International Journal of Group Psychotherapy
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
The Behavioral Approach to Group Therapy Francis C. Harris To cite this article: Francis C. Harris (1979) The Behavioral Approach to Group Therapy, International Journal of Group Psychotherapy, 29:4, 453-469, DOI: 10.1080/00207284.1979.11492013 To link to this article: https://doi.org/10.1080/00207284.1979.11492013
Published online: 29 Oct 2015.
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The Behavioral Approach to Group Therapy
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F R A N C IS C . H A R R I S , M .S.
H
I ST O RI C ALL Y , ~IOST G RO UP TREAT~IENT PRO CED URES have been based on t he th eori es a nd me t hods of traditional psych od yn amic psychology (Kap la n a nd Sadock, 197 1). W ithin the la st fifteen yea rs, however, gro u p treatme nt strateg ies ba sed on successful a pp lica tion of socia l learning theory to individual cas es hav e st arted to emerge. T hese be hav iora l ap p roaches ma y be defined as " procedu res t ha t uti lize systematic environme nta l co ntinge ncies to a lter di rectl y the subject's rea ctio ns to situa tions " (Ullma n a nd Kr asner, 1975 ). Beha vioral tec h niq ues have be en app lied to th e group treatment of probl em s as specific as st utte ring (Ego lf et a l., 1971 ) and sna ke phobia (Leon, 1965; Lit vak , 1969 ; Ritter, 1968) a nd as ne b ulous a nd difficul t to de fine operationa lly as depression (Killia n, 1971 ; Lewinsohn et al. , 1970). The use of client groups has pe rmitted beh a vior therapists a nd research er s to use modeling, vica rious learning, gro up discu ssion s, be havior reh earsal , a nd other co ncep ts a nd p roce d ures no t ea sily a pp lied to indi vidu al ther apy sit ua tions (Ka pla n a nd Sadock, 1971 ). The purpose of th e presen t work is to survey th e various ways in which be hav ior al procedures have bee n used in gr oup th erap y.
PH OBIC BEH AVI OR Ph obic behavior , c c • • • inten se fea r of a n object or sit ua tion which the pa tient consciously reali zes is no real threat to him " Mr. H a rris is in th e Psychology Intern ship Pr ogra m a t Camarillo St a te H ospita l, Camarillo , Calif.
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(D S:-' l II , 1968. p. 40 ), is the ge ne ra l cla ss of be havior th at ha s mos t often been dealt with by mea ns of b ehavi o ra l group p roce dures . La zaru s (1 961 ) t rea te d 18 middle-class ad ults de mo ns t ra ti ng a va riet y of p hobi c beha viors, inclu d in g a crop hob ia. cla ust ro p hob ia , and impotence . in small gro ups by sys te mat ic des ensi tiza tion procedu re s ba sed o n Wolp es ( 1958 ) principl e of rec ip ro ca l inh ibi t ion . Subjects with sim ila r phobi c be haviors wer e first tau ght to rel ax a nd then in stru cted to visual ize gra d ua lly mo re t hr ea tening scenes whi le remainin g re laxed. W hi le the th er api st ga ve ge nera l instruc tions , ind ivid ua lized hier archi ca l item s we re presented to eac h su bject via cards descri b ing sce nes speci fic to h is/h er p hobi c b ehavio r. Aft er a me an of 20 treatment sess io ns. 13 of t he 18 subjects treated b y sys temat ic desen sitiza t ion wer e a b le to pa ss a behaviora l po st -t est in whi ch eac h had to ap p roac h a nd d eal with hi s/ h er previously phobic sti m ulus . A mat ch ed gr ou p of 17 su bj ects t reat ed by t rad itiona l grou p p sychotherap y yie ld ed two recov eries after a mean of 22 sess ions. Th e remaining 15 su b jects were then treat ed using grou p system a t ic d esen sitiz ation me thod s a nd 10 succe ssfully completed th e beh avioral test in an a verage of 10 ad d itio na l sess ions. T est Anxiety
Paul a nd Shanno n ( 196 6 ) com pa red group desen si tization to individu al de sensit izati on and individu al in sigh t-oriented psychoth erapy using colleg e st u de nt subjects who indi cat ed ge nera lly hig h levels of aro us a l on severa l se lf-repor t a n xiety m easures . S ubje ct s ass igned to group de sensit izat ion were treated in groups of five. A lt ho ugh the subjects indica ted hi gh a rous a l in a va riety of sit uatio ns , t ho se in the de sen sitizatio n grou ps worked t h rough hi erarch ies spec ific to t est a n xiety . a problem the y al l repo rted . Subj ec ts rece iving individu ali zed systematic d esen sitization were g uided throu gh thei r hi erarchies , af te r bei ng tau gh t to rel ax , in a st a n da rd in d ivid ua l therapy m ann er . Subj ect s receivin g gro up d esensiti zation parti cipat ed in prese nsiti zati on di scussion s in wh ich t hey discussed t he const r uct io n of their test-an xiety h ierarch y. T he y a lso met a nd dis cu ssed the procedures a n d a ny po sit ive results or problems that ca me up du ring the trea tment per iod . Im p roveme nt for a ll subje cts who expe rie nce d desensiti zati on pr ocedures
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was significa ntl y greater on the self- re port m easures than tho se ex perienc ing indi vid ua l in sight-or iented t reat me nt. In a d dition, the dese ns it iza tion subjects ac hieved significa ntly gre a te r improvement in th eir g rade po int ave rages . The gra de point avera ge index is especia lly important since it is a me aningful outcome me asure. T he a uthors d iscu ssed th e likelihood of th e gro up dis cu ssions supple menting the t reat me nt proced ure by perm itt ing the subjects to in tera ct with people having simil ar probl ems. They a lso pointed out th e op po rtu nity for those exhib iti ng genera l soc ia l a nx iety to develop so me soc ia l skills in a str uc tu red sett ing . A two- year followup st udy (Pa ul, 1968 ) indicated m aintenan ce of the improved gra de -point a vera ges a nd self-repo rt in dices for the desen siti zation su bjects with no differen ce bet ween group a nd indi vidu al desensitiza tion. T est a nx iet y has co ntinue d to be a n a rea of co nce nt ration for researche rs inves tiga ting the effica cy of usin g gro up treatment methods to cha nge p ho bic be havior. Se vera l other in vesti gators (C ohe n, 1969 ; Kat ahn et al.. 1966 ; M cM anus, 1971 ; Su in n, 1968 ) ha ve co m b ined grou p di scu ssions with group desen siti zation proced u re s in th e treat m ent of test a nxiety . Ka tahn et a l. (1966) a nd Suinn ( 1968) used presen siti zati on gro u p me etings for gro up relax a tion , exp la na tion of dese ns itiza tion rational e, a nd gro u p discussion of poss ib le item s for inclu sion in each member 's indi vidu ali zed hiera rch y. Between the first di scu ssion and the first treatme nt sessio n a ll subjects constr uc ted thei r ow n hi erarchies. D uri ng dese nsit izati on traini ng t he th era p ist gave ge ne ral in structio ns whil e the subjects visu ali zed their own items. Group dis cussio ns of proced ures were held before ea ch th era py sess ion. The com bina tion of grou p dese nsit ization a n d di scu ssion produced sig nifica n tly imp ro ved self-report measures of a nxiety and gr adepoint avera ges. M cManu s ( 1971) taugh t su bje cts relax a ti on skills a nd th e ra tional e for de sen sit iza tion a n d ha d them cons t ruct th eir own hier a rchi es without gro up d iscu ssion. They wer e p ermitted to di scu ss st udy ha b its a nd their wo rr ies about taking exa m ina ti ons . T h is proced ure led to signifi can t improvement in th e grades of the t rea te d subject s. Since the rap ist s in gro up systemat ic desen sit izati on th erapy typ icall y present sta nda rdized inst ructions to the subj ect s with a
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rrurumum of ot he r d iscu ssion, th e use of a ud io ta pe d ins tr uc t io ns would seem to be ec onomica l a nd fea sibl e. Donner a nd G uerney (196 9 ) ass igne d 42 femal e students w ho had indica te d hi gh test a n xiety o n a self-report me a sure to receive a control procedure, gro u p sy ste ma t ic desensiti zati on wi th th e th era pi st present ing instruct io ns persona lly , or group desen sitiza tion in whic h the ins t ruc ti ons were presented by au d iotape . Both d ese nsit izat ion gro u ps ha d sig ni fica nt ly im proved gra de -poin t averages whil e the co nt rol gro up did not. The d iffere nce in grades of t he gro u p- a nd individual -d esensit izat ion grou ps a p p roa che d signi fica nce, with th e su bjects receivin g in div id ua l t reat ment ge tt ing bett er g ra des . A fivem on th follow-u p rep o rt (Donner, 1970 ) indicated m a in ten ance of the ga ins m ad e b y the treatment gro ups, with no d ifferenc e b etween grou p an d indi vidual desens itization . Sc issons a nd Njaa ( 1973) used a sim ila r gro u p d esign b ut emp loye d a u d iota pe d d esen sit izat io n ins t r uc tions for bot h indi vidu al a nd . gro up de sensi ti zat ion p roced ures . Both dese ns it izat io n treat ments were eq ua Hy effec tive , based o n a self-re po r t m ea sure, a nd sig nifica n tly be t te r th an th e no-trea tment co ntro l. The use of group sys tema t ic dese nsi tizat ion to re duce t he test a n xiety of elem entary sc hoo l child re n ha s also bee n in vest iga ted . Ba rb a sz ( 1973 ) used a gro up sys tematic desens itization proced ure to treat a gro up of fift h- a nd sixt h-gra de stude nts who d emon stra ted hi gh a ro usa l in a n a nalog ue tes t sit uat ion . The desensi ti za tion proced ure p roduced significant ly d ecrea sed a nx iety levels on the post-t est. Also not eworthy was t he s ignifica nt im p rovemen t in t he desensiti zat ion subjects ' performa nce o n a n int ell igen ce test. T he re is some evide nce that be havio ra l proced u res other t han sys te ma t ic d esen sitiz a tion m a y be used to eli minate tes t a n xiety . Alle n ( 1973) rep or ted t ha t gro u p beha vioral st ud y co unse ling al one or combined wit h rel a xati on tra in in g significantly imp roved t he gra d e point a vera ges of test- anxiou s college stu de nts. Dawley a nd W enrich ( 1973) attempted to redu ce t he test a nxiety of st ude n ts b y ha vin g them imagi ne the m ost t hreateni ng items of a test a nx iet y heirarch y whi le re m a ining rela xed . This impl osive techni qu e wa s no mo re effective than a p lacebo treatmen t. The authors sugges ted t hat t he im p lo sion wa s u ns uccessful du e to proble ms in the hi er archy const r uc t io n .
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Speech Anxiety The meth ods of sys tematic desen siti zati on have been a pp lied to t he gr oup tre atmen t of publ ic s peaking an xiet y. Mei chenbaum et a l. ( 1971) a ssig ned 53 newspaper- ad respondents to either grou p de sen siti za tion , gro up in sigh t-ori en ted psychotherapy, group dese n sitiza tion plus in sight-oriented psychother apy , or co nt ro l conditio ns. Ba sed on sel f-rep o rt q uest ionna ires a nd beh a vior al o bserva tions of spe ech es, both desen siti zat ion gro ups showe d signifi cant imp ro veme nt , with the most improvement demonstrated by th e gro up experienc ing desen siti zation plus insi ght-oriented psychot herap y. Both gro u ps of de sen sit izati on su bj ects en gag ed in dis cussions rega rdin g problems and hierarch y co nstr uc tion . Kond as ( 1967) investiga ted th e speec h a nx iet y of 23 tea ch er-referred , testa nxious elementa ry school child ren usin g a n expe rim enta l desi gn that co nt rolled for th e effects of relax ation training . One grou p serve d as a con t rol while a nother wa s only ta ug ht rela xation skills. T he th ir d g rou p went throu gh a spee ch-a n xiety hierarch y with no re lax a tio n tr aining an d the fou rth g ro up exp erience d the entire g ro up systema tic desensitizati on procedure. S ubj ec ts receiving the full desen siti za tion tr eatm en t were the o nly ones demonstrating sign ifica nt re d uc tion of the ir speech a n xiety as measured by a selfreport index. Snake Phobia Ph ob ic b eh avior in relati on to sn ak es has been a not her area in wh ich be ha vioral gro up tre atment meth od s have b een used . Lit vak (1969) co m pa re d the effectiveness of syste ma tic desen sitization to a contac t dese nsit izati on pro ced u re. C ollege st udent volunt eers who d id not get a minimum score o n a test in which they were ask ed to a pp roac h a nd handle a live sna ke were ass igne d to one of t hree grou ps . The system atic desen siti zat ion grou p was trained to rel ax a nd wa s in st ru ct ed throu gh a pre det erm ine d hierarchy a p plica b le to sna ke avoida nce. Subjects in the con tact desen siti zation grou p observ ed t he experim en ter a pproa ch a n d handle a sna ke. The expe r ime nte r encoura ged memb ers of the group to a p p roa ch grad ua lly a nd touc h th e sna ke. Onl y on e training session was given to b oth desensitization gro ups . The third gro up se rved as a co ntro l. O n ly t he co ntac t d esen siti zati on led to sign ifica nt imp rovement o n
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the post-test. C o ntac t desensitization ha s also been used to modify child ren's a void a nce of sna kes (R itt er, 1968 ). Forty- four bo ys a nd girls from 5 to 11 yea rs of age who did not a ttai n a minimum score on a in-vivo behavioral s na ke a voida nc e measure were assig ned to either a vicarious-learning group, a co n tac t desensiti zation grou p, or a co nt rol group . Those in the vicarious-l earning group watched as five other chi ldren of co m pa rab le ages a p p roac hed a nd handled a snake. Thos e child ren in the con tac t des ensitization group were enco u raged b y th e expe rim en ter gra d ua lly to come closer to th e snake . Both treatment group s improved significantl y on th e posttest , with the con tac t desensitization group improving mo st. Leon ( 196 5) gu id ed gro u ps of colleg e st ude nts throu gh de sensiti zat ion hierarchies , su p plem en t ing the verbal cues with eit he r pictures of s na kes or printed descriptions. Th e subj ec ts exposed to th e pictures improved most on th e post-test.
Opposite Sex Phobia One study (D ua , 1972 ) report ed the use of group d esensitization when a member of t he op pos ite se x wa s th e phobi c st imu lus for a group of colleg e st u den ts. Two sel f-report m easures and a n a na logu e test in which behavior toward a n opposit e-sex con fede ra te wa s rated serve d a s the dep endent mea sures. Three gro u ps of su bj ec ts ea ch re ceived sess io ns of group sy stematic d esensit ization . One grou p experienced a ll ses sio ns within a 12-hou r period . The other two groups were trained over 5- and 15-day periods . All gro u ps improved si gnificantl y on a ll measures, with the 12-hour a nd S-d ay procedures being more effec t ive t ha n th e IS-da y procedure. SOCIAL BEHAVIOR Behavioral gro u p therapy a pp roac he s ha ve been u sed to sha pe spec ific soci al behaviors in child re n (C leme nt a nd Milne, 1967 ; Graziano , 1970 ), in stitutional ized a d ults (Alu m ba ug h, 1971 ), a nd indep endentl y fun ctioning a d u lts (G a las si et a l., 1974 ; Jo anning, 1974 ). Cl ement a nd Milne ( 1967) worked with ele ven third- gr aders who had be en referred by t he ir teac he rs as shy a nd withdrawn by assi gning them to one of two tr eatment group s or a no-treatment con tro l grou p . In one trea tme nt grou p the leader prompt ed th e
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ch ild re n to in te rac t with one a not he r a n d pro vide d verbal p raise a nd tokens, whic h cou ld la ter be traded for b ac k-u p re inforce rs, wh enever soci a l inte ra ctio ns occurr ed . The a d u lt lead er of th e other tre atme nt gro up gave pro m pts a nd verba l reinforcers, b ut no token s, for socia l be hav ior. T he control group met regul arl y but no rein for cers were provided . Direct observa tio ns indica ted sig n ifica n tly increased verbal int er acti on s for both treatment grou ps , wit h mo re im p roveme nt for the gro up receivin g token s. R ep or ts from teac hers a nd parent s indica ted ge ne ral improvement in the soc ia l behavior of t he child ren in the trea tment gro ups. G ra zia no ( 1970 ) re ported a four- yea r project in which pro m pting , food rein fo rcers , a n d prai se were used to teach four " reg ressed p sycho tic" ch ild re n to increa se t he ir socia l int era ctions in play a n d mea l situa tions. As with most soc ia l skill deficit s th e lack of a sserti veness see m s idea lly su ited to trea tment in a group sit uat ion. In a not her st udy (G a la ssi et a l., 1974 ) un as serti ve co llege stude nts parti cipat ed in eight grou p trai ning ses sions . Du rin g the first third of eac h sess ion g roup di scu ssion s of a ssertiveness were led b y two t herapi sts. Afte r th e disc uss ions vide ota pes of mod els exhib iting a pp ro p riate asse rtive beha vior were viewe d . For the rema inder of th e sess io ns gro up memb ers pa rti cipa ted in dya dic role-pl aying sit uations with feed bac k o n t he ir asse rt iveness p rovided by th e leaders and other gro up memb ers. R esult s of a na logu e tests give n to so me of th e sub jects ind ica ted sig nifica nt improvement du ring trai ning for t he treat ed su bj ects but not for th e no- treatment co nt rol grou p. Joanning (1974 ) prov ide d six sessio ns of t radi tio na l p sych otherap eut ic grou p treat ment to a group of un assertive volunteer subj ects a nd six sessio ns of beh a vior re hea rsa l trainin g to a simila r gro up . Subjects ex peri en cing beh avior reh earsa l t rai n ing we re ta ug ht spe cific asse rtive beh av iors . Asse rtive beh a vior increased and a nxiety decreased for t he be havio r reh ea rsal group in co m pa rison to t he trad itional gr oup . SM O K ING A ND OVE REAT ING Beh a vioral group procedures ha ve bee n used to cont rol excessive sm oking (O ber, 1968 ; Wh itm an , 1972 ) a nd eating (Ba lch a n d
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R oss, 1974 ; Penick et a I., 1971 ; St ua rt a nd D a vis, 1972 ; W ollershei m , 1970) . O ber (1968 ) assigne d college st ude nt smo ke rs to eit her a self-control treatment group in which they met to di scu ss be hav iora l princip les relating to self-cont ro l of smo king a nd we re given a m anual detailin g tho se p rinc ip les or to a n ave rsio n-t he ra py gro up in which subjects di scu ssed a nd received a man ual descri b in g self-a d m iniste re d punishmen t a nd were in structed to shock the mselves wit h a port a b le shoc ki ng device whe never t hey wa nte d to smo ke . The remaining subjects were as signed to a transa cti on al ana lysis gro up in whic h t hey disc uss ed the person al co nflicts a ssoc iated with smoking . Based on self-report measures of smoking behavior, a ll three treatmen ts were significa nt ly effective. T he a bs ence of a contro l gro up mak es t hese result s di ffi cult to inte rp ret. Wh itman ( 1972) contro lled for p lace bo effects by us ing a gro up of smo ke rs who did not ap p ly for tr ea tment as a cont ro l group . Expe r ime ntal subjects were p la ced in eit he r ind ividual or gro up ave rsive -t hera py groups. In the ind ivid ua l treatment subjects wer e see n a lone a nd inst r ucte d to p lace a tab let in t heir mouths prior to smo king . T he tabl et ca use d a fou l ta ste a moment lat er wh en th e subjec t was smo king. The gro up aversive-t he ra py subjects received the sa me instru ctions in a grou p co ntext . In a dd itio n, they att ended wee kly meetings at w hic h t hey d isc usse d the procedures a nd wh ether or not they u sed t he ta blets a pp ropria te ly. Group member s urged t hose not making pro per use of th e ta blets to do so a nd prai sed th ose memb ers who wer e usin g th em cor rec tly. The subjects ' self report da ta indicated t hat those ex posed to the gro u p di scu ssion s used more tablet s a pp ro pr iate ly a nd smoked less t ha n th e subjects in ind ividu al t rea t ment. In a n in vestiga tion of weight loss, W ollersh eim (1970) pla ced overweight undergr aduat e studen ts in a no-treatment co ntrol group or o ne of three group trea tment gro ups . In on e tr eatment gro up , subjects we re ta ug h t t he principle s of sys te ma tic desen siti zation a nd to ld to rel a x w he never they we re hungry. In a dd itio n, they learned to recogn ize the co nditions under wh ich th ey were most likely to ea t an d t hey recorded everything th ey a te . Re gul ar meetings were held to dis cu ss progress and probl ems. Ano t he r gro up was ta ug ht how to rela x but not inst ruc te d to do so wh en
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h u ngr y. T hey also had meetings but only d iscu ssed weight loss in ge nera l terms. The other trea tm en t gro up was not ta ug ht to relax b ut did have weekly gro up meetings. The gr oup taught to selfmo nitor their eat in g beh a vior a nd rel ax whe n hun gr y ac hieved significan tly grea te r weight loss than a ny of the oth er groups a nd indica ted maint enance of the reduction a t a n eight week follow-up . Ba lch a nd Ross (197 4) used sma ll gro u ps to teach over we ight subjects to manage their ea tin g beh avior b y usin g th e recording, beh avior a na lytic, and conti nge nc y managem ent procedures di scussed by Stua rt a nd Da vis ( 1972). An interesting co ntinge ncy was pla ced on weight co ntro l by Peni ck et aL (1971 ) wh en they in structed a gro up in be ha viora l principles as they related to ea ting be havior a nd had them rewa rd th em selves for good weight management wit h token s. The token s represented amou nts of mon ey th e subject could la ter d onate to a favorite cha rity . This procedure led to significa nt weigh t reduct ion whil e a trad itiona l gro up psychotherapy treatment did not with a sim ilar gro up of subjec ts.
DEVIA NT C H ILD BEHAVIOR Research in applying behavioral principl es to the modification of deviant chi ld be hav ior has invo lved invest igations of gro up methods to teach parents to become effective contingency mana ger s (Rose , 1969 ; Wiltz, 1970) a nd techniques used with groups of p robl em children in scho ols (Ferinden, 1971; Mi ra n et al ., 1974 ) a nd in stitutions (R ose et al ., 1970 ). Rose (1969) used a group sett ing to te ach parents of problem beha vior children to define p roblem behaviors operationall y, identify their antecedents a nd conseq uenc es, delineate specific objectives for approp riate behaviors, a nd manage the co nsequenc es of their child ren 's behavior . The a utho r reported th e usefulness of having group members publicl y com m it themselves to performing homework as signments rel a ted to th e group tra in ing experience. U nfortu nately, no data reflect in g the behavior of th e child ren were presented, although a nec dot al rep orts of some of th e parents seemed favorable . Wiltz (1970) also tau ght a group of pare nts social learning principles
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th ey co u ld a p p ly to th eir own ch ild re n 's p ro b lem beh aviors. This study is nota b le in t hat it emp loyed di rect observatio ns of chi ld b ehavior in th e natural enviro nme nt as t he maj or dep enden t va ria b le. C h ild re n wh o parti cip at ed in the gro u p t ra ining a nd di scu ssions exhib ite d significa nt ly im p rove d beh a vior while co nt ro l g ro up ch ildre n did not. Ferinden (1 971 ) had four aggress ive eleven-yea r old boys se lfrecord in stances of ba d behavior. Once eve ry wee k each boy acte d o ut hi s bad beh a viors in a class roo m wit h hi s class mates present. They a ll dis cussed a lte rna tive beha vior s that co uld ha ve been em itte d . Then t he ta rge t chi ld re hea rsed the a pprop riate be havior a nd was prai sed by t he ot her chi ldre n. Da ta we re p rese nted whi ch in di ca ted imp ro veme nt for a ll four boys . Althou gh thi s st udy wa s not well co nt ro lle d, it illu st ra tes goo d use of a grou p p rocess to modify ch ild be havio r . In t he M ir an et a l. (19 74 ) st u dy, twenty ge ne ra l probl em beh a vior 13- and 14-year-ol d bo ys parti cip at ed in sma ll gro up t he ra py sessions in whi ch th e obj ecti ve wa s di scu ssion of ways to em it m ore ap pro p riate be havio r at schoo l. T en of the boys we re ra ndom ly se lected to be treatmen t su bjec ts a nd new th er ap y gro u ps were formed . Th e treatment grou p boys co ntin ue d havin g grou p t he rapy sessio ns but in a d d itio n th ey were give n a n oppo rt u nity to ea rn tok en s for a p pro p ria te be hav ior outs ide th era py sessions. These tok en s co u ld be sa ved a n d traded for permi ssion to tak e va rio us field tri p s. Whil e th e tok en co n d it ion wa s in effect , teache rs' blind ra ti ngs of sc hoo l be havior im proved for th e tok en gro u p b ut not the co nt ro l boys . The number of school sus pe nsio ns, p res u ma bly a n in dex of es pecia lly bad behavior, decrea sed for th e token gro u p . Rep ort s of the t he ra py gro u p leader s indica ted mor e on ta sk beh a vio r for the tok en gro u p as th ey d iscussed ways they mi ght ea rn tok ens. This st udy inad vertentl y em ploye d a reversal desig n whe n t he funds used for the field t rips we re exhau sted . At t hat point, ge ne ra l sc ho ol be havior, sus pe ns io ns , an d in-t he ra py beh a vior of th e tok en grou p returned to th eir pretrea tment unsat isfactory levels. with no c ha nges in the indices of t he co nt ro l gro up . R ose et al. ( 1970 ) gave tok en s, w hich co uld be exc ha nge d for a wide vari et y of b ack -up reinforcer s, to juvenile offenders for participating in gro up the rapy sessio ns in whi ch t hey reh earsed a pprop ria te be hav iors and receive d feed back o n th eir performa nce.
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DEPRESS ION Lew ins ohn et al. (1970) in structed a group of depressed students to try to increase t he number of posi tive interactions th ey initiat ed o r received . They were pe riodi call y given verba l and graphic feedba ck on th eir perfo rmance. They were ab le to inc rea se a variety of social beh a vior s d uring the feed back co ndi tion . The primary em p has is of th e st udy was to prese nt a recording sys tem t hat could be used to re cord social intera ction during group therap y. K illian ( 197 1) investiga ted th e po ssibili ti es of ha vin g half th e members of a th erap y gro up be depress ed individual s a nd the o ther ha lf no t depressive. The not ion was to ha ve the nondepres sive gro up me mbers p rompt a nd rein force o utwa rd d irect ed social behavior a nd positiv e self- stat ements . The t rea t me nt was no t effective. The idea , how ever, see ms to merit furth er explora tio n , perhaps using clinica l ca ses ra th er th an college st ude nts as sub jects. SPEECH PATH OLOG '\, A time-ou t co ntingency has be en su ccessfull y em p loye d to re d uce t he st utte ring a nd incr ease th e a pp rop ria te speec h of ch ronic st utt ere rs in gr o up therapy (Egolf et a l., 1971 ). During treatmen t th e clie nts were eac h permitted to spea k for onl y as long as they did not st utt er. This procedu re incr eas ed the mean number of words sp oken correctly before a stutter and the a vera ge time elap sed be fo re a st utt er. Rep ea ted reversal s demonstrated the co nt rol of the cont ingency. Eisenmann ( 1965 ) used ve rba l rewards to sha pe the de sired orde r of spe a kers in gr oup th erap y. Krueger (197 1) demo nst ra te d t he effective ness of peer-me d ia te d verb a l reinfo rcers in sha p ing a nd maintai n ing th e on-tas k verbal behavior of del inquent a dolesce nts in gro up th erap y. P R O C ESS O BJECTIVES The in vesti gat ions dis cussed th us far ha ve described wa ys in which b eha viora l grou p t reatment techniques ha ve be en used to mo dify be hav iors ta rgeted as outc ome in d ices of improvem ent. Severa l ot her st ud ies (H a use rma n et al. , 1972 ; Liberma n , 1970 ,
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1971 ; Wi ggins an d Sa lzbe rg, 1966 ) are of primary import ance beca use they illu strate ways to a chieve within-th era py process objectives co m mo n to a va riety of t reatment procedures. \Vi ggins a nd Sa lz berg ( 1966 ) presented an a vers ive nois e continge nt upon silence a nd speec h to th e t hera pist rat her t ha n a no the r gro up memb er to increase int er acti on s a mo ng cl ients . Liberm an (19 70 ) used therapist-med iated verba l prai se to increase ho stile com me nts to th e th erapi st as op pos ed to ot he r members of th e gro u p a nd a lso used therapist reinfor cem ent a nd prompting (L iberm a n, 1971 ) to in cre ase st at ement s indi cating solidarit y and cohesiven ess among gro up m embers. Rathu s (1972 ) described a grou p tra in ing pro gr am in wh ich sma ll grou ps of un a sserti ve undergr adu at e st ude nts we re as ke d to perform severa l discrete a ssertive b ehavior s in th e th erap y ses sions a nd a lso in their natural environ m ents . Group meetings dealt with presen tin g a be ha vio ra l ra tio na le for asse rt iveness , di scu ssing progress a nd problems , and b eha vior al reh earsal of ass ertive beh a vior s with feedb a ck provid ed b y other gro up members a nd t he leader. H auserman et a l. (1972) and Bardill (1972) used rever sal des ign s to demonstrat e the contro l of tok en reinforcement over verbal initiations made by beh avior-problem a dolesce nts in a gro u p the ra py situa tion set up to deal with a va riety of problems. Sted m a n et a l. (1 971 ) a lso used token s to in cr ease general appropriate beh avior in group therapy discussion. They exte nded the token program to include reward s for good academic grades. Neither schoolwork nor socia l behavior were origina l outcome objectives for the clients. O 'Donnell (19 72 ) cond uc ted weekl y group se ssions with chronic inpatient women during which specific behaviors d ire ct ed toward discharge were planned and discus sed. The residents performed some of th e behaviors and dis cu ssed them with the group in subseq uent se ssions. The author sug gested that the sessions facilitated the dis charges of some of th e group members but no data were presented to su p port this cont ention. In another study which used psychiatric patients a s su bj ec ts (T racey et aI. , 1974 ) token reinforcers were u sed to increase the positive statements of the grou p members regarding activities at the institution and other people. The procedure wa s effecti ve in in creasin g the statements
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du ring sessions and , mor e important , th e incr ease in positiv e statements gene ra lized to a n out-of-the ra py test setting. O lso n a nd Greenber g (1972) described a token program whi ch reinforce d process as well as outcome obj ectives in a n applied progra m in a res ide ntia l psych iatric facilit y. Po int s were a wa rded to members of a sma ll group for independent ly con duc ting a group meeti ng or indi viduall y atte nd ing a sche du led acti vity. Addi tional poin ts were given to group members for p reparin g report s a nd recom mendation s rega rding a group member. Further points were earned if th e instit utiona l sta ff implemented 'a gro up recommendatio n. T he poi nts could be regul arl y exc ha nge d for money a nd town passes. The major dep endent mea sures , number of individual act ivities a n d tow n passes earned, showe d significa nt improvement for t he tre a tme nt group mem bers.
GU ID E LI NES FOR CO N DUCT IN G BEHA VIORAL G R OU P TH ERAPY Law ren ce a nd Sundel (19 72 ) provid e widel y a pp lica b le, detailed gu idelines for orga n izing a nd cond uc ting beh a vioral group therapy . Pri or to the first sess ion th ey recommend individual in tervie~s with eac h client to define problem s to be worked on in th erapy a nd get agreement on a contract descri bing th e gro u nd rul es of in-therapy be havior. Next , th ey sugges t tea ch ing group members basi c princip les a nd skills in b eh a vior al a na lys is a nd assess me nt. Then gro up member s should learn to prescribe a ppropriate interventions for different prob lem s. E mphasis is pl aced on making full use of op po rt un ities for group participation a t all levels in the grou p 's development th rou gh th e use of beh a vior reh earsal , modeling, a nd gr oup d iscus sions . Johnson (1975) conc urs with the Lawrence a nd Su nde l (1972) guidelines an d add s th at problem-solving skills sho uld be taught and an effort be made to include individuals of di fferent socioeco no mic levels, ages, and probl ems in th e sa me group so th at th e gro up has many d ifferent viewp oints in discu ssions. R oss (197 4) proposed sim ila r guidel ine s for cond ucti ng grou p th erap y with alcoholi cs.
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CONC LUS IO N The va rio us pr oblems t hat ha ve , t hus fa r, be e n dealt wi th through th e use of be ha vioral grou p tec h niq ues ha ve been su rveye d . Kn owl ed ge of the m ethod s used to cha nge the s urve yed beha vior s, u nderstanding of the procedures fo r acc om p lishing in-t he ra py process objectives, a nd a n a wa reness of the guide lines for cond ucting behavio ra l group therapy sho uld prep are research ers a nd t herap ists to refine methods a nd ex pa nd t he a reas in whi ch beh a vior al gro u p method s may be used.
REF ERE NCE S Allen. G . J. ( 1973 ). T rea tm ent of T est Anxi ety b y G ro up -A dmini stered Rela xati on a nd St udy Co u nse ling . Behau. T her.. 4 :34 9- 360 . Alu mba ug h. R . V. ( 197 1). T he M a na gement of Socia l Beha vior of Chroni c Psychi atri c Pati ent s: A n Em p irical An al ysis of Sma ll G roup Beh a vior s. ]. Clin. Psycho!.. 27 :525-528 . Am eri can Psych iat ric Associatio n ( 1968). D iagnostic and Sta tisti cal .\ I allual of .\lmtal D isorders . 2nd . ed . W ash in gton. D .C . : American Psychia tric Assoc ia tion. Bal ch . P.. a nd Ross. A. W . ( 1974) . A Behavior all y O riented Dida cti c G ro up T rea t ment of O besi ty : An Exp lorato ry Stud y. ]. Behar. Th er. & E spe r. Psvch iai., 5 :239-243 . Ha r ba sz, A. F. ( 1973), Gro up Desensit iza tion of T est Anx iety in Elem ent a ry Scho ol. ]. Psycho!.. 83 :295 -30 1.
Ba rdill . D. R. ( 1972) . Beh a vior Co nt rac ting a nd G rou p T herap y with Prea dolescent M a les in a Resi den ti al Trea tm ent Se tt ing . T his J ournal. 22 :333- 342 . Cle men t. P. :\.. a nd M ilne, D. C . ( 1967). G ro up Pla y Ther ap y and T an gible Reinfor cers Used to ~I od ify th e Beha vior of Eight Year O ld Boys. B eh ac, R es, & T hrr.. 5 :30 1-3 12. Co he n. R. ( 1969 ). The Effect s of G ro up Int er a ction a nd Progressive Hi erarch y Prese nta t ion o n Dese nsitizat ion of T est Anx iet y. Behne. Res. & Th rr .. 7 : 15-26. Dawl ey, H. H .. a nd Wen rich . W . W . ( 1973 ). G rou p Im pl osive Therap y in t he T reatm en t of T est An xiet y: A Brief Report. Behar. T her.. 4 :26 1-2 63. Don ne r. L. ( 1970) . Au to ma te d G ro u p Desen siti zat ion : A Foll ow- Up Re por t. Behau. R es. & Th er.. 8 :241 -24 7 . _ _ _ . a nd Gue rne y. B. G . ( 1969 ). Automat ed G ro u p Desensit ization fo r T est An xiety. Behan. Res. & T her.. 7: 1-13. Dua , P. S. ( 1972). G ro up Desen siti zat ion of a Phobia with Three M a ssing Proced u res. ]. Counsel . Psycho!.. 19:125-129 . Egolf. D. B.. Sha mes. G . H .. a nd Ge ltzer. H . N . ( 197 1). T he Effect s of T imeout o n th e Flu en cy of Stutt ere rs in G rou p T hera py . ]. Comm umca tum D isorders, 4 : 111- 118 . Eise nma n n. R . ( 1965 ). O pe ra nt Co nd it ioni ng of the Sequence of Spea kers In Co nve rsat ion a nd Gro up Psychoth era py. ]. Psycho!., 6 1:305-309.
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Ferinden , W . E. ( 197 1), Beh a vior istic Psych odrama : A T echniq ue for M od ifyin g Aggr essive Beha vior in C hi ldren. Group Psychother. & Psychodrama, 24 :101-106 . Galass i, J. P., Ga llass i, M. D ., a nd Litz, M . C . ( 1974), Assertiv e Trainin g in G roup s Using Vid eo Feedba ck. J. Counsel. Psychol., 21 :390-394. G raz ia no, A. M . ( 1970), A Gro u p Treatment Approac h to M ult iple Problem Beh avio rs of Au tist ic C hi ld ren . Exceptional Children. 36:765 -770 . H au ser ma n, N ., Zweb ack, S., a nd Plot kin , A. ( 1972 ), Use of Co ncrete R einfor ceme nts to Facili ta te Verba l In itia tion s in Ad olescent G rou p Ther ap y. J. Consult . & Gin. Psychol., 38 :90-96. J oa nni ng, H . ( 1974), Beha vior al Rehearsal Ver sus Trad itio na l Ther a py in the Grou p Trea tm ent of Socia lly Non asser t ive Ind ividual s. Dissertation Abstracts International, 34:4665-4666 B (U niversity Mi crofilm s No . 7388) . J ohnson, W . G . ( 1975), Gro up T hera py : A Beh a vior al Per sp ecti ve. Behan. Th er.. 6 :30 -38 . Kap lan . H . I. , a nd Sa do ck, B. (eds .) ( 197 1), Comprehensioe Group Psychotherapy. Ba lt imor e : Will iams & Wilkins. Ka rah n. ~I. , Strenger, S., a nd C herry, N . (1966) , Group Co unseling a nd Beha vior The rapy with T est A nx ious Co llege Stu den ts. J. Consult. Psychol., 30 :544-549. K illia n D. H . ( 197 1), T he Effect of Instructions a nd Soc ia l Re infor cem ent on Selected C at egories of Beh a vior Em itted by Dep ressed Per son s in a Sma ll Gro up Sett ing. Dissertation Abstracts International, 32:3640 B (U niversity Mi cr ofilms No. 72-944). Konda s, O . ( 1967 ), Red uction of Exa mina t ion Anx iety a nd Stage F right by G ro up Desen siti zati on a nd Relax ation . Behao, Res. & T her.. 5: 171-181. Kru eger. D. E. ( 197 1), O pe ra nt Group T herapy with Delinqu ent Boys Usi ng Ther apist ' 5 Versus Peer 's Reinforcem ent. Dissertation Abstracts International, 3 1:6877-6878B. Lawren ce , H ., and Sunde l, M . ( 1972), Beh avior M od ificati on in Ad ult Groups. Social Work, 17:34-43. La za rus, A. A. ( 196 1), G ro u p Ther ap y of Phobic Disorder by System ati c Dese nsiti za tion . J. Abn. Soc. Psychol., 63 :504-510. Leon , H . V. (1965 ), Recip roca l Inh ibition : An Eva luat ion of Grou p Procedures with " No rma l" Snak e Ph obic Subj ect s. D issertation A bstracts In ternational, 28 :38 78-3879 B (U niversi ty M icrolil m s No. 68-3752). Lewi nsoh n, P. ~ I. , W ein stein, M. S., and Alpe r , T. ( 1970) , A Beh avioral Approach to the G roup Trea tment of Dep ressed Perso ns : A M eth od ological Cont ri but ion. J. Gin. Psychol., 26 :525-532 . Liber ma n, R . ( 1970) , A Beh a viora l App roach to G ro up Dyna mi cs : II. Reinfor cin g a nd Prom ptin g Hostility-t o-t he-Therapi st in G roup Ther a py. B ehao, Ther., 1:3 12-327. _ __ ( 197 1), Beha vioral G roup T her apy : A C ont rolled C linic a l Study. Brit. ]. Psvchiat., 19:535-544 . Litvak : S. B. (1969 ), A Com pa rison of T wo Brief G ro u p Beh a vior Ther a py T echniqu es in the Reduction of Avoida nce Beha vio r. Psychol. R ec., 19 :329-33 1. M eich e nba um , D. H. , G ilmo re, J. B., a nd Fed ora viciu s, A. ( 197 1), G ro u p In sight Versus G ro up Desensiti zat ion in T reating Speech Anxiety. ]. Consult. & Gin . I' IJChol.. 36 :4 10-42 1. M cM a nus, M . ( 197 1), G roup Desensiti zat ion of T est Anxie ty. Behav. Res. & Th er., 9:5 1-56 .
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Mi ran , M ., Lehrer , P., Koehl er, R ., a nd Miran , E. (19 74), What Happ ens Wh en Deviant Beh a vior Begin s to C ha ng e' The Rele van ce of a Socia l Systems Approach for Beha vioral Pro grams with Adol escents. ]. Community Psychol., 2 :370-375 . O ber , D. C. ( 1968) , M odifi cat ion of Sm oking Beh a vior. ]. Consult . & Clin. Psychol ., 32 :542-549. O 'Donnell , C . R . (1972 ), Group Beh av ior Modification wit h Inpatients: A Case Study . Psychotherapy: T heory , R es. & Prac., 9 :120 -12 2 . Ol son , R . P., a nd G ree nbe rg , D. J . ( 1972 ), Effects of C on ti ng ency-Contracti ng and Decision-M ak ing Groups with Chronic M ental Pa tient s. ]. Consult. & Clin. Psychol ., 38 :376- 383 .
Pa ul , G . L. (1968 ), T wo Yea r Follow- Up of Syst ematic Desensi tizat ion in Therapy G roup s. ]. A bn. Psychol., 7 3: 119- 130 . _ _ _ , and Shanno n, D . T . ( 1966), Treatment of Anxi ety th ro ug h Syste matic Desen sitiza tion in Ther ap y G ro ups .]. Ab n. Psy chol., 73: 119-130 . Pen ick, S. B., Fil ion , R ., Fox, S., a nd Stu nka rd, A. J . ( 197 1), Beha vior Modification in the Treatment of O bes ity . Psychosomatic Me d ., 33 :49 -55 . R athus, S. ( 1972 ), An Expe rime nta l In vest iga tion of Asse rtive Training in a G ro up Se tt ing .]. Behau. Th er. & Ex per. Psychiat., 3 :81 -86 . R itt er , B. ( 1968 ), The G ro up Desens iti za tion of C hi ld re n 's Snake Ph obia s Usi ng Vicarious a nd Co ntact Desen siti za tion Proc edures. B ehav. Res. & T her., 6 : 1-6 .
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Rose, S., Sunde l, M .. Delanse, J. , Co win, L. , an d Palumbo, A. ( 1970), The H art wig Pro iect : A Beh avioral App ro ach to the T rea tment of J uvenile Offe nde rs . In : Control of Human Behavior, Vol. 2, ed . R. Ulric h, T. Sta chnik, andj. M abry . G lenview, Ill.: Scott , For esm an. Ross, S. M . (1974 ), Beh a viora l Gro up T herapy with Alcoho l Abuse rs . In : Behavior M odification in R ehabilitation Settings: Applied Principles, ed. j. G . Cu ll a nd R. E. H ardy. Springfield , Ill. : C ha rles C T ho mas . Schofield , L. j. , a nd Won g, S. ( 1975) , O pe ra nt Ap pro ac hes to Group Therap y in a Sc hoo l for H a nd icap ped C hi ldren. Developmental M ed. & Child Neurol ., 17 :425-433. Scisson s, E. H ., and Njaa ., L. j. ( 1973), Systemati c Desen sitizati on of T est Anxiety : A Compa riso n of G ro up a nd In d ividu al Trea tment . ]. Consult . & Clin. Psychol ., 41 :470. Ste d ma n, j. IV!. , Peter son , T. L.. and Ca rda relle, j. ( 197 1), Applica tion of a T oken Syste m in a Pread olescent Boys G rou p. ]. Behao. Ther . & Exp er. Psy chiat .,2:23-29 .
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Wh itm an , T. L. ( 1972 ), Aversive Contro l of Smoking Beha vior in a Group C onte xt. Behav. Res. & Ther., 10:97-104 . Wigg in s, S. L. , a nd Sa lzberg, H . C. ( 1966 ), Co ndi tioni ng aga inst Silence and Therapist Directed Comments in Group Psychotherapy Usi ng Auditory St im ula tion. Psychol, Rep., 18:59 1-599. Wilt z, N . A. ( 1970), M odifi cat ion of Behav ior s of Deviant Boys through Parent Parti cip ation in a Group T ech nique. Dissertation Abstracts International, 30:4786-478 7A (U nive rsity M icrofi lm s No . 70-9482). Woll ersheim, J. P. ( 1970), Effectiven ess of Group Therapy Based on Learni ng Prin ciples in th e Treatment of O verweight Women. ]. Abn. Psychol., 76 :462474 . Wo lpe, J. ( 1958) , Psychotherapy b)' Reciprocal Inhibition. Stanford, Calif. : Stanford University Press .
Mr . Harris 's address: Psychology Internship Program Camarillo State Hospital Camarillo, Calif. 930 10
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
The Behavioral Approach to Group Therapy Francis C. Harris To cite this article: Francis C. Harris (1979) The Behavioral Approach to Group Therapy, International Journal of Group Psychotherapy, 29:4, 453-469, DOI: 10.1080/00207284.1979.11492013 To link to this article: https://doi.org/10.1080/00207284.1979.11492013
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F R A N C IS C . H A R R I S , M .S.
H
I ST O RI C ALL Y , ~IOST G RO UP TREAT~IENT PRO CED URES have been based on t he th eori es a nd me t hods of traditional psych od yn amic psychology (Kap la n a nd Sadock, 197 1). W ithin the la st fifteen yea rs, however, gro u p treatme nt strateg ies ba sed on successful a pp lica tion of socia l learning theory to individual cas es hav e st arted to emerge. T hese be hav iora l ap p roaches ma y be defined as " procedu res t ha t uti lize systematic environme nta l co ntinge ncies to a lter di rectl y the subject's rea ctio ns to situa tions " (Ullma n a nd Kr asner, 1975 ). Beha vioral tec h niq ues have be en app lied to th e group treatment of probl em s as specific as st utte ring (Ego lf et a l., 1971 ) and sna ke phobia (Leon, 1965; Lit vak , 1969 ; Ritter, 1968) a nd as ne b ulous a nd difficul t to de fine operationa lly as depression (Killia n, 1971 ; Lewinsohn et al. , 1970). The use of client groups has pe rmitted beh a vior therapists a nd research er s to use modeling, vica rious learning, gro up discu ssion s, be havior reh earsal , a nd other co ncep ts a nd p roce d ures no t ea sily a pp lied to indi vidu al ther apy sit ua tions (Ka pla n a nd Sadock, 1971 ). The purpose of th e presen t work is to survey th e various ways in which be hav ior al procedures have bee n used in gr oup th erap y.
PH OBIC BEH AVI OR Ph obic behavior , c c • • • inten se fea r of a n object or sit ua tion which the pa tient consciously reali zes is no real threat to him " Mr. H a rris is in th e Psychology Intern ship Pr ogra m a t Camarillo St a te H ospita l, Camarillo , Calif.
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(D S:-' l II , 1968. p. 40 ), is the ge ne ra l cla ss of be havior th at ha s mos t often been dealt with by mea ns of b ehavi o ra l group p roce dures . La zaru s (1 961 ) t rea te d 18 middle-class ad ults de mo ns t ra ti ng a va riet y of p hobi c beha viors, inclu d in g a crop hob ia. cla ust ro p hob ia , and impotence . in small gro ups by sys te mat ic des ensi tiza tion procedu re s ba sed o n Wolp es ( 1958 ) principl e of rec ip ro ca l inh ibi t ion . Subjects with sim ila r phobi c be haviors wer e first tau ght to rel ax a nd then in stru cted to visual ize gra d ua lly mo re t hr ea tening scenes whi le remainin g re laxed. W hi le the th er api st ga ve ge nera l instruc tions , ind ivid ua lized hier archi ca l item s we re presented to eac h su bject via cards descri b ing sce nes speci fic to h is/h er p hobi c b ehavio r. Aft er a me an of 20 treatment sess io ns. 13 of t he 18 subjects treated b y sys temat ic desen sitiza t ion wer e a b le to pa ss a behaviora l po st -t est in whi ch eac h had to ap p roac h a nd d eal with hi s/ h er previously phobic sti m ulus . A mat ch ed gr ou p of 17 su bj ects t reat ed by t rad itiona l grou p p sychotherap y yie ld ed two recov eries after a mean of 22 sess ions. Th e remaining 15 su b jects were then treat ed using grou p system a t ic d esen sitiz ation me thod s a nd 10 succe ssfully completed th e beh avioral test in an a verage of 10 ad d itio na l sess ions. T est Anxiety
Paul a nd Shanno n ( 196 6 ) com pa red group desen si tization to individu al de sensit izati on and individu al in sigh t-oriented psychoth erapy using colleg e st u de nt subjects who indi cat ed ge nera lly hig h levels of aro us a l on severa l se lf-repor t a n xiety m easures . S ubje ct s ass igned to group de sensit izat ion were treated in groups of five. A lt ho ugh the subjects indica ted hi gh a rous a l in a va riety of sit uatio ns , t ho se in the de sen sitizatio n grou ps worked t h rough hi erarch ies spec ific to t est a n xiety . a problem the y al l repo rted . Subj ec ts rece iving individu ali zed systematic d esen sitization were g uided throu gh thei r hi erarchies , af te r bei ng tau gh t to rel ax , in a st a n da rd in d ivid ua l therapy m ann er . Subj ect s receivin g gro up d esensiti zation parti cipat ed in prese nsiti zati on di scussion s in wh ich t hey discussed t he const r uct io n of their test-an xiety h ierarch y. T he y a lso met a nd dis cu ssed the procedures a n d a ny po sit ive results or problems that ca me up du ring the trea tment per iod . Im p roveme nt for a ll subje cts who expe rie nce d desensiti zati on pr ocedures
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was significa ntl y greater on the self- re port m easures than tho se ex perienc ing indi vid ua l in sight-or iented t reat me nt. In a d dition, the dese ns it iza tion subjects ac hieved significa ntly gre a te r improvement in th eir g rade po int ave rages . The gra de point avera ge index is especia lly important since it is a me aningful outcome me asure. T he a uthors d iscu ssed th e likelihood of th e gro up dis cu ssions supple menting the t reat me nt proced ure by perm itt ing the subjects to in tera ct with people having simil ar probl ems. They a lso pointed out th e op po rtu nity for those exhib iti ng genera l soc ia l a nx iety to develop so me soc ia l skills in a str uc tu red sett ing . A two- year followup st udy (Pa ul, 1968 ) indicated m aintenan ce of the improved gra de -point a vera ges a nd self-repo rt in dices for the desen siti zation su bjects with no differen ce bet ween group a nd indi vidu al desensitiza tion. T est a nx iet y has co ntinue d to be a n a rea of co nce nt ration for researche rs inves tiga ting the effica cy of usin g gro up treatment methods to cha nge p ho bic be havior. Se vera l other in vesti gators (C ohe n, 1969 ; Kat ahn et al.. 1966 ; M cM anus, 1971 ; Su in n, 1968 ) ha ve co m b ined grou p di scu ssions with group desen siti zation proced u re s in th e treat m ent of test a nxiety . Ka tahn et a l. (1966) a nd Suinn ( 1968) used presen siti zati on gro u p me etings for gro up relax a tion , exp la na tion of dese ns itiza tion rational e, a nd gro u p discussion of poss ib le item s for inclu sion in each member 's indi vidu ali zed hiera rch y. Between the first di scu ssion and the first treatme nt sessio n a ll subjects constr uc ted thei r ow n hi erarchies. D uri ng dese nsit izati on traini ng t he th era p ist gave ge ne ral in structio ns whil e the subjects visu ali zed their own items. Group dis cussio ns of proced ures were held before ea ch th era py sess ion. The com bina tion of grou p dese nsit ization a n d di scu ssion produced sig nifica n tly imp ro ved self-report measures of a nxiety and gr adepoint avera ges. M cManu s ( 1971) taugh t su bje cts relax a ti on skills a nd th e ra tional e for de sen sit iza tion a n d ha d them cons t ruct th eir own hier a rchi es without gro up d iscu ssion. They wer e p ermitted to di scu ss st udy ha b its a nd their wo rr ies about taking exa m ina ti ons . T h is proced ure led to signifi can t improvement in th e grades of the t rea te d subject s. Since the rap ist s in gro up systemat ic desen sit izati on th erapy typ icall y present sta nda rdized inst ructions to the subj ect s with a
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rrurumum of ot he r d iscu ssion, th e use of a ud io ta pe d ins tr uc t io ns would seem to be ec onomica l a nd fea sibl e. Donner a nd G uerney (196 9 ) ass igne d 42 femal e students w ho had indica te d hi gh test a n xiety o n a self-report me a sure to receive a control procedure, gro u p sy ste ma t ic desensiti zati on wi th th e th era pi st present ing instruct io ns persona lly , or group desen sitiza tion in whic h the ins t ruc ti ons were presented by au d iotape . Both d ese nsit izat ion gro u ps ha d sig ni fica nt ly im proved gra de -poin t averages whil e the co nt rol gro up did not. The d iffere nce in grades of t he gro u p- a nd individual -d esensit izat ion grou ps a p p roa che d signi fica nce, with th e su bjects receivin g in div id ua l t reat ment ge tt ing bett er g ra des . A fivem on th follow-u p rep o rt (Donner, 1970 ) indicated m a in ten ance of the ga ins m ad e b y the treatment gro ups, with no d ifferenc e b etween grou p an d indi vidual desens itization . Sc issons a nd Njaa ( 1973) used a sim ila r gro u p d esign b ut emp loye d a u d iota pe d d esen sit izat io n ins t r uc tions for bot h indi vidu al a nd . gro up de sensi ti zat ion p roced ures . Both dese ns it izat io n treat ments were eq ua Hy effec tive , based o n a self-re po r t m ea sure, a nd sig nifica n tly be t te r th an th e no-trea tment co ntro l. The use of group sys tema t ic dese nsi tizat ion to re duce t he test a n xiety of elem entary sc hoo l child re n ha s also bee n in vest iga ted . Ba rb a sz ( 1973 ) used a gro up sys tematic desens itization proced ure to treat a gro up of fift h- a nd sixt h-gra de stude nts who d emon stra ted hi gh a ro usa l in a n a nalog ue tes t sit uat ion . The desensi ti za tion proced ure p roduced significant ly d ecrea sed a nx iety levels on the post-t est. Also not eworthy was t he s ignifica nt im p rovemen t in t he desensiti zat ion subjects ' performa nce o n a n int ell igen ce test. T he re is some evide nce that be havio ra l proced u res other t han sys te ma t ic d esen sitiz a tion m a y be used to eli minate tes t a n xiety . Alle n ( 1973) rep or ted t ha t gro u p beha vioral st ud y co unse ling al one or combined wit h rel a xati on tra in in g significantly imp roved t he gra d e point a vera ges of test- anxiou s college stu de nts. Dawley a nd W enrich ( 1973) attempted to redu ce t he test a nxiety of st ude n ts b y ha vin g them imagi ne the m ost t hreateni ng items of a test a nx iet y heirarch y whi le re m a ining rela xed . This impl osive techni qu e wa s no mo re effective than a p lacebo treatmen t. The authors sugges ted t hat t he im p lo sion wa s u ns uccessful du e to proble ms in the hi er archy const r uc t io n .
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Speech Anxiety The meth ods of sys tematic desen siti zati on have been a pp lied to t he gr oup tre atmen t of publ ic s peaking an xiet y. Mei chenbaum et a l. ( 1971) a ssig ned 53 newspaper- ad respondents to either grou p de sen siti za tion , gro up in sigh t-ori en ted psychotherapy, group dese n sitiza tion plus in sight-oriented psychother apy , or co nt ro l conditio ns. Ba sed on sel f-rep o rt q uest ionna ires a nd beh a vior al o bserva tions of spe ech es, both desen siti zat ion gro ups showe d signifi cant imp ro veme nt , with the most improvement demonstrated by th e gro up experienc ing desen siti zation plus insi ght-oriented psychot herap y. Both gro u ps of de sen sit izati on su bj ects en gag ed in dis cussions rega rdin g problems and hierarch y co nstr uc tion . Kond as ( 1967) investiga ted th e speec h a nx iet y of 23 tea ch er-referred , testa nxious elementa ry school child ren usin g a n expe rim enta l desi gn that co nt rolled for th e effects of relax ation training . One grou p serve d as a con t rol while a nother wa s only ta ug ht rela xation skills. T he th ir d g rou p went throu gh a spee ch-a n xiety hierarch y with no re lax a tio n tr aining an d the fou rth g ro up exp erience d the entire g ro up systema tic desensitizati on procedure. S ubj ec ts receiving the full desen siti za tion tr eatm en t were the o nly ones demonstrating sign ifica nt re d uc tion of the ir speech a n xiety as measured by a selfreport index. Snake Phobia Ph ob ic b eh avior in relati on to sn ak es has been a not her area in wh ich be ha vioral gro up tre atment meth od s have b een used . Lit vak (1969) co m pa re d the effectiveness of syste ma tic desen sitization to a contac t dese nsit izati on pro ced u re. C ollege st udent volunt eers who d id not get a minimum score o n a test in which they were ask ed to a pp roac h a nd handle a live sna ke were ass igne d to one of t hree grou ps . The system atic desen siti zat ion grou p was trained to rel ax a nd wa s in st ru ct ed throu gh a pre det erm ine d hierarchy a p plica b le to sna ke avoida nce. Subjects in the con tact desen siti zation grou p observ ed t he experim en ter a pproa ch a n d handle a sna ke. The expe r ime nte r encoura ged memb ers of the group to a p p roa ch grad ua lly a nd touc h th e sna ke. Onl y on e training session was given to b oth desensitization gro ups . The third gro up se rved as a co ntro l. O n ly t he co ntac t d esen siti zati on led to sign ifica nt imp rovement o n
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the post-test. C o ntac t desensitization ha s also been used to modify child ren's a void a nce of sna kes (R itt er, 1968 ). Forty- four bo ys a nd girls from 5 to 11 yea rs of age who did not a ttai n a minimum score on a in-vivo behavioral s na ke a voida nc e measure were assig ned to either a vicarious-learning group, a co n tac t desensiti zation grou p, or a co nt rol group . Those in the vicarious-l earning group watched as five other chi ldren of co m pa rab le ages a p p roac hed a nd handled a snake. Thos e child ren in the con tac t des ensitization group were enco u raged b y th e expe rim en ter gra d ua lly to come closer to th e snake . Both treatment group s improved significantl y on th e posttest , with the con tac t desensitization group improving mo st. Leon ( 196 5) gu id ed gro u ps of colleg e st ude nts throu gh de sensiti zat ion hierarchies , su p plem en t ing the verbal cues with eit he r pictures of s na kes or printed descriptions. Th e subj ec ts exposed to th e pictures improved most on th e post-test.
Opposite Sex Phobia One study (D ua , 1972 ) report ed the use of group d esensitization when a member of t he op pos ite se x wa s th e phobi c st imu lus for a group of colleg e st u den ts. Two sel f-report m easures and a n a na logu e test in which behavior toward a n opposit e-sex con fede ra te wa s rated serve d a s the dep endent mea sures. Three gro u ps of su bj ec ts ea ch re ceived sess io ns of group sy stematic d esensit ization . One grou p experienced a ll ses sio ns within a 12-hou r period . The other two groups were trained over 5- and 15-day periods . All gro u ps improved si gnificantl y on a ll measures, with the 12-hour a nd S-d ay procedures being more effec t ive t ha n th e IS-da y procedure. SOCIAL BEHAVIOR Behavioral gro u p therapy a pp roac he s ha ve been u sed to sha pe spec ific soci al behaviors in child re n (C leme nt a nd Milne, 1967 ; Graziano , 1970 ), in stitutional ized a d ults (Alu m ba ug h, 1971 ), a nd indep endentl y fun ctioning a d u lts (G a las si et a l., 1974 ; Jo anning, 1974 ). Cl ement a nd Milne ( 1967) worked with ele ven third- gr aders who had be en referred by t he ir teac he rs as shy a nd withdrawn by assi gning them to one of two tr eatment group s or a no-treatment con tro l grou p . In one trea tme nt grou p the leader prompt ed th e
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ch ild re n to in te rac t with one a not he r a n d pro vide d verbal p raise a nd tokens, whic h cou ld la ter be traded for b ac k-u p re inforce rs, wh enever soci a l inte ra ctio ns occurr ed . The a d u lt lead er of th e other tre atme nt gro up gave pro m pts a nd verba l reinforcers, b ut no token s, for socia l be hav ior. T he control group met regul arl y but no rein for cers were provided . Direct observa tio ns indica ted sig n ifica n tly increased verbal int er acti on s for both treatment grou ps , wit h mo re im p roveme nt for the gro up receivin g token s. R ep or ts from teac hers a nd parent s indica ted ge ne ral improvement in the soc ia l behavior of t he child ren in the trea tment gro ups. G ra zia no ( 1970 ) re ported a four- yea r project in which pro m pting , food rein fo rcers , a n d prai se were used to teach four " reg ressed p sycho tic" ch ild re n to increa se t he ir socia l int era ctions in play a n d mea l situa tions. As with most soc ia l skill deficit s th e lack of a sserti veness see m s idea lly su ited to trea tment in a group sit uat ion. In a not her st udy (G a la ssi et a l., 1974 ) un as serti ve co llege stude nts parti cipat ed in eight grou p trai ning ses sions . Du rin g the first third of eac h sess ion g roup di scu ssion s of a ssertiveness were led b y two t herapi sts. Afte r th e disc uss ions vide ota pes of mod els exhib iting a pp ro p riate asse rtive beha vior were viewe d . For the rema inder of th e sess io ns gro up memb ers pa rti cipa ted in dya dic role-pl aying sit uations with feed bac k o n t he ir asse rt iveness p rovided by th e leaders and other gro up memb ers. R esult s of a na logu e tests give n to so me of th e sub jects ind ica ted sig nifica nt improvement du ring trai ning for t he treat ed su bj ects but not for th e no- treatment co nt rol grou p. Joanning (1974 ) prov ide d six sessio ns of t radi tio na l p sych otherap eut ic grou p treat ment to a group of un assertive volunteer subj ects a nd six sessio ns of beh a vior re hea rsa l trainin g to a simila r gro up . Subjects ex peri en cing beh avior reh earsa l t rai n ing we re ta ug ht spe cific asse rtive beh av iors . Asse rtive beh a vior increased and a nxiety decreased for t he be havio r reh ea rsal group in co m pa rison to t he trad itional gr oup . SM O K ING A ND OVE REAT ING Beh a vioral group procedures ha ve bee n used to cont rol excessive sm oking (O ber, 1968 ; Wh itm an , 1972 ) a nd eating (Ba lch a n d
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R oss, 1974 ; Penick et a I., 1971 ; St ua rt a nd D a vis, 1972 ; W ollershei m , 1970) . O ber (1968 ) assigne d college st ude nt smo ke rs to eit her a self-control treatment group in which they met to di scu ss be hav iora l princip les relating to self-cont ro l of smo king a nd we re given a m anual detailin g tho se p rinc ip les or to a n ave rsio n-t he ra py gro up in which subjects di scu ssed a nd received a man ual descri b in g self-a d m iniste re d punishmen t a nd were in structed to shock the mselves wit h a port a b le shoc ki ng device whe never t hey wa nte d to smo ke . The remaining subjects were as signed to a transa cti on al ana lysis gro up in whic h t hey disc uss ed the person al co nflicts a ssoc iated with smoking . Based on self-report measures of smoking behavior, a ll three treatmen ts were significa nt ly effective. T he a bs ence of a contro l gro up mak es t hese result s di ffi cult to inte rp ret. Wh itman ( 1972) contro lled for p lace bo effects by us ing a gro up of smo ke rs who did not ap p ly for tr ea tment as a cont ro l group . Expe r ime ntal subjects were p la ced in eit he r ind ividual or gro up ave rsive -t hera py groups. In the ind ivid ua l treatment subjects wer e see n a lone a nd inst r ucte d to p lace a tab let in t heir mouths prior to smo king . T he tabl et ca use d a fou l ta ste a moment lat er wh en th e subjec t was smo king. The gro up aversive-t he ra py subjects received the sa me instru ctions in a grou p co ntext . In a dd itio n, they att ended wee kly meetings at w hic h t hey d isc usse d the procedures a nd wh ether or not they u sed t he ta blets a pp ropria te ly. Group member s urged t hose not making pro per use of th e ta blets to do so a nd prai sed th ose memb ers who wer e usin g th em cor rec tly. The subjects ' self report da ta indicated t hat those ex posed to the gro u p di scu ssion s used more tablet s a pp ro pr iate ly a nd smoked less t ha n th e subjects in ind ividu al t rea t ment. In a n in vestiga tion of weight loss, W ollersh eim (1970) pla ced overweight undergr aduat e studen ts in a no-treatment co ntrol group or o ne of three group trea tment gro ups . In on e tr eatment gro up , subjects we re ta ug h t t he principle s of sys te ma tic desen siti zation a nd to ld to rel a x w he never they we re hungry. In a dd itio n, they learned to recogn ize the co nditions under wh ich th ey were most likely to ea t an d t hey recorded everything th ey a te . Re gul ar meetings were held to dis cu ss progress and probl ems. Ano t he r gro up was ta ug ht how to rela x but not inst ruc te d to do so wh en
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h u ngr y. T hey also had meetings but only d iscu ssed weight loss in ge nera l terms. The other trea tm en t gro up was not ta ug ht to relax b ut did have weekly gro up meetings. The gr oup taught to selfmo nitor their eat in g beh a vior a nd rel ax whe n hun gr y ac hieved significan tly grea te r weight loss than a ny of the oth er groups a nd indica ted maint enance of the reduction a t a n eight week follow-up . Ba lch a nd Ross (197 4) used sma ll gro u ps to teach over we ight subjects to manage their ea tin g beh avior b y usin g th e recording, beh avior a na lytic, and conti nge nc y managem ent procedures di scussed by Stua rt a nd Da vis ( 1972). An interesting co ntinge ncy was pla ced on weight co ntro l by Peni ck et aL (1971 ) wh en they in structed a gro up in be ha viora l principles as they related to ea ting be havior a nd had them rewa rd th em selves for good weight management wit h token s. The token s represented amou nts of mon ey th e subject could la ter d onate to a favorite cha rity . This procedure led to significa nt weigh t reduct ion whil e a trad itiona l gro up psychotherapy treatment did not with a sim ilar gro up of subjec ts.
DEVIA NT C H ILD BEHAVIOR Research in applying behavioral principl es to the modification of deviant chi ld be hav ior has invo lved invest igations of gro up methods to teach parents to become effective contingency mana ger s (Rose , 1969 ; Wiltz, 1970) a nd techniques used with groups of p robl em children in scho ols (Ferinden, 1971; Mi ra n et al ., 1974 ) a nd in stitutions (R ose et al ., 1970 ). Rose (1969) used a group sett ing to te ach parents of problem beha vior children to define p roblem behaviors operationall y, identify their antecedents a nd conseq uenc es, delineate specific objectives for approp riate behaviors, a nd manage the co nsequenc es of their child ren 's behavior . The a utho r reported th e usefulness of having group members publicl y com m it themselves to performing homework as signments rel a ted to th e group tra in ing experience. U nfortu nately, no data reflect in g the behavior of th e child ren were presented, although a nec dot al rep orts of some of th e parents seemed favorable . Wiltz (1970) also tau ght a group of pare nts social learning principles
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th ey co u ld a p p ly to th eir own ch ild re n 's p ro b lem beh aviors. This study is nota b le in t hat it emp loyed di rect observatio ns of chi ld b ehavior in th e natural enviro nme nt as t he maj or dep enden t va ria b le. C h ild re n wh o parti cip at ed in the gro u p t ra ining a nd di scu ssions exhib ite d significa nt ly im p rove d beh a vior while co nt ro l g ro up ch ildre n did not. Ferinden (1 971 ) had four aggress ive eleven-yea r old boys se lfrecord in stances of ba d behavior. Once eve ry wee k each boy acte d o ut hi s bad beh a viors in a class roo m wit h hi s class mates present. They a ll dis cussed a lte rna tive beha vior s that co uld ha ve been em itte d . Then t he ta rge t chi ld re hea rsed the a pprop riate be havior a nd was prai sed by t he ot her chi ldre n. Da ta we re p rese nted whi ch in di ca ted imp ro veme nt for a ll four boys . Althou gh thi s st udy wa s not well co nt ro lle d, it illu st ra tes goo d use of a grou p p rocess to modify ch ild be havio r . In t he M ir an et a l. (19 74 ) st u dy, twenty ge ne ra l probl em beh a vior 13- and 14-year-ol d bo ys parti cip at ed in sma ll gro up t he ra py sessions in whi ch th e obj ecti ve wa s di scu ssion of ways to em it m ore ap pro p riate be havio r at schoo l. T en of the boys we re ra ndom ly se lected to be treatmen t su bjec ts a nd new th er ap y gro u ps were formed . Th e treatment grou p boys co ntin ue d havin g grou p t he rapy sessio ns but in a d d itio n th ey were give n a n oppo rt u nity to ea rn tok en s for a p pro p ria te be hav ior outs ide th era py sessions. These tok en s co u ld be sa ved a n d traded for permi ssion to tak e va rio us field tri p s. Whil e th e tok en co n d it ion wa s in effect , teache rs' blind ra ti ngs of sc hoo l be havior im proved for th e tok en gro u p b ut not the co nt ro l boys . The number of school sus pe nsio ns, p res u ma bly a n in dex of es pecia lly bad behavior, decrea sed for th e token gro u p . Rep ort s of the t he ra py gro u p leader s indica ted mor e on ta sk beh a vio r for the tok en gro u p as th ey d iscussed ways they mi ght ea rn tok ens. This st udy inad vertentl y em ploye d a reversal desig n whe n t he funds used for the field t rips we re exhau sted . At t hat point, ge ne ra l sc ho ol be havior, sus pe ns io ns , an d in-t he ra py beh a vior of th e tok en grou p returned to th eir pretrea tment unsat isfactory levels. with no c ha nges in the indices of t he co nt ro l gro up . R ose et al. ( 1970 ) gave tok en s, w hich co uld be exc ha nge d for a wide vari et y of b ack -up reinforcer s, to juvenile offenders for participating in gro up the rapy sessio ns in whi ch t hey reh earsed a pprop ria te be hav iors and receive d feed back o n th eir performa nce.
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DEPRESS ION Lew ins ohn et al. (1970) in structed a group of depressed students to try to increase t he number of posi tive interactions th ey initiat ed o r received . They were pe riodi call y given verba l and graphic feedba ck on th eir perfo rmance. They were ab le to inc rea se a variety of social beh a vior s d uring the feed back co ndi tion . The primary em p has is of th e st udy was to prese nt a recording sys tem t hat could be used to re cord social intera ction during group therap y. K illian ( 197 1) investiga ted th e po ssibili ti es of ha vin g half th e members of a th erap y gro up be depress ed individual s a nd the o ther ha lf no t depressive. The not ion was to ha ve the nondepres sive gro up me mbers p rompt a nd rein force o utwa rd d irect ed social behavior a nd positiv e self- stat ements . The t rea t me nt was no t effective. The idea , how ever, see ms to merit furth er explora tio n , perhaps using clinica l ca ses ra th er th an college st ude nts as sub jects. SPEECH PATH OLOG '\, A time-ou t co ntingency has be en su ccessfull y em p loye d to re d uce t he st utte ring a nd incr ease th e a pp rop ria te speec h of ch ronic st utt ere rs in gr o up therapy (Egolf et a l., 1971 ). During treatmen t th e clie nts were eac h permitted to spea k for onl y as long as they did not st utt er. This procedu re incr eas ed the mean number of words sp oken correctly before a stutter and the a vera ge time elap sed be fo re a st utt er. Rep ea ted reversal s demonstrated the co nt rol of the cont ingency. Eisenmann ( 1965 ) used ve rba l rewards to sha pe the de sired orde r of spe a kers in gr oup th erap y. Krueger (197 1) demo nst ra te d t he effective ness of peer-me d ia te d verb a l reinfo rcers in sha p ing a nd maintai n ing th e on-tas k verbal behavior of del inquent a dolesce nts in gro up th erap y. P R O C ESS O BJECTIVES The in vesti gat ions dis cussed th us far ha ve described wa ys in which b eha viora l grou p t reatment techniques ha ve be en used to mo dify be hav iors ta rgeted as outc ome in d ices of improvem ent. Severa l ot her st ud ies (H a use rma n et al. , 1972 ; Liberma n , 1970 ,
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1971 ; Wi ggins an d Sa lzbe rg, 1966 ) are of primary import ance beca use they illu strate ways to a chieve within-th era py process objectives co m mo n to a va riety of t reatment procedures. \Vi ggins a nd Sa lz berg ( 1966 ) presented an a vers ive nois e continge nt upon silence a nd speec h to th e t hera pist rat her t ha n a no the r gro up memb er to increase int er acti on s a mo ng cl ients . Liberm an (19 70 ) used therapist-med iated verba l prai se to increase ho stile com me nts to th e th erapi st as op pos ed to ot he r members of th e gro u p a nd a lso used therapist reinfor cem ent a nd prompting (L iberm a n, 1971 ) to in cre ase st at ement s indi cating solidarit y and cohesiven ess among gro up m embers. Rathu s (1972 ) described a grou p tra in ing pro gr am in wh ich sma ll grou ps of un a sserti ve undergr adu at e st ude nts we re as ke d to perform severa l discrete a ssertive b ehavior s in th e th erap y ses sions a nd a lso in their natural environ m ents . Group meetings dealt with presen tin g a be ha vio ra l ra tio na le for asse rt iveness , di scu ssing progress a nd problems , and b eha vior al reh earsal of ass ertive beh a vior s with feedb a ck provid ed b y other gro up members a nd t he leader. H auserman et a l. (1972) and Bardill (1972) used rever sal des ign s to demonstrat e the contro l of tok en reinforcement over verbal initiations made by beh avior-problem a dolesce nts in a gro u p the ra py situa tion set up to deal with a va riety of problems. Sted m a n et a l. (1 971 ) a lso used token s to in cr ease general appropriate beh avior in group therapy discussion. They exte nded the token program to include reward s for good academic grades. Neither schoolwork nor socia l behavior were origina l outcome objectives for the clients. O 'Donnell (19 72 ) cond uc ted weekl y group se ssions with chronic inpatient women during which specific behaviors d ire ct ed toward discharge were planned and discus sed. The residents performed some of th e behaviors and dis cu ssed them with the group in subseq uent se ssions. The author sug gested that the sessions facilitated the dis charges of some of th e group members but no data were presented to su p port this cont ention. In another study which used psychiatric patients a s su bj ec ts (T racey et aI. , 1974 ) token reinforcers were u sed to increase the positive statements of the grou p members regarding activities at the institution and other people. The procedure wa s effecti ve in in creasin g the statements
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du ring sessions and , mor e important , th e incr ease in positiv e statements gene ra lized to a n out-of-the ra py test setting. O lso n a nd Greenber g (1972) described a token program whi ch reinforce d process as well as outcome obj ectives in a n applied progra m in a res ide ntia l psych iatric facilit y. Po int s were a wa rded to members of a sma ll group for independent ly con duc ting a group meeti ng or indi viduall y atte nd ing a sche du led acti vity. Addi tional poin ts were given to group members for p reparin g report s a nd recom mendation s rega rding a group member. Further points were earned if th e instit utiona l sta ff implemented 'a gro up recommendatio n. T he poi nts could be regul arl y exc ha nge d for money a nd town passes. The major dep endent mea sures , number of individual act ivities a n d tow n passes earned, showe d significa nt improvement for t he tre a tme nt group mem bers.
GU ID E LI NES FOR CO N DUCT IN G BEHA VIORAL G R OU P TH ERAPY Law ren ce a nd Sundel (19 72 ) provid e widel y a pp lica b le, detailed gu idelines for orga n izing a nd cond uc ting beh a vioral group therapy . Pri or to the first sess ion th ey recommend individual in tervie~s with eac h client to define problem s to be worked on in th erapy a nd get agreement on a contract descri bing th e gro u nd rul es of in-therapy be havior. Next , th ey sugges t tea ch ing group members basi c princip les a nd skills in b eh a vior al a na lys is a nd assess me nt. Then gro up member s should learn to prescribe a ppropriate interventions for different prob lem s. E mphasis is pl aced on making full use of op po rt un ities for group participation a t all levels in the grou p 's development th rou gh th e use of beh a vior reh earsal , modeling, a nd gr oup d iscus sions . Johnson (1975) conc urs with the Lawrence a nd Su nde l (1972) guidelines an d add s th at problem-solving skills sho uld be taught and an effort be made to include individuals of di fferent socioeco no mic levels, ages, and probl ems in th e sa me group so th at th e gro up has many d ifferent viewp oints in discu ssions. R oss (197 4) proposed sim ila r guidel ine s for cond ucti ng grou p th erap y with alcoholi cs.
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CONC LUS IO N The va rio us pr oblems t hat ha ve , t hus fa r, be e n dealt wi th through th e use of be ha vioral grou p tec h niq ues ha ve been su rveye d . Kn owl ed ge of the m ethod s used to cha nge the s urve yed beha vior s, u nderstanding of the procedures fo r acc om p lishing in-t he ra py process objectives, a nd a n a wa reness of the guide lines for cond ucting behavio ra l group therapy sho uld prep are research ers a nd t herap ists to refine methods a nd ex pa nd t he a reas in whi ch beh a vior al gro u p method s may be used.
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Ferinden , W . E. ( 197 1), Beh a vior istic Psych odrama : A T echniq ue for M od ifyin g Aggr essive Beha vior in C hi ldren. Group Psychother. & Psychodrama, 24 :101-106 . Galass i, J. P., Ga llass i, M. D ., a nd Litz, M . C . ( 1974), Assertiv e Trainin g in G roup s Using Vid eo Feedba ck. J. Counsel. Psychol., 21 :390-394. G raz ia no, A. M . ( 1970), A Gro u p Treatment Approac h to M ult iple Problem Beh avio rs of Au tist ic C hi ld ren . Exceptional Children. 36:765 -770 . H au ser ma n, N ., Zweb ack, S., a nd Plot kin , A. ( 1972 ), Use of Co ncrete R einfor ceme nts to Facili ta te Verba l In itia tion s in Ad olescent G rou p Ther ap y. J. Consult . & Gin. Psychol., 38 :90-96. J oa nni ng, H . ( 1974), Beha vior al Rehearsal Ver sus Trad itio na l Ther a py in the Grou p Trea tm ent of Socia lly Non asser t ive Ind ividual s. Dissertation Abstracts International, 34:4665-4666 B (U niversity Mi crofilm s No . 7388) . J ohnson, W . G . ( 1975), Gro up T hera py : A Beh a vior al Per sp ecti ve. Behan. Th er.. 6 :30 -38 . Kap lan . H . I. , a nd Sa do ck, B. (eds .) ( 197 1), Comprehensioe Group Psychotherapy. Ba lt imor e : Will iams & Wilkins. Ka rah n. ~I. , Strenger, S., a nd C herry, N . (1966) , Group Co unseling a nd Beha vior The rapy with T est A nx ious Co llege Stu den ts. J. Consult. Psychol., 30 :544-549. K illia n D. H . ( 197 1), T he Effect of Instructions a nd Soc ia l Re infor cem ent on Selected C at egories of Beh a vior Em itted by Dep ressed Per son s in a Sma ll Gro up Sett ing. Dissertation Abstracts International, 32:3640 B (U niversity Mi cr ofilms No. 72-944). Konda s, O . ( 1967 ), Red uction of Exa mina t ion Anx iety a nd Stage F right by G ro up Desen siti zati on a nd Relax ation . Behao, Res. & T her.. 5: 171-181. Kru eger. D. E. ( 197 1), O pe ra nt Group T herapy with Delinqu ent Boys Usi ng Ther apist ' 5 Versus Peer 's Reinforcem ent. Dissertation Abstracts International, 3 1:6877-6878B. Lawren ce , H ., and Sunde l, M . ( 1972), Beh avior M od ificati on in Ad ult Groups. Social Work, 17:34-43. La za rus, A. A. ( 196 1), G ro u p Ther ap y of Phobic Disorder by System ati c Dese nsiti za tion . J. Abn. Soc. Psychol., 63 :504-510. Leon , H . V. (1965 ), Recip roca l Inh ibition : An Eva luat ion of Grou p Procedures with " No rma l" Snak e Ph obic Subj ect s. D issertation A bstracts In ternational, 28 :38 78-3879 B (U niversi ty M icrolil m s No. 68-3752). Lewi nsoh n, P. ~ I. , W ein stein, M. S., and Alpe r , T. ( 1970) , A Beh avioral Approach to the G roup Trea tment of Dep ressed Perso ns : A M eth od ological Cont ri but ion. J. Gin. Psychol., 26 :525-532 . Liber ma n, R . ( 1970) , A Beh a viora l App roach to G ro up Dyna mi cs : II. Reinfor cin g a nd Prom ptin g Hostility-t o-t he-Therapi st in G roup Ther a py. B ehao, Ther., 1:3 12-327. _ __ ( 197 1), Beha vioral G roup T her apy : A C ont rolled C linic a l Study. Brit. ]. Psvchiat., 19:535-544 . Litvak : S. B. (1969 ), A Com pa rison of T wo Brief G ro u p Beh a vior Ther a py T echniqu es in the Reduction of Avoida nce Beha vio r. Psychol. R ec., 19 :329-33 1. M eich e nba um , D. H. , G ilmo re, J. B., a nd Fed ora viciu s, A. ( 197 1), G ro u p In sight Versus G ro up Desensiti zat ion in T reating Speech Anxiety. ]. Consult. & Gin . I' IJChol.. 36 :4 10-42 1. M cM a nus, M . ( 197 1), G roup Desensiti zat ion of T est Anxie ty. Behav. Res. & Th er., 9:5 1-56 .
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Wh itm an , T. L. ( 1972 ), Aversive Contro l of Smoking Beha vior in a Group C onte xt. Behav. Res. & Ther., 10:97-104 . Wigg in s, S. L. , a nd Sa lzberg, H . C. ( 1966 ), Co ndi tioni ng aga inst Silence and Therapist Directed Comments in Group Psychotherapy Usi ng Auditory St im ula tion. Psychol, Rep., 18:59 1-599. Wilt z, N . A. ( 1970), M odifi cat ion of Behav ior s of Deviant Boys through Parent Parti cip ation in a Group T ech nique. Dissertation Abstracts International, 30:4786-478 7A (U nive rsity M icrofi lm s No . 70-9482). Woll ersheim, J. P. ( 1970), Effectiven ess of Group Therapy Based on Learni ng Prin ciples in th e Treatment of O verweight Women. ]. Abn. Psychol., 76 :462474 . Wo lpe, J. ( 1958) , Psychotherapy b)' Reciprocal Inhibition. Stanford, Calif. : Stanford University Press .
Mr . Harris 's address: Psychology Internship Program Camarillo State Hospital Camarillo, Calif. 930 10
