“YES I DO MIND”; SOCIAL SKILLS FOR NON-SMOKERS’
TRAINING
JOSEPHS. PACHMANand LEE W. FREDERIKSEN Veterans
Administration
Center
and University
of Mississippi
Medical
Center
Abstract--Social skills training was used to teach two non-smokers to effectively alter the disturbing smoking behavior of others in their immediate environments. Training included instructions, modeling, behavioral rehearsal and therapist feedback on specific target responses. The training procedure changed all targeted behaviors in the desired directions during role-played interactions, and persisted at a six-month follow-up. Training effects also generalized to (1) laboratory scenes on which the subjects received no training and (2) to the immediate natural environments of the subjects. Descriptors: smoking, social skills training, modeling, role-playing, multiple baseline, naturalist assessment, non-smokers rights.
There is now little doubt that smoking represents a health risk for the smoker (USPHS, 1975). More recently, the deleterious effects of tobacco smoke on non-smokers (so called passive or involuntary smoking) are also being documented. These effects include subjective annoyance, nasal discharge, and eye irritations (Johansson, 1976), psychomotor retardation (Wright et al., 1973), and impaired auditory functioning and visual acuity (Steinfeld, 1972). In addition, non-smokers who have certain lung and heart impairments (e.g. allergic asthma, angina pectoris, chronic obstructive broncho-pulmonary disease) often find themselves in the dangerous position of having their symptoms exacerbated as a result of involuntary exposure to tobacco smoke-ridden environments (USPHS, 1975). Numerous large scale attempts have been made to secure the rights of non-smokers to smoke free environments. These include the formation of political lobby groups, legislative action, advertising campaigns, mass distribution of salient anti-smoking signs and buttons, and the setting aside (by merchants) of certain days for non-smoking patrons (Sowdell, 1974; Huber, 1975; Vanderslice, 1976). Although these tactics have been moderately successful in curtailing passive smoking in certain instances, a clear problem still exists (Eddy, 1976). The approaches mentioned above have been broad gauged movements or interventions aimed at smokers as a group. Further, most research focuses on the effects of non-social interventions, such as the presence of no-smoking signs or ashtrays (Auger et al., 1972; Jason, 1976) on open-ended populations. These approaches afford individual non-smokers little help in asserting their rights during encounters with smokers. Jason (1976) has concluded that “More research should be directed toward identifying effective strategies in helping non-smokers gain more control over cigarette consumption in their smoking friends (p. 7-8)“. One approach that may help people assert their individual rights is social skills training (e.g. Eisler .et al., 1973; Kazdin, 1974). Although the efficacy of various social skills training paradigms has been well established in the laboratory, generalization of training and the social validity of the new skills remain important issues (Minkin ef al., 1976). In the present study, social skills training was used with two non-smokers. The goal was teaching them skills to effectively alter the disturbing behavior of smokers in their ’ Senior authorship is shared equally. Reprints may be obtained from Lee W. Frederiksen, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, 24061 U.S.A. Portions of this paper were presented at the Midwestern Association of Behavior Analysis, Chicago, May, 1977. The research reported in this article was supported, in part, by the medical research service of the Veterans Administration. 75
JOSEPHS. PACHMANand LEE W. FREDERIKSEN
76
immediate environments. Training included instructions, modeling, behavioral rehearsal and therapist feedback on specific target responses. Generalization ,and social validity of these behaviors were evaluated during role-played laboratory situations and actual interpersonal situations unobtrusively reproduced in the subjects’ natural environments. METHOD
Subjects
Both subjects were hospital employees at the Veterans Administration Hospital in Jackson, Mississippi. Subject 1 was a 22 year old male who reported experiencing headaches and minor throat irritations following the passive inhalation of tobacco smoke. This individual contacted the authors in hope of receiving help with this troublesome situation. Subject 2 was a 51 year old female who reported that involuntary exposure to smoke resulted in frequent eye irritations. This subject was approached by the authors following observations of her unsuccessfully attempting to curtail the smoking behavior of others. Assessment procedures
Scene selection. The subjects were instructed to complete the Non-Smokers Assertion Inventory* (NSAI) as part of an initial screening procedure. This instrument consists of 30 interpersonal situations that were garnered from a group of non-smokers’ selfmonitored reports of situations in which they had experienced difficulty in asserting their rights with smokers. Respondents are requested to rate each situation, on a O-5 scale, relative to the degree of difficulty they experience in requesting a change in another person’s smoking behavior. Upon completion of this assignment, respondents are instructed to likewise rate how often each situation typically occurs. The 12 scenes that each subject rated as most difficult to handle were selected for behavioral assessment. These scenes were then matched on situation frequency scores and six were randomly assigned to function as generalization scenes and six as training scenes. Laboratory assessment. Scenes were presented through a 2-way intercom by a narrator in an adjoining room (cf. Frederiksen et al., 1976). The therapist, who role-played the part of the protagonist, lit up a cigarette following the description of each vignette. During baseline, training and generalization scenes were role-played with instructions to the subjects to respond (or not respond) as if they were actually in the situation described. Scenes were administered sequentially during this phase without feedback from the therapist. If the subject remained silent for a period of 10 set, the narrator went on to the next scene. If the subject responded, the protagonist emitted one of three standard refusal statements (“But I really want to smoke a cigarette now”; “Look the other way if the smoke is bothering you”: “Why don’t you just hold on for a little while and I’ll be finished”). If the subject again responded, the protagonist emitted one of the other standard refusal statements. Naturalistic assessment. Prior to the laboratory assessment, three scenes were unobtrusively reproduced in the subjects’ natural environments. These scenes were selected based on (1) high subjective ratings of difficulty and frequency; and, (2) ease of naturalistic reproduction. For example, in one situation a female co-worker entered the office of the subject to conduct routine business while smoking a cigarette. Following each encounter the confederate was asked to (1) indicate the presence or absence of some request from the subject to alter his or her smoking behavior, and, (2) rate the subject on overall assertiveness (see below). This assessment procedure was repeated following completion of training. At that time, each subject was debriefed. Careful questioning indicated that the assessment procedure was indeed unobtrusive. * Copies instrument
of this experimental are presently under
inventory are available investigation.
upon
request.
The
reliability
and
validity
of this
Social
skills training
for non-smokers
II
Dependent measures
The following behaviors were assessed for each subject: Appropriate Requests-Verbal content requesting new behavior from the individual who is smoking (e.g. “I would appreciate it if you would not smoke a cigarette now.“). Offering a Rationale-Verbal content explaining the rationale for the request (e.g. “The smoke is irritating my eyes.“). Suggesting Alternative Behaviors-Verbal content suggesting alternative behavioral options for the smoker (e.g. “If you must smoke, I suggest that you step outside my office and finish your cigarette, or we can plan on meeting some other time.“). Overall Assertiveness-An overall rating of the likely effectiveness of the subject’s behavior in changing the smoker’s behavior. This rating was made on a O-5 scale (5 = “very assertive-smoker would definitely change behavior”; 0 = “very unassertivesmoker would definitely not change behavior”). Videotapes of the subject’s performance were replayed and scored by a trained observer. To assess measurement reliability, a second observer also scored each of the videotaped sessions. Percent agreement was calculated as agreements (point by point correspondence on the behavioral measures and identical ratings on the assertiveness rating) over agreements plus non-agreements. The resulting percent agreements were: appropriate Requests-99.6%; Offering a Rationale-99.4%; Suggesting Alternative Behaviors-99.8%; and, Overall Assertiveness-81.2%. Training procedure
Following baseline, the subjects received training on each of their 6 training scenes during each training session. The training procedure consisted of four components: (1) Focused instructions-the trainer first described the particular behavior to be taught and offered a rationale for its use, e.g. “It’s important that you actually request the smoker to change his or her behavior. They can’t read your mind. You have to actually make the request. The request should tell the smoker what they need to do differently”. (2) Videotaped modeling-the trainer instructed the subject to attend to the specific target behavior being trained as a videotape of a trained model’s performance was displayed on a television monitor. (3) Behavioral rehearsal-the scene was then described by the narrator and role-played by the subject and the trainer. (4) Feedback-the videotape of the interaction was immediately replayed for the subject. The trainer provided social reinforcement for the appropriate aspects of the subject’s performance and constructive suggestions for further improvement, e.g. “That was a good request. Next time try and be a bit more specific about what you want the smoker to do.” When this sequence was completed, training advanced to the next scene until all six training scenes had been completed (cf. Frederiksen et al., 1976). The six generalization scenes were then role-played, as during baseline, without additional comment. Training on the target behaviors was introduced in a multiple baseline across behaviors design. Appropriate Requests were trained first, followed by Offering a Rationale and Suggesting Alternative Behaviors. Six months after the completion of training both subjects underwent follow-up laboratory assessment without benefit of additional training.
RESULTS
,
Target behavior performance
During baseline, Subject 1 showed an initial increment, followed by a performance decrease on all three target behaviors (Fig. 1). With the introduction of training, Requests stabilized at maximum levels during both training and generalization scenes. An initial performance increment was also observed on the Rationale and Suggestion variables.
78
JOSEPHS. PACHMAN and LEE W. FREDERIKSEN
Subject
#1
BLN
TYG -
$.-UP
.
Rationale
4;+~-,,,\
;p+Y;
.
I-
Suggestions
I Sessions Fig. 1. Behavioral performance during laboratory assessment for Subject 1. The frequency of each target behavior emitted during the six training scenes (solid line) and six generalization scenes (broken line) is shown during baseline (BLN). training (TNG), and at the six-month follow-up (FOL-UP).
With the introduction of training, performance on these latter two variables also stabilized at maximal levels during both training and generalization scenes. Maximum performance was maintained on all three variables at the six-month follow-up (Fig. 1). Subject 2 showed low levels of baseline performance on all three target behaviors (Fig. 2). With the introduction -of training, each target behavior stabilized at maximal levels during both training and generalization scenes. Unlike Subject 1, no performance increments were observed on any variable prior to the introduction of training. At the six-month follow-up maximum performance was maintained on all variables (Fig.2).
Subject
- *R*w6 *-a QENERCLlzAra
Suggestions
if, 4
, ,:‘,
#2
f-_-_ I 4
, , , ,I, , , , , , .~*
,
Sesilions Fig. 2. Behavioral performance during laboratory assessment for Subject 2. The frequency of each target behavior emitted during the six training scenes (solid line) and six generalization scenes (broken line) is shown during baseline (BLN), training (TNG), and at the six-month follow-up (FOL-UP).
Social
skills training
79
for non-smokers
rRNG
_c
GEN .--*
SESSIONS
’
Fig. 3. Mean overall assertiveness ratings for training (solid line) and generalization (broken line) scenes at each laboratory session. Data are shown for Subject I (top panel) and Subject 2 (bottom panel) during baseline (BSLN), training on appropriate requests (RQ), offering a rationale (RT), suggesting alternative behavior (SUG) as well as at the six-month follow-up (FOL).
Social validity Ratings of overall assertiveness were at low baseline levels for both subjects (Fig. 3). For Subject 1, these ratings showed an increase and eventual stabilization following the introduction of training on Requests. At the six-month follow-up an additional increase in rated assertiveness was observed on both training and generalization scenes. Subject 2 showed no increment until the introduction of training on the Rationale component. Overall assertiveness continued to gradually improve until the end of training (Fig. 3). These gains in overall assertiveness were maintained with only a minimal decrement at the six-month follow-up. Generalization to the natural environment Prior to training, Subject 1 failed to emit any requests for behavior change and received a mean overall assertiveness rating of 0 (Fig. 4). At the post assessment, he emitted the maximum number (3) of requests. The mean overall assertiveness rating of this subject also increased by 4 points. Subject 2 likewise did not emit any requests for behavior change in the pre-training assessment and received a mean overall assertiveness rating of 0. Upon completion of training, Subject 2 emitted requests for behavior change in 2 out of the 3 situations and received a mean overall assertiveness rating of 2. DISCUSSION
For both subjects, the training procedure changed the targeted behaviors in the desired directions during role-played interactions. Further, training effects generalized to scenes on which the subjects received no training. The durability of these changes was also demonstrated in that both subjects showed high levels of performance on all target
JOSEPH S. PACHMAN and LEE W. FREDERIKSEN
a
SUBJECT
1
SUBJECT
2
:
3
5
:
Q
t ZJ 2
4
f
3
2 a
2
2
1
Ix
1 0
0 PRE
POST
PRE
POST
Fig. 4. Naturalistic assessment data for Subject 1 (top panel) and Subject 2 (bottom panel). The number of requests emitted during the three assessment situations prior to (pre) and following (post) training are shown in the left half of the figure. The mean assertiveness ratings for the three assessment situations are shown in the right half of the figure.
behaviors at a six-month follow-up. Perhaps most importantly though, the effects of training generalized to the immediate natural environments of the subjects. As in most applied research, the question of generalization is critical. The demonstration of generalization across role-played situations and over time is indeed important. However, the demonstration of generalization to critical situations encountered in the subjects’ natural environments is an important additional step forward. The fact that cigarette smokers in the natural environment saw the subjects as (1) emitting more requests for refraining from smoking, and, (2) being more effectively assertive in these situations, attests to the social and clinical validity of the training. Further efforts in this area might be enhanced by the development of more refined procedures for assessing the transfer of training to the natural environment. Clinically, the next step might be the application of this training package to seriously impaired cardiac and respiratory patients, a population who may experience serious health consequences from “passive smoking”. The efficacy of this treatment package delivered in a group format might also be evaluated as a potential vehicle for reducing therapist response cost. The present findings are of special interest in light of the controversy regarding the “rights” of non-smokers (Eddy, 1976). Vargas (1975) has analyzed rights as verbal behavior, and the exercise of rights as behavior in which the individual has primary control over the consequences applied to him/her. Our analysis of non-smokers’ rights is essentially similar. A major implication of the present study is that the individual with the requisite social skill behaviors will most likely have the inside track on rights in a smoker/non-smoker confrontation. REFERENCES
Auger, T. J.. Wright, E., Jr & Simpson, R. H. Posters as smoking deterents. Journal of Applied Psyholoy~. 1972, 56, 169-171. Dowdell, W. Nonsmokers’ revolt accelerates. Cancer News, 1973-74, 27, 2-4. Eddy, J. Toward the breathing rights of counselors and other persons. Journal of Drug Education, 1976. 6, 43-51.
Social skills training
for non-smokers
81
Eisler, R. M., Hersen, M., & Miller, P. M. Effects of modeling on components of assertive behavior. Journal of Behacior Therapy and Experimental Ps.vchiatr.v, 1973, 4, l-6. Frederiksen, L. W., Jenkins, J. O., Foy, D. W., & Eisler, R. M. Social skills training to modify abusive verbal outbursts in adults. Journal of Applied Behauior Analysis, 1976, 9, 117-125. Huber, G. L. Smoking and non-smokers-what is the issue? New England Journal of Medicine, 1975, 16, 858-859. Jason, L. Eliminating smoking through stimulus control. Paper presented at the meeting of the Association for Advancement of Behavior Therapy, New York, December, 1976. Johansson, C. R. Tobacco smoke in room air-an experimental investigation of odor perception and irritating effects. Building Services Engineer, 1976, 43, 254262. Kazdin, A. Effects of covert modeling and model reinforcement on assertive behavior. Journal of Abnorrmd Psrcholoyr, 1974, 83, 24G252. Minkin, N., Braukman, C. J., Minkin, B. L., Timbers, G. D., Fixsen, P. J., Phillips, D. L., Elery, L., & Wolf, M. M. The social validation and training of conversation skills. Journal of Applied Behaaior Analysis, 1976, 9, 127-140. Steinfeld, J. L. The public’s responsibility: A bill of rights for the non-smoker, Rhode Island Medical Journal, 1972, 55, 124126. United States Public Health Service, The Health Consequences of Smoking. United States Department of Health, Education, and Welfare. Washington, DHEW Publication, 1975. Vanderslice, J. State laws on smoking in public places. American Lung Association Bulletin, 1976, 62, 810. Vargas, E. A. Rights: A Behavioral Analysis, Behaciorism, 1975, 3, 178-190. Wright, G., Randell. P., & Sheppard, R. J. Carbon monoxide and driving skills. Archit%es of Erwironmental Health, 1973. 27, 349-354.
TRAINING
JOSEPHS. PACHMANand LEE W. FREDERIKSEN Veterans
Administration
Center
and University
of Mississippi
Medical
Center
Abstract--Social skills training was used to teach two non-smokers to effectively alter the disturbing smoking behavior of others in their immediate environments. Training included instructions, modeling, behavioral rehearsal and therapist feedback on specific target responses. The training procedure changed all targeted behaviors in the desired directions during role-played interactions, and persisted at a six-month follow-up. Training effects also generalized to (1) laboratory scenes on which the subjects received no training and (2) to the immediate natural environments of the subjects. Descriptors: smoking, social skills training, modeling, role-playing, multiple baseline, naturalist assessment, non-smokers rights.
There is now little doubt that smoking represents a health risk for the smoker (USPHS, 1975). More recently, the deleterious effects of tobacco smoke on non-smokers (so called passive or involuntary smoking) are also being documented. These effects include subjective annoyance, nasal discharge, and eye irritations (Johansson, 1976), psychomotor retardation (Wright et al., 1973), and impaired auditory functioning and visual acuity (Steinfeld, 1972). In addition, non-smokers who have certain lung and heart impairments (e.g. allergic asthma, angina pectoris, chronic obstructive broncho-pulmonary disease) often find themselves in the dangerous position of having their symptoms exacerbated as a result of involuntary exposure to tobacco smoke-ridden environments (USPHS, 1975). Numerous large scale attempts have been made to secure the rights of non-smokers to smoke free environments. These include the formation of political lobby groups, legislative action, advertising campaigns, mass distribution of salient anti-smoking signs and buttons, and the setting aside (by merchants) of certain days for non-smoking patrons (Sowdell, 1974; Huber, 1975; Vanderslice, 1976). Although these tactics have been moderately successful in curtailing passive smoking in certain instances, a clear problem still exists (Eddy, 1976). The approaches mentioned above have been broad gauged movements or interventions aimed at smokers as a group. Further, most research focuses on the effects of non-social interventions, such as the presence of no-smoking signs or ashtrays (Auger et al., 1972; Jason, 1976) on open-ended populations. These approaches afford individual non-smokers little help in asserting their rights during encounters with smokers. Jason (1976) has concluded that “More research should be directed toward identifying effective strategies in helping non-smokers gain more control over cigarette consumption in their smoking friends (p. 7-8)“. One approach that may help people assert their individual rights is social skills training (e.g. Eisler .et al., 1973; Kazdin, 1974). Although the efficacy of various social skills training paradigms has been well established in the laboratory, generalization of training and the social validity of the new skills remain important issues (Minkin ef al., 1976). In the present study, social skills training was used with two non-smokers. The goal was teaching them skills to effectively alter the disturbing behavior of smokers in their ’ Senior authorship is shared equally. Reprints may be obtained from Lee W. Frederiksen, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, 24061 U.S.A. Portions of this paper were presented at the Midwestern Association of Behavior Analysis, Chicago, May, 1977. The research reported in this article was supported, in part, by the medical research service of the Veterans Administration. 75
JOSEPHS. PACHMANand LEE W. FREDERIKSEN
76
immediate environments. Training included instructions, modeling, behavioral rehearsal and therapist feedback on specific target responses. Generalization ,and social validity of these behaviors were evaluated during role-played laboratory situations and actual interpersonal situations unobtrusively reproduced in the subjects’ natural environments. METHOD
Subjects
Both subjects were hospital employees at the Veterans Administration Hospital in Jackson, Mississippi. Subject 1 was a 22 year old male who reported experiencing headaches and minor throat irritations following the passive inhalation of tobacco smoke. This individual contacted the authors in hope of receiving help with this troublesome situation. Subject 2 was a 51 year old female who reported that involuntary exposure to smoke resulted in frequent eye irritations. This subject was approached by the authors following observations of her unsuccessfully attempting to curtail the smoking behavior of others. Assessment procedures
Scene selection. The subjects were instructed to complete the Non-Smokers Assertion Inventory* (NSAI) as part of an initial screening procedure. This instrument consists of 30 interpersonal situations that were garnered from a group of non-smokers’ selfmonitored reports of situations in which they had experienced difficulty in asserting their rights with smokers. Respondents are requested to rate each situation, on a O-5 scale, relative to the degree of difficulty they experience in requesting a change in another person’s smoking behavior. Upon completion of this assignment, respondents are instructed to likewise rate how often each situation typically occurs. The 12 scenes that each subject rated as most difficult to handle were selected for behavioral assessment. These scenes were then matched on situation frequency scores and six were randomly assigned to function as generalization scenes and six as training scenes. Laboratory assessment. Scenes were presented through a 2-way intercom by a narrator in an adjoining room (cf. Frederiksen et al., 1976). The therapist, who role-played the part of the protagonist, lit up a cigarette following the description of each vignette. During baseline, training and generalization scenes were role-played with instructions to the subjects to respond (or not respond) as if they were actually in the situation described. Scenes were administered sequentially during this phase without feedback from the therapist. If the subject remained silent for a period of 10 set, the narrator went on to the next scene. If the subject responded, the protagonist emitted one of three standard refusal statements (“But I really want to smoke a cigarette now”; “Look the other way if the smoke is bothering you”: “Why don’t you just hold on for a little while and I’ll be finished”). If the subject again responded, the protagonist emitted one of the other standard refusal statements. Naturalistic assessment. Prior to the laboratory assessment, three scenes were unobtrusively reproduced in the subjects’ natural environments. These scenes were selected based on (1) high subjective ratings of difficulty and frequency; and, (2) ease of naturalistic reproduction. For example, in one situation a female co-worker entered the office of the subject to conduct routine business while smoking a cigarette. Following each encounter the confederate was asked to (1) indicate the presence or absence of some request from the subject to alter his or her smoking behavior, and, (2) rate the subject on overall assertiveness (see below). This assessment procedure was repeated following completion of training. At that time, each subject was debriefed. Careful questioning indicated that the assessment procedure was indeed unobtrusive. * Copies instrument
of this experimental are presently under
inventory are available investigation.
upon
request.
The
reliability
and
validity
of this
Social
skills training
for non-smokers
II
Dependent measures
The following behaviors were assessed for each subject: Appropriate Requests-Verbal content requesting new behavior from the individual who is smoking (e.g. “I would appreciate it if you would not smoke a cigarette now.“). Offering a Rationale-Verbal content explaining the rationale for the request (e.g. “The smoke is irritating my eyes.“). Suggesting Alternative Behaviors-Verbal content suggesting alternative behavioral options for the smoker (e.g. “If you must smoke, I suggest that you step outside my office and finish your cigarette, or we can plan on meeting some other time.“). Overall Assertiveness-An overall rating of the likely effectiveness of the subject’s behavior in changing the smoker’s behavior. This rating was made on a O-5 scale (5 = “very assertive-smoker would definitely change behavior”; 0 = “very unassertivesmoker would definitely not change behavior”). Videotapes of the subject’s performance were replayed and scored by a trained observer. To assess measurement reliability, a second observer also scored each of the videotaped sessions. Percent agreement was calculated as agreements (point by point correspondence on the behavioral measures and identical ratings on the assertiveness rating) over agreements plus non-agreements. The resulting percent agreements were: appropriate Requests-99.6%; Offering a Rationale-99.4%; Suggesting Alternative Behaviors-99.8%; and, Overall Assertiveness-81.2%. Training procedure
Following baseline, the subjects received training on each of their 6 training scenes during each training session. The training procedure consisted of four components: (1) Focused instructions-the trainer first described the particular behavior to be taught and offered a rationale for its use, e.g. “It’s important that you actually request the smoker to change his or her behavior. They can’t read your mind. You have to actually make the request. The request should tell the smoker what they need to do differently”. (2) Videotaped modeling-the trainer instructed the subject to attend to the specific target behavior being trained as a videotape of a trained model’s performance was displayed on a television monitor. (3) Behavioral rehearsal-the scene was then described by the narrator and role-played by the subject and the trainer. (4) Feedback-the videotape of the interaction was immediately replayed for the subject. The trainer provided social reinforcement for the appropriate aspects of the subject’s performance and constructive suggestions for further improvement, e.g. “That was a good request. Next time try and be a bit more specific about what you want the smoker to do.” When this sequence was completed, training advanced to the next scene until all six training scenes had been completed (cf. Frederiksen et al., 1976). The six generalization scenes were then role-played, as during baseline, without additional comment. Training on the target behaviors was introduced in a multiple baseline across behaviors design. Appropriate Requests were trained first, followed by Offering a Rationale and Suggesting Alternative Behaviors. Six months after the completion of training both subjects underwent follow-up laboratory assessment without benefit of additional training.
RESULTS
,
Target behavior performance
During baseline, Subject 1 showed an initial increment, followed by a performance decrease on all three target behaviors (Fig. 1). With the introduction of training, Requests stabilized at maximum levels during both training and generalization scenes. An initial performance increment was also observed on the Rationale and Suggestion variables.
78
JOSEPHS. PACHMAN and LEE W. FREDERIKSEN
Subject
#1
BLN
TYG -
$.-UP
.
Rationale
4;+~-,,,\
;p+Y;
.
I-
Suggestions
I Sessions Fig. 1. Behavioral performance during laboratory assessment for Subject 1. The frequency of each target behavior emitted during the six training scenes (solid line) and six generalization scenes (broken line) is shown during baseline (BLN). training (TNG), and at the six-month follow-up (FOL-UP).
With the introduction of training, performance on these latter two variables also stabilized at maximal levels during both training and generalization scenes. Maximum performance was maintained on all three variables at the six-month follow-up (Fig. 1). Subject 2 showed low levels of baseline performance on all three target behaviors (Fig. 2). With the introduction -of training, each target behavior stabilized at maximal levels during both training and generalization scenes. Unlike Subject 1, no performance increments were observed on any variable prior to the introduction of training. At the six-month follow-up maximum performance was maintained on all variables (Fig.2).
Subject
- *R*w6 *-a QENERCLlzAra
Suggestions
if, 4
, ,:‘,
#2
f-_-_ I 4
, , , ,I, , , , , , .~*
,
Sesilions Fig. 2. Behavioral performance during laboratory assessment for Subject 2. The frequency of each target behavior emitted during the six training scenes (solid line) and six generalization scenes (broken line) is shown during baseline (BLN), training (TNG), and at the six-month follow-up (FOL-UP).
Social
skills training
79
for non-smokers
rRNG
_c
GEN .--*
SESSIONS
’
Fig. 3. Mean overall assertiveness ratings for training (solid line) and generalization (broken line) scenes at each laboratory session. Data are shown for Subject I (top panel) and Subject 2 (bottom panel) during baseline (BSLN), training on appropriate requests (RQ), offering a rationale (RT), suggesting alternative behavior (SUG) as well as at the six-month follow-up (FOL).
Social validity Ratings of overall assertiveness were at low baseline levels for both subjects (Fig. 3). For Subject 1, these ratings showed an increase and eventual stabilization following the introduction of training on Requests. At the six-month follow-up an additional increase in rated assertiveness was observed on both training and generalization scenes. Subject 2 showed no increment until the introduction of training on the Rationale component. Overall assertiveness continued to gradually improve until the end of training (Fig. 3). These gains in overall assertiveness were maintained with only a minimal decrement at the six-month follow-up. Generalization to the natural environment Prior to training, Subject 1 failed to emit any requests for behavior change and received a mean overall assertiveness rating of 0 (Fig. 4). At the post assessment, he emitted the maximum number (3) of requests. The mean overall assertiveness rating of this subject also increased by 4 points. Subject 2 likewise did not emit any requests for behavior change in the pre-training assessment and received a mean overall assertiveness rating of 0. Upon completion of training, Subject 2 emitted requests for behavior change in 2 out of the 3 situations and received a mean overall assertiveness rating of 2. DISCUSSION
For both subjects, the training procedure changed the targeted behaviors in the desired directions during role-played interactions. Further, training effects generalized to scenes on which the subjects received no training. The durability of these changes was also demonstrated in that both subjects showed high levels of performance on all target
JOSEPH S. PACHMAN and LEE W. FREDERIKSEN
a
SUBJECT
1
SUBJECT
2
:
3
5
:
Q
t ZJ 2
4
f
3
2 a
2
2
1
Ix
1 0
0 PRE
POST
PRE
POST
Fig. 4. Naturalistic assessment data for Subject 1 (top panel) and Subject 2 (bottom panel). The number of requests emitted during the three assessment situations prior to (pre) and following (post) training are shown in the left half of the figure. The mean assertiveness ratings for the three assessment situations are shown in the right half of the figure.
behaviors at a six-month follow-up. Perhaps most importantly though, the effects of training generalized to the immediate natural environments of the subjects. As in most applied research, the question of generalization is critical. The demonstration of generalization across role-played situations and over time is indeed important. However, the demonstration of generalization to critical situations encountered in the subjects’ natural environments is an important additional step forward. The fact that cigarette smokers in the natural environment saw the subjects as (1) emitting more requests for refraining from smoking, and, (2) being more effectively assertive in these situations, attests to the social and clinical validity of the training. Further efforts in this area might be enhanced by the development of more refined procedures for assessing the transfer of training to the natural environment. Clinically, the next step might be the application of this training package to seriously impaired cardiac and respiratory patients, a population who may experience serious health consequences from “passive smoking”. The efficacy of this treatment package delivered in a group format might also be evaluated as a potential vehicle for reducing therapist response cost. The present findings are of special interest in light of the controversy regarding the “rights” of non-smokers (Eddy, 1976). Vargas (1975) has analyzed rights as verbal behavior, and the exercise of rights as behavior in which the individual has primary control over the consequences applied to him/her. Our analysis of non-smokers’ rights is essentially similar. A major implication of the present study is that the individual with the requisite social skill behaviors will most likely have the inside track on rights in a smoker/non-smoker confrontation. REFERENCES
Auger, T. J.. Wright, E., Jr & Simpson, R. H. Posters as smoking deterents. Journal of Applied Psyholoy~. 1972, 56, 169-171. Dowdell, W. Nonsmokers’ revolt accelerates. Cancer News, 1973-74, 27, 2-4. Eddy, J. Toward the breathing rights of counselors and other persons. Journal of Drug Education, 1976. 6, 43-51.
Social skills training
for non-smokers
81
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