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A study of the effects of group assertion training on anxiety, depression, self-concept and assertiveness in heroin addicts

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A study of the effects of group assertion training on anxiety, depression, self-concept and assertiveness in heroin addicts

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Content A STUDY OF THE EFFECTS OF GROUP ASSERTION TRAINING
ON ANXIETY, DEPRESSION, SELF-CONCEPT AND
ASSERTIVENESS IN HEROIN ADDICTS
by
Janice Joy Herdey
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Education)
May 1982
UMI Number: DP24829
All rights reserved
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a note will indicate the deletion.
UMI DP24829
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES. CALIFORNIA 9 0 0 0 7
This dissertation, w ritte n by
........ J.aniunder the direction of h.Q.r.„ Dissertation C o m
mittee, and approved by a ll its members, has
been presented to and accepted by The G raduate
School, in p a rtia l fu lfillm e n t o f requirements of
the degree of
D O C T O R O F P H I L O S O P H Y
.........
Dean
Date.
c o m m i t t e e
/ Chairman
DISSERTATION
£duc
P U .
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ACKNOWLEDGMENTS
How do I begin to say 1 1 thank you” to the many friends
who have encouraged and supported me during my years in
graduate school? How fortunate to have such wonderful
people in my life. And I do thank all of you. But especi
ally, I would like to thank Drs. Joanne Steuer and Marjorie
Cook who so unselfishly gave of their time and knowledge
during the critical periods of this endeavor.
The process of "going through" a dissertation is made
less painful by a committee of individuals who encourage,
support and guide one’s fledgling movements. I am grateful
to my committee, Drs. Betty Walker, Dennis Hocevar and
Isle Krauss who patiently allowed me the time and space to
"do my thing." My deepest thanks to both Drs. Walker and
Krauss for their added friendship and belief in my ability
to "do it."
This study would not have been possible without the
approval of Mrs. Tommie Erickson, Director of the Drug
Program. As my boss, Tommie has helped me in any way
possible in order that my schooling and this study would
be successful. I am deeply indebted to her for her sin
cere interest in me and her desire to help. I also wish
to thank Cal Tooker, Hospital Librarian, for his time and
effort in the "digging process."
________________________________________________________ ii
To Daryl Rowe and Laurie Poore, a special thanks for
their work as my group leaders. Their interest and concern
for my project and the clients certainly helped to make the
study a positive experience for those who got to know them.
I also wish to thank Harriet Dunmead for her patience
in typing this dissertation.
Let me not forget the many clients in the drug program
who have grown with me over the years, who always wanted to
know how I was doing and who seemed to enjoy the knowledge
that I was also trying to learn and grow. Often times they
would ask me when I was going to graduate. Well, I can
honestly say, soon!
And, I think I will thank myself for not giving up.
In some ways this seems like the end of a long, hard
journey, but in reality it is only the beginning of a new
adventure.
ill
TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS.......................................... .ii
LIST OF TABLES........................................... vii
Chapter
1 THE PROBLEM............. 1
Background of the Problem .................. 1
Statement of the Problem .................... 3
Importance of the S t u d y ........... 4
Research Hypotheses ........................ 6
Definitions ................................. 7
Addict ...................................... 7
Anxiety .................................... 7
Assertion training ........................ 7
Assertiveness ............................. 7
Depression ................................. 8
Self-Concept ............................... 8
Therapeutic Community (TC) ................. 8
Organization of the Remainder
of the Study............................... 8
2 REVIEW OF THE LITERATURE.........................10
Etiology of Drug Addiction.................... 10
Historical Perspectives of
Assertion Training ........................ 15
Summary........................................ 23
iv
Chapter Page
3 METHODOLOGY .................................... 25
Research Methodology ...................... 25
D esi g n........................................ 25
Sampling Strategy ........................... 26
Treatment Conditions ...................... 27
Instrumentation ............................. 30
Operational Definitions .................... 34
Anxiety...................................... 34
Assertiveness ............................. 34
Depression..................................34
Self-Concept ............................. 34
Data Gathering................................34
Data Analyses..................................36
Limitations...................'................ 37
4 ANALYSIS AND INTERPRETATION OF
THE FINDINGS..................................38
Analysis of Findings ...................... 38
Comparison of experimental and
control groups at pretest ............. 38
Comparison of drop-outs and completors . 41
Reliability scores of measures
used in study............................. 41
Comparison of experimental and
control groups at posttest ........... 41
Hypothesis I ..................................48
Hypothesis I I ................. 48
v '
Chapter Page
Hypothesis I I I ................................50
Summary of Questionnaire............. 50
Discussion....................................52
5 SUMMARY , CONCLUSIONS, RECOMMENDATIONS .... 57
Methodology............. 58
Data Analysis..................................58
Summary of Findings .................... 59
Conclusions ..................................60
Recommendations ............................. 62
REFERENCES . ...........................................65
APPENDICES
A OUTLINE OF GROUP ASSERTION TRAINING
SESSIONS...................................... 74
B TAYLOR MANIFEST ANXIETY SCALE ................ 82
C BECK DEPRESSION INVENTORY .................... 85
D TENNESSEE SELF-CONCEPT SCALE (SHORT FORM) . . 89
E RATHUS ASSERTIVENESS SCHEDULE ................ 91
F DEMOGRAPHIC INFORMATION ....................... 94
G PERMISSION TO CONDUCT STUDY .................. 97
H CONTRACT FOR RESEARCH PROJECT ................ 99
I OATH OF CONFIDENTIALITY........................ 101
J INFORMED CONSENT FOR THE STUDY
OF GROUP PSYCHOTHERAPY .................... 103
K QUESTIONNAIRE .................................. 105
_________________________ vi-:
LIST OF TABLES
Table Page
1 Demographic Information - Combined
Sample, N = 29 28
2 t-test Summary Comparing Experimental
and Control Groups at Pre-test ............. 39
3 Demographic Information for the Experimental
and Control Groups, N = 29 42
4 t-test Summary of Pre-test Scores for
Drop-outs and Completors .................... 44
5 Cronbachfs Coefficient Alpha Comparison
of Reliability Scores for Measures
Used in the S t u d y ............................. 45
6 t-test Summary on all Possible Comparisons
of Experimental and Control Groups
at Posttest....................................46
7 Analysis of Covariance Using Pre-test
Scores as the Covariate.......................49
Chapter 1
THE PROBLEM
Background of the Problem
Historically, drug abuse treatment has utilized such
modalities as methodone maintenance, detoxification clinics,
residential treatment centers, therapeutic communities, and
outpatient drug-free treatment facilities. Within these
treatment modalities, group therapy, individual therapy,
family counseling, pharmacological agents, and/or a variety
of therapeutic techniques were used to help produce behavior
change (Blaine and Julius, 1977). These treatment modali
ties have met with varying degrees of success, with thera
peutic communities having the most success in terms of
abstinence and no return to drug treatment (Savage and
Simpson, 1977).
Therapeutic communities may differ greatly in their
use of treatment techniques which may or may not have
therapeutic value for the drug addict. Few therapeutic
communities have attempted to evaluate any specific treat
ment technique within their program in order to understand
its impact upon their clients. As proposed by this paper,
such a line of inquiry asks whether or not success or im
provement relates to treatment. In doing so, the emphasis
1
shifts to the treatment process and to identifying effec
tive elements of a program. As suggested by the Panel on
Research and Evaluation of Therapeutic Communities, process
studies are the model for "in-house" research as they pro
vide feedback to clinician and administrator as to the
efficacy and integrity of program functioning (DeLeon and
Beschner, 1977).
Central to the issue of evaluating different treat
ments for drug abuse has been the somewhat indiscriminate
acceptance of "drug abuse" as a diagnostically homogeneous
term. Heroin abuse is viewed by Kaufman (197^0 as more a
symptom than a disease. As such it occurs within a wide
range of diagnostic disorders and has a variety of causes.
In a study by Monroe, Ross and Berzins (1971) it was found
that Narcotic Addiction Rehabilitation Act participants
represented a heterogeneous group of personality types.
Sheppard, Fracchia, Ricca and Merlis (1972) also found that
the data clearly indicated that heroin addicts represented
a diverse group in terms of type and degree of pathology.
However, it should be noted that both studies used only
male subjects.
Rarely has there been an attempt to develop a treat
ment directed at particular personality characteristics.
For Sells et al. (1976) the matching of individual types
with treatment types with respect to successful
’ 2
rehabilitation needs exploration. It is difficult to
understand how treatment can be efficacious especially for
long-term rehabilitation efforts when "we continue to treat
individuals having different psychopathologies with a
hodge-podge of treatments specific to none of them" (Blaine
and Julius, 19773 p. 4).
Therapeutic communities today are faced with a younger
population whose needs include family therapy, education,
vocational training and skills for getting along in the
"real world." This "real world" orientation recognizes
that the individual comes from a community and must return
there after treatment, and that an emphasis needs to be
0
placed on skills which can be applied upon re-entry (DeLeon
and Beschner, 1977).
Statement of the Problem
The literature suggests -that one of the reasons in
dividuals revert to drugs is due to the conflicts and
difficulties in interpersonal relationships and the
stresses in society (Gilbert and Lombardi, 1967; McDonald,
1965; and Vaillant, 1975). In the Gilbert and Lombardi
study, male addicts were seen as depressed, tense, in
secure, having feelings of inadequacy, and had difficulty
forming warm and lasting interpersonal relationships.
Drugs seemed to offer temporary relief from the pain of
living. Wurmser (1972) also described heroin addiction as
______________________________________: __________________________ a
a form of self-medication to control hostility and depres
sion. Therefore, assertion training was considered as a
possible effective treatment modality for addicts.
In recent years, assertion training has been intro
duced as an effective therapeutic technique in helping in
dividuals establish positive interpersonal relationships
and enhance their sense of self-worth (Ross, 1975;
Heimberg, Montgomery, Madsen, Jr., and Heimberg, 1977)*
It rarely comprises the sole treatment modality but is
generally part of a wider strategy designed to overcome
anxiety, depression, hostility and other communication
problems (Lange and Jakubowski, 1979).
The purpose of this study was to investigate the
effect of assertion training on anxiety, depression, self-
concept and assertiveness. The specific question to be
answered was: Will persons in a residential drug treatment
program receiving group assertion training show decreases
in anxiety and depression, an increase in self-concept and
become more assertive than persons in a residential drug
treatment program who do not receive group assertion
training?
Importance of the Study
The past twenty years have seen a broad shift in the
patterns of heroin addiction in this country. During these
two decades the abuse of heroin has spread from the lower
________4
socioeconomic, highly urban areas, to every regional and
social group in the United States (Kaufman, 197*0 • By
1970, the Bureau of Narcotics and Dangerous Drugs estimated
that there were 500,000 heroin addicts in the United
States, and public awareness and concern about licit and
illicit use of drugs has grown until today the drug prob
lem is seen as a major crisis (DeLeon and Beschner, 1977).
In I97I3 the White House established a Special Action
Office for Drug Abuse Prevention, and over $350 million was
allocated for treatment, law enforcement, research and pre
vention. The need for such legislation was in response to
the growing relationship between crime and addiction
(DeLeon and Beschner, 1977).
With the help of Federal funding, therapeutic com
munities for the treatment of heroin addiction prolifer
ated. The therapeutic community is a drug-free residential
treatment program in which clients take an active part in
the management of the program. However, with the rising
costs of treatment and the scarcity of funds, pressures for
more accountability were exerted. There was a need for the
communities to produce results, to demonstrate effective
ness and to prove their worthiness. Many therapeutic com
munities failed to keep accurate records and were resis
tant to evaluation. Available statistics indicated that a
good portion of clients left their programs before
5
completing treatment (Sells et al. , 1976). It is impera
tive that therapeutic communities evaluate their program
and,attempt to identify those aspects of their treatment
which might specifically account for their success (DeLeon
and Beschner, 1977).
Research Hypotheses
1. Those individuals in a long-term residential drug
treatment program receiving group assertion training will
show significantly more improvement in self-concept as
measured by the Tennessee Self-Concept Scale (short form)
than do similar individuals not receiving group assertion
training.
2. Those individuals in a long-term residential drug
treatment program receiving group assertion training will
show significant decreases in anxiety and depression as
measured by the Taylor Manifest Anxiety Scale and the Beck
Depression Inventory than do similar individuals not re
ceiving group assertion training.
3. Those individuals in a long-term residential drug
treatment program receiving group assertion training will
become significantly more assertive as measured by the
Rathus Assertiveness Schedule than similar individuals not
receiving group assertion training.
6
Definitions
Addict-. Addict is used interchangeably with drug
addict and heroin addict. The concept implies a strong
psychological and/or physical dependence (withdrawal symp
toms in abstinence) and often a tendency to increase dose
(tolerance) (Families Involved in Nurture and Development
[FIND], 1976).
Anxiety. With anxiety, threatening situations tend to
be unknown and internal, and the feeling is vague (Ludwig,
1979).
Assertion training. Refers to group assertion train
ing which includes four basic procedures: (1) teaching
individuals the difference between assertion, aggression
and nonassertion and politeness; (2) identifying and ac
cepting one's own personal rights and the rights of others;
(3) reducing cognitive and affective barriers to acting
assertively; and (4) developing assertive skills through
practice (Lange and Jakubowski, 1979).
Assertiveness. Behavior which enables a person to act
in his/her own best interest, to stand up for him/herself
without undue anxiety, to express feelings comfortably, or
to exercise his/her rights without denying the rights of
others (Alberti and Emmons, 1972);
7
Depression. Depression is a constellation of symptoms
described in DSM-III (1980) and includes: (1) feelings of
sadness; (2) lack of motivation or interest in a variety of
activities; (3) somatic complaints; and (4) distortion of
experiences in the form of guilt, negative self-evaluation,
pessimism about the world and the future.
Self-Concept. An attitudinal and conceptual self-
image based on the person’s perception and awareness of
him/herself, especially his/her feelings of self-worth,
values, and aspirations (Wilkening, 1973).
Therapeutic Community (TC). Although the concept is
changing, it is commonly defined as a communal, residen
tial, drug-free rehabilitation center in which drug addic
tion is treated as a social disorder. A variety of tech
niques are used and the center is generally run by ex
addicts and residents of the center (DeLeon and Beschner,
1977).
Organization of the
Remainder of the Study
In Chapter II the theoretical framework underlying
assertion training is identified, and a review of selected
literature on assertion training, its effects on anxiety,
depression, self-concept and assertiveness, and its use
with heroin addicts is presented.
8
In Chapter III methodology is discussed and includes
the research design, sample selection, treatment con
ditions, instrumentation, statistical analyses, and the
limitations of the study.
The findings of the investigation are reported and
interpreted in Chapter IV along with their implications.
t
Chapter V consists of a summary of the findings,
conclusions and recommendations for further research.
9
Chapter 2
REVIEW OF THE LITERATURE
This chapter will review empirical literature on the
etiology of drug addiction and the historical perspectives
of assertion training with respect to anxiety, depression,
self-concept and assertiveness. The chapter will be organ
ized as follows: (1) the etiology of drug addiction and
(2) historical perspectives of assertion training. In
cluded will be studies of assertion training in general and
in particular with drug addicts.
Etiology of Drug Addiction
One of the more characteristic features of drug
research over the last few years is the development of
various models and theories attempting to explain the
problems of drug abuse (Lettieri, Sayers and Wallenstein-
Pearson, 1980). Two viewpoints have prevailed in an at
tempt to ascertain factors which influence heroin addic
tion. One suggests that addiction is a learned behavior,
and the particular methodology for studying addiction is
similar to that used for studying any learned behavior.
The other point of view posits that addiction is an
"abnormal" behavior whose etiology can be explained by
personality variables such as insecurity, poor self-esteem,
10_
anxiety, depression, aggression and sociopathy (Krasnegor,
1979). It is the latter view which seems to have dominated
both research and treatment.
The major thrust of many investigations of drug
addiction has been to describe differences between addicts
and nonaddicts using standard personality tests (such as
the MMPI, Rorschach, CPI, EPPS, 16PF and TAT), case
studies, observations and experimentor designed question
naires. Some authors propose that there is a deep-seated
and widespread pathology among addicts. In Gilbert and
Lombardi’s (1967) study of 45 male addicts and 45 non
addicted males the addict group showed higher levels of
depression, tension, insecurity, and feelings of inade
quacy and had difficulty in forming warm and lasting inter
personal relationships. Similar results were reported by
Laskowitz (1961) and McDonald (1965). Sutker (1971) re
ported more depression, pessimism and anxiety in the 40
male heroin addicts compared to the 40 male non-addict
prisoners. Khaztzian, Mack and Schatzberg (1974) suggest
that addicts’ use of opiates represents ”a unique and
characteristic way of dealing with ordinary human problems
and the real world around them.’ ’ Through the use of drugs,
the addict attempts to deal with problems involving
emotional pain, stress, dysphoria, and problems associated
with interpersonal relations. It should be noted that the
11
above study dealt; ,;with only five case reports of male
clients. Based on nine years of clinical experience,
Wurmser (1972) suggests thilt compulsive drug use is an
attempt at self-treatment, a defense against overwhelming
affect. According to Wurmser, the effects of narcotics
seem to calm intense feelings of rage, shame, loneliness
and the anxiety evoked by these feelings. Robbins1 (197*0
study of 114 male addicts suggested that depression as
measured by the MMPI seemed part of a complex involving
hostility, suspiciousness, anxiety and schizoid tendencies.
He concluded that depression appeared to be an important
feature of the addicts’ problem. This is also supported by
two studies (DeLeon, et al., 1973; and DeLeon, 197*0 in
which both male and female addicts scored in the moderately
depressed range on the Beck Depression Inventory. Their
findings generally agree with reports in both clinical and
research literature. However, results from a study by
Emery, Steer and Beck (1981) in which 191 addicts (145
males, 46 females) were administered the BDI showed a mean
score of 13.27 (SD = 9.13) indicating that the group was
mildly depressed, according to Beck’s (1972) diagnostic
range. Using the BDI, Shaw, Steer, Beck and Schut (1979)
report a mean score of 15*36 (SD = 8.04), which is con
sidered to be in the mildly-moderately depressed range.
Findings in the two studies by DeLeon indicated that
12
addicts who came to the Phoenix House, New York, consis
tently scored in the psychopathic range on the MMPI.
Berzins (197*0 5 using the MMPI and Lexington Personality
Inventory, isolated two main profiles across ten inde
pendent samples of addicts varying in sex and admission
category. Type I subjects were characterized by high
levels of subjective distress, nonconformity and confused
thinking. They attributed a wide range of pathology to
themselves and depreciated themselves as addicts. Type II
subjects appeared satisfied with themselves as persons and
addicts. Berzins suggests that Type I individuals may
employ drugs to control feelings of anxiety, depression
and distress while Type II may use drugs to enhance hedon-
istic pursuits and possibly to reduce hostile feelings.
It should be pointed out that although 33 percent of the
subjects (total sample = 1,500) fell into Type I and only
7 percent in Type II categories, 60 percent were unclassi
fied.
According to Pittel (1971) drug dependence is most
likely to occur among individuals who lack the psychologi
cal resources needed to deal adequately with inner conflict
and/or environmental frustrations. Some individuals become
addicted having achieved a reasonable degree of integration
when subjected to severe situational stress, chronic pain
or anxiety.
11
One cannot overlook that from a psychosocial
point of view both internal and external factors pre
cipitate and/or predispose an individual to drug
abuse. The causes are multiple and additive in their
impact rather than mutually exclusive. (Ausubel,
1961)
Some cautions need to be exercised when interpreting
much of the research in drug abuse. There has been con
siderable use of convicts or clinic populations which may
tend to cast doubt on the validity, reliability and repre
sentativeness of the research findings. Such important
variables as sex, age, education, socioeconomic status, IQ
and marital status were generally not addressed. Several
studies (Platt, 1975; Gendreau and Gendreau, 1970, 1971;
and Sutker and Allain, 1973) have found no differences be
tween addicts and other deviant groups when these variables
were controlled. There is a glaring absence of research on
the female drug addict. Most of the previously mentioned
studies sampled.men exclusively and attempted to generalize
to the total addict population. Finally, results reported
are primarily the product of small samples, observational
research, case histories, or conjecture.
The overriding themes in the previous studies indicate
that drug addicts experience heightened anxiety and de
pression and lack a positive self-concept and the ability
to develop and maintain healthy relationships with others.
The use of drugs is a way in which the addict attempts to
cope with these feelings and deal with the problems of
every day living. It makes sense, therefore, that treat
ments which focus on alleviating these symptoms need to he
investigated for their usefulness in rehabilitating the
addict.
Historical Perspectives
of Assertion Training
In recent years, assertion training (AT) has received
increasing attention in the psychological literature as a
behavior procedure for alleviating undue anxiety and stress
in social situations (Cotier and Guerra, 1978; Ross, 1975).
One of the classic works in the area of assertive behavior
is Salter’s (1961) book entitled, Conditioned Reflex
Therapy. Many of the procedures utilized in assertion
training today can be traced to Salter’s work. The major
credit for the current form of assertion training is gener
ally attributed to Joseph Wolpe and Arnold Lazarus who more
clearly drew distinctive lines between assertion and ag
gression and who integrated role-playing techniques as a
part of their treatment (Lange and Jakubowski, 1979).
While Salter applied his ’ ’excitatory reflex” procedures to
almost all of his clients, Wolpe and Lazarus (1966) found
these procedures (which they called assertive) to be parti
cularly valuable in overcoming unadaptive anxiety arising
from interpersonal relationships. Several authors (Wolpe
and Lazarus, 1966; Alberti and Emmons, 1972; and Lange and
15
Jakubowski, 1979) suggest that individuals have certain
basic (assertive) rights which should be exercised in order
to achieve a healthy adjustment in life. The authors also
describe treatment procedures found in assertion training
such as hierarchial presentation of stimulus situations,
shaping techniques, behavioral rehearsal, modeling, audio
feedback and homework assignments. Alberti and Emmons de
fine assertion by stating that it is behavior which enables
persons to act in their own best interest, to stand up for
themselves without undue anxiety and to exercise their
rights without denying the rights of others. Cotier and
Guerra (1976) agree with their definition and would add
that it is a philosophy of life directed towards acquiring
greater self-respect and dignity.
Since 1966, the number of articles on assertion train
ing and assertion-related procedures has increased dramati
cally. Areas studied have included investigations designed
to assess the effectiveness of assertion training and
isolate effective components and demonstrate the effective
ness of group assertion training (Heimberg, Montgomery,
Madsen and Heimberg, 1977). Lazarus (1966) compared the
effects of behavior rehearsal with nondirective therapy and
direct advise in effecting behavior change. He found that
behavior rehearsal was effective whereas direct advise and
nondirective therapy were less effective. Other studies
16
(Cautela, 1966; Kelly, 1955; Wolpe and Lazarus, 1966) in
dicated that behavior rehearsal is a potentially effective
treatment technique.
Several studies (McFall and Lillesand, 1971; McFall
and Twentyman, 1973; Kazdin, 1980) compared overt rehearsal
*
with covert rehearsal and found both procedures to be
generally effective. However, elaboration of situations
rehearsed as well as coaching or modeling produced addi
tional positive effects. Modeling and role-playing with
,!nonassertive, T individuals have been investigated by
Friedman (1972) and Eisler, Hersen and Miller (1973) with
both procedures being superior to all other treatments
except unstructured role-playing. Although the above
studies differ in the measurements employed, the design
and the amount of treatment, they generally conclude that
behavioral rehearsal, coaching and modeling are the most
effective components of assertion training. In the view
of Lange and Jakubowski (1979) assertion training in
corporates four basic procedures: (1) teaching individuals
the difference between assertion and aggression and between
nonassertion and politeness; (2) identifying and accepting
oners own personal rights and the rights of others; (3)
reducing cognitive and affective obstacles to acting
assertively; and (4) developing assertive skills through
practice methods.
17
Increasingly, more attention has been given to the use
of assertion training within a group setting (Hedquist and
Weinhold, 1970; Alberti and Emmons, 1972; Pensterheim,
1972; Cotier and Guerra, 1978; Flowers and Guerra, 197*0.
However, most investigations of group assertion training
suffer from methodological problems. Studies by Percell,
Berwick and Beigels (197*+) and Rimm, Hill, Brown and Stuart
(197*+) employed only one group per condition which con
founds therapist or group composition variables with treat
ment effects and makes interpretation unclear. Rathus
(1972, 1973) utilized the experimentor as therapist in all
conditions also making interpretation of results difficult.
While research on the relative effectiveness of group
assertion training is insufficient to suggest its superi
ority over other procedures, it is generally believed to
be more effective as the group provides a "laboratory" of
other people with whom to work (Alberti and Emmons, 1972;
Lange and Jakubowski, 1979). By utilizing the group
setting, the client can obtain support and encouragement
from others, may learn and profit from listening and/or
watching others acquire competence, has an opportunity for
feedback from several sources, and has the opportunity to
coach others in becoming more assertive.
Assertion training has been used with a diversity of
clinical populations ranging from college students to
18
chronic psychiatric patients (Eisler, 1976). Its primary
focus has been the reduction of anxiety in interpersonal
relations and social skills training (Alberti and Emmons,
1972; Lange and Jakubowski, 1979; Cotier and Guerra, 1978;
and Percell, 1973).
Pensterheim and Baer (1975) state: "The more you
stand up for yourself and act in a manner you respect, the
higher will be your self-esteem." Alberti and Emmons also
suggest that a relationship exists between being assertive
and being self-accepting. The hypothesis that people who
are assertive are also more self-accepting and less anxious
was tested by Percell, Berwick and Beigels (197*0. A sig
nificant positive relationship was found between the IBT
(an assertive measure) and the Self-Acceptance scale of the
CPI (.49 for men and .51 for women). A strong negative
relationship was found between the IBT and the TMAS for
women only (-.88), suggesting that less assertive women are
more anxious than their assertive counterparts. Percell
(1973) found that 12 psychiatric patients given assertion
training showed an increase in self-acceptance and a de
crease in anxiety. Additionally, Galassi, DeLo, Galassi
and Bastien (1974) reported that those students in their
study who scored low on an assertive measure also selected
adjectives on an adjective checklist that indicated a
negative self-evaluation.
19
In contrast, no evidence to support the contention
that an assertive individual is more likely to feel posi
tively about him/herself was found by Pachman and Foy
(1978). However, Pachman and Foy used behavioral measures
while Percell, et al. and Galassi, et al. relied on self-
report measures.
More recently, assertion training has been used
effectively in the treatment of depression. Beck (1979)
states: ’ ’Assertive training and role-playing can be ef
fectively employed in the treatment of depressed patients’ ’
(p. 137). Studies by Hayman and Cope (1980) and Sanchez,
Lewinsohn and Larson (1980) found depression to be nega
tively correlated with assertiveness. Pachman and Foy also
found support for the theory that depression is negatively
related to assertiveness.
Many drug treatment communities (such as Synanon) use
various forms of behavior techniques including aversive
verbal stimuli and the removal of positive reinforcements
within the treatment modality (Droppa, 1973)* Droppa be- *
lieves that to the extent that anxiety and/or guilt may be
causal factors in drug taking, verbal aversive treatment
may actually serve to increase the probability of drug-
related behavior. Ludwig (1979) suggests that when pre
cipitating causes can be identified, behavior techniques
such as assertion training can be employed as the primary
20
treatment. While a number of different behavioral treat
ments (classical conditioning, chemical aversive condition
ing, aversive conditioning, token economy, and assertion
training with aversive techniques) have been used with some
success in the treatment of individual cases (Droppa, 1973;
Cautela, 1975), a review of the literature suggests a
paucity of studies using assertion training with drug
addicts as a group.
A study by Lindquist, Lindsay and White (19 79) assess
ing the assertiveness of heroin addicts as compared to
psychiatric outpatients, court-referred drug users and
college students (N = 114) found heroin addicts and court-
referred drug users to be less assertive and more socially
anxious than non-addict populations (as measured by the
RAS). A significant' difference was found between groups on
the measure of assertiveness (P = 7*72, df = 3a P .01).
Results also indicated a high correlation between assertion
and aggression for heroin addicts and for psychiatric
patients (p = _< .001 and p = _< .01, respectively) indicat
ing that special attention should be paid to discriminating
between aggression and assertion when training the drug
addict population. The authors suggest that individuals in
clinical settings who score high on assertive measures may
in fact be aggressive. However, the Lindquist, et al.
study only compared heroin addicts with nonaddicts in terms
21
of assertiveness, and the results of the study are limited
due to the small and possibly unrepresentative sample.
The one investigation found using group assertion
training with heroin addicts was a study by Callner and
Ross (1978). It was a short-term treatment (nine one-hour
sessions over a three-week period) comparing an assertion
training group of four subjects to a control group (N = 4).
All subjects were part of an on-going treatment program.
Pre- and posttest measures were administered individually
and included a 40-item assertion questionnaire designed by
the authors and 10 short audiotaped behavioral situations
rated on a 5-point scale of three verbal performance
measures (duration, fluency and affect). The assertion
training group utilized discussion, role-playing, feedback,
modeling and role reversal as part of the treatment pro
cedures. The results showed no difference between groups
on the pre-posttest scores of the assertion questionnaire.
Significant main effects between groups (p = _< .05) was
found for the three verbal performance measures. The
authors suggest that the questionnaire items may be less
sensitive to subtle changes over a three-week period. The
question of aggression was not addressed in this study.
Although the study indicates some positive results, caution
should be used when interpreting the data for the following
reasons: (1) the small sample size (N = 8); (2) the lack
22
of heterogeneity; (3) skill level and sex of assertion
training group leader was not identified; (4) individual
testing may have caused some tester bias; and (5) the use
of measures which lack normative data (the authors cite a
test-retest reliability of .83 for the questionnaire with
an N = 32).
Summary
The implications drawn from the literature on drug
addiction indicated that drug addicts tend to feel anxious
and depressed, lack a positive self-concept and have diffi
culty with interpersonal relationships. The use of drugs
may be a way in which the addict attempts to cope with
these feelings and deal with the problems of every day
living.
The focus of assertion training has been the reduction
of anxiety and depression resulting from poor interpersonal
relationships and poor social skills. It includes the de
velopment of a positive self-concept and building effective
assertive behaviors. Although studies investigating the
use of group assertion training suffer from methodological
problems, it is generally believed to be more effective as
the group provides a "laboratory" of other people with whom
to work.
There seems to be a paucity of research regarding the
assertiveness of heroin addicts or the use of assertion
____________________________ 23_
training groups with addict populations. The two studies
reviewed suggest that heroin addicts are less assertive
than non-addict populations and that group assertive train
ing may be successful in alleviating social anxiety and
developing assertive skills.
24
Chapter 3
METHODOLOGY
This chapter describes the research design, sample
selection, instrumentation, treatment condition, statisti
cal analyses and limitations.
Research Methodology
Due to the natural social setting in which the in
vestigation was conducted, this study employed a non
equivalent, quasi-experimental, pretest-posttest control
group design (Campbell and Stanley, 1963)• The design
included two experimental and one control group. Group
assertion training (the treatment) was the independent
variable. The dependent variables consisted of two
numerical scores on each of the four measures: the Taylor
Manifest Anxiety Scale; the Beck Depression Inventory; the
Tennessee Self-Concept Scale (short form); and the Rathus
Assertiveness Schedule.
Design
Pretest
Experimental Group A T^
Experimental Group B T-j_
Control Group T^
__________ 25
Treatment Posttest
X t2
X t2
T2
Sampling Strategy
Subjects consisted of the entire population of heroin
addicts in the long-term treatment program at Metropolitan
State Hospital during August-September 1981. All referrals
to the program had to be at least 18 years old, could not
be acutely psychotic, did not have incapacitating medical
or physical problems, and did not have a history of un
controlled physical acting out. Admission to the program
is on a voluntary basis.
Because there were so few females in the program,
individuals were randomly assigned to groups by sex, thus
allowing an equal number of females in the experimental and
control groups. Each group consisted of 12 individuals.
The sample consisted of 36 (including drop-outs)
persons ages 21-53 (mean age of 30.5). Of the 36 who began
treatment, 29 or 80.5 percent completed the eight-week
program. Those completing the study consisted of 19 males
(65.5 percent) and 10 females (34.5 percent). The ethnic
make-up of the group included 15 Caucasians (51.7 percent),
4 blacks (13.8 percent) and 9 Hispanics (31.0 percent).
Twelve (41.4 percent) individuals had less than high school
education, eight (27.6 percent) received high school dip
lomas, and nine (31.0 percent) had some college. While
eleven (37.9 percent) had no previous drug program treat
ment, eighteen (62.1 percent) had re-entered treatment.
26'
The average amount of time spent in the program was
approximately 75 days with twenty subjects (69.9 percent)
having stayed 90 days or less and nine (31.0 percent) stay
ing over 90 days. Of the twenty-nine subjects, twenty-five
(86.2 percent) had no previous assertion training. This
sample tended to be either single (N = 12, 41.4 percent)
or separated/divorced (N = 11, 37.9 percent), with only
five subjects married at the time of this study. Twenty-
two of the subjects had an annual income of less than
$10,000 (see Table 1).
In summary, the subjects in this study were male and
female heroin addicts from 21-53 years old, divided equally
between Caucasian and non-Caucasians and in general had low
incomes, although the majority had at least a high school
education.
Treatment Conditions
The format for the group assertion training sessions
was based on the work done by Lange and Jakubowski (1979)
(see Appendix A). Their approach is based upon an inte
grative model utilizing cognitive restructuring procedures
and behavior techniques. Cognitive restructuring is a
process by which individuals become aware of their own
thought processes which lead to ineffectual behaviors and
change these thought processes to more productive ones.
The belief is that individuals are more likely to change
__________ 27
Table 1
Demographic Information -
N = 29*
Combined Sample
N % X Range
Sex
Male
Female
19
10
65.5
34.5
Age
Male and Female
29 32.5 21-53
Ethnicity
Caucasian
Black
Hispanic
15
4
9
51.7
13.8
31.0
Education
Less than high school
High school diploma
Some college
12
8
9
41.4
27.6
31.0
Previous Treatment
Yes
No
18
11
62.1
37.9
Length in Program
90 days or less
More than 90 days
20
9
68.9
31.0
Assertion Training
Yes
No
4
25
13.8
86.2
Marital Status
Single
Separated/divorced
Married
12
11
5
41.4
37.9
20.7
Annual Income
Less than $10,000
More than $10,000
22
7
75.9
24.1
*Those completing the study.
28
when they learn to control what they say to themselves as
well as how they honestly feel or behave. The model in
cludes four basic procedures: (1) teaching individuals the
difference between assertion and aggression and between
nonassertion and politeness; (2) helping individuals
identify and accept both their own personal rights and the
rights of others; (3) reducing existing cognitive and af
fective obstacles to acting assertively, e.g., irrational
thinking, excessive anxiety, guilt; and (4) developing
assertive skills through active participation and practice.
It is a semistructured training approach which emphasizes
acquiring assertive skills through observation, modeling
and role-playing.
Both experimental groups (A and B) received eight
weeks of group assertion training. Groups met once each
week for one and one-half hours. Both experimental groups
met on the same evening utilizing the same group leaders.
The group leaders (one male and one female) for the group
assertion training were doctoral candidates who had ex
tensive experience as assertion training leaders.
The control group met the same evening as the two
experimental groups for the eight-week project. However,
their time was nonstructured, and members were allowed to
work on projects, prepare papers and finish tasks assigned
to them during the treatment day.
29
Instrumentation
Pour measures of outcome were employed in this study:
the Taylor Manifest Anxiety Scale (see Appendix B); the
Beck Depression Inventory (see Appendix C); the Tennessee
Self-Concept Scale (short form) (see Appendix D); and the
Rathus Assertiveness Schedule (see Appendix E). Demo
graphic information was gathered, and subjects who com
pleted the group assertion training were asked to fill out
a questionnaire indicating their attitude towards the group
(see Appendix F).
The Taylor Manifest Anxiety Scale (TMAS) consists of
50 items designed to measure overt or manifested symptoms
of anxiety. To obtain a score a subject must agree with
those items of the scale which have been designated as true
or false. A high score indicates higher anxiety. The
scale has been used extensively in conditioning studies and
has proved to be useful in the selection of subjects for
experimental purposes (Taylor, 1953). The TMAS has gone
through several revisions, and. a Pearson product-moment
correlation of .85 between the old and new version was re
ported by Taylor (1953). Test-retest reliability showed a
product-moment correlation of .88 after an interest inter
val of four weeks was reported. A comparison between
university students and neurotic and psychotic patients
showed student scores (median of 13) being significantly
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ao_
different from those of patients (median of 3*0 (Taylor,
1953).
The Beck Depression Inventory (BDI) is a clinically
derived self-report inventory of depression designed for
use in psychiatric populations. The inventory was chosen
on the basis of its relationship to the overt behavioral
manifestations of depression and its use in studies with
heroin addicts. The BDI was originally utilized with in
patient and outpatient psychiatric subjects (Beck, Ward,
Mendelson and Erbraugh, 1961). It is a 21-item scale
composed of four alternative statements rated in increasing
severity of 0-3. The range of possible scores extends from
0-63. Suggested cut-off scores are: 0-9, normal range;
10-15, mild depression; 16-19, mild-moderate depression;
20-29, moderate-severe depression; and 30-63, severe de
pression (Beck, 1972). According to Beck, the high cor
relation (.86) with clinical observation indicates that
the instrument is highly reliable. Shaw, Steer, Beck and
Schut (1979) conducted a factor analytic study and found
that the structure of depression in male heroin addicts
is similar to that of non-addicted depressed patients.
The Tennessee Self-Concept Scale is designed to
measure an individuals concept of him/herself. Individu
als who score high on the total positive score "tend to
like themselves, feel that they are persons of value and
worth, have confidence in themselves, and act accordingly”
(Pitts, 1965, P* 2). The instrument has been used
extensively, and the reliability and validity have been
demonstrated in prior research (see Pitts C1965] for
review). Test-retest reliability for the total positive
score is .92. Richard M. Siunnin’s review of the scale
states: ”The Tennessee Self-Concept Scale ranks among the
better measures combining group discrimination with self-
concept information” (Buros, 1972, p. 369).
The Tennessee Self-Concept Scale (short form) consists
of the 18 items comprising the Personal Self Subscale of
the complete TSCS. The Personal Self Subscale reflects the
individual’s sense of self-worth, his/her feelings of ade
quacy, and his/her evaluation of him/herself apart from
his/her body or relationships with others (Fitts, 1965).
The Personal Self Subscale (short form) has been shown to
correlate .90 with the total positive score (Fitts, 1965) .
In his study with psychiatric patients Congdon (1958) ,
using the short form version of the scale, obtained an
internal consistency coefficient of .88. In the TSCS
(short form) subjects are asked to respond on a five-point
scale ranging from completely false (1) to completely true
(5). The higher the score, the greater is the individual’s
sense of personal worth. A consideration in using this
instrument was that only a sixth grade education was
______________ ’ ___________________ 32_
necessary for understanding the items. This was parti
cularly important given the diverse background of the sub
jects .
The Rathus Assertiveness Schedule (RAS) is a 30-item
instrument designed to measure an individualTs perception
of his/her assertiveness and includes feeling/attitude
statements (Rathus, 1973). Each item is rated on a six-
point scale from -3 (very uncharacteristic) to +3 (very
characteristic) with a range of possible total scores of
-90 to +90. Total score is obtained by adding numerical
responses to each item after changing the signs of re
versed items. The higher the total score the more
assertive the person.
In the initial report on this schedule, test-retest
reliability over a two-month period was .78 with a split
half reliability of .77 (Rathus, 1973). A validity co
efficient of .70 was obtained by comparing self-reported
RAS scores to two external behavioral measures of asser
tiveness (Rathus, 1973).
In a study by Rathus and Nevid (1977) assessing the.
assertiveness of 191 inpatient and outpatient psychiatric
subjects with a variety of diagnoses, a correlation of .80
between therapist rating with the RAS was obtained. The
RAS has been utilized with college students, psychiatric
patients and alcoholics.
33
Operational Definitions
Anxiety. For the purpose of this study, anxiety is
defined as the score on the Taylor Manifest Anxiety Scale
(TMAS, Taylor, 1953).
Assertiveness. Assertiveness is defined as the score
on the Rathus Assertiveness Schedule (RAS, Rathus, 1973).
Depression. Depression is defined as the score on
the Beck Depression Inventory (BDI, Beck, et al., 1961).
Self-Concept. Self-concept is defined as the score
on the short form (Personal Self Subscale) of the Tennessee
Self-Concept Scale (TSCS, Fitts, 1965).
Data Gathering
Permission to conduct the study in the long-term
residential drug treatment program at Metropolitan State
Hospital was obtained through the Research Committee and
Human Subjects Committee at the hospital with final ap
proval from the Committee for the Protection of Human
Subjects, Sacramento, California (see Appendix G).
The study was discussed with staff and peer leaders of
the long-term drug treatment program (known as the Family).
Peer leaders are responsible for daily routines and
schedule all activities including therapeutic groups. In
34
the Family, peer leaders are monitored by a staff member
(the Family Coordinator). Those wishing to be included in
the daily schedule make a request through the peer leaders.
The experimentor thought it important to enter into a con
tractual agreement with the peer leaders and the Family
Coordinator in order to insure smooth running of the
project. The contract spelled out how the project would
be conducted (including dates, times and testing), how the
groups would be selected, and included commitments neces
sary from the Family leaders (see Appendix H).
Due to the State of California confidentiality laws
each leader of the assertion training groups was asked to
sign an Oath of Confidentiality (see .Appendix I). Leaders
were approved by the program director.
All subjects taking part in the study read and signed
an informed consent describing.the nature of the study
(see Appendix J). All information gathered was coded to
insure confidentiality.
Test packets including the four instruments and a
demographic information questionnaire were precoded. At
the time of testing, coded material was checked against
subjects1 names to insure that the proper code was given
out. All 36 subjects were tested at the same time. Each
test was administered separately with verbal instructions,
and there was no time limit for the tests.
35
After the eight-week group assertion training, the 29
remaining in the study were administered the same coded
packet of tests (excluding the demographic information).
Again, there was no time limit on the administration of the
tests. Individuals who participated in the group assertion
training were asked to fill out a questionnaire indicating
their attitude towards the group (see Appendix K).
Data Analyses
The purpose of this study was to compare the efficacy
of group assertion training with that of a control group in
reducing anxiety and depression and increasing self-concept
and assertiveness in drug addicts in the long-term treat
ment program. The statistical procedure which provided the
best method of determining the outcome of the study was the
analysis of covariance (ANCOVA) with pretest scores and the
covariate. According to Campbell and Stanley (1963)9
the analysis of covariance with pretest scores
as the covariate are usually preferable to simple
gain-score comparisons. Since the great bulk of
educational experiments show no significant differ
ence, and hence are frequently not reported, the use
of this more precise analysis would seem highly de
sirable. (p. 23)
Other statistical procedures used were: (1)
Cronbach's (1950) coefficient Alpha was utilized to assess
the reliability of the four measurements used in the study;
and (2) t-tests were run comparing pre- and posttest scores
for both experimental and control groups. t-tests were
26_
also utilized to compare drop-outs with subjects who com
pleted the study in terms of pretest scores.
Limitations
The results of this study may be generalized only to
those individuals who are drug addicts in the long-term
residential treatment program at Metropolitan State
Hospital. Sample size may affect the statistical sig
nificance of the tests utilized.
Limitations of the study include the inability to
control for early drop-outs, the contamination of results
due to the "live-in" nature of the program, and concurrent
external life events such as vocational concern, family
problems and legal problems which may influence the results
of this study. The amount of time during which the treat
ment variable (assertion training) took place might not
have been sufficient to permit either short-term or long
term changes in anxiety, depressipn, self-concept or
assertiveness. Because behavioral indicies were not em
ployed in this study, generalizability to overt behavior
may be limited.
21
Chapter 4
ANALYSIS AND INTERPRETATION
OF THE FINDINGS
In this chapter the findings of data analyses are
presented and the extent to which experimental treatment
affected subjects1 scores on the outcome measures described
in Chapter 3 discussed. Drop-outs and completors were com
pared on pre-treatment scores and - demographic information.
The reliability coefficient, Alpha, was calculated for the
four measures used in the study. An analysis of data per
taining to each hypothesis in Chapter 1 was run. Also in
cluded is a summary of questionnaire data from individuals
who completed the assertion training groups.
Analysis of Findings
Comparison of experimental and control groups at
pretest. t-tests were run comparing pretest scores of the
experimental and control groups. There were no significant
differences between groups at the time of pretest on the
measures of self-concept, anxiety, depression and asser
tiveness (see Table 2). Both experimental and control
groups were found to be similar in terms of sex, age,
ethnicity, education, and whether they had previous
38
t-test
and
Summary
Control
Table 2
Comparing
Groups at
Experimental
Pre-test
Measure Group Mean SD df t
Pre-self-concept A
62.09
4.46
18 0.98
B 58.78
10.17
Pre-anxiety A
18.55 8.87
18 -0.90
B 22 .56 11.11
Pre-depression A
11.73
4.90
18
-0.87
B 14.22 7.86
Pre-assertiveness A 31.00
3.13
18
0.47
B 30.00
6.23
Pre-self-concept A 62.09 4.46
18
0.53
C 60.22
10.63
Pre-anxiety A
18.55 8.87
18 -1.28
C 24.56 12.08
Pre-depression A
11.73
4.90
18 -0. 61
C
13.33
6.84
Pre-assertiveness A 31.00
3.13
18 0.80
C
29.33
5.98
39
Table 2 (continued)
Measure
Group Me an SD df t
Pre-self-concept B 58.78 10.17
16
-0.29
C 60.22
10.63
Pre-anxiety B 22.56 11.11
16
-0.37
C 24.56 12.08
Pre-depression B 14.22 7.86
16 0.26
C
13.33
6.84
Pre-assertiveness B 30.00
6.23
16
0.23
C
29.33
5.98
40
assertion training experience (see Table 3). The experi
mental group had less time in the program in terms of days
in treatment than the control group.
Comparison of drop-outs and completors. There were no
significant differences between drop-outs (N = 7) and com
pletors (N = 29) on pre-treatment measures of self-concept,
anxiety and assertiveness, as seen in Table 4. There was
a significant difference in depression scores =
-2.18, p _< .05). Drop-outs were significantly less de
pressed than completors at the time of pretesting. There
were no significant differences between drop-outs and com
pletors in terms of their demographic information. Of
note, however, is that of the seven drop-outs, five were in
the first stage (within the first 90 days of treatment)
(71 percent as compared to 55 percent for completors).
Reliability scores of measures used in study. Using
Cronbach's coefficient Alpha reliability scores were ob
tained and are found in Table 5. Included in the table is
a comparison of reliabilities found in the studies dis
cussed in Chapter 3.
Comparison of experimental and control groups at
posttest. t-tests were again run comparing posttest scores
on each of the experimental and control groups (see
Table 6). Once again it was found that experimental
41
Demographic
Experimental
Table 3
Information
and Control
N=29*
for the
Groups
Experimental
Group
N=20
Control Group
N=9
N % X N % X
Sex
Male 14
70.7 5
55.6
Female 6
29.3
4 44.4
Age
Male and Female 31.4** 35.2**
Ethnicity
Caucasian 11 53.0
5
55.6
Black 2 22.2 2 22.2
Hispanic 7 35.9
2 22.2
Education
Less than High
School 10
50.5
2 22.2
High School
Diploma 2 18.2 6
66.7
Some College 8 40.4 1 11.1
Previous Treatment
Yes
13
64.1
5
55.6
No
7 35.9
4 44.4
Length in Program
90 Days or Less
15 76.3 5 55.5
More than 90 Days
5
23.8 4 44.4
Assertion Training
Yes 3 15.7
1 11.1
No
17
84.4 8
88.9
Marital Status
Single
7 34.9 5
55.6
Married 4 20.2 1 11.1
Separated/Divorced
9 45.0
3 33.3
42
Table 3 (continued)
Experimental Control Group
Group
N=20
N=9
N % X N % X
Annual Income
Less than $10,000 14 68.7 8
88.9
More than $10,000 6 25.8 1 11.1
*Those completing the study
**Range 21-53
43
Table 4
t-test Summary of Pre-test Scores
Drop-outs and Completors
for
Measure Drop
N
-outs
= 7
Completors
N=29
Mean SD Mean SD t
Pre-self-concept 60.14 9.30 60.48 8. 42
-0.09
Pre-anxiety
21. 71 8.73 21.65
10.58 0.01
Pre-depression
7.43 4.43
13.00 6.38 -2.18*
Pre-assertiveness
27.43
5. 38
30.17 5.03 -1.2 8
P■ < •°5
df = 34
Table 5
Cronbach*s Coefficient Alpha Comparison of
Reliability Scores for Measures
Used in the Study
Measures Alpha Other Reliabilities
Taylor Manifest Anxiety
Scale
Beck Depression Inventory
Tennessee Self-Concept
Scale (short form)
Rathus Assertiveness
Schedule
45
0.92 0.88 (Taylor, 1953)
0.72 0.86 (Beck, 1972)
0.78 0.90 (Fitts, 1965)
0.56 0.78 (Rathus, 1973)
Table 6
t-test Summary on all Possible Comparisons
of Experimental and Control
Groups at Posttest
Measure Group Mean SD df 1
Post-self-concept A 69.91 8.30
18 1
.59
B 65.22 3.30
Post-anxlety A 14.00
7.27
18 -1 .16
B 17.00
7.75
Post-depressIon A 4.82
3.43
18 -1 .78
B
8.33
5.34
Post-assertiveness A 29.64
3.59
18 0,60
B
28.33
6.06
Post-self-concept A
69.91
8.30
18 2.30*
C 61.78 ' 7.26
Post-anxiety A 14.00
7.27
18 -1. 71
C 20.11 8.72
Post-depression A 4.82
3.43
18 -1. 99
C 8.67 5.17
Post-assertiveness A 29.64
3.59
18 -0.54
C 31.00
7.37
46
Table 6 (continued)
Measure ' Group Mean SD df t
Post-self-concept B 65.22
3.31
16 1.30
C 61.78 7.26
Post-anxlety B
17-89 7.75
16
-0.57
C 20.11 8.72
Post-depressIon B
8.33 5.34
16
-0.13
C 8.67 5.17
Post-assertiveness B
28.33
6.06
16 -0.84
C 31.00
7.37
*p < .05
47
groups A and B did not differ significantly on posttest
scores. Therefore, both groups were combined for further
analysis.
Hypothesis I
Those individuals in a long-term residential drug
treatment program receiving group assertion training will
show significantly more improvement in self-concept as
measured by the Tennessee Self-Concept Scale (short form)
than do similar individuals not receiving group assertion
training.
Table 7 shows the results of the Analysis of Co-
variance of the TSCS (short form) scores. As can be seen,
there was a significant difference in the expected direc
tion between the experimental and control group =
6.40, p < _ .01). Based on the results presented in Table 75
Hypothesis I was supported.
Hypothesis II
Those individuals in a long-term residential drug
treatment program receiving group assertion training will
show significant decreases in anxiety and depression as
measured by the Taylor Manifest Anxiety Scale and the Beck
Depression Inventory than do similar individuals not re
ceiving group assertion training.
48
Table
7
Analysis of Covariance
Scores as the
Using Pre-test
Covariate
Measure Source of Variance Sum of Squares Mean Square f
Self-Concept Covariate
pre-self-concept
Main Effects
group
459.37
211.82
459.37
211.82
13.88
6.40*
Anxiety Covariate
pre-anxiety
Main Effects
group
1327.24
16.96
1327.24
16.96
73.96
,0-95
Depression Covariate
pre-depression
Main Effects
group
113.05
27.79
113.05
27.79
5 • 74.
1.4l
Assertiveness Covariate
pre-assertiveness
Main Effects
group
323.63
48.34
323.63
48.34
16.29
2.43
-£r
VO
*
1 A
.01, df = 1
Although improvement in the predicted direction was
made by both groups, no significant differences in anxiety
or depression were found between the experimental and con
trol groups (see Table 6). Therefore, Hypothesis II was
not confirmed.
Hypothesis III
Those individuals in a long-term residential drug
treatment program receiving group assertion training will
become significantly more assertive as measured by the
Rathus Assertiveness Schedule than similar individuals not
receiving group assertion training.
Data from the assertiveness schedule indicate that
there is no significant differences between the experi
mental and control groups (see Table 6). Therefore,
Hypothesis III was not supported.
Summary of Questionnaire
An open-ended questionnaire was filled out by those
individuals completing group assertion training. There was
a possibility of 20 responses for each of the six questions
asked. Nineteen out of twenty (95 percent) responded that
the group was helpful. The following statements are in=-
dicative of how individuals perceived the group experience:
I liked the way I had opportunity to partici
pate. It helped me to know myself better.
50
The way you can get your point across without
getting aggressive or hurting the other person’s
feelings. The different ways of asserting yourself.
Learning how to express what you have to say and not
be afraid of looking or sounding foolish.
I like the way the people who ran the Assertion
Class explain everything. I know I received help in
showing me how to express myself a little more.
Off the top I liked the fact that I was doing
something to improve my mind. I was learning some
thing that I could take out of here and use in my day
to day living situations. I can see that there is a
better way of obtaining what I want than the methods
I have used in the past. I believe that the role
playing was the most helpful tool used. By doing this
I was able to practice and actually see how what I was
learning worked.
The only negative response was that the homework assign
ments were difficult to remember to do during the week.
Some of the most helpful skills learned in the assertion
training were: (1) getting one’s point across; (2) how to
be assertive in different ways; (3) learning to communicate
clearly; (4) learning the difference between assertion and
aggression; (5) how to say "no" in an assertive way; (6)
how to get what you want in a more constructive manner; (7)
learning about personal rights; and (8) learning to be more
tactful. The least helpful were the ’ ’whips” at the end of
the sessions and the homework which was difficult to ac
complish during the day. One individual felt he ’ ’ was out
of it” by the time his evening session started, and another
wanted more time. Out of 20 responses, the overwhelming
consensus was that the group leaders were skilled, well
51
prepared, were good models, instilled confidence, and were
seen as caring, patient, empathic and concerned persons.
Again, the overwhelming consensus was that assertion tech
niques should be a part of on-going treatment in the drug
program. All participants of the assertion training groups
felt that they were using what they had learned either in
practice with their peers or in terms of the confidence
they felt they had gained.
Pis cussion
In this study, it appears that assertion training was
successful in raising self-concept as measured by the
TSCS (short form). The following responses taken from the
questionnaire also suggest that assertion training helps
an individual feel better about him/herself.
. . . it helps make me feel better about what
ever I’m doing.
. . . I feel I have more confidence in asking
for what I need.
I learned that I can take positions with people
in different ways. And feel good about it.
These findings are in accord with previous authors who have
suggested that assertion training is successful in enhanc
ing an individual’s self-concept. Alberti and Emmons
(1972) believe that assertive behavior, the honest expres
sion of feelings and choosing for oneself how to act is
self-enhancing and typically allows a person to feel good
________________________________________________________________________ 52_
about him/herself. On the other hand, it is possible that
the significant difference in self-concept scores between
experimental and control groups is due to a variety of
variables such as the "Hawthorne Effect" (improvement in
performance due to the special attention given to the
assertion training groups). The difference between groups
may also be due to measurement error or environmental situ
ations not under the control of the experimentor.
Assertion training has been thought to be effective in
decreasing anxiety and depression (Alberti and Emmons,
1972; Percell, 1973; Hayman and Cope, 1980; and Sanchez
et al., 1980). Although the results from this investi
gation did not completely support this view, decreases,
while not significant, were in the expected direction. It
may be that individuals in this study were not sufficiently
anxious or depressed enough for significant decreases to be
made. It could also be that the TMAS and BDI may not have
been sensitive enough to detect subtle individual changes
in manifest anxiety and depression. The small sample size
may very well have precluded any possibility for signifi
cance to be found. Or, it may be that the treatment was
not effective in relieving these symptoms in drug addicts.
Results indicated that individuals receiving group
assertion training did not improve in assertiveness over
individuals not receiving group assertion training. This
53
is contrary to results of studies with other populations.
Once again there are a number of possible reasons including
those already mentioned why no significant differences in
assertiveness were found in this study. Measurement issues
may be very important. Addicts tend to come from different
SES and ethnic backgrounds than subjects utilized in other
studies. The reading level of the RAS may be an important
issue. In a study by Andrasik, Heimberg, Edlund and
Blankenberg (1981) reading levels were obtained for several
commonly employed self-report assertion inventories. It
was found that directions for the RAS have a reading level
from 10-12 grade. For items in the inventory, a 7th grade
reading level is required. The ability to read self-report
measures is critical when dealing with the addict popula
tion where individuals have generally not finished high
school (41.1 percent in this study).
Whether or not significant changes were reported for
the assertion training groups, those individuals who par
ticipated, when asked if they were in favor of using
assertive techniques as a part of their regular treatment
program replied:
I would have to say yes because of the positive
ness that goes along with assertion and that might
help us to be more understanding towards each other.
Yes, it gives us a chance to exercise the way
we should represent ourselves on the streets.
54
I think it should be a regular activity, role-
playing situations thru the week. Being able to let
out how we really feel about any given situation with
out worrying about repercussions and find different
ways to deal with the situation.
Yes, most certainly. I think one of the areas
most addicts lack in the most is how to communicate
in a mature way. I know it has been one of my biggest
problems. Most of us are either door mats or we run
all over everyone. Just the fact that there is an
alternative way to go has been a big help.
Concensus was overwhelmingly in favor of assertion training
and statements such as these seem to express the need for
more opportunities for people' in the sample to learn
assertive skills.
Results of this study should be viewed with caution
as they may have been confounded by: (1) small sample
size; (2) contamination of the control group due to the
"live-in” treatment facility; (3) holding of groups in the
evening with subjects who may have been less attentive than
*
earlier in the day; (4) use of measures which are self-
report instruments and rely on an individual’s ability to
realistically assess his/her attributes in a given area;
and (5) other external variables for which the experimentor
could not control.
Although the subjects were randomized, the sample con
sisted of the total population of the drug treatment pro
gram, i.e., the sum of the experimental plus control
groups. Therefore, results cannot be generalized to the
larger drug population. However, Wilk and Kemthorne have
_____________________________________________________________ 55
stated that, "Possible underestimation of significance is
greatest when there are only two experimental conditions
and all available subjects are used" (cf. Campbell and
Stanley, 1963, p. 24).
56
Chapter 5
SUMMARY, CONCLUSIONS, RECOMMENDATIONS
The purpose of this study was to investigate the
effects of group assertion training on anxiety, depression,
self-concept and assertiveness in a drug addict population
within a residential treatment center. The specific
question to be answered was whether persons in a residen
tial drug treatment program receiving group assertion
training would become significantly less anxious and de
pressed, raise their self-concept and become more assertive
than those individuals in the program who did not receive
group assertion.
A review of the literature suggested that heroin
addiction is an "abnormal1 1 behavior whose etiology can be
explained by personality variables such as insecurity, poor
self-esteem, anxiety, depression, aggression and socio-
pathy (Krasnegor, 1977)* Studies show that addicts have
higher levels of anxiety, depression, insecurity, feelings
of inadequacy and more difficulty with interpersonal re
lationships than nonpsychopathological populations. In
recent years, assertion training has received increasing
attention as a behavior procedure for alleviating undue
anxiety, depression and stress related to social situations
57
as well as a method for enhancing self-esteem.
Although assertion training has been used in a variety
of settings, very little research has been done with drug
addicts. The two studies available suggest that heroin
addicts are less assertive than non-addict populations and
that group assertion training may be successful in allevi
ating social anxiety and developing assertive skills.
Methodology
This study employed a nonequivalent, quasi-experi-
mental pretest-posttest control group design. The design
included two experimental and one control groups. Subjects
in the study consisted of the entire population of heroin
addicts in a long-term drug treatment program during
August-September 1981. All referrals to the program were
at least 18 years old and had voluntarily admitted them
selves for treatment. Subjects were randomly assigned to
groups by sex. Twenty-nine of the original thirty-six
subjects completed the study (group A = 11, group B = 9*
group C = 9). The seven drop-outs left the study and the
drug program.
Data Analysis
t-tests were run comparing experimental and control
groups at pretest and again at posttest. Drop-outs and
completors were also compared through t-test analysis on
58
pretest scores. Cronbach's Alpha was utilized to assess
the reliability of the four measures used in the study.
ANCOVATs were calculated on the measurements of anxiety,
depression, self-concept and assertiveness with pretest
scores as the covariate.
Summary of Findings
It appears that group assertion training was success
ful in raising self-concept in subjects participating in
group assertion training as measured by the TSCS (short
form). Responses from the questionnaire also suggest that
group assertion training helps individuals feel better
about themselves. These findings are in accord with
previous authors who have suggested that assertion training
is successful in enhancing an individuals self-concept.
Although assertion training has been thought to be
effective in decreasing anxiety and depression, the results
from this investigation did not completely support this
view. However, gains made were in the expected direction.
Contrary to the results of other studies, individuals
in this investigation receiving group assertion training
did not improve in assertiveness over those individuals
not receiving group assertion.
Whether or not significant improvements were reported
for the assertion training group, responses from the self-
report questionnaire were overwhelmingly in favor of
59
assertion training and the need for more opportunities for
the individuals in this study to learn assertive skills.
Conclusions
Of the three hypotheses proposed in this study, only
Hypothesis I, which stated that there would be a signifi
cant improvement in self-concept for those individuals in
group assertion training as compared to the control group,
was supported (p _< .05). However, the fact that the
assertion training groups were receiving special attention
cannot be overlooked as a possible source of improvement.
It has been generally found that high self-esteem
individuals have healthier personalities and more warmth
and openness in their interpersonal interactions (Fitts,
Adams, Radford, Richard, Thomas, Thomas and Thompson,
1971)• Fitts et al. suggest that self-concept is most
affected by: (1) experiences, especially interpersonal
experiences which generate positive feelings and a sense
of worth; (2) competence in areas valued by the individual
and others; and (3) the ability to realize one's true
potential. There seems to be a relationship between an
individual's perception of self and the way he/she reacts
to life's events. Individuals who feel good about them
selves are able to use both positive and negative experi
ences to enhance their psychological growth while indivi
duals with negative feelings about themselves tend to be
60
more defensive and wary of life. It has also been found
that individuals with a high frequency of positive experi
ences are more likely to have a positive self-concept.
Fittsaet al. (1971) also suggest that the rehabilitative
process is an attempt to change behavior so that it is more
positive and constructive for both the individual and
society. In the same vein, the cognitive restructuring
process discussed by Lange and Jakubowski (1979) endeavors
to identify and change those thinking patterns which lead
to ineffective behaviors. In addition to helping indivi
duals acquire assertive skills, the process encourages the
development of a basic belief system that assertion, rather
than manipulation, submission or hostility enriches the
person’s life and ultimately leads to more satisfying per
sonal relationships with others. It seems that in terms
of this study, an important step has been taken in the
restructuring process, that is, the ability for those in
dividuals participating in the group assertion training to
perceive themselves in a more positive way. According to
Lange and Jakubowski (1979) and Fitts, et al. (1971) this
is the basic ingredient that is needed for an individual to
change his or her behavior so that it is more beneficial to
the individual and society.
61
Re commendat ions
Before concluding, some recommendations for future
research are in order. One of the criticisms made by the
experimentor in reviewing the literature was that little
research explored the specific dynamics and needs of the
female addict. Unfortunately, due to the few women in this
study, this question, once again, was not addressed. It
is the feeling of this investigator that the issue of
female addiction is a critical area and needs greater ex
ploration .
Most research measures have been developed for and
utilized with non-addict populations (i.e., college stu
dents and psychiatric patients) and lack adequate data as
to their appropriateness with the drug population. In some
instances, directions on the measures are difficult to
understand. The fact that some measures (as was found with
the RAS) have reading levels which may be above that of the
general addict population suggests their inability to ade
quately assess the specific variables in question. Either
research measurements designed specifically for the addict
need to be developed, or the reading levels of existing
instruments need to be reevaluated in terms of their use
fulness within a larger population.
This study appears to lend support to the use of group
assertion training as a viable procedure with drug addicts,
62
specifically in enhancing their self-concept. Overwhelm
ingly, participants in this study reported that they had
had a positive learning experience. As Fitts, et al.
(1971) suggest, positive experiences are more likely to
have a positive effect on self-concept, and self-concept
may be one of the more important variables in the rehabili
tative process. Since this study seems to be one of the
very few conducted in the area of assertion training with
drug addicts, the question of whether assertion training
can be used effectively in the treatment of drug addiction
remains a fertile area. Any effective rehabilitation pro
gram must focus on the greatest resource in the rehabili
tation process, that is, the individual himself or herself.
Many rehabilitation plans fail because the individual is
unable to actualize his or her own potentialities. If
self-concept somehow cuts across or captures the essence
of other variables (motives, needs, attitudes, values,
personality) and if self-concept is a means of understand
ing and predicting behavior (as Fitts, et al. [1971]
imply) then it should be a significant variable in the
process of rehabilitation.
Most studies using assertion training show improve
ments in assertiveness and self-concept after treatment;
however, few follow-up studies have been conducted to
ascertain long-term gains. More important to the
63
rehabilitation of addicts is whether treatment efforts
contribute to the individuals ability to live a "drug
free" productive life. Treatment goals extend far beyond
the mere reduction of drug use. They include goals to
improve an individuals employment status, to decrease
criminal behavior, widen non-drug-related social contacts,
and to improve physical and mental health. Follow-up data
with drug addicts in terms of treatment effectiveness is
almost nonexistent. Such information would assist treat
ment programs in assessing long-term gains, developing
program goals and revising treatment emphasis in terms of
the quantity and types of services rendered. Treatment
programs may be highly effective in attaining desired goals
while clients are actively involved in the program, but may
fail when the client returns to nonsupportive or destruc
tive environments. Assessment of outcome immediately after
treatment has ended and then again during a follow-up
period much more clearly separates the dynamics of improve
ment and the elements contributing to an individuals re
lapse. Without such data, drug treatment programs cannot
effectively use their time and resources to the fullest
extent.
64
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65
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351-360. —
Sutker, P. B. Personality differences and sociopathy in
heroin addicts and nonaddict prisoners. Journal of
Abnormal Psychology, 1971, . 8, 247-251.
Sutker, P. B., and Allain, A. M. Incarcerated and street
heroin addicts: a personality comparison. Psycho
logic a! Reports, 1973, _3_2, 243-246.
Taylor, J. A. A personality scale of manifest anxiety.
Journal of Abnormal and Social Psychology, 1953, 48,
285-290,
Vaillant, G. E. Sociopathy as a human process. Archives
of General Psychiatry, 1975, _22, 178-183.
Wallace, C. J. The effects of delayed rewards, social
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U. S. Department of Health, Education and Welfare
Publication No. [ADM] 79-839). Rockville, Maryland:
U. S. Government Printing Office, 1979.
Wilkening, H. E. The Psychology Almanac. Monterey,
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Wolpe, J., and Lazarus, A. A. Behavioral Therapy Tech
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Wurmser, L. Drug abuse: nemesis of psychiatry. Inter
national Journal of Psychiatry, 1972, 10, 97-107.
12
APPENDICES
73
APPENDIX A
OUTLINE OF GROUP ASSERTION TRAINING SESSIONS
The following outline is modeled after the recommended exercises found
in Lange and Jakubowski's (1979) book, Responsible Assertive Behavior.
Week 1
A. Introductions
Who are we?
Who are they?
What do they expect?
B. Overview of Assertion
What is assertion? A semistructured training approach with an
emphasis on acquiring assertive skills through:
1. teaching the difference between assertion, aggression, non
assertion and politeness;
2. helping identify and accept both personal rights and the rights
of others;
3. reducing existing cognitive and affective obstacles to acting
assertively (excessive anxiety, irrational thinking, guilt,
anger);
4. developing assertive skills through active participation.
C. What can it do for you? It can help you to:
1. recognize own aggressive and nonassertive responses to specific
situations;
2. develop a wider repertoire of assertive responses;
3. maintain a belief system which values personal rights as well
as the rights of others;
4. help change irrational thinking;
5. feel less anxious and more self-confident in situations which
require assertive behavior;
6. encourage others to be equally assertive.
D. Distinguish between assertion-aggression-nonassertion.
1. Assertion— involves standing up for personal rights and expression
of thoughts, feelings, and beliefs in direct, honest, appropriate
ways which respect the rights of others.
2. Aggression— involves self-expression which violates other’s rights
and demeans others in an attempt to achieve one’s own objectives.
75
- 2 -
3. Nonassertion— involves behavior which violates one’s own self by
failing to express honest feelings or thoughts. It may also in
volve apologetic, diffident or effacing expression of personal
rights or preferences.
E. Discussion of nonverbal behavior (eye contact, body gestures,
patterns of speech).
1. Nonassertive— evasive eye contact, body gestures such as hand
wringing, stepping back from an assertive remark, voice may be
soft, speech hesitant, inappropriate laugh and wink when ex
pressing anger.
2. Aggressive— behavior which dominates, sarcastic or condescending
tone of voice, finger pointing, eye contact that tries to stare
down a person.
3. Assertive— nonverbal behavior congruent with verbal messages and
add support, strength and emphasis to what is being verbalized,
eye contact firm but not a stare-down, voice appropriately loud,
speech pattern is fluent, body gestures denote strength.
F. Summary of preceding materials and time for questions.
G. Whip— time for questions, thoughts, feelings; time for group members
to express how they feel— go around group so each member has an
opportunity to share.
H. Homework: pay attention to times you do or do not assert yourself
during the next week.
Week 2
Whip of names
Homework sharing-
1. What was the outcome?
2. Was it difficult to be assertive?
3. Did you get what you expected?
4. Reaction of others?
5. How did you feel about yourself?
C. Review of any necessary items from the first week.
76
- 3 -
D. Inane Topics Exercise (Purpose of exercise is to recognize which
behaviors people react to in others and to learn what others like
about how they "come across.”)
1. One person will talk while two others listen. The primary
learning occurs as a ''listener” in this exercise.
2. The trainer writes inane topics on slips of paper (such as
pegsj watches, lint, etc.). An individual randomly selects a
topic and talks for 1-1/2 minutes. The two listeners are asked
to be attentive but not to speak, instead should identify the
nonverbal behaviors that are holding their attention. After
all three persons have spoken, each receives positive behavioral
feedback on how the person behaved rather than what the person
said (focus is on nonverbal behavior).
3• Process
What was it like? How did you feel?
4. Key points
Even though it may have been a "dumb” topic, they were able to
talk for 1-1/2 minutes, so they could do it with an important
topic.
Learn to identify nonverbal behaviors person uses, consider
behaviors person might want to change during group.
Teach members to give specific behavior feedback.
E. Highlight Basic Rights— brainstorm on blackboard— -compare "street”
rights with ”jailhouse” rights.
1. We have the right to respect from others.
2. We have the right to have needs and to have these needs be as
important as other’s needs. Moreover, we have the right to ask
(not demand) that other people respond to our needs and to
decide whether we will take care of other people’s needs.
3. We have the right to have feelings and to express these feelings
in ways which do not violate the dignity of other people (e.g.
the right to feel tired, happy, depressed, angry, sexy, lonely,
silly).
4. We have the right to decide whether we will meet other people's
expectations or whether we will act in ways which fit us, as
long as we act in ways which do not violate other people’s rights.
5. We have the right to form our own opinions and to express these
opinions.
77
- 4 -
P. Whip— sharing feelings, thoughts, ask questions
G. Homework
1. Be aware of your basic rights and which may be being violated.
2. Give three compliments per day for a week.
Week 3
A. Whip of names
B. Discuss homework
C. Review of Week 2— basic rights
D. Role play by leaders on basic rights
1. Which one is being violated?
2. Discussion
E. New Information— "how to's" of Basic Assertion.
Basic assertion refers to a simple expression of standing up for
personal rights, beliefs, feelings or opinions as well as affection
and appreciation.
1. Empathic Assertion— involves making a statement that conveys
recognition of the other individual's situation or feelings and
is followed by a statement which stands up for the speaker's
rights. (e.g.,I know it's difficult to tell me exactly when
the delivery will be made, but I'd like to have an estimate of
the arrival time.)
2. Escalating Assertion— -involves starting with a "minimal"
assertive response that can usually accomplish the speaker's
goal but allows for the possibility to increase assertiveness
when the other individual fails to respond. (e.g.,(l) No thank
you! (2) We really would rather just talk. Thanks, anyway!
(3) This is the last time I am going to tell you that we don't
want your company!)
3. Confrontive Assertion— involves objectively describing what the
other individual said would be done, what he or she actually did
do, after which the speaker expresses what he or she wants. It
is said in a matter-of-fact, nonevaluative manner. (e.g., I
said it was OK to borrow ray records as long as you checked with
me first. Now you're playing my new albums without asking. I'd
like to know why you did that.)
78
- 5 -
P. Discussion and role-playing of basic assertions
G. Homework: Notice if or when others use the basic assertive messages
with you. Attend to your feelings and thoughts in the
situation.
H. Whip— questions, feelings, thoughts, sharing
Week 4
A. Review of homework
B. Review of "how to's" with "1" language assertion.
"1" language helps the individual to determine when his or her
feelings stem from some violation of his or her rights and feelings
or whether their negative feelings are due to the imposition of
their own values and expectations on other people. It involves a
four-part statement:
When .... (speaker objectively describes the other person's
behavior)
The effects are .... (how other person's behavior affects
speaker)
I feel .... (speaker describes feelings)
I'd prefer .... (speaker describes what is wanted)
(1) Discussion
(2) Modeling
C. Review the fine basic assertions
D. Role-playing
1. A staff member or peer leader assigns an unfair discipline
(there were extenuating circumstances). The higher-up is
receptive but still questioning.
Process and Discussion
2. A family member or friend doesn't want to come and visit you—
it's depressing for them to see you inside— you try to convince
them to come.
Process and Discussion
3. One of your peers wants to borrow something for a visit but the
other person makes excuses.
Process and Discussion
79
- 6 -
E. Review of Session
P. Homework: try out the different types of assertive behaviors
(3 basic assertions and "1" language).
G. Whip— questions, feelings, thoughts, sharing
Week 5
A. Discuss homework
B. Overview of "irrational ideas"— Cognitive Restructuring.
Cognitive restructuring is the process by which individuals become
aware of their own thought processes which lead to ineffectual
behaviors and change these thought processes to more productive
ones. There are three basic steps to the process:
1. Identify the specific assertion situation clearly, determining
its appropriateness for assertion training and help group
members set their own goals for that situation;
2. Use cognitive behavioral techniques, intervention techniques;
and
3. Identify one's personal rights in the situation.
Outcome goals include:
(1) to reduce anxiety in the situation;
(2) to help individuals develop a belief system which values
their personal rights and those of others;
(3) to increase the individual's repertoire of effective
responses;
(4) .to teach individuals to recognize irrational assumptions
and catastrophizing and to replace these with rational
assumptions ana expectations; and
(5) to help individuals develop their own cognitive capabilities
to behave more assertively.
80
- . 7 -
C. Rational Emotive' Theory - The A-E-G Paradign
A-B-C A-B-C-D-E
A - upsetting activity A - upsetting activity
B - irrational belief B - irrational belief
C - consequences— anxiety, C - consequences— anxiety, depression,
depression, despair, despair, guilt, rage
guilt, rage
D - challenge any irrational belief—
see if connected to nonassertive
behavior
E - substitute more rational ideas—
and assertive behavior
D. Group discussion
E. Homework: focus on the things you tell yourself; focus on thoughts
when you assert yourself.
F. Whip— questions, feelings, thoughts, sharing
Weeks 6-8
A. Review homework
B. Role-playing
1. Work on situations of concern
2. Process and discussion
G. Individuals make positive self statements for one minute and hear
positive statements from others for two minutes.
D. Identify potential reinforcers and sources of support for assertive
behavior outside the group that each member might use when group ends
E. Homework: continue to practice assertive skills and to report
1. outcome,
2. feelings,
3. thoughts that interfered with being assertive.
F. Whip— questions, feelings, thoughts, sharing
81
APPENDIX B
TAYLOR MANIFEST ANXIETY SCALE
82
Code #_____________
Date ____________
DIRECTIONS: ANSWER EACH OP THE FOLLOWING QUESTIONS AS THEY RELATE TO YOU.
(T) True, if it is descriptive of you.
(F) False, if it is not descriptive of you.
1. I do not tire quickly.
2. I am troubled by attacks of nausea.
3-
I believe I am no more nervous than most others,
4. I have very few headaches.-
5.
I work under a great deal of tension.
6. I cannot keep my mind on one thing.
7. I worry over money and business.
8. I frequently notice my hand shake when I try to do something.
9. I blush no more often than others.
10. I have diarrhea once a month or more.
11. I worry quite a bit over possible misfortunes.
12. I practically never blush.
13. I am often afraid that I am going to blush.
14. I have nightmares every few nights.
15. My hands and feet are usually warm enough.
16. I sweat very easily even on cool days.
17. Sometimes when embarrassed, I break out in a sweat
me greatly.
which annoy;
18. I hardly ever notice my heart pounding and I am
breath.
seldom short 0:
19. I feel hungry almost all the time.
20. I am very seldom troubled by constipation.
21. I have a great deal of stomach trouble.
22. I have had periods in which I lost sleep over worry.
23. My sleep is fitful and disturbed.
24. I dream frequently about things that are best kept to myself.
83
Code §
Date
— --
25. I am easily embarrassed.
— --
26. I am more sensitive than most other people.
__,
27. I frequently find myself worrying about something.
— --
28 . I wish I could be as happy as others seem to be.
—^ — —
29. I am usually calm and not easily upset.
30. I cry easily.
___
31. I feel anxiety about something or someone almost all the time.
32. I am happy most of the time.
-- 33. It makes me nervous to have to wait.
— -
34. I have periods of such great restlessness that I cannot sit long
in a chair.
_ _ 35. Sometimes I become so excited that I find it hard to go to sleep.
— _
36. I have sometimes felt that difficulties were piling up so high
that I could not overcome them.
—
37. I must admit that I have at times been worried beyond reason
over something that really did not matter.
- -
38. I have very few fears compared to my friends.
— -
39. I have been afraid of things or people that I know could not
hurt me.
___
40. I certainly feel useless at times.
_ ---
41. I find it hard to keep my mind on a task or job.
- •
42. I am unusually self-conscious.
43. I am inclined to take things hard.
44. I am a high-strung person.
— 45. Life is a strain for me much of the time.
46. At times I think I am no good at all.
- -
47. I am certainly lacking in self-confidence.
' --
48. I sometimes feel that I am about to go to pieces.
---
49. I shrink from facing a crisis or difficulty.
50. I am entirely self-confident.
84
APPENDIX C
BECK DEPRESSION INVENTORY
85
Co de #
Date
On this questionnaire are groups of statements. Please read each group
of statements carefully. Then pick out the one statement in each group
which best describes the way you have been feeling the PAST WEEK, IN
CLUDING TODAY! Circle the number beside the statement you picked. If
several statements in the group seem to apply equally well, circle each
one. Be sure to read all the statements in each group before making
your choice.
1 I DO NOT PEEL SAD.
2 I PEEL SAD.
3 I AM SAD ALL THE TIME AND
I CAN’T SNAP OUT OP IT.
4 I AM SO SAD OR UNHAPPY
THAT I CAN’T STAND IT.
1 I GET AS MUCH SATISFACTION OUT
OF THINGS AS I USED TO.
2 I DON’T ENJOY THINGS THE WAY
I USED TO.
3 I DON’T GET REAL SATISFACTION
OUT OF ANYTHING ANYMORE.
4 I AM DISSATISFIED OR BORED
WITH EVERYTHING.
1 I AM NOT PARTICULARLY DIS
COURAGED ABOUT THE FUTURE.
2 I FEEL DISCOURAGED ABOUT
THE FUTURE.
3 I PEEL I HAVE NOTHING TO
LOOK FORWARD TO.
4 I PEEL THAT THE FUTURE IS
HOPELESS AND THAT THINGS
CANNOT IMPROVE.
1 I DON’T FEEL PARTICULARLY
GUILTY.
2 I FEEL GUILTY A GOOD PART
OF THE TIME.
3 I PEEL QUITE GUILTY MOST OF
THE TIME.
4 I FEEL GUILTY ALL OF THE TIME.
1 I DO NOT FEEL LIKE A
FAILURE.
2 I FEEL I HAVE FAILED MORE
THAN THE AVERAGE PERSON.
3 AS I LOOK BACK ON MY LIFE,
ALL I CAN SEE IS A LOT OF
failures.
4 I FEEL I AM A COMPLETE
FAILURE AS A PERSON.
1 I DON’T FEEL I AM BEING
PUNISHED.
2 I FEEL I MAY BE PUNISHED.
3 I EXPECT TO BE PUNISHED.
4 I FEEL I AM BEING PUNISHED.
1 I DON’T FEEL DISAPPOINTED IN
MYSELF.
2 I AM DISAPPOINTED IN MYSELF.
3 I AM DISGUSTED WITH MYSELF.
4 I HATE MYSELF.
86
Code it
Date
1 I DON'T PEEL I AM ANY WORSE
THAN ANYBODY ELSE.
2 I AM CRITICAL OP MYSELP POP.
MY WEAKNESSES OR MISTAKES.
3 I BLAME MYSELP ALL THE TIME
FOR MY FAULTS.
4 I BLAME MYSELP FOR EVERY
THING BAD THAT HAPPENS.
1 I HAVE NOT LOST INTEREST IN
OTHER PEOPLE.
2 I AM LESS INTERESTED IN OTHER
PEOPLE THAN I USED TO BE.
3 I HAVE LOST MOST OF MY
INTEREST IN OTHER PEOPLE.
4 I HAVE LOST ALL OF MY INTEREST
IN OTHER PEOPLE.
1 I DON'T HAVE ANY THOUGHTS
OP KILLING MYSELP.
2 I HAVE THOUGHTS OF KILLING
MYSELF-, BUT I WOULD NOT
CARRY THEM OUT.
3 I WOULD LIKE TO KILL MYSELP.
4 I WOULD KILL MYSELP IF I HAD
THE CHANCE.
1 I MAKE DECISIONS ABOUT AS
WELL AS I EVER COULD.
2 I PUT OFF MAKING DECISIONS
MORE THAN I USED TO.
3 I HAVE GREATER DIFFICULTY JN
MAKING DECISIONS THAN BEFORE.
4 I CAN'T MAKE DECISIONS AT
ALL ANYMORE.
1 I DON’T CRY ANYMORE THAN
USUAL.
2 I CRY MORE NOW- THAN I
USED TO.
3 I CRY ALL THE TIME NOW.
4 I USED TO BE ABLE TO CRY,
BUT NOW I CAN’T CRY EVEN
THOUGH I WANT TO.
1 I DON'T FEEL I LOOK ANY WORSE
THAN I USED TO.
2 I AM WORRIED THAT I AM LOOKING
OLD OR UNATTRACTIVE.
3 I FEEL THAT THERE ARE PERMANENT
CHANGES IN MY APPEARANCE THAT
MAKE ME LOOK UNATTRACTIVE.
4 I BELIEVE THAT I LOOK UGLY.
1 I AM NO MORE IRRITATED NOW
THAN I EVER AM.
2 I GET ANNOYED OR IRRITATED
MORE EASILY THAN I USED TO.
3 - I FEEL IRRITATED ALL THE
TIME NOW.
4 I DON'T GET IRRITATED AT ALL
BY THE THINGS THAT USED TO
IRRITATE ME.
1 I CAN WORK ABOUT AS WELL AS
BEFORE.
2 IT TAKES AN EXTRA EFFORT TO
GET STARTED AT DOING SOMETHING.
3 I HAVE TO PUSH MYSELF VERY
HARD TO DO ANYTHING.
4 I CAN’T DO ANY WORK AT ALL.
87
Code #
Date
1 I CAN SLEEP AS WELL AS USUAL.
2 I DON'T SLEEP AS WELL AS I
USED TO.■
3 I WAKE UP 1-2 HOURS EARLIER
THAN USUAL AND FIND IT HARD
TO GET BACK TO SLEEP.
4 I WAKE UP SEVERAL HOURS
EARLIER THAN I USED TO AND
CANNOT GET BACK TO SLEEP.
1 I DON’T GET MORE TIRED THAN
USUAL.
2 I GET TIRED MORE EASILY THAN
I USED TO.
3 I GET TIRED FROM DOING
ALMOST ANYTHING.
4 I AM TOO TIRED TO DO ANYTHING.
1 MY APPETITE IS NO WORSE THAN
USUAL.
2 MY APPETITE IS NOT AS GOOD
AS IT USED TO BE.
3 MY APPETITE IS MUCH WORSE
NOW.
4 I HAVE NO APPETITE AT ALL
ANYMORE.
88
1 I HAVEN'T LOST MUCH WEIGHT,
IF ANY, LATELY.
2 I HAVE LOST MORE THAN 5
POUNDS.
3 I HAVE LOST MORE THAN 10
POUNDS.
4 I HAVE LOST MORE THAN 15
POUNDS. _________
1 I AM NO MORE WORRIED ABOUT MY
HEALTH THAN USUAL.
2 I AM WORRIED ABOUT PHYSICAL
PROBLEMS SUCH AS ACHES AND
PAINS; OR UPSET STOMACH; OR
CONSTIPATION.
3 I AM VERY WORRIED ABOUT
PHYSICAL PROBLEMS AND IT'S
HARD TO THINK OF MUCH ELSE.
4 I AM SO WORRIED ABOUT MY
PHYSICAL PROBLEMS, THAT I CAN
NOT THINK ABOUT ANYTHING ELSE.
1 I HAVE NOT NOTICED ANY RECENT
CHANGE IN MY INTEREST IN SEX.
2 I AM LESS INTERESTED IN SEX
THAN I USED TO BE.
3 I AM MUCH LESS INTERESTED IN
SEX NOW.
4 I HAVE LOST INTEREST IN SEX
COMPLETELY.
APPENDIX D
TENNESSEE SELF-CONCEPT SCALE
(SHORT FORM)
89
Code #
Date
The statements on this page are to help you describe yourself as you see
yourself. Please respond to them as if you were describing yourself to
yourself. Do not omit any item. Read each statement carefully; then
select one of the five responses listed below. Enter the response you
choose in the box to the left of the statement.
Responses
Completely Mostly Partly false, Mostly
false false partly true
1 2 3
true
4
1. I am a cheerful person.
2 . I am a calm and easy going person.
3. I am a nobody.
4. I am a hateful person.
5. I have a lot of self control.
6. I am losing my mind.
7. I am satisfied to be just what I am.
8. I am just as nice as I should be.
9.
T
J- despise myself.
10. I am as smart as I want to be.
11. I am not the person I would like to be.
12. I wish I didn't give up as easily as I do.
13.
I can always take care of myself in any situation.
14. I take the blame for things without getting mad.
15. I- do things without thinking about them first.
16. I solve my problems quite easily.
17. I change my mind a lot.
18. I try to run away from my problems.
Completely
true
5
90
APPENDIX E
RATHUS ASSERTIVENESS SCHEDULE
91
Code #
Date
DIRECTIONS: INDICATE HOW CHARACTERISTIC OR DESCRIPTIVE EACH OP THE FOLLOWING
STATEMENTS IS OF YOU BY USING THE CODE GIVEN BELOW.
+3 Very characteristic of me, extremely descriptive
+2 Rather characteristic of me, quite descriptive
+1 Somewhat characteristic of me, slightly descriptive
-1 Somewhat uncharacteristic of me, slightly descriptive
-2 Rather uncharacteristic of me, quite nondescriptive
-3 Very uncharacteristic of me, extremely nondescriptive
1. Most people seem to be more aggressive and assertive than I am.
2. I have hesitated to make or accept dates because of shyness.
3* When the food served at a restaurant is not done to my satisfaction
I complain about it to the waiter or waitress.
4. I am careful to avoid hurting other people's feelings, even when
I feel that I have been injured.
_ 5* If a salesman has gone to considerable trouble to show me
merchandise which is not quite suitable, I have a difficult
time in saying "No".
6. When I am asked to do something, I insist upon knowing why.
7- There are times when I look for' a good, vigorous argument.
8. I strive'to get ahead as well as. most people in my position.
. 9. To be honest, people often take advantage of me.
10. I enjoy starting conversations with new acquaintances and strangers
11. I often don't know what to say to attractive persons of the
opposite sex.
12. I will hesitate to make phone calls to business establishments
and institutions.
13. I would rather apply for a job or for admission to a college by
writing letters than by going through with personal interviews.
1*J. I find it embarrassing to return merchandise.
__ lb. If a close and respected relative were annoying-me, I would smother
my feelings rather than express my annoyance.
16. I have avoided asking questions for fear of sounding stupid.
92
Code #
Date
17. During an argument I am sometimes afraid that I will get so upset
that I will shake all over.
18. If a famed and respected lecturer makes a statement which I think
is incorrect, I will have the audience hear my point of view os
well.
19. I avoid arguing over prices with clerks and salesmen.
20. When I have done something important or worthwhile, I manage to
let others know about it.
21. I am open and frank about my feelings.
22. If someone has been spreading false and bad stories about me, I
see him/her as soon as possible to "have a talk" about it.
23. I often have a hard time saying "No".
2U. I tend to bottle up my emotions rather than make a scene.
25. I complain about poor service in a restaurant and elsewhere.
26. When I am given a compliment, I sometimes just don't know what
to say.
27. If a couple near me in the theater or at a lecture were conversing
rather loudly, I would ask them to be quiet or take their con
versation elsewhere.
28. Anyone attempting to push ahead of me in a line is in for a good
battle.
29. I am quick to express sin opinion.
30. There are times when I just can't say anything.
93
APPENDIX F
DEMOGRAPHIC INFORMATION
94
1.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Code #__________
Date
PLEASE ANSWER, AS BEST YOU CAN, THE FOLLOWING QUESTIONS.
Age:_________________. _________ 2. Sex: M___ F_____
Ethnic Background: Asian_____ Black Hispanic
American Indian_____ Caucasian Other _
Educational Background: Less than High School Diploma^________
High School Diploma or G E D _________
Some College Credits_____________ .
College Degree . ■
Graduate Degree ________.
Before you entered the drug program, what was your annual income?
Less than $5,000 a year $5,000-10,000 $11,000-15,000
$16,000-20,000 over $20,000_____
Marital Status:__Married_____ Divorced_____ Separated_____
Single Widowed_____
Do you have children? Yes No Number of Children_____
With whom were you raised?
Both Parents Mother only Father only_____ Relatives
Other Specify_______■ ________________________
Are your parents : Both living Mother only How old were
you when your father died?______ Father only How old were you
when your mother died?_____ Both Deceased
What was/is your mother's annual income?
under $5,000 $5,000-10,000 $11,000-15,000
$16,000-20,000 over $20,000
What is/was your father's annual income?
under $5,000 $5,000-10,000 $11,000-15,000
$16,000-20,000 over $20,000_____
At what age did you first start to use drugs (other than alcohol)?
under 10______ 11-14_____ 15-19_____ 20-25_____ over_25_____
How were you introduced to drugs?
My peer group a relative or family member on my own_____
a spouse or person I was living with other_ _
95
Code §______________
Date ■ .
14. What was the first drug you experimented with (other than alcohol)?
Marihuana^ Amphetamines (uppers) Cocaine______
Tranquilizers Barbituates (downers) Heroin Other
drugs not prescribed_____
15- What do you consider your drug of choice?
Marihuana Amphetamines (uppers) Cocaine
Tranquilizers Barbituates (downers) Heroin_ Other
drugs not prescribed_____
16. Have you ever overdosed? Yes No_____ Number of times_____
17. Have you ever been a residential (live-in) drug treatment program
before? Yes No______
18. How long have you been in this drug program (do not include the
time you were in detox)?
Less than 30 days 30-60 days 61-90 days about
5 months_______over 6 months_____
19. At what stage are you?
First_____ Second______ Third_____ Phase-out_____
20. Are you in individual therapy at this time?
Yes No
21. While in this program, were you ever in individual therapy?
Yes No______
22. If no, have you ever been in individual therapy?
Yes_^ No_____
23. Have you ever taken part in an assertion training course or workshop?
Yes No_____
96
APPENDIX G
PERMISSION TO CONDUCT STUDY
31.
STATE OF CALIFORNIA
EDMUND G. BROWN JR.. Governor
SECRETARY
< W . <*f
UNDERSECRETARY
(916) 322-3212
H e a l t h and W e lf a re A g e n c y
OFFICE OF THE SECRETARY
915 CAPITOL MALL, ROOM 200
Sacramento, California 95814
(916) 445-6951
March 23, 1981
Committee for the Protection
of Human Subjects
714 P Street, Room 993
Sacramento, CA 95814
Re: Project # 80-12-05
"A Comparative Study of the
Effects of Two Types of Group
Therapy on Depression, Anxiety,
Self-Concept and Assertiveness
in Heroin Addicts"
Janice Joy Herdey, M.S.
Metropolitan State Hospital
11400 Norwalk Blvd.
Norwalk, CA 90650
Dear Ms. Herdey:
Thank you for your submittal of a revised consent form for the above entitled
project.
The Committee reviewed and approved the project at its March 10, 1981 meeting.
Thank you for your cooperation. If you have any questions please call (916)
322-3212.
Sincerely,
Charles R. Gardipee, M.D.
Chairperson, Committee for the
Protection of Human Subjects
cc: Members, Committee for the
Protection of Human Subjects
DEPARTMENTS OF THE AGENCY
Aging • Alcohol & Drug Programs • Data Center • Developmental Services • Employment Development • Health Services
Mental Health • Rehabilitation • Social Services • Office of Statewide Health Planning and Development
98
APPENDIX H
CONTRACT FOR RESEARCH PROJECT
32l
CONTRACT FOR RESEARCH PROJECT
This research project is an 8-week Assertion Training workshop led by
two graduate students from UC Irvine. The workshop is part of the dis
sertation proposal submitted and approved by Tommie Erickson, the hospital
and Sacramento, and is part of the requirement for Janice Herdey's Ph.D.
The workshop will consist of two groups:
Group A ....................10-12 members
Group B . . . .............10-12 members
who will be randomly (by chance) selected from the members of the family.
Those not selected will comprise Group C— a no treatment group (they will
not receive assertion training). This is called a control group.
The groups will begin Monday evening, August 17 and will run for 8 con
secutive Monday evenings (August 17, 24, 31, September 7, 14, 21, 28,
October 5). Times for the groups will be as follows:
Group A ......... 6:00-7:30 p.m. ) Groups will be held in
Group B . . . . . . 7:45-9:15 p.m. ) room 1-Ed Bldg.
Each individual who is involved in the research project (members of
groups A, B, C) will be tested before and after the workshops.
Pretest ......... August 10, 7:00-9:30 p.m.
Posttest .... October 7, 7:00-9:30 p.m.
In order that the project can run smoothly, the following commitments
from the family and staff will be needed:
1. Once the workshop begins, Monday evenings will be reserved for
Assertion Training only— from 6:00 until 9:30 p.m.
2. Once the workshop begins, members will not be added to the Assertion
Training groups.
3. Visitors are not allowed in the Assertion Training groups. Individuals
cannot be pulled out of the groups for any reason. Staff are also not
allowed as visitors in the groups.
4. Second and Third stagers taking part in the Assertion Training groups
will not be able to take passes on Mondays during the workshop.
5* Members of the Assertion Training groups may be asked to keep records
or papers as part of the training. First stagers will have to be
allowed to keep papers pertaining to the training in their vanity
area.
6. Any problems arising from the workshop should be directed to Janice
who will be the project coordinator. Janice will be available Monday
evenings on the ward.
Project Coordinator
Date
Family Coordinator
House Coordinator
House Coordinator
100
APPENDIX I
OATH OF CONFIDENTIALITY
101
State of C alifornia-H ealth and Welfare Agency D epartm ent of Mental Health
OATH OF CONFIDENTIALITY
I, the undersigned, hereby agree n o t to divulge any inform ation or records concerning any clien t/p atien t w ithout
proper authorization in accordance w ith C alifornia W elfare and Institutions C ode, Section 5 328, et seq.
I recognize the unauthorized release o f confidential inform ation m ay m ake me subject to a civil action under
provisions o f the Welfare and Institutions Code and Tide 9, C alifornia A dm inistrative Code, as follows:
W & 1 Code, Section 5330: A ny person m ay bring an action against an individual w ho has w illfully and
know ingly released confidential inform ation or records concerning the person in violation o f the provisions of
this chapter, fo r the greater o f the following am ounts:
(1) Five hundred dollars ($500).
(2) Three tim es the am ount o f actual dam ages, if any, sustained by the plaintiff.
Any person m ay, in accordance w ith the provisions of C hapter 3 (com m encing w ith Section 525) o f T itle 7 of
Part 2 o f the Code o f Civil Procedure, bring an action to enjoin the release o f confidential inform ation or
records in violation of the provisions o f this chapter, and m ay in the same action seek damages as provided in
this section.
It is n o t a prerequisite to an action under this section th a t the p lain tiff suffer or be threatened w ith actual
damages.
Title 9, C alifornia A dm inistrative Code, Section 942, O ath o f C onfidentiality
All officers and em ployees o f the d ep artm en t collecting, m aintaining and utilizing any p atien t data
inform ation in the course o f their duties w ith the d ep artm en t shall sign an oath o f confidentiality.
As a condition o f perform ing m y duties as an officer or em ployee o f th e D epartm ent
of M ental H ealth, I agree n o t to divulge to any unau th o rized person any clien t/p atien t data
inform ation o btained fro n any facility by the d epartm ent.
I recognize th at unauthorized release of confidential inform ation m ay m ake ine
subject to a civil action under th e provisions o f the W elfare and In stitu tio n s Code, and m ay
result in th e term ination o f any office o f em ploym ent.
Name (Please Print) Position Tide
Place of Em ploym ent Address
Signature Date
1st copy: Em ployee personnel file
2nd copy; Em ployee copy
MH 1773 (7/78)
1 0 2
APPENDIX J
INFORMED CONSENT FOR THE STUDY
OF GROUP PSYCHOTHERAPY
1. I understand I will be participating in a research project, the purpose
of which is to study the possible effectiveness of two types of group
psychotherapy in the treatment of anxiety, depression, self-concept
and assertiveness. I will be randomly (by chance) assigned to either
an assertiveness training group, or a group led by one of my peers.
The focus of the assertiveness training group will be on developing
assertive behavior and effective social skills in dealing with my
interpersonal interactions. The focus of the peer-led group will be
the same as the treatment I am now receiving in the drug program and
may use such techniques as games (Synanon Game), rejections, stroking
encounters and other similar small group therapeutic activities with
which I am familiar.
2. The procedures used in this study may include interviews, group parti
cipation, psychological testing, and structured exercises. I also
authorize the researcher to have access to any records the drug pro
gram may have regarding my physical, legal and psychological well
being.
3. I understand that it is possible that I will receive no personal
benefit from the therapy and that I may become more anxious, depressed
or frustrated because the treatment has not helped me. I also under
stand that individual counseling will be offered to me as needed.
Details of the study have been explained to me by . 1 under
stand that she will answer any questions I may have concerning this
study at any time. I may contact the project office at
5. I understand that my participation in this study is entirely voluntary
and that I may decline to enter the study or may withdraw from it at
any time without penalty or jeopardy. There is no compensation for
any physical or psychological harm that might occur. Should any harm
occur or be reasonably foreseen by me, I shall immediately notify the
project office at the above number.
6. My identity will be kept completely anonymous. My consent applies
only to this program, and if the study design or use of information
is to be changed, I will be informed and my consent re-obtained.
7. I understand that all materials are confidential and that the experi
menter and group leaders will maintain strict confidentiality. I
also agree to maintain confidentiality for all group material.
Experimentation Date:
Signature:
Print Name:
Dat e:
104
Witness:
Print Name:
Dat e:
APPENDIX K
QUESTIONNAIRE
105
QUESTIONNAIRE,
1. Did you feel that the Assertion Training Workshop was helpful?
Yes_____ No_____
2. If yes, what was most helpful, what did you like about it?
If .no, what didn't you like about it, what was not helpful?
3. What were some of the most helpful things that you learned?
What was the least helpful, was not helpful?
4. How did you feel about your group leaders? What did you like about
them, or not like about them? Try to give comments about each leader.
5. Do you think that Assertion Training should be included in the drug
program as a part of your treatment? Why?
6. How have you used what you learned in Assertion Training in your
day-to-day activities?
OTHER COMMENTS
106

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Asset Metadata

Creator Hardey, Janice Joy (author)

Core Title A study of the effects of group assertion training on anxiety, depression, self-concept and assertiveness in heroin addicts

Degree Doctor of Philosophy

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Psychology, clinical

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c26-500724

Unique identifier UC11246723

Identifier usctheses-c26-500724 (legacy record id)

Legacy Identifier DP24829.pdf

Dmrecord 500724

Document Type Dissertation

Rights Hardey, Janice Joy

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA