Assertiveness training

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Assertiveness training a meta-analysis of the research findings
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Shatz, Mark Allen, 1955-
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Assertiveness training   ( lcsh )
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Thesis:
Thesis (Ph. D.)--University of Florida, 1983.
Bibliography:
Includes bibliographical references (leaves 86-99).
Statement of Responsibility:
by Mark Allen Shatz.
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Typescript.
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Vita.

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ASSERTIVENESS TRAINING: A META-ANALYSIS
OF THE RESEARCH FINDINGS






BY

MARK ALLEN SHATZ


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE
UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY








UNIVERSITY OF FLORIDA


1983













ACKNOWLEDGMENTS

I welcome this opportunity to acknowledge the individuals who have

been instrumental in helping me achieve my doctorate.

Bill Kirk, Clay Ladd, Boyd Spencer, John Best, and Glen Walter are

among the many friends and colleagues at Eastern Illinois University who

were responsible for helping me achieve this professional goal. They

gave me the opportunity and support that I needed to demonstrate to my-

self (and others) that I was capable of becoming a healthy, productive,

and loving person. I will always view the six years I spent at Eastern

as the pivotal point of my life.

I hold the utmost respect for the members of my supervisory com-

mittee and wish to thank them individually, and collectively, for their

guidance and support.

At every possible opportunity, Dr. Pat Miller has been willing to

share her wealth of knowledge with me. Her insightful and honest com-

ments concerning my professional development have helped me in making

my career decisions. I regret that I did not make the trek to the

psychology building more often to talk with her.

Dr. Linda Crocker had the uncanny ability to provide me with en-

couragement at the times I most needed the support from others. Her

warmth and enthusiasm always brought a smile to my face.

Dr. Jamie Algina has put considerable time and effort into developing

my skills as a researcher. I admire his intelligence, teaching ability,







and pragmatic approach to research and appreciate his willingness to

teach me in a patient manner.

Dr. Art Lewis has been my "boss" for the past few years. I feel

extremely fortunate to have worked with someone that I view as the

consummate professor. Through his modeling and gentle shaping of my

behavior, I have learned how to work within the system effectively (and

how to enjoy life to its fullest extent).

As my chairperson, Dr. Pat Ashton has helped me make career de-

cisions, pass my qualifying exams, write a dissertation, and in general

survive graduate school. The willingness to listen, warmth, understanding,

and intelligence are characteristics of chairpersons that most graduate

students fantasize about. I was fortunate enough to have that type of

chairperson. My admiration, respect, and warm feelings for her are a

reflection of how much I appreciate her guidance and support over the

last few years.

Special thanks are extended to my typists. Margaret Hodges had

the uneviable but unavoidable task of reading my handwriting before she

could type the initial drafts of this dissertation. Linda Drake's ex-

perience, skill, and kindness made a potentially painful experience a

bearable (at times almost enjoyable) one for me.

And finally, I want to thank my friends and family for their un-.

conditional support of my efforts. Without their love and encourage-

ment, I would have not been able to achieve this goal.













TABLE OF CONTENTS

Page

ACKNOWLEDGMENTS . . . ii

LIST OF TABLES . . . vi

ABSTRACT . . . vii

CHAPTER

I. INTRODUCTION . . 1

Statement of the Problem . . 1
Purpose of the Study. . . 5
Significance of the Study . . 9

II. REVIEW OF THE LITERATURE . . 10

Assertiveness Training . . 10
Meta-Analysis Research . . 29

III. METHOD . . . 36

Sources of Data . . 36
Describing Study Characteristics . 37
Quantifying Study Outcomes . . 41
Unit of Analysis . . 41
Data Analysis . . 42

IV. RESULTS . . . 43

Unit of Analysis . . 43
Overall Effectiveness of Assertiveness Training 44
Assertiveness Training Components . 46
Therapist Characteristics . . 49
Subject Characteristics . .54
Distribution of Training . . 54
Publication Features . . 60
Summary of the Results . . 60








CHAPTER

V. DISCUSSION . . .

Discussion of the Findings . .
Criticisms of Meta-Analysis . .
Critique of Assertiveness Training Research .
Implications of this Study . .

APPENDIX A: STUDIES NOT INCLUDED IN THE META-ANALYSIS
AND REASONS FOR EXCLUSION .

APPENDIX B: INTERRATER AGREEMENT COEFFICIENTS FOR THE
CODING OF STUDY CHARACTERISTICS .

APPENDIX C: CODING OF STUDIES USED IN THE META-ANALYSIS

REFERENCES . . .

BIOGRAPHICAL SKETCH . . .


Page

. 63

. 63
* 70
. 73
* 75


* 79


. 81

. 83

. 86

. 100













LIST OF TABLES


Table Page

1. Studies Used in Meta-Analysis . 38

2. Summary Statistics for Effect Size Distribution 45

3. Descriptive Statistics for Assertiveness
Training Components . . 47

4. Inferential Statistics for Assertiveness
Training Components . . 50

5. Summary Statistics for Groups of Assertiveness
Training Components . . 51

6. Descriptive Statistics for Therapist Characteristics 52

7. Inferential Statistics for Therapist Characteristics 53

8. Descriptive Statistics for Subject Characteristics 55

9. Inferential Statistics for Subject Characteristics 57

10. Descriptive Statistics for Distribution of Training 58

11. Inferential Statistics for Distribution
Characteristics . . 59

12. Descriptive Statistics for Publication Features 61

13. Inferential Statistics for Publication Features 62













Abstract of Dissertation Presented to the Graduate Council of
the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy


ASSERTIVENESS TRAINING: A META-ANALYSIS
OF THE RESEARCH FINDINGS

By

Mark Allen Shatz

April, 1983

Chairperson: Patricia T. Ashton
Major Department: Foundations of Education

Meta-analytic methodology was used to synthesize research findings

concerning the efficacy of assertiveness training. The data for the

meta-analysis came from 21 assertiveness training studies reporting 29

behavioral and 36 self-report outcome measures of assertiveness. With

an average effect size of .74 for the 21 studies, the findings provided

strong evidence for the efficacy of assertiveness training. Converted

into percentile terminology, the overall effect size of .74 indicates

that on the average a client at the mean of the control group would be

expected to move to the 77th percentile of the control group after re-

ceiving assertiveness training.

Additional findings of the meta-analysis were as follows:

1. The common core components of assertiveness training were

identified as instructions, modeling, behavioral rehearsal, and coaching.

Other assertiveness training components (e.g., homework, video feedback)

were frequently added to the core components. None of the components was

significantly related to treatment outcomes.







2. The training level, sex, and number of therapists employed in

the studies varied considerably. None of the therapist characteristics

was significantly related to treatment effectiveness.

3. The most frequently used population was mixed-sex groups of

college students. The age level of the subjects was significantly re-

lated to treatment effectiveness while the sex of the subjects and the

subjects' pretreatment level of assertiveness approached significance.

The number of subjects per treatment group was not significantly related

to treatment outcomes.

4. On the average, subjects received five to six sessions of

assertiveness training over a five to six-week period for a total of

eight to nine hours. The length of training was not related to treatment

effectiveness.

5. None of the publication features (e.g., year of publication,

type of publication) was significantly related to treatment effectiveness.

It was impossible to assess the effectiveness of certain components

(e.g., covert rehearsal, cognitive restructuring), the long-term efficacy

of assertiveness training, and the effectiveness of assertiveness training

with certain populations (e.g., alcoholics, psychiatric patients) because

of the lack of investigations dealing with these issues. Recommendations

were made for ways to improve the quality of future assertiveness training

research. Also, the implications of the findings for clinicians were

discussed.


viii













CHAPTER I

INTRODUCTION

Statement of the Problem

The field of behavior therapy has recently witnessed a dramatic

increase in the number of clinical applications and research investiga-

tions of assertiveness training. The widespread interest in assertive-

ness training is also demonstrated by the demand of the general public

for self-help material detailing how to become more assertive. While

most laypersons and professionals are acquainted with assertiveness

training, few individuals could accurately describe the procedure or

define the concept of assertiveness.

Influenced by Salter's (1949) clinical work with socially inhibited

individuals, Wolpe (1958) developed the construct of assertiveness and

formalized the procedure called assertiveness training. Assertiveness

was defined by Wolpe as "the proper expression of any emotion other than

anxiety toward another person" (1973, p. 81). Wolpe advocated assertive-

ness training as a clinical intervention for persons suffering inter-

personal anxiety.

Since Wolpe's groundbreaking work, numerous definitions of assertive-

ness varying in specificity have been offered (e.g., Alberti & Emmons,

1974; Galassi, Delo, Galassi, & Bastien, 1974; Lazarus, 1973). The most

popular definition, and the one that has had the most influence on the

assertiveness training movement, was offered by Alberti and Emmons (1974)

who invoked the concept of "personal rights" in their construct of







assertiveness. Alberti and Emmons defined assertiveness as "behavior

which enables a person to act in his own best interest, stand up for

himself without undue anxiety, to express his rights without destroying

the rights of others" (1974, p. 2). In their definition, Alberti and

Emmons distinguished assertiveness from two other response patterns,

non-assertiveness and aggressiveness.

Using Alberti and Emmons' concept of personal rights to identify

response patterns, non-assertive behavior was defined as the denial of

one's own personal rights by placing the opinions, feelings, and needs

of others before one's own. The goal of the non-assertive behaving

individual is to appease others and avoid conflict and confrontation at

any cost. At the other extreme of behavior patterns is the aggressive

style of responding. Aggressive behavior involves directly standing up

for one's own personal rights but at the expense of other individuals'

rights. For the aggressively behaving individual, emphasis is placed on

achieving desired goals and not the manner in which one behaves or how

others will respond. Both the non-assertive and aggressive behavior

patterns are viewed as ineffective communication styles which seriously

affect interpersonal relationships and have negative intrapersonal con-

sequences.

In contrast to the non-assertive and aggressive response styles is

the assertive behavior pattern. Assertive behavior involves standing

up for one's own personal rights in a direct, honest, and appropriate

manner which does not violate other individuals' rights. For the

assertively responding individual, emphasis is placed on responding

appropriately and not the potential consequences of the assertive act.







To help individuals acquire assertive skills, clinicians and re-

searchers developed assertiveness training packages which incorporated a

variety of behavioral-oriented clinical procedures. These techniques

included behavior rehearsal, therapist coaching, modeling, homework

assignments, video taped feedback, and self-reinforcement. Assertive-

ness training procedures are designed to teach individuals verbal and

nonverbal assertive behaviors using techniques based on operant and

social learning principles. More recently, several assertiveness trainers

(e.g., Galassi & Galassi, 1978; Lange & Jakubowski, 1976) have incorpor-

ated the cognitive strategies of Ellis and Harper (1975) and Meichenbaum

(1974) into their training procedures. The proponents of cognitive-

behavioral oriented assertiveness training argue that in addition to

learning specific assertive responses, individuals should be trained to

deal with the cognitive belief structures that may interfere or prohibit

assertive responding. While the primary component of assertiveness

training packages is usually behavior rehearsal, the combination of

assertiveness techniques employed varies greatly and "appears to be

determined primarily by convention and personal preference rather than by

functional analysis" (Galassi & Galassi, 1978, p. 22).

Following the lead of clinicians, researchers began to investigate

the efficacy of assertiveness training. The influence of assertiveness

training on self-report and behavioral indices of assertiveness has been

assessed for a variety of populations including psychiatric patients

(e.g., Hersen, Eisler, Miller, Johnson, & Pinkston, 1973), homosexual

men (e.g., Russell & Winkler, 1977), college students (e.g., McFall &

Marston, 1970), non-assertive individuals (e.g., Joanning, 1976), and

alcoholics (e.g., Scherer & Freedberg, 1976). Also, the separate and








combined treatment effects of such procedures as behavior rehearsal,

covert rehearsal, modeling, video taped feedback, coaching, and cognitive

restructuring have been assessed for a variety of populations.

While the preliminary findings concerning the effectiveness of

assertiveness training appeared quite favorable, the ability to draw

definitive conclusions from this body of literature has been hampered by

the lack of a standardized training procedure and by the inability of

traditional review strategies to effectively synthesize the research

findings. Specifically, reviewers of assertiveness training research

(Galassi & Galassi, 1978; Heimberg, Montgomery, Madsen, & Heimberg,

1977; Rich & Schroeder, 1976) could not provide a clear synthesis of

the research findings because of the inability to directly compare the

results of studies utilizing different training procedures. Also,

traditional review strategies cannot determine the following information:

an estimate of the magnitude of treatment effectiveness, the relationship

between various assertiveness training components and treatment effective-

ness, and the impact of subject, therapist, and design characteristics on

treatment outcomes. Proponents of assertiveness training have paid little

attention to these liabilities and have proceeded to view the findings as

support for the efficacy of assertiveness training. Thus, the popularity

of assertiveness training has continued to expand faster than the research

base supporting the procedure.

In summary, assertiveness training is a collection of behavioral and

cognitive procedures that are designed to improve individuals' social

skills. Assertiveness training originated from clinical work in behavior

therapy and is now considered a fundamental tool of most clinicians. The

procedure has been widely publicized in the self-help literature and now








has enthusiastic converts in both the professional and public sectors.

However, as will be discussed in the next section, questions concerning

the efficacy of assertiveness training still remain unanswered.

Purpose of the Study

Since Alberti and Emmons (1974) popularized assertiveness training

in their book, Your Perfect Right, assertiveness training has received

increasing attention from researchers and clinical practitioners. The

growth of assertiveness training as a research area can be illustrated

by the increase in the number of entries in Psychological Abstracts

dealing with assertiveness training. In 1974, there were approximately

20 articles listed under the heading of assertiveness training while in

1981 the number of entries increased six fold. Though the body of re-

search dealing with assertiveness training has expanded greatly over the

last few years, reviewers of this literature have been unable to provide

answers to the following questions: How effective is assertiveness

training? How frequently are various treatment components employed in

assertiveness training programs and how are they related to treatment

outcomes? What is the influence of subject, therapist, and design char-

acteristics on treatment effectiveness? The inability to answer these

and other related questions conclusively is not due to a lack of in-

vestigations but rather the failure of traditional review techniques to

synthesize the research findings effectively.

In his presidential address to the American Educational Research

Association, Glass (1976) proposed "a rigorous alternative to the casual,

narrative discussions of research studies which typify our attempts to

make sense of the rapidly expanding research literature" (p. 3). He

referred to his review method as meta-analysis, or the analysis of








analyses. Glass described meta-analysis as "the statistical analysis of

a large collection of results from individual studies for the purpose of

integrating the findings" (1976, p. 3). To employ Glass's technique,

researchers must first locate studies dealing with a specific topic by

following well defined procedures. Next, the features and outcomes of

these studies are coded in quantitative or quasi-quantitative terms.

Finally, descriptive statistics and multivariate techniques are used to

describe findings and relate study characteristics to outcomes. Since

Glass's address, meta-analysis has been used to synthesize the findings

in a variety of research areas: for example, psychotherapy outcome

effects (Smith & Glass, 1977) ; open versus traditional education (Peterson,

1979); class size and achievement (Glass & Smith, 1979); and tutoring

(Cohen, Kulik, & Kulik, 1982).

Meta-analysis has several clear advantages over traditional inte-

grative reviews (Glass, 1977; Jackson, 1980). First, meta-analysis is a

systematic, clearly articulated, and reliable procedure for integrating

findings from a set of studies. Second, meta-analysis can use informa-

tion from studies of varying methodological quality and control for

possible biases caused by the differences in the studies. Third, a pre-

cise estimate of treatment effectiveness can be calculated. Fourth,

meta-analysis can be used to identify the settings and conditions where

treatment effects are strongest.

Meta-analysis is particularly useful for integrating the findings

of a set of studies that do not contain a standardize treatment procedure,

as is the case with assertiveness training research. By using multivarte

statistical procedures, meta-analysis can simultaneously investigate re-

lationships among studies' methods, populations of subjects, treatment







variables, design features, and study outcomes. No other integrative

review technique is capable of doing this.

The purpose of this study is to utilize meta-analytic methodology

to synthesize the research findings concerning the effectiveness of

assertiveness training. More specifically, this investigation will be

designed to consider the following questions:

1. How effective are assertiveness training procedures? The

effectiveness of assertiveness training will be assessed in four ways.

First, the overall magnitude of the treatment effect will be estimated.

Second, the meta-analysis will estimate the decay of assertiveness

training effects over time. Third, treatment effectiveness will be

calculated for the different types of assertiveness outcome measures

(behavioral or self-report) that were employed. And finally, the meta-

analysis will determine the magnitude of the treatment effect produced

by studies using different types of control conditions (placebo or no-

treatment).

2. What is the contribution of various assertiveness training com-

ponents to treatment effectiveness? The meta-analysis will, determine

how frequently these components are used in assertiveness training

packages and will estimate the influence of each component on treatment

effectiveness. This study will also assess the relative contribution of

the following sets of training components (Rich & Schroeder, 1976):

response-acquisition operations (instructions, modeling), response-

reproduction operations (behavior rehearsal, covert rehearsal), response-

shaping operations (coaching, video taped feedback, self-feedback, group

feedback), cognitive restructuring techniques (cognitive strategies), and

response-transfer operations (homework, bibliotherapy).








3. How are therapist characteristics related to treatment out-

comes? The meta-analysis will assess the relationship of the number of

therapists per treatment group, the sex of the therapistss, and the

training of the therapists) to treatment effectiveness.

4. How are the characteristics of the subjects related to treatment

effectiveness? This study will assess the influence of the following

subject-related variables on treatment: the subjects' pretreatment

level of assertiveness, the number of subjects per group, the subjects'

diagnostic classification, the sex of the subjects, and the age of the

subjects.

5. What is the relationship between the distribution of training

time and the efficacy of treatment? Since assertiveness training can be

scheduled in a variety of time formats (e.g., a one-day six-hour work-

shop or six one-hour sessions scheduled over six weeks), this study will

consider the effect that the distribution of training (number of hours,

sessions, weeks) has on treatment effectiveness.

6. What are the publication features of the studies reviewed? The

various publication characteristics (year of publication, type of publi-

cation) of the studies used in the meta-analysis will be recorded and

related to outcome results.

In summary, the ability to synthesize assertiveness training re-

search findings has been hampered by the lack of a standardized training

procedure and by the limitations of traditional review strategies. Meta-

analysis is an alternative approach to the conventional review that is

capable of providing quantitative answers to research questions that were

previously unanswerable.







Significance of the Study

The findings of this study will have significance for the practi-

tioner and researcher of assertiveness training. For the clinician, the

results of the meta-analysis will aid in the training of clients in

several ways. First, the meta-analysis will determine whether assertive-

ness training is an effective training procedure. Second, this study

will determine the relative effectiveness of various assertiveness training

components. Third, the influence of subject and therapist characteristics

on treatment outcomes will be described. Fourth, the findings from this

study will help the practitioner develop effective guidelines concerning

the scheduling and formating of assertiveness training. And finally,

recommendations for developing a more standardized and effective assertive-

ness training program will be drawn from the results of the meta-analysis.

For the researcher, the results of the meta-analysis will provide a

clearer picture of the state-of-art in this research area. By charac-

terizing the tendencies of prior research, researchers will become aware

of the deficits of past research and be able to determine where future

research efforts should be directed. Also, specific recommendations for

further research in assertiveness training will be drawn from the results

of the meta-analysis.

In summary, the use of meta-analytic methodology will aid in the

synthesis of the research findings concerning assertiveness training.

While meta-analysis is not a panacea, it is an innovative technique which

will further our understanding of the effects of assertiveness training.













CHAPTER II

REVIEW OF THE LITERATURE

This chapter is divided into two sections. In the first half of

the chapter, the following topics pertaining to assertiveness training

are reviewed: definitions of assertion, the theoretical formulations of

assertiveness, the measurement of assertive behavior, and the efficacy of

assertiveness training procedures. The second section focuses on the

methodological issues surrounding meta-analytic techniques.

Assertiveness Training

Definition of Assertion

The original definitions of assertion were vague and general. For

example, the first psychological definition (Chittenden, 1942) of asser-

tion was "any overt attempt to influence the behavior" (p. 3), or any

overt attempt to influence one's own behavior while maintaining one's

status in a situation. Other general definitions of assertion have

emphasized the expression of feelings and thoughts in an open, honest,

and appropriate manner (e.g., Fensterheim, 1972; Serber, 1972). Several

authors have used the concept of personal rights to define assertion

(e.g., Alberti & Emmons, 1974; Jakubowski-Spector, 1973).

In an effort to refine and operationalize the concept of assertion,

clinicians have attempted to describe the specific response classes that

constitute assertive behavior. Lazarus (1973) classified assertive

behavior into four response patterns: (a) the ability to say no, (b)

the ability to make requests, (c) the ability to express positive and








negative feelings, and (d) the ability to initiate, continue, and termi-

nate general conversations. Other authors have identified response

classes which include the expression of feelings (Galassi, DeLo, Galassi,

& Bastien, 1974) and the ability to initiate and maintain social inter-

actions (O'Connor, 1969).

In their review of assertiveness training research, Rich and

Schroeder (1976) incorporated the elements of several previous definitions

to form the most specific operationalized definition of assertive behavior

to date. Rich and Schroeder view assertiveness as

the skill to seek, maintain, or enhance reinforcement in an
interpersonal situation through an expression of feelings or
wants when such expression risks the loss of reinforcement
or even punishment. The degree of assertiveness may
be measured by the effectiveness of an individual's responses
in producing, maintaining, or enhancing reinforcement. (p. 1082)

While Rich and Schroeder's definition is primarily aimed at facili-

tating research, Rakos (1979) contends that its inability to discriminate

between assertiveness and aggressiveness severely restricts its utility

in clinical settings. Rakos expanded on Rich and Schroeder's definition

by viewing assertive behavior as a behavioral chain composed of "rights"

and "obligations." According to Rakos (1979),

assertive behavior involves (1) the emission of rights (ex-
pressive) behavior, which is the skill to seek reinforcement
in an interpersonal situation through verbal behavior when
such behavior risks the loss of reinforcement or even punish-
ment; and (2) the emission of functionally related antecedent
and subsequent obligation behavior (in our society, analyzing
all rights and consequences, developing an appropriate be-
havioral repertoire, attempting to enhance everyone's rein-
forcement maximally). (p. 771)

Rakos believes that his definition is useful to clinicans because it marks

the distinction between assertive and aggressive behavior.








In summary, the majority of definitions of assertiveness have been

adequate for clinical application but have generally lacked the speci-

ficity needed for the measurement and research of assertive behavior.

Galassi and Galassi (1978) noted that

An adequate conceptualization of assertive behavior involves the
specification of three components of assertion; a behavioral
dimension (behaviors), a persons dimension (persons), and a
situational dimension (situations) within a cultural or subcul-
tural context. (p. 17)

Theoretical Formulations

Relatively little attention has been directed towards the considera-

tion of the theoretical formulations of assertiveness. Instrumental and

operant learning models have been traditionally utilized to explain the

development of assertive behavior and the workings of assertiveness

training procedures. The major formulations offered by Salter (1949)

and Wolpe (1958) "have not been subjected to serious scrutinization nor

to systematic investigation" (Galassi & Galassi, 1978, p. 20).

Salter (1949) believed that inhibition and excitation in emotional

expressiveness are generalized personality traits. He theorized that

individuals have a natural tendency toward excitatory behavior and that

the punishment of children's expressive behavior by adults results in

an increase of inhibitory responses. Salter viewed the "inhibitory

person" as incapable of emotional expression and uncomfortable and in-

effective in social situations. Treatment for inhibited individuals was

comprised of activities designed to increase their "excitatory reflexes"

(e.g., initiating conversations, expressing opinions). Salter's primary

clinical goal was to help the inhibited person become more expressive

and assertive in social situations.







Wolpe (1958) followed Salter's work by utilizing the principles of

classical conditioning, and later operant learning theory, to explain

the development and modification of nonassertive behavior. According to

Wolpe, nonassertive behavior develops primarily through the pairing of

assertive behavior with punishment which results in anxiety responses in

the presence of assertive cues. Wolpe viewed assertive behavior and

conditioned anxiety responses as incompatible. Assertiveness training

was described by Wolpe as a procedure that eliminated anxiety responses

inhibiting assertive behavior by pairing assertive responses with inter-

personal stimulus situations.

In time, Wolpe and others (e.g., Alberti & Emmons, 1974; Wolpe &

Lazarus, 1966) recognized that the classical conditioning model was

sometimes insufficient in explaining the production or inhibition of

assertive behavior and began noting that influence of operant learning

elements on assertive responding. Wolpe (1973) noted that the inability

to respond assertively was not always caused by the conditioning of

anxiety but rather the lack of requisite assertive responses present in

one's response repertoire. Wolpe recommended the use of behavioral pro-

cedures such as behavior rehearsal, response shaping, therapist exhorta-

tion, self-reinforcement, and external reinforcement to teach individuals

how to respond assertively.

Although classical conditioning and operant learning models explain

most of the behavior change which occurs as a result of assertiveness

training, many researchers feel that these theoretical formulations

cannot completely account for the development or modification of assertive

behavior. In the past few years, researchers have considered how cogni-

tive factors such as belief structures, perceptions of others, and sense








of self-efficacy affect the expression of assertive behavior (e.g.,

Alden & Safrian, 1978; Eisler, Frederiksen, & Peterson, 1978; Schwartz

& Gottman, 1978). The studies dealing with cognitive variables suggest

that the trainers and researchers of assertiveness should give consider-

ation to the influence of cognitive as well as behavioral factors on

assertive responding.

In summary, there is no one theory that comprehensively explains

the development of assertive behavior. Future theoretical formulations

must offer an integrated account of the influence of such factors as

external reinforcement, anxiety, client expectations, and cognitive

belief structures on assertive responding.

Assessment of Assertive Behavior

Self-report measures

Approximately 25 self-report measures of assertiveness are presently

available (e.g., Galassi, DeLeo, Galassi, & Bastien, 1974; Gambrill &

Richey, 1975; McFall & Lillesand, 1971; Rathus, 1973). Assertive in-

ventories typically contain 20 to 30 items that are designed to assess

the likelihood of individuals! responding assertively in a variety of

settings. The devices vary greatly in the amount of research devoted

to their validation and each contains certain methodological problems. In

addition to the specific methodological flaws of each device, Galassi

and Galassi (1978) have identified two problems common to many self-

report measures of assertiveness.

The first problem concerns the lack of specificity of items in

assertiveness inventories. A survey of the research literature supports

the view that assertiveness is comprised of a group of situation-specific

response classes (e.g., refusing requests, giving compliments). Most








authors of assertiveness inventories have failed to take this finding

into consideration when developing their measures by using items that

only assess general patterns of responding. An example of an item

lacking specification comes from the Rathus Assertiveness Scale (Rathus,

1973): "I often have a hard time saying no." The Galassis feel that

this liability of many self-report measures can only be resolved through

an increased specification in scale items to include the behavior, the

person, and the situation involved.

The second issue involves the type of information provided by self-

report measures. The majority of assertiveness inventories yield a

single numerical index which implies that assertion is a unitary person-

ality trait. Factor analytic studies of several devices (e.g., Gambrill

& Richey, 1975; Leah, Law, & Snyder, 1979) have yielded multiple factors

(e.g., making requests, initiating conversations, expressing opinions)

suggesting that there is a need for self-report instruments to be com-

prised of subscales that tap all the response classes of assertiveness.

In summary, many of the earlier self-report measures of assertive-

ness contain serious methodological flaws. Several recently published

assertiveness inventories (e.g., Leah, Law, & Snyder, 1979; Lorr & More,

1980) have overcome many of the liabilities of previous measures and

now offer more valid and reliable assessments of assertiveness.

Behavioral assessment

Role-playing assessment is the most frequently used behavioral

measurement procedure in assertiveness training. In role-playing assess-

ment, the subject is required to respond to either a live or taped con-

federate who emits a standard dialogue. Subjects are instructed to

respond to the confederate as they would in a real life setting. A








variety of verbal and nonverbal behaviors that are assumed to be related

to assertion are measured by observers. Although role-playing assessment

is a standard component of most assertiveness training packages, a

couple of validity-related issues have surfaced (Bellack, Hersen, &

Lamparski, 1979; Rich & Schroeder, 1976).

The primary question surrounding the utility of role-playing

assessment is whether the measurement procedure provides an adequate

estimate of real life performance. Studies investigating the external

validity of role-playing assessments have failed to yield conclusive

support for the use of role-playing as a valid measure of subjects' real

performance (e.g., Hersen, Eisler, & Miller, 1975; Kazdin, 1974; McFall

& Lillesand, 1971; McFall & Marston, 1970). In addition to the question-

able external validity of role-playing assessment, there are also inter-

nal validity-related issues that remain unresolved. A variety of vari-

ables have been demonstrated to influence the performance of subjects

in role-playing situations; the level of demand (Nietzel & Bernstein,

1976), the social context (Eisler, Hersen, Miller, & Blanchard, 1975),

and the perceived consequences (Fiedler & Beach, 1978). Although role-

playing is a valuable clinical training tool, its utility as an assess-

ment procedure still remains to be demonstrated.

Direct observation in naturalistic settings (Gutride, Goldstein, &

Hunter, 1973; O'Connor, 1969) and contrived behavioral tasks (McFall &

Marston, 1970; McFall & Twentyman, 1973) have also been utilized to

assess assertive behavior. Obtaining direct samples of behavior in

natural settings is difficult and usually only feasible in institutional

settings. Using contrived behavioral tasks to assess assertiveness, such

as placing a telephone call to a subject from a "salesman" (McFall &








Marston, 1970), raises serious ethical issues. The liabilities of these

measurement procedures have caused researchers to rely on role-playing

for the behavioral assessment of assertiveness.

In summary, it is recognized that obtaining a behavior sample is

the most appropriate and valid manner to assess behavior change. Until

strategies are devised to assess behavior unobtrusively in subjects'

natural settings, researchers will have to rely on the existing be-

havioral measures of assertiveness.

Assertiveness Training Research

The ability to draw generalizations from assertiveness training re-

search or make direct comparisons of studies is hampered by the varying

methodologies employed (Galassi & Galassi, 1978; Rich & Schroeder, 1976).

Differences in methodology include the populations sampled, treatment

components, subjects' initial level of assertiveness, outcome measures,

and treatment lengths. As Rich and Schroeder (1976) observed, "Asser-

tiveness training is not a unique or even well-defined training pro-

cedure. The term assertiveness defines the target of the training pro-

cedures rather than their nature" (p. 1085).

This review of assertiveness training research will be divided

into two sections: the efficacy of assertiveness training and the

differential effectiveness of assertiveness training components.

Effectiveness of assertiveness training

The strongest support for the efficacy of assertiveness training

has come from studies employing college students and normal adults. As

assessed by a variety of self-report and behavioral measures, assertive-

ness training has been shown to be superior to placebo or no treatment

control conditions in increasing assertiveness (Gormally, Hill, Otis, &








Rainey, 1975; Jacobs & Cochran, 1982; Janda & Rimm, 1977; Jansen &

Litwack, 1979; Kirschner, 1976; McFall & Marston, 1970; McKellar, 1977;

Tiegerman & Kassinove, 1977). Assertiveness training has also been

shown to be effective with individuals with social dating problems

(Galassi, Galassi, & Litz, 1974; Joanning, 1976), nonassertive individuals

(Alden, Safrian, & Weideman, 1978; Brown, 1980; Carmody, 1978; Derry &

Stone, 1979; Hammen, Jacobs, Mayol, & Cochran, 1980; Hedquist & Weinhold,

1970; McFall & Twentyman, 1976), handicapped persons (Mischel, 1978),

resident assistants (Layne, Layne, & Schoch, 1977), and couples (Epstein,

Degiovanni, & Jayne-Lazarus, 1978).

With the growth of the women's rights movement in the 1970's,

assertiveness training was proclaimed in the popular and professional

literature as a vehicle to help women achieve personal and professional

equality (e.g., Butler, 1973; Jakubowski-Spector, 1973; Phelps & Austin,

1975). The research data support the efficacy of assertiveness training

when used with female adults or college students (Bander, Russell, &

Weiskott, 1978; Berah, 1981; Rathus, 1972; Steel, 1977). Assertiveness

training has also been used effectively with nonassertive women (Holmes

& Horan, 1976; Manderino, 1974; Thelen & Lasoski, 1980; Weiskott &

Clelland, 1977; Wolfe & Fodor, 1977) and nurses (Carlson, 1976). The
nonsignificant results obtained for studies employing professional

women (Brockway, 1976), overweight females (Conoley, 1976; McMillan,
1976), and widowed women (Bettis, 1978) demonstrate that assertiveness

training is not a panacea for all interpersonal problems.

Duehn and Mayadas (1976), McKinlay, Kelly, and Patterson (1977),

and Edwards (1972) reported case studies illustrating how assertiveness

training can be used to enhance the social interaction skills of male







homosexuals. In the only group assertiveness training research study

employing male homosexuals, Russell and Winkler (1977) found no dif-

ference between the effectiveness of an assertiveness training group and

a discussion group in modifying nonassertive behavior. The authors

suggest that important issues concerning the social-cultural attitudes

toward homosexuality must be dealt with before the usefulness of

assertiveness training with homosexuals can be accurately assessed.

While Bridenbach (1978), Wehr (1978), and Pentz (1980) have had

success in using assertiveness training related procedures with adoles-

cents, other researchers have reported mixed results. Shy adolescents

who were assigned to an assertiveness training group demonstrated

improved assertiveness skills in role-play situations but did not indi-

cate significant changes on a self-report measure (Kirkland, 1978).

Doran (1977) found that the addition of assertiveness training to a high

school career awareness course did not significantly influence the

self-reported assertiveness of adolescent females.

Though assertiveness training programs have been proposed for

children (Palmer, 1977; Rausbaum-Selig, 1976), only a few studies have

investigated the utility of assertiveness training with children. In a

case study, Patterson (1972) used assertiveness training techniques and

time-out procedures to modify the crying behavior of a nine-year-old

boy. Vorgin and Kassinove (1979) found that assertion lectures combined

with behavior rehearsal were effective in increasing the self-reported

assertiveness of third graders. Reese and Resick (1979) used individual

and group assertiveness training with third and fourth graders and were

able to increase assertive responding in trained and untrained role-play

scenes but not in the children's classroom setting. Buell (1976)







demonstrated that boys, ages 8 to 18 years old, who received assertive-

ness training were superior to control subjects on role-playing measures

regardless of age or degree of emotional stability.

Assertiveness training has had moderate success in modifying the

aggressive behavior of individuals. Mills (1978) and Gentile (1977)

reported that male prison inmates who received assertiveness training

self-reported an increase in assertiveness with no change in be-

havioral performance. Rimm, Hill, Brown, and Stuart (1974) found that

males with a history of expressing anger in an antisocial or innappro-

priate manner who received assertiveness training reported a higher

level of assertiveness than control subjects. Assertiveness training,

in conjunction with contingency contracting, was successfully used to

modify the violent behavior of a 22-year-old handicapped male (Wallace,

Teigen, Liberman, & Baker, 1973).

The usefulness of assertiveness training in modifying the aggres-

sive behavior of adolescents and children has also been assessed.

Juvenile delinquents who received assertiveness training improved on

self-report and role-play assertiveness measures but showed only limited

generalization of training to daily situations (DeLange, Lanham, & Barton,

1981; Hazel, Schumaker, Keuhn, Shennan, & Sheldon-Wildgen, 1979; Korn-

feld, 1974). Lee, Hallberg, and Hassard (1979) found that adolescents,

judged as aggressive by their peers, who received assertiveness training
increased in self-reported assertiveness but that improvement was not

reflected in peer rating. And finally, Knauss (1977) used assertiveness

training to decrease the aggressive behavior of 9 out of 12 fourth grade

boys.







The second most frequently used population in assertiveness training

research is psychiatric patients. As assessed by a variety of assertive-

ness outcome measures, assertiveness training has been demonstrated to

be superior to placebo or no treatment conditions in increasing

assertiveness in several studies (Booraem & Flowers, 1972; Field & Test,

1975; Finch & Wallace, 1977; Hanson & Bencomo, 1972; Longin & Rooney,

1975; Percell, Berwick, & Beigel, 1974). Nonsignificant results for the

use of assertiveness training with psychiatric patients have been re-

ported by Friedman (1976), Serber and Nelson (1971), Lomont, Gilner,

Spector, and Skinner (1969), and Weinman, Gelbart, Wallace, and Post

(1972). The criticisms raised by Galassi and Galassi (1978) concerning

the lack of consistency of assertiveness training programs used in

research studies are more applicable to this population than any other

group. Also, the inability of diagnostic classifications to adequately

describe the social skills of psychiatric patients and the confounding

of assertiveness training with other on-going treatments make an accurate

interpretation of these findings very difficult.

In addition to being used with psychiatric patients, assertiveness

training has been used with other types of maladaptive behavior patterns,

such as alcoholism and depression. Several investigators have used

assertiveness training in conjunction with traditional treatments in an

attempt to modify the social skills of alcoholics. Adinolfi, McCourt,
and Geoghegan (1976), Foy, Miller, Eisler, and O'Toole (1976), and

Martorano (1974) have reported increases in attitudinal assertiveness

for alcoholics receiving assertiveness training and Hirsch, Von Rosen-

berg, Phelan, and Dudley (1978) and Freedberg and Johnston (1981) have

noted behavioral improvements.








Since the first case studies reported by Wolpe and Lazarus (1966),

several researchers have attempted to assess the effectiveness of

assertiveness training with depressed individuals. Sanchez, Lewinsohn,

and Larson (1980) found assertiveness training to be more effective than

traditional psychotherapy or no treatment in increasing self-reported

assertiveness with depressed patients. However, Fagan (1979) found no

significant differences between the effects of assertiveness training

and traditional treatments. Many of the assertiveness training studies

with depressed and alcoholic individuals contained the following metho-

dological flaws: assertiveness training was frequently confounded with

other treatments (e.g., on-going psychotherapy, medication), the lack of

adequate control conditions, the lack of behavioral measures, and the

absence of follow-up assessments.

Although Salter (1949) introduced assertiveness training as a form

of individual therapy, the majority of individuals receiving assertive-

ness training today do so in a group setting. In fact, most assertive-

ness trainers feel that assertiveness training is more effective when

delivered in a group format (e.g., Alberti & Emmons, 1974; Lange &

Jakubowski, 1976). Only two studies have attempted to directly assess

the relative effectiveness of individual versus group assertiveness

training. Linehan (1979) compared the effectiveness of assertiveness

training delivered in eight one-hour individual sessions to eight 90-

minute group sessions with adult women. Results indicated that all the

participants made significant improvements and no differences were found

between the treatment groups. Reese and Resick (1979) also found no

difference between individual and group assertiveness training for third

and fourth grade children. The findings from these studies, and others








which have assessed the efficacy of assertiveness training, suggest that

assertiveness training is effective regardless of whether it is delivered

in individual or group settings.

Little consideration has been given to the impact of subject or

therapist characteristics on the effectiveness of assertiveness training.

While the majority of studies indicate that assertiveness training is

effective for males and females, only a few studies have directly

assessed the impact of sex on treatment effectiveness. The findings

from these studies suggest that the sex of the therapist or subjects has

no noticeable effect on treatment outcome (Eichenbaum, 1978; Hall, 1976;

Linehan, Goldfried, & Goldfried, 1975; Parr, 1975). No studies have

investigated the effect of group size or the number of therapists on

the effectiveness of assertiveness training.

A couple of studies have directly investigated the influence of

scheduling of treatment sessions on the effectiveness of assertiveness

training. Berah (1981) and El-Shamy (1978) demonstrated that regardless

of the scheduling of assertiveness training (i.e., six hours in one

session versus six weekly one-hour sessions), treatment subjects showed

greater increases in self-reported and behavioral assertiveness than

control subjects though no differences between treatment groups were

established. Bander, Russell, and Weiskott (1978), using shorter treat-

ment periods, found that an eight-hour assertiveness training group was

significantly more effective than a two-hour assertiveness training

group. With the limited number of studies in this area, it is impossible

at this time to determine the optimal treatment length of assertiveness

training.








In summary, the support for the efficacy of assertiveness training

has been particularly strong from studies employing college students.

Assertiveness training has shown moderate success with other populations.

The ability to draw a conclusion from the research findings has been

hampered by a lack of a standardized treatment procedure. As Galassi

and Galassi (1978) concluded, "the non-equivalence of the treatment

packages precludes a definitive statement about the effectiveness of

assertiveness training at this time" (p. 23).

Components of assertiveness training

This section reviews studies which compare the differential effec-

tiveness of the various components of assertiveness training. Galassi

and Galassi (1978) have identified two problems that are encountered

when comparing component studies. First, the components may not be

clearly identified (i.e., behavior rehearsal may include only rehearsal

or a combination of rehearsal and feedback). Second, studies may use

the same components but with different populations, outcome measures,

or treatment durations.

Richard McFall and his associates completed some of the first in-

vestigations designed to assess the efficacy of various assertiveness

training components, specifically behavior rehearsal. Using a standard-

ized semi-automated behavior rehearsal training procedure with college

students, McFall and Marston (1970) investigated the effectiveness of

behavior rehearsal with and without performance feedback. Both behavior

rehearsal conditions resulted in greater improvement on a variety of

measures with no significant difference between the treatment groups.

McFall and Lillesand (1971) expanded on the previous study by adding

two components, symbolic modeling and therapist coaching, and also







compared overt and covert response rehearsal. Both treatment groups

proved superior to the control group on self-report and behavioral

measures and no differences were found between the covert rehearsal

group and the overt rehearsal condition. In a more complex study,

McFall and Twentyman (1973) evaluated the contributions of rehearsal,

modeling, and coaching in modifying the nonassertive behavior of college

students. Results indicated that rehearsal and coaching have an indi-

vidual and additive effect on training while the addition of modeling

was negligible.

While several studies have demonstrated the superiority of be-

havior rehearsal to placebo or no treatment conditions (Arnold, Winrich,

& Dawley, 1973; Bach, Lowry, & Moylan, 1973; Joanning, 1976), other

researchers have investigated the effectiveness of behavior rehearsal

in conjunction with other assertiveness training components. Behavior

rehearsal combined with modeling, coaching, or both, has been shown to

be an effective procedure for modifying nonassertive behavior (Thorpe,

1975; Twentyman, Gibralter, & Inz, 1979; Voss, Arrick, & Rimm, 1978).

The addition of video and audio feedback did not significantly improve

the effectiveness of a behavior rehearsal procedure (Aiduk & Karoly,

1975). Loo (1972) found that the addition of a projected consequences

component (i.e., knowledge of the other person's reaction to an assertive

response) to McFall's behavior rehearsal procedure did not significantly

contribute to training.

The results concerning the relative effectiveness of overt rehearsal

as compared to covert rehearsal have been conflicting. Both Longin and

Rooney (1975) and Prout (1974) demonstrated the superiority of overt

rehearsal to covert rehearsal with psychiatric patients and college








students respectively. In contrast, McFall and Lillesand (1971) and

Buttrum (1975) found that variations of covert and overt rehearsal were

equally effective in increasing assertiveness.

The second most frequently researched component in assertiveness

training has been modeling. Rathus (1972) and Snyder (1973) have

demonstrated the effectiveness of modeling procedures with college

students in increasing assertiveness as contrasted to placebo or no

treatment conditions. Young, Rimm, and Kennedy (1973) using a modeling

procedure with and without reinforcement found that both modeling groups

made significant gains over the control groups but were not different

in their effectiveness. And finally, the addition of a response play-

back component did not significantly improve the effectiveness of a

modeling procedure designed to improve assertive skills (Hutchinson,

1977).

Studies with psychiatric patients have also attempted to clarify

the contribution of modeling in developing assertive responding. Eisler,

Hersen, and Miller (1973) showed that modeling plus practice was sig-

nificantly more effective in increasing assertiveness than either a

practice only or a control condition. Hersen, Eisler, Miller, Johnson,

and Pinkston (1973) demonstrated that a modeling with instructions

condition was more effective than modeling only, practice-control, in-

structions only, or no treatment groups in modifying nonassertive be-

havior. Several case studies have been reported that also support the

usefulness of various modeling procedures with psychiatric patients

(Edelstein & Eisler, 1976; Foy, Eisler, & Pinkston, 1975). Using modeling

combined with instructions or instructions for generalization, Hersen,

Eisler, and Miller (1975) found that both treatment groups increased








assertive responding and that the instructions for generalization had

little effect on the transfer of training.

The efficacy of an alternative modeling procedure, covert modeling,

has been evaluated in several studies. Kazdin (1974) compared the effec-

tiveness of covert modeling (i.e., subjects were asked to imagine a model

acting assertively) to covert modeling plus reinforcement (i.e., subjects

imagined a model acting assertively and being reinforced for such an

action) in developing the assertive responding of college students. Both

treatment groups improved significantly on self-report and role-playing

measures and the treatment effects were maintained at a three month

follow-up. Expanding on the previous study, Kazdin (1976) examined the

effects of the number of imagined models and model reinforcement in covert

modeling. Results indicated that multiple models and positive reinforce-

ment increased assertiveness as measured by a variety of measures and

treatment effects were maintained at a four month follow-up. Nietzel,

Martorano, and Melnick (1977) demonstrated that the addition of reply

training to covert modeling significantly improved the effectiveness of

covert modeling.

Though assertiveness training began with a behavioral orientation,

researchers have recently incorporated and emphasized cognitive training

procedures. It is assumed that cognitive procedures, which are designed

to modify maladaptive cognitions, will be more effective than assertive-

ness training that directly focuses on social skills training. Several

studies have found that behavioral and cognitive oriented assertiveness

training, or combinations of the two, were consistently superior to various

types of control conditions while no differences were established between

the procedures (Alden & Safrian, 1978; Hammen, Jacobs, Mayol, & Cochran,








1980; Linehan, Goldfried, & Goldfried, 1979; Tiegerman & Kassinove, 1977;

Wolfe & Fodor, 1977). Derry and Stone (1979) found no differences between

groups receiving behavior rehearsal alone or in combination with cogni-

tive training strategies on behavioral outcome measures but did demon-

strate better performance of the cognitive oriented groups on self-report

measures. Jacobs and Cochran (1982),utilizing an in vivo self-monitoring

procedure deemed more personally relevant than previously used outcome

measures, demonstrated the treatment superiority of cognitive restruc-

turing strategies combined with behavior rehearsal to behavior rehearsal

procedures.

Although components such as audio-videotape feedback, homework, and

bibliotherapy have been used in successful assertiveness training programs,

only a few studies have attempted to directly assess their contribution

to treatment effectiveness. McGovern (1977) and Phinney (1977) found

that the addition of bibliotherapy to assertiveness training packages

did not have an additive effect on treatment outcome. The addition of

videotape feedback (Rich, 1976) and videotape feedback and homework

(Lang, 1977) did significantly enhance the effectiveness of assertiveness

training. In general, most studies showed that the addition of videotape

feedback did not have an additive effect on assertiveness training

(Aiduk & Karoly, 1975; Gormally, Hill, Otis, & Rainey, 1975; Prout, 1974).

In summary, it appears that the components of behavior rehearsal,

modeling, covert rehearsal, or combinations of these procedures are

effective techniques in the teaching of assertive behavior. The effec-

tiveness of less frequently used components is not clear. Which opera-

tions are best for which populations still remains to be determined.








Summary of assertiveness training research

The research evidence to date supports the efficacy of assertive-

ness training as a loosely grouped set of procedures that can modify

the social skills of a variety of populations. The lack of standardized

procedure has hampered reviewers from drawing conclusions from the

research findings. The meta-analysis proposed in this study will over-

come the inability of previous reviews to directly compare the findings

of assertiveness training studies utilizing different components and

will provide the following information: a clear synthesis of the

assertiveness training research findings, a precise estimate of treat-

ment effectiveness, an assessment of the impact of subject, therapist,

and design characteristics on treatment outcomes, and recommendations

for future research efforts based on the findings of the meta-analysis.

Meta-Analysis Research

There are five methodological issues that must be dealt with in

any meta-analysis; the locating of studies, the setting of criteria for

including studies, the coding of study characteristics, the judging of

independence among studies, and the quantifying of study outcomes. In

this section, the procedures for each of these steps will be outlined.

The Smith and Glass (1977) meta-analysis of psychotherapy outcomes--

which is the most widely critiqued meta-analysis and is similar to the

present study--will be used to illustrate meta-analytic procedures.

Locating the Studies

The first step in a meta-analysis is to locate as many studies as

possible that deal with the subject area under investigation. The pri-

mary sources that are used to locate studies in psychology and education

are Psychological Abstracts, Dissertation Abstracts International,


. i







Educational Research Information Center, and major review journals

(e.g., Psychological Bulletin, Review of Education and Research). Smith

and Glass's search of the literature yielded approximately 1,000 docu-

ments that were related to their subject area.

While most researchers have used published and unpublished studies

in their meta-analyses, others (e.g., Boulanger, 1980; Haertel, 1980;

Uguroglu & Wahlberg, 1979) give preference to published research. There

are two findings which suggest that reliance on only published studies

may introduce a source of bias in meta-analytic procedures: First,

Greenwald (1975) and Smith (1980) have noted that published studies

report a higher percentage of significant findings than unpublished

research. Second, the type of publication (i.e., published or unpub-

lished) was found to be significantly related to study outcomes in

two meta-analyses (Hartley, 1977; Kulik, Kulik, & Cohen, 1979). These

findings encourage the use of both published and unpublished studies

in meta-analytic research.

Criteria for Including Studies

After locating all the relevant studies, the meta-analyst sets

guidelines to define and delimit the content area under investigation.

The specific guidelines vary from meta-analysis to meta-analysis and

are dependent upon the nature of the subject area and the researcher's

interests. Smith and Glass stipulated that studies must have involved

some form of psychotherapy and have at least one treatment condition

compared to either a placebo or control group. Using these criteria,

Smith and Glass reduced their pool of studies from 1,000 to 375.

One of the most frequently raised criticisms of meta-analysis is

the lack of control for the quality of studies used. Glass (1978)








defends the use of studies of varying quality with the following argu-

ment:

An early attempt at meta-analysis was characterized somewhat
cynically by a critic as follows: "Although no single study
was well enough done to prove that psychotherapy is effective,
when you put all these bad studies together, they show beyond
doubt that therapy works." This skeptical characterization
with its paradoxical ring is a central thesis of research
integration. In fact, many weak studies can add up to a
strong conclusion. Suppose that, in a group of 100 studies,
studies 1-10 are weak in measurement but otherwise strong;
studies 11-30 are weak in internal validity only; studies
31-40 are weak only in data analysis; and so on. But imagine
also that all 100 studies are somewhat similar in that they
show a superiority of the experimental over the control group.
The critic who maintains that the total collection of studies
does not support strongly the conclusion of treatment efficacy
is forced to invoke an explanation of multiple causality (i.e.,
the observed difference can be caused either by this particular
measurement flaw or this particular design flaw or this
particular analysis flaw or .). The number of multiple
causes which must be invoked to counter the explanation of
treatment efficacy can be embarrassingly large for even a few
dozen studies. Indeed, the multiple-defects explanation will
soon grow into a conspiracy theory or else collapse under its
own weight. Respect for parsimony and good sense demands an
acceptance of the notion that imperfect studies can converge
on a true conclusion. (p. 367)

In contrast to Glass, other meta-analysts have been more concerned

about the quality of studies incorporated in their meta-analyses (e.g.,

Cohen, 1981; Kulik, Kulik, & Cohen, 1979). For example, Cohen (1981)

used only studies free of major methodological flaws (e.g., if no dif-

ferences existed between treatment and control at protesting) in his

meta-analysis. With a low correlation found between the overall treat-

ment effect size and the degree of internal validity of studies used in

meta-analyses (Glass & Smith, 1979; Smith, Glass, & Miller, 1980), the

impact of poorly designed studies on meta-analysis is still unclear.








Coding the Study Characteristics

The coding of study characteristics is a relatively straight for-

ward procedure. The meta-analyst first tries to identify the features

of the research problem which may mediate study outcomes and then codes

each study accordingly. These characteristics may include methodological

features, subject characteristics, treatment features, and publication

features. For example, Smith and Glass identified 16 study character-

istics ranging from subject characteristics (e.g., age, classification)

to features of treatment (e.g., type of therapy, duration of treatment).

To assess the accurate coding of study characteristics, most meta-

analysts have used two or more individuals to code the studies (e.g.,

Cohen, 1981; Cohen, Kulik, & Kulik, 1982). The intercoder reliability

coefficients of study features in meta-analytic studies have generally

ranged from .70 to 1.00. Although the agreement among coders has been

quite high, some researchers (Jackson, 1980; Stock, Okun, Haring, Miller,

Kinney, & Ceurvorst, 1982) have expressed the need for more well-defined

coding procedures (e.g., well-defined coding forms, more extensive coder

training).

Judging the Independence of Studies

Many of the studies that are included in a meta-analysis may have

more than one finding. This poses an important methodological issue

for the meta-analyst: That is, whether the collection of study findings

or the individual findings in a study should serve as the unit of

analysis. If the study is treated as the unit of analysis, the amount

of information extracted from the meta-analysis may be limited. Con-

sidering each study outcome as a unit of analysis may yield more








information but violates the independence assumption underlying infer-

ential statistics.

The question of independence among study findings has been dealt

with by different methodological perspectives. Smith and Glass treated

each individual outcome finding as one unit of analysis. While the

data set to be analyzed invariably contained sets of dependent results,

Glass and Smith proceeded with the assumption of independence among the

data. Glass (1978) admits that the assumption of independence is untrue

and "risky" but believes the assumption is practical since it allows for

the use of inferential statistics. Other meta-analysts (Haertel, 1980;)

have also treated individual study findings as the unit of analysis but

have utilized complicated statistical procedures (Tukey jackknife method,

Mosteller & Tukey, 1968) to account for the interdependences among the

data.

Some meta-analysts have been more cautious in their treatment of

the independence of study findings. Kulik and his colleagues (Cohen,

1981; Kulik, Kulik, & Cohen, 1979) strive for a low ratio of individual

findings to studies in their meta-analyses by excluding studies that

contribute more than two findings. Other meta-analysts (Johnson,

Maruyama, Johnson, Nelson, & Skon, 1981; Landman & Dawes, 1982) have

controlled for interdependencies among data by pooling all the indi-

vidual outcomes within a single study and then calculating the average

treatment effect for each study. In a reanalysis of Smith and Glass's

meta-analysis, Landman and Dawes (1982) found no differences in treat-

ment effects sizes computed by the latter procedure or by Glass's pro-

cedure of treating each outcome as an unit of analysis. At this time,








meta-analysts may want to select the conservative alternative; that is,

compute effect sizes by using both procedures in their meta-analyses.

Quantifying Study Outcomes

There are two procedures for determining treatment effects across

studies. One strategy involves combining the separate statistical sig-

nificance tests of each study and computing an overall average signifi-

cant level for the body of the studies (Rosenthal, 1978; Rosenthal,

1979). While the use of significance levels is adequate for the testing

of hypotheses about groups of studies, the procedure is directly affected

by sample size and fails to yield the descriptive information of the

effect size metric.

Glass (1976) proposed that the magnitude of the effect of a treat-

ment condition can be estimated with the effect size statistic. Effect

size was defined by Glass (1976) as

xt x
E = SD
SDc

where

xt = treatment group mean,

xc = control group mean, and

SDc = control group standard deviation.

As a standard score, effect size indicates how many standard devia-

tion units one group mean deviates from another group mean. The larger

the effect size, the greater the magnitude of the treatment effect.

Smith and Glass (1977) found an effect size of .68 for psychotherapy

outcomes. Glass (1976) transformed the effect size of .68 to percentile

terminology and concluded that "therapy of any type can be expected to







move the typical client from 50th to the 75th percentile of the un-

treated population" (p. 7).

Summary of Meta-Analysis Research

Meta-analysis is a relatively new procedure designed to systemat-

ically synthesize research findings. Meta-analytic procedures offer

clear advantages over traditional narrative review strategies. These

advantages include obtaining an effect size estimate, describing the

form of a relationship, integrating the findings of a large body of re-

search, and providing descriptive statistical information about those

studies. While there are many statistical and methodological issues

that are just beginning to be resolved, meta-analysis is a form of data

synthesis that will facilitate our understanding of assertiveness

training research.













CHAPTER III

METHOD

This section describes the procedure used for locating studies,

selecting studies, coding study features, quantifying study outcomes,

and analyzing the data.

Sources of Data

The first step in the meta-analysis was to locate as many studies

as possible that investigated the efficacy of assertiveness training.

The sources used to locate studies included: Psychological Abstracts,

Dissertation Abstracts International, the major review articles of

assertiveness training (Galassi & Galassi, 1978; Heimberg, Montgomery,

Madsen, & Heimberg, 1977; Rich & Schroeder, 1976), and the annotated

bibliography of assertiveness training research by Springer-Moore and

Jack (1981). The bibliographies in articles located through the initial

search provided an additional source of studies.

The reference search located approximately 550 titles dealing with

assertiveness training. On the basis of information contained in the

abstracts of the articles, the initial pool of studies was reduced to 55

useful published studies. (Because of limited interlibrary services,

only 25 out of 65 potentially useful dissertations could be reviewed.)

Copies of these 80 studies were obtained and read in full. Of these

studies, 22 (16 journal, 6 dissertation) met the criteria for inclusion

in the final sample.








To be included in the meta-analysis, a study had to meet the fol-

lowing criteria: First, the procedure used in a study must have been

clearly labeled as assertiveness training. Second, a study must have

had at least one treatment condition compared to a control condition.

Third, a study must have used at least one outcome measure of assertive-

ness. And finally, a study must have reported enough data for the

coding of study characteristics and the quantifying of study outcomes.

The 22 studies that met these criteria are listed in Table 1. The studies

that were read in full and excluded from the meta-analysis are listed in

Appendix A.

Describing Study Characteristics

To characterize the studies, 29 variables were identified. These

variables covered the methodological features, subject characteristics,

therapist characteristics, assessment characteristics, and publication

features of the studies reviewed. The 29 variables and the criteria for

coding were as follows:

1. The use of instructions. Were subjects provided with descrip-

tions of assertive responding or general performance guidelines?

2. The use of live models. Were examples of assertive behavior

portrayed by role models?

3. The use of taped models. Were examples of assertive responding

displayed via video tape?

4. The use of behavior rehearsal. Did subjects practice, rehearse,

or role-play assertive responses?

5. The use of covert rehearsal. Did subjects practice imagining

assertive responding?

6. The use of video taped feedback. Was feedback provided to sub-

jects in the form of audio or video taped playback?













Table 1

Studies Used in Meta-Analysis

Study

Ball, 1976
Brazelton, 1976
Brockway, 1976
Brown, 1980
Carmody, 1978
Fielder, Orenstein, Chiles, Fritz, & Breitt, 1979
Friedman, 1976
Galassi, Galassi, & Litz, 1974
Gormally, Hill, Otis, & Rainey, 1975
Holmes & Horan, 1976
Jansen & Litwack, 1979
Joanning, 1976
Layne, Layne, & Schoch, 1977
Lee, Hallberg, & Hassard, 1979
McKellar, 1977
Rathus, 1972
Rimm, Hill, Brown, & Stuart, 1974
Russell & Winkler, 1977
Scherer & Freedberg, 1976
Thibodeau, 1975
Tiegerman & Kassinove, 1977
Wall, 1977







7. The use of coaching. Did the therapists) provide the subjects

with corrective feedback?

8. The use of self-feedback. Did the subjects evaluate their own

behavior against performance criteria?

9. The use of group feedback. Did subjects receive verbal feed-

back from each other?

10. The use of cognitive restructuring strategies. Were the sub-

jects taught cognitive restructuring techniques (i.e., Rational Emotive

Therapy)?

11. The use of homework. Were the subjects required to monitor or

perform specific behaviors outside of the training setting?

12. The use of bibliotherapy. Were the subjects required to read

material pertaining to assertiveness training?

13. The training of the therapists. Were the therapists graduate

students or professional counselors?

14. The number of therapists. How many therapists were assigned

to each treatment condition?

15. The sex of the therapists. Were the therapists male or female?

16. The classification of the subjects. What population was the

subjects drawn from?

17. The pretreatment level of assertiveness of the subjects. Prior

to treatment, were the subjects assessed as aggressive, nonassertive, or

assertive?

18. The age of the subjects. Were the subjects adolescents,

college students, or adults?

19. The number of subjects. How many subjects were assigned to

each treatment condition?








20. The sex of the subjects. Were the subjects male of female?

21. Type of control condition. Did the study design include a

placebo or a no treatment control condition?

22. Type of outcome measures. Were the outcome measures behavioral

or self-report assessments of assertiveness?

23. Time of outcome measurement. When were the outcome measures

taken?

24. Number of sessions. How many treatment sessions were held?

25. Duration of sessions. What was the total amount of time

spent in treatment?

26. Distribution of sessions. How many weeks did treatment span

over?

27. Source of publication. Was the study a dissertation or a

journal article?

28. Time of publication. What year was the study published?

29. Name of technique. Was the procedure referred to as assertion,

assertiveness, or assertive training?

The author coded all the studies according to the above criteria.

To check coding reliability, a trained graduate student independently

coded all the studies. For the 29 coding variables, interrater reli-

ability coefficients ranged from .72 to 1.00 with a median of .95. The

interrater agreement coefficients for all the variables are listed in

Appendix B. On items which were clearly coded incorrectly, the author

made the necessary corrections. When disagreement on items occurred,

the author and coder reviewed the coding of both raters to assure total

agreement on all the coding items. The final coding of the studies used

in the meta-analysis is described in Appendix C.








Quantifying Study Outcomes

The index used to describe the magnitude of the treatment effect

was the effect size statistic. Effect size is defined as the difference

between the means of the treatment and control groups divided by the

standard deviation of the control group (Glass, 1976). For studies that

employed both placebo and no treatment conditions, the data from the

placebo group were used.

The calculation of effect sizes was straight forward for studies

that reported unadjusted means and standard deviations of the experi-

mental and control groups. When this information was not reported,

effect sizes were derived from inferential test statistics by using pro-

cedures outlined by Glass (1978) and McGraw and Glass (1980). Based on

Hedges' (1981) recommendations, each effect size was weighted to control

for the sample size of each study.

Unit of Analysis

The data were analyzed with two different approaches with respect

to the question of independence among the study findings. The first

procedure treated each study finding as the unit of analysis. This pro-

cedure (i.e., unit of analysis = individual outcome measure) yielded 67

effect sizes for the 22 studies. The second strategy pooled effect

sizes within each study (or within a treatment condition if a study had

two or more different assertiveness training treatment groups) before

averaging across studies. This approach yielded 27 effect sizes for

the 22 studies.







Data Analysis

Three general sets of statistical analyses were performed on the

data using both the study and the individual outcome measure as the unit

of analysis. The first set of analyses used descriptive statistics to

estimate the overall treatment effect and effect sizes for each study

characteristic. The second group of analyses used regression techniques

to determine whether study characteristics were significantly related

to effect size. The last set of analyses employed multiple regression

techniques to determine the relationship between combinations of study

variables and effect size.













CHAPTER IV

RESULTS

The findings of the meta-analysis of the 21 studiesI are described

in this section. This chapter is structured to coincide with the ques-

tions raised in the first chapter. Before discussing the specific

findings of the meta-analysis, the impact of the unit of analysis on

the results is detailed.

Unit of Analysis

The data were analyzed with both the individual outcome measure and

the study serving as the unit of analysis. A comparison of the results

across the two vertical halves of any of the tables presented in this

chapter reveals that effect sizes computed at the level of individual

outcomes and at the level of the study are not significantly different.

The results show that treating nonindependent data (i.e., individual

outcomes within studies as the unit of analysis) as if they were inde-

pendent produced on the average larger effect sizes. The inflated

effect sizes are a consequence of the increased sample size that the pro-

cedure creates. Since no significant differences exist between the

approaches, the ensuing discussion will focus on the more conservative

findings produced by treating the study (rather than the individual out-

comes) as the unit of analysis.


1An outlier (Brown, 1980) was identified and removed from the
original sample of studies. The study contributed two effect sizes
which were approximately 10 times larger than the average effect size.








Overall Effectiveness of Assertiveness Training

The summary statistics for the overall effectiveness of assertive-

ness training are presented in Table 2. The average effect size for the

21 studies was .74. The effect size index is a standard score; it indi-

cates that the assertiveness training group mean deviated .74 standard

deviation units from the control group mean.

The standard deviation of the effect sizes is .70. The distribu-

tion of effect sizes was positively skewed with only 6 of the 65 effect

sizes indicating a negative treatment effect. Fifty percent of all the

effect sizes fell within the range of .34 to 1.08.

The 65 effect sizes were classified into two categories descriptive

of the type of outcome measure employed. There were 29 self-report

assessments of assertiveness with a mean effect size of .65 and a

standard deviation of .71. The average effect size for the 36 behavioral

outcomes was .80 with a standard deviation of .87.

The majority of the outcome measures were taken within one week of

the completion of treatment. Only two studies assessed the long-term

effects of assertiveness training (at two weeks and one year). Although

the effect sizes reported at the later assessment times were larger than

the average effect size, it was impossible to describe the decay of

treatment effects over time with only two post-treatment data points.

The meta-analysis also assessed the impact of the type of control

condition (no treatment or placebo) on the calculation of effect sizes.

First, when treatment was compared with no treatment, the average effect

size was .85 with a standard deviation of .83. Second, when treatment

was contrasted with placebo conditions, the mean effect size was .63

with a standard deviation of .52













Table 2

Summary Statistics for Effect Size Distribution


Unit of analysis
Statistic Individual outcome measure Study


Number 65 25

Mean .80 .74

Standard deviation .74 .70

Percentile

90 1.81 1.31

75 1.06 1.08

50 .67 .58

25 .37 .34

10 -.02 -.04








Assertiveness Training Components

The descriptive statistics for the 12 assertiveness training com-

ponents are reported in Table 3. To illustrate the nature of this table,

consider the effect size for the instructions component. The statistics

reported in the "with" rows refers to the average effect size for all

the studies that used instructions as a treatment component. The "with-

out" row refers to the average effect size of the studies that did not

use instructions as a treatment component.

The components that were employed most frequently in the 21 studies

were instructions, modeling (live models), behavior rehearsal, and

coaching. Group feedback and homework appeared in approximately half

the studies sampled, while the other components were infrequently in-

corporated into the training packages.

The effect sizes associated with the presence of the most frequently

employed components (instructions, modeling-live models, behavior re-

hearsal, and coaching) were all approximately equal to the overall

effect size. For the remaining components, effect sizes ranged from .90

for bibliotherapy to .44 for covert rehearsal.

The correlations between the individual components and the overall

effect size varied greatly. The squares of the correlation coefficients

are reported in Table 3. The squared correlation coefficient measures

the proportion of the variance in effect sizes that is associated with

variability in each study characteristic. The larger the value of the

squared correlation coefficient the stronger is the linear relationship

between the study characteristic and effect size.








Table 3

Descriptive Statistics for Assertiveness Training Components


Unit of analysis
Individual outcome measure Study
Component n ME SDES r' n AS DES r_


Instructions

With

Without

Modeling live

With

Without

Modeling taped

With

Without

Behavior rehearsal

With

Without

Covert rehearsal

With

Without

Taped feedback

With

Without

Coaching

With

Without


.020


.84 .75

.28 .32


.001


.71

1.05


.76

.70


.036


1.14

.74



.80


.020


.008


.96

.73



.74


.026


.43 .48

.83 .75


.023


.96 .51

.72 .82


.029


.81

-.18


.002


.79 .39

.73 .78


.073


.78

-.18








Table 3--Continued


Unit of analysis
Individual outcome measure Study
Component n M SD2 n MEs SD r
-ES -=ES -t -ES -


Self-feedback

With 19

Without 46

Group feedback

With 38

Without 27

Cognitive restructuring

With 4

Without 61

Homework

With 32

Without 33

Bibliotherapy

With 10

Without 55


.014


.040


.66 .51

.85 .81


.49

.78


.012


.073


.44

.96


.003


.65 .50

.81 .75


.036


.94 .91

.66 .50


.017


.008


.81 .99

.68 .28


.032


1.11

.74


.006


.90

.72


Note. n = number of effect sizes; MEs = mean effect size;
SDES = standard deviation of effect sizes; r = correlation between
component and effect size.








Table 4 reports inferential statistics comparing the "with" and

"without" means for each component listed in Table 3. To clarify the

nature of these tests, consider the instructions component. The F sta-

tistics are non-significant for both the individual outcome measure and

the study as the unit of analysis. This indicates that on the average

the effect size of studies using instructions as a component is not

significantly different from the effect size of studies that did not use

instruction as a treatment component. Inspection of Table 4 reveals

that there are no significant effects for any of the components.

Table 5 summarizes additional analyses of the assertiveness training

components. To illustrate the meaning of these analyses, consider the

analysis of the response-acquisition operations. This analysis investi-

gated whether knowledge of the response-acquisition components involved

in a treatment could be used to predict effect size. As indicated in

Table 5, the results are not significant for any of the component sets.

This suggests that the component combinations used in the 21 studies

were not differentially effective in predicting effect size.

Therapist Characteristics

The descriptive statistics for the characteristics of the therapists

are reported in Table 6. There were usually one or two therapists

assigned to each treatment condition. The training level of the thera-

pist was fairly evenly divided between student and professional counselors.

The sex of the therapists varied among the studies. None of the thera-

pist characteristics was significantly related to the overall effect

size (see Table 7).












Table 4
Inferential Statistics for Assertiveness Training


Components


Unit of analysis
Individual outcome measure Study
Component F (P <) F ( <)

Instructions 2.74 (.10) .45 (.51)
Modeling live 2.51 (.12) .02 (.89)
Modeling taped 2.39 (.13) .20 (.66)
Behavior rehearsal -
Covert rehearsal 1.31 (.26) .62 (.44)
Taped feedback 1.53 (.22) .03 (.87)
Coaching 1.79 (.19) 1.87 (.18)
Self-feedback .91 (.34) .95 (.34)
Group feedback .75 (.39) 1.83 (.19)
Cognitive restructuring .17 (.68) .41 (.53)
Homework 2.38 (.13) .21 (.65)
Bibliotherapy 2.12 (.15) .14 (.71)













Table 5
Summary Statistics for Groups of Assertiveness Training Components

Unit of analysis
Individual outcome measure Study
Component sets F (P <) rd F (_ <) rZ

Response-acquisition
operations 1.69 (.18) .078 .22 (.88) .014
Response-
reproduction
operations 1.31 (.26) .020 .62 (.44) .026
Response-shaping
operations 1.64 (.18) .096 1.73 (.18) .26

Response-transfer
operations 1.57 (.22) .048 .12 (.89) .010

Note. Response-acquisition operations = instructions, modeling -
live, modeling taped; Response-reproduction = behavior rehearsal,
covert rehearsal; Response-shaping operations = taped feedback, coaching,
self-feedback, group feedback; Response-transfer operations = homework,
bibliotherapy.













Table 6

Descriptive Statistics for Therapist Characteristics


Unit of analysis
Therapist Individual outcome measure Study
characteristic n MES S-ES r2 n MES ES r_


Therapist training .008 .00

Student 51 .76 .56 15 .74 .33

Professional 14 .92 1.21 10 .76 1.07

Sex of therapist .01:4 .053

Female 18 .84 1.09 6 1.02 1.20

Male 23 .68 .68 11 .62 .57

Both 24 .87 .42 8 .71 .32

Number of therapists .040 .044

One 26 .62 .63 11 .58 .57

Two 37 .92 .81 13 .87 .82

Three 2 .85 .25 1 .85 -












Table 7
Inferential Statistics for Therapist Characteristics


Unit of analysis
Therapist Individual outcome measure Study
characteristic F (p <) F (p <)

Number of therapists 1.26 (.29) .50 (.62)
Therapist training .50 (.48) .01 (.94)
Sex of therapists .43 (.65) .61 (.55)








Subject Characteristics

The descriptive statistics for the subject characteristics are re-

ported in Table 8. The most common population utilized in the studies

were mixed sexed groups of normal college students. With only a small

number of the studies utilizing psychiatric, alcoholic, and aggressive

individuals, it is impossible to estimate accurate effect sizes for

these populations. As for the assignment of subjects to treatment con-

dition, the number of subjects per assertiveness training group varied

considerably among the studies sampled.

When the individual outcome measure was the unit of analysis, the

entire collection of subject variables was significantly related to

effect size (f 9, 64 = 3.35, 2 > .003). Specifically, the age of the

subjects variable was significantly related to effect size,while the

level of assertiveness and sex of the subjects variables approached

significance (see Table 9 for the inferential statistics of the subject

characteristics).

Distribution of Training

The descriptive statistics for the characteristics of distribution

of training are reported in Table 10. The amount of distribution of

treatment time varied greatly among the studies sampled. On the average,

clients met for 5-to-6 sessions over a 5-to-6 week period for a total of 8-

to-9 hours of assertiveness training. Effect sizes were relatively

stable across the number of sessions, weeks, and hours of treatment.

None of the distribution characteristics was significantly related to

effect size (see Table 11)








Table 8

Descriptive Statistics for Subject Characteristics


Unit of analysis
Subject Individual outcome measure Study
characteristic n ME SDS -f n ES D S-r


Classification of

Psychiatric

Normal

Alcoholic

Subjects level of
assertiveness

Non-asserti ve

Aggressive

Not assessed

Age of subjects

Adolescent

College
students

Adult

Sex of subjects

Female

Male

Both


subjects

3

58

4


.026


.98

.81

.34


.090


1.08

.61

.63


1.28

.66

.56


.090


4 .49


2 .57


.090


.032


.194


1.07

.22

.49


.096


.063







Table 8--Continued


Unit of analysis
Subject Individual outcome measure Study
characteristic n MES S-DS r2 n ME SD-ES r'


Number of subjects .026 .020

1 13 .66 .38 3 .69 .36

2 3 0 0 -

4 5 16 .55 .66 8 .51 .47

6 7 8 .69 .56 4 .69 .43

8 9 11 .53 1.04 3 .70 1.49

10 or more 17 .70 .62 7 .67 .54












Table 9
Inferential Statistics for Subject Characteristics


Unit of analysis
Subject Individual outcome measure Study
characteristic F ( <) F (_ <)

Classification of subjects .83 (.44) .36 (.70)
Subjects' level of
assertiveness 2.99 (.06) 2.63 (.09)
Age of subjects 3.05 (.05) 1.19 (.32)
Number of subjects 1.61 (.21) .43 (.52)
Sex of subjects 2.93 (.06) .74 (.49)








Table 10

Descriptive Statistics for Distribution of Training


Unit of analysis
Distribution Individual outcome measure Study
characteristic n M-E SD r2 n !E SD S r2
-ES =ES --ES -

Number of sessions .002 .029

1 8 .89 .17 2 .89 .002

2 3 1 .52 1 .52 -

4 5 19 .66 .62 8 .61 .45

6 7 21 .84 .97 8 .98 1.00

8 9 13 1.01 .66 3 .91 .43

10 or more 3 .45 .87 3 .45 .87

Number of weeks .00 .003

1 9 .85 .20 3 .77 .22

2 3 13 .43 .31 6 .49 .24

4 5 20 .98 .63 6 .78 .53

6 7 15 .93 1.14 5 1.16 1.30

8 9 5 .70 .86 2 .77 .49

10 or more 3 .45 .87 3 .45 .87

Number of hours .001 .000

1 0 0 -

2 3 13 .66 .38 3 .69 .36

4 5 3 .53 .63 3 .53 .63

6 7 15 .85 .71 5 .85 .36

8 9 6 1.56 1.46 4 1.28 1.41

10 or more 28 .69 .61 10 .56 .53












Table 11
Inferential Statistics for Distribution Characteristics


Unit of analysis
Distribution Individual outcome measure Study
characteristic F (P <) F (p <)

Number of sessions .08 (.78) .69 (.41)
Number of weeks .04 (.84) .06 (.80)
Number of hours .04 (.84) .00 (.99)







Publication Features

The descriptive statistics for the publication features of the

studies included in the meta-analysis are reported in Table 12. The

final sample was composed of 15 journal studies and six dissertations.

The majority of the studies were published during the mid to late 1970's.

The procedures used in the studies were usually labeled as assertive or

assertion training rather than assertiveness training. None of the

publication features was significantly related to effect size (see

Table 13).

Summary of the Results

The meta-analysis demonstrated the overall effectiveness of assertive-

ness training with an average effect size of .74 for the 21 studies that

were reviewed. The core components of assertiveness training programs

were identified as instructions, modeling, behavior rehearsal, and

coaching. Therapist, subject, and distribution characteristics varied

considerably among the 21 studies. Subject characteristics were the

only variables significantly related to effect size.













Table 12

Descriptive Statistics for Publication Features


Unit of analysis
Publication Individual outcome measure Study
feature n ES SES r n MS SS -r2


Source of
publication

Journal


Dissertation

Year of publication

1980 1982

1978 1979

1976 1977

1974 1975

Before 1974

Name of procedure

Assertiveness

Assertion

Assertive


.001


58 .80

7 .73


.053


.62

.89

.36

1.01


.001


19 .75

6 .71


.003


.84

.61

.96

1.21


.032


.090


.39

1.00

.65












Table 13
Inferential Statistics for Publication Features


Unit of analysis
Publication Individual outcome measure Study
feature F (p <) F (p <)

Source of publication .06 (.81) .02 (.90)
Year of publication 1.15 (.34) .46 (.72)
Name of procedure .99 (.38) 1.09 (.35)













CHAPTER V

DISCUSSION

This chapter is divided into three sections. In the first section

a discussion of the findings of the meta-analysis will be presented.

The limitations of meta-analytic procedures in the context of the pre-

sent study are discussed in the second section. The final section

focuses on the clinical and research implications of this study.

Discussion of the Findings

Overall Effectiveness of
Assertiveness Training

The meta-analysis of the 21 assertiveness training studies yielded

an overall effect size of .74. This estimate of treatment effectiveness

indicates that the average person receiving assertiveness training was

.74 standard deviations above the typical control group member on out-

come measures of assertiveness. Converted into percentile terminology,

the effect size of .74 shows that assertiveness training can be expected

to move the average client from the 50th to the 77th percentile. It is

interesting to note that the effect size for assertiveness training is

similar to the effect size found for psychotherapy and for behavior

modification therapies (Smith & Glass, 1976).

The decay of assertiveness training treatment effects over time was

assessed by only two studies in the meta-analysis sample. Without a

substantial number of delayed outcome assessments, it is impossible to

estimate the long-term effectiveness of assertiveness training.








Obviously, reserachers should include some form of delayed assessment

of treatment effectiveness in future investigations of assertiveness

training. Until that information becomes available, proponents of

assertiveness training can only advocate the short-term benefits of the

procedure.

In the 21 studies, there were 29 self-report and 36 behavioral

assessments of assertiveness. The average effect size associated with

the self-report measures was .65 while the effect size for the behavioral

outcomes was .80. The lack of difference between the effect sizes of

self-report and behavioral measures demonstrates the interdependence of

behavior and attitudes. This finding suggests that behavioral changes

in assertiveness are accompanied by similar attitudinal changes.

The meta-analysis also assessed the impact of the type of control

condition on the calculation of effect sizes. The effect size associated

with studies that had no-treatment control groups was .85. Studies that

used placebo control conditions had an average effect size of .63. This

finding demonstrates that assertiveness training is effective regardless

of whether it is contrasted with placebo or no-treatment control condi-

tions.

Assertiveness Training Components

The results of the meta-analysis indicated the frequency that

various assertiveness training components were used in the 21 studies.

The components that were used in almost every study were instructions,

modeling, behavior rehearsal, and coaching. Other assertiveness training

components were used in conjunction with the core components but no

regular pattern of additional components was discernable.








The effect sizes associated with the components of instructions,

modeling, behavior rehearsal, and coaching were all approximately equal

to the overall effect size. For components that were occasionally used

in treatment programs, effect sizes ranged from .81 for homework to .54

for self-feedback. The components of taped modeling, covert rehearsal,

cognitive restructuring, and bibliotherapy were used so infrequently

that it is impossible to estimate effect sizes for these components.

None of the assertiveness training components was significantly related

to effect size.

The identification of instructions, modeling, behavior rehearsal,

and coaching as the core components of assertiveness training help des-

cribe the typical training procedure. For example, therapists typically

begin training by providing a general description of assertiveness and

other response patterns (non-assertiveness and aggressiveness). Clients

then might be asked to role-play a situation in which assertive re-

sponses are required. After the role-play scene, the therapist typically

describes or models assertive responses. Clients practice these re-

sponses and their behavior is gradually shaped by the verbal reinforce-

ment of the therapist. This pattern of training would be repeated until

the client exhibits assertive behavior.

In all the studies, other components were added to the basic four

components. Noticeably missing from many studies were cognitive re-

structuring strategies and components (bibliotherapy, homework) designed

to generalize the effects of training to other settings. Rich and

Schroeder (1976) proposed that any effective assertiveness training pro-

gram must contain at least one procedure from each of the following com-

ponent sets: response-acquisition (instructions, modeling), response-







reproduction (behavior rehearsal, covert rehearsal), response-shaping

(video feedback, coaching, self-feedback, group feedback), cognitive

restructuring strategies (e.g., Rational Emotive Therapy), and response-

transfer operations (homework, bibliotherapy). With many of these com-

ponents (cognitive and response-transfer operations) being used infre-

quently in assertiveness training studies, it is impossible to test

Rich and Schroeder's proposition.

Therapist Characteristics

The meta-analysis assessed the relationship between treatment out-

comes and the following therapist characteristics: number, sex, and

level of training. Although the three therapist variables were not

significantly related to treatment outcomes, there are certain trends

in the data worthy of discussion. Studies that used two therapists re-

ported larger effect sizes than studies that employed only one therapist.

Developers of assertiveness training programs (Alberti & Emmons, 1974;

Lange & Jakubowski, 1976) have suggested that two therapists offer the

following advantages over one therapist: two therapists allow the sub-

jects to observe two different models of assertiveness, the two therapists

can supplement each other's work, and the evaluation of each session is

facilitated with two therapists.

The effect size associated with studies that used only female

therapists was approximately twice as large as effect sizes for male or

male and female therapists. The effect size for studies with female

therapists is possibly inflated because most of those studies involved

the subjects who exhibited the greatest gains, non-assertive individuals.

Also, previous studies (e.g., Hall, 1976; Parr, 1977) have supported the

non-significance of the therapist's sex on treatment effectiveness.








There was no difference in effect sizes reported for studies that

used student or professional counselors. Since assertiveness training

is a relatively new procedure, it is likely that students and professional

counselors do not significantly differ in their amount of experience

with assertiveness training procedures. A better indicator for differ-

entiating the expertise of therapists would be the type of preparation

they received. Frequently, individuals call themselves assertiveness

trainers after attending one or two training workshops. Researchers

may desire to only use therapists that meet the guidelines for assertive-

ness trainers adopted by the Association for the Advancement of Behavior

Therapy (see Alberti & Emmons, 1974).

Subject Characteristics

The meta-analysis considered the relationship between the following

subject-related variables and treatment outcomes: the sex of the sub-

jects, the number of subjects, the subjects' level of assertiveness,

the age of the subjects, and the classification of subjects. The primary

population used for the 21 studies was mixed sex groups of college

students. There were an insufficient number of studies with aggressive

individuals, psychiatric patients, alcoholics, and adolescents to accur-

ately assess the impact of assertiveness training with those populations.

When the unit of analysis was the individual outcome, the entire

group of subject variables was significantly related to treatment out-

comes. When the subject variables were analyzed individually, the age

variable was significantly related to effect size while the sex variable

and the pretreatment level of assertiveness variable were nearly signifi-

cant. For the age variable, subjects were classified into three levels:

adolescent, college student, and adult. The majority of studies employed







college students as subjects. The effect size for studies with college

students is approximately twice the size of the effect size associated

with studies that used adolescents or adults. There are two possible

reasons for the smaller effect size for adolescents and adults. First,

with only a few studies investigating the effects of assertiveness

training with these populations, it was impossible to obtain an accurate

estimate of treatment effectiveness. Second, the studies with adults or

adolescents usually did not involve "normal" populations rather these

studies used aggressive, psychiatric, or alcoholic individuals. More

studies need to be completed with different types of populations before

the effectiveness of assertiveness training can be judged for these

populations.

The subjects were classified into three pretreatment levels of

assertiveness; non-assertive, aggressive, and not assessed. The studies

with non-assertive subjects had an effect size that was twice as large

as for studies with aggressive or randomly selected subjects. This

finding is expected since non-assertive subjects have the most to gain

from assertiveness training. This finding demonstrates that assertive-

ness training is most effective for individuals with social skill

deficits.

The effect size for studies with male and female subjects was larger

than the effect size for studies with only female or only male subjects.

Assertiveness trainers have claimed that assertiveness training is more

effective when both sexes compose the treatment group. Having both

sexes in a training group allows for greater role-playing combinations

and more opportunity to observe role models of both sexes.








The number of subjects per treatment condition varied considerably

throughout the studies. Effect sizes remained relatively equivalent

regardless of size of the treatment group. Although most assertiveness

trainers recommend forming groups of five to seven clients, the results

of this study failed to find a significant relationship between group

size and treatment outcomes.

Distribution of Training

The amount of distribution of treatment time varied considerably

among the studies. The average time distribution for the studies

sampled was five-to-six sessions over a five-to-six week period for a

total of eight-to-nine hours. The findings of the meta-analysis indi-

cate that there is no significant relationship between the distribution

of training time (number of weeks, hours, or sessions) and treatment

outcomes. However, there is a trend in the data that suggests there

may be an optimal treatment length. Effect sizes were largest at the

following levels: six-to-seven sessions, six-to-seven weeks, and eight-

to-nine hours. This finding must be viewed as tentative because of the

small number of studies at each distribution level and the large vari-

ances associated with the largest effect sizes. Only through future

research efforts can the optimal distribution of training be identified.

Publication Features

The meta-analysis of assertiveness training research findings was

comprised of 15 journal articles and six dissertations that were published

primarily in the late 1970's. There was no difference between effect

sizes from journal studies or dissertations. This finding indicates

that a reliance on published or unpublished assertiveness training re-

search would not introduce a source of bias into a meta-analysis. For





70


the studies surveyed, the majority were titled as assertion or assertive

training rather than assertiveness (this finding caused the author to

ponder the choice of assertiveness training for this study). In general,

none of the publication features was significantly related to treatment

effectiveness.

Summary of Research Findings

The results of the meta-analysis provide information concerning

assertiveness training that previous reviews were unable to do. First,

the meta-analysis estimated the overall magnitude of treatment effective-

ness. Second, the meta-analysis identified the frequency that various

components were used in assertiveness training studies and their rela-

tionship to treatment outcomes. Third, the impact of various subject,

therapist, and design characteristics on treatment effectiveness was

estimated. With this information, researchers and clinicians have a

better understanding of assertiveness training research. The implica-

tions of these findings will be discussed later in this chapter.
Criticisms of Meta-Analysis

The criticisms and limitations of meta-analysis have been described

elsewhere (Cook & Leviton, 1980; Glass, 1976; Jackson, 1982). In this

section, the criticisms of meta-analytic procedures that are applicable

to this study are discussed. Also, the specific limitations of this

meta-analysis are described in this section.

Critics of meta-analysis have questioned some of the statistical

techniques that are frequently used. The first criticism involves

whether it is appropriate to use individual outcomes as the unit of

analysis. As noted in the second chapter, the procedure that uses

individual outcomes as the unit of analysis assumes independence among





71


the individual findings even though the outcomes (within a study) are

dependent. In this study, analyses were conducted using both the study

and individual outcomes measures as the unit of analysis. Using both

approaches allowed for a comparison of results obtained by both approaches.

No significant differences in effect sizes calculated by the two pro-

cedures were indicated.

The second statistical criticism involves the importance of sample

size in the calculation of effect sizes. Critics of meta-analyses have

noted that effect sizes from studies with different sample sizes are

usually given equal consideration. In this study, effect sizes were

weighted according to the number of subjects to control for the influence

of sample size.

A third criticism of meta-analysis has been the practice of summing

findings across outcome measures. For example, in the Smith and Glass

study effect sizes were averaged across different constructs (e.g.,

anxiety, depression) that were computed by different methods (e.g.,

interviews, objective tests) or by different informants (e.g., patient,

significant other, therapist). In this meta-analysis, the outcome

measures were restricted to one construct. The outcome measures were

behavioral and self-reported assessments of assertiveness. The meta-

analysis determined that there was no difference in effect sizes computed

from behavioral or self-report measures.

A fourth criticism of meta-analytic procedures is the practice of

including studies of varying quality in the meta-analysis. As discussed

in the second chapter, Glass (1976) has argued that poorly designed

studies should not be disregarded because all studies can provide valuable

information concerning the issue under question. In this meta-analysis,





72 /


the impact of design characteristics (i.e., type of control condition,

reactivity of outcome measures) on effect size was found to be non-

significant.

A fifth criticism is that meta-analysts have failed to determine

the number of studies that are needed to perform a valid meta-analysis.

Glass (1976) offers the following answer

An ensuing question--what is the smallest number of studies
required for a meta-analysis?--ought to be rephrased. The
spirit of meta-analysis is that statistical methods aid
perception; tables, graphs, simple descriptive measures of
locations and spread, scatter diagrams, and regression sur-
faces reveal information not apparent to otherwise unaided
perception. The question then becomes, How many studies can
be read and integrated without resorting to statistical
methods to reveal aggregate findings and relationships? The
number is probably very small. (p. 362)

The primary criticism, or limitation, of this study is the small

number of the studies that are used in the meta-analysis. The small

sample size directly limits the ability to answer some of the questions

raised in the first chapter. For example, the meta-analysis was unable -

to assess the long-term effectiveness of assertiveness training, the

effectiveness of certain assertiveness training components (e.g., covert

rehearsal, cognitive restructuring strategies), and the effectiveness

of assertiveness training with certain populations (e.g., alcoholics,

psychiatric patients). The inability to answer these questions is pri-

marily due to the failure of assertiveness training researchers to in-

vestigate many of these issues.

There are several additional factors that influenced the sample

size of this study. First, because of limited inter-library services,

only 40% of the potentially useful dissertations on assertiveness training

were obtained. Second, two studies failed to use appropriate measures of




73 ,


assertiveness. Third, several studies failed to report enough informa-

tion about their training procedures or about their statistical findings

to determine whether the study would qualify for this meta-analysis.

The inability of many studies to qualify for this meta-analysis illus-

trates the overall poor quality of many research studies in this area.

The specific limitations of assertiveness training research will be dis-

cussed in the next section.

Although the small sample size inhibits the ability to answer some

of the questions raised in the first chapter, one can be confident that

the overall conclusions of this study are valid. Rosenthal (1980) de-

vised a procedure that allows researchers to estimate the number of un-

retrived or unpublished studies averaging null results that would have

to exist before the overall probability of a Type I error is brought to

any desired level of significance (e.g., p = .05). For this meta-

analysis, approximately 200 studies averaging a null result (2 = .00)

would have to exist somewhere before the overall significance of asser-

tiveness training could be attributed to sampling bias.

In summary, there are several limitations of meta-analytic procedures.

This study attempted to control for these limitations by using the latest

available strategies. The primary limitation of this study, the small

sample size, was primarily attributed to the poor quality of assertive-

ness training research. The problems with research studies dealing with

assertiveness training are discussed in the next section.

Critique of Assertiveness Training Research

Although meta-analysis is a quantitative review technique, valuable

information concerning the quality of research in a topic area can be

derived from the implementation of the meta-analysis. In this section,





74 %


the discussion focuses on some of the limitations of assertiveness

training research.

First, assertiveness training researchers have paid little atten-

tion to the theoretical formulations underlying their training procedures.

Assertiveness training programs are often designed without any considera-

tion given to any theoretical framework. Frequently, researchers failed

to provide any rationale for their choice of components or design of

the assertiveness training program. Researchers often failed to provide

a theoretical explanation of their findings. Assertiveness training

researchers' emphasis has been on demonstrating the efficacy of the

procedure and not theory building.

Second, the theoretical explanations that researchers used to explain

findings from assertiveness training studies frequently failed to inte-

grate such factors as external reinforcement, self-reinforcement, anxiety,

and cognitive belief structures. As noted in the first chapter, there

is no comprehensive theory that explains the development or modification

of assertive skills. The gap between application and theory is quite

noticeably in assertiveness training research.

Third, many assertiveness training researchers did an inadequate

job of reporting their studies. In many studies, the following infor-

mation was incompletely reported: the components used in the training

procedures, the training level of the therapists, the length of training,

and statistical findings. It is assumed that these researchers took

account of these factors and failed to report this information.

There are other problems with this body of literature. These prob-

lems include the mislabeling of procedures as assertiveness training

even though the studies investigate only single components, the large





75 V


number of dissertation studies that have not been published in more

readily available sources, the insufficient number of investigations

dealing with the impact of subject, design, and therapist characteristics

on treatment outcomes, and the implementation of assertiveness training

without regard to the presenting problems of the subjects.

In summary, as a relatively new research area assertiveness training

researchers have failed to consider important theoretical issues. Re-

search has focused on the application of assertiveness training rather

than the factors underlying the development of assertive behavior. This

critique of assertiveness training research was not intended to disregard

the high quality of many studies but to illustrate some trends in

assertiveness training research that need to be attended to.

Implications of this Study

Clinical Implications

The results of this study have the following implications for

assertiveness training practitioners:

1. The major conclusion of this meta-analysis is that assertiveness

training is an effective procedure for increasing individuals' levels

of assertiveness. This finding will help clinicians justify the use of

assertiveness training as an intervention for individuals with social

skills deficits.

2. Clinicians need to be aware that the basic components of

assertiveness training as defined in this study are instructions,

modeling, behavior rehearsal, and coaching. Depending upon the pre-

senting problems of clients, clinicians may desire to add other components

to the four core components. Until future research assesses the








additive effect of other components, we cannot determine the most effec-

tive combination of procedures at this time.

3. Although therapist characteristics were not significantly re-

lated to treatment outcomes, clinicians may consider the use of two

therapists, preferably one of each sex, when conducting assertiveness

training. Also, clinicians should review the criteria set forth by the

Association for the Advancement of Behavior Therapy (see Alberti &

Emmons, 1974) to determine whether they meet the qualifications of an

assertiveness trainer.

4. The results of the meta-analysis found that various subject

variables were closely related to treatment effectiveness. This finding

confirms the assertion that assertiveness training should not be used

as an all purpose intervention. Specifically, clinicians need to con-

sider the following findings. First, the effectiveness of assertiveness

training has not been clearly demonstrated with psychiatric, alcoholic,

or aggressive populations. Second, assertiveness training was found to

be most effective when both male and female clients participated in the

procedure. Third, assertiveness training is most effective when used

with non-assertive individuals. Fourth, the size of the treatment group

was not related to treatment effectiveness.

,5. The amount of treatment time was not significantly related to

treatment effectiveness. The average time distribution for the studies

sampled was five-to-six sessions over five-to-six weeks for a total of

eight-to-nine treatment hours. Clinicians may desire to use this time

allotment until more information concerning.optimal treatment length

becomes available.








Research Implications

The results of this study have the following implications for re-

searchers of assertiveness training:

1. Assertiveness training is a relatively new area of research.

In the attempt to keep up with the public demand for assertiveness

training, researchers ignored many basic theoretical and measurement

issues and proceeded to assess the efficacy of the procedure. It is

strongly recommended that researchers first attempt to bridge these

formative issues before completing further investigations of assertive-

ness training.

There are many unanswered, or partially answered, questions con-

cerning the development of assertive skills. Are assertiveness deficits

due to a lack of requisite skills or lack of prior reinforcement? If

individuals have assertive skills and fail to display them, what are the

inhibiting factors? Does an increase in assertive responding produce a

change in cognitions concerning assertiveness? Obviously, researchers

need to determine the influence of behavioral and cognitive factors on

assertiveness.

2. The difficulty in obtaining studies for the meta-analysis was

in part due to the poor quality of many assertiveness training research

studies. Researchers should consider the following list as the charac-

teristics of a well designed and reported assertiveness training study:

A. A well defined description of the components included in

the procedure. This description should include the name of the

components used, examples of the components, and the percentages

of the training devoted to each. Also, researchers should pro-

vide on request a detailed description of the training.








B. A rationale for why various components were used and an

explanation of why assertiveness training is being used with

the population under consideration.

C. A description of the training of therapists. It would

be preferable if researchers only employed therapists that were

well acquainted with asssertiveness training procedures.

D. Any assertiveness training study should have at least

one measure of assertiveness. Also, the effect of treatment

over time should be assessed.

E. A clear report of the statistical findings. The minimal

statistics include sample size, means (adjusted and unadjusted),

standard deviations, and significance levels of inferential tests.

F. The characteristics of subjects and therapists. Also,

the method of assignment to treatment conditions should be

described.

3. At some stage, researchers need to decide on what assertiveness

training is. As it stands now, assertiveness training is an assorted

collection of behavioral and cognitive procedures. The findings from

this study identified four core components. Researchers may want to

call a conference meeting at a national convention (e.g., American

Psychological Association, Association for the Advancement of Behavior

Therapy) to describe the status of assertiveness training research and

decide on the future direction of the field.

4. It would be beneficial if researchers could decide on the same

name for this procedure. The terms assertion, assertive, and assertive-

ness training are frequently used interchangeably. The lack of agreement

on a name for the procedure illustrates the need for communication among

researchers.













APPENDIX A


STUDIES NOT INCLUDED IN THE META-ANALYSIS
AND REASONS FOR EXCLUSION


Study


Assertiveness Training Components Only
Aiduk & Karoly, 1975
Briedenbach, 1977
Derry & Stone, 1979
Epstein, Deciouanni, & Jayne-Lazarus, 1975
Field & Test, 1975
Freundlich, 1977
Hammen, Jacobs, Mayol, & Cochran, 1980
Henderson, 1976
Hersen, Eisler, & Miuer, 1974
Hersen, Eisler, Miuer, Johnson, & Pinkston, 1973
Hinson-Zeiger, 1973
Jacobs & Cochran, 1982
Kazdin, 1974
Kazdin, 1976
Kazdin, 1980
Kirkland, 1978
Kirschner, 1970
Lang, 1976
Cogin & Rooney, 1975
Mastria, 1975
McFall & Lillesand, 1971
McFall & Marston, 1970
McFall & Twentyman, 1973
McKellar, 1977
Nietzel, Martorano, & Melnick, 1977










Study

Parr, 1974
Pentz, 1981
.Steel, 1977
Thelen & Casoski, 1980
Turner, 1976
Thelen & Casoski, 1980
Turner & Adams, 1977
Twentyman, Gibralter, & Inz, 1979
Vorgin & Kassinove, 1979
Weiskott & Clevand, 1977
Wolfe & Fodor, 1977
Zeiger, 1974
Zielinski & Williams, 1979

No Control Condition
Keating, 1975
Rehm, Fuchs, Roth, Kornblith, & Romano, 1979

No Appropriate Measures
Fagan, 1979
Freedberg & Johnston, 1981
Glassman,. 1977

Not Enough Data Reported for Coding Purposes
Bander, Russell, & Weiskott, 1978
Berah, 1981
Janda & Rimm, 1977
Mischel, 1978
Rotheram & Armstrong, 1980
Sanchez, Lewinson, & Larson, 1980

Not Applicable
Alden, Safran, & Weidman, 1978
Cantone, 1978
Grimes, 1978













APPENDIX B

INTERRATER AGREEMENT COEFFICIENTS FOR THE
CODING OF STUDY CHARACTERISTICS

Study Characteristics Interrater Agreement Coefficients

Instructions .91

Modeling Live .77

Modeling Taped .82

Behavior Rehearsal .91

Covert Rehearsal .82

Taped Feedback .86

Coaching .86

Self-Feedback .72

Group Feedback .86

Cognitive Restructuring .95

Homework .86

Bibliotherapy 1.00

Number of Therapists .91

Therapist Training 1.00

Sex of Therapists .91

Subjects' Classification 1.00

Subjects' Assertiveness .95

Age of Subjects 1.00

Number of Subjects .91

Sex of Subjects 1.00










Study Characteristics Interrater Agreement Coefficients

Control Condition .91

Type of Outcome 1.00

Time of Assessment 1.00

Number of Sessions 1.00

Number of Weeks 1.00

Number of Hours 1.00

Publication Source 1.00

Year of Publication 1.00

Name of Procedure 1.00


Note: Two raters; 22 studies.










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