ASSERTIVENESS TRAINING: A META-ANALYSIS
OF THE RESEARCH FINDINGS
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
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
ACKNOWLEDGMENTS . . . ii
LIST OF TABLES . . . vi
ABSTRACT . . . vii
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
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 . . .
LIST OF TABLES
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
Mark Allen Shatz
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
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
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-
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-
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-
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
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
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.
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.
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)
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
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
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.
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
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
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
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,
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
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
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.
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,
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-
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
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-
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
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
E = SD
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
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
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
6. The use of video taped feedback. Was feedback provided to sub-
jects in the form of audio or video taped playback?
Studies Used in Meta-Analysis
Fielder, Orenstein, Chiles, Fritz, & Breitt, 1979
Galassi, Galassi, & Litz, 1974
Gormally, Hill, Otis, & Rainey, 1975
Holmes & Horan, 1976
Jansen & Litwack, 1979
Layne, Layne, & Schoch, 1977
Lee, Hallberg, & Hassard, 1979
Rimm, Hill, Brown, & Stuart, 1974
Russell & Winkler, 1977
Scherer & Freedberg, 1976
Tiegerman & Kassinove, 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
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
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
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
27. Source of publication. Was the study a dissertation or a
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.
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.
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
Summary Statistics for Effect Size Distribution
Unit of analysis
Statistic Individual outcome measure Study
Number 65 25
Mean .80 .74
Standard deviation .74 .70
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.
Descriptive Statistics for Assertiveness Training Components
Unit of analysis
Individual outcome measure Study
Component n ME SDES r' n AS DES r_
Unit of analysis
Individual outcome measure Study
Component n M SD2 n MEs SD r
-ES -=ES -t -ES -
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.
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).
Inferential Statistics for Assertiveness Training
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)
Summary Statistics for Groups of Assertiveness Training Components
Unit of analysis
Individual outcome measure Study
Component sets F (P <) rd F (_ <) rZ
operations 1.69 (.18) .078 .22 (.88) .014
operations 1.31 (.26) .020 .62 (.44) .026
operations 1.64 (.18) .096 1.73 (.18) .26
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,
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 -
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)
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
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)
Descriptive Statistics for Subject Characteristics
Unit of analysis
Subject Individual outcome measure Study
characteristic n ME SDS -f n ES D S-r
Subjects level of
Age of subjects
Sex of subjects
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
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)
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
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)
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
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.
Descriptive Statistics for Publication Features
Unit of analysis
Publication Individual outcome measure Study
feature n ES SES r n MS SS -r2
Year of publication
Name of procedure
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)
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
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
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-
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.
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).
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
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
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.
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
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
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
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,
the impact of design characteristics (i.e., type of control condition,
reactivity of outcome measures) on effect size was found to be non-
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
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,
the discussion focuses on some of the limitations of assertiveness
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
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
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
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
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
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-
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
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
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
STUDIES NOT INCLUDED IN THE META-ANALYSIS
AND REASONS FOR EXCLUSION
Assertiveness Training Components Only
Aiduk & Karoly, 1975
Derry & Stone, 1979
Epstein, Deciouanni, & Jayne-Lazarus, 1975
Field & Test, 1975
Hammen, Jacobs, Mayol, & Cochran, 1980
Hersen, Eisler, & Miuer, 1974
Hersen, Eisler, Miuer, Johnson, & Pinkston, 1973
Jacobs & Cochran, 1982
Cogin & Rooney, 1975
McFall & Lillesand, 1971
McFall & Marston, 1970
McFall & Twentyman, 1973
Nietzel, Martorano, & Melnick, 1977
Thelen & Casoski, 1980
Thelen & Casoski, 1980
Turner & Adams, 1977
Twentyman, Gibralter, & Inz, 1979
Vorgin & Kassinove, 1979
Weiskott & Clevand, 1977
Wolfe & Fodor, 1977
Zielinski & Williams, 1979
No Control Condition
Rehm, Fuchs, Roth, Kornblith, & Romano, 1979
No Appropriate Measures
Freedberg & Johnston, 1981
Not Enough Data Reported for Coding Purposes
Bander, Russell, & Weiskott, 1978
Janda & Rimm, 1977
Rotheram & Armstrong, 1980
Sanchez, Lewinson, & Larson, 1980
Alden, Safran, & Weidman, 1978
INTERRATER AGREEMENT COEFFICIENTS FOR THE
CODING OF STUDY CHARACTERISTICS
Study Characteristics Interrater Agreement Coefficients
Modeling Live .77
Modeling Taped .82
Behavior Rehearsal .91
Covert Rehearsal .82
Taped Feedback .86
Group Feedback .86
Cognitive Restructuring .95
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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