosexuals Persons with marital problems Mental retardates Prisoners Mental hospital patients People with emotional problems Child molesters Children with mild academic difficulties People who are uncomfortable at casual parties
Population
Somewhat appropriate
Somewhat inappropriate
Very inappropriate
51
57 14
10 30
46 55
25
18
37 25
38
39
42 27 38 28
26 25
34
35 37 44 48
39
20
35 26
28 39
22 26
29 35
I8
46
34
38
44
31
24
23
13 12
19 20 14 18
17 21
27 22
24 20
23
29
6
18
18
19
13
7
4 8
4 16 4 6
20 14
40 22
21 20
39
10
4
6
4
12
Behavior Shock or Psycho- Behavior Shock or PsychoBehavior Shock or PsychoBehavior Shock or Psychomodification isolation therapy modification isolation therapy modification isolation therapy modification isolation therapy
Very appropriate
Table 2. Percentages of all students indicating the appropriateness of a procedure with various client populations (IV = 462)
P
? 3 g
3 ?
3
IL
3
2
: ;e
F E
193
INFORMATION
Table 3. Proportion
of all students expressing a particular opinion of behavior modification (N = 440)
How desirable is the use of behavior modification for increasing desired behavior? How effective is the use of behavior modification for increasing desired behavior? How desirable is the use of behavior modification for decreasing undesired behavior? How effective is the use of behavior modification for decreasing undesired behavior? How unethical is the use of behavior modification?
How dehumanizing is the use of behavior modification?
To what degree does behavior modification enhance human potential? How is human dignity affected by the use of behavior modification? How much should behavior modification be regulated?
What is the effect of behavior modification on the personal freedom of the client or patient? What is the implication of behavior modification for human freedom in general? Is behavior modification more appropriate for serious or minor problems? Do you think that behavior modification procedures could help you improve the quality of your life?
Very desirable Somewhat desirable Somewhat undesirable Very undesirable Very effective Somewhat effective Somewhat ineffective Very ineffective Very desirable Somewhat desirable Somewhat undesirable Very undesirable Very effective Somewhat effective Somewhat ineffective Very ineffective Not at all Not very much Slightly Very much Not at all Not very much Slightly Very much Not at all Not very much Slightly Very much Very positively Somewhat positively Somewhat negatively Very negatively No regulations at all Fewer regulations than presently No change Few more regulations Should be illegal Increased Slightly increased Slightly decreased Decreased Very negative Somewhat negative Somewhat positive Very positive Serious Minor No difference Not at all Not very much Some Quite a lot
% ii 48 10 2 25 65 9 2 33 49 14 4 25 60 14 2 25 42 28 5 22 38 34 6 5 19 48 28 11 44 39 5 4 21 36 38 2 14 36 42 8 5 34 54 7 48 19 33 16 21 53 10
194
LARRY D. YOUNG and JANA N. PATTERSON
task. The High Information group constituted all students correctly assigning 13 or more techniques (Table 1) to behavior modification and non-behavior modification categories while the Low Information group comprised those who allocated six or fewer techniques to the correct categories. The High Information group regarded behavior modification as more appropriate for normal children [x2 (1) = 7.71, P < 0.011 and those who have difficulty at casual parties [x2 (1) = 9.69, P< 0.011 than did the Low Information group. The High Information group apparently made greater differentiation between behavior modification and punitive procedures. They indicated that the more punitive procedures were less appropriate than did the Low Information for homosexuals, prisoners, and child molesters, x2 (I) = 4.53, 5.63 and 4.39, respectively; all Ps < 0.05. The High Information students also regarded behavior modification as less dehumanizing than did the Low Information, x2 (1) = 4.36, P < 0.05. Inherent in Turkat et af.‘s decision to use only students with no psychology course experience to approximate more closely the general population is the assumption that such exposure would affect their perceptions and reactions to the term “behavior modification”. The data of the present study support such an assumption. Students assessed at the end of the semester were more favorable to behavior modification for intervention with normal children, people with marital problems, children with mild academic difficulties, and people who are uncomfortable at casual parties, x2 (1) = 10.6, 5.4, 8.0 and 26.7, respectively; all Ps < 0.05. Endof-semester respondents also regarded behavior modification as more desirable and effective for decreasing undesired behavior, and as a less dehumanizing procedure than did other respondents. They viewed behavior modification as capable of increasing personal freedom and human dignity and as capable of improving the quality of their own lives more than did beginning-of-semester respondents. Additionally, end-of-semester students indicated their belief that either no change should be made in the
legal restrictions on the implementation of behavior modification practices or that only a few more restrictions should be added. Responses of the faculty Responses of the non-psychology faculty were virtually identical to those of the students. In fact, the only significant difference between the two groups was the more frequent indication by the faculty that behavior modification practices should be subject to more regulations or should be illegal, 50-40%, x2 (1) = 4.82, P< 0.05. When the responses of those non-psychology faculty members who regarded themselves as Informed regarding behavior modification (N = 20) were compared with psychology faculty and other behavioral clinicians (iV = 18), the non-psychology faculty correctly identified fewer behavior modification procedures and were particularly poor in identifying time out, thought-stopping, overcorrection, and systematic desensitization as behavior modification procedures. The self-defined “Informed” nonpsychology faculty saw behavior modification as less appropriate for application with normal children and people who are uncomfortable at casual parties, as less enhancing of human potential and dignity, as more restrictive of human freedom in general, and as having less applicability in improving the quality of their own lives, all Fs < 0.05. On a more positive note, however, those non-psychology faculty members who did well on the recognition performance task (High Information) saw behavior modification as more appropriate for use with several nonstigmatized populations (normal children, children with mild academic difficulties, and people with difficulties at parties) than did those who did poorly on the recognition task. The High Information faculty members were also less supportive of additional regulations and restrictions on the exercises of behavior modification procedures, more likely to regard behavior modification as increasing personal freedom and more likely to regard it as able to improve
INFORMATION
the quality of their own lives (all A < 0.05) than were the Low Information faculty respondents.
DISCUSSION A superficial inspection of the attitude data from the present study reveals an even more positive perception of behavior modification than that reported by Turkat et al. (1979). Whereas subjects in the Turkat et al. study regarded behavior modification as “Appropriate” for a restricted set of problems and populations, subjects in the present study regarded behavior modification as applicable to all problems which were evaluated. Additionally, the current investigation suggests that the opinions reported are relatively specific to behavior modification since students responded differentially regarding it and general psychotherapy and between it and more punitive procedures. The issues of attitude specificity was not addressed by Turkat et al. However, a more thorough and critical examination of the present data suggests that the results are a cause for concern rather than comfort. A substantial proportion of respondents misidentified several procedures (e.g. mind control drugs, brainwashing, sensory deprivation, ECT, psychoanalysis, and psychotherapy) as constituting behavior modification procedures. Additionally, they failed to recognize several procedures which are behavioral. In particular, only 11 per cent correctly recognized time out and less than one-third successfully identified systematic desensitization as a behavioral procedure. While disturbing in their own right, these data compel concern that the general positive reactions reported in the current investigation, as well as those of Turkat et al., may be based on a definition of behavior modificiation that is drastically different from that held by most professionals in the field. Psychologists legitimately have been concerned over attitudes based on distorted or biased information. Equal concern is justified regarding attitudes based upon ignorance. Al-
195
though the present investigation does not permit the poorly informed to be subdivided into ignorant and misinformed subgroups, this distinction is not of major importance to the issue at hand. What is important is the clear demonstration that both students and nonpsychology faculty regard behavior modification as a different entity or phenomenon than do the psychologists and other behavioral clinicians who were sampled. If the conceptualization of behavior modification held by respondents is based on either ignorance or inaccurate information, then the validity of any attitude or opinion is in serious doubt. Further justification for this concern over the validity of the interpretation of opinions held by the uninformed is provided anecdotally by the observation that 12% of the returned faculty questionnaires were unanswered but were returned with explanations that the respondent did not know enough about behavior modification to answer meaningfully. Furthermore, even though the majority of both students and faculty responded favorably to behavior modification, a substantial proportion did not. When between one-third and one-half of all students report their belief that behavior modification is unethical and dehumanizing and that it diminishes human dignity and human freedom individually and generally, we regard the situation as cause for concern. These observations illustrate the importance with which behaviorally oriented clinicians should regard their public image. The effects of knowledge or information depend upon the manner in which they are assessed. In contrast to self-defined level of knowledge which made little difference in attitudes, increases in performance-defined level of information were associated with more positive opinions regarding behavioral therapies. This was true even though the degree of knowledgeability was assessed by a procedure as simple as recognizing the names of various behavioral techniques from a list of psychological terms. Although results using a performance-based
1%
LARRY D. YOUNG and JANA N. PATTERSON
measure of knowledgeability encouragingly suggest that more highly informed respondents react more favorably to behavior modification than do the poorly informed, these effects should be accepted cautiously. First, the obtained effects were not large ones. Second, for both students and non-psychology faculty, the opinions of High and Low Information respondents differed on only a small proportion of the items. Likewise, the expectation that the opinions of a better informed and more enlightened population, the faculty, would differ from those of the students was not realized. Third, the use of a recognition task to assess level of knowledgeability may be too crude to provide meaningful differentiation at all levels. It is quite possible that ceiling effects prevented the separation of individuals with intermediate levels of knowledge from those who are more highly informed. Thus, it is unknown whether the positive linear relationship of attitudes and knowledge holds at all levels or whether it is curvilinear. The results of the present investigation should not lull us into complacency with their seemingly positive and comforting picture. Acknowledgement-The manuscript.
Rather, they should raise our concerns regarding the public’s level of understanding of behavioral therapies and the effect that this level of understanding has upon public opinion of behavioral interventions. There is ample evidence to encourage our activities to improve the public’s understanding of, and attitudes toward, behavioral therapies.
REFERENCES
Bandura A. (1975) The ethics and social purposes of behavior modification. In Annual Review if Behavior Therapy (Ed. by Franks C. M. and Wilson 0. T.). Brunr&/Mazel, New York. Burgess A. (1%3) A Cfockwork Orange. Norton, New York. Franks C. M. and Wilson G. T. (1975) Ethical and related issues in behavior therapy. In Annual Review of Behavior Therapy (Ed. by Franks C. M. and Wilson G. T.). Brunner/Mazel, New York. Turkat I. D. and Feuerstein M. (1978) Behavior modification and the public misconception, Am. Psychol. 33,194. Turkat I. D., Harris F. C. and Forehand R. (1979) An assessment of the public reaction to behavior modification, J. Behav. Ther. &Exp. Psychiat. lO, lOl-103. Woolfolk A., Woolfolk R. and Wilson G. T. (1977) A rose by any other name . . .: Labeling bias and attitude toward behavior moditication, J. Consult. Clin. Rsychol.
45,184-191.
authors would like to thank Dr. Margaret K. Straw for her comments on an earlier draft of the
Vol. 12, No. 3, pp. 1894%.
1981.
00057908/81/03018948 0 1981 Pa8amon
SOZ.CWO Press Ltd.
INFORMATION AND OPINIONS ABOUT BEHAVIOR MODIFICATION LARRY D. YOUNG Section on Medical Psychology, Bowman Gray School of Medicine
and JANA N. PATTERSON Department of Psychology, University of Mississippi Summary-Previous research ha8 suggested that the general population views behavior modification as an “appropriate” therapy for certain problems but it has not assured that these attitudes are based on an accurate conceptualization of behavior modification. In the present investigation, students and non-psychology faculty were assessed regarding their knowledge about and their attitudes toward several aspects of behavior modification. Attitudes toward behavior modification generally were favorable. Although greater knowledge as measured by a very simple task was associated with more favorable attitudes toward behavior modification, the overall level of information was very low. The significance of positive attitudes based on distorted information was discussed and concern8 for behavioral clinician8 were highlighted.
The history of behavior modification has been puncuated with controversy regarding the morality and ethics of employing behavior change technology. Although A Clockwork Orange (Burgess, 1963) and similar fictional works presented behavior modification in a negative light, many behavior therapists have voiced greater concern over its negative portrayal in the news media (cf., Bandura, 1975; Franks and Wilson, 1975). Turkat and Feuerstein (1978) surveyed The New York Times for a period of over 4 yr and found that half of the articles discussing behavior modification contained substantial misinformation (e.g. identification of brainwashing or psychosurgery with behavior modification). Woolfolk, Woolfolk and Wilson (1977) reported that college students evaluated a procedure labelled “behavior modification” significantly less favorably than they did the same procedure when it bore the label “humanistic education”. This suggests that descriptive and explanatory terminology may be more important in effecting negative responses than are the procedures themselves, although this possibility has not been tested directly. A second investigation (Turkat, Harris and Forehand, 1979) assessed the perceptions and
reactions of college students to the term “behavior modification” and to the implications of behavior modification. Respondents reported that behavior modification was appropriate for use with certain problems and populations but not with others. The investigators concluded, therefore, that behavior modification was not viewed as threatening nor was it regarded as “good”. Because of several methodological problems which exist with the Turkat et al. article, however, the generally benign conclusion that the public does not regard behavior modification negatively cannot be accepted without further investigation. A central difficulty was the failure to demonstrate that the students’ definition of behavior modification bore any resemblance to the investigators’ definition. Secondly, no distinction was made in the survey between the use of behavior modification and the use of psychological therapies in general. Such a lack of distinction makes it unclear whether, for example, disagreement with the use of behavior modification to change homosexual behavior is attributable to a generalized belief in the inappropriateness of changing homosexual behavior regardless of the means, or to a belief in the inappropriateness of behavior modification for changing that behavior.
Requests for reprints should be addressed to Larry D. Young, Section on Medical Psychology, Bowman Gray School of Medicine, Winston-Salem, NC 27103. 189
190
LARRY D. YOUNG and JANA N. PATTERSON
The present study represents an attempt to clarify some of these issues as well as to broaden the scope of the conclusions by sampling from three different populations. Turkat et al. (1979) surveyed only college students who had not taken psychology courses in an attempt to reduce bias. The current investigation sampled college students in an introductory psychology course during the first week of the semester, prior to any exposure to principles of behavior modification. Other students’ attitudes were assessed at the conclusion of their first semester of (introductory) psychology. Finally, in an attempt to sample from a population with broader exposure to media accounts of behavior modification, increased social consciousness, and a more thoroughly reasoned ethical stance, several faculty members were asked to give their opinions of behavior modification. METHOD Subjects Four hundred and seventy-five male and female undergraduate students at the University of Mississippi participated in the study. One hundred and sixty-five of these answered a questionnaire during the last 2 weeks of the semester and the remaining 310 participated during the first week of the subsequent semester. All were students in a required introductory psychology course and, as such, are probably representative of the University population. All received course credit for participation. Id addition, 120 questionnaires were mailed to members of the non-psychology faculty at the University of Mississippi. Forty-nine of these were anwered and returned for a return rate of 40%. A half dozen additional faculty members returned their questionnaires unanswered but with letters explaining that they did not know enough about behavior modification to provide informed answers. To compare the responses of persons not primarily involved with psychology with those of persons who were, members of two other groups were asked to complete the questionnaire. One group consisted of the psychology faculty at the University; the other, of members of a professional organization supportive of behavior modification. A total of 18 completed questionnaires were obtained from these two groups. Procedure Students were asked to complete questionnaires which assessed their knowledge, beliefs, and opinions of behavior modification practices. The questionnaire was divided into three sections conceptually. In the first section, respondents provided estimates of their own degree of knowledgeability regarding behavior modification, listing the sources.of their information, and identifying from a list of psychological
terms those techniques which they considered to be “Behavior Mcdification”. In the second section, respondents rated the “appropriateness” of the use of “Behavior Modification” for 10 different problems or groups. They also were asked to rate the appropriateness (a) of “either shock therapy or sensory deprivation” with 5 of these problem areas or groups, and (b) of “psychotherapy” with 5 of these conditions. The final section requested respondents to give their attitudes and opinions regarding several facets of “Behavior Modification”. Because only descriptive personal information was requested, all responses were anonymous. All faculty members also were asked to complete the questionnaire anonymously. No follow-up prompts to increase the return rate from faculty were made.
RESULTS
Responses of the students Students were asked to indicate the relative amount and source of the information they possessed regarding behavior modification. The proportion of students describing themselves as Very Informed, Informed, Poorly Informed and Very Poorly Informed was 10, 35, 46 and 9070,respectively. Although students who labelled themselves Informed reported slightly more sources of information than did those who labelled themselves Poorly Informed, the groups did not differ significantly in the number of sources which they indicated. At the beginning of the questionnaire, students were presented with a recognition task in which they were to identify from a list of psychological terms techniques which would be considered procedures of behavior modification. Table 1 presents .the proportion of all students identifying particular procedures as behavior modification techniques. A substantial proportion of the respondents incorrectly identified mind control drugs, brainwashing, sensory deprivation, electroconvulsive therapy, psychoanalysis, and psychotherapy, as behavior modification procedures. Likewise, students generally failed to identify correctly the behavioral procedures. Only positive and negative reinforcement were identified correctly by the majority of students. It is of interest that the self-labelled Informed and Very Informed did not differ from the Poorly Informed and Very Poorly Informed in their overall performance
INFORMATION Table 1. Proportion of all students who identified each technique as a “behavior modification technique” (N = 462)* Procedure Positive reinforcement* Negative reinforcement* Sensory deprivation Psychotherapy Electroconvulsive therapy Mind control drugs Psychoanalysis Brainwashing Cognitive restructuring* Neutral reinforcement Systematic desensitization* Thought-stopping* Transactional analysis Psychosurgery Overcorrection* EST Time out* Rolfing
Percentage of students 13 68 64 63 56 53 48 47 40 32 32 29 27 26 25 11 11 8
*Behavioral techniques are marked with an asterisk.
on the recognition task (mean number correctly identified = 9.1 vs 9.0). Self-labelled knowledgeability appears to bear little relationship to a very simple performance-based measure of knowledgeability. Table 2 presents data about the opinions of all students regarding three types of intervention: behavior modification, shock therapy or sensory deprivation, and “psychotherapy”, in several different conditions and populations. Students generally regarded behavior modification as “Very” or “Somewhat Appropriate” in treating all the listed populations, including normal children and homosexuals. These latter results are in contrast with those of Turkat et al.
Students generally regarded the more punitive procedures (shock therapy and sensory deprivation) as less appropriate (all Ps < 0.05) than behavior modification for treating ail conditions, including those that are socially stigmatized (e.g. prisoners and child molesters). The percentage of students endorsing the appropriateness of behavior modification and the percentage endorsing the appropriateness of psychotherapy
191
did not differ significantly at any category of appropriateness or for any of the populations. In an effort to determine whether students made any differentiation between the two classes of intervention for the treatment of the various conditions mentioned above, the percentage of students giving identical ratings in either of the two extreme categories (Very Appropriate or Very Inappropriate) was determined. Since only 10% of the students gave identical extreme ratings for the same condition, the data suggest that some degree of differentiation was being made. However, the differentiation between behavior modification and general psychotherapy is less clear-cut than between behavior modification and punitive procedures. The proportion of students endorsing various opinions about behavior modification is presented in Table 3. The data indicate that most students believe that behavior modification is both desirable and effective (separate components of “Appropriate”) for increasing desired behavior and for decreasing undesired behavior. Behavior modification was not generally regarded as unethical or dehumanizing. It was thought to enhance human potential and to affect human dignity positively. Although students were divided regarding the impact of behavior modification on the personal freedom of a particular individual, most expressed the belief that it has positive effects on human freedom in general. Nonetheless a plurality believed that it should be subjected to somewhat greater legal restriction than is currently the case. Students regarded behavior modification as more appropriate for serious than minor problems. Finally, a majority indicated that the quality of their own lives could be improved by behavior modification. Self-defined level of. knowledgeability affected only one question. The Informed regarded behavior modification as less unethical than did the more Poorly Informed, x2 (1) = 5.23, < 0.05. In contrast to the minimal effects observed for self-defined level of information, several differences were noted between groups which were classified either as High or Low Information by their respective performance on the recognition
Normal children Homosexuals Persons with marital problems Mental retardates Prisoners Mental hospital patients People with emotional problems Child molesters Children with mild academic difficulties People who are uncomfortable at casual parties
Population
Somewhat appropriate
Somewhat inappropriate
Very inappropriate
51
57 14
10 30
46 55
25
18
37 25
38
39
42 27 38 28
26 25
34
35 37 44 48
39
20
35 26
28 39
22 26
29 35
I8
46
34
38
44
31
24
23
13 12
19 20 14 18
17 21
27 22
24 20
23
29
6
18
18
19
13
7
4 8
4 16 4 6
20 14
40 22
21 20
39
10
4
6
4
12
Behavior Shock or Psycho- Behavior Shock or PsychoBehavior Shock or PsychoBehavior Shock or Psychomodification isolation therapy modification isolation therapy modification isolation therapy modification isolation therapy
Very appropriate
Table 2. Percentages of all students indicating the appropriateness of a procedure with various client populations (IV = 462)
P
? 3 g
3 ?
3
IL
3
2
: ;e
F E
193
INFORMATION
Table 3. Proportion
of all students expressing a particular opinion of behavior modification (N = 440)
How desirable is the use of behavior modification for increasing desired behavior? How effective is the use of behavior modification for increasing desired behavior? How desirable is the use of behavior modification for decreasing undesired behavior? How effective is the use of behavior modification for decreasing undesired behavior? How unethical is the use of behavior modification?
How dehumanizing is the use of behavior modification?
To what degree does behavior modification enhance human potential? How is human dignity affected by the use of behavior modification? How much should behavior modification be regulated?
What is the effect of behavior modification on the personal freedom of the client or patient? What is the implication of behavior modification for human freedom in general? Is behavior modification more appropriate for serious or minor problems? Do you think that behavior modification procedures could help you improve the quality of your life?
Very desirable Somewhat desirable Somewhat undesirable Very undesirable Very effective Somewhat effective Somewhat ineffective Very ineffective Very desirable Somewhat desirable Somewhat undesirable Very undesirable Very effective Somewhat effective Somewhat ineffective Very ineffective Not at all Not very much Slightly Very much Not at all Not very much Slightly Very much Not at all Not very much Slightly Very much Very positively Somewhat positively Somewhat negatively Very negatively No regulations at all Fewer regulations than presently No change Few more regulations Should be illegal Increased Slightly increased Slightly decreased Decreased Very negative Somewhat negative Somewhat positive Very positive Serious Minor No difference Not at all Not very much Some Quite a lot
% ii 48 10 2 25 65 9 2 33 49 14 4 25 60 14 2 25 42 28 5 22 38 34 6 5 19 48 28 11 44 39 5 4 21 36 38 2 14 36 42 8 5 34 54 7 48 19 33 16 21 53 10
194
LARRY D. YOUNG and JANA N. PATTERSON
task. The High Information group constituted all students correctly assigning 13 or more techniques (Table 1) to behavior modification and non-behavior modification categories while the Low Information group comprised those who allocated six or fewer techniques to the correct categories. The High Information group regarded behavior modification as more appropriate for normal children [x2 (1) = 7.71, P < 0.011 and those who have difficulty at casual parties [x2 (1) = 9.69, P< 0.011 than did the Low Information group. The High Information group apparently made greater differentiation between behavior modification and punitive procedures. They indicated that the more punitive procedures were less appropriate than did the Low Information for homosexuals, prisoners, and child molesters, x2 (I) = 4.53, 5.63 and 4.39, respectively; all Ps < 0.05. The High Information students also regarded behavior modification as less dehumanizing than did the Low Information, x2 (1) = 4.36, P < 0.05. Inherent in Turkat et af.‘s decision to use only students with no psychology course experience to approximate more closely the general population is the assumption that such exposure would affect their perceptions and reactions to the term “behavior modification”. The data of the present study support such an assumption. Students assessed at the end of the semester were more favorable to behavior modification for intervention with normal children, people with marital problems, children with mild academic difficulties, and people who are uncomfortable at casual parties, x2 (1) = 10.6, 5.4, 8.0 and 26.7, respectively; all Ps < 0.05. Endof-semester respondents also regarded behavior modification as more desirable and effective for decreasing undesired behavior, and as a less dehumanizing procedure than did other respondents. They viewed behavior modification as capable of increasing personal freedom and human dignity and as capable of improving the quality of their own lives more than did beginning-of-semester respondents. Additionally, end-of-semester students indicated their belief that either no change should be made in the
legal restrictions on the implementation of behavior modification practices or that only a few more restrictions should be added. Responses of the faculty Responses of the non-psychology faculty were virtually identical to those of the students. In fact, the only significant difference between the two groups was the more frequent indication by the faculty that behavior modification practices should be subject to more regulations or should be illegal, 50-40%, x2 (1) = 4.82, P< 0.05. When the responses of those non-psychology faculty members who regarded themselves as Informed regarding behavior modification (N = 20) were compared with psychology faculty and other behavioral clinicians (iV = 18), the non-psychology faculty correctly identified fewer behavior modification procedures and were particularly poor in identifying time out, thought-stopping, overcorrection, and systematic desensitization as behavior modification procedures. The self-defined “Informed” nonpsychology faculty saw behavior modification as less appropriate for application with normal children and people who are uncomfortable at casual parties, as less enhancing of human potential and dignity, as more restrictive of human freedom in general, and as having less applicability in improving the quality of their own lives, all Fs < 0.05. On a more positive note, however, those non-psychology faculty members who did well on the recognition performance task (High Information) saw behavior modification as more appropriate for use with several nonstigmatized populations (normal children, children with mild academic difficulties, and people with difficulties at parties) than did those who did poorly on the recognition task. The High Information faculty members were also less supportive of additional regulations and restrictions on the exercises of behavior modification procedures, more likely to regard behavior modification as increasing personal freedom and more likely to regard it as able to improve
INFORMATION
the quality of their own lives (all A < 0.05) than were the Low Information faculty respondents.
DISCUSSION A superficial inspection of the attitude data from the present study reveals an even more positive perception of behavior modification than that reported by Turkat et al. (1979). Whereas subjects in the Turkat et al. study regarded behavior modification as “Appropriate” for a restricted set of problems and populations, subjects in the present study regarded behavior modification as applicable to all problems which were evaluated. Additionally, the current investigation suggests that the opinions reported are relatively specific to behavior modification since students responded differentially regarding it and general psychotherapy and between it and more punitive procedures. The issues of attitude specificity was not addressed by Turkat et al. However, a more thorough and critical examination of the present data suggests that the results are a cause for concern rather than comfort. A substantial proportion of respondents misidentified several procedures (e.g. mind control drugs, brainwashing, sensory deprivation, ECT, psychoanalysis, and psychotherapy) as constituting behavior modification procedures. Additionally, they failed to recognize several procedures which are behavioral. In particular, only 11 per cent correctly recognized time out and less than one-third successfully identified systematic desensitization as a behavioral procedure. While disturbing in their own right, these data compel concern that the general positive reactions reported in the current investigation, as well as those of Turkat et al., may be based on a definition of behavior modificiation that is drastically different from that held by most professionals in the field. Psychologists legitimately have been concerned over attitudes based on distorted or biased information. Equal concern is justified regarding attitudes based upon ignorance. Al-
195
though the present investigation does not permit the poorly informed to be subdivided into ignorant and misinformed subgroups, this distinction is not of major importance to the issue at hand. What is important is the clear demonstration that both students and nonpsychology faculty regard behavior modification as a different entity or phenomenon than do the psychologists and other behavioral clinicians who were sampled. If the conceptualization of behavior modification held by respondents is based on either ignorance or inaccurate information, then the validity of any attitude or opinion is in serious doubt. Further justification for this concern over the validity of the interpretation of opinions held by the uninformed is provided anecdotally by the observation that 12% of the returned faculty questionnaires were unanswered but were returned with explanations that the respondent did not know enough about behavior modification to answer meaningfully. Furthermore, even though the majority of both students and faculty responded favorably to behavior modification, a substantial proportion did not. When between one-third and one-half of all students report their belief that behavior modification is unethical and dehumanizing and that it diminishes human dignity and human freedom individually and generally, we regard the situation as cause for concern. These observations illustrate the importance with which behaviorally oriented clinicians should regard their public image. The effects of knowledge or information depend upon the manner in which they are assessed. In contrast to self-defined level of knowledge which made little difference in attitudes, increases in performance-defined level of information were associated with more positive opinions regarding behavioral therapies. This was true even though the degree of knowledgeability was assessed by a procedure as simple as recognizing the names of various behavioral techniques from a list of psychological terms. Although results using a performance-based
1%
LARRY D. YOUNG and JANA N. PATTERSON
measure of knowledgeability encouragingly suggest that more highly informed respondents react more favorably to behavior modification than do the poorly informed, these effects should be accepted cautiously. First, the obtained effects were not large ones. Second, for both students and non-psychology faculty, the opinions of High and Low Information respondents differed on only a small proportion of the items. Likewise, the expectation that the opinions of a better informed and more enlightened population, the faculty, would differ from those of the students was not realized. Third, the use of a recognition task to assess level of knowledgeability may be too crude to provide meaningful differentiation at all levels. It is quite possible that ceiling effects prevented the separation of individuals with intermediate levels of knowledge from those who are more highly informed. Thus, it is unknown whether the positive linear relationship of attitudes and knowledge holds at all levels or whether it is curvilinear. The results of the present investigation should not lull us into complacency with their seemingly positive and comforting picture. Acknowledgement-The manuscript.
Rather, they should raise our concerns regarding the public’s level of understanding of behavioral therapies and the effect that this level of understanding has upon public opinion of behavioral interventions. There is ample evidence to encourage our activities to improve the public’s understanding of, and attitudes toward, behavioral therapies.
REFERENCES
Bandura A. (1975) The ethics and social purposes of behavior modification. In Annual Review if Behavior Therapy (Ed. by Franks C. M. and Wilson 0. T.). Brunr&/Mazel, New York. Burgess A. (1%3) A Cfockwork Orange. Norton, New York. Franks C. M. and Wilson G. T. (1975) Ethical and related issues in behavior therapy. In Annual Review of Behavior Therapy (Ed. by Franks C. M. and Wilson G. T.). Brunner/Mazel, New York. Turkat I. D. and Feuerstein M. (1978) Behavior modification and the public misconception, Am. Psychol. 33,194. Turkat I. D., Harris F. C. and Forehand R. (1979) An assessment of the public reaction to behavior modification, J. Behav. Ther. &Exp. Psychiat. lO, lOl-103. Woolfolk A., Woolfolk R. and Wilson G. T. (1977) A rose by any other name . . .: Labeling bias and attitude toward behavior moditication, J. Consult. Clin. Rsychol.
45,184-191.
authors would like to thank Dr. Margaret K. Straw for her comments on an earlier draft of the