THERAPEUTIC STRIKE

SOCIAL INFLUENCE: STERNLY WHILE THE IRON IS HOT

TED L. ROSENTHAL. JOHN H. HUNG and JOHN E. KELLEY Department

of Psychology.

Memphis

State University.

Memphis.

TN 38152. U.S.A

Summary-Two studies tested social influence options in symbolic modeling therapy. The first gave a pretreatment interview in which the therapist behaved in a “warm” or “businesslike” manner. and then urged the clients to approach a snake as closely as possible when (immediately afterward) the) repeated a prior runway BAT and fear assessment. The “businesslike” group reported less fear than the “warm” group. but differential therapist perceptions did not affect overt avoidance. Stud! 2 compared directive social influence or its omission when clients performed approach immediately LY. the next week. The strongest BAT gains occurred if social influence was followed by prompt execution of the relevant task. but these differences were not maintained after treatment. The data suggested that timing is critical for applying social influence. which should be given immediately before task demands. Continued efforts to capitalize on initial differences might sustain socially-influenced gains for enduring treatment purposes.

Since treatment involves dyadic interactions between therapist and client, it follows that sociopsychological data on attitude change, interpersonal attraction and influence, and expectancy effects should directly bear on clinical research into the therapist-client interactions. Goldstein (1964) and Goldstein, Heller and Sechrest (1966) for example. have pleaded strongly for approaching clinical and counseling from a social psychological frame of reference. as has Brehm (1976). Increasingly, researchers have construed therapy as situations where the therapist exerts social influence in one form or another upon the client by changing his expectancies about the process and outcome of treatment. This expectancy or demand effect has been a center of research focus. It is defined by Paul (1966; p. 5) as “behavioral change arising from nonspecific aspects of attention, suggestion and faith (in the therapist and his techniques) that are common to most such interpersonal situations.” Some studies found significantly improved therapy outcomes after instructions to establish positive expectancies in the client (Borkovec. 1972; Frank, 1968: Marcia. Rubin and Efran. 1969; Paul, 1966; Woy and Efran, 1974). For example. Marcia or trl. (19691 have argued that systematic desensitization is merely an expectancy manipulation. Still other scholars have indicted the Behavioral Avoidance Tests (BATS) used in treatment research with mini-phobias and various analogue fears. Bernstein and Nietzel (1974) and Smith. Biener and Beaman (1974) thus contend that strong demand characteristics associated with the BAT might be responsible for reduced avoidance: hence they cast doubt on the role of the actual treatment operations under study. Since there is general agreement that client expectancies and social influence can play important roles in treatment outcomes. research is needed to guide therapeutic use of such options. Rather than arguing whether social influence is the on/~’ relevant component in change programs. is it not better to test how it can best be harnessed for treatment purposes? Two studies were conducted to address these issues. The first compared the effects of varying clients’ perceptions of the therapist on immediate approach and ultimate therapy outcome. Previous work (e.g. Leitenberg et al., 1969; McGlynn. Reynolds and Linder. 1971) has compared the results of varied therapy instructions. The present study kept directions constant but varied therapist’s style: for half the clients he was warm and accepting of their fears; for the remaining cases, he behaved in a colder. more stern and businesslike manner. The results (below) suggested that the warm role was seen as more tolerant of delay and hence elicited more ,I

253

TED L. ROSESTHAL. JOHN H. HUNG and JOHV E. KELLER

254

rated fear. In light of those results. it seemed of interest to compare directive (“businesslike”) social influence -or its omission when task-oriented behavior could be performed immediately cs. at a later time. This was done in Study 2. It can be argued that for social influence to create measurable. and hence clinically useful impact, the client would need an opportunity to act upon it promptly as in Study 1. If, however, after a directive task demand. substantial delay intervenes. the short-run effects of the influence attempt may dissipate. Then. if change is assessed much later. a real contribution of social influence might go undetected. Therefore. primary concern involved changes that most closely followed the therapist’s demand or its omission. It was predicted that the group given social influence followed by prompt performance testing would show the strongest positive changes /W&Y the start of routinized (constant) symbolic modeling therapy. Confirming that hypothesis would imply a clear guideline for future research: If social influence is attempted. implement the demand by quickly bringing clients into sustained contact (e.g. response prevention or participant modeling) with the formerly avoided events, that is, Strike while the iron is hot! EXPERIMENT

1

Method Subjects. Clients were 18 (16 female and 2 male) students, screened to assure fearfulness, from a larger group that agreed to participate (for extra credit) when surveyed for reported snake fear in introductory classes. Procedure. The experiment consisted of the following three phases: (1) pretesting (initial assessment of snake fear and avoidance); (2) an interview followed by post-interview assessment of snake fear and avoidance, and (3) treatment and then post-therapy assessment of snake fear and avoidance. All assessments were conducted by two undergraduate assistants, blind to the design. to condition assignments, and not otherwise connected with the study; the interview and treatment were conducted by Hung. Pretesting. Pretesting was conducted in a runway room with 17 one-foot intervals marked off for BAT testing. At the far end. a small table supported a screened, 20-gallon aquarium. that contained a ‘l-in harmless boa constrictor. Clients came for testing individually. were met by an assistant. and were asked to start from outside the room and approach the snake as closely as possible. Avoidance was assessed by noting the number of acts performed on the Behavioral Avoidance Checklist, which contained descriptions of 20 hierarchically arranged steps. The following are representative items: (No. 20) “Standing (No. (No. (No. then

more than 17 feet away from animal, not looking at it.” 12) “Standing next to cag,c and lookmg down at animal through the screen.” 7) “Holding a 12.inch pomter and touching the animal with it once.” I) “Reaching mto the cage and picking up any part of the animal an inch or more and puttmg it down.

The assistant always remained outside the doorway during the BATS. A second dependent measure was taken when the client was at his closest to the snake. He then was asked to rate “How afraid do you feel right now?’ on a 10 point scale, with 1 = “very comfortable” and 10 = “very terrified”. This constituted the Fear Rating (FR). ljzterriew. The week after pretesting. clients came individually to the Psychology Clinic for a 20-min structured interview with the therapist. The interview consisted of 20 questions about the client’s biographical data, the extent and nature of snake fear, and feelings about having such a fear. For half the clients (groups matched on pretest BATS), interview was conducted in a very warm, friendly manner and on five questions the therapist responded to client’s answers in a warm, understanding, accepting fashion. For the remaining clients. the interview was conducted in a more formal, stern manner and on the same five interview questions the therapist responded to the client’s answers in a very critical, “nonempathetic” manner; the contrasting interview styles constituted the experimental manipulation.

Therapeutic

255

social influence

At the end of the interview, each client was asked to go to the testing room to be evaluated once more. After this request. the therapist told all clients: “This time I want you to give it your best try. I know you can do better than last time if you try.” The therapist did not accompany the client to the testing room. where the same undergraduate assistant administered the fear and avoidance assessments. Then. clients were asked to rate on a 7-point scale a list of adjectives describing how comfortable they felt and also how they perceived the therapist during the interview. Treatn~ent. For the third and last week of the study, clients returned to the Clinic for symbolic modeling therapy. This consisted of watching a 20-min videotape. which began with the therapist giving a brief talk on snakes, clarifying some common misconceptions about them, and emphasizing how harmless most snakes are. In the second part of the videotape, the therapist approached a 5-ft boa constrictor very gradually and ended up eventually playing with the snake as it coiled around his body. Each client was instructed to pay close attention to the modeled behavior and imagine that he was in the therapist’s place. experiencing his feelings. After the videotape. the client returned to the testing room and received a final BAT and FR assessment. after which the client was debriefed about the nature and purpose of the study, and thanked for participating. Results

The interview variations produced the desired differences in clients’ perceptions. The warm group reported significantly more subjective comfort during the interview than did the stern condition (I = 3.18; p < 0.01) and the warm group also rated the therapist higher on warmth than did the “businesslike” condition (r = 3.51; p < 0.01). On the BAT measures. however, no differences were found between warm and stern conditions in any phase. As can be seen in Table 1, interview style did not significantly alter BATS either before or after treatment. Across conditions, modeling treatment produced a significant reduction in avoidance (t = 3.64; p < 0.01) compared to the earlier (pretherapy) BATS. Table 1 suggests some numerical advantage for the stem group. This was confirmed on the FRs. The stern condition reported significantly less fear than the warm condition on the post-therapy assessment (r = 3.47; p < 0.01). No other differences between warm and stern groups were found either on pretesting or in the post-interview phase. For improvement across conditions. a pattern of FR results like that for the BATS was found. with combined clients reporting subjectively less fear at the end of the study (t = 6.02; p < 0.01). However. the stern condition did significantly reduce FRs. both after the interview, and at the end of the study (smaller r = 2.62; p < 0.05); the warm group declined significantly at the end of the study (t = 7.43; p < 0.01) but not after the interview. The foregoing data suggested that the social influence demand had better effects when delivered in a businesslike than a warmly tolerant (of fear) manner. If stern direction is the better influence strategy. how should it be implemented? From the standpoint of social judgment or adaptation-level theory. it might be expected that. as an anchor, a performance demand would have its optimal effects when freshest, before competing Table

I. Pretest, post-interview. and post-therapy measures for the “warm” and “stem”

means on the BAT and conditions. Study I

“warm” BAT

FR

* p < 0.01

Pretest Post-interview Post-therdp) Pretest Post-intervie& Post-therapy

15.22 15.22 12.67 6.89 1.44 4.56

“stern” 14.61 13.33 10.89 6.67 5.22 4.1 I

t 0.19 I .44 0.90 0.24 3.47* 0.47

FR

Tm L. ROSESTHAL. JOHN H. HUNG and JOHN E. KELLER

256

cognitions could interfere or compel attention to alternative standards. Put otherwise. one would expect a demand to bear most weight when new and focal, before forgetting or the impetus of competing anchors could move its weight toward the central tendency of all prior experiences. This reasoning was tested in the second study.

EXPERIMENT

2

Method .S+YYX Clients were 48 (36 females and 12 males) snake-fearful introductory Psychology students. selected in a similar fashion as in Study 1. but the following semester. Procrd~e. The basic procedure was much like that of Study 1. involving the same three phases: (1) pretesting, (2) interview followed by post-interview assessment of snake fear and avoidance. and (3) treatment and then post-therapy assessment. The only procedural differences concerned (a) inclusion of a latency measure-how long it took clients to initiate approach when told to do so in the assessments. (b) the experimental manipulation of social influence by the therapist after the interview in phase 2, and (c) the timing of the post-interview assessment. Hence, the complete study involved a 2 (social influence given or withheld) x 2 (immediate or delayed post-interview assessment) x 3 (repeated phase) factorial design. applied to each dependent measure, with 12 clients (sexes equalized) per cell. Inrrrcie~. The interview followed the same basic format as before, but there was no “warm-stern” manipulation: the therapist always behaved in a non-committal, somewhat accepting fashion. After the interview, the separate conditions were given different instructions. M~r~iphtior~ qf socid i$luerm. Clients in the “Social influence given” group were told: Based on what you’ve told me during the interview. I would say that your problem with snakefear is realI> not as bad as jou think it is. Now. 1 want you to go back to the testing room you were at last week and take the same test again, but this time I want you to get as close to the snake as possible. I’m sure that you can do better than you did last time.

Clients

in the “Social

Now. I want test again. Manipulation

influence

you to go back

qf‘ tinting.

withheld” to the testing

An immediate

group room

were instead

told:

you were at last week and

performance

client

take

was told:

Please go to the testing room right now for the evaluation. My assistant is waiting there. And then next week we will show you a videotape as part of the treatment.

A delayed

performance

client

was instead

the same

for you

told:

You can go now. but when you come back next week to watch a videotape as part of the treatment. I want you to go to the testing room first for the evaluation. My assistant will be waiting for you there. Trentment. Therapy was identical to that of Study 1. Clients were shown the previously-described videotape. after which each was given the post-therapy assessment and then debriefed by the therapist.

Results Analyses of the data showed that Ss in the four conditions did not differ on the BAT, FR or latency measures in pretesting: thus all conditions were equated on all dependent measures at the onset of the experiment. BAT.s. Table 2 presents the phase means for each condition on the BAT, FR and latency measures. Analysis of variance revealed a significant main effect (F = 73.95; df= 2/M; p < 0.01) for the repeated phases. showing that, aggregately, clients improved over the course of the study. Specific comparisons revealed that this improvement occurred after the

Therapeutx

Table

2. Means

by group

and phase

for each treatment

1 Group

2 BAT

‘57

social influence

3

group

on BAT. FR. and Latency

1

Phase ’ FR

3

I

measures.

2

Study 2

3

Latent!

With influence immediate approach delayed approach No influence immediate approach delayed approach

interview for Ss in the social influence given, immediate performance group (t = 2.51: after rreatrnent for both groups not given social influence. Of special interest was the failure of the socially influenced. delayed performance group to improve either after the interview. or after modeling treatment when compared with itself across repeated phases. In contrast. both no social influence groups showed progress from first to last phases (smaller t = 2.84; p < 0.05). Thus. a significant (social influence) x (phase) interaction was obtained (F = 6.67: &‘= 2,‘88: 17< 0.01). As predicted, giving social influence conjoined with immediate implementation produced the largest impact. The immediately-tested social influence group surpassed each other group’s BATS by Newman-Keuls tests (all p < 0.05). The three remaining conditions did not differ from each other. nor did they progress significantly from pretesting to the post-interview assessment. Since the explicit predictions related to effects that would hold for immediate Z:PI’SII.S delayed performance, they were based on just the first two (before treatment) phases. Hence a further analysis was required. comparing the input variables just for the pretraining and post-interview phases. Consistent with our predictions. that ANOVA yielded a significant phases x social influence x timing interaction (F = 8.09: 4f’ = l/88: p < 0.01). As can be seen in Table 2. the pattern of means was as predicted. Thus. it appears that significant improvement only resulted when social influence was followed by immediate performance; no other experimental condition yielded such improvement on the post-interview assessment. However, the triple interaction lost strength when post-therapy performance was included in the analysis. By the end of the study. a Newman-Keuls test revealed no significant differences among the four groups. This suggests the early advantage of the immediate. influenced group dissipated after treatment was implemented. Thus. the effect of task-oriented social influence given just prior to performance was not later sustained since gains were not promptly embedded in further task execution practice. FRs. Neither social influence nor the timing of task implementation produced a significant main effect or any interactions on self-reported fear. However, clients who approached significantly closer at phase 2 (social influence, immediate performance group) were not more aroused than the others who remained farther from the snake. Those data suggest that promptly-enacted influence did not merely coerce approach. but also aided clients to take it better in stride. A significant main phases effect (F = 6.02; d’= 2/88; p < 0.01) showed that the clients aggregately reported decreased arousal between pretesting and the later stages. Latency. A pattern of results identical to that for FRs was found on the latency measure. The only significant effect was that for repeated phases (F = 116.75; r!f= 2/88; p < 0.01) showing that all clients combined took significantly less time approaching the snake after post-testing than formerly (see Table 2). p < 0.05). but progress only occurred

Correlations between BAT md FR datu

In light of recent theorizing (Rachman. 1976a), it is of interest to consider the covariation between overt approach and self-rated fear during the stages of each study. Table 3 presents the relevant coefficients at each phase of Experiments 1 and 2.

2-58

TED L. ROSENTHAL. JOHK H. HUNG and JOHN E. K~:LL~\ Table

3. Correlation

coefficients by group and phase for each treatment and FR measures. for Studies 1 and 2

Group EXPERIMENT 1 “warm” I’S “stem” rs Combined rs combined rllos EXPERIMENT 2 Wirlt irg/WlW immediate approach TS delayed approach rs N:o ir1fluer1ce immediate approach I’S delayed approach I’S Combined rs combined rl7os

Pretest

Phase Post-intervie\\

group

between

Post-therapy

0.32 0.44 0.46: 0.74*

0.0 I 0.44 0.36 0.56*

-0.06 0.29

0.36 0.15

0.5’ 0.42

-0.32 -0.17

-0.58* 0.X 0.04

0.47 0.38 0.56* 0.66*

-0.05 0.04

0.03

BAT

-0.21 0.28 0.15

0.32

* p < 0.05.

Briefly, Rachman (1976a) proposes that fear and avoidance should covary more closely before treatment, when both are more intense, than after. The progressive decline of the coefficients in successive phases of Study 1 agrees well with the hypothesis, but the parallel data of Study 2 are markedly discrepant. However, a further corollary of the theory is that fear and avoidance should diverge when clients face external demands (as in the social influence, immediate performance group). Rachman (1976b. Hypothesis 2) posits that high therapist demands “will produce relatively rapid changes in behavior (e.g. in fear-reduction therapy, this will take the form of a rapid reduction of avoidance behavior.)” Note that the pattern of cleans (Table 2) bears this out. yet the pattern of I’S (Table 3) shows no decreased covariation and, if anything. some rise across phases. Also, the pretest I’ values differ sharply between studies, substantial and positive in the first. but zero-order and negative in .the second. No obvious explanation accounts for these pretest differences but. since I’ is especially sensitive to minor score changes. vhoson’the combined data are also presented, with no great shift in the overall pattern. What is suggested? A great virtue of Rachman’s theory is its clarity and openness to empirical data. The present results imply that the theory needs further refinement: it must better specify the boundary conditions under which it does and does not hold; and it must define the form(s) of dependent measure(s) more precisely. e.g. does concordance signify mean changes. degree of correlation, or both; and does the theory predict if the coefficients are negative. or only if positive coefficients range from low to higher values? DISCUSSION It is clear from the present experiments that fear and avoidance can be modified by manipulating social influence. its timing, and also clients’ perceptions of the therapist. In Study 1. although clients viewed the therapist differently in the “warm” and “businesslike” conditions. the absence of significant BAT effects suggests that differential perceptions were too weak to alter overt avoidance although sufficient to modify self-reported fear. Clients who saw the therapist as “businesslike” during the interview significantly reduced FRs both on the post-interview and the post-therapy measures. The superiority of the “businesslike” over the “warm” therapist is superficially surprising in light of the counseling research literature claiming that “warm and accepting” therapists yield better results than “cold and non-accepting” therapists. Not only were such results not found on the behavioral measure, but analysis of subjective ratings revealed an opposite pattern. It seemed that the very warm therapist was perceived as more tolerant of complaint. and confirmed or validated clients’ self-judged arousal, although overt avoidance was the same in both groups.

Therapeutic

‘59

social influence

The results of Study 2 have far greater practical relevance. They suggest. as predicted. that directive social influence may have clear value jf’clients must promptly implement demands, but may be hazardous otherwise. The immediate. socially influenced clients increased overt approach with no more fear than reported by their counterparts who remained farther from the snake. In contrast. the delayed. socially influenced clients were the only group who failed to significantly surpass their own pretest scores in the later phases. The core results were confirmed by the significant social influence x timing interaction across the first two phases. The post-interview superiority of the immediate, socially influenced clients was not maintained after therapy. This was hardly surprising since no effort was made to quickly exploit their phase 2 progress by requiring further overt snake contacts. It seemed important to verify that behavioral gains from brief approach demands would not persist in CUCUO.as was the case. However. the practical implications are clear: If influence is successfully exerted and promotes increased approach by clients. their initial advances should be harnessed by protracted in vivo exposure, through participant modeling. response prevention. or related task practice. Unless such steps are taken, there is little reason for clients to redefine themselves as more competent or to expect they will cope better in the future after one isolated instance (e.g. improved BAT trial). The foregoing premises seem straight-forward and invite more sustained research tests. The present studies are part of a program to rethink, and hopefully to harness, social cueing operations for treatment purposes. Taken together, they suggest that a shift in emphasis from stylistic or personal demeanor of influence sources (Study 1) may be warranted. Instead, attention to more concrete options like the timing and utilization of social demands (Study 2) or prompt efforts to capitalize on tentative gains by concerted overt rehearsal. may prove the more fruitful strategy. Also, in both experiments, brief filmed modeling treatment was generally effective but fell far short of complete success. There too, one may surmise that the best use of symbolic techniques for reducing avoidance is as a gateway to ilr cit?o performance trials, preferably with little intervening delay. The provisional conclusion remains the same. to strike while the iron is hot. Ackrlowledgemeilts-We

wish to thank

Vicki Arant.

Beth Garland

and Walter

Houston

who served as testers.

REFERENCES BERNSTEIN D. A. and NIETZEL M. T. (1974) Behavioral avoidance tests: The effects of demand characteristics and repeated measures on two types of subjects. B&r. Thcrup.r 5. 18X-197. BREHM S. S. (1976) Ihe Applicarion of Sociu/ Ps~c/tolog~ ro Clinicul Prrrcricr. Halstead. New York. BORKOVEC T. D. (1972) Effects of expectancy on the outcome of systematic desensitization and implosive treatments and analogue anxiety. Beha~. Therupy 3. 2940. FRANK J. D. (1968) The role of hope in psychotherapy. Inr. J. Psrcl~ic~r. 5. 3X3-395. GOLDSTEIN A. P. (I 962) Thrrupist~Purirrrr Ezpccrcrncirs in Ps~cl~orhertrp~. MacMillan. New York. GOLDSTEIN A. P.. HELLER K. and SECHREST L. B. (1966)Ps~~V~ot/~mpy cm/ r/w P~KVI~/~~~~~ o/ Be/wior C’hor~~/~~. Wiley, New York. LEITENBERG H.. AGRAS W. S.. BARLOW D. H. and OLIVEAU D. C. (1969) Contribution ot” selective positive reinforcement and therapeutic instructions to systematic desensitization therapy. J. trhrto1711. P.s~~h/. 74. 113-118. MARCIA J. A.. RL.BIN B. M. and EFRAN J. S. (1969) Systematic desensitization: expectancy change or countcrconditioning? J. ahnor~n. Psycho/. 74. 3X4-387. M&LYNN F. D.. REYNOLDS E. J. and LINUER L. H. (1971) Systematic desensitization with pre-treatment and intra-treatment therapeutic instructions. Brhtrc. Rcs. rrrld T/wrcrp~ 9. X-63. PAUL G. L. (1966) Imighr L‘S.De.wl.sirixtiou irl P.s!,~hothotrp~. Stanford University Press. Stanford. CA. RACHMAN S. (1976a) The passing of the two-stage theory of fear and avoidance: Fresh possibilities. Bchur. Res. and T/wrap~ 14. 125~131. RACHMAS S. (1976b) A theoretical analysis of high and low therapeutic demands. Bchtrc.. RCS. u~d T/I~J,-u~J, 14. 301-302. SMITH R. E.. DIENEK E. and B~AMAN A. L. (1974) Demand characteristics and the behavioral avoidance measure of fear m behavior therapy and analogue research. B&c. Tltwcrpy 5. 171-1X2. WOY J. R. and EFRAK J. S. (1972) Systematic desensitization and expectancy in the treatment of speaking anxiety. Brhut. Rrs md T/wupy 10. 4349.

Therapeutic social influence: sternly strike while the iron is hot.

THERAPEUTIC STRIKE SOCIAL INFLUENCE: STERNLY WHILE THE IRON IS HOT TED L. ROSENTHAL. JOHN H. HUNG and JOHN E. KELLEY Department of Psychology. Mem...
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