Group Title: comparison of the differential effects of four aversive procedures utilizing electric shock on smoking behavior
Title: A comparison of the differential effects of four aversive procedures utilizing electric shock on smoking behavior
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Title: A comparison of the differential effects of four aversive procedures utilizing electric shock on smoking behavior
Physical Description: v, 87 leaves : illus. ; 28 cm.
Language: English
Creator: Stokols, Michael Samuel, 1938-
Publication Date: 1968
Copyright Date: 1968
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Subject: Aversive stimuli   ( lcsh )
Smoking   ( lcsh )
Psychology thesis Ph. D   ( lcsh )
Dissertations, Academic -- Psychology -- UF   ( lcsh )
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Thesis: Thesis - University of Florida.
Bibliography: Bibliography: leaves 81-86.
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General Note: Vita.
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Source Institution: University of Florida
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A COMPARISON OF THE DIFFERENTIAL
EFFECTS OF FOUR AVERSIVE PROCEDURES
UTILIZING ELECTRIC SHOCK ON
SMOKING BEHAVIOR









By

MICHAEL SAMUEL STOKOLS


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










UNIVERSITY OF FLORIDA
1968













ACKNOWLEDGMENTS

I would like to express my deep appreciation to the

Chairman of my Dissertation Committee, Dr. William Wolking, for

his encouragement, understanding, and valuable assistance during

the completion of this research. I would also like to convey

my thanks to the other members of my committee, Drs. Henry

Pennypacker, Hugh Davis, Paul Satz, and Ellsworth Bourque,

for their valuable help and advice. A special note of gratitude

is also due Dr. Roy Brener, Chief, Psychology Service, and the

Research Council of the Edward G. Hines Veterans Administration

Hospital, Hines, Illinois, for granting me the necessary research

time and facilities for the apparatus construction and data

collection phases of this investigation. Finally, I would like

to thank the men and women--for the most part, staff members at

Hines--who participated as subjects in this study.










TABLE OF CONTENTS




ACKNOWLEDGMENTS . . . . . . . . . .


LIST OF TABLES . . . . . . . . . . .

LIST OF FIGURES . . . . . . . . . .


Chapter


I. INTRODUCTION . . . . . . . . .

A Formulation of the Problem . . . .
Punishment and the Clinical Literature. . .
The Problem Behavior: Smoking . . . .
The Hypotheses Under Investigation. . . .


II. METHOD . .


Subjects.
Apparatus .
Procedures.


III. RESULTS. . .


IV. DISCUSSION .


Confounding
Situational
founding
Some Issues


V. SUMMARY. . .


APPENDICES . . .


REFERENCES . . .

BIOGRAPHICAL SKETCH. .


. Function of the Proced .







iables as a Source of Con-


Future Research . . . .


. . . . . . . .


. . . . . . . .


. . . . . . . .


. . . . . .* . .


Page


ii


iv


v








LIST OF TABLES


Table La__

I. Stimulus Items, Shock Points, and Representative
Escape Responses. .. ...... . . . .. . 37

2. Repeated Measurements Analysis of Variance of the
MPSR Scores Across Session-Days--Groups HI, H2,
and H3 N = 24. . . . . . . . . . 48

3. Neuman-Keuls Test of all Ordered Pairs of Session-
Day Means for Groups HI, H2, and H3 . . ... 50

4. Repeated Measurements Analysis of Variance of the
MPSR Scores Across Session-Days--Groups HI, 1H2,
H3, and H4 N = 32 . . . . . . . . 51

5. Analysis of Variance of the MPSR Scores on the 15th
Session-Day--Groups HI, H2, and H3 N = 24 ..... 52

6. Analysis of Variance of the MPSR Scores on the 15th
Session-Day--Groups HI, H2, H3, and H4 N = 32. 53

7. Repeated Measurements Analysis of Variance of the
MPSR Scores Two, Six, and 12 Weeks After
Treatment Termination--Groups HI, H2, H3, and H4
N = 32. . . . . . . . . ... . .. 54

8. Neuman-Keuls Test of all Ordered Pairs of Follow-
Up Means for Groups HI, H2, H3, and H4. . . .. 55

9. Analysis of Variance of Age--Groups HI, H2, 13,
and H4 N = 32. . . . . . . . . .. 77

10. Analysis of Variance of the Pre-Treatment Mean
Number of Cigarets Smoked per Day--Groups H1, H2, H3,
and H4 N = 32. . . . . . . . . ... 77

11. Analysis of Variance of the Number of Years A
Cigaret Smoker--Groups HI, H2, H3, and H4 N = 32 77

12. Per Cent Smoking Reduction Scores Across Experi-
mental Treatment and Follow-Up Periods--All Ss. . 78

13. Three-Day Means for Each S Compiled from the Actual
Numbers of Cigarets Smoked Before Treatment and at
the End of Follow-Up. . . . . .. . 80















LIST OF FIGURES


Figure Page

1. HI, H2, 113, and H4 Group MPSR Scores Across the
Experimental Treatment and Follow'-Up Periods . 47















CHAPTER I

INTRODUCTION

While punishment training has been the least utilized

behavior therapy method to date, a review of the recent lit-

erature does indicate that this method, often referred to as

aversive conditioning, is finding increased favor among be-

havior modifiers. Nevertheless, many clinicians of varied

theoretical persuasions continue to doubt the effectiveness

of punishment training, viewing its use in clinical situations

with serious misgivings. The reasons underlying such attitudes

are numerous, and several likely ones will be mentioned here.

Before proceeding, however, a definition of punishment,

as it pertains to this study, is in order. Punishment, then,

has been defined as: (1) some physically aversive or noxious

stimulus which is either contiguous with a CS, or contingent

upon the performance of some behavior (Church, 1963); and (2) a

stimulus which a subject (S) will reject if given a choice be-

tween it and no stimulus at all (Solomon, 1964). Thus, such

procedures as, e.g., verbal disapproval, restraint, the with-

holding of positive reinforcement, time-outs, or massed practice,

while they may properly fall under the general rubric of negative

reinforcement, will not be considered punishment in this nar-

rower sense.









As Solomon (1964) has pointed out, a large number of

clinicians undoubtedly feel that punishment just does not work;

that its effects are transient, unstable, inconsistent, and do

not really weaken habits. The therapist who has his doubts

about the effectiveness of punishment is in good company. Many

prominent psychologists have disavowed punishment as having

any lasting suppressive effects on behavior (e.g., Bandura,

1962; Estes, 1944; Skinner, 1948, 1953; Thorndike, 1932). Many

writers and editors of texts dealing with the areas of learning

and conditioning devote but a few lines to the problem of pun-

ishment (e.g., Hull, 1951; Kimble, 1961; Woodworth and Schlos-

berg, 1958). Solomon points out that many contemporary intro-

ductory psychology texts devote scant space to punishment as a

scientific problem, citing as a case in point George Miller's

recent text, Psychology, the Science of Mental Life, which con-

tains no discussion of punishment anywhere.

The state of the experimental learning literature is in

itself most confusing, and undoubtedly contributes in no small

measure to the negative feelings many clinicians hold towards the

use of punishment in clinical situations. While much experi-

mental evidence indicates that punishment decreases the prob-

ability of a response occurring, contrary experimental results,

often referred to as "paradoxical effects," are legion (refer

to articles by Church, 1963; Kushner and Sandler, 1966; Martin,

1963; Sandler, 1964; and Solomon, 1964). For example, several

studies have shown that when punishment is correlated with

positive reinforcement during acquisition trials, punishment-









extinction trials produce an increase in responding over con-

ditions of regular extinction; also, there is usually increased

resistance to extinction (Carlsmith, mentioned by Solomon, 1964;

Holz and Azrin, 1961, 1962; Martin and Ross, 1964). Karsh (1962)

found that punishment, if introduced before the asymptotic

performance under regular training has been reached, may well

induce further improvement under the punishment procedure.

Azrin (1959, 1960) found that when mild punishment of an in-

strumental response acquired under positive reinforcement is

terminated, there is often a temporary increase in response rate

over that which would have occurred without punishment. Several

researchers have reported that increased learning in selective

learning situations often obtains when "right" responses are

punished (Muenzinger et al., 1938; Muenzinger and Powloski,

1951; Prince, 1956). And, there have been studies showing

that, under certain conditions, Ss prefer continued exposure

to punishment, even though non-punishing alternatives are

available (Brown et al., 1964; Sandler, 1964). While many

more examples could be given, perhaps Church (1963) best summed

up the "paradoxical" literature with his observation that

punishment, under particular circumstances, might result in

almost any conceivable effect.

Solomon (1964) also suggests that the fear of unwanted

emotional side effects, often produced in the laboratory, has

probably deterred many therapists from making use of punishment

procedures. Many animal studies have, in fact, produced highly

disturbed Ss (e.g., Brady's f1958] work with ulcerous








monkeys; Gantt's [19443 work with neurotic dogs; Maier's

[19493 work with fixated rats; Masserman's [1943] work with

neurotic cats and monkeys; and Masserman and Pectel's [19533

work with monkeys). Among others, such factors as high stimulus

intensities, the punishment of consummatory and instinctive

behavior, punishment under non-discriminatory control, the un-

avoidability of punishment, and the punishment of responses

acquired under negative reinforcement all seem to contribute

towards such results.

Finally, but perhaps most importantly, the often am-

biguous and inconclusive results of many of the published

clinical studies and case reports using punishment as the

treatment variable have, in all probability, discouraged many

therapists from making use of punishment training procedures.

Before turning to relevant examples of this literature, how-

ever, the major focus of this study will first be considered.

A Formulation of the Problem

In the majority of the clinical cases which have

utilized a punishment paradigm, the major underlying assump-

tion seems to have been the following: that the simple pair-

ing of a short-duration noxious stimulus with either a pre-

senting stimulus (the CS) or an elicited response would be

sufficient to insure the subsequent lasting suppression of the

target behavior in question. Ihile the emphasis seems to have

been focused on the problem of obtaining response suppression

-- i.e., getting the patient not to do something -- relatively








little experimental literature is available concerning the

problem facing the clinician of systematically getting the

patient to do something else instead. This issue is certainly

familiar to the laboratory investigator studying escape and

avoidance learning. In such experiments the design usually

provides for the development of alternative instrumental

escape and avoidance behaviors as a way of averting or atten-

uating the noxious stimulus.

Solomon (1964) has stated: "Punishment becomes ex-

tremely effective when the response-suppression period is

tactically used as an aid to the reinforcement of new re-

sponses that are topographically incompatible with the punished

one" (p. 241). One way to achieve this end would be to use the

noxious stimulus itself as a reinforcer for new behavior

judged to be incompatible with the punished response. If

cessation of shock is made contingent upon the occurrence of an

operant, this escape response will be reinforced. Soon, escape

and then avoidance responses should be occurring in stable

fashion immediately upon presentation of the stimulus patterns)

which formerly elicited the punished response. Mowrer (1960)

calls such learning "active avoidance learning" and presents

several examples illustrating this paradigm in his book,

Learning Theory and Behavior.

Turner and Solomon (1962) using human Ss, and electric

shock as the UCS, showed the effectiveness of making ces-

sation of long-duration shock contingent upon deliberate,








voluntary operants (as opposed to short-latency reflexive re-

sponses) for escape and avoidance learning. Of course, the

behavior therapist is primarily concerned with the suppression

of unwanted behavior, and Turner and Solomon did not concern

themselves with response suppression, per se, in their mono-

graph. However, it could reasonably be expected that by combining

in treatment what the behavior therapist employing punishment

training attempts to do -- that is, foster response inhibition

as a result of the negative conditioned emotional response

which develops when punishment is made contingent upon a

response -- with what Solomon (1964) suggests be done -- that

is, sequentially reinforce an operant response incompatible

with the punished response -- far more effective and longer

lasting response suppression should occur.

While this procedure is well known in the experimental

literature, many clinicians have either ignored such an approach,

or have made relatively little systematic use of this tactic in

their treatment of patients. This has been especially true in

the many instances where drugs have been employed as the avers-

sive stimulus. A major intent of this study, then, will be the

attempt to demonstrate clinically whether a long-duration

noxious stimulus employed in the manner suggested above would,

in fact, be more effective in inducing lasting response sup-

pression than the same stimulus of short duration simply paired

with the target response, or the CS(s) eliciting such behavior.

And, the experimental learning and conditioning findings

have also overwhelmingly indicated that non-contingent or randomly









administered stimuli -- either positive or negative -- have

little lasting suppressive or facilitative effects on behavior.

All clinical attempts utilizing aversive conditioning methods

have at least assumed this much in the design of the treatment

procedures. To this end, then, the attempt to demonstrate that

a short-duration noxious stimulus presented randomly would not

have any lasting suppressive effect on a given response pattern,

will also be made. The results of such a demonstration should

establish a more meaningful base from which to view the data

obtained from the above mentioned comparison.

Punishment and the Clinical Literature

Choice of the Noxious Stimulus

By far, the majority of the published aversive condi-

tioning studies have concerned themselves with the treatment of

alcoholism and the sexual deviations. In most cases the aver-

sive stimulus has been an emetic drug such as apomorphine or

emetine, and, by and large, conditioning principles have been

violated in many instances (Eysenck, 1963; Franks, 1958, 1963;

Rachman, 1965). Apparently some clinicians have given the

patient alcohol (the CS) after the patient reached the height

of nausea (backward conditioning), time intervals between pre-

sentation of the various stimuli have not been controlled, and

the nausea-inducing drugs may have acted as central depressants,

thereby possibly interfering with the acquisition of the condi-

tioned responses (Eysenck and Rachman, 1965). Others have

focused on the act of vomiting rather than the feeling of nausea

as the CS, and individual reactivity to the drugs has been a








confounding factor (Barker et al., 1961).

Sanderson (1963) notes that the reaction to apomor-

phine is too gradual and too irregular to meet the requirements of

a good UCS. Also, the use of emetic drugs as aversive stimuli

is: (1) cumbersome and messy; (2) involves undue man-hours,

expense, and effort; and (3) often necessitates the taking

of exacting medical precautions including hospitalization

to insure the safety of the patient (Rachman, 1965). Cases

in point are the studies of Clark (1963), who treated a case

of fetishism; Sanderson et al., who treated alcoholics (reported

in Franks, 1964); Raymond (1956), who treated a case of hand-

bag fetishism and perambulator destruction; Cooper (1963), who

treated a case of impotence and fetishism; and Barker (1965)

and Barker et al. (1961), who treated cases of transvestism.

Cooper's paper in particular dramatically points out the degree

to which patients undergoing this kind of treatment are physically

debilitated, fatigued, and endangered.

Thus, in this study, electric shock was used as the

noxious stimulus of choice. Not only can electrical stimula-

tion be more precisely controlled, it can be delivered at a

determined intensity for an exact duration of time at precisely

the required moment. And, not only does electric stimulation

avoid many of the disadvantages of the emetics listed above,

it has the added advantages of not requiring medical supervision

nor more than one person in its administration (Barker, 1965;

McGuire and Vallance, 1964; Rachman, 1965). Further, from the








personal clinical experience of E with this method, and from ex--

perience directly related to this study, it has been observed

that, while most patients or Ss have not liked the experi-

ence of getting shocked, none exhibited intense fear reactions

or immobilization to the procedure. And, lastly, the vast major-

ity of the studies in the experimental punishment literature have

used electric shock as the aversive stimulus, thus providing the

clinician with a wealth of potentially valuable experimental

data. Thus, only aversive conditioning studies which have em-

ployed shock as the noxious stimulus will be mentioned here.

Clinical Studies Using Electric Shock

Thorpe et al. (1963) administered shock to a homosexual

patient through a grid on the floor after two non-aversive pro-

cedures with the same patient had failed to bring about any

change in his behavior. Using a VI/VR reinforcement schedule,

shock, presumably of short duration, closely followed the

illumination of a photograph of a nude male on approximately one

quarter of the presentations. The patient received a total

of 100 trials, each consisting of 40 illuminations. Follow-up

apparently showed that, at best, the patient could be considered

bisexual rather than exclusively homosexual. Using essentially

the same procedure with another homosexual, Thorpe and Schmidt

(1963) reported in the same volume that the patient terminated

treatment after three sessions over two days. This case was

deemed a failure.

McGuire and Vallance (1964), also following a simple

punishment model, reported treating cases involving fetishism,








smoking, writer's cramp obsessional ruminations, and alcoholism.

They indicated that just over 50 per cent of these patients

(N = 39) improved sufficiently to receive a "good improvement"

or "symptom removed" rating at the end of treatment. Apparently,

the authors encouraged their patients to administer their own

shock, both during treatment sessions and at home.

Mees (1966) recently reported in great detail the treat-

ment of a case of sadistic fantasies in a 19-year-old male.

After 25 weeks of baseline data collection, short-duration shock

was delivered to the fingers when the patient imagined selected

parts of his fantasy. Over 6,000 shocks during 65 sessions

were given during the 14-week treatment period. Follow-up 11

weeks later indicated that the patient's sadistic fantasies

accompanying masturbation had markedly decreased and that

heterosexual fantasies were increasing. Like the patients of

McGuire and Vallance above, Mees' patient began shocking him-

self during the second week of punishment training, sometimes

for periods up to two hours. Wolpe (1965) also reported that

a physician with drug addiction of three years' standing was

able to "significantly reduce" his cravings with only nine

"distinctly strong" shocks which were self-administered over

approximately a three-week period. Three months later, however,

there was a complete relapse and drug taking resumed unabated.

Feldian (1966) criticizes the procedure of allowing the subject

to shock himself on the grounds that punishment may become

sought after; i.e., may become positively reinforcing, especially








if the patient is free to set his own intensity level.

Sandler's (1964) concept of masochism, defined as the situation

in which a noxious stimulus does not result in avoidance be-

havior being exhibited by the S receiving it, might also be

relevant here.

Kushner (1965), and Kushner and Sandler (1966), refer to

a fetishist who was treated along simple punishment lines, for

the most part. Shock of short duration was paired with the

patient's images of himself engaging in various aspects of his

fetishist activity, presentation of the fetishist object

(woman's panties), and the presentation of a sexually arousing

picture. An 18-month follow-up showed the patient to be

essentially free of his fetishist behavior. The latter study

(Kushner and Sandler, 1966) also reported the treatment of an

obsessive suicidal ruminator, an occupational compulsive hand

contractor, and an exhibitionist with short-duration shock.

Follow-up (12 months) indicated complete suppression of the

exhibitionist activity, moderate success in the case of the

suicidal ruminator (three-month follow-up), and little if any

improvement on the job after 101 shock sessions for the hand

contractor. The last-mentioned patient's teletypewriter per-

formance was much improved during treatment sessions, however.

Thorpe et al. (1964) used a technique which they called

"aversion relief therapy" in treating three "homosexuals" (two

were called latent), one fetishist, one phobic, one obsessive-

compulsive, and one depressive compulsive eater. Using 24








words on a disc appropriate to each patient's problem as the CSs,

they presented each word in turn, pairing it with short-dura-

tion shock to the feet. The last word -- e.g., in the case of

a homosexual it might be "heterosexual" -- was not shocked and

thus was the "relief" word, as it signaled the end of the trial.

While results of this study were ambiguous as presented, all the

patients seemed to be improved to some degree immediately

following treatment, with the exception of the obsessive-com-

pulsive and the compulsive overeater. Both of these patients

terminated treatment. Since only very brief follow-ups were

given, little can be said about the efficacy of this particular

brand of punishment training.

Meyer and Crisp (1964) reported treating two obese women

with shock, but the exact procedures are anything but clear.

Certain foods were displayed in the same room with the patient,

and shock was contingent upon actual movement by the patient

towards the "temptation" food. The shocks ceased when the

patient ceased moving towards the food, and apparently could

be avoided entirely during any given session. The authors

report one success and one failure but leave unanswered ques-

tions pertaining to, e.g., shock duration and number, whether

the reinforcement contingency was completely controlled by the

S, whether gross movement toward the "temptation" food was the

only experimental response focused on, or how much time the

patients spent in the treatment rooms.

Through the use of short-duration response-contingent

shock (onset sometimes delayed up to 30 seconds, though) Tate








and Baroff (1966) deconditioned acute self-injurious behavior

(SIB) in a hospitalized psychotic boy over a period of five

months. Eventually, just the threat of shock was sufficient to

produce a reduction in other unwanted behavior such as postur-

ing and not eating. Withdrawal of physical contact ("time-

out") was previously used as the negative reinforcement, but

shock was found to be far more effective in suppressing the

unwanted behavior. The authors refer to a paper read by Lovaas

et al., and a personal communication by Ball, all of whom used

similar shock procedures to successfully suppress SIB in

several schizophrenic children and a severely retarded girl,

respectively.

Bancroft et al. (1966) recently reported treating a

pedophiliac with electric shock over a 38-day period. Briefly,

the patient was told to concentrate on sexually stimulating

fantasies after viewing pictures of children. When an

erectile response occurred, which registered on a specially

constructed transducer, shock was administered to his arm.

Once in every four trials, the shock box was disconnected, and

the patient was given pictures of adult women and encouraged

to produce an erection with heterosexual fantasies. After an

18-month follow-up period, the patient continued to display a

variety of sexual difficulties although pedophilia was no

longer the major problem.

Hsu (1965) placed a tray containing six one-ounce

plastic cups filled with beer, wine, whiskey, milk, water,

and fruit juice in front of alcoholic patients, and then as








each alcoholic drink was swallowed, an electric shock, 30

seconds in duration, was administered. After completion of

the five-day treatment sequence, the patient was released

from the hospital with the provision that he return for two-

day booster treatments at four-week and six-month intervals.

The results of this treatment procedure were ambiguous.

First, Hsu used "out of the hospital working or seeking employ-

ment" as the criterion measure for treatment effectiveness, not

the decrease or absence of further drinking behavior. Secondly,

Hsu failed to provide clear-cut follow-up data. It was simply

reported that of 40 patients who received treatment, 20 failed

to complete the initial five-day sequence or the first rein-

forcement booster treatment. The other 20 patients did at

least get that far, and of these, 13 were simply described as

being "out of the hospital working or seeking employment."

There were other puzzling aspects to this study. Hsu's place-

ment of the electrodes above both ears of his patients was, to

say the least, atypical and without precedent or subsequent

imitation in the recent aversive conditioning literature. The

patients' reactions to the shock stimulus were also atypically

severe. Many patients exhibited marked physical responses such

as foot stamping, hand trembling, crying and screaming, nausea

and vomiting. Others reported feeling head pain and seeing

"flashing lights." Finally, the duration of the shock -- 30

seconds -- was not explained on theoretical or empirical grounds,

and shock cessation was not contingent upon any particular re-

sponse or stimulus event.








Very few of the aversive procedures cited in the

foregoing case reports have seemed to be rooted very deeply

or systematically in the general body of the experimental

psychology of learning. Certainly none of these papers sys-

tematically provided for the development of alternative and

more desirable escape and avoidance behavior by utilizing the

positive reinforcing effects of response-contingent shock

cessation. Several studies employing shock as the noxious

stimulus have, however, evidenced their greater awareness of

these procedural considerations, and to these attention will

now be turned.

Blake (1965), working with some 50 to 60 fee-paying

alcoholics, has attempted to test the efficacy of "straight"

aversive conditioning against the same aversive procedures

following deep muscle relaxation training. Blake argued that

because alcoholic behavior is often motivated and accompanied

by high drive (anxiety or fear), the effects of aversive con-

ditioning would be enhanced if the S could approach the treat-

ment situation in a state of low drive. Also, motivational

efforts would be more effective while the patient was deeply

relaxed.

In a recent paper, Blake (1967) has published 12-

month follow-up data for both groups. The results show that

59 per cent of the relaxation-aversive group (N = 37) and 50

per cent of the straight aversive group (N = 25) were classified

as either "abstinent" or "improved." The difference is not

statistically significant though. Of major interest for the








present study, however, was the aversive procedure used by

Blake which incorporated escape from shock. Ss were given the

necessary ingredients to mix a drink according to taste, and

then were shocked on a 50 per cent reinforcement schedule

as they sipped (without swallowing) the liquid, presumably

on command. Shock could be terminated by spitting out the

alcohol. On non-reinforced trials, the alcohol was ejected

in response to a light signal. The number of conditioning

sessions was not controlled, and they varied over a four-to

eight-day period.

In reviewing the various forms of punishment training

in the aversive conditioning literature, Feldman and MacCulloch

(1965) concluded that anticipatory avoidance learning -- a

situation wherein the S can prevent the occurrence of the

noxious stimulus (the UCS) by performing an instrumental re-

sponse to the CS -- was particularly resistant to extinction.

Support for this position, as mentioned previously, has been

amply demonstrated by Solomon and Wynne (1953), Turner and

Solomon (1962), and Solomon (1964).

In their work with homosexuals, Feldman and MacCulloch

constructed two hierarchies, one comprising slides of nude and

clothed males in ascending order of attractiveness, and the

other of females in the reverse order of attractiveness.

Briefly, a male slide (starting with the least attractive) was

presented on a screen, and if the S did not switch off

the slide within eight seconds, he received a shock. The







shock stimulus was terminated when the illuminated slide was

finally switched off. Introduction of the appropriate female

slide (initially, the most attractive) was made contiguous

with the removal of the male side on many trials. The thera-

pist controlled the removal of the female slide, but the S

could ask for its return. This request, randomly met by the

therapist, was increasingly made, as the presence of the female

slide acted to delay the reappearance of a male slide. About

30 trials per session were given, but the number of sessions

varied from five to 28. "Booster" sessions were also ad-

ministered during the follow-up period.

Of 19 homosexuals treated at the time of publication,

three failed to complete the procedures, six showed little, if

any, improvement, and ten have altered their sexual orientation

to some clinically significant degree. Follow-ups ranged from

one month to 14 months.

Most interestingly, MacCulloch et al. (1966), using the

same methodology as that described above for Feldman and Mac-

Culloch, treated four alcoholics, all of whom returned to their

previous drinking behavior following treatment. In assessing

these failures, the authors questioned whether their patients'

drinking behavior was any longer amenable to psychological

control, due to the possible development of a pathological

biochemical necessity for alcohol. It should be noted, how-

ever, that motor, gustatory, and olfactory components of the

drinking response -- e.g., sipping, tasting, and smelling the








alcohol -- were not shocked as part of treatment, as occurred

in Blake's (1965) procedures with alcoholics. Instead, Mac-

Culloch et al. relied almost entirely on visual stimuli such as

slides of alcohol, and alcohol in a bottle and a glass in the

S's visual field. And, in like vein, it might be hypothesized

that Feldman and MacCulloch's moderate success with homosexuals

may have been occasioned by the very fact that the visual-

perceptual mode plays a more vital part in the arousal and pre-

cipitation of homosexual behavior than it does for alcoholic

behavior.

In summary, then, the case reports and studies mentioned

so far have all used electrical stimulation as the noxious

stimulus, and all have attempted to suppress some undesirable or

unacceptable behavior-complex judged to be the result of mal-

adaptive learning. In addition, a relative few have attempted

to reinforce alternative behavior deemed incompatible with, and

preferable to, the punished behavior -- at least to some degree.

Beyond this, little in the way of comparison can be said.

Various rationales and justifications purportedly based on ex-

perimental evidence have been offered, as well as a variety of

classical and instrumental punishment procedures -- some simple

and some more complex. Treatment intensities, controls, and

lengths have varied. The patients and their behavioral syn-

dromes, as well as treatment results, and follow-up procedures

and lengths are not comparable. Often, follow-up data have

not been offered at all. Rachman's (1965) Table 1 shows, for

example, that of 114 persons reported in the literature who








were treated with aversive conditioning procedures using

electric shock for a variety of behavior disorders, 40 per

cent were not followed past treatment termination.

Most importantly, :-o:.-.-.r, the clinical literature

offers little, if any, evidence bearing on the issue of

whether the reinforcement of an appropriate escape response

through long-duration electric shock cessation is more effective

in establishing lasting behavior suppression than short-duration

shock which is simply contiguous with a CS or target response.

And, in no study to date has the noxious stimulus been adminis-

tered in completely random fashion, either for control or

treatment purposes.

With the above in mind, and before proceeding with a more

formal statement of the hypotheses under investigation,

attention will first be turned to the specific behavior syn-

drome dealt with in this study.

The Problem Behavior: Smoking

The target behavior selected for deconditioning was

cigaret smoking. This habit appeared to be a satisfactory

compromise between using a behavior syndrome of full clinical

proportions such as alcoholism, with all the attendant prob-

lems for S selection, experimental control, and treatment

which would have been entailed, and a non-clinical contrived

response such as lever pressing which could have been

conditioned before punishment training began. With a target

response such as lever pressing, generalizability of results

to clinical situations and problems would have been limited.









Koenig and Masters (1965) list three criteria which

should be satisfied in selecting a behavior for clinical ex-

perimentation:

1. The behavior should have the characteristic of
maladaptiveness to keep within the paradigm of
neurotic behavior.

2. The behavior must be potentially observable
and occur in discriminable units.

3. The behavior should ideally occur with a
fairly high frequency in the population at
large.

Cigaret smoking appears to satisfy all three. It is

an entrenched habit that has proved to be extremely difficult

to modify for many smokers. The smoker is constantly being

urged to maintain his habit by virtue of the massive and

ubiquitous advertisement campaigns the cigaret manufacturers

conduct. Smoking is socially acceptable, and the health-

hazard issue raised by numerous investigations -- in particular,

the Surgeon General's report (Smoking and Health, 1964) --

linking cigaret smoking with lung cancer and a variety of other

disease states, has apparently proven to be an insufficient

deterrent. Hammond and Percy (1958) found that of 333 ex-

smokers identified in a random telephone directory sample of

3,560 smokers and ex-smokers, only 8.7 per cent had quit be-

cause of health concerns. However, 62.5 per cent of the ex-

smokers had given up the habit because of some condition, such

as coughing or throat irritation, made worse by smoking.

Apparently, the threat of lung cancer or some other disease,

while seemingly a most powerful deterrent, is too far removed








in time as a consequence of smoking to be a very effective

negative reinforcer.

A great deal of effort has been expended investi-

gating the psychological characteristics of smokers and

non-smokers. As an illustration of this research activity,

Fine et al. (1966) recently compiled a bibliography on the

psychological aspects of smoking consisting of 143 studies

conducted from January 1940 through September 1965. Matterazzo

and Saslow (1960), in their extensive review of the literature,

found that while smokers -- particularly heavy smokers -- and

non-smokers differed on some 30 variables, none of the studies

offered a single variable found exclusively in one group but

absent in the other. The authors concluded that smokers seem

to be slightly more neurotic, on the average, than non-smokers.

At the individual level, however, this statistical relationship

is meaningless. Also, they concluded, a clear-cut smoker's

personality has yet to be found.

Much research has been aimed at modifying this physio-

logical habit by substituting lobeline, a drug which produces

the effects of nicotine, for nicotine (British Tuberculosis

Association, 1963; Goodman and Gilman, 1960). The inconclusive

results of lobeline studies indicate the probability that there

is a more compelling component in smoking than mere physiologi-

cal addiction, if in fact there is any such addiction involved.

Cigaret smoking has also been the subject of a number

of behavior therapy studies. Several have focused attention









on a comparison of the relative effectiveness of divergent

treatment forms, and at least two of these have included an

aversive conditioning procedure as one of the treatment methods.

Koenig and Masters (1965), using seven therapists and 42 Ss

between the ages of 19 and 23, compared the effectiveness of

systematic desensitization, supportive counseling, and aver-

sive conditioning methods. The aversive conditioning procedure

consisted of short-duration shock administered to the S's

fingers as he proceeded to smoke two cigarets during the treat-

ment session. All Ss received nine treatment sessions over a

five-week span. While no significant treatment or inter-

actional differences were found at the end of this period,

significant therapist differences (p < .05) were delineated.

The groups showed a significant decrease in smoking consump-

tion from pre-treatment levels (52 per cent reduction; p < .001);

six months later, the mean per cent reduction score had dropped

to 19 per cent.

Ober (1967) compared the results of a "self-control"

group, an aversive conditioning group, one which received treat-

ment based on transactional analysis concepts and methods,

and a no-treatment control group. The Ss in the aversive condi-

tioning group were instructed to self-administer shocks with a

portable battery-operated shocker whenever they experienced the

desire for a cigaret. Sixty Ss (college students) and two

therapists were used. The Ss were seen for ten 50-minute group

sessions over a four-week period. At termination of treatment








and after a one-month follow-up, all treatment conditions were

significantly lower than the no-treatment control group (p < .001).

Presumably, the cigaret consumption reduction rates for the ex-

perimental groups were also significantly lower than their pre-

treatment rates after treatment, although this is not ex-

plicitly stated. Following treatment, the per cent reduction

rates were 81, 100, and 52 per cent for the self-control,

aversive, and transactional groups, respectively. One month

later, these rates were 49, 58, and 57 per cent, respectively.

The no-treatment control group showed a 3 per cent reduction in

smoking following treatment. No significant treatment, thera-

pist, or interactional differences were found, however.

Pyke et al. (1966) compared the results of one group

receiving desensitization training, combined with regular group

discussions on the ills of smoking, the viewing of films, and

the reading of anti-smoking literature, with two control groups

whose members merely kept frequency counts of their smoking

consumption. The first control group Ss monitored their

smoking for eight successive weeks, and the second kept fre-

quency counts only during the first and eighth weeks. The

experimental group Ss attended one group meeting and one private

session each week for ten successive weeks. Fifty-five paid

Ss, all college students, participated in the study, and a

stated "desire to stop smoking" was the only selection criterion

used. Apparently many, if not most, of the Ss smoked less than

20 cigarets per day prior to their participation. The results

after eight weeks clearly favored the experimental group over










the two control groups (p < .01), although little else can be

definitely said with respect to the treatment procedures be-

cause of the potpourri of methods used. The follow-up data

offered for the experimental group, while indicating some

lasting effects of treatment over several weeks, were of question-

able value as one third of the Ss in this group were not in-

cluded. No follow-up data for the control groups were pre-

sented.

Other aversive stimuli have been used in an effort

to decondition cigaret smoking. Wilde (1964) and Franks

et al. (1966) used a mixture of smoke and hot air as the

noxious UCS, and cessation of this gaseous mixture was made

contingent on the escape response of snuffing out the cigaret.

In the first case, Wilde treated seven Ss, between the ages of

25 and 54, all of whom smoked at least 20 cigarets daily.

Three stopped smoking completely after two treatment sessions

in two days. One was down to two cigarets per day after a single

session, and another S changed over to a pipe after 20

sessions. Two others discontinued treatment and no mention

was made of their progress, if any, or the number of treatment

sessions received. No follow-up information was offered for any

of the Ss. Franks et al. began treatment with 23 adult

Ss but only nine completed the prescribed course -- 12 condi-

tioning sessions within a four-week period. Of these nine,

follow-up one-half year later revealed that four were not

smoking, one was smoking "less", two were smoking as much as








ever, and one had switched to a pipe. The ninth S was not

heard from. The authors did not include the smoking rates

for any of the Ss immediately following treatment termination.

And, finally, Greene (1964) attempted to reduce the

smoking rate of mental retardates in a free-operant situation

with the use of white noise, superimposed upon continuous

music, as the negative reinforcement. A control group without

the superimposed white noise was also run. Twenty-one Ss,

ranging in age from 16.5 to 25.6 and with a mean I.Q. of 67.5,

were used, and each participated in five consecutive daily

sessions. The results showed that increased smoking rates

were obtained over pre-treatment levels for both the experi-

mental and control groups (p = .10, p <.05, respectively), and

these findings were attributed to the positive reinforcing

properties of barely audible clicking noises made by the relays.

A second control group was then run without the clicking noises,

and no change in smoking rates was found.

While the treatment procedures and methods of these

studies concerned with the suppression of cigaret smoking are

interesting and even innovative, they, like the studies re-

viewed earlier, offer little additional evidence bearing on the

issues of this study. With this in mind then, a statement of

the hypotheses investigated in this study is now in order.

The Hypotheses Under Investigation

Most of the clinical studies and case reports reviewed

in this chapter have employed aversive conditioning treatment

procedures based on a simple punishment model. That is, in








attempting to obtain the suppression of unwanted behavior, a

short-duration aversive stimulus has either been paired with

the appropriate CSs, and/or both the target responses themselves.

The prediction was made however (see pages 4- 7), that increased

and longer lasting behavior suppression would occur if patients

were, in addition, positively reinforced for the performance of

more desirable alternative instrumental acts incompatible with

the behavior being punished.

One way to accomplish this end in the clinical situation

would be to utilize an aversive conditioning procedure based

upon the experimentally familiar "escape" paradigm. Here, the

conditions governing the onset of the aversive stimulus would

be identical with those for a "simple punishment" procedure;

stimulus termination, however, would be made contingent upon

the performance of the appropriate escape response, thereby

serving to positively reinforce such instrumental acts.

A small number of the studies and clinical case reports

reviewed earlier (Blake, 1965; Feldman and MacCulloch, 1965;

MacCulloch et al., 1966) have attempted to utilize, with vary-

ing degrees of success, treatment procedures based upon such

an escape paradigm. A perusal of the clinical aversive con-

ditioning literature indicates, however, that a controlled

comparison of treatment procedures based upon the two punish-

ment models has yet to be attempted. The first two hypotheses

of this study, then, are concerned with this issue; whether, in

fact, a clinical aversive conditioning procedure based upon an








escape model will result in significantly greater or more

effective response suppression than one based upon the

"simple" punishment model.

Hypothesis 1 (HI) -- Ss presented with an ordered set

of stimulus items associated with, and related to cigaret

smoking, and subjected to short-duration electric shock con-

tiguous with the CS(s) or contingent upon the performance of

the target responsess, will evidence a statistically signifi-

cant reduction from pre-treatment levels in their mean cigaret

consumption rate on the last experimental treatment session-

day, as well as during the 12-week follow-up period.

Hypothesis 2 (H2) -- (1) Ss presented with the same

ordered set of stimulus items and shock onset conditions as

the HI Ss above, but in addition subjected to electric shock

which terminates only upon the performance of an appropriate

escape response pre-determined by E, will also evidence a

statistically significant reduction from pre-treatment levels

in their mean cigaret consumption rate on the last experimental

treatment session-day, as well as during the 12-week follow-up

period. (2) In addition it is predicted that this mean re-

duction in cigaret smoking will be significantly greater than

that for the HI Ss for the following: (a) during the course

of the experimental treatment period; (b) specifically on the

last experimental treatment session-day; and (c) during the

12-week follow-up period.

While the above hypotheses would appear to cover the

central issue underlying the conception of this study, one









further related consideration remains. As mentioned earlier,

the experimental learning and conditioning literature has

strongly indicated that, all other factors held constant,

reinforcement delivered in a purely random or "chance" fashion

has little lasting suppressive or facilitative effect on

subsequent performance. All the clinical attempts utilizing

aversive conditioning methods have at least assumed this much

in the design of the treatment procedures. Nevertheless, as

this experimentally derived finding has not been tested under

clinical treatment conditions using an aversive stimulus, such

as electric shock, it would seem appropriate, and even germane,

to do so here. The results of Ss run under random shock con-

ditions would offer a "base for comparison," putting the data

obtained under the two experimental treatment procedures

described above into a more meaningful perspective. Therefore,

the following hypothesis has been incorporated into this study.

Hypothesis 3 (H3) -- Ss presented with the same ordered

set of stimulus items as those under HI and H2, but subjected to

randomly administered electric shock of short duration, will not

evidence a statistically significant reduction from pre-treatment

levels, either on the last experimental treatment session-day,

or during the follow-up period.

Hypotheses HI, H2, and H3, then, constitute the major

hypotheses of this study.

Addendum


After the data collection phase of the study had








gotten under way, certain observations concerning the reactions

of the Ss to the daily shock session regime became apparent.

Several Ss, after completing approximately half of the experi-

mental treatment sessions, attempted to "buy" their way out of,

or otherwise attenuate their commitment to complete the sessions

yet remaining. These Ss, in essence, offered to more quickly

terminate or reduce their cigaret consumption if E in turn would

agree to eliminate some or all of the experimental treatment ses-

sions remaining to be run. This matter will be expanded upon in

the Discussion chapter. Accordingly, a fourth experimental group

was then run to test the hunches generated by these observations,

and the following hypothesis was included in the study.

Hypothesis 4 (H4) -- (1) Ss presented with the same ex-

perimental conditions as those under H2, but with the added pro-

vision that they can avoid completely the aversive conditioning

treatment session on any day within the treatment period immedi-

ately following a day free of cigaret smoking, will also evi-

dence a statistically significant reduction from pre-treatment

levels in their mean cigaret consumption rate on the last ex-

perimental treatment session-day, as well as during the 12-week

follow-up period. (2) In addition it is predicted that this mean

reduction in cigaret smoking will be significantly greater

than that for each of the other three groups for the following:

(a) during the course of the experimental treatment period;

(b) specifically on the last experimental treatment session-

day; and (c) during the 12-week follow-up period.

All references to significance in the above four

hypotheses refer to the .05 level of significance.















CHAPTER II

METHOD

Subjects

Twenty men and 12 women, all volunteers who wished to stop

smoking, served as Ss for this study. Most of these participants

were either "middle level" professional staff members or non-

professional personnel of the Edward Hines Jr. V. A. Hospital,

Hines, Illinois. Examples of the former were occupational

therapists, corrective therapists, and medical technologists;

and of the latter, secretaries and ward assistants. In addition,

a small number of Ss (five) were recruited through a small

classified advertisement placed in the local neighborhood

newspapers calling for volunteers for a V.A. hospital-sponsored

study, who wished to give up cigaret smoking. Hospital

personnel were obtained through the use of bulletin board

notices, personal contact, or referrals by other staff members

familiar with the investigation.

Prospective Ss were assessed for suitability in a pre-

liminary interview and then randomly assigned, as they became

available, to one of the treatment groups. These groups were

labeled the HI, H2, and H3 groups, corresponding to the three

major hypotheses, respectively. Group 4 was labeled and filled

in like manner when it became operational midway in the data

collection phase. Each group consisted of eight Ss; groups









HI, H3, and H4 received three female Ss each, while group H2

received two.

Those interested in participating were selected as

Ss if they were between the ages of 25 and 49, smoked an

average of at least one but not more than two and a half packs

of cigarets daily, and had been continuous smokers for at

least the past four years prior to their participation in the

study. In addition, all Ss had to voluntarily desire to stop

smoking and be willing to cooperate with all the study's re-

quirements. Those who indicated that they had been able to

stop smoking on their own for periods longer than two weeks

in the past were eliminated from further consideration.

Analysis of variance on data of age, number of cigarets

smoked per day, and total number of years smoked prior to par-

ticipation in the study revealed no significant differences

between the four groups at the .01 level of significance

(Tables 9,10, andll; Appendix A).

Apparatus

Electric Shock Source

A matched impedance shock generator was specially

constructed for use in this study. The circuit consisted of

a variable transformer with 115 v AC input and 0-120v output

which was connected to a 1,000 v CT step-up transformer. The

output of the latter was then connected through a 100 k, 100

w power resistor, a 0-10 milliammeter, and two 1/100 amp.

fuses to S. The intensity of the shock output to 5 was varied

by setting the dial on the variable transformer, and the









milliammeter allowed monitoring of the actual shock intensity

delivered. While the resistance of S, and therefore the im-

pedance of S, could be matched directly by varying the value

of the power resistor, this was not done, as it was not deemed

necessary.

This circuit made use of such safety features as an

isolation transformer which physically separated S from the

wall current, thereby preventing the occurrence of dangerously

intense shocks and burns, and a circuit fused on both sides of

S. This latter restricted the variability of shock and elim-

inated large surges of current from the circuit. In addition,

the chassis was grounded.

The S was connected to the shock circuit via Nu-way

snap leads, which were in turn fastened to snaps embedded in

rubber finger protectors. These latter were trimmed to pro-

vide a band approximately 3/4" wide, which slipped over the

finger like a ring. Both electrodes were placed on the fingers

of one hand, the index and third; thus, no current passed

across S's body. A light coating of Sanborn Redux electrode

jelly was first applied to the fingers.

Additional features of the unit consisted of a toggle

on-off circuit switch and indicator light, an electric counter,

and a remote switch for administering the shocks.

Timer

The device employed was an interval timer with auto-

matic reset made by Industrial Timer Corporation (Model P-4R).

Two plug receptacles, one for a remote switch and the second









for a standard AC load, were provided. Load-switch contacts

were rated at 15 amps., the time cycle was 0-15 seconds, and

the dial divisions were in quarters of a second.
*
Random Interval Programmer

The device used was a Gerbrands programmer, incor-

porating a Telechron synchronous motor (type B3, 110/120 v,

60CY) set at one RPM, and a standard microswitch. A loop

of 16 mm leader film, taking 30 minutes for one complete

revolution and randomly punched 40 times, was used to trip

the microswitch. The punch-hole diameter allowed the shock

circuit to remain open for one second with each successive

activation.

Experimental Room

All preliminary interviews and experimental condition-

ing sessions were conducted in an easily accessible private

office reserved for this purpose. The apparatus was arranged

so that S, sitting on the opposite side of a desk from E, was

unable to see the manipulation of the stimulus cards, remote

control switch, or shock generator dial settings. While the

shock generator sat on a low, small table at the right of E,

no attempt was made to conceal its presence. The random

interval programmer was mounted on a board attached to the

far edge of the table in such a way that neither S nor E

could determine beforehand when the next shock would occur.

In addition to the above-mentioned apparatus, such

items as chewing gum, life savers, peanuts, dietetic candies,

ash trays, and matches were provided in the experimental room.







Procedures

In order to maximize conditioning and enhance the re-

sistance to extinction equally across all groups, certain vari-

ables mentioned in the literature as being relevant to punishment

training were incorporated into all the treatment procedures.

Thus: initial shock intensities for every session were intro-

duced at levels perceived by the individual Ss as being dis-

tinctly unpleasant (Miller, 1960): novel stimulus items were

introduced from time to time in accordance with a pre-determined

schedule (McNamara and Wike, 1958) and, shock intensities were

varied randomly during each session from levels perceived as

just unpleasant to levels which bordered on being painful

(Church, 1963; Solomon, 1964).

Preliminary Interview

Prospective Ss for all groups were individually seen by

E in a preliminary interview. If all selection criteria were met,

a brief smoking history was then obtained, and the require-

ments for further participation were explained. These latter

included agreeing to: (1) come in for daily sessions over

the three-week experimental period for a total of 15 sessions,

(2) keep a daily count of cigarets consumed through comple-

tion of the experimental sessions; and (3) be available

for follow-up purposes over a three-month period. Ss were

then asked to continue their usual smoking practices until

their first experimental session, and also to begin keeping

daily cigaret consumption frequency scores. Small cards

the size of a cigaret package were provided by E for

this purpose. Ss were cautioned not to rely on memory for








the daily totals but to mark the cards each time a cigaret

was lit, regardless of the number of puffs taken. Ss were

asked to bring in these daily tallies along with two or three

packages of their favorite brand of cigarets for deposit,

when they returned for the first experimental session. This

latter request was made so that the act of purchasing cigarets

would not be tacitly encouraged once the sessions began. The

mean of the daily cigaret consumption frequency scores for the

period between the preliminary interview and the first experi-

mental session provided each S's cigaret consumption base

rate. This period varied from five days to a week and always

included three weekdays and a weekend.

Also at this time a brief explanation of smoking be-

havior in simple learning theory terms was offered by E. Smok-

ing was conceptualized as learned behavior which had become a

highly practiced habit in a variety of life situations. Ss

were told that the purpose of the experimental treatment

sessions was to provide an opportunity for "unlearning" this

behavior through the application of learning principles;

specifically, by associating an unpleasant stimulus -- shock

-- with that behavior which had come to acquire rewarding

properties. The experimental nature of the study was men-

tioned, and E offered himself as an "advanced graduate student

in clinical psychology" who was conducting research on methods

which would help people give up the cigaret smoking habit.

Before concluding the preliminary interview, several demon-

stration shocks were given in order to allay Ss' anxieties








about getting shocked, and to establish initial thresholds

for uncomfortableness and pain. An appointment for the first

experimental session was then arranged.

Approximately 35 individuals were disqualified from

further participation during this interview for one of several

reasons. A few smoked less than one pack of cigarets daily

or had not been smoking long enough. About 20 others were

unable to attend sessions on a daily basis. The remainder

either did not wish to subject themselves to electric shock,

or had second thoughts about giving up cigarets.

Stimulus Items

The stimulus items consisted of components of the smo-

king behavioral chain, ideational stimuli, and various

"precipitating stimuli" such as, e.g., the smell of cigaret

smoke, the sight of someone lighting up, and seeing a maga-

zine advertisement for cigarets. Table 1 lists the stimulus

items used, but not necessarily in the order presented. As

indicated, many of the items were presented during every

session, while others were introduced at pre-determined points

after the sessions began. Also, while all Ss received the same

number of items for each session, the content of several --

primarily the ideational items -- sometimes varied in accord-

ance with the idiosyncrasies of the individual S's smoking

behavior pattern. Thus, when asked to imagine, e.g., the

occasion for taking the first cigaret of the day, one S might

"see" himself reaching for his pack immediately upon awaken-

ing, while another might visualize taking his first cigaret

of the day after breakfast.

















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Item presentation was random. Each was written on an

index card, and the cards were shuffled before each session.

On occasion, changes were made by E as the individual cards

came up to provide for a more logical ordering of the items.

Experimental Shock Sessions

The format followed during the sessions was essen-

tially the same for all groups. Upon entering the experimental

room, Ss pulled the two electrode-embedded rubber bands on the

index and third fingers of their smoking hand so that the metal

snaps were positioned against the palm side of the fingers.

The bands were placed far enough back on the fingers so that

normal finger dexterity was not unduly hampered. The pre-

vious day's cigaret consumption tally was then recorded by E.

Stimulus item presentation began after a quick check by E

determined that the electrodes were positioned correctly and

the apparatus'was connected properly. For all groups, the

sessions terminated when the electric counter on the shock

generator indicated that the S had received 40 shocks. The

sessions lasted, on the average, about 30 minutes, and, with

the exception of the H4 group Ss, all Ss received a total of

600 shocks over the 15 sessions. The H4 group Ss averaged

350 shocks over this period.

At the start of the first session, each S was advised

that no specific restrictions would be placed on his smoking

behavior during the duration of the study. It was suggested

at that time, however, that if he attempted to "do something

else instead" in response to the urge to smoke, progress








towards the goal of terminating smoking would possibly be aided.

Several alternative responses were then suggested as possibil-

ities. Examples of these were the following: taking a deep

breath and holding it for 20 or 30 seconds, chewing or eating

some gum or candy, taking a few sips of cold water, performing

an isometric exercise, or reviewing one's own reasons for want-

ing to stop smoking. It was then suggested that each S experi-

ment with such alternatives until he found those which best

suited him.

This approach was decided upon for several reasons. It

soon became apparent in working with several pilot Ss, and in

general conversations with smokers, that many, if not most

smokers had at one time read or heard about various ploys one

could utilize to stop smoking. Many had tried one or more of

these methods themselves. And too, some Ss wondered whether

they should "fight" the effects of the experimental procedures,

or do anything to help on their own. Telling Ss they could try

to reduce their cigaret consumption away from the sessions, as

well as suggesting some things that they could do, helped to

standardize S attitudes and motivation, and also introduced a

measure of experimental control.

HI Group -- Ss in this group received electric shocks

of one second duration, administered at the points indicated in

column 2 of Table 1. Shock onset was controlled by means of a

remote control hand switch held below desk level; the shock

stimulus was terminated by the circuit's automatic reset timer.

No special instructions were additionally given to the HI

group Ss.








H2 Group -- While the Ss in this group received shocks

of variable duration, the shock onset points were identical

to those for Ss in the H1 group above. Before each H2 group S

entered the experimental room, the automatic reset timer was

disengaged from the circuit, thus enabling E to control both

shock onset as well as shock termination. H2 group Ss were also

given the following special instructions at the beginning of the

first experimental session in addition to the general instruc-

tions noted previously:

Once the shock begins, it will not turn off until you
proceed to do something or say something, either as an
alternative to what you will be doing upon my request,
or in response to a question I might ask you. Your
task, then, will be to respond in such a way that the
shock will be turned off. Remember, you yourself will
be able to turn off the shock every time by responding
correctly in each situation. Let's take an example.

The S was then asked to "light up", and shock onset occurred as

he put the cigaret in his mouth, but before he lit it. "Correct"

responses here included removing the cigaret and laying it down

on the table, breaking the cigaret, putting it back in the pack,

or throwing it in the waste basket. If the S did not immediately

dispose of the cigaret, or if he removed it from his mouth but

continued to hold it in his hand, E then said, "Remember now,

you can terminate this shock. What can you do with that cig-

aret in order to turn the shock off?" In all instances, this

was sufficient to prompt the S to get rid of the cigaret.

Item presentation then proceeded in regular fashion.

There were several "correct" responses, then, which the

S could offer for most of the items. The third column of








Table 2 lists examples of escape responses which were defined

as acceptable. To deter stereotypic or repetitious responding

to any given item as it came up through the 15-session sequence,

and to encourage the development of an array of incompatible-to-

smoking response tendencies, the same escape response was not

always allowed to be the correct one. Often, when a S would

respond in a manner which had previously proved to be "correct,"

the shock would, nevertheless, continue, and E would say, e.g.,

"Yes, but what else could you do in this case?"

H3 Group -- The Ss of this group received electric

shocks of one second duration, administered at random intervals.

The shock generator was plugged into the random programmer

before the S entered the experimental room, and immediately

after the electrodes were positioned, the circuit was activated.

Thus, E neither controlled shock onset nor shock termination.

No special instructions were additionally given to the Ss in

this group. It was often necessary, however, for E to terminate

the S's performance at the point at which Ss in the other three

groups were getting shocked, in order to maintain stimulus item

equivalency for this group. For example, if the stimulus item

card called for shock onset to occur as the S placed the cigaret

in his mouth, the 1H3 group S was told at this point to dispose

of the cigaret and place the cigaret package back on the table.

H4 Group -- The procedures for Ss in this group were

identical to those already described for the 112 group Ss, with

the following exception: At the end of the first experimental

shock session, each S was told that any given subsequent session








could be avoided if, on the immediately preceding day, he com-

pletely refrained from smoking any cigarets. (The two week-

end days were counted as one day.) Each S did, however, have

to "report in" by phone or in person each weekday morning in

order to apprise E of his smoking performance during the pre-

ceding day. It was pointed out to each S that, in effect, he

could determine the number of sessions he would have to attend

during the three-week experimental period.

Follow-Up

Cigaret consumption follow-up data were collected for

all Ss two, six,and 12 weeks after treatment termination.

Ss were contacted two days prior to these dates and asked to keep

tallies over a three-day period. Three-day means were then

computed for the follow-up cigaret consumption scores. At

the end of the 12-week follow-up period, each S was asked to

informally express any impressions or thoughts he had about

the study or his participation in it. These will be explored

in the Discussion chapter.













CHAPTER III

RESULTS

The dependent measure of this study consisted of the

per cent reduction scores computed for each S during both the

experimental treatment and follow-up periods. These scores

were based upon the mean of each S's pre-treatment cigaret

consumption tallies, obtained between the preliminary interview

and the first experimental session-day. Each individual's pre-

treatment mean was given a value of zero, and any subsequent

reduction in smoking was converted from this base line measure

into a per cent reduction score (or, in another sense, a per

cent improvement score). For example, if a S's pre-treatment

mean consumption rate had been 40 cigarets per day, and he

then smoked 30 cigarets during the second session-day, his

per cent reduction score for that day would have been 25 per

cent (30 divided by 40 = .75; .75 subtracted from 1.00 multi-

plied by 100 = 25 per cent). A per cent reduction score of

100 then, would indicate that the S did not smoke any cigarets

on that particular day. Individual per cent reduction scores

were computed from the number of cigarets each S smoked on

each of the 15 session-days, and from the mean number of

cigarets smoked during the three-day intervals two, six, and

12 weeks after treatment termination. These individual per

cent reduction scores are shown in Appendix B. A total of 11

45








Ss, eight during the first week and three during the second,

were dropped from participation after treatment began. Five of

these decided they no longer wanted to stop smoking, and

the other six either couldn't make the treatment sessions on

a daily basis or failed to show up for their scheduled appoint-

ments. The partial records of these 11 Ss were not included

in the data analysis nor are they shown in Appendix B.

Figure 1 shows the MPSR scores of the four groups plotted

across both the experimental treatment and follow-up periods.

As hypothesized, the H4 group MPSR scores are consistently lar-

ger than those for the other three groups across the session-

days, but the relative rankings of the other three group curves

are less pronounced. The 15th session-day MPSR scores of 97,

91, 89, and 86 for the H4, H2, HI, and H3 groups, respectively,

are ranked in accordance with the group ordering predicted by the

hypotheses. Two, six, and 12 weeks after treatment termination,

however, the relative group rankings can again be seen to be

ordered somewhat differently, with the largest MPSR scores

consistently being attained by the H2 group.

Perhaps the most notable feature of Figure 1, however,

is not the relative orderings of the group MPSR scores at

specific points on the horizontal axis, but rather the high

degree of concordance of the curve slopes across both the

session-days and the follow-up periods. This concordance suggests

that the differential effects of the experimental procedures

on the mean smoking reduction rates of the groups were not




































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great throughout either the experimental treatment or follow-

up phase of the study. Analysis of the data does, in fact,

bear this out.

Table 2 shows the results of a repeated measurements

analysis of variance of the H1, H2,and H3 group MPSR scores

compiled during the experimental treatment period. The H4

group was excluded from this primary analysis, as the Ss in

this group differed from those in the other three in the number

of shock sessions they received. (The mean number of shock

sessions administered the H4 Ss was 8.5; the least number of

sessions a H4 group S received was five, and the most, 12.)



TABLE 2

REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE MPSR SCORES
ACROSS SESSION-DAYS--GROUPS HI, H2, AND H3
N = 24


Sources of Variation df Mean Squares F P


Between Ss

Group Procedures 2 901.50 < 1.00

Ss Within Groups 21 5031.05

Within Ss

Session-Days 14 7901.36 50.40 <.005

Procedures by 28 82.25 < 1.00 -
Session-Days

Session-Days by Ss 294 156.76
Within Groups








From the results of this analysis of variance, it is

evident that neither the differential effects of the various

group procedures, nor the procedures by session-days interac-

tion were significant sources of variance. The main session-

days effect--i.e., the effect of treatment repetition over time--

was, however, highly significant (F = 50.40; P<.005). Part

(2)a of Hypothesis 2, then, was not supported.

The HI, H2, and H3 group MPSR scores across session-

days were then combined, and a Neuman-Keuls test of all the

ordered pairs of session-day means was computed. The results,

shown in Table 3, corroborate what the group curves suggest in

Figure 1; namely, that most of the smoking reduction occurred

during the first half of the experimental treatment period.

As Table 3 indicates, no further increase in per cent smoking

reduction, from the eighth session-day to any of the remaining

seven session-days, attained statistical significanceat the .05

level of confidence.

In order to determine what effect the inclusion of the H4

group MPSR scores would have on the Group Procedures F ratio, a

second ancillary repeated measurements analysis of variance was

computed. Despite the slight divergence of the H4 group curve

seen in Figure 1, the results of this second analysis, shown in

Table 4, parallel those obtained in the first analysis. It is

interesting to note that the Group Procedures mean square

is, relatively speaking, much larger than the corresponding one












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obtained in the first analysis. Nevertheless, only the Session-

Days main effect was, again, a statistically significant source

of variance (F = 56.85; P<.005). These results, then, failed

to confirm both Part (2)a of Hypothesis 2 as well as Part (a)

of Hypothesis 4.



TABLE 4

REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE MPSR SCORES
ACROSS SESSION-DAYS--GROUPS H1, H2, H3, AND H4
N = 32


Source of Variation df Mean Squares F P


Between Ss

Group Procedures 3 5723.33 1.38

Ss Within Groups 28 4159.00

Within Ss

Session-Days 14 10312.71 56.85 <.005

Procedures by 42 145.28 <. 1.00
Session-Days

Session-Days by Ss 392 181.39
Within Groups



Finally, with respect to the data obtained during the

experimental treatment phase of the study, two analyses of

variance of the 15th session-day MPSR scores were computed.

While all Hi, H2, and H3 Ss received an experimental shock

treatment on this last session-day, six of the eight H4 group

Ss avoided a shock session on the last day because they had

abstained from smoking on the preceding day. To control,








then, for the effects of shock, per se, on cigaret consumption

on this last experimental treatment day, only the MPSR scores

of the first three groups were included in the first, or pri-

mary, analysis of variance. The results, summarized in Table

5, reveal no significant differences between the MPSR scores

of the three groups; therefore, they failed to support Part

(2)b of Hypothesis 2.



TABLE 5

ANALYSIS OF VARIANCE OF THE MPSR SCORES ON THE 15th
SESSION-DAY--GROUPS HI, H2, AND H3
N = 24



Source of Variation df Mean Squares F P


Procedures Between 2 47.79 < 1.00 -
Groups

Procedures Within 21 256.58
Groups



A second analysis of variance, this time including the

H4 group MPSR scores on the 15th session-day, was additionally

calculated. The results, shown in Table 6, also indicate no

significant differences between the group MPSR scores, al-

though again, this second Group Procedures mean square is

larger than that obtained in the first analysis. The results

again did not support part (2)b of Hypothesis 2, as well as

Part (b) of Hypothesis 4.




53


TABLE 6

ANALYSIS OF VARIANCE OF THE MPSR SCORES ON THE 15th
SESSION-DAY--GROUPS HI, H2, H3, and H4
N = 32




Source of Variation df Mean Squares F P



Procedures Between 3 169.37 < 1.00
Groups

Procedures Within 28 205.97
Groups



With respect to the data compiled during the follow-up

period, a final repeated measurements analysis of variance of

the MPSR scores of all four groups computed two, six, and 12

weeks after treatment termination was then calculated. As the

independent variable -- the passage of time -- operated equally

for all groups, the H4 group MPSR scores were included, and

only one analysis was made. The results are summarized in

Table 7. Again, the differential effects of the experimental

procedures, this time on the recovery rates of the groups,

were not statistically significant at the .05 level of con-

fidence, nor, was there a statistically significant Procedures

by Follow-Up interaction effect. The main effect of time

(Follow-Up) was, however, significant beyond the .005 level of

confidence. These results, then, failed to support Part (2)c

of Hypothesis 2 as well as Part (b) of Hypothesis 4.








TABLE 7

REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE
MPSR SCORES TWO, SIX, AND 12 WEEKS AFTER
TREATMENT TERMINATION--GROUPS HI, H2, H3, and H4
N= 32



Source of Variation df Mean Squares F P


Between Ss

Group Procedures 3 454.33 < 1.00

Ss Within Groups 28 2312.32

Within Ss

Follow-Up 2 12356.00 37.43 <.005

Procedures by 6 68.00 < 1.00
Follow-Up

Follow-Up by Ss 56 330.09
Within Groups



Combining the MPSR scores of all the groups, a Neuman-

Keuls test of the differences between all ordered pairs of the

two, six, and 12-week means was then computed (Table 8). The

results indicate that the differences between both the two and

six-week, and six and 12-week mean MPSR scores were signifi-

cant at the .01 level of confidence. It is interesting to note

that the first mean difference is approximately twice as large

as the second, despite the fact that the six-to-12-week in-

terval was 50 per cent longer than the two-to-six-week inter-

val. Thus, it would appear that the smoking recovery rate,

as suggested by the group curves during follow-up (Figure 1),

is a negatively accelerating function of the passage of time.









TABLE 8

NEUMAN-KEULS TEST OF ALL ORDERED PAIRS OF FOLLOW-UP
MEANS FOR GROUPS HI, H2, H3, AND H4


Ordered Means
40.0 52.8 78.6


Ordered Follow-Up Points
1 (12 wks.) 2 (6 wks.) 3 (2 wks.)


Differences 1 12.9* 38.6*
Between
Mean Pairs 2 25.7*

*P < .01


To determine whether the mean cigaret consumption scores

of the four groups were significantly lower than their respec-

tive pre-treatment levels on the 15th session-day, and two, six,

and 12 weeks after treatment termination, a single t-test (one-

tailed) of the difference between the over-all pre-treatment

and 12-week correlated means was computed (r = .24). The

three-day interval means of each S, compiled from the actual

numbers of cigarets smoked by all 32 Ss on these two occasions,

were the data used in the calculations. (See Appendix C).

The "t" value obtained (5.29) was significant beyond the

.0005 level of confidence. (Pre-treatment M = 34.3, S.D. =

6.96; 12-week M = 20.3, S.D. = 13.24.)

The justification for using the over-all pre-treatment

and 12-week means to compute only one "t" followed from the fact

that the pre-treatment cigaret consumption scores, and the

15th session-day, and follow-up MPSR scores of the four groups









did not differ significantly from each other (see Table 10,

Appendix A; Tables 6 and 7). Thus, if the "t" value for the

difference between the over-all pre-treatment and 12-week means

was significantly large, then the differences between the over-

all pre-treatment mean and the over-all 15th session-day, two-

week,, and six-week cigaret consumption rate means would also

have to be statistically significant; these latter over-all

mean differences would have been even larger than the differ-

ence between the over-all pre-treatment and 12-week means.

And, since the cigaret consumption rates of the four groups

themselves did not differ significantly from each other at any

point, then it could be said that the cigaret consumption rate

of each group on the last day of treatment, and during follow-up,

was significantly lower than its pre-treatment level. Thus,

Hypothesis 1, Part (1) of Hypothesis 2, and Part (1) of Hy-

pothesis 4 were supported. Hypothesis 3 was not.

In summary, then, the prediction that the cigaret con-

sumption rates of the four groups would differ significantly

from each other in a prescribed fashion, as a function of the

differential effects of the experimental procedures each group

received, was not supported in any way. This was true for

both the experimental treatment and follow-up phases of the

study. Irrespective of the nature of the aversive shock treat-

ment received, the mean performance of each group was essen-

tially the same as that of the other three. The prediction

that the cigaret consumption rates of the HI, H2, and H4

groups on the last day of treatment, and during follow-up








would be significantly lower than their respective pre-treat-

ment levels was supported; the prediction that the H3 group's

cigaret consumption rates would not be significantly lower

was not.

Additionally, it was observed that the Session-Days

main effect (the effect of treatment repetition over time) was

the only significant source of variance contributing to the

reduced cigaret consumption rates of the groups during the

experimental treatment phase. Upon combining the MPSR scores

of the HI, H2, and H3 groups, it was found that after the

eighth session-day, no further decrease in smoking during the

remaining seven session-days attained statistical significance.

Finally, during the follow-up phase, smoking recovery, as

evidenced by the increased smoking consumption rates of all

four groups, appeared to be a negatively accelerating function

of the passage of time. There were no other significant

sources of variance.













CHAPTER IV

DISCUSSION

The two major outcomes of this research were the

following: (1) the failure of the results to demonstrate a

significant Group Procedures main effect, both during the

experimental treatment and follow-up phases; and (2) the finding

that cigaret consumption rates of the groups, all varying

together, were significantly lower than their pre-treatment

levels during both the experimental treatment and follow-up

phases. Thus, the inherent differences imputed to the treat-

ment procedures as a function of the conditioning models upon

which they were based, were greatly attenuated in practice.

Even so, the above findings demonstrate that treatment var-

iables common to all four experimental treatment situations

were operating to effect a significant smoking reduction for

all four groups. This common over-all treatment effect was,

in all probability, either the result of (1) confounding

arising from the procedures themselves which served to make

the procedural effects more similar than dissimilar, (2) the

presence of uncontrolled situational variables, common to all

the treatment conditions, which overshadowed or negated the

differential effects of the individual treatment procedures,

or (3) some combination of both (1) and (2).








Confounding as a Function of the Procedures

Reactive Inhibition

During each experimental treatment session of approxi-

mately 30 minutes' duration, 40 stimulus item presentations

were made. The HI and H3 group Ss simply responded to each

and were, at least in the case of the former Ss, then shocked

for one second at the appropriate shock point. The situation

was, however, more complicated for the H2 and H4 group Ss. Upon

the presentation of each stimulus item, these Ss had to first

begin the task of arriving at the "correct" escape response

which would terminate the distinctly unpleasant shock. It

was not uncommon for 20 or more seconds to elapse between

shock onset and shock termination. The "activity level"

during the H2 and H4 group treatment sessions, then, was far

greater than that which obtained during typical HI and H3

group sessions.

One consequence of this was a shortening of the inter-

stimulus item intervals for the H2 and H4 groups, a situation

somewhat analagous to "massed practice." Increased response

effort, a result of this "massed practice" effect, as well as

heightened tension as a consequence of far greater exposure to

shock, led to the H2 and H4 group treatment sessions being far

more intense and task-oriented. This state of affairs may

well have resulted in a buildup of response inhibition during

each session, a phenomenon experimentally known to adversely

affect resistance to extinction (of, in this case, the newly

acquired alternative responses to smoking) (Kimble, 1961).







Thus, while in theory, the H2 and H4 group treatment procedures

should have resulted in the systematic positive reinforcement of

appropriate non-smoking escape responses, and, therefore, longer

lasting smoking behavior suppression, the contaminating effects

of reactive inhibition may have attenuated this expected result.

Intermittent Reinforcement

Probably the most surprising group performance was that of

the random shock (H3) group, a group for which it was predicted

there would be no significant mean reduction in smoking, both

during the experimental treatment and follow-up phases. Once

again, it would appear that the number of stimulus item presenta-

tions during the 30-minute session, as well as the frequency of

shock onset--for the H3 group, an average of one shock approxi-

mately every 45 seconds--were important factors in determining

the results obtained by this group. With the occurrence of 40

stimulus item presentations, it was inevitable that many of the

shocks were delivered at points in the temporal order which were

appropriate for conditioning; i.e., shock onset was often con-

tiguous with some aspect of a S's ongoing performance of a motoric

or ideational smoking response. At other times, the shock would

be delivered after the "optimal" point in the temporal order had

passed. Thus, in effect, the H3 group was in many ways as

much a partial reinforcement group as it was a random shock group.

As there is experimental evidence indicating that inter-

mittent negative reinforcement of an operant acquired under

essentially positive reinforcement contingencies not only leads

to behavior suppression, but also increased resistance to

recovery of the suppressed response (Mowrer, 1960), this may

explain in part the performance of this group, particularly








during follow-up. The issue is less clear with respect to the

possible effects of delay of (negative) reinforcement, but

there is some evidence to indicate that this phenomenon,

especially if the delay is \ir3able, increases resistance to

recovery over that obtained by immediate punishment alone

(Crum, et al., mentioned by Feldman and MacCulloch, 1965).

While it is not possible to determine to what extent the

effects of intermittent reinforcement, as well as delay of

reinforcement, adventitiously increased the mean smoking re-

duction rate of the H3 group, the possibility does exist that

it may have been considerable.

Respondent Conditioning

It might also be argued, again with the mean smoking

performance of the H3 group primarily in mind, that the internal

response states of the Ss came to acquire suppressive properties

during the experimental treatment sessions as a function of

their contiguity with electric shock onset. These internal

respondents, then, elicited in subsequent situations con-

ducive to smoking--or to put it in slightly different terms,

in the presence of those CSs which typically would have

precipitated smoking behavior--may have served to attenuate

a given S's desire to smoke. If such respondent conditioning

did in fact occur to a significant degree, this might help ex-

plain why the mean smoking reduction rate of the H3 group

in particular, but also for the HI group, was not sig-

nificantly different from the mean smoking rates of the other

two groups, especially during the follow-up phase.








It is possible, then, that the variables mentioned in

this section, either singularly or in combination, may have

caused the net effects of the treatment procedures on the Ss

to be more alike than dissimilar. Such confounding, as a

function of the treatment procedures themselves, might explain,

at least in part, the absence of significant results obtained

in this research. In the next section, several possible con-

taminating factors, arising from over-all experimental conditions

common to all the groups, will be looked at.

Situational Variables as a Source of Confounding

Interpersonal Effects

Many behavior therapists have increasingly focused

their attention on the issue of the importance of the therapist-

patient relationship as a catalyst for behavior change. For

example, Barker (1965) talks about the "personal attraction"

which may develop towards the therapist, and which "can't be

ignored'." Andrews (1966) maintains that behavior therapists,

in common with traditionally oriented therapists, are sup-

portive, authoritarian, directive, encouraging, etc., in

response to the needs of their individual patients, and that

the establishment of satisfactory relationships is mandatory

if behavior change is to occur. Feldman and MacCulloch (1965)

admitted that their patients "liked to talk" and that they often

gave them advice and reassurance. These authors claim that

such practices are necessary in order to gain good "background

rapport." Coates (1964), and Meyer and Gelder (1963) assert

that in all of the conditioning procedures employed to date in








the clinical literature, the therapist-patient relationship

has played a major, if not always recognized, part. And Oswald

(1962) has claimed that the success of aversive conditioning,

in particular, is vitally dependent upon therapist-patient

relationships.

It is perhaps impossible to determine what part re-

lationship variables played in influencing and determining the

results of the present study. Koenig and Masters (1965) used

seven therapists to treat 42 smokers and found a significant

therapist difference (p <.05), but not significant treatment

or interactional differences. Thus, the therapist to whom the

smoker was randomly assigned, and not the treatment method,

was the significant determinant of success with respect to

smoking reduction. However, Ober (1967), using three therapists,

found no significant treatment, interaction, or therapist

effects in his study of smoking behavior. He attributed this

lack of a significant therapist main effect to the "highly

standardized" treatment procedures his therapists adhered to.

Nevertheless, as the smoking reduction scores for the three

treatment groups in his study were significantly lower than

their pre-treatment levels upon treatment termination, the

possibility still remains that relationship effects common

to all groups were responsible for this over-all reduction to

some significant degree.

With respect to the present study, the attempt was made

to minimize E's influence on the mean smoking consumption rates

of the experimental treatment groups. For example, not only








were the treatment presentations standardized, incidental or

unnecessary conversation was discouraged, and comments of an

evaluative nature concerning the smoking performance of the

Ss were withheld. Nevertheless, it may be naive to assume that

such attempts alone can effectively control or significantly

minimize the E influence on S performance. It was noticed,

e.g., that many of the Ss still appeared to view the treatment

session as an occasion for non-task verbal interaction. Such

Ss frequently attempted to bring up conversational material

of a more personal nature. Others either appeared to want

some sort of confirmation that they were progressing satis-

factorily, or encouragement from E that they would, in fact,

be able to give up cigarets. On occasion, Ss would appear

angry, implying by their comments that E was being "unfair"

for continuing to shock them despite the fact that they were

obviously doing well in their efforts to quit smoking. Ex-

amples of "resistance"--the breaking of appointments, arriving

late, etc.--were sometimes manifest.

Rosenthal (1966), in his recent book on experimenter

effects, discusses an array of situational variables which

have been shown to influence research outcome. Of particular

relevance for the present study is the one he labels the

"acquaintanceship" variable. Since many of the individuals

who served as Ss either worked on the same or adjacent wards,

or ate in the same lunchroom as E, the treatment sessions were

not the only source of E-S contact. For these individuals,

then, E was more than an anonymous person who "shocked them








for smoking." He was also an acquaintance and co-worker. Under

these circumstances, it is possible that at least some Ss re-

duced or terminated their cigaret consumption--especially

during the treatment phase--either because they didn't want to

"disappoint" someone they knew on an individual basis, or

because they felt guilty or embarrassed about failing in such

a person's presence.

It is also interesting to speculate about the degree

to which E's aversive properties were enhanced during the

treatment phase of this research. Through repeated association

with electric shock, and by virtue of being the person who,

insofar as the perception of many of the Ss was concerned,

was "trying to get people to stop smoking," E may have acquired

significant aversive stimulus properties in his own right. In

this vein, Rosenthal also points out the tendency for Ss to

perceive, either correctly or erroneously, E as someone who

"expects" them to respond in accordance with their perception

of the goals of the experiment. And, as Rosenthal continues,

Ss often do just that, primarily for this reason alone. Thus,

E's very presence in the hospital setting may have affected the

smoking consumption rates of many Ss beyond that which would

have obtained from E-S contact confined only to the treatment

room.

Three months after treatment termination, each S was

informally asked to give any impressions he had about the

treatment he had received. Perhaps indicative of the importance

of the relationship effect was the observation offered by al-








most every S that E's presence in the treatment situation was

an extremely important source of smoking behavior influence.

Many Ss reported, in fact, that this influence continued after

treatment termination. On the other hand, approximately 80

per cent of the Ss either denied or downgraded the importance

of shock, per se, as being a major factor in their reduction

or cessation of smoking. Perhaps an example from Goldiamond's

(1965) review of stuttering and fluency research is most

apropos at this point. Goldiamond mentions one S who completely

denied that the occurrence or non-occurrence of shock during the

experimental period had anything to do with his non-fluency

rates, even though the data clearly indicated that the S's verbal

behavior had been under direct control of the reinforcement

contingencies. Nevertheless, while it is perfectly plausable

to suspect that the Ss in the present study were either unaware

of, or felt the need to deny, the effect shock had on their

smoking behavior, it is an interesting fact that the major focus

of their comments was on the interpersonal aspects of the

experimental situation.

Subject Motivation

In all likelihood, S motivation represents a variable

complex whose effects on performance and treatment outcome are

only incompletely understood and poorly controlled (Meyer and

Crisp, 1966). A number of writers have discussed the importance

of positive initial attitudes towards therapy and strong

motivation to change, with respect to the ultimate outcome

(e.g., Lazarus, 1963; Meyer and Gelder, 1963). The Ss used








in this study all appeared, at least initially, to be well

motivated. All were voluntary participants, professed the

strong desire to give up smoking, and had one or more per-

sonally significant reasons underlying their desire to give

up cigarets. Yet, motivation was often observed to fluctuate

during the course of the study in ways which may have intro-

duced important changes into the experimental situation.

The most common S reaction observed by E after the

sessions had gotten under way, was the emergence of ambivalence--

"second thoughts" about giving up cigarets "at this time."

Some Ss seemed dismayed that the task of giving up cigarets

might require effort and hard work on their part; i.e., that

there was no "magic" involved. Others seemed to realize, the

closer they came to the goal, the extent to which they had be-

come dependent upon cigarets. At least five or six Ss expressed

great concern about failing; i.e., not being able to quit

after committing themselves to spouses, relatives, or friends.

Perhaps the most interesting reaction noted was the

tendency for many of the Ss across groups to become "unhappy"

with the course of treatment, especially around the 7th, 8th,

or 9th session. This was particularly pronounced if, by that

time, a given S's cigaret consumption rate had declined

sharply. Such Ss often attempted to negotiate new terms with

B, the goal being to attenuate the original agreement to meet

for the full sequence of 15 sessions on a daily basis.

It was primarily for this reason that the H4 group was

begun. It was felt that if Ss could control, in part, the

amount of punishment they received, their motivation to terminate








smoking more quickly would be strengthened. The reward value

of avoiding a shock session on the day immediately following

one free from smoking, it was further felt, would provide the

Ss with sufficient incentive to continue abstaining from

smoking on the day that the session was being avoided. It

was hypothesized, then, that after such Ss had been able to

avoid getting shocked for several days as a consequence of

successfully abstaining from smoking, their ability to continue

not smoking after treatment termination would be correspond-

ingly greater than that evidenced by the HI, H2, and H3

group Ss. As the H4 group mean cigaret consumption rate

during this period was not significantly different from

those of the other three groups, it is obvious that the above

contention was not supported.

Perhaps the punishment value of the shock sessions

themselves may have been over-estimated. If so, then it

might be logical to assume the following: that the amount

of positive reinforcement obtained through shock session

avoidance was not sufficient to establish inhibitory or self-

controlling mechanisms powerful enough to overcome the urge

to smoke, once the threat of punishment (attending shock

sessions) was removed. On the other hand, it is also possible

that the differential effects imputed to the H4 group pro-

cedure--and to the other group procedures as well--may have

been viable and operating as hypothesized. However, these

experimental effects, though present, may have been over-

shadowed by more potent situational variables common to all

the groups.








In short, much of the smoking reduction or cessation

evidenced by all groups during the experimental treatment

phase of this study may have been induced by interpersonal or

relationship considerations mentioned in this section. It

should be pointed out that even the H4 group Ss, who attended

an average of only 8.6 shock sessions over the three-week

experimental period, received daily E contact whether they suc-

cessfully avoided a session or not. And, insofar as

follow-up performance is concerned, motivational factors

(i.e., ambivalence about really giving up cigarets, possible

feelings of dependency and loss, etc.) may have accounted,

at least in part, for the degree of smoking recovery evidenced

by all the groups. In the next section, some considerations

for future research bearing on the points mentioned in this

chapter will be discussed.

Some Issues for Future Research

If the major questions posed by the findings of this

study are to be resolved in a satisfactory manner, several

issues will have to be considered and dealt with in subsequent

investigations. Before proceeding, one point should be made

clear. Even though the smoking reduction rates obtained in

this study compare quite favorably with the results of other

smoking investigations reviewed earlier in the Introduction

chapter, the major concern of this research is not smoking

reduction or cessation, per se. The major issues are (1)

whether treatment procedures based upon an active escape








conditioning model are any more effective in suppressing un-

wanted or maladaptive behavior than those based upon simple

punishment models, and (2) what the effects of random negative

reinforcement are on the performance rates of such behaviors.

As this chapter's discussion clearly suggests, before

the differential effects of various treatment procedures can be

successfully compared, they must first be demonstrated in

practice. Therefore, to the degree that it is possible,

potential sources of confounding pointed out in the pre-

ceding pages must be controlled or removed from future ex-

perimental situations. Perhaps the first possible source of

confounding that should be dealt with is the relationship

variable complex.

It is apparent from the present research that E

effects on S performance must be minimized. A step towards

this end would be to use Es who are not known to the Ss.

Certainly Es should not be co-workers, or have contact with Ss

beyond that which is actually necessary during the treatment

sessions themselves. An even better solution might be the

removal of E from the immediate stimulus environment while

Ss are being run. Stimulus item presentations could be pro-

grammed through the use of tape recorders, projectors, or

written instructions, and shock could be delivered remotely

through the use of one-way mirrors or automatic devices. The

use of "blind" Es -- those who do not know to which group a

given S has been assigned -- is also indicated. And, to the

degree that E-S contact is necessary, multiple Es could be utilized

for each S.







The treatment procedures themselves should be tightened

so that the contaminating effects of, e.g., reactive inhibition,

partial reinforcement, or delay of reinforcement are not intro-

duced. Towards this end, optimal interstimulus item intervals,

as well as the optimal number of stimulus item presentations

during each session, should be determined. With respect

to the number of treatment sessions actually needed, it will

be recalled that the results cited earlier indicated that

further reduction in smoking for the HI, H2, and H3 groups

was not significant beyond the eighth session-day. Perhaps

if fewer shock sessions, and/or a shorter experimental treat-

ment period had been incorporated into the present research

design, some of the resistance evidenced by many of the Ss

would have been circumvented.

Changes in the escape paradigm used in the present

study might also be considered in subsequent investigations.

Solomon (1964), among others, has pointed out that active

escape procedures are most effective when they eventually

lead to stable avoidance responding. For methodological con-

siderations--primarily, to insure that all Ss received the

same number of shock onsets during each treatment session--the

H2 group Ss could only terminate the shocks, not avoid them.

Perhaps the differential effects of the H2 group (escape)

procedure would have been more pronounced, then, if active

avoidance responding had been allowed to develop.

Finally, the findings and observations of the present

study point up the need for incorporation of a non-shock control


I-




72



group in future research attempts. The considerations of S

availability and time precluded the inclusion of such a group

here. Additionally, it was thought that the random shock

group would serve the same function. The results obtained

from a non-shock group would establish a more meaningful base

from which to compare the results obtained from the groups

utilizing shock. Most importantly, however, the results of

such a group might be most illuminating insofar as the issue

of the importance of relationship and motivational variables

for behavior change is concerned.














CHAPTER V

SUMMARY

In the majority of the published clinical aversive

conditioning studies, the treatment procedures have been based

upon a simple punishment model. That is, a short-duration

aversive stimulus (usually electric shock) has either been

paired with appropriate CSs, and/or the target behaviors them-

selves. The experimental learning and conditioning literature,

however, has indicated that increased and longer lasting be-

havior suppression would occur when procedures based upon an

escape paradigm are used. In addition, experimental findings

have also shown that aversive stimuli, randomly administered,

have little, if any, lasting suppressive effects on specific

ongoing behaviors. Since a comparison of the differential

suppressive effects of procedures based upon simple punishment,

escape, and random reinforcement paradigms has not been made

to date under clinical conditions, this study attempted to do

so.

The target behavior used was cigaret smoking, and the

aversive stimulus was electric shock. Thirty-two volunteers

who wished to stop smoking served as Ss during the course of this

investigation. All were between the ages of 25 and 49, smoked

between one and two and a half packs of cigarets per day,








and had been continuous smokers for at least four years prior

to their participation as Ss.

Initially, three experimental treatment groups based

upon the above mentioned paradigms were begun. Eight Ss were

randomly assigned to each as they became available. All Ss

attended 15 individual treatment sessions on a daily basis

(omitting weekends), and all received the same number of

stimulus item presentations and shock onsets during each

session. After the data collection phase had gotten under

way, a fourth (session-avoidance) group, whose Ss could miss

a scheduled shock session on any day immediately following a

day free of smoking, was initiated.

Both motoric and ideational type stimulus items related

to smoking behavior were used. The number of cigarets smoked

during each of the treatment session-days was recorded for

each S. Individual cigaret consumption scores were also

collected two, six, and 12 weeks after treatment termination.

The hypotheses predicted that the significantly largest

mean smoking reduction rate during both the treatment and

follow-up phases would be attained by the session-avoidance

group. This was to be followed, in decreasing order of procedu-

ral effectiveness, by mean smoking reduction rates of the

escape, simple punishment, and finally random shock groups.

It was additionally predicted that the session-avoidance, es-

cape, and simple punishment group mean consumption rates on

the last session-day, and two, six, and 12 weeks after treat-








ment termination, would be significantly lower than their

respective pre-treatment levels.

The results clearly showed that, in contradiction to

the hypotheses, the mean smoking reduction rates of the four

groups did not differ significantly from each other during

either the experimental treatment or follow-up periods. In

other words, each group procedure was essentially as effective

as any other in suppressing smoking behavior. Also, the mean

smoking reduction scores of all the groups on the last session-

day, and two, six, and 12 weeks after treatment termination,

were significantly lower than their pre-treatment levels.

The over-all smoking recovery trend evidenced during the follow-

up period was, however, pronounced.

While evidence suggested that uncontrolled variables

common to all four treatment groups were operating to effect

an over-all reduction in smoking, differential effects of the

treatment procedures themselves were not demonstrated.

It was hypothesized that the possible confounding

effects of reactive inhibition, intermittent reinforcement,

and adventitious respondent conditioning, which may have

been introduced by the procedures themselves, as well as re-

lationship and motivational factors, combined to effect the ob-

tained results.





































APPENDICES








APPENDIX A

TABLE 9


ANALYSIS OF VARIANCE OF AGE--GROUPS HI, H2, H3 AND H4
N = 32


Source of Variation df Mean Squares F P


Age, Between Groups 3 51.67 < 1.00

Age, Within Groups 28 76.71



TABLE 10

ANALYSIS OF VARIANCE OF THE PRE-TREATMENT MEAN NUMBER
OF CIGARETS SMOKED PER DAY--GROUPS HI, H2, H3, AND H4
N = 32


Source of Variation df Mean Squares F P


Cigarets per Day, 3 17.67 < 1.00
Between Groups

Cigarets per Day, 28 51.71
Within Groups



TABLE 11

ANALYSIS OF VARIANCE OF THE NUMBER OF YEARS A
CIGARET SMOKER--GROUPS HI, H2, H3,AND H4
N = 32


Source of Variation df Mean Squares F P


Years Smoked, Between 3 7.67 < 1.00
Groups

Years Smoked, Within 28 62.25
Groups
















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APPENDIX C

TABLE 13

THREE-DAY MEANS FOR EACH S COMPILED FROM THE ACTUAL NUMBERS OF
CIGARETS SMOKED BEFORE TREATMENT AND AT THE END OF FOLLOW-UP



Before Treatment After Follow-Up


31 25
28 11
25 24
HI Group 35 30
45 31
30 24
42 0
24 10

23 6
40 36
42 0
H2 Group 26 25
38 0
48 20
31 28
28 30

32 11
30 24
42 40
H3 Group 34 0
28 10
44 20
26 25
38 37

28 7
38 0
35 25
H4 Group 30 8
43 41
34 30
41 40
40 34














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BIOGRAPHICAL SKETCH

Michael Samuel Stokols was born in Chicago, Illinois,

on September 11, 1938, and mo4ed to Miami, Florida, with his

family at the age of six. lie graduated from Miami Senior High

School in 1956, attended the University of Florida from

September, 1956 to June, 1958, and received the Bachelor of

Arts degree with a major in Psychology and minor in Biology from

the University of Miami (Florida) in January, 1960. Mr. Stokols

entered the Graduate School of the University of South Carolina

in February, 1961, and received the Master of Science degree in

Psychology from this institution in August, 1962. Since entering

the Gradiate School of the University of Florida in September,

1962, he has been engaged in fulfilling the requirements for

the degree of Doctor of Philosophy in Clinical Psychology.

Mr. Stokols' financial support while at the University

of Florida has included an assistantship in the Reading Clinic,

traineeships through the Department of Vocational Rehabilitation,

and participation in the Veterans Administration Psychology

Assistantship Program. In May, 1967, he completed a predoctoral

internship in clinical psychology at the Edward G. Hines

Veterans Administration Hospital, Hines, Illinois. Mr. Stokols

is presently employed as a Clinical Psychologist, Level III,

at the Illinois State Pediatric Institute, Chicago, Illinois.








This dissertation was prepared under the direction of
the chairman of the candidate's supervisory committee and has
been approved by all members of that committee. It was sub-
mitted to the Dean of the College of Arts and Sciences and
to the Graduate Council, and was approved as partial fulfill-
ment of the requirements for the degree of Doctor of Philosophy.

December, 1968



Dean, Colleg /o-Artj and Sciences



Dean, Graduate School
Supervisory Committee:


(Ch / /mln
Chairman


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