A COMPARISON OF THE DIFFERENTIAL
EFFECTS OF FOUR AVERSIVE PROCEDURES
UTILIZING ELECTRIC SHOCK ON
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
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 . . . . . . . . . .
I. INTRODUCTION . . . . . . . . .
A Formulation of the Problem . . . .
Punishment and the Clinical Literature. . .
The Problem Behavior: Smoking . . . .
The Hypotheses Under Investigation. . . .
II. METHOD . .
III. RESULTS. . .
IV. DISCUSSION .
V. SUMMARY. . .
APPENDICES . . .
REFERENCES . . .
BIOGRAPHICAL SKETCH. .
. Function of the Proced .
iables as a Source of Con-
Future Research . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . .* . .
LIST OF TABLES
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
1. HI, H2, 113, and H4 Group MPSR Scores Across the
Experimental Treatment and Follow'-Up Periods . 47
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-
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  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
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,
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
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
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
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
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-
1. The behavior should have the characteristic of
maladaptiveness to keep within the paradigm of
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
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
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-
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.
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.
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
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).
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
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.
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
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.
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).
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.
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
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
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.
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.
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
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.)
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
Group Procedures 2 901.50 < 1.00
Ss Within Groups 21 5031.05
Session-Days 14 7901.36 50.40 <.005
Procedures by 28 82.25 < 1.00 -
Session-Days by Ss 294 156.76
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.
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
Group Procedures 3 5723.33 1.38
Ss Within Groups 28 4159.00
Session-Days 14 10312.71 56.85 <.005
Procedures by 42 145.28 <. 1.00
Session-Days by Ss 392 181.39
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.
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 -
Procedures Within 21 256.58
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.
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
Procedures Within 28 205.97
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.
REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE
MPSR SCORES TWO, SIX, AND 12 WEEKS AFTER
TREATMENT TERMINATION--GROUPS HI, H2, H3, and H4
Source of Variation df Mean Squares F P
Group Procedures 3 454.33 < 1.00
Ss Within Groups 28 2312.32
Follow-Up 2 12356.00 37.43 <.005
Procedures by 6 68.00 < 1.00
Follow-Up by Ss 56 330.09
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.
NEUMAN-KEULS TEST OF ALL ORDERED PAIRS OF FOLLOW-UP
MEANS FOR GROUPS HI, H2, H3, AND H4
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*
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
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.
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
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
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.
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.
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
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
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
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
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
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
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
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.
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
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-
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
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
Cigarets per Day, 28 51.71
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
Years Smoked, Within 28 62.25
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H2 Group 26 25
H3 Group 34 0
H4 Group 30 8
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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.
Dean, Colleg /o-Artj and Sciences
Dean, Graduate School
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