Psychological Reportr, 1977,41, 503-506. @ Psychological Reports 1977
CREDIBILI'IY OF SMOKING CONTROL STRATEGIES IN NON-SMOKERS : IMPLICATIONS FOR CLINICIANS1 .GEORGE W. HYND, CLYDE CHAMBERS, TERRY T. STRATTON, AND EUGENE MOAN
Northern Arizona University ' Summary.-The credibility of rapid smoking, relaxation, covert sensitization, satiation, and a combined approach was assessed in 113 subjects who were selfreported non-smokers. The results suggest that non-smokers more than smokers rate with greater variability strategies for smoking treatment favoring relaxation significantly over the other treatments examined. It also appears that satiation was least preferred when compared with descriptions of other tratments. These findings, while similar to those reported for smokers, suggest that significant others who do not smoke may likely support the positive treatment expectations of those who undergo treatment for the control of smoking.
The effectiveness of behavioral approaches using both overt and covert aversive conditioning procedures in controlling cigarette smoking has been well documented in the recent. literature (Lichtenstein & Danaher, in press). In examining this research, Hynd, Scracton, and Severson (in press) have proposed that there .me at least three areas of concern in research on control of smoking one of which relates to the effects of positive expectancies for treatment and non-specific variables in discrepant results. They report research which suggests that relaxation is significantly more credible than satiation for a group of cigarette smokers while rapid smoking, covert sensitization, and a combined approach seem equally as credible in terms of positive expectations from treatment. The purpose of this investigation was to determine whether different treatment rationales elicit differential credibility ratings for a group of non-smokers as they seem to for self-reported cigarette smokers. As the authors have, in their research on the control of smoking, noted on several occasions that spouses or ocher significant individuals ( i n these cases non-smokers) have been very critical or positive about the treatment applied to the subject, it was of interest to determine whether over-all credibility ratings would differ for smokers and non-smokers.
METHOD The subjects included 67 male ( M = 20.21, SD = 4.24) and 46 female ( M = 19.76, SD = 3.76) college students who were enrolled in several sections of a general psychology course. Testing was completed within the first few weeks of the semester so none of the subjects had been exposed to theories of learning or behavioral interventions. Requests for reprints, copies of the smoking treatment descriptions, and roup survey iorm should be directed to George W. Hynd. Box 6002, Department o f Fsychologl, Northern Arizona University, Flagstaff, Arizona 86011.
504
G.W. HYND,ET AL. -
The subjects were told that the experimenters were going to conduct a smoking control clinic but needed input to determine which treatment rationale would most likely be successful in eliminating cigarette smoking. A survey form was administered to the subjects in a group with the instruc-; tions to rate each strategy by responding to the questions which followed the descriptions of the five treatments. The descriptions were counterbalanced to control for order. The salient clinical rationales and procedures were adopted from Lichtenstein, Harris, Birchler, Wahl, and Schmahl's ( 1973) description of the rapid smoking procedure, Cautela's (1970) covert sensitization procedure, a combined approach2 using both rapid smoking and covert sensitization, a satiation technique (Marrone, Merksarner, & Salzberg, 1970; Lando, 1975 ) , and a procedure using relaxatioln as its major component.? All descriptions of the strategies were written to minimize possible variables which might have affected an objective evaluation. Hence, che rationales (available on request) ranged 109 to 124 words in length, contained an initial statement on rationale, several sentences on procedure, and a concluding statement on positive outcomes. T o obtain a mean credibility rating for each strategy, the same five questions, modified from those reported by Borkovec and Nau (1972), were asked after each description. The subjects were asked to respond to each question by circling the appropriate number on a scale from 1 to 10 (e.g., 1 = Very Illogical, 10 = Extremely Logical) for each item. The following questions appeared after each description: ( 1 ) How logical does this type of treatment seem to you? ( 2 ) How confident would you be that this treatment would be successful in eliminating cigarette smoking? ( 3 ) How confident would you be in recommending this treatment to a friend who wanted to quic smoking cigarettes? ( 4 ) If you smoked and wanted to quit would you be willing to undergo this treatment? ( 5 ) Over-all, do you feel that this treatment would k effective over quitting "cold turkey"?
RESULTSAND DISCUSSION The mean ratings of credibility were obtained by summing the responses to the five questions for each treatment description. While no significant effect was noted according to sex, an over-all treatment effect was evidenced (F4,564 = 32.92, p < ,001). The application of Scheffe's method (Hays, 1963) of posttest comparisons indicated significant differences between the mean credibility ratings for various treatments. These data are reported in Table 1. Inspection of the data presented in Table 1 suggests that non-smokers as a group demonstrate similar positive expectations through treatment as do cigarette smokers. The mean ratings of credibility reported by Hynd, et al. (in press) using the same procedure were: Rapid smoking/covert sensitization = 'H. Severson, M. O'NeaI, & G. Hynd, Cognitive coping strategies and aversive counterconditioning in the modification of smoking behavior. (Unpublished manuscript, 1977 j
CREDIBILITY OF SMOKING CONTROL STRATEGIES
TABLE 1 P o s m s COMPARISONS ~ OF MEANRATINGS OF CREDIBILITY Treatment 1. Rapid Smoking/Covert Sensitization 2. Relaxation 3. Covert Sensitization 4. Rapid Smoking 5. Satiation
'p
M
SD
2
3
23.73 30.04 23.55 24.67 15.28
12.64 10.25 11.04 11.42 10.33
-6.31*
.18 6.49'
4
5
-.94 8.45' 5.37* 14.76* -1.12 8.27* 9.39*
< .01.
23.11 (SD = 12.53), relaxation = 27.50 (SD = 10.93), covert sensitization = 21.55 (SD = 11.47), rapid smoking = 24.45 (SD = 11.84), and satiation = 18.34 (SD = 12.13). While the range among the non-smokers seems greater ( 15.28-30.04 vs 18.34--27.50), the results are similar in that relaxation is viewed as most credible while satiation is perceived most critically by smokers and non-smokers alike. Unlike Hynd, et ul.'s (in press) results, however, satiation in the present study was significantly less credible than any other treatment described while relaxation was significantly preferred over other strategies. It appears that both smokers and non-smokers view relaxation as incompatible with smoking. These results suggest that non-smokers have positive expectations for descriptions of treatments for the control of smoking. While Borkovec (1972) has demonstrated that there is no causal relation between outcome and credibility of treatment for avoidance of snakes, non-smokers may be expected to support as credible the perceptions of smokers relative to expectations for outcome of therapy. The non-smoker who may have a significant impact on the ability of the smoker to maintain and generalize an initial behavioral change, should be expected to offer additional support in terms of positive expectations. Until research validates the conclusions reached by Borkovec ( 1972) as it relates to strategies for control of smoking, clinicians should take into account the possible effects of positive expectations for treatment on outcomes both for their subjects and other individuals who may aid in achievement of therapy goals. REFERENCES
BORKOVEC, T. Effects of expectanq on the outcome of systematic desensitization and
implosive treatments for analogue anxiety. Behavior Therapy, 1972, 3, 29-40. & NAU, S. Credibility of analogue therapy rarionales. Journal of Behavior Therapy and Experiment$ Psychiatry, 1972, 3, 257-260. CAUTELAJ. Treatment of smoking by covert sensitization. Psychological Reporrr, 1970, 2d. 415-420. mYS, W: Stdistics. New York: Holt, Rinehart & Winston, 1963. HYND. G., S ~ T M N T., , & SEVERSON,H. Smoking treatment strategies, expectancy outcomes, and credibility in attention-placebo control conditions. journal of Clinical Psychology, in press.
B o ~ ~ o v aT., c,
G. W. HYND, ET AL.
506
LANDO, H. A comparison of excessive and rapid smoking in the modification of chronic smoking behavior. Jorrrnal of Consulting a d Clinical Psychology, 1.975, 43, 350-355. LICHTENSTEIN, E., & DANAHBR, B. Mdification of smoking behavior: a critical analysis of theory, research, andpa*. I n M. Hersen, R Eisler, & P Miller (Eds.), Pfogress in behavior mo tfrcairon. Vol. 3. New York: Academic Press, in press. LICHTENSTBIN, E., HARRIS, D., BIRCHLER, G., WAHL,J., & SCHMAHL, D. Comparison of rapid smoking, warm smoky air, and attention-placebo in the modification of smoking behavior. Journal of Consulting and Clinical Psychology, 1973, 40, 92-
78. MARRONE,R., MERKSAMBR, M.,
& SALZEJERG, P. A short duration roup treatment of smoking behavior by stimulus satiation. Behavior Research a n t ~ h e r a p y ,1970, 8, 347-352.
Accepted July 7 , 1977.
CREDIBILI'IY OF SMOKING CONTROL STRATEGIES IN NON-SMOKERS : IMPLICATIONS FOR CLINICIANS1 .GEORGE W. HYND, CLYDE CHAMBERS, TERRY T. STRATTON, AND EUGENE MOAN
Northern Arizona University ' Summary.-The credibility of rapid smoking, relaxation, covert sensitization, satiation, and a combined approach was assessed in 113 subjects who were selfreported non-smokers. The results suggest that non-smokers more than smokers rate with greater variability strategies for smoking treatment favoring relaxation significantly over the other treatments examined. It also appears that satiation was least preferred when compared with descriptions of other tratments. These findings, while similar to those reported for smokers, suggest that significant others who do not smoke may likely support the positive treatment expectations of those who undergo treatment for the control of smoking.
The effectiveness of behavioral approaches using both overt and covert aversive conditioning procedures in controlling cigarette smoking has been well documented in the recent. literature (Lichtenstein & Danaher, in press). In examining this research, Hynd, Scracton, and Severson (in press) have proposed that there .me at least three areas of concern in research on control of smoking one of which relates to the effects of positive expectancies for treatment and non-specific variables in discrepant results. They report research which suggests that relaxation is significantly more credible than satiation for a group of cigarette smokers while rapid smoking, covert sensitization, and a combined approach seem equally as credible in terms of positive expectations from treatment. The purpose of this investigation was to determine whether different treatment rationales elicit differential credibility ratings for a group of non-smokers as they seem to for self-reported cigarette smokers. As the authors have, in their research on the control of smoking, noted on several occasions that spouses or ocher significant individuals ( i n these cases non-smokers) have been very critical or positive about the treatment applied to the subject, it was of interest to determine whether over-all credibility ratings would differ for smokers and non-smokers.
METHOD The subjects included 67 male ( M = 20.21, SD = 4.24) and 46 female ( M = 19.76, SD = 3.76) college students who were enrolled in several sections of a general psychology course. Testing was completed within the first few weeks of the semester so none of the subjects had been exposed to theories of learning or behavioral interventions. Requests for reprints, copies of the smoking treatment descriptions, and roup survey iorm should be directed to George W. Hynd. Box 6002, Department o f Fsychologl, Northern Arizona University, Flagstaff, Arizona 86011.
504
G.W. HYND,ET AL. -
The subjects were told that the experimenters were going to conduct a smoking control clinic but needed input to determine which treatment rationale would most likely be successful in eliminating cigarette smoking. A survey form was administered to the subjects in a group with the instruc-; tions to rate each strategy by responding to the questions which followed the descriptions of the five treatments. The descriptions were counterbalanced to control for order. The salient clinical rationales and procedures were adopted from Lichtenstein, Harris, Birchler, Wahl, and Schmahl's ( 1973) description of the rapid smoking procedure, Cautela's (1970) covert sensitization procedure, a combined approach2 using both rapid smoking and covert sensitization, a satiation technique (Marrone, Merksarner, & Salzberg, 1970; Lando, 1975 ) , and a procedure using relaxatioln as its major component.? All descriptions of the strategies were written to minimize possible variables which might have affected an objective evaluation. Hence, che rationales (available on request) ranged 109 to 124 words in length, contained an initial statement on rationale, several sentences on procedure, and a concluding statement on positive outcomes. T o obtain a mean credibility rating for each strategy, the same five questions, modified from those reported by Borkovec and Nau (1972), were asked after each description. The subjects were asked to respond to each question by circling the appropriate number on a scale from 1 to 10 (e.g., 1 = Very Illogical, 10 = Extremely Logical) for each item. The following questions appeared after each description: ( 1 ) How logical does this type of treatment seem to you? ( 2 ) How confident would you be that this treatment would be successful in eliminating cigarette smoking? ( 3 ) How confident would you be in recommending this treatment to a friend who wanted to quic smoking cigarettes? ( 4 ) If you smoked and wanted to quit would you be willing to undergo this treatment? ( 5 ) Over-all, do you feel that this treatment would k effective over quitting "cold turkey"?
RESULTSAND DISCUSSION The mean ratings of credibility were obtained by summing the responses to the five questions for each treatment description. While no significant effect was noted according to sex, an over-all treatment effect was evidenced (F4,564 = 32.92, p < ,001). The application of Scheffe's method (Hays, 1963) of posttest comparisons indicated significant differences between the mean credibility ratings for various treatments. These data are reported in Table 1. Inspection of the data presented in Table 1 suggests that non-smokers as a group demonstrate similar positive expectations through treatment as do cigarette smokers. The mean ratings of credibility reported by Hynd, et al. (in press) using the same procedure were: Rapid smoking/covert sensitization = 'H. Severson, M. O'NeaI, & G. Hynd, Cognitive coping strategies and aversive counterconditioning in the modification of smoking behavior. (Unpublished manuscript, 1977 j
CREDIBILITY OF SMOKING CONTROL STRATEGIES
TABLE 1 P o s m s COMPARISONS ~ OF MEANRATINGS OF CREDIBILITY Treatment 1. Rapid Smoking/Covert Sensitization 2. Relaxation 3. Covert Sensitization 4. Rapid Smoking 5. Satiation
'p
M
SD
2
3
23.73 30.04 23.55 24.67 15.28
12.64 10.25 11.04 11.42 10.33
-6.31*
.18 6.49'
4
5
-.94 8.45' 5.37* 14.76* -1.12 8.27* 9.39*
< .01.
23.11 (SD = 12.53), relaxation = 27.50 (SD = 10.93), covert sensitization = 21.55 (SD = 11.47), rapid smoking = 24.45 (SD = 11.84), and satiation = 18.34 (SD = 12.13). While the range among the non-smokers seems greater ( 15.28-30.04 vs 18.34--27.50), the results are similar in that relaxation is viewed as most credible while satiation is perceived most critically by smokers and non-smokers alike. Unlike Hynd, et ul.'s (in press) results, however, satiation in the present study was significantly less credible than any other treatment described while relaxation was significantly preferred over other strategies. It appears that both smokers and non-smokers view relaxation as incompatible with smoking. These results suggest that non-smokers have positive expectations for descriptions of treatments for the control of smoking. While Borkovec (1972) has demonstrated that there is no causal relation between outcome and credibility of treatment for avoidance of snakes, non-smokers may be expected to support as credible the perceptions of smokers relative to expectations for outcome of therapy. The non-smoker who may have a significant impact on the ability of the smoker to maintain and generalize an initial behavioral change, should be expected to offer additional support in terms of positive expectations. Until research validates the conclusions reached by Borkovec ( 1972) as it relates to strategies for control of smoking, clinicians should take into account the possible effects of positive expectations for treatment on outcomes both for their subjects and other individuals who may aid in achievement of therapy goals. REFERENCES
BORKOVEC, T. Effects of expectanq on the outcome of systematic desensitization and
implosive treatments for analogue anxiety. Behavior Therapy, 1972, 3, 29-40. & NAU, S. Credibility of analogue therapy rarionales. Journal of Behavior Therapy and Experiment$ Psychiatry, 1972, 3, 257-260. CAUTELAJ. Treatment of smoking by covert sensitization. Psychological Reporrr, 1970, 2d. 415-420. mYS, W: Stdistics. New York: Holt, Rinehart & Winston, 1963. HYND. G., S ~ T M N T., , & SEVERSON,H. Smoking treatment strategies, expectancy outcomes, and credibility in attention-placebo control conditions. journal of Clinical Psychology, in press.
B o ~ ~ o v aT., c,
G. W. HYND, ET AL.
506
LANDO, H. A comparison of excessive and rapid smoking in the modification of chronic smoking behavior. Jorrrnal of Consulting a d Clinical Psychology, 1.975, 43, 350-355. LICHTENSTEIN, E., & DANAHBR, B. Mdification of smoking behavior: a critical analysis of theory, research, andpa*. I n M. Hersen, R Eisler, & P Miller (Eds.), Pfogress in behavior mo tfrcairon. Vol. 3. New York: Academic Press, in press. LICHTENSTBIN, E., HARRIS, D., BIRCHLER, G., WAHL,J., & SCHMAHL, D. Comparison of rapid smoking, warm smoky air, and attention-placebo in the modification of smoking behavior. Journal of Consulting and Clinical Psychology, 1973, 40, 92-
78. MARRONE,R., MERKSAMBR, M.,
& SALZEJERG, P. A short duration roup treatment of smoking behavior by stimulus satiation. Behavior Research a n t ~ h e r a p y ,1970, 8, 347-352.
Accepted July 7 , 1977.
