Pzychological Reports, 1976, 38, 235-238. @ Psychological Reports 1976
SELF-MONITORING IN THE TREATMENT OF NOSE SQUEEZING AND DAYDREAMING LEONARD A. JASON' De Paul University Stmrnma~y.-Self-monitoring was successfully used in modifying a patient's undesirable behaviors. The initial unwanted behavior, nose squeezing, was appreciably decreased over a 2-mo. period and gains were maintained for over 2 yr. While self-monitoring also reduced a second disruptive behavior, daydreaming while studying, the onset of abdominal pains forced che termination of this study. The present study, therefore, demonstrated a successful and unsuccessful application of self-monitoring.
Several investigators have begun studying the effectiveness of self-monitoring in reducing problem behaviors. Tharp and Wetzel (1767), for example, found that clients' problems were successFully modified 7% of the time when patients simply collected baseline data. Other investigators employing selfmonitoring techniques have attained success in reducing the number of cigarettes smoked ( McFall, 1770; McFall & Harnmen, 177 1 ), improving academic grades (Johnson & White, 1971) and studying (Broden, Hall, & Mitts, 1971), eliminating auditory hallucinations (Rutner & Bugle, 1969), alleviating insomnia (Jason, in press), decreasing face touching (Lipinski & Nelson, 1974), changing rates of taUting (Gottman & McFall, 1772), eliminating repetitive scratching, fingernail biting, and inappropriate hand raising in a classroom (Maletdcy, 1974). These findings suggest self-monitoring can produce positive changes in a diverse group of behaviors. Most of the above studies have only assessed the short-term effectiveness of self-monitoring. Furthermore, the impact of such behavioral techniques on nontargeted areas of patient's functioning have rarely been evaluated. The present study investigated (1) the long-term efficacy of self-monitoring procedures and ( 2 ) the effects self-monitoring exerted on areas of functioning not specified for treatment. STUDY I
Method
The patient, a 23-yr.-old college student, seen in therapy, complained OF an unwanted compulsive behavior (nose squeezing). For the past 12 yr., he had frequently alleviated an unpleasant itching sensation in his nose by squeezing his nose for about 1 sec. The patient desired to reduce the frequency of 'Requests for reprints should be sent to Leonard Jason, Psychology Department, De Paul University, Chicago, Ill. 60614.
236
L. A. JASON
the compulsive behavior because nose squeezing often made his nose sore and painful, and he was occasionally embarrassed when others saw him squeezing his nose. During the first session, the patient was asked to record each time he squeezed his nose. H e was told this was a normal procedure for obtaining accurate information as to the severity of his problem. At that session, no positive expectations concerning the efficacy of self-monitoring were communicated to the patient.
Results During the first day of self-monitoring, the patient recorded 33 episodes of squeezing his nose. The first month, he squeezed his nose an average of 15.5 times daily; the second month his daily average decreased to 5.2, and the following 20 mo. he averaged .8 daily nose-squeezing episodes. Following the end of the 22-mo. period, the patient stopped self-monitoring. H e reported that nose-squeezing episodes did not increase over the next 4 mo. During the first day of self-monitoring, the patient reported that when he felt an unpleasant itching feeling in his nose, without thinking, he moved his hand to his nose and squeezed it, thereby alleviating the itching. With the onset of self-monitoring, when the unpleasant feeling occurred in his nose, the patient began giving himself instructions to resist squeezing his nose, e.g., "Don't touch your nose, the itching feeling will soon go away." When the patient resisted squeezing his nose, he was rewarded by not having to take out a pencil and record the event (a task which was perceived as aversive) and by self-reinforcement, e.g., "I was able to resist again." In a matter of days, the patient began reducing the frequency of nose squeezing behaviors. Therefore, during the first week of self-recording, the patient very quickly recognized the potential therapeutic benefits of self-monitoring.
s m y I1 Method While the first experiment was being conducted, the patient expressed an interest in reducing daydreaming episodes, e.g., playing baseball, walking in a forest, etc., which occurred during studying. These episodes typically lasted from 2 to 20 sec. While the patient was obtaining excellent grades in courses, he still felt studying would be less time consuming and more productive if daydreaming episodes were reduced. The patient was asked to record daydreaming episodes which occurred during approximately four hours of daily studying. Episodes were recorded by making a pencil mark on a piece of paper for each daydream. Given the success of self-monitoring in reducing nose squeezing behaviors, the patient expected decreases in daydreaming episodes following onset of self-monitoring.
SELF-MONITORING NOSE SQUEEZING AND DAYDREAMING
237
Results Daydreaming episodes were recorded for 39 days. During the first day, 52 daydreaming episodes were recorded, whereas no episodes were noted during the 37th day. The patient gradually began recognizing stimuli signalling the onset of a daydream, i.e., eyes beginning to drift from study materials. Daydreaming episodes were eventually eliminated by realigning his eyes with the reading materials when his eyes began to drift. The patient mentioned, however, that constant effort and vigilance were required to keep his eyes focused on study materials. On the 38th and 39th days, uncomfortable stomach pains were experienced, which the patient attributed to tension built up during his efforts to prevent daydreaming. The second study was then terminated. The patient reported that abdominal pains disappeared a day after the study ended.
Drscuss~o~ The present study indicated that self-monitoring techniques modified a patient's unwanted behaviors. Positive behavioral changes in the first study were maintained for over 2 yr. In both studies, self-recordings followed the unwanted responses and the patient gradually learned to identify preparatory stimuli preceding onset of the undesirable behaviors. Recognition of these cues interrupted the ongoing chain of behavior which typically terminated in an undesirable response and provided the opportunity for substituting an incompatible behavioral pattern. Positive elements of this incompatible behavioral chain included self-reward for not indulging in the unwanted behavior and relief generated from avoiding the bothersome chore of recording the event. A serious shortcoming in the present study was the absence of reliability estimates. Several investigators have claimed that data accrued from self-monitoring may often be unreliable (Broden, Hall, & Mitts, 1971; Lipinski & Nelson, 1974; Simkins, 1971) and thus it would be methodologically advantageous to have independent observers also rate target behaviors. However, even if self-monitoring was highly unreliable, the fact that target behaviors were appreciably altered lends credibility to the efficacy and importance of self-monitoring techniques (Nelson & McReynolds, 1771). When self-monitoring daydreaming episodes, unforeseen complications forced the termination of the study. Conceivably, other behavioral strategies might have successfully overcome this obstacle, i.e., more graduated reductions in daydreaming episodes, self-monitoring for only 1 hr. daily, etc. Still, it is of importance for behaviorists to report adverse (Meyer & Crisp, 1966; Balson, 1973) and positive (Mahoney, Kazdin, & Lesswing, 1974) reactions of behavioral interventions on nontargeted and targeted areas of functioning. The present study's contribution resides in the demonstration of both an unsuccessful and a successful application of a behavioral technique (self-monitoring) with a patient's unwanted behaviors.
238
L. A. JASON REFERENCES
BALSON,P. M. Encopresis: a case with symptom substitution. Behavior Therapy, 1973, 4, 134-136. BRODm, M., HALL, R. U., & MITTS, B. The effect of self-recording on the classroom behavior of two eighth-grade students. Jownal of Applied Behavior Analysis, 1971, 4, 191-199. GOITMAN, J. M., & MCFALL,R. M. Self-monitoring effects in a program for potential high school dropouts: a time-series analysis. Iownal of Consulting and Clinical Psychology, 1972, 39, 273-281. JASON,L. Rapid improvement in insomnia following self-monitoring. Behavior Therapy and Experimental Psychiatry, in press. JOHNSON,S. M., & WHITE, G. Self-observation as an agent of behavioral change. Behavior Therapy, 1971, 2, 488-497. LIPINSKI,D., & NELSON, R. The reactivity and unreliability of self-recording. Journal of Consulting rrnd Clinical Psychology, 1974, 42, 118-123. MAHONEY,M. J., KAZDIN,A. E., & LESSWING,N. J. Behavior modification: delusion or deliverance? In C. M. Franks & G. T. Wilson (Eds.), Annual review of behavior therapy, theory and practice. New York: Bmnner/Mazel, 1974. Pp. 11-40. MALETZKY,R. M. Behavior recording as treatment: a brief note. Behavior Therapy, 1974, 5, 107-111. MCFALL, R. M. Effects of self-monitoring on normal smoking behavior. Journal o f Consrrlting and Clinical Psychology, 1970, 35, 135-142. MCFALL,R. M., & HAMMEN,C. L. Motivation, structure and self-monitoring: role of nons ecific factors in smoking reduction. Journal of Consulting and Clinical Psyc ology, 1971, 37, 80-86. MEYER,V., & CRISP, A. H. Some problems in behavior therapy. British Jorcmal oj Psychidry, 1966, 112, 367-381. NELSEN,C. M., & MCREYNOLDS, W. T. Self-recording and control of behavior: a reply to Simkins. Behavior T h m p y , 1971, 2, 594-597. RUTNER,I. T., & BUGLE,C. An ex rimental rocedure for the modification of sychotic l 1969, 33, 651-$53. behavior. Journal o f ConsuEneng and ~ i n i c a Psychology, SIMKINS,L. The reliability of self-recorded behavior. Behavior Thempy, 1971, 2, 83-87. THARP, R., & WETZEL, R. Behavior modification i n the natural environment. New York: Academic Press, 1969.
!
Accepted December 3, 1975.
SELF-MONITORING IN THE TREATMENT OF NOSE SQUEEZING AND DAYDREAMING LEONARD A. JASON' De Paul University Stmrnma~y.-Self-monitoring was successfully used in modifying a patient's undesirable behaviors. The initial unwanted behavior, nose squeezing, was appreciably decreased over a 2-mo. period and gains were maintained for over 2 yr. While self-monitoring also reduced a second disruptive behavior, daydreaming while studying, the onset of abdominal pains forced che termination of this study. The present study, therefore, demonstrated a successful and unsuccessful application of self-monitoring.
Several investigators have begun studying the effectiveness of self-monitoring in reducing problem behaviors. Tharp and Wetzel (1767), for example, found that clients' problems were successFully modified 7% of the time when patients simply collected baseline data. Other investigators employing selfmonitoring techniques have attained success in reducing the number of cigarettes smoked ( McFall, 1770; McFall & Harnmen, 177 1 ), improving academic grades (Johnson & White, 1971) and studying (Broden, Hall, & Mitts, 1971), eliminating auditory hallucinations (Rutner & Bugle, 1969), alleviating insomnia (Jason, in press), decreasing face touching (Lipinski & Nelson, 1974), changing rates of taUting (Gottman & McFall, 1772), eliminating repetitive scratching, fingernail biting, and inappropriate hand raising in a classroom (Maletdcy, 1974). These findings suggest self-monitoring can produce positive changes in a diverse group of behaviors. Most of the above studies have only assessed the short-term effectiveness of self-monitoring. Furthermore, the impact of such behavioral techniques on nontargeted areas of patient's functioning have rarely been evaluated. The present study investigated (1) the long-term efficacy of self-monitoring procedures and ( 2 ) the effects self-monitoring exerted on areas of functioning not specified for treatment. STUDY I
Method
The patient, a 23-yr.-old college student, seen in therapy, complained OF an unwanted compulsive behavior (nose squeezing). For the past 12 yr., he had frequently alleviated an unpleasant itching sensation in his nose by squeezing his nose for about 1 sec. The patient desired to reduce the frequency of 'Requests for reprints should be sent to Leonard Jason, Psychology Department, De Paul University, Chicago, Ill. 60614.
236
L. A. JASON
the compulsive behavior because nose squeezing often made his nose sore and painful, and he was occasionally embarrassed when others saw him squeezing his nose. During the first session, the patient was asked to record each time he squeezed his nose. H e was told this was a normal procedure for obtaining accurate information as to the severity of his problem. At that session, no positive expectations concerning the efficacy of self-monitoring were communicated to the patient.
Results During the first day of self-monitoring, the patient recorded 33 episodes of squeezing his nose. The first month, he squeezed his nose an average of 15.5 times daily; the second month his daily average decreased to 5.2, and the following 20 mo. he averaged .8 daily nose-squeezing episodes. Following the end of the 22-mo. period, the patient stopped self-monitoring. H e reported that nose-squeezing episodes did not increase over the next 4 mo. During the first day of self-monitoring, the patient reported that when he felt an unpleasant itching feeling in his nose, without thinking, he moved his hand to his nose and squeezed it, thereby alleviating the itching. With the onset of self-monitoring, when the unpleasant feeling occurred in his nose, the patient began giving himself instructions to resist squeezing his nose, e.g., "Don't touch your nose, the itching feeling will soon go away." When the patient resisted squeezing his nose, he was rewarded by not having to take out a pencil and record the event (a task which was perceived as aversive) and by self-reinforcement, e.g., "I was able to resist again." In a matter of days, the patient began reducing the frequency of nose squeezing behaviors. Therefore, during the first week of self-recording, the patient very quickly recognized the potential therapeutic benefits of self-monitoring.
s m y I1 Method While the first experiment was being conducted, the patient expressed an interest in reducing daydreaming episodes, e.g., playing baseball, walking in a forest, etc., which occurred during studying. These episodes typically lasted from 2 to 20 sec. While the patient was obtaining excellent grades in courses, he still felt studying would be less time consuming and more productive if daydreaming episodes were reduced. The patient was asked to record daydreaming episodes which occurred during approximately four hours of daily studying. Episodes were recorded by making a pencil mark on a piece of paper for each daydream. Given the success of self-monitoring in reducing nose squeezing behaviors, the patient expected decreases in daydreaming episodes following onset of self-monitoring.
SELF-MONITORING NOSE SQUEEZING AND DAYDREAMING
237
Results Daydreaming episodes were recorded for 39 days. During the first day, 52 daydreaming episodes were recorded, whereas no episodes were noted during the 37th day. The patient gradually began recognizing stimuli signalling the onset of a daydream, i.e., eyes beginning to drift from study materials. Daydreaming episodes were eventually eliminated by realigning his eyes with the reading materials when his eyes began to drift. The patient mentioned, however, that constant effort and vigilance were required to keep his eyes focused on study materials. On the 38th and 39th days, uncomfortable stomach pains were experienced, which the patient attributed to tension built up during his efforts to prevent daydreaming. The second study was then terminated. The patient reported that abdominal pains disappeared a day after the study ended.
Drscuss~o~ The present study indicated that self-monitoring techniques modified a patient's unwanted behaviors. Positive behavioral changes in the first study were maintained for over 2 yr. In both studies, self-recordings followed the unwanted responses and the patient gradually learned to identify preparatory stimuli preceding onset of the undesirable behaviors. Recognition of these cues interrupted the ongoing chain of behavior which typically terminated in an undesirable response and provided the opportunity for substituting an incompatible behavioral pattern. Positive elements of this incompatible behavioral chain included self-reward for not indulging in the unwanted behavior and relief generated from avoiding the bothersome chore of recording the event. A serious shortcoming in the present study was the absence of reliability estimates. Several investigators have claimed that data accrued from self-monitoring may often be unreliable (Broden, Hall, & Mitts, 1971; Lipinski & Nelson, 1974; Simkins, 1971) and thus it would be methodologically advantageous to have independent observers also rate target behaviors. However, even if self-monitoring was highly unreliable, the fact that target behaviors were appreciably altered lends credibility to the efficacy and importance of self-monitoring techniques (Nelson & McReynolds, 1771). When self-monitoring daydreaming episodes, unforeseen complications forced the termination of the study. Conceivably, other behavioral strategies might have successfully overcome this obstacle, i.e., more graduated reductions in daydreaming episodes, self-monitoring for only 1 hr. daily, etc. Still, it is of importance for behaviorists to report adverse (Meyer & Crisp, 1966; Balson, 1973) and positive (Mahoney, Kazdin, & Lesswing, 1974) reactions of behavioral interventions on nontargeted and targeted areas of functioning. The present study's contribution resides in the demonstration of both an unsuccessful and a successful application of a behavioral technique (self-monitoring) with a patient's unwanted behaviors.
238
L. A. JASON REFERENCES
BALSON,P. M. Encopresis: a case with symptom substitution. Behavior Therapy, 1973, 4, 134-136. BRODm, M., HALL, R. U., & MITTS, B. The effect of self-recording on the classroom behavior of two eighth-grade students. Jownal of Applied Behavior Analysis, 1971, 4, 191-199. GOITMAN, J. M., & MCFALL,R. M. Self-monitoring effects in a program for potential high school dropouts: a time-series analysis. Iownal of Consulting and Clinical Psychology, 1972, 39, 273-281. JASON,L. Rapid improvement in insomnia following self-monitoring. Behavior Therapy and Experimental Psychiatry, in press. JOHNSON,S. M., & WHITE, G. Self-observation as an agent of behavioral change. Behavior Therapy, 1971, 2, 488-497. LIPINSKI,D., & NELSON, R. The reactivity and unreliability of self-recording. Journal of Consulting rrnd Clinical Psychology, 1974, 42, 118-123. MAHONEY,M. J., KAZDIN,A. E., & LESSWING,N. J. Behavior modification: delusion or deliverance? In C. M. Franks & G. T. Wilson (Eds.), Annual review of behavior therapy, theory and practice. New York: Bmnner/Mazel, 1974. Pp. 11-40. MALETZKY,R. M. Behavior recording as treatment: a brief note. Behavior Therapy, 1974, 5, 107-111. MCFALL, R. M. Effects of self-monitoring on normal smoking behavior. Journal o f Consrrlting and Clinical Psychology, 1970, 35, 135-142. MCFALL,R. M., & HAMMEN,C. L. Motivation, structure and self-monitoring: role of nons ecific factors in smoking reduction. Journal of Consulting and Clinical Psyc ology, 1971, 37, 80-86. MEYER,V., & CRISP, A. H. Some problems in behavior therapy. British Jorcmal oj Psychidry, 1966, 112, 367-381. NELSEN,C. M., & MCREYNOLDS, W. T. Self-recording and control of behavior: a reply to Simkins. Behavior T h m p y , 1971, 2, 594-597. RUTNER,I. T., & BUGLE,C. An ex rimental rocedure for the modification of sychotic l 1969, 33, 651-$53. behavior. Journal o f ConsuEneng and ~ i n i c a Psychology, SIMKINS,L. The reliability of self-recorded behavior. Behavior Thempy, 1971, 2, 83-87. THARP, R., & WETZEL, R. Behavior modification i n the natural environment. New York: Academic Press, 1969.
!
Accepted December 3, 1975.
