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PubMed1991

Assertiveness, social support, and psychological adjustment following spinal cord injury.

Tested predictions that assertiveness and social support would be significantly predictive of psychological adjustment. Furthermore, it was anticipated that assertiveness and certain types of social relationships would differentially interact to predict adjustment, since positive and negative effects of both variables have been noted in prior research. Trained raters interviewed 156 persons receiving either in-patient or out-patient care for cord injuries and administered measures of assertiveness, social support, depression and psychosocial impairment. Persons who reported a keen sense of responsibility for the welfare of another reported more depression and impairment. Persons reporting higher levels of support facilitating social integration and reassuring personal worth were less depressed. Several significant interactions between assertiveness and different social support relationships revealed beneficial and deleterious effects on depressive behavior and impairment secondary to the disability. Results are discussed as they advance theoretical understanding of the effects of assertiveness and social support. Implications for discriminate cue learning in assertion training for persons with physical disability are proposed.

Adaptation, Psychological↗
PubMed1989

Psychometric properties and social correlates of assertion measures in chronic alcoholics.

Assertion is a major focus of many social skills interventions for alcoholics. The assessment of assertion often relies on self-report measures. However, few psychometric data are available on the most frequently used instruments. This study determined the internal characteristics and structure of two commonly employed measures of assertion: the Wolpe-Lazarus Assertion Inventory and the Callner-Ross Assertion Inventory. In addition, the relationship between responses on these devices and demographic variables, extent of substance abuse, and level of social functioning were examined. Results indicated that both inventories exhibit adequate internal consistency and test-retest reliability. Factor structures were relatively simple and represented general assertion situations. Results are discussed in terms of the need for further refinement of these instruments.

Adult↗
PubMed1997

Assertion training therapy in psychiatric milieus.

The current investigation involved an attempt to develop a clinical procedure to decrease anxiety and increase responsiveness (assertion) of psychiatric inpatients of both sexes in mixed diagnostic categories and to evaluate the effectiveness of the procedure. Using a Solomon Four-Group Design, patients, matched on age, sex, and diagnosis, were assigned to one of the following conditions: (1) pretest, treatment, posttest; (2) pretest, no treatment, posttest; (3) treatment, posttest; or (4) no treatment, posttest. The Gambrill-Richey Assertive Inventory was used to assess patient Degree of Discomfort and Response Probability with and without assertion training therapy. Results indicated that (1) patients receiving assertion training therapy were less anxious and more responsive after treatment than before, (2) patients receiving assertion training therapy were less anxious and more responsive than were matched control subjects, (3) control subjects who received no assertion training therapy and who were pretested showed moderate significant gains on the posttest measure, (4) patients reported a greater reduction of anxiety than they did an increase in responsiveness, and (5) pretesting did not significantly influence posttest scores.

Adult↗
PubMed1997

Sexual Assertiveness Scale (SAS) for women: development and validation.

Four studies were conducted to develop and validate the Sexual Assertiveness Scale (SAS), a measure of sexual assertiveness in women that consists of factors measuring initiation, refusal, and pregnancy-sexually transmitted disease prevention assertiveness. A total of 1,613 women from both university and community populations were studied. Confirmatory factor analyses demonstrated that the 3 factors remained stable across samples of university and community women. A structural model was tested in 2 samples, indicating that sexual experience, anticipated negative partner response, and self-efficacy are consistent predictors of sexual assertiveness. Sexual assertiveness was found to be somewhat related to relationship satisfaction, power, and length. The community sample was retested after 6 months and 1 year to establish test-retest reliability. The SAS provides a reliable instrument for assessing and understanding women's sexual assertiveness.

Adult↗
PubMed2003

Self-reported assertiveness in Swedish and Turkish adolescents: a cross-cultural comparison.

The present cross-cultural study compared self-reported assertiveness in 652 Swedish and 654 Turkish high school students by using a multi-dimensional measure called the Scale for Interpersonal Behavior (SIB). Four hypotheses were tested in the study. First, the hypothesis that Swedish adolescents would be more assertive than their Turkish counterparts was supported by the data. Second, the expectation that Turkish boys would be more assertive than Turkish girls, while there would be no differences between Swedish girls and boys, was not confirmed. In general, girls were found to be more skilled than boys in expressing and dealing with personal limitations. Third, as expected, more assertive adolescents in both Sweden and Turkey reported having more friends and receiving more social support than their less assertive peers. Finally, the data supported the expectation that older adolescents would be more assertive than younger ones. The results are discussed in terms of cultural and gender differences.

Adolescent↗
PubMed1987

The emergence of assertion and aggression during infancy: a psychoanalytic systems approach.

A model is presented in which assertion and aggression are seen as arising from two entirely different biopsychological systems in the human infant. Assertion derives from the universal tendency to be active, to seek stimuli, to generate plans, and to carry them out. It is a self-activating system and is generally associated with the positive affects of joy, interest, and excitement. Aggression derives from the equally universal self-protective system. This system, however, is reactive in the face of a perceived threat and is associated with the dysphoric affects of anger, fear, and distress. During the infant and toddler period, the child's assertions may be treated punitively by the parents as if they were aggressive acts. The child in turn feels threatened and becomes self-protective. The result is a contamination between assertion and aggression and the creation of a new self-sustaining system in which aggression appears to be spontaneous and self-activating. If assertions are frequently blocked, the contamination may be extensive, and it may appear as if an aggressive instinctual process is present. However, a systemic explanation provides a much better fit with the empirical observations than does an instinctual one. Four examples of different family styles are presented. The model permits one to understand the subtle qualitative differences in style reflecting different individual combinations of assertion and aggression and their associated affects.

Affect↗
PubMedDate not supplied

Assertiveness training using rehearsal and modeling with male alcoholics.

Two different forms of an assertiveness training program were designed for use in an inpatient ward at a VA hospital. Alcoholic subjects were pretested on self-report, behavioral and unobtrusive measures of assertiveness, and randomly assigned to one of three conditions: rehearsal group, modeling group, or discussion control group. Six 1-h group assertiveness training sessions were held over a 2-week period. On completion of the assertiveness training, trained subjects scored significantly higher on the measures of assertiveness than did controls; they also received more regular (vs irregular) discharges from the hospital. These alcoholic patients responded best to a treatment based on rehearsal. At a 2-month follow-up interview from date of discharge from the hospital, assertiveness trained subjects reported less drinking and more abstinent days than controls, though the differences were not statistically significant. Collateral report of subject behaviors generally agreed highly with subject report though collaterals gave slightly less favorable reports. Results were discussed in terms of the problems in conducting follow-up research and in terms of application to alcoholism treatment.

Adult↗
PubMed2005

Social skill in self-assertive strategies of toddlers with depressed and nondepressed mothers.

The authors examined the effects of maternal depression on the skillfulness of toddlers' self-assertive strategies in interactions with their mother and with a female examiner. The participants were 110 mothers and their 26-month-old toddlers. Of these mothers, 57 had experienced an episode of clinical depression sometime since their child's birth, and 53 had had no history of depression. Toddlers exposed to maternal depression demonstrated significantly less social skill in their self-assertive strategies and more defiance when interacting with their mothers than did toddlers who were never exposed to maternal depression. The chronicity and severity of toddlers' exposure to maternal depression did not account for more pronounced differences in toddlers' skill in self-assertion toward mothers; however, toddlers exposed to more chronic courses of depression demonstrated less skill in their self-assertion toward the examiner. Toddlers who were exposed to maternal depression with a comorbid anxiety disorder did not exhibit less skill in their self-assertion toward mothers than did toddlers in either the depression-only or nondepressed groups. These findings suggest that exposure to maternal depression may interfere with toddlers' development of socially competent self-assertion strategies and may pose risks for future problems in the mother-toddler relationship.

Adult↗
PubMed2006

[A concept analysis of assertiveness].

PURPOSE: The purpose of this study was to analyze and clarify the meaning of the concept, assertiveness. METHOD: This study used Walker and Avant's process of concept analysis. RESULTS: 1. Attributes of assertiveness were defined as 1) Self-esteem 2) Comprehension to others 3) Clarification of the subject 4) Verbal communication 5) Non-verbal communication. 2. The antecedents of assertiveness consist of these facts 1) The occurrence of a conflict situation 2) The occurrence of will to stick to one's opinions. 3. There are consequences occurring as a result of assertiveness 1) Positive self-confidence 2) Increased comprehension or consideration to others 3) Expand of mutual respect 4) Maintenance of continuously cooperative relationship with each other 5) Output of acceptable results to each other. CONCLUSION: Assertiveness is a core human behavior and is key to interpersonal relationships. Using the components of the concept of assertiveness, many conflicts in a nursing situation can be effectively prevented.

Assertiveness↗
PubMed2000

Examining communication and assertiveness as predictors of condom use: implications for HIV prevention.

The current study explored the relationship between communication and assertiveness in general and sexual contexts and examined each construct's differential ability to predict reported condom use among college students. The results suggest that the constructs are positively related to each other, but general communication does not predict sexual assertiveness. Although sexual assertiveness is a better predictor of condom use than general assertiveness, general communication, and sexual communication, it needs to be considered within the context of other variables (e.g., normative beliefs regarding condom use). HIV prevention programs and models of health behavior should incorporate individual characteristics such as sexual assertiveness. The results of this study suggest that sexual assertiveness, social norm perceptions of condom use, self-efficacy for HIV prevention, and condom attitudes are among the critical variables that should be examined in an integrated model of sexual health behavior.

Adolescent↗
PubMed1987

Assessment of assertion.

Behavioral assessment of assertion is an evolving technology. Although there have been many recent advances in the assessment of assertion, many unresolved issues continue to plague researcher and clinician alike. At a conceptual level, a precise theoretical rationale of assertion has yet to be articulated and accepted. Comprehensive identification of the various parameters that influence assertive responding have not been adequately evaluated, although person and situational variables are widely accepted parameters. Although a plethora of assessment instruments and strategies have emerged, more attention needs to be diverted to establishing their psychometric properties. There have been some promising starts, though there continues to be relatively little psychometric support for the adequacy of existing measures. Several self-report instruments have reasonably well-documented reliability and validity, but questions remain regarding the accuracy of self-reported assertion. In addition, a flood of new instruments continues the proliferation of measures. Researchers would be better advised to direct their efforts to establishing psychometric support for the more promising of the existing instruments than in continuing to expand energy on unproven new measures. Serious reservations have emerged regarding, in particular, the external validity of role-play assessment and cloud the confidence that can be placed on findings generated from role-play measures. The issues that have been critically identified throughout this chapter are not new. They occur time and time again in the assessment literature of the past decade. Yet the field continues to reflect inattention to cautions that have been repeatedly voiced. Measures continue to flood the literature without adequate psychometric support, and researchers rush toward outcome evaluation without attending to the questionable utility of findings generated from unproven measures. There has been a great deal of progress in a relatively short period of time. However, clearer answers are necessary before scientific credibility can be established for social skills research in general--and assertion research in particular.

Arousal↗
PubMed1977

Assessing assertion in the elderly: an application of the behavioral-analytic model of competence.

This study developed a behavioral measure of assertiveness for older adults. The behavioral assessment device was developed by use of procedures outlined by Goldfried and D'Zurilla (1969) and Price and Bouffard (1974). Four assertion-appropriate situations for older adults were developed. The situations were administered to 33 Ss. Their responses were scored two ways, for overall assertion and content assertion. Generalizability of the device was examined. Reliability of judges' ratings (for assertion and content) was high, as was test-retest reliability. Assertion was shown to be situation-specific since estimated individual by situation uninerse variance was relatively hight. The assessment device showed significant concurrent validity, although the evidence for construct validity was minimal. Despite the rigorousness of the methods involved, the behavioral-analytic model of competence (Goldfried & D'Zurilla, 1969) has both theoretical and practical advantages in constructing other assessment devices for the elderly.

Aged↗
PubMed1998

Refusal of out-of-hospital medical care: effect of medical-control physician assertiveness on transport rate.

OBJECTIVE: Previous studies have shown that contacting an on-line medical-control physician increases the transport rate of patients who attempt to refuse medical assistance. The authors studied the physician-patient interaction to determine the type of interaction that was more likely to result in patient transport. METHODS: A prospective, observational study of patient-initiated refusals of medical assistance (RMAs) was performed in a suburban volunteer emergency medical services (EMS) system, with 12 receiving hospitals county-wide. Medical-control contact was required for all patient-initiated RMAs. Consecutive patients who attempted out-of-hospital RMA over a 3-month period were monitored. Structured data instruments were completed by the medical-control operator and medical-control physician for all patients who attempted RMA. Data collected included patient demographics and contact information, scene characteristics, history and physical examination data, length of time of interaction, and the physician's assessment of the need for transport and the patient's capacity to refuse transport. The operator and physician independently graded the physician's assertiveness in talking to the patient on a continuous 10-point scale. RESULTS: There were 130 patients who attempted RMA; 69 (53%) refused transport even after discussion with the medical-control physician, while 61 (47%) were transported to a hospital. The patients who were transported did not differ from those not transported with respect to age, chief complaint, vital signs, or presence of police on scene. Using the operators' independent assessments, the physicians were more assertive when they graded the patient as being more ill (needs transport, 8.8; may need transport, 7.7; doesn't need transport, 4.1; p < 0.01). When the physicians were more assertive, the patients were more likely to agree to transport (assertiveness > 8, 81% transport; assertiveness < 8, 19% transport; p < 0.01). CONCLUSIONS: Contact with a medical-control physician appears to markedly improve the transport rate for patients who initially attempt to refuse out-of-hospital medical care. This is especially so when physicians are more assertive in recommending transport.

Chi-Square Distribution↗
PubMed2002

An exploratory study of what clients like least about assertive community treatment.

As part of a larger interview, clients of assertive community treatment programs answered an open-ended question about what they liked least about assertive community treatment. Of 182 clients, 44 percent reported that they disliked nothing; 21 percent said that they disliked features that are considered specific to assertive community treatment, such as home visits, or that have been criticized in the literature, such as intrusiveness; 16 percent said that they were dissatisfied with underimplementation of elements thought to characterize assertive community treatment, such as frequency of visits; and 19 percent said that they were dissatisfied with general aspects of mental health service delivery, such as an inconvenient office location. Compared with clients of programs with low levels of fidelity to assertive community treatment, clients of high-fidelity programs had fewer complaints overall and fewer complaints about features considered to be specific to assertive community treatment.

Behavior Therapy↗
PubMed2007

A comparison of assertive community treatment and intensive case management for patients in rural areas.

OBJECTIVE: This article reviews the evidence for the effectiveness of community-based services for rural areas, specifically assertive community treatment and intensive case management. Service delivery to persons with severe mental illness in rural areas is challenged by low population densities, limited services, and shortages of professionals. METHODS: A comprehensive literature search identified six studies of rural assertive community treatment, only two of which were controlled studies, and four rural intensive case management studies, only one of which was a controlled study. Assertive community treatment would seem ideally suited to areas lacking services because of its self-contained multidisciplinary treatment team approach. However, rural programs have been forced to make several adaptations to the assertive community treatment model, including smaller teams, less comprehensive staff, and less intensive services. There is no published evidence that these adaptations are able to produce the same results as full-fidelity teams. Some believe that intensive case management may be an alternative to assertive community treatment in rural settings because intensive case management emphasizes individual caseloads, fewer staff, less intensive contacts, and brokered services. CONCLUSIONS: The evidence suggests that intensive case management programs are effective only in community settings where there is an ample supply of treatment and support services. To build the evidence base for the effectiveness of these models, much more attention needs to be focused on evaluating the current wave of assertive community treatment and intensive case management dissemination in rural areas.

Case Management↗
PubMed1979

Assessment of assertiveness in drug abusers.

Administered measures of assertion, social assertion, aggression, and social anxiety to a heroin-addicted population, psychotic outpatients, court-referred drug users and a college student group (N = 114). The addicts and court-referred drug patients were less assertive, less socially assertive, and more socially anxious than non-addict populations. Furthermore, the heroin and psychiatric outpatient groups had a very high correlation between their assertion and aggression scores, which was not found in the college student or court-referred, drug-using group.

Adolescent↗
PubMed1984

Conversational skills for autistic adolescents: teaching assertiveness in naturalistic game settings.

A naturalistic social skills training program was used to teach assertive responses to three autistic adolescents. Training and assessment of positive and negative assertions occurred in the context of two game situations-a card game and a ball game. Training consisted of modeling and behavioral rehearsal prior to each game, with tokens delivered contingent on assertive responses. Evaluation of training effects was accomplished in a multiple baseline across response classes. The results demonstrated the effectiveness of the procedure in generating high levels of positive and negative assertions that maintained across a 4.5-month follow-up interval. This in vivo procedure for teaching social behaviors permits the concurrent acquisition of assertive responses and leisure behaviors, two skills that are of special importance in improving the quality of autistic youth's experiences with their peers.

Adolescent↗
PubMed1982

Interpersonal reactions to assertive and unassertive styles when handling social conflict situations.

Determining how persons perceive and evaluate social assertiveness is a particularly important topic, since assertive training is primarily intended to alter the behavior of individuals in the context of social interactions. In the present study, college students observed videotapes which showed a model handling several social conflict situations in either an assertive or an unassertive manner. Because race in individual may also influence the way assertiveness is viewed, both black and white models were used. Subjects then completed a 26-item adjective checklist to evaluate the personality of the model they observed. Results indicated that while assertive models were viewed as skilled and able in their handling of the portrayed social conflict situations, they were rated much less favorably than unassertive models on 14 adjectives assessing likeability. Race of model did not differentially affect this pattern. Implications of these findings are discussed.

Adult↗