extinguishing or modifying smoking behavior: a comparison

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Master's Theses Graduate College

11-1972

Extinguishing or Modifying Smoking Behavior: A Comparison of Extinguishing or Modifying Smoking Behavior: A Comparison of

Four Therapeutic Techniques Four Therapeutic Techniques

Alcid M. Pelletier

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Recommended Citation Recommended Citation Pelletier, Alcid M., "Extinguishing or Modifying Smoking Behavior: A Comparison of Four Therapeutic Techniques" (1972). Master's Theses. 2813. https://scholarworks.wmich.edu/masters_theses/2813

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EXTINGUISHING OR MODIFYING SMOKING BEHAVIOR: A COMPARISON OF FOUR THERAPEUTIC TECHNIQUES

byA l c i d M. P e l l e t i e r

A T h e s i s S u b m i t t e d t o t h e

F a c u l t y o f The G r a d u a t e C o l l e g e i n p a r t i a l f u l f i l l m e n t

o f t h eD e g r e e o f M a s t e r o f A r t s

W e s t e r n M ic h i g a n U n i v e r s i t y K a la m a z o o 3 M ic h i g a n

D e c e m b e r , 1972

R eproduced with perm ission of the copyright owner. Further reproduction prohibited without perm ission.

ACKNOWLEDGEMENTS

I w i s h t o e x p r e s s s i n c e r e a p p r e c i a t i o n t o

D r . M alco lm R o b e r t s o n , t o D r . P a u l F u l l e r an d t o

D r . W i l l i a m C a r l s o n f o r t h e i r e n c o u r a g e m e n t a n d

g u i d a n c e i n t h e p r e p a r a t i o n o f t h i s t h e s i s . My

t h a n k s a l s o a r e e x p r e s s e d t o D r . B r a d l e y H u i t e m a

f o r h i s s u g g e s t i o n s a n d g u i d a n c e i n s t a t i s t i c a l

d e s i g n an d t o M r s . S a n d r a Borgman f o r t y p i n g t h e

r e s u l t s o f t h e p r e s e n t s t u d y .

A l c i d M. P e l l e t i e r


MASTERS THESIS M-4101

PELLETIER, Alc id M.EXTINGUISHING OR MODIFYING POKING BEHAVIOR: A COMPARISON OF FOUR THERAPEUTIC TECHNIQUES.

Western Michigan U n ivers i ty , M.A., 1972 Psychology, exper imental

University Microfilms, A XEROX Company , Ann Arbor, Michigan


PLEASE NOTE:

Some pages may have

indistinct print.

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TABLE OP CONTENTS

ACKNOWLEDGEMENTS i i

INDEX OF TABLES i v

INDEX OP FIGURES v

INTRODUCTION 1

S u rv e y o f L i t e r a t u r e and R e s u l t s 1

The P r e s e n t P r o b le m 10

METHOD 12

S u b j e c t s 12

D e s i g n 13

P r o c e d u r e 16

CO2 I n h a l a t i o n 19

C o v e r t S e n s i t i z a t i o n -S y s t e m a t i c D e s e n s i t i z a t i o n 21

C o n t r a c t u a l Management 2 6

C o u n t i n g - I n t e r a c t i o n an dS u p p o r t i v e C o u n s e l i n g 28

RESULTS 30

DISCUSSION 40

REFERENCES 45

APPENDICES 53


INDEX OF TABLES

T a b l e

1 D a ta o b t a i n e d I n i n t e r v i e w s w i t h s i x t e e n s u b j e c t s e n r o l l e d i n a S m o k e r s ' C l i n i c

2 D a ta c o m p a r i n g s i x t e e n s u b j e c t s a s s i g n e d t o f o u r d i f f e r e n t t r e a t m e n t s g r o u p s i n a S m o k e r s ’ C l i n i c

3 P e r c e n t a g e o f b a s e l i n e o f c i g a r e t t e s smoked by s i x t e e n s u b j e c t s i n f o u r t r e a t m e n t c a t e g o r i e s o v e r f o u r w eeks o f t r e a t m e n t and o v e r e i g h t weeks o f f o l l o w - u p w i t h o u t t r e a t m e n t

4 A n a l y s i s o f v a r i a n c e o f w e e k l y c i g a r e t t e c o n s u m p t i o n d u r i n g a f o u r week t r e a t m e n t p e r i o d a s co m p ared t o o p e r a n t l e v e l

5 A n a l y s i s o f v a r i a n c e o f w e e k l y c i g a r e t t e c o n s u m p t i o n d u r i n g a n e i g h t week p o s t t r e a t m e n t f o l l o w - u p a s c o m p a r e d t o o p e r a n t l e v e l

Page

15

17

31

37

39


INDEX OF FIGURES

F i g u r e

1 C i g a r e t t e c o n s u m p t i o n a s p e r c e n t a g eo f o p e r a n t l e v e l f o r f o u r g r o u p i n g s o f s u b j e c t s o b t a i n i n g t r e a t m e n t o v e r f o u r weeks a n d f o r e i g h t w eeks o f f o l l o w - u p w i t h o u t t r e a t m e n t

v


Page

33

INTRODUCTION

S u r v e y o f L i t e r a t u r e and R e s u l t s

S i n c e t h e U n i t e d S t a t e s S u r g e o n G e n e r a l ' s r e p o r t

( A d v i s o r y C o m m i t t e e , 1 9 6 4 , 1 9 7 1 ) , many s m o k e r s ' c l i n i c s

h a v e come i n t o b e i n g and a n i n c r e a s i n g number o f s t u d i e s

h a v e b e e n c o n d u c t e d on r e l a t e d t e c h n i q u e s t o a s s i s t p e r

s o n s i n e l i m i n a t i n g t h e t o b a c c o h a b i t . B e r n s t e i n ( 1 9 6 9 )

a n d K e u t z e r , L i c h t e n s t e i n , and Mees ( 1 9 6 8 ) , i n t h e i r

r e v i e w s , r e p o r t a n e x t e n s i v e v a r i e t y o f t r e a t m e n t t e c h

n i q u e s w h ic h h a v e b e e n u t i l i z e d i n a t t e m p t s t o t r e a t

t o b a c c o a d d i c t i o n . Many o f t h e s t u d i e s , w h i l e c a r r i e d

o u t i n c l i n i c a l s e t t i n g s , h a v e l a c k e d a s u f f i c i e n t

amount o f s u b j e c t s ( S s ) o r f a i l e d t o a d e q u a t e l y s p e c i f y

a n d c o n t r o l many v a r i a b l e s . O t h e r s w e r e c o n d u c t e d i n

t o o b r i e f a p e r i o d w i t h n o t e n o u g h t r e a t m e n t s e s s i o n s .

S t i l l o t h e r s f a i l e d t o t e s t f o r h o l d o v e r e f f e c t s o f

t r e a t m e n t t e c h n i q u e s by s i m p l y n e g l e c t i n g t o f o l l o w - u p

o v e r a p e r i o d o f w e e k s . T h u s , many s t u d i e s f a i l t o show

i f t h e r e was a r e v e r s a l o f sm o k in g b e h a v i o r a f t e r t r e a t

ment h a d s t o p p e d .

M c F a r la n d (1 9 6 9 ) a s s e r t s p h i l o s o p h i c a l l y t h a t t h e

t o b a c c o h a b i t c a n be e l i m i n a t e d i n f i v e d a y s b u t f a i l s

t o p r o v i d e any s u p p o r t i n g c l i n i c a l d a t a i n e v i d e n c e .

B e r n s t e i n ( 1 9 6 9 ) , Cahoon ( 1 9 7 1 ) , and K e u t z e r ,

1


L i c h t e n s t e i n , and Mees (1 9 6 8 ) r e p o r t t h a t m os t o f t h e

i m p o r t a n t v a r i a b l e s w h ic h c o n t r o l sm ok ing b e h a v i o r a r e

e i t h e r unknow n, o r n o t a d e q u a t e l y b r o u g h t u n d e r c o n t r o l

i n t r e a t m e n t s c h e d u l e s . They c o n c l u d e t h a t t h e t h r e e

m o s t e f f e c t i v e v a r i a b l e s f u n c t i o n i n g i n t h e m a j o r i t y o f

t h e t r e a t m e n t s c h e d u l e s a r e a n x i e t y a r o u s a l , t h e power

o f s u g g e s t i o n , and p l a c e b o e f f e c t s . I t i s n o t e d t h a t

many d e f i c i e n c i e s i n s p e c i f i c i t y o f d e s i g n , c o n t r o l s ,

s t a t i s t i c a l a n a l y s i s o r p o s t - t e s t s , l i m i t t h e v a l u e o f

many s t u d i e s a p p e a r i n g i n t h e l i t e r a t u r e .

Not t o o much s u c c e s s h a s b e e n r e p o r t e d f ro m t h e u s e

o f a u t o m a t e d e q u i p m e n t . A z r i n a n d P o w e l l ( 1 9 6 8 )

d e v e l o p e d a s p e c i a l l y d e s i g n e d c i g a r e t t e c a s e w h ich

a u t o m a t i c a l l y l o c k e d f o r a p e r i o d o f t i m e when a S t o o k

a c i g a r e t t e f rom i t . Smoking was r e d u c e d t o l e s s t h a n

h a l f t h e b a s e l i n e r a t e ; h o w e v e r , o n l y f i v e Ss w ere u s e d

i n t h e e x p e r i m e n t . F r a n k s , F r i e d , and Ashem ( 1 9 6 6 ) w e re

no more s u c c e s s f u l w i t h t h e i r a u t o m a t e d m a c h i n e w h ic h

b l e w h o t smoke i n t o t h e S ’ s f a c e when he p u f f e d on a

c i g a r e t t e , a n d c o o l a i r when he r e f r a i n e d f r o m s m o k in g .

O nly n i n e S s w ere u s e d i n t h e i r e x p e r i m e n t . W hi le

G re e n (1 9 6 4 ) u s e d 30 S s , h i s e x p e r i m e n t , u s i n g a u t o m a t e d

m u s i c , was r e s t r i c t e d t o r e t a r d a t e s who m e r e l y t o o k more

d r a g s t o smoke a s many c i g a r e t t e s a s t h e y h ad p r e v i o u s l y

c o n s u m e d .


3

C o n s i d e r a b l e r e s e a r c h r e p o r t s t h e e f f e c t i v e n e s s o f

p u n i s h m e n t a s a v e r s i v e - c o n d i t i o n i n g i n t r e a t i n g u n d e s i r e -

a b l e b e h a v i o r s ( A z r i n & H o l z , 1 9 6 6 ; B a n d u r a , 1 9 6 9 ;

C a m p b e l l & C h u r c h , 1 9 6 9 ; So lom on , 1 9 6 4 ) . S e l f - a d m i n i s

t e r e d a v e r s i v e s t i m u l i i n t h e fo rm o f e l e c t r i c s h o c k s

was shown t o be a n e f f e c t i v e t h e r a p e u t i c t e c h n i q u e i n

e x p e r i m e n t s c o n d u c t e d by B u t c h e r ( 1 9 6 8 ) , McGuire &

V a l l a n c e ( 1 9 6 4 ) , Mees ( 1 9 6 6 ) , a n d Ober ( 1 9 6 6 ) , b u t

f a u l t y d e s i g n s a n d i n s u f f i c i e n t n u m b ers o f Ss make t h e

f i n d i n g s g e n e r a l l y i n c o n c l u s i v e . B e r e c z (1971» 1 9 7 2 ) i n

a n e x p e r i m e n t w i t h 44. Ss f o u n d s e l f - a d m i n i s t e r e d p a i n f u l

s h o c k f o r i m a g i n e d an d a c t u a l s m o k in g s u c c e s s f u l i n

t r e a t i n g b o t h i m a g i n e d and a c t u a l m o d e r a t e sm o k in g among

m a l e s , s u c c e s s f u l f o r i m a g i n e d h e a v y sm o k in g , b u t u n s u c

c e s s f u l i n t r e a t i n g a c t u a l h e a v y sm o k in g m a le s . However,

r e s u l t s w ere i n c o n c l u s i v e f o r f e m a l e S s . S e v e r a l e a r l i e r

e x p e r i m e n t s a l s o r e p o r t e d t h a t s h o c k i n g a c t u a l s m o k in g

b e h a v i o r among h e a v y sm o k e r s was a n i n e f f e c t i v e t r e a t

ment ( B e r n s t e i n , 1 9 6 9 ; K o e n ig & M a s t e r s , 1 9 6 5 ; O b e r ,

1 9 6 6 , 1 9 6 8 ; a n d P o w e l l & A z r i n , 1 9 6 8 ) .

R e s n i c k ( 1 9 6 8 ) u s e d a s a t i a t i o n t e c h n i q u e s u c c e s s

f u l l y w i t h t h r e e - f o u r t h s o f t h e Ss t r e a t e d i n on e

e x p e r i m e n t . H o w ev er , t h e f a c t t h a t h e u s e d o n l y e i g h t

Ss may l i m i t t h e r e s u l t s . I n a l a t e r e x p e r i m e n t u s i n g

60 S s , R e s n i c k (1968 b ) a p p l i e d s a t i a t i o n t e c h n i q u e s


a n d s u c c e e d e d o n l y i n r e d u c i n g t h e sm oking l e v e l .

M a r s t o n & M c F a l l (1 9 7 1 ) a l s o f a i l e d t o show a n y l a s t i n g

s u c c e s s i n m o d i f y i n g sm o k in g b e h a v i o r t h r o u g h t h e

s a t i a t i o n m e th o d .

E x p e r i m e n t s e m p l o y i n g c o n t i n g e n c y management t e c h

n i q u e s h av e met w i t h v a r i e d a n d c o n t r a d i c t o r y r e s u l t s .

H a l l (1 9 7 1 ) r e p o r t e d c o n t i n u e d s u c c e s s w i t h one g r a d u a t e

s t u d e n t . However , a s t u d y c o n t a i n i n g o n l y one S h a s

l i m i t e d g e n e r a l i z i n g v a l u e . Lawson and May (1 970)

r e p o r t e d c o n t i n g e n c y m anagem ent t o be e f f e c t i v e t o a

p o i n t o f s t a t i s t i c a l s i g n i f i c a n c e (P-C.00 .1) i n r e d u c i n g

s m o k in g b e h a v i o r . H ow ever , t r e a t m e n t e f f e c t s , when

c o m p a re d w i t h t h r e e o t h e r t r e a t m e n t t e c h n i q u e s , showed

no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e . I n t e r a c t i o n

b e t w e e n t r e a t m e n t e f f e c t s an d t h e f i v e weeks o f t h e

e x p e r i m e n t a l s o f a i l e d t o show s t a t i s t i c a l s i g n i f i c a n c e .

W h i le t e c h n i q u e s e m p l o y i n g c o n t r a c t u a l management

r e p o r t some s u c c e s s i n r e d u c i n g t h e number o f c i g a r e t t e s

co n s u m e d , one s t u d y (Lawson & May, 1970) f a i l e d t o

i n c l u d e f o l l o w - u p d a t a t o m e a s u r e p o s t - t r e a t m e n t e f f e c t s .

The e x p e r i m e n t a l d e s i g n o f a n o t h e r ( T o o l e y & P r a t t , 1 9 6 7 )

d i d n o t p e r m i t a s t u d y o f d i f f e r e n t i a l e f f e c t s , s i n c e

t h e i r t r e a t m e n t t e c h n i q u e s c o m b in e d a s e q u e n c e o f c o v e r t

s e n s i t i z a t i o n , c o n t i n g e n c y m a n a g em en t , and c o n t r a c t u a l

m a n a g e m e n t .


A t e c h n i q u e w h i c h h a s g a i n e d w i d e s p r e a d p u b l i c i t y

i s t h e t h e r a p e u t i c u t i l i z a t i o n o f i m a g i n a t i o n ( C a u t e l a ,

1 9 6 6 , 1 9 6 7 , 1 9 7 0 ; G old & N e u f e l d , 1 9 6 5 ; Homme, 1965 ;

M ees, 1 9 6 6 ; W olpe , 1 9 6 9 ) . S e v e r a l s t u d i e s h a v e shown

t h e p r a c t i c e o f v i s u a l im a g e r y t o h a v e a s u b - h y p n o t i c

e f f e c t , a n d t o i n d u c e m u s c u l a r r e l a x a t i o n e f f e c t i v e l y i n

t r e a t i n g p h o b i c b e h a v i o r s ( D a v i s o n , 1 9 6 8 ; L a n g , L a z o v i k ,

& R e y n o l d s , 1 9 6 5 ; S c h u b o t , 1 9 6 6 ) . I n s e v e r a l e x p e r i m e n t s

im a g e r y h a s b e e n shown t o be a n e f f e c t i v e t r e a t m e n t

t e c h n i q u e f o r v a r i e d m a l a d a p t i v e b e h a v i o r s , s u c h a s

t r a n s v e s t i s m and f e t i s h i s m an d i n t r e a t i n g d e a f - m u t e s

( J a c o b s e n , 1 931 ; Malmo, 1 9 6 2 ; Marks & G e l d e r , 1967 ; Max,

1 9 3 5 , 1 9 3 7 ) .

U n f o r t u n a t e l y , many o f t h e s e r e p o r t s h a v e n o t

c l e a r l y s p e c i f i e d t h e v a r i a b l e i s s u e s w h i c h a r e i n v o l v e d

i n t h e p r o c e s s o f t r a n s f e r r i n g e f f e c t s f r o m i m a g i n e d

r e s p o n s e s t o r e a l l i f e r e s p o n s e s , t h u s , m a k in g i t

d i f f i c u l t f o r an i n v e s t i g a t o r t o r e p l i c a t e t h e f i n d i n g s

o f t h e s e s t u d i e s .

The t e c h n i q u e o f i m a g i n a t i o n h a s b e e n shown t o be

e f f e c t i v e i n two f o r m s o f t r e a t m e n t , ( 1 ) c o v e r t s e n s i t i

z a t i o n , a n d (2 ) s y s t e m a t i c d e s e n s i t i z a t i o n . Hogan &

K i r c h n e r (1 9 6 7 ) u s e d c o v e r t s e n s i t i z a t i o n e f f e c t i v e l y i n

e x t i n g u i s h i n g l e a r n e d p h o b i c b e h a v i o r s . The u s e o f t h i s

t r e a t m e n t h a s r e p o r t e d s u c c e s s i n t r e a t i n g c o m p u l s i v e


6

b e h a v i o r ( C a u t e l a , 1 9 6 6 ) , h o m o s e x u a l i t y (Gold & N e u f e l d ,

1965) and g e n e r a l m a l a d a p t i v e a n d p h o b i c b e h a v i o r s

(Homme, 19 6 5 ; M ees , 1 9 6 6 ; W olpe , 1 9 6 9 ) . S e v e r a l s t u d i e s

r e p o r t s u c c e s s i n l e s s e n i n g o r e x t i n g u i s h i n g t h e sm o k in g

h a b i t by c o v e r t s e n s i t i z a t i o n ( C a u t e l a , 1970 ; Lawson &

May, 1 9 7 0 ; R u t n e r , 19 6 7 ; Wagner & B r a g g , 1 9 7 0 ) . '

S i n c e W olpe*s (1 9 5 8 ) d e s c r i p t i o n s o f s y s t e m a t i c

d e s e n s i t i z a t i o n h a v e become w i d e l y known, t h e r e h a v e

a p p e a r e d a number o f s t u d i e s u s i n g t h e m e thod w i t h v a r y

i n g d e g r e e s o f s u c c e s s . The e x t e n t o f i t s s u c c e s s c a n

g e n e r a l l y be t r a c e d to: t h e e f f e c t i v e n e s s o f t h e p e r s o n

u s i n g i t , r a t h e r t h a n t h e m e th o d by i t s e l f , u n d e r s c o r i n g

a g a i n t h e v i t a l i m p o r t a n c e o f v a r i a b l e s r e l a t e d t o

t h e r a p i s t c o m p e t e n c y . On t h e o t h e r h a n d , s e v e r a l w e l l

d e s i g n e d s t u d i e s c a n be c i t e d w h i c h g i v e c r e d e n c e t o t h e

p l a c e b o i n f l u e n c e s o f s y s t e m a t i c d e s e n s i t i z a t i o n i n

t r e a t i n g p h o b i a s a n d l e a r n e d m a l a d a p t i v e b e h a v i o r s

( D a v i s o n , 1 9 6 8 ; G e e r , & K a t k i n , 1 9 6 6 ; K o e n ig & M a s t e r s ,

1 9 6 5 ; L a n g , L a z o v i k & R e y n o l d s , 1 9 6 5 ; M a r c i a , R u b i n &

E f r a n , 1 9 6 9 ; M a r s t o n & M e P a l l , 1 9 7 1 ; McGlynn, M e a l i e a &

Nawas, 1 9 6 9 ; M cReynolds & T o r i , 1 9 7 2 ; O l i v e a u , A g r a s ,

L e i t e n b e r g , Moore & W r i g h t , 1 9 6 9 ; P a u l , 19 6 9 ; P y k e ,

Agnew & K o p p e ru d , 1 9 6 6 ; S c h u b o t , 1 9 6 6 ; Wolpe, 1 9 6 1 , 1 9 6 8 ,

1 9 6 9 ) . P a u l ( 1 9 6 9 ) and Rachman ( 1 9 6 7 ) c o m b i n i n g s y s t e

m a t i c d e s e n s i t i z a t i o n w i t h r e l a x a t i o n t e c h n i q u e s co m p a red


t h e a p p r o a c h w i t h o t h e r b e h a v i o r a l t h e r a p i e s and r e p o r t e d

t h a t s y s t e m a t i c d e s e n s i t i z a t i o n had a t t e n t i o n - p l a c e b o

e f f e c t s c o n s i s t e n t l y more e f f e c t i v e t h a n d i d o t h e r t e c h

n i q u e s . A two y e a r f o l l o w - u p s t u d y , o ne o f t h e l o n g e s t

known, o f s y s t e m a t i c d e s e n s i t i z a t i o n i n g r o u p t h e r a p y

showed a m a i n t e n a n c e o f e f f e c t i v e n e s s i n t h e u s e o f t h i s

t e c h n i q u e ( P a u l , .1968 ) .

The a p p a r e n t s u c c e s s o f t h e u t i l i z a t i o n o f i m a g i n a

t i o n t h e r a p e u t i c a l l y h a s e v o k e d an i n t e r e s t i n c o m b i n i n g

t h e two m e th o d s t h a t employ i t . Wolpe ( 1 9 5 8 ) e x p l o r e d

t h e s e q u e n t i a l u s e o f t h e two m e th o d s by e m p lo y in g a v e r -

s i v e c o n d i t i o n i n g t h r o u g h i m a g i n a t i o n t o e l i m i n a t e some

u n d e s i r e d b e h a v i o r s o r p h o b i a s . Upon a c h i e v i n g s u c c e s s ,

he d e s e n s i t i z e d t h e c l i e n t s so t h e y would s t o p i m a g i n i n g

t h e a v e r s i v e s t i m u l u s . C a u t e l a (1 9 6 6 ) h y p o t h e s i z e d t h a t

by a l t e r n a t i n g t h e m e th o d s o f s y s t e m a t i c d e s e n s i t i z a t i o n

a n d c o v e r t s e n s i t i z a t i o n , c u e s w h ic h h a v e b e e n a s s o c i a t e d

w i t h a v e r s i v e s t i m u l i w i l l become d i s c r i m i n a t i o n s t i m u l i

f o r a v o i d a n c e b e h a v i o r . A c o m b i n a t i o n o f t h e two m e th o d s

h a s b e e n shown t o be more e f f e c t i v e i n t r e a t i n g h o s p i t a l

i z e d a l c o h o l i c s t h a n u s i n g a v e r s i o n t h e r a p y a l o n e

(L an y o n , P r im o , T e r r i l l & W ener , 1 9 7 2 ) . The c o m b i n a t i o n

o f t h e two m e th o d s i n t r e a t i n g h a b i t u a l sm o k in g h a s b e e n

s u p p o r t e d by r e s e a r c h . Wagner & B ra g g ( 1 9 7 0 ) t r e a t e d

sm o k e r s f o r a t o t a l o f l e s s t h a n t h r e e h o u r s . A f t e r a


8

9 0 - d a y f o l l o w - u p , t h e y s u g g e s t e d t h e a d v a n t a g e o f com

b i n i n g c o v e r t s e n s i t i s a t i o n , s y s t e m a t i c d e s e n s i t i z a t i o n ,

and i n s t r u c t i o n s . G e r s o n & Lanyon (1 9 7 2 ) r e p o r t e d a

s i g n i f i c a n t r e d u c t i o n ( P - < . 0 5 ) i n sm oking was m a i n t a i n e d

e v e n 13 weeks a f t e r t r e a t m e n t had s t o p p e d .

One o f t h e m os t r e c e n t h y p o t h e s e s on t h e r e a s o n s

f o r t o b a c c o a d d i c t i o n i s p r o p o s e d by Cahoon (1 9 7 1 ) who

w r i t e s ,

" . . . t h a t c h r o n i c c i g a r e t t e sm o k in g may l e a d t o a v i c i o u s c i r c l e o f C02 d e p l e t i o n d ue t o a t y p i c a l b r e a t h i n g h a b i t s r e l a t e d t o c h r o n i c smoke i n h a l a t i o n an d e x a c e r b a t e d by t h e i n f l u e n c e o f n i c o t i n e , f o l l o w e d by a h i g h CO2 i n t a k e t h r o u g h c i g a r e t t e smoke i n h a l a t i o n [ p p . 2 4 8 - 2 4 9 ] "

E v i d e n c e t o s u p p o r t t h i s h y p o t h e s i s i s p r e s e n t e d by

t h e A d v i s o r y C o m m it te e t o t h e S u r g e o n G e n e r a l o f t h e

P u b l i c H e a l t h S e r v i c e ( 1 9 6 4 ) w h ic h n o t e s t h a t t h e r e i s a

9 - 5 $ CO2 c o n c e n t r a t i o n i n t h e g a s e s i n h a l e d i n t o b a c c o

smoke a n d t h a t t h e r e may be a c o n t i n u i n g n e e d f o r t h i s

c o n c e n t r a t i o n o n ce t h e h a b i t i s f o r m e d . The A d v i s o r y

C o m m i t t e e ’s R e p o r t a l s o d e n i e s t h a t h a b i t u a l s m o k e r s

d e v e l o p a t i s s u e o r p h y s i o l o g i c a l need f o r t o b a c c o s i n c e

t h e r e a r e no w i t h d r a w a l symptoms f o u n d among t h o s e who

s t o p sm o k in g a s t h e r e a r e among t h o s e who s t o p u s i n g n a r

c o t i c s . I t h a s b e e n shown t h a t CO2 c o n c e n t r a t i o n s o f

10% a n d o v e r b r e a t h e d f o r 10 o r more m i n u t e s m o s t g e n e r

a l l y r e s u l t s i n l o s s o f c o n s c i o u s n e s s i n humans (Brown,

1 9 3 0 ) .


H e a t h (1 9 5 8 ) s u p p o r t s t h e C02 h y p o t h e s i s a s a

r e s u l t o f h i s r e s e a r c h . He c o n c l u d e s t h a t h e a v y sm okers

b r e a t h e more r a p i d l y , i n d u c i n g a C02 d e f i c i e n c y s i m i l a r

t o t h a t e x p e r i e n c e d i n h y p e r v e n t i l a t i o n . Thus h e a v y

s m o k e r s , l i k e h y p e r v e n t i l a t o r s , s u f f e r a l o s s o f a l v e o

l a r C02 r e s u l t i n g i n d i z z i n e s s a n d f e e l i n g s o f a n x i e t y .

The n i c o t i n e c o n t e n t may a l s o h a v e a n e f f e c t r e s u l t i n g i n

more r a p i d b r e a t h i n g , a n d , i n t u r n , C02 d e p r i v a t i o n .

Meduna ( 1 9 5 8 ) , who h a s done e x t e n s i v e r e s e a r c h w i t h C02

t h e r a p y among t h o s e s u f f e r i n g n e r v o u s d i s o r d e r s , r e p o r t s

t h a t C02 c o n c e n t r a t i o n s o f 10% o r l e s s hav e n a r c o t i c

e f f e c t s on mammals i n g e n e r a l .

S e v e r a l s t u d i e s i n d i c a t e t h a t CO.g t h e r a p y h a s met

w i t h f a v o r a b l e r e s u l t s . The t e c h n i q u e h a s b e e n s u c c e s s

f u l l y e m p lo y e d i n t r e a t i n g a n x i e t y , p s y c h o s o m a t i c p r o b

lem s a n d c o n v e r s i o n r e a c t i o n s (McGraw & O l i v e r , 1959)

an d a l c o h o l a d d i c t i o n (Thompson, 1 9 5 9 )* C a r b o n d i o x i d e

b u i l d - u p i n t h e l u n g s may be a c c o m p l i s h e d by b r e a t h -

h o l d i n g p r a c t i c e , t h u s p r e v e n t i n g t h e h y p e r v e n t i l a t i o n

syndrom e o f CO2 l o s s . One s t u d y , u s i n g t h e b r e a t h -

h o l d i n g t e c h n i q u e , f o u n d t h a t i t s e r v e d a s a t e m p o r a r y

s u b s t i t u t e f o r sm o k in g b e h a v i o r , b u t i t was n o t s u c c e s s

f u l i n b r e a k i n g t h e sm o k in g h a b i t (M ees , 1 9 6 6 ) . R e l i a b l e

d a t a s u p p o r t i n g s y s t e m a t i c e x p e r i m e n t a t i o n w i t h r e s p e c t .

t o CO2 t h e r a p y i n t r e a t i n g sm o k in g b e h a v i o r i s l a c k i n g .


10

The P r e s e n t P r o b l e m

A r e v i e w o f t h e l i t e r a t u r e r e v e a l s v a r y i n g d e g r e e s

o f s u c c e s s i n t r e a t i n g t o b a c c o a d d i c t i o n . The p r e s e n t .

s t u d y u t i l i z e d an d c o m p a re d tw o b e h a v i o r a l t e c h n i q u e s i n

a d d i t i o n t o CO2 i n h a l a t i o n and t h e p s y c h o d y n a m ic t e c h

n i q u e . The two b e h a v i o r a l t e c h n i q u e s u t i l i z e d some

t r a d i t i o n a l s u p p o r t i v e c o u n s e l i n g a s r e i n f o r c e m e n t .

O t h e r s t u d i e s h a v e r e p o r t e d t h e b e n e f i t s o f t h i s

a p p r o a c h i n d e c e l e r a t i n g c o m p u l s i v e and m a l a d a p t i v e

b e h a v i o r s ( C a r t e r & S t u a r t , 1 957 ; D ' A l e s s i o , .1968;

H e r s e n , 1 9 7 0 ; K a n f e r , 1 9 6 6 ; L e v e n t h a l , 1 9 6 8 ; P e l l e t i e r ,

1 9 7 1 ) •

One o f t h e p u r p o s e s o f t h i s s t u d y was t o e x p l o r e

C a h o o n ’ s (1 9 7 1 ) C02 h y p o t h e s i s , u s i n g a m o d i f i c a t i o n o f

Mees (1 9 6 6 ) o b s e r v a t i o n c o n c e r n i n g t h e p o s s i b l e b e n e f i t s

o f p r a c t i c i n g b r e a t h h o l d i n g . The h y p o t h e s i z e d b e n e f i t s

o f c o m b i n i n g c o v e r t s e n s i t i z a t i o n an d s y s t e m a t i c d e s e n s i

t i z a t i o n ( C a u t e l a , 1 9 66) p r o v i d e d some i n c e n t i v e t o

e x p l o r e i t s p o s s i b i l i t i e s a s was done i n t h e p r e s e n t

t h e r a p e u t i c s t u d y . The h y p o t h e s i s o f T o o l e y & P r a t t

( 1 9 6 7 ) t h a t c o n t r a c t u a l management w ould p r o v e e f f e c t i v e

i n m o d i f y i n g t h e t o b a c c o h a b i t s e r v e d a s a t h i r d p o i n t

o f i n v e s t i g a t i o n . The f o u r t h a r e a r e s e a r c h e d t h e e f f e c t s

o f m e r e l y c o u n t i n g c i g a r e t t e sm ok ing f r e q u e n c y (Lawson

& May, 1 9 7 0 ; M e F a l l , 1 9 7 0 ; O b e r , 1 9 6 8 ) , c o m b in e d w i t h


11

p s y c h o d y n a m ic s u p p o r t i v e c o u n s e l i n g (K o e n ig & M a s t e r s ,

1 9 6 5 )• F i n d i n g t h e b e s t t e c h n i q u e t o h e l p t h e c l i e n t

o c c u p i e d a m a j o r i n t e r e s t r a t h e r t h a n a t t e m p t i n g t o

p r o v e t h e e f f e c t i v e n e s s o f a s p e c i f i c t e c h n i q u e (Munro,

1 9 5 1 ) .

The p r e s e n t s t u d y was d e s i g n e d t o e x p l o r e , c l a r i f y

an d com pare some o f t h e i s s u e s n o t e d i n t h e l i t e r a t u r e .

I t was h y p o t h e s i z e d t h a t a c o m b i n a t i o n o f c o v e r t s e n s i

t i z a t i o n an d s y s t e m a t i c d e s e n s i t i z a t i o n would be t h e

m os t e f f e c t i v e t r e a t m e n t t e c h n i q u e , and c o u n t i n g i n t e r

a c t i o n c o m b in e d w i t h s u p p o r t i v e c o u n s e l i n g would b e t h e

l e a s t e f f e c t i v e . I t was a l s o e x p e c t e d t h a t c o n t r a c t u a l

management would be more e f f e c t i v e t h a n CO2 a s a t r e a t

ment t e c h n i q u e . However , t h e h y p o t h e s i s d i d n o t o c cu p y

a s i n t e n s e a n i n t e r e s t i n t h e s t u d y a s d i d a c o n c e r n

t o d i s c o v e r t e c h n i q u e s w h ic h c o u l d b e a p p l i e d t o t r e a t

i n g t h e p r e s e n t p r o b l e m . I t was f e l t t h a t t h i s c o n c e r n

would s e r v e t o m i n i m i z e e x p e r i m e n t e r b i a s .


METHOD

S ub j e c t s .

The Ss e m p lo y e d i n t h i s s t u d y came t o t h e Human

D e v e lo p m e n t M i n i s t r i e s C e n t e r 1 i n r e s p o n s e t o a b r i e f

n e w s p a p e r a r t i c l e a p p e a r i n g i n t h e Grand R a p i d s P r e s s

( s e e A p p e n d ix A ) , a n a n n o u n c e m e n t i n two i s s u e s o f 2

R a p p o r t ( s e e A p p e n d ix B ) , p o s t e r s p l a c e d i n 30 b u s i n e s s

e s t a b l i s h m e n t s , h e a l t h f o o d s t o r e s an d c h u r c h f o y e r s

( s e e A p p e n d ix C ) , a n d g e n e r a l p e r s o n - t o - p e r s o n a n n o u n c e

m e n t s .

A t o t a l o f 30 p e r s o n s r e q u e s t e d i n f o r m a t i o n c o n c e r n

i n g t h e " S m o k e r s ' C l i n i c , " some i n p e r s o n a l i n t e r v i e w s

a n d o t h e r s o v e r t h e t e l e p h o n e . A l l i n q u i r e r s w ere

s c r e e n e d by a s e r i e s o f q u e s t i o n s c o n c e r n i n g t h e e x t e n t

o f t h e i r d e s i r e t o q u i t s m o k i n g . T hose who r e p o r t e d t h e y

w e re s i m p l y " c u r i o u s , " o r who f e l t t h e y c o u l d "meet new

p e o p l e by g o i n g t o t h e c l i n i c , " o r who w a n t e d t o g i v e up

s m o k in g o n l y " f o r a s h o r t t i m e " t o p r o v e t h e y c o u l d do i t

w e re n o t a c c e p t e d f o r t r e a t m e n t . Only t h o s e who r e p o r t e d

1An a f f i l i a t e a g e n c y s p o n s o r e d by t h e G rand R a p i d s , M i c h i g a n D i s t r i c t o f t h e R e o r g a n i z e d C h u rch o f J e s u s C h r i s t o f L a t t e r Day S a i n t s .

2 A m o n t h l y l 6 - p a g e n e w s p a p e r o f t h e a b o v e m e n t i o n e d d i s t r i c t e d i t e d by t h e e x p e r i m e n t e r o f t h e p r e s e n t s t u d y .

12


»■ T ,

1 3

a s i n c e r e d e s i r e t o c o m p l e t e l y g i v e up t h e sm oking h a b i t

w e re e n r o l l e d i n t h e t h e r a p e u t i c s e s s i o n s . A l l Ss

r e p o r t e d s m o k in g o n l y c i g a r e t t e s . T h e r e were n i n e m a l e s

and s e v e n f e m a l e s (N = 16) who e n r o l l e d . I n f o r m a t i o n on

e a c h o f t h e Ss was o b t a i n e d i n i n d i v i d u a l o r i e n t a t i o n

i n t e r v i e w s a n d i s n o t e d i n T a b l e 1 .

The a g e s o f t h e Ss a r e n o t e d (R ange = 1 6 -5 8 y e a r s ,

X = 3 4 . 5 y e a r s ) . I t c a n be s e e n t h a t t h e g r e a t e s t num

b e r o f Ss h a d c o n t i n u e d t h e t o b a c c o h a b i t f o r many y e a r s

(Range = 1 . 5 - 4 0 y e a r s , X = 1 6 . 2 2 y e a r s ) . A l l b u t one

o f t h e Ss h a d made e a r l i e r a t t e m p t s t o g i v e up smoking

(Range = 0 - 1 0 t i m e s , X = 6 t i m e s ) . W i t h o n l y one e x c e p

t i o n , a l l Ss i n e a r l i e r a t t e m p t s t o g i v e up t h e t o b a c c o

h a b i t h a d r e f r a i n e d f ro m s m o k in g f o r l e s s t h a n two weeks

(13 Ss h a d q u i t f o r o n l y one w eek o r l e s s ) .

D e s i g n

The 16 Ss who w ere a c c e p t e d w e r e p r e - t e s t e d p r i o r t o

t h e b e g i n n i n g o f t h e a c t u a l t r e a t m e n t . Each S was

i n s t r u c t e d t o c o n s c i e n t i o u s l y k e e p a n a c c u r a t e d a i l y

r e c o r d o f t h e am ount o f t o t a l c i g a r e t t e s smoked f o r a

p e r i o d o f o n e week w h i l e d e l i b e r a t e l y m a i n t a i n i n g h i s

r e g u l a r s m o k i n g h a b i t . The Ss w e re p r o v i d e d w i t h i n d i

v i d u a l d a i l y r e c o r d i n g s h e e t s , 8 1 / 2 b y 11 i n c h e s ( s e e

A p p e n d ix D) w h i c h h a d d e s i g n a t e d p l a c e s t o i n c l u d e t h e

S ' s name, d a t e o f b e g i n n i n g o f r e c o r d i n g , a d a i l y d a t e


14

T a b l e 1

D a ta O b t \ i n e d i n I n t e r v i e w s W ith S i x t e e n S u b j e c t s E n r o l l i n g i n a S m o k e r s ’ C l i n i c

N Sex Age HowManyY earsW ithH a b i t ?

E v e ry T r y To Q u i t ?Yes/No ? How O f t e n ? L o n g e s t

Y o u 'v eS t o p p e d ?

n l M 16 1 . 5 Yes 5 . 5 d a y s

n 2 M 58 30 No 0 0

n 3 M 57 40 Yes 8 2 weeks

n 4 . F 46 24 Yes 6 2 weeks

n 5 F 27 13 Yes 10 6 m o n th s

n 6 F 16 3 Yes 8 2 d a y s

n 7 F 46 26 Yes 9 1 week

n 8 M 28 11 Yes 5 3 d a y s

n 9 F 35 16 Yes 7 6 d a y s

n 10 M 41 22 Yes 9 1 week

n l l M 35 19 Yes 6 1 week

n 12 M 29 10 Yes 5 . 5 d a y s

n 13 F 32 13 Yes 4 4 d a y s

n l 4 M 28 10 Yes 7 5 d a y s

n 15 M 33 14 Yes 5 3 d a y s

n l 6 F 25 7 Yes 2 4 d a y s

N=l6 £ = 552. 2 5 9 -5 . 96

x= 3 4 . 5 1 6 . 2 2 .6.


15

c o lu m n , a co lum n for* r e c o r d i n g sm ok ing f r e q u e n c y and a

c o lu m n f o r comments t h e S m i g h t c a r e t o i n c l u d e . These

r e c o r d i n g s h e e t s w e re r e t u r n e d t o t h e t h e r a p i s t t o com

p u t e i n d i v i d u a l S b a s e l i n e o f d a i l y c i g a r e t t e consump

t i o n .

H o m o s c e d a s t i c i t y was a c c o m p l i s h e d f ro m t h e d a t a

o b t a i n e d i n b a s e l i n e p r e - t e s t s by a s s i g n i n g e a c h S t o

o ne o f f o u r g r o u p s r e p r e s e n t i n g t h e l e v e l o f c i g a r e t t e

a d d i c t i o n . The se w e re (1 ) Low ( r a n g e = 1 0 - 2 3 c i g a r e t t e s

smoked d a i l y , X = 1 7 * 5 ) ; ( 2 ) L ow -M odera te ( r a n g e = 2 9 - 3 0 ,

X = 2 9 - 5 ) ; ( 3 ) M o d e ra t e ( r a n g e = 3 5 - 3 6 , X = 3 5 - 2 5 ) ; and

(4 ) Heavy ( r a n g e = 3 9 - 4 5 , X = 4 1 .5 ) l e v e l s o f sm ok ing .

S e v e r a l o t h e r s t u d i e s i n c l u d e d t h o s e who smoked 20

c i g a r e t t e s a d a y i n t h e h e a v y s m o k e r s c a t e g o r y ( B e r n s t e i n ,

1 9 6 9 ; K o e n ig & M a s t e r s , 1 9 6 5 ; O b e r , 1 9 6 6 ; P o w e l l &

A z r i n , 1 9 6 8 ) . I n e a c h o f t h e f o u r l e v e l s , n = 4 . T h i s

a s s i g n m e n t o f Ss was s i m i l a r t o one u s e d by Lawson and

May ( 1 9 7 0 ) , a l t h o u g h t h e y u s e d o n l y t h r e e l e v e l s .

S t r a t i f i e d s a m p l i n g was a c c o m p l i s h e d by t a k i n g t h e

Ss f ro m t h e f o u r hom ogeneous p o p u l a t i o n s a n d r a n d o m ly

a s s i g n i n g them t o f o u r d i f f e r e n t t r e a t m e n t g r o u p s . C a re

was t a k e n t o s e e t h a t e a c h t r e a t m e n t g r o u p r e c e i v e d b u t

one S f ro m e a c h o f t h e f o u r l e v e l s o f a d d i c t i o n . T h e re

w e re f o u r Ss i n e a c h t r e a t m e n t g r o u p . A m a t r i x o f t h e s e

S a s s i g n m e n t s a n d t r e a t m e n t t e c h n i q u e s i s n o t e d i n


1 6

T a b l e 2 . I t c a n be n o t e d , when c o m p a r i n g T a b le 2 a n d

T a b l e 1 , t h a t . the Ss w e re f a i r l y e v e n l y d i s t r i b u t e d

a c c o r d i n g t o a g e , s e x , t o t a l y e a r s o f a d d i c t i o n , a n d

e a r l i e r a t t e m p t s t o q u i t s m o k i n g .

The mean d a i l y b a s e l i n e o f a d d i c t i o n was q u i t e

s i m i l a r i n e a c h t r e a t m e n t c o n d i t i o n a s a r e s u l t o f

s t r a t i f i e d s a m p l i n g . T h i s l a t t e r m e a s u re was t h e m os t

i m p o r t a n t , s i n c e t h e s t u d y was p r i m a r i l y i n t e r e s t e d i n

s t u d y i n g t h e p o s s i b l e e f f e c t s a n d i n t e r a c t i o n o f f o u r

d i f f e r e n t t r e a t m e n t t e c h n i q u e s a p p l i e d o v e r a p e r i o d o f

f o u r w e e k s . A ran d o m b l o c k f a c t o r i a l d e s i g n was em ployed

No a t t e m p t s w e re made t o s t u d y t h e e f f e c t s o f S a g e o r

s e x on e x t i n g u i s h i n g t h e t o b a c c o h a b i t .

To g r a p h i c a l l y v ie w t h e p o s s i b l e e f f e c t s o f t r e a t

m ent t e c h n i q u e s a c r o s s a f o u r week p e r i o d p l u s an e i g h t

week f o l l o w - u p , means o f c i g a r e t t e s smoked p e r d a y w ere

c om pu ted a n d p l o t t e d on a g r a p h .

P r o c e d u r e

F o u r d i f f e r e n t t r e a t m e n t m e th o d s w ere e m p lo y e d .

Each t r e a t m e n t t e c h n i q u e c o n t a i n e d r a n d o m ly a s s i g n e d

f o u r S s , one f r o m e a c h o f t h e f o u r b a s e l i n e o p e r a n t

l e v e l s o f d a i l y c i g a r e t t e c o n s u m p t i o n . A l l t r e a t m e n t

s e s s i o n s w ere c o n d u c t e d w i t h i n d i v i d u a l S s . T h e r e was

no g r o u p t h e r a p y i n t h e p r e s e n t s t u d y , a l t h o u g h t h e

r e s u l t s f r o m t h e t r e a t m e n t s c h e d u l e s w ere s t a t i s t i c a l l y


17

TABLE 2

D a t a C om par ing S i x t e e n S u b j e c t s A s s i g n e d t o F o u r D i f f e r e n t T r e a t m e n t G roups i n a S m o k e r s 1 C l i n i c

T r e a t m e n t T e c h n i q u e s (TT)

N Age Sex Y e a r sSm oking

TimesT r i e dToQ u i t

Number * o fC i g a r e t t e sa tB a s e l i n e

TTil n 5 27 F 13 10 3 0 (Low-Mod)

n 8 28 M 11 5 23 (Low)C02 n 10 4 l M 22 9 42 (H eavy)I n h a l a t i o n n 13 32 F 1 3 4 35 (Mod)

x = 32 14 .8 7 3 2 . 5

t t 2n l 16 M 1 . 5 5 1 0 (Low)

n 7 46 F 26 9 4 5 ( H e a v y )C o v e r t n Q 35 F 16 7 2 9 (Low-Mod)S e n s i t i z a t i o n - 9S y s t e m a t i c n 15 33 M 14 5 3 6 (Mod)D e s e n s i t i z a t i o n -----------------------------------------------------

___________________ X= 3 2 . 5 __________ 1 4 . 4 6 . 5 30t t 3

n ? 58 M 30 0 3 5 (Mod)

C o n t r a c t u a lManagement

“ 4

n ! 2

46

29

F

M

2410

6

5

3 0 (Low-Mod) 2 2 (Low)

n l 4 28 M 10 7 3 9 (H eavy)

X= 4 0 . 2 5 1 8 . 5 4 . 5 3 1 .5

t t 4 n 3 57 M 4o 8 3 5 (Mod)16 F 3 8 1 5 (Low)

C o u n t i n gI n t e r a c t i o n -S u p p o r t i v eC o u n s e l i n g

n l l

n l 6

3525

MF

197

62

4 0 (H eavy)2 9 (Low-Mod)

X= 3 3 . 5 1 7 . 2 5 6 2 9 . 7 5

* A c o m p a r i s o n o f c i g a r e t t e c o n s u m p t i o n a t b a s e l i n e y i e l d e d a n ^ 2 , 1 2 ~ ( n o t s i g n i f i c a n t ) .


18

co m p u te d by g r o u p i n g t h e Ss o f e a c h t r e a t m e n t : c a te :g o ry .

One e x p e r i m e n t e r (E) c o n d u c t e d a l l t h e t r e a t m e n t

s e s s i o n s i n t h e e n t i r e e x p e r i m e n t . Ea ch S met t w i c e a

week f o r 30 m inu te , s e s s i o n s a t t h e Human D e v e lo p m e n t

M i n i s t r i e s C e n t e r , i n t h e f i r s t s e s s i o n , a f t e r a s s i g n

ment t o a t r e a t m e n t s c h e d u l e , e a c h S was g i v e n a c o p y o f

a " P r e s c r i p t i o n f o r S m o k e rs " ( s e e A p p e n d i x E ) , a m o d i f i

c a t i o n o f M c F a r l a n d ’ s (1 9 6 9 ) f i v e d a y p l a n . The same

" P r e s c r i p t i o n " was g i v e n t o e a c h S i n a l l t r e a t m e n t c o n

d i t i o n s a f t e r i t was r e a d a l o u d a n d t h e E a s k e d t h e S i f

t h e r e w e re a n y q u e s t i o n s . No s p e c i f i c i n s t r u c t i o n was

g i v e n on r e l a x a t i o n ; t h e Ss s i m p l y w e re l e f t on t h e i r

own t o p r a c t i c e r e l a x a t i o n a s i n s t r u c t e d i n t h e " p r e

s c r i p t i o n . " The r e s t o f t h e f i r s t s e s s i o n was s p e n t i n

e x p l a i n i n g t h e t r e a t m e n t s c h e d u l e and g e n e r a l l y d i s c u s

s i n g t h e S ’s r e a s o n s f o r w a n t i n g t o s t o p sm o k in g a s w e l l

a s t h e g e n e r a l h e a l t h h a z a r d s a s s o c i a t e d w i t h t o b a c c o .

D u r i n g t h e i n i t i a l s e s s i o n t h e S was a l s o t o l d t h a t t h e

t r e a t m e n t s c h e d u l e a b o u t t o be e m p lo y e d i n a n a t t e m p t t o

e l i m i n a t e sm o k in g b e h a v i o r c o u l d a l s o b e g e n e r a l i z e d t o

d e a l i n g w i t h o t h e r m a l a d a p t i v e b e h a v i o r s .

The r e m a i n i n g s e v e n s e s s i o n s w e r e s p e n t i n ' a more

c o m p l e t e a p p l i c a t i o n o f t h e t r e a t m e n t t e c h n i q u e s . The

Ss w e re a l s o i n s t r u c t e d t o c o n t i n u e r e c o r d i n g t h e num ber

o f c i g a r e t t e s smoked d a i l y a n d t o r e p o r t t h e num ber t o


19

t h e E . A t w e n t y - f i v e d o l l a r r e g i s t r a t i o n f e e was c o l l e c

t e d t o i n s u r e a t t e n d a n c e a t t h e t r e a t m e n t s e s s i o n s a s

w e l l a s c o n t i n u e d r e c o r d k e e p i n g . The r e g i s t r a t i o n f e e

was r e t u r n e d a f t e r t h e e x p e r i m e n t was c o m p l e t e w i t h o u t .

b e i n g made c o n t i n g e n t on g i v i n g up t h e t o b a c c o h a b i t .

T r e a t m e n t T e c h n i q u e s (TT)

CC>2 I n h a l a t i o n = TT-j_. Ea ch o f t h e f o u r Ss i n t h i s

c a t e g o r y was g i v e n s i m p l e i n s t r u c t i o n s on b a s i c b r e a t h i n g

e x e r c i s e s an d how t o r e t a i n more CC>2 . They w ere r e a d

s p e c i f i c i n s t r u c t i o n s w h ic h w e re p r e p a r e d by t h e E, g i v e n

a n o p p o r t u n i t y t o d i s c u s s t h e i n s t r u c t i o n s , and h a n d e d a

p e r s o n a l c o p y t o r e f e r t o a t home f ro m t i m e t o t i m e .

The i n s t r u c t i o n s a s w r i t t e n w e r e :

1 . F i r s t t h i n g upon a r i s i n g e a c h m o r n i n g , y o u a r e t o p r a c t i c e d e e p b r e a t h i n g e x e r c i s e s f o r a p e r i o d o f a b o u t f i v e m i n u t e s .a . B r e a t h e i n a s much a i r a s p o s s i b l e ,

b r e a t h e v e r y d e e p l y a n d f i l l y o u r l u n g s a s c o m p l e t e l y a s p o s s i b l e .

b . H old t h e a i r i n y o u r l u n g s f o r a t l e a s t 5 - 1 0 s e c o n d s .

c . L e t a l l t h e a i r o u t v e r y s l o w l y .d . R e p e a t s t e p s a , b , c u n t i l f i v e m in

u t e s h a v e p a s s e d .(As you p r a c t i c e , y ou w i l l d i s c o v e r you w i l l be a b l e t o h o l d y o u r b r e a t h l o n g e r a n d l o n g e r . You a r e t o h o l d i t a s l o n g a s you c a n . W henever y o u f e e l y o u r s e l f b e c o m in g q u i t e d i z z y t o t h e p o i n t o f s w o o n i n g , y o u a r e t o s l o w l y l e t t h e a i r o u t o f y o u r l u n g s . )

2 . E v e r y t i m e y o u want t o smoke d u r i n g t h e d a y , b r e a t h e i n t o a s m a l l p a p e r o r p l a s t i c b a g . *H o ld b a g o v e r y o u r m o u th , b u t k e e p y o u r n o s e u n c o v e r e d by t h e b a g . W i th t h e b a g h e l d o v e r y o u r m o u th , b r e a t h e t h r o u g h y o u r n o s e


20 .

a n d m o u th f o r one m in u te . , rem ove t h e bag and b r e a t h e n o r m a l l y f o r 30 . s e c o n d s , r e p l a c e t h e b a g an d b r e a t h e t h r o u g h y o u r n o s e a n d m o u th f o r a n o t h e r one minute: p e r i o d . R e p e a t t h i s s e v e r a l t i m e s t h e n s t o p t h e e x e r c i s e an d go on y o u r w ay .R e p e a t t h i s s t e p e v e r y t i m e you g e t t h e u r g e t o smoke a g a i n .

3 . W henever i t i s n ' t c o n v e n i e n t t o u s e a b a g , s u c h a s when i n p u b l i c p l a c e s , s i m p l y p r a c t i c e d e e p b r e a t h i n g a n d h o l d i n g y o u r b r e a t h u n t i l you c a n h o l d i t w i t h o u t d i s c o m f o r t . Keep on r e p e a t i n g t h i s p r o c e s s s e v e r a l t i m e s u n t i l y o u b e g i n t o f e e l d i z z y .

* A s m a l l p l a s t i c b a g i s p r o v i d e d f o r y o u .I f y o u l o s e i t o r i t i s d e s t r o y e d , we w i l l f u r n i s h you w i t h a n o t h e r or. y o u may s u b s t i t u t e . a n y p a p e r o r p l a s t i c b a g o f c o m p a r a b l e s i z e .

A f t e r t h e i n s t r u c t i o n s w e re r e a d and e x p l a i n e d , t h e

E d e m o n s t r a t e d e x a g g e r a t e d d e e p b r e a t h i n g t o e n c o u r a g e

t h e S i n p r a c t i c i n g . The S was t h e n i n s t r u c t e d t o

p r a c t i c e d e e p b r e a t h i n g w h i l e t h e E t i m e d h im w i t h an

A p o l l o S to p W a tch . The E r e i n f o r c e d t h e S ' s p r a c t i c e

w i t h p r a i s e , i . e . , " g o o d " ; "hm, hm"; " e x c e l l e n t " ;

" b e a u t i f u l " ; e t c . The S ' s r e s p o n s e t o E r e i n f o r c e r s was

e v i d e n c e d i n g r e a t e r e a s e i n p r a c t i c e r e s u l t i n g i n

l o n g e r p e r i o d s o f b r e a t h h o l d i n g . A number o f o t h e r

s t u d i e s h a v e shown how E r e i n f o r c e r s o f p r a i s e i n

t h e r a p y s e s s i o n s p r o v e t o b e v e r y e f f e c t i v e ( B a r t z & Loy,

1 9 7 0 ; Namenek & S c h u l d t , 1 9 7 1 ; P e l l e t i e r , 1 9 7 1 ; T r a u x ,

1 9 6 6 ) .

The r e m a i n i n g s e v e n t h e r a p e u t i c s e s s i o n s w ere


21

d evoted to c o n t in u in g b reath c o n t r o l e x e r c i s e s , p r a c t i c e

b r e a th in g in to , a p l a s t i c bag, and d i s c u s s i n g and

r e i n f o r c i n g th e S ' s p r o g r e s s . The Ss were a l s o a d v ise d

o f th e g e n e r a l h e a l t h advantages o f p r a c t i c i n g deep

b r e a th in g and. good b rea th c o n t r o l .

Covert S e n s i t i z a t i o n - S y stem atic D e s e n s i t i z a t i o n =

TT2 • The f i r s t s e s s i o n was devoted to e x p la in in g th e

te c h n iq u e and to te a c h each S in t h i s c a te g o r y how to

r e l a x em ploying an a b b re v ia ted form o f J a c o b so n ’s (1925)

p r o g r e s s iv e r e l a x a t i o n te c h n iq u e . Lawson & May (1970)

used a s im i la r r e l a x a t i o n tech n iq u e i n a c o v e r t s e n s i

t i z a t i o n trea tm en t o f sm okers. The E dem onstrated th e

r e l a x a t i o n t e c h n iq u e , and d is c u s s e d i t s g e n e r a l advan

t a g e s when a p p l ie d to many i s s u e s o f d a i l y l i v i n g , b e fo re

h e lp in g th e S to p r a c t i c e th e e x e r c i s e s . About te n

m inutes in each o f th e rem ain ing t h e r a p e u t ic s e s s i o n s

were d evo ted to l e a d in g th e S in t o a r e la x e d s t a t e .

In th e f i r s t s e s s i o n the E read a loud a s h e e t o f

s p e c i f i c i n s t r u c t i o n s which he had prepared f o r t h e S.

He answered any q u e s t io n s th e S asked and th e n p rov id ed

th e S w ith a copy o f th e i n s t r u c t i o n s w ith d i r e c t i o n s

fo r th e S t o p r a c t i c e a t home. The i n s t r u c t i o n s as

w r i t t e n w e r e :

1 . For th e f i r s t two w e e k s :a . D a i ly p r a c t i c e r e l a x a t io n th e f i r s t th in g

i n th e m orning. (Use th e r e l a x a t i o n t e c h -


22

n i q u e s l e a r n e d i n t h e c l i n i c a l s e s s i o n s . )Do t h i s f o r t e n m i n u t e s .

b . A f t e r b e i n g r e l a x e d , i m a g i n e y o u r s e l f e n j o y i n g a c i g a r e t t e , and p r a c t i c e t h e i m a g e r y o f n a u s e a , v o m i t t i n g , e x t r e m e s t e n c h , an d d i z z i n e s s a s w e ' v e i m a g i n e d i n t h e c l i n i c a l s e s s i o n s . Do t h i s u n t i l yo u f e e l s i c k o r f o r a b o u t 10 m i n u t e s , w h i c h e v e r comes f i r s t .

c . D u r i n g t h e d a y , e v e r y t i m e you d e s i r e t o sm oke , r e p e a t , " I c h o o s e n o t t o smoke" a n d t r y t o r e c a l l t h e s i c k n e s s i m a g i n e d i n y o u r e a r l y m o r n i n g s e s s i o n n o t e d i n i t e m b . a b o v e .

2 . F o r t h e l a s t two w e e k s :a . C o n t i n u e t h e same p r a c t i c e n o t e d i n l a

a b o v e .b . A f t e r b e i n g r e l a x e d , p r a c t i c e t h e

h i e r a r c h y o f 15 i t e m s o f imagery , a g r e e d u p o n a n d w r i t t e n down i n t h e c l i n i c a l s e s s i o n s . T h e s e 15 im ag e s i n c l u d e 15 s i t u a t i o n s i n w h ic h you c a n i m a g i n e y o u r s e l f w a n t i n g t o smoke, b e g i n n i n g w i t h t h e l e a s t d e s i r e d an d e n d i n g w i t h t h e im age o f y o u r g r e a t e s t d e s i r e f o r a sm o k e . D u r i n g t h e r e c a l l o f t h e s e 15 i m a g e s , i m a g i n e y o u r s e l f w i t h o u t c i g a r e t t e s , t h u s u n a b l e t o sm oke . Do n o t r u s h t h r o u g h t h e i m a g e r y , t a k e t i m e t o i m a g i n e e a c h i t e m v i v i d l y . D u r i n g t h i s i m a g e r y , p r a c t i c e r e p e a t i n g , " I c h o o s e n o t t o s m o k e . "

c . D u r i n g t h e d a y , e v e r y t i m e you d e s i r e t o s m o k e , r e p e a t , " I c h o o s e n o t t o s m o k e , " a n d t r y t o r e c a l l t h e h i e r a r c h y o f 15 i m a g e s .

I n t h e c l i n i c a l s e s s i o n s , t h e E, by i n t e r v i e w i n g

t h e S , was a b l e t o d e t e r m i n e s i t u a t i o n s i n w h ic h t h e S

e n j o y e d a c i g a r e t t e . He h e l p e d p l a c e t h e S i n a r e l a x e d

s t a t e an d t h e n t o l d t h e S t o v i s u a l i z e ( w i t h h i s e y e s

c l o s e d ) l i g h t i n g a c i g a r e t t e , b r e a t h i n g t h e smoke d e e p l y ,

l a z i l y a n d e n j o y i n g l y , t h e n l e t t i n g i t a l l o u t s l o w l y .


23.

While th e S r e p e a te d t h i s v i s u a l i z e d smoking b e h a v io r ,

th e E noted s m i le s o f p le a s u r e on th e S ' s fa c e a f t e r a

few " p u ffs ." I t c o u ld a l s o be noted, th a t th e S was

a c t u a l l y g o in g through th e p h y s ic a l p r o c e s s o f deep

in h a l in g and s low r e la x e d e x h a l in g w h ile p u rs in g h i s

l i p s as though b r e a th in g out th e smoke. A f te r a few

"puffs" th e E stopped t a l k i n g about th e deep b r e a th s o f

smoke s a t i s f y i n g l y f i l l i n g th e S ' s lu n g s . G en er a lly th e

S con tin u ed th e p h y s i c a l p r o c e s s o f i n h a l in g and exh a lin g

r e f l e c t i n g h i s smoking im agery . On th e r a r e o c c a s io n s

when th e S d id s t o p , t h e E resumed t a l k i n g i n a s o f t

monotonous v o i c e to s u g g e s t th e image o f s a t i s f y i n g

sm oking .

When th e S c o n t in u ed to b rea th e d e e p ly a s though he

were ta k in g s a t i s f y i n g p u f f s on a c i g a r e t t e , w ith o u t the

E ’ s v o c a l s u g g e s t io n s , t h e E p e r m itted him t o c o n t in u e

f o r two or th r e e more " p u f f s ." At th a t p o i n t , th e E

in trod u ced th e im agined a v e r s iv e s t i m u l i which was most

n o x io u s to th e S a c c o r d in g to h i s r e p o r t s i n th e e a r l i e r

in t e r v ie w .

A t y p i c a l i n t r o d u c t i o n o f th e im agined a v e r s iv e

s t i m u l i might f i n d th e E s a y in g in a s o f t but f ir m v o i c e ,

"That l a s t p u f f su re t a s t e d g r e a t , g e t ready to ta k e a n o th er v e r y , v e r y deep drag on th e c i g a r e t t e . Now you take a deep hungry p u f f and you hear a c r a c k le and sm e ll a t e r r i b l e s t e n c h . As you i n h a l e ,


i t burns and you have a t e r r i b l e t a s t e in your m outh. What was th a t? You d o n ’t know so you ta k e a n oth er drag to g e t r i d o f th a t aw fu l t a s t e . T h ere ’ s an oth er c r a c k l in g n o i s e and th e s t i n k i s w o r se , your lu n g s are on f i r e and your mouth i s sour and s l i m y .You f e e l som ething c ra w lin g on your l i p and you brush i t away.- You lo o k a t your c i g a r e t t e and s e e m aggots c ra w lin g out o f i t .The c r a c k l in g n o i s e was burning m aggots.Somebody packed m aggots in your c i g a r e t t e and y o u ’ve been in h a l in g cooked s t in k in g s l im y m aggo ts . Your stomach i s churning and your mouth i s f u l l o f s l im y sour s a l i v a .You t r y to throw th e c i g a r e t t e aw ay , but i t i s s tu ck to your f i n g e r s . More maggots are c r a c k l in g . The s t i n k i s a lm ost u n b ea ra b le , th e smoke i s g o in g up your nose making you s i c k and d i z z y . Maggots are c ra w lin g out th e o th e r end o f th e c i g a r e t t e , onto your h an d s, up your arm, a c r o s s your s h o u ld e r , you c a n ' t move to rub them o f f . The c o ld s l im y m aggots are c r a w lin g up your neck a c r o s s your l i p s and up in to your n o s e . You f e e l them i n your n a s a l p a s sa g e s g o in g down in t o your mouth w h ile th e s t i n k and smoke are g e t t i n g worse and w orse . The sour s a l i v a i n your mouth s t in k s and your stomach i s churnin g u n c o n t r o l la b ly . You f e e l magg o t s craxvling down your t h r o a t . You c a n ' t stand i t anymore so you v o m it . You vomit out th e m a g g o ts , but now y o u 'v e g o t a new s t i n k , th e s t i n k o f vom it i s making you s i c k e r and s i c k e r . R e l i e f f i n a l l y comes as you v o m it , th e maggots are gone now, your stomach i s s e t t l i n g and th e s t i n k has subs id e d . Only a s l i g h t bad t a s t e rem ains in your mouth a s you r e p e a t , 'You w on't f in d me smoking a g a in . You won't f in d me smoking a g a i n . ’ Okay, open your e y e s . How do you f e e l? "

The fo r e g o in g i s an a b b r e v ia t io n o f a t y p i c a l E

v o c a l in p u t d u r in g th e s e s s i o n s . Whatever was rep o rted

th e most n ox io u s to th e S was used a s a r e f e r e n t in the

im agery. The E found th a t ab l i b b i n g through th e v o c a l


25

s u g g e s t i o n s was m o s t e f f e c t i v e b e c a u s e he c o u l d z e r o i n

o n im a g e s t h a t a p p e a r e d t o be g e t t i n g t h e m os t a v e r s i v e

r e a c t i o n s f ro m t h e S. I n a l l c a s e s , t h e Ss r e p o r t e d

a c t u a l l y h a v i n g t h e v i s c e r g e n i c s e n s a t i o n s d e s c r i b e d by

t h e E i n t h e i m a g e r y s e s s i o n s .

I n p r e p a r i n g t h e h i e r a r c h y o f 15 i t e m s o f i m a g e r y

f o r t h e l a s t two w eeks o f t r e a t m e n t , t h e E s im p l y w r o t e

down t h e l i s t a s r e p o r t e d by t h e S , t h u s e a c h 15 s t e p

h i e r a r c h y was u n i q u e t o t h e s p e c i f i c S . V a r i a t i o n s i n

t h e number o f i t e m s h a v e b e e n u s e d by o t h e r s w i t h e q u a l

s u c c e s s . G e r s o n & Lanyon (1 9 7 2 ) u s e d 20 i t e m s w h i l e

M cReynolds & T o r i ( 1 9 7 2 ) u s e d o n l y 10 i t e m s . The im a g e s

w ere q u i t e s i m i l a r a s r e p o r t e d by t h e f o u r Ss i n TT2 *

h o w e v e r , t h e o r d e r o f h i e r a r c h a l a r r a n g e m e n t v a r i e d f ro m

S t o S . Some o f t h e im a g e s i n c l u d e d sm ok ing "upon

a r i s i n g i n t h e m o r n i n g , " " a f t e r m e a l s , " " a t a c o f f e e

b r e a k , " " a t a p a r t y , " " s o c i a l l y w i t h f r i e n d s , ” " a f t e r

a w a k e n in g i n t h e m i d d l e o f t h e n i g h t , " "when n e r v o u s o r

u p t i g h t , " " w h i l e d r i v i n g t h e a u t o m o b i l e , " " r e s t i n g a t

t h e b e a c h , " " w a i t i n g f o r s o m e o n e , " e t c .

The p r o c e d u r e i n e v o k i n g i m a g e r y d u r i n g t h e l a s t

two weeks o f s e s s i o n s i n v o l v e d E v o c a l ab l i b b i n g s i m i l a r

t o t h a t d o n e d u r i n g t h e two weeks o f c o v e r t s e n s i t i z a t i o n .

The d i f f e r e n c e , o f c o u r s e , was i m a g i n i n g t h e u n a v a i l

a b i l i t y o f c i g a r e t t e s and t h e S ' s a c c e p t a n c e o f n o t


26

sm o k in g , e n d i n g w i t h t h e S ' s p o s i t i v e a f f i r m a t i o n w h ic h

t h e E h ad h im r e p e a t s e v e r a l t i m e s , " I c h o o s e n o t t o

s m o k e . " The Ss r e p o r t e d t h a t t h e r e p e a t i n g o f t h a t

p h r a s e made them f e e l l i k e t h e y w e re a c t u a l l y c o n q u e r i n g

t h e h a b i t and t h a t t h e a v e r s i v e im a g e s e a r l i e r i n d u c e d

were b e c o m in g l e s s and l e s s i n t e n s e u n t i l by t h e t i m e

t h e e x p e r i m e n t was o v e r , t h e m a t t e r o f n o t sm ok ing was

i n f l u e n c e d by t h e S ' s own d e s i r e t o a b s t a i n . A l l Ss

r e p o r t e d t h i s i n c r e a s e d t h e i r s e l f - c o n c e p t s , a m a t t e r

f o u n d t o be o f v i t a l i m p o r t a n c e i n e x t i n g u i s h i n g m a l

a d a p t i v e b e h a v i o r s ( B l o u n t & P e d e r s o n , 1 9 7 0 ; B r a u c h t ,

1 9 6 9 , 1 9 7 0 ; C a r t e r & S t u a r t , 1 9 7 0 ; F i s c h e r e t a l , 1 9 7 1 ;

G o ld ia m o n d , 1 9 6 5 ; Montgomery & P a r t o n , 1 9 7 0 ; Omwake,

1 9 5 4 ; S e i t z , 1 9 7 0 ; S t u a r t , 1 9 6 7 ) .

C o n t r a c t u a l Management = T T ^ . The Ss a s s i g n e d t o

t h i s t r e a t m e n t w e re r e a d s p e c i f i c i n s t r u c t i o n s p r e p a r e d

by t h e E :

1 . Keep d a i l y r e c o r d s o f t h e t i m e and t h e p l a c e w h e re you smoke e a c h c i g a r e t t e .Add t h e t o t a l c i g a r e t t e s smoked p e r d a y .

2 . D e t e r m i n e w h ich c i g a r e t t e s you would l e a s t m ind g i v i n g u p . W r i t e down on p a p e r w h i c h c i g a r e t t e s t h e s e a r e . S ig n y o u r name t o a c o n t r a c t a s f o l l o w s ;

D a t e _____I c o n t r a c t b e t w e e n A. M. P e l l e t i e r and m y s e l f t o d a i l y g i v e up c i g a r e t t e s numb e r ________________________ ' _____i n r e t u r n f o r a p p r o v a l a n d p r a i s e a s w e l l a s t o im p ro v e a n d / o r p r e s e r v e my h e a l t h .


27

s i g n e d

s i g n e d A. M. P e l l e t i e r

3 . T e l l y o u r f r i e n d s a n d f a m i l y o f y o u r d e s i r e t o g i v e up sm o k in g an d d a i l y t e l l them how much y o u a r e c u t t i n g down.

4 . At o u r n e x t s e s s i o n , w e ' l l r e v i e w y o u r p r o g r e s s an d c o n t r a c t t o g i v e u p a d d i t i o n a l c i g a r e t t e s i f you c a r e t o .

5 . W e ' l l p l o t y o u r p r o g r e s s o n a g r a p h a n d r e v i e w i t i n o u r s e s s i o n s .

6 . E v e ry t i m e you f e e l l i k e sm ok ing t h e c i g a r e t t e s you c o n t r a c t e d t o g i v e u p , r e p e a t , " I c h o o s e n o t t o sm oke . I madea p r o m i s e , I s i g n e d a c o n t r a c t . I c h o o s en o t t o s m o k e . ”

The E a n s w e r e d a n y q u e s t i o n s t h e S c a r e d t o a s k an d

t h e n s p e n t t h e r e m a i n d e r o f t h e f i r s t s e s s i o n d i s c u s s i n g

t h e h a z a r d s o f s m o k in g , t h e n a t u r e o f t h e c o n t r a c t an d

t h e b e n e f i t s i n r e f r a i n i n g f r o m t h e u s e o f t o b a c c o . The

f i r s t c o n t r a c t was a l s o d ra w n up d u r i n g t h e f i r s t s e s s i o n

s i n c e o p e r a n t b a s e l i n e sm o k in g b e h a v i o r h ad a l r e a d y b e e n

e s t a b l i s h e d d u r i n g t h e p r e v i o u s w e e k . A co p y o f t h e c o n

t r a c t was r e t a i n e d by t h e E a n d one by t h e S .

I n e v e r y s u b s e q u e n t s e s s i o n t h e f r e q u e n c y o f sm o k in g

a n d t h e r e s u l t s o f c o n t r a c t u a l m an agem en t w e re d i s c u s s e d .

The m a t t e r o f e l e c t i n g t o w r i t e up a new c o n t r a c t t o

e l i m i n a t e e v e n more sm o k in g b e h a v i o r was d i s c u s s e d and

l e f t up t o t h e S t o d e c i d e . I n e v e r y i n s t a n c e , t h e S

e l e c t e d t o n e g o t i a t e new a n d m o re e x t e n s i v e c o n t r a c t s .

E a c h s u b s e q u e n t s e s s i o n f o u n d th e m n e g o t i a t i n g new c o n -


28

t r a c t s w i t h m ore e a s e a n d a n t i c i p a t i o n .

C o u n t i n g - I n t e r a c t i o n a n d S u p p o r t i v e C o u n s e l i n g =

T T ^ . The Ss a s s i g n e d t o t h i s c o n d i t i o n w h ic h s e r v e d a s

a c o n t r o l g r o u p , h ad a l s o k e p t r e c o r d s f o r one week t o

d e t e r m i n e o p e r a n t b a s e l i n e sm o k in g b e h a v i o r . I n t h e

f i r s t t r e a t m e n t s e s s i o n t h e S was i n s t r u c t e d t o c o n t i n u e

d a i l y r e c o r d k e e p i n g o f h i s c i g a r e t t e c o n s u m p t i o n and t o

b r i n g t h e r e c o r d s t o t h e E a t e a c h s u b s e q u e n t s e s s i o n .

F r e q u e n c y o f sm o k in g b e h a v i o r r e c o r d s w e r e d i s c u s s e d i n

t h e s e s s i o n s . No c o n t r a c t s w e re d i s c u s s e d a n d no c r i

t e r i o n l e v e l t o d e c e l e r a t e sm o k in g b e h a v i o r was e s t a b

l i s h e d o r s u g g e s t e d . The E s i m p l y t o l d t h e S t h a t h i s

w a n t i n g t o g i v e up sm o k in g a n d h i s c o u n t i n g t h e

c i g a r e t t e s a c t u a l l y smoked w ould h a v e a f a v o r a b l e e f f e c t

o n t h e S ’ s k i c k i n g t h e t o b a c c o h a b i t o r a t l e a s t r e d u c i n g

c i g a r e t t e c o n s u m p t i o n . I n e a c h s e s s i o n , t h e E o f f e r e d

m o t i v a t i o n a l r e i n f o r c e m e n t s u c h a s , "You c a n do i t , " o r

"Who i s b i g g e r , you o r t h a t c i g a r e t t e ? " , e t c .

The a p p r o a c h i n t h i s t e c h n i q u e was s i m i l a r t o t h e

s u p p o r t i v e - c o u n s e l i n g t h e r a p y u s e d by K o e n ig an d M a s t e r s ,

(1 9 6 5 ) w h ere t h e E w a s , " s u p p o r t i v e an d e n c o u r a g i n g when

t h e s u b j e c t r e p o r t e d i m p r o v e m e n t , a n d u n d e r s t a n d i n g and

n o n - p u n i t i v e when t h e s u b j e c t r e p o r t e d no im p ro v e m e n t o r

r e g r e s s i o n t o e a r l i e r s t a g e s o f t h e h a b i t [ p . 2 3 8 ] . "

The t e c h n i q u e was a l s o s i m i l a r t o t h a t u s e d by Lawson a n d


29

May (1970) who c o m bined c o u n t i n g - i n t e r a c t i o n w i t h

s u p p o r t i v e c o u n s e l i n g w h e r e , ' 'R e g u l a r m e e t i n g s w i t h E,

h o w e v e r , w ere t o m a i n t a i n t h e i r m o t i v a t i o n a l l e v e l

[ p . 1 5 5 ] . "

The Ss i n a l l t r e a t m e n t c o n d i t i o n s w ere a l s o

i n s t r u c t e d t o c o n t i n u e r e c o r d i n g d a i l y c i g a r e t t e c o n

s u m p t i o n f r e q u e n c y ( i f t h e y had n o t s u c c e e d e d i n

t o t a l l y a b s t a i n i n g ) and r e p o r t t h e s e t o t h e E a t t h e end

o f t w o , f o u r , s i x and e i g h t weeks f o l l o w i n g t h e t e r m i n a

t i o n o f t r e a t m e n t . T h i s a l l o w e d f o r s u b s t a n t i a l f o l l o w -

up i n f o r m a t i o n t o be g a t h e r e d t o t e s t f o r h o l d o v e r

e f f e c t s o f t r e a t m e n t s .


RESULTS

T a b l e 3 shows t h e p e r c e n t a g e o f t h e o p e r a n t l e v e l

o f c i g a r e t t e s smoked f o r e a c h o f t h e 16 S s . The l e f t

hand co lum n i d e n t i f i e s t h e Ss n o t e d i n T a b le 2 . D a t a

w ere o b t a i n e d f ro m S s e l f - r e p o r t s d u r i n g t h e f o u r w eeks

o f t r e a t m e n t a n d f o r t h e e i g h t w eeks o f f o l l o w - u p a f t e r

c l i n i c a l t r e a t m e n t had s t o p p e d . The r e l i a b i l i t y o f t h e

S s ' s e l f - r e p o r t s a s t o w h e t h e r t h e r e was a l e s s e n i n g o f

c i g a r e t t e c o n s u m p t i o n was c o n f i r m e d by t h e r e p o r t s o f

s i g n i f i c a n t o t h e r s o f S s . I t c a n b e s e e n t h a t e a c h o f

t h e t r e a t m e n t m e th o d s was g e n e r a l l y s u c c e s s f u l i n a

w e e k ly d e c e l e r a t i o n o f c i g a r e t t e c o n s u m p t i o n d u r i n g

a c t u a l t r e a t m e n t w e e k s . By t h e end o f t r e a t m e n t , t h r e e

Ss had c o m p l e t e l y s to p p e d s m o k i n g , a n o t h e r f i v e Ss w ere

sm oking l e s s t h a n 10 p e r c e n t o f b a s e l i n e , a n o t h e r f o u r

Ss w ere b e lo w 25 p e r c e n t o f b a s e l i n e , and o n l y t h r e e Ss

w ere s t i l l c o n s u m i n g o v e r o n e - h a l f o f t h e amount o f

c i g a r e t t e s smoked a t o p e r a n t l e v e l . The l e s s e n i n g o f

c i g a r e t t e c o n s u m p t i o n c o n t i n u e d d u r i n g t h e f o l l o w - u p

p e r i o d f o r a l l b u t f o u r o f t h e S s . By t h e end o f t h e

f o l l o w - u p p e r i o d , e i g h t Ss r e p o r t e d e x t i n c t i o n o f t h e

t o b a c c o h a b i t a n d o n l y two Ss w ere c o n s u m in g o v e r o n e -

h a l f o f t h e am o u n t o f c i g a r e t t e s smoked a t o p e r a n t l e v e l .

I t c a n a l s o be s e e n i n T a b l e 3 t h a t by t h e end o f t h e

30


iHCO

TABLE 3

P e r c e n t a g e o f B a s e l i n e o f C i g a r e t t e s Smoked by S i x t e e n S u b j e c t s i n F o u r T r e a t m e n t C a t e g o r i e s Over F o u r Weeks o f T r e a t m e n t

and Over E i g h t Weeks o f F o l lo w -U p W i th o u t T r e a t m e n t

S i d e n t i f i e d i n T a b l e 2

TREATMENrr WEEKS FOLLOW-UP WITHOUT TREATMENT1 s t Week 2nd Week 3 r d Week 4 t h Week 2 Weeks 4 Weeks 6 Weeks 8 Weeks

TTXn8n 5n13n10

78 . 2 6 # 6 2 . 0 8 5 . 7 1 7 6 . 1 9

52.17%3 5 .3 3 6 4 .5 76 3 .3 3

39-13%6 . 2

3 5 -1 42 9 . 5 2

13.04% 0 . 0

1 6 . 2 9 4 .05

8.7%0 . 0

1 1 . 4 30 . 0

0 . 0 $0 . 0

1 7 . 42 .3 8

0 . 0 $0 . 0

2 8 .5 70 . 0

8.7%0 . 0

3 1 . 4 30 . 0

t t 2n ln 9n l 5n 7

21.0J87 8 . 0 27 8 . 6 18 2 . 2 2

3.6%4 7 .2 45 5 .5 55 2 . 2 2

5.7%2 3 . 13 4 . 1 62 3 . 5 5

0 . 0 % 1 . 3 9

1 1 . 1 1 8 . 0

0 . 0 %0 . 00 . 00 . 0

0 . 0 %3 . 4 52 . 7 82 . 2 2

0 . 0 $0 . 05 -5 60 . 0

0 . 0 %0 . 02 .70 . 0

TTon12

n 2nl i |

74.09%8 3 . 3 37 7 . 1 47 8 . 4 6

5 0 . 0 %5 0 . 04 0 . 0 4 5 . 1 5

3 1 . 8 2 %2 3 -3 32 0 . 01 9 -4 8

1 6 . 6 6 %1 . 6 60 . 03 .3 3

0 . 0 %6 . 6 70 . 00 . 0

18 . 1 8 % 3 . 3 3 0 . 0 0 . 0

40.91%0 . 00 . 00 . 0

4 5 . 4 5 %0 . 00 . 00 . 0

t t 4n 6n l 6n 3n l l

93.33%9 3 - 17 7 -149 0 , 7 5

8 2 .6 6 $ 7 9 . 3 6 0 . 0 8 5 .O

77-33%7 0 .74 8 . 5 77 5 -7 5

72.33%5 2 .7 63 1 .4 36 8 . 5

6 6 .6 6 $ 4 4 .8 3 28 .57 6 2 . 5

6 6 .6 6 $4 8 .2 83 4 . 2 9 6 5 . 0

8 0 . 0 $ 4 8 . 2 8 3 1 .4 3 7 0 . 0

7 3 . 3 3 %4 8 . 2 83 1 . 4 37 0 . 0

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3 2

e ig h t weeks o f f o l l o w - u p , fo u r Ss were m a in ta in in g the

p e r c e n t o f b a s e l i n e r e p o r te d a t th e end o f t h e treatm en t

weeks and e ig h t Ss had a c t u a l l y im proved. At th e same

t im e , o n ly fo u r Ss were smoking more th an th e y had been

consuming when trea tm en t had stopped and o n ly one o f

t h e s e Ss was smoking more than tw ic e what he had a t the

b e g in n in g o f th e f o l lo w - u p .

Grand means were computed com bining th e d a ta o f the

fo u r Ss in each o f th e fo u r groups and c o n v e r ted in to

p e r c e n ta g e s o f operant b a s e l i n e . These p e r c e n ta g e s fo r

each o f th e tr e a tm e n ts over fou r weeks and over e ig h t

p o s t tre a tm en t weeks o f fo l lo w -u p were p l o t t e d i n

F ig u re 1 .

The e m p i r i c a l h y p o t h e s i s was t h a t a r a n k o r d e r o f

t r e a t m e n t e f f e c t i v e n e s s would b e a s f o l l o w s : 1 . a com

b i n a t i o n o f c o v e r t s e n s i t i z a t i o n a n d s y s t e m a t i c d e s e n s i

t i z a t i o n , 2 . c o n t r a c t u a l m an a g e m e n t , 3 - COg i n h a l a t i o n ,

a n d 4 . c o u n t i n g i n t e r a c t i o n co m b in ed w i t h s u p p o r t i v e

c o u n s e l i n g . I t c a n be n o t e d i n F i g u r e 1 t h a t t h e

h y p o t h e s i s was n o t w h o l l y s u p p o r t e d , s i n c e t h e m o s t

e f f e c t i v e t r e a t m e n t t e c h n i q u e by t h e end o f t h e f o u r

weeks o f t r e a t m e n t was c o n t r a c t u a l m anagem ent ( 3 - 8 1 $ o f

o p e r a n t l e v e l ) , and t h e s e c o n d m o s t e f f e c t i v e was t h e

c o m b i n a t i o n o f c o v e r t s e n s i t i z a t i o n a n d s y s t e m a t i c

d e s e n s i t i z a t i o n ( 6 . 6 7 $ o f o p e r a n t l e v e l ) . The CO2


FIGURE 1

C i g a r e t t e c o n s u m p t i o n a s p e r c e n t a g e o f o p e r a n t l e v e l f o r f o u r g r o u p i n g s o f s u b j e c t s o b t a i n i n g t r e a t m e n t o v e r f o u r weeks an d f o r e i g h t w eek s o f f o l l o w - u p w i t h o u t t r e a t m e n t .

33


■=rco

• CO I n h a la t io n

O Covert S e n s i t i z a t i o n -S y stem a tic D e s e n s i t i z a t i o n

A C o n tra c tu a l Management

A Counting I n t e r a c t io n and S u p p o rtive C ou n se lin g

a >

•.? a

treatm ent Follow-Up (No C l i n i c a l Treatment)

if'*, ^ ;

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35

i n h a l a t i o n t e c h n i q u e was a t 8$ o f o p e r a n t l e v e l a n d t h e

c o u n t i n g i n t e r a c t i o n com bined w i t h s u p p o r t i v e c o u n s e l i n g

t e c h n i q u e was a t 5 4 . 2 9 $ o f b a s e l i n e . T h e se d a t a show

t h a t t h e p e r c e n t a g e o f o p e r a n t l e v e l f o r t h e c o n t r a c t u a l

management t e c h n i q u e was 1 7 5 $ l e s s t h a n t h e c o m b i n a t i o n

o f c o v e r t s e n s i t i z a t i o n and s y s t e m a t i c d e s e n s i t i z a t i o n

t e c h n i q u e and 210$ l e s s t h a n t h e CO^ i n h a l a t i o n m ethod

d u r i n g c l i n i c a l t r e a t m e n t .

H ow ever , by t h e end o f two w eeks f o l l o w i n g t h e

t r e a t m e n t p e r i o d , t h e t e c h n i q u e c o m b i n i n g c o v e r t s e n s i

t i z a t i o n an d s y s t e m a t i c d e s e n s i t i z a t i o n was o b t a i n i n g

t h e m os t e f f e c t i v e r e s u l t s and m a i n t a i n e d i t s e f f e c t i v e

n e s s t h r o u g h o u t t h e e i g h t week f o l l o w - u p . P e r c e n t a g e s

o f o p e r a n t b a s e l i n e a t t h e end o f t h e f o l l o w - u p p e r i o d

w e r e : c o v e r t s e n s i t i z a t i o n a n d s y s t e m a t i c d e s e n s i t i z a

t i o n = . 8 3 $; c o n t r a c t u a l management = 7 * 9 4 $ ; C02 i n h a l a

t i o n = 10%j, a n d a c o m b i n a t i o n o f c o u n t i n g i n t e r a c t i o n

and s u p p o r t i v e c o u n s e l i n g = 5 3 - 7 8 $ .

These d a t a show t h a t t h e i m a g e r y t e c h n i q u e s c o n

t i n u e d t o i n c r e a s e i n e f f e c t i v e n e s s ( f r o m 3 - 8 1 $ t o . 8 3 $

o f o p e r a n t l e v e l ) t h r o u g h o u t t h e f o l l o w - u p p e r i o d . The

o t h e r two m o s t e f f e c t i v e t e c h n i q u e s a l s o m a i n t a i n e d

e f f e c t i v e n e s s w i t h o n l y a 2$ i n c r e a s e i n c i g a r e t t e c o n

s u m p t i o n o v e r t h e e i g h t w e e k s . By t h e end o f t h e 12

weeks o f t h e e x p e r i m e n t t h e Ss who h a d b e e n t r e a t e d by


t h e c o v e r t s e n s i t i z a t i o n an d s y s t e m a t i c d e s e n s i t i z a t i o n

t e c h n i q u e s w ere a t a p e r c e n t a g e o f o p e r a n t l e v e l w h ic h

was 970% l e s s t h a n were t h e Ss e m p l o y i n g c o n t r a c t u a l

m anagem en t and 1200.$ l e s s t h a n t h e Ss t r e a t e d by CO2

i n h a l a t i o n .

The random b l o c k f a c t o r i a l d e s i g n o f t h e s t u d y made

p o s s i b l e a m e a s u r e o f t r e a t m e n t . e f f e c t s , e f f e c t s o v e r

f o u r w e e k s , and t h e i n t e r a c t i o n e f f e c t s o f t r e a t m e n t x

w e e k s . U s in g a b a l a n c e d a n a l y s i s o f v a r i a n c e , t h e r e was

e v i d e n c e t h a t t r e a t m e n t e f f e c t s w e re s t a t i s t i c a l l y s i g

n i f i c a n t b eyond t h e .01 l e v e l (P^ ^g = 6 . 4 l ) . A

summary o f t h e an o v a i s c o n t a i n e d i n T a b le 4 . I t i s

a l s o a p p a r e n t t h a t t h e r e w ere w e e k l y c u m u l a t i v e t r e a t m e n t

e f f e c t s w e l l beyond t h e . 0 1 l e v e l o f s t a t i s t i c a l s i g n i f i

c a n c e (P3 a 48 = 2 1 . 0 7 ) . I n t e r a c t i o n b e t w e e n t r e a t m e n t

g r o u p s a n d weeks o f t r e a t m e n t d i d n o t a p p r o a c h s i g n i f i

c a n c e . The l a c k o f i n t e r a c t i o n e f f e c t s s u g g e s t s t h e r e

w e r e no v a r i a t i o n s i n means o f t h e f o u r t r e a t m e n t g r o u p s

w h i c h c a n n o t be a c c o u n t e d f o r b y a n o b s e r v a t i o n o f t h e

m a i n e f f e c t s o f t r e a t m e n t s a n d w e e k s . T h u s , t h e r e i s

e v i d e n c e t h a t e a c h t r e a t m e n t was e f f e c t i v e i n e l i m i n a t i n g

o r d e c e l e r a t i n g c i g a r e t t e a d d i c t i o n . T r e a t m e n t e f f e c t i v e

n e s s i n c r e a s e d s i g n i f i c a n t l y o v e r f o u r w e e k s .

The s e l f - r e p o r t s o f e a c h o f t h e 16 Ss d u r i n g a n

e i g h t week f o l l o w - u p a f t e r c l i n i c a l t r e a t m e n t h a d b e e n


oo

TABLE 4

A n a l y s i s o f V a r i a n c e o f Weekly C i g a r e t t e C o n su m p t io n D u r i n g a P o u r Week T r e a t m e n t P e r i o d a s Compared t o O p e r a n t L e v e l

S o u rc e SS d f MS P P

A = T r e a t m e n t G roups 9 7 8 .6 3 3 3 2 6 .2 1 6 .4 1 * P < .0 1

B = T r e a t m e n t Weeks 3 2 1 5 . 6 9 3 1 0 7 1 . 9 0 2 1 .0 7 * P < .0 1

A x B 273 .67 9 3 0 . 4 1 0 . 6 0 P > .0 5

E r r o r 2 4 4 1 .6 4 48 5 0 .8 7

* F - r a t i o s i g n i f i c a n t beyond t h e .01 l e v e l

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t e r m i n a t e d was c o m p u te d i n t o d a i l y means o f c i g a r e t t e s

c o n s u m e d . The f o l l o w - u p d a t a w e re u s e d t o com pute a n

a n a l y s i s o f v a r i a n c e . The summary o f t h e s e r e s u l t s i s

i n c l u d e d i n T a b l e 5* The c a r r y - o v e r e f f e c t s o f t r e a t

m en t i n t h e f o u r g r o u p c a t e g o r i e s w e r e a p p a r e n t (F^ =

3 7 * 3 1 ) beyond t h e l e v e l o f s i g n i f i c a n c e ( a l p h a = . 0 1 ) .

A l t h o u g h F i g u r e 1 shows a s l i g h t i n c r e a s e i n p o s t t r e a t

m e n t sm oking f o r e a c h t r e a t m e n t e x c e p t t h e c o v e r t

s e n s i t i z a t i o n - s y s t e m a t i c d e s e n s i t i z a t i o n t e c h n i q u e , t h e .

a n o v a s u m m ar ized i n T a b l e 5 d i d n o t r e f l e c t any s t a t i s

t i c a l s i g n i f i c a n c e a s a r e s u l t o f w eeks o f f o l l o w - u p .

T h e r e w ere no m a in e f f e c t s a s a r e s u l t o f e i g h t weeks o f

f o l l o w - u p a f t e r c l i n i c a l t r e a t m e n t h ad s t o p p e d , an d

t h e r e w ere no i n t e r a c t i o n e f f e c t s (G ro u p s x W eek s ) .

T h e s e d a t a s u p p o r t t h e c o n c l u s i o n t h a t ’ t h e s u c c e s s o f

t h e t r e a t m e n t t e c h n i q u e s was m a i n t a i n e d e v e n a f t e r

c l i n i c a l t r e a t m e n t was t e r m i n a t e d f o r Ss who d e s i r e d t o

e l i m i n a t e t h e t o b a c c o h a b i t .


cr\co

TABLE 5

A n a l y s i s o f V a r i a n c e o f Weekly C i g a r e t t e C o n su m p t io n D u r i n g An E i g h t Week P o s t T r e a t m e n t F o l lo w -U p a s Compared t o O p e r a n t L e v e l

S o u r c e SS d f MS F P

A = G roups 2 4 3 0 .4 2 3 8 1 0 .1 4 3 7 .3 1 * P< .01

B = 'Weeks 18 .92 3 6 .3 1 0 . 2 9 P> .05

A x B 7 - 2 7 9 0 . 8 1 0 .0 4 P>. 05

E r r o r 1 0 4 2 . 2 5 48 2 1 .7 1

* F - r a t i o s i g n i f i c a n t a t t h e .01 l e v e l

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DISCUSSION

The Ss i n t h e p r e s e n t t h e r a p e u t i c e x p e r i m e n t w e re

h i g h l y m o t i v a t e d , s i n c e o n l y t h o s e who a c t u a l l y e x p r e s s e d

a s i n c e r e d e s i r e t o s t o p sm oking w ere p e r m i t t e d t o e n

r o l l . Lawson & May (1 9 7 0 ) a l s o e m p h a s i z e d t h e v a l u e o f

t h i s t y p e o f m o t i v a t i o n . A n o t h e r m e a s u r e o f m o t i v a t i o n

was t h e $ 2 5 .0 0 d e p o s i t w h ich e a c h S h a d t o p a y t o e n r o l l

f o r t h e r a p y . I t was e x p l a i n e d t h a t t h e d e p o s i t would be

r e t u r n e d i f t h e Ss a t t e n d e d a l l t h e r a p e u t i c s e s s i o n s and

k e p t a c c u r a t e r e c o r d s o f d a i l y c i g a r e t t e c o n s u m p t i o n .

B e r e c z (1972) a n d G e r s o n & Lan y o n (1 9 7 2 ) a l s o d i s c o v e r e d

t h a t a r e f u n d a b l e d e p o s i t v a r i a b l e was e f f e c t i v e a s a

means o f r e i n f o r c i n g S a t t e n d a n c e a t t h e t r e a t m e n t

s e s s i o n s .

Each S was g i v e n t h e r e s p o n s i b i l i t y o f r e p o r t i n g

t h e d a i l y f r e q u e n c y o f c i g a r e t t e c o n s u m p t i o n t h r o u g h o u t

t h e c l i n i c a l s e s s i o n s a n d f o l l o w - u p p e r i o d . I t h a s b e e n

o b s e r v e d t h a t t h i s i n v o l v e m e n t would a s s i s t Ss i n s e l f -

c o n t r o l (G o ld ia m o n d , 1 9 6 5 ) . The r e l i a b i l i t y o f s e l f -

r e p o r t s h a s b e e n shown by o t h e r s (Agnew, 1 9 6 4 j B e r e c z ,

1 9 7 2 ; P e l l e t i e r , 1 9 7 1 ; and P i n n e a u , 1 9 5 8 ) . One s t u d y

n o t e d a + .9 4 c o r r e l a t i o n w i t h r e l i a b i l i t y c h e c k s made by

i n d e p e n d e n t o b s e r v e r s . ( O b e r , 1 9 6 6 ) . The p r e s e n t s t u d y

u s e d r e l i a b i l i t y c h e c k s made by s i g n i f i c a n t o t h e r s , e . g . ,

40


4 l

h u s b a n d , w i f e , o r p a r e n t o f t h e S s , a n d fo u n d a s i m i l a r

c o r r e l a t i o n .

I t i s n o t e w o r t h y , a s s e e n i n T a b l e 2 , t h a t a l l Ss

i n t h i s s t u d y w e r e o f v a r y i n g a g e s . E x t e n t o f a d d i c t i o n

a n d y e a r s o f a d d i c t i o n a l s o v a r i e d a g r e a t d e a l . I t i s

o f n o t e t h a t a l l who e n r o l l e d f o r t h e c l i n i c a l s e s s i o n s

w ere a c t u a l l y s e e k i n g a way t o g i v e up sm o k in g . Most o f

t h e o t h e r s t u d i e s d e a l i n g w i t h c i g a r e t t e a d d i c t i o n a s

r e p o r t e d i n t h e l i t e r a t u r e h a v e u s e d c o l l e g e s t u d e n t s i n

a c o l l e g e l a b o r a t o r y s e t t i n g t o e x p e r i m e n t w i t h t e c h

n i q u e s ( B e r e c z , 1 9 7 2 ; G erso n & L a n y o n , 1 9 7 2 ; Lawson &

May, 1 9 7 0 ) .

W h i le t h e r e was some d i f f e r e n c e i n t h e e f f e c t i v e

n e s s o f t h e t r e a t m e n t t e c h n i q u e u s e d , i t i s a p p a r e n t

f r o m t h e c u r v e s n o t e d on F i g u r e 1 t h a t t h e d e g r e e o f

e f f e c t i v e n e s s was b a s i c a l l y s i m i l a r f o r t h e t h r e e e x p e r i

m e n t a l g r o u p s . The t r e a t m e n t t e c h n i q u e e m p lo y in g a v e r

s i v e i m a g e r y h a d t h e g r e a t e s t e f f e c t s o v e r t h e 12 week

p e r i o d o f t h e s t u d y , a f i n d i n g w h i c h s u p p o r t s B e r e c z ' s

(1 9 7 2 ) r e p o r t t h a t p u n i s h i n g i m a g i n e d sm ok ing was a s

e f f e c t i v e a s p u n i s h i n g a c t u a l s m o k in g .

The a r g u m e n t r a i s e d by Cahoon (1 9 7 1 ) t h a t CO2

i n h a l e d i n t o b a c c o smoke c o u l d be one o f t h e v a r i a b l e s

w h ic h n e e d t o b e c o n t r o l l e d i n e l i m i n a t i n g c i g a r e t t e

a d d i c t i o n f o u n d s u p p o r t i n t h e r e s u l t s o b t a i n e d i n t h e


p r e s e n t s t u d y .

I t i s n o t e d t h a t d u r i n g t h e a c t u a l c l i n i c a l t r e a t

m en t p e r i o d , c o n t r a c t u a l m an ag em en t was t h e m os t e f f e c

t i v e . I t may be h y p o t h e s i z e d t h a t t h e r e a s o n s f o r t h i s

a r e t h a t when a p e r s o n a c t u a l l y e n d o r s e s a c o n t r a c t w i t h

a n o t h e r p e r s o n , a n d i s r e i n f o r c e d f o r c o n t r a c t u a l a g r e e

m e n t , t h a t he w i l l be m ore a p t t o k e e p h i s word b e c a u s e

he h a s a f f i x e d h i s s i g n a t u r e t o a n a g r e e m e n t . The

p r e s e n t e x p e r i m e n t d i d n o t t e s t t h i s h y p o t h e s i s , w h ich i s

l e f t t o o t h e r s t u d i e s .

The f a c t t h a t t r e a t m e n t e m p l o y i n g i m a g e r y a n d r e l a x

a t i o n t e c h n i q u e s h ad t h e g r e a t e s t m a i n t e n a n c e and f o l l o w -

up e f f e c t s c o u l d be t h e r e s u l t o f t h e Ss c o n t i n u i n g t o

do t h e i r home work w i t h t h e s e t e c h n i q u e s e v e n a f t e r

c l i n i c a l t r e a t m e n t a n d i n s t r u c t i o n h a d s t o p p e d . G e r s o n &

Lanyon (1 972) r e p o r t e d s i m i l a r f o l l o w - u p r e s u l t s . The

u s e o f v i s u a l f a n t a s y a n d r e l a x a t i o n i s a goo d t e c h n i q u e

f o r h y p n o t i c i n d u c t i o n ( E r i c k s o n , 1 9 6 7 ) . The r e p o r t e d

s u c c e s s r e s u l t i n g f r o m t h e u s e o f i m a g e r y t e c h n i q u e s i n

t h e p r e s e n t s t u d y may be a n i n d i c a t i o n o f t h e d e g r e e o f

s u b j e c t h y p n o t i z a b i l i t y . The u s e o f t h e B a r b e r S u g g e s

t i b i l i t y S c a l e (1 9 6 9 ) i n p r e - a n d p o s t - t r e a t m e n t t e s t s i n

s u b s e q u e n t s t u d i e s c o u l d t e s t t h i s p o s s i b i l i t y . One o f

t h e e f f e c t s r e s u l t i n g f ro m t h e s e n s i t i z a t i o n -

d e s e n s i t i z a t i o n t e c h n i q u e s may, i n p a r t , be t h e r e s u l t

with perm ission of the copyright owner. Further reproduction prohibited without perm ission.

43

o f p r o d u c i n g a c h a n g e i n S b e h a v i o r by c h a n g i n g t h e

c o g n i t i o n o f t h e S. The e f f e c t s o f o t h e r t e c h n i q u e s

w ere n o t a s w e l l m a i n t a i n e d p e r h a p s b e c a u s e Ss had l o s t

some m o t i v a t i o n when c l i n i c a l r e i n f o r c e m e n t was w i t h

d r a w n . W h i le c l i n i c a l r e i n f o r c e m e n t was a l s o w i t h d r a w n

f ro m t h e Ss u s i n g i m a g e r y t e c h n i q u e s , t h e y , n o n e t h e l e s s ,

had b u i l t - i n r e i n f o r c e r s a s c r i b a b l e t o t h e c o n d i t i o n i n g

s u c h t e c h n i q u e s p r o v i d e .

The t h r e e e x p e r i m e n t a l t e c h n i q u e s r e s u l t e d i n o v e r

w h e l m i n g l y g r e a t e r r e s u l t s t h a n d i d t h e s i m p l e c o u n t i n g

i n t e r a c t i o n - s u p p o r t i v e c o u n s e l i n g c o n t r o l g r o u p , a

f i n d i n g w h ic h c o n c u r s w i t h o t h e r s t u d i e s ( K o e n ig &

M a s t e r s , 1 9 6 5 ; Lawson & May, 1 9 7 0 ) . The c o n t r o l g r o u p ,

h o w e v e r , was b r o u g h t t o o n l y 54.29% o f b a s e l i n e l e v e l

by t h e end o f t h e f o u r c l i n i c a l w e e k s , an d was m a i n t a i n e d

(53*78% o f b a s e l i n e ) t o t h e end o f t h e e i g h t weeks o f

f o l l o w - u p . T h i s may s u g g e s t t h a t a n y t r e a t m e n t m e th o d ,

e v e n t h a t w h i c h s i m p l y o f f e r s t h e t h e r a p i s t ’ s s u p p o r t ,

i s more e f f e c t i v e t h a n no t r e a t m e n t a t a l l .

The p r i m a r y c o n c e r n o f t h e E was a d e s i r e t o d i s

c o v e r t e c h n i q u e s w h ic h c o u l d be a p p l i e d t o t r e a t i n g t h e

p r e s e n t p r o b l e m a s w e l l a s s u p p o r t i n g h y p o t h e s e s i n

t r e a t i n g o t h e r m a l a d a p t i v e b e h a v i o r s . I n a d d i t i o n , a

h y p o t h e s i s was g e n e r a t e d a n d s t a t i s t i c a l l y e x am in ed

f rom o b t a i n e d d a t a . The c o n c e r n t o e x p l o r e v a r i e d t r e a t -


4 4

m ent t e c h n i q u e s h a s p r o v e n v a l u a b l e . T h e r e r e m a i n s a

n e e d t o s y s t e m a t i c a l l y s t u d y t h e e f f e c t s o f e m p l o y i n g

t h e same t e c h n i q u e s i n t r e a t i n g o t h e r m a l a d a p t i v e

b e h a v i o r s , s u c h a s a l c o h o l i s m and d r u g a d d i c t i o n .

S t u d i e s u s i n g t h e t e c h n i q u e s o f t h e p r e s e n t e x p e r i m e n t

i n t r e a t i n g g r o u p s o f Ss c o u l d p r o v i d e v a l u a b l e d a t a t o

c o m p are w i t h t h e d a t a h e r e i n o b t a i n e d i n t r e a t i n g

i n d i v i d u a l S s .

The e f f e c t s o f l o n g t e r m f o l l o w - u p o f t h e p r e s e n t

s t u d y a w a i t a d d i t i o n a l d a t a c o l l e c t i o n . The m a i n t e n a n c e

o f t h e t r e a t m e n t s em p lo y e d e v e n a f t e r c l i n i c a l t r e a t m e n t

i s t e r m i n a t e d u n d e r s c o r e s a g a i n t h e v a l i d i t y o f B e r e c z ’s

(1972) o b s e r v a t i o n , " I n a n e r a when t h e s h o r t a g e o f

t r a i n e d c l i n i c i a n s i s b e c o m in g more a c u t e , i t i s d i f f i

c u l t t o o v e r s t a t e t h e i m p o r t a n c e o f a t r e a t m e n t t e c h n i q u e

w h ic h i s , t o a g r e a t e x t e n t , s e l f - o p e r a t i v e [ p . 2 4 9 ] . "


REFERENCES

A d v i s o r y C o m m it tee to. t h e S u r g e o n G e n e r a l o f t h e P u b l i c H e a l t h S e r v i c e . Smoking a n d h e a l t h . U n i t e d S t a t e s P u b l i c H e a l t h S e r v i c e , W a s h i n g t o n , D. C . , 1 9 6 4 .

A d v i s o r y C om m it tee t o t h e S u r g e o n G e n e r a l o f t h e P u b l i c H e a l t h S e r v i c e . H e a l t h c o n s e q u e n c e s o f s m o k i n g . U n i t e d S t a t e s D e p a r t m e n t o f H e a l t h , E d u c a t i o n , a n d W e l f a r e , P u b l i c H e a l t h S e r v i c e s , H e a l t h S e r v i c e s and M e n t a l H e a l t h A d m i n i s t r a t i o n , 1971*

Agnew, N. McK. The r e l a t i v e v a l u e o f s e l f - r e p o r t and o b j e c t i v e t e s t s i n a s s e s s i n g t h e e f f e c t s o f a m p h e t a m i n e . J o u r n a l o f P s y c h i a t r i c R e s e a r c h , 1 9 6 4 , 2 , 85 - 1 0 0 .

A z r i n , N. H . , & H o l z , W. C. P u n i s h m e n t . . I n W. K. Honig ( E d . ) , Op e r a n t b e h a v i o r : A r e a s o f r e s e a r c h anda p p l i c a t i o n . New Y o r k : A p p l e t o n - C e n t u r y - C r o f t s ,1 9 6 6 .

A z r i n , N. H . , & P o w e l l , H. J . B e h a v i o r a l e n g i n e e r i n g :The r e d u c t i o n o f sm ok ing b e h a v i o r by a c o n d i t i o n i n g a p p a r a t u s a n d p r o c e d u r e . J o u r n a l o f A p p l i e d B e h a v i o r A n a l y s i s , 1968 , 1 , 1 9 3 - 2 0 0 .

B a n d u r a , A. P r i n c i p l e s o f b e h a v i o r m o d i f i c a t i o n . NewYork: H o l t , R i n e h a r t & W i n s t o n , 1 9 6 9 •

B a r b e r , T . X. H y p n o s i s : A s c i e n t i f i c a p p r o a c h . NewY o r k : Van N o s t r a n d R e i n h o l d C o . , I 9W9 <

B e r e c z , J . M. The m o d i f i c a t i o n o f sm o k in g b e h a v i o rt h r o u g h s e l f - a d m i n i s t e r e d p u n i s h m e n t o f i m a g i n e d b e h a v i o r . ( D o c t o r a l d i s s e r t a t i o n , I n d i a n a U n i v e r s i t y ) Ann A r b o r , M i c h . : U n i v e r s i t y M i c r o f i l m s , 1971*No. 7 0 - 2 6 , 9 0 9 .

B e r e c z , J . M o d i f i c a t i o n o f s m o k in g b e h a v i o r t h r o u g h s e l f a d m i n i s t e r e d p u n i s h m e n t o f i m a g i n e d b e h a v i o r : A newa p p r o a c h t o a v e r s i o n t h e r a p y . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1 9 7 2 , 38 ( 2 ) , 2 T 4 - 2 5 0 .

B a r t z , . W. R . , & L o y , D. L . U s i n g l o v e i n b e h a v i o rt h e r a p y . H o s p i t a l and Community P s y c h i a t r y , 1970 2 ( 1 0 ) , 333 -334 . .

45


4 6

B e r n s t e i n , A. M o d i f i c a t i o n o f sm o k in g b e h a v i o r : Ane v a l u a t i v e r e v i e w . P s y c h o l o g i c a l B u l l e t i n , 1 9 6 9 ,7 1 , 418-440.. ( a )

B e r n s t e i n , D. A. The' m o d i f i c a t i o n o f sm ok ing b e h a v i o r . ( D o c t o r a l d i s s e r t a t i o n , N o r t h w e s t e r n U n i v e r s i t y )Ann A r b o r , M ic h . : U n i v e r s i t y M i c r o f i l m s , 1 9 6 9 ,No. 6 9 - 6 8 1 1 . (b )

B l o u n t , H. P . , & P e d e r s e n , D. H. E f f e c t s o f v i d e o p l a y b a c k o f a p e r s o n on h i s s e l f - c o n c e p t . P s y c h o l o g i c a l R e p o r t s , 1 9 7 0 , 26_ ( 2 ) , 667 - 6 7 0 .

>B r a u c h t , G. N. I m m e d i a t e e f f e c t s o f s e l f - c o n f r o n t a t i o n

on t h e s e l f - c o n c e p t . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1 9 7 0 , 35., .9 5 -1 0 1 .

Brown, E . W. The p h y s i o l o g i c a l e f f e c t s o f h i g h c o n c e n t r a t i o n o f c a r b o n d i o x i d e . U n i t e d S t a t e s N a v a l M e d ic a l B u l l e t i n , 1 9 3 0 , 28, 7 2 1 .

B u t c h e r , B. D. A p o c k e t - p o r t a b l e s h o c k d e v i c e w i t h a p p l i c a t i o n t o n a i l b i t i n g . B e h a v i o r R e s e a r c h an d T h e r a p y , 1 9 6 8 , 6 , 3 8 9 - 3 9 2 .

C ahoon , D. D. C i g a r e t t e a d d i c t i o n a n d c a r b o n d i o x i d e i n h a l a t i o n : A h y p o t h e s i s . The P s y c h o l o g i c a lR e c o r d , 1 9 7 1 , 21 , 2 4 7 - 2 4 9 .

C a m p b e l l , B. A . , & C h u r c h , R. M. P u n i s h m e n t a n d a v e r s i v e b e h a v i o r . New Y o r k : A p p l e t o n - C e n t u r y - C r o f t s , 1 9 6 9 .

C a r t e r , R. D . , & S t u a r t , R. B. B e h a v i o r m o d i f i c a t i o n t h e o r y and p r a c t i c e : A r e p l y . S o c i a l Work, 1 9 7 0 ,15 ( 1 ) , 3 7 - 5 0 .

C a u t e l a , J . R. T r e a t m e n t o f c o m p u l s i v e b e h a v i o r byc o v e r t s e n s i t i z a t i o n . P s y c h o l o g i c a l R e c o r d , 1 9 6 6 ,16 ( 2 ) , 3 3 - 4 1 .

C a u t e l a , J . R. C o v e r t s e n s i t i z a t i o n . P s y c h o l o g i c a l R e p o r t s , 1 9 6 7 , 2 0 , 4 5 9 - 4 6 8 .

C a u t e l a , J . R. T r e a t m e n t o f sm oking b e c o v e r t s e n s i t i z a t i o n . P s y c h o l o g i c a l R e p o r t s , 1 9 7 0 , 2 6 , 4 1 4 - 4 2 0 .

D ' A l e s s i o , G. The c o n c u r r e n t u s e o f b e h a v i o r m o d i f i c a t i o n a n d p s y c h o t h e r a p y . Psy c h o t h e r a p y : T h e o r y ,R e s e a r c h a n d P r a c t i c e , 1 9 6 8 , 5 ( 3 ) , 1 5 4 - 1 5 9 •


47-

D a v i s o n , G. C. S y s t e m a t i c d e s e n s i t i z a t i o n a s a c o u n t e r c o n d i t i o n i n g p r o c e s s . J o u r n a l o f A bnorm al P s y c h o l o g y , 1 9 6 8 , .73., 9 1 - 9 9 .

E r i c k s o n , M. H . ; ( E d . ) H a l e y , J . H y p n o s i s a n d t h e r a p y . New Y o rk : G reen e & S t r a t t o n , 1 9 6 7 .

F i s c h e r , E. H. , H e r s c h b e r g e r , A. C . , & W in e r , D. The v e r b a l r e i n f o r c e m e n t t e c h n i q u e i n p e r s o n a l i t y r e s e a r c h . J o u r n a l o f S o c i a l P s y c h o l o g y , 1 9 7 1 ,83 ( 1 ) , 79-S9^

F r a n k s , C. M . , F r i e d , R . , & Ashem, B. An im p ro v e d a p p a r a t u s f o r t h e a v e r s i v e c o n d i t i o n i n g o f c i g a r e t t e s m o k e r s . B e h a v i o r R e s e a r c h a n d T h e r a p y , 1 9 6 6 , 4 , 3 0 1 - 3 0 8 .

G e e r , J . H . , & K a t k i n , E . S . T r e a t m e n t o f i n s o m n i a u s i n g a v a r i a n t o f s y s t e m a t i c d e s e n s i t i z a t i o n t e c h n i q u e :A c a s e r e p o r t . J o u r n a l o f A bnorm a l P s y c h o l o g y . 1966 . 71 ( 3 ) , 1 6 1 - 1 6 4 .

G e r s o n , P . , & L a n y o n , R. I . M o d i f i c a t i o n o f s m o k in gb e h a v i o r w i t h a n a v e r s i o n - d e s e n s i t i z a t i o n p r o c e d u r e . J o u r n a l o f C o n s u l t i n g a n d C l i n i c a l P s y c h o l o g y , 19 7 2 , M U S T T 3 9 9 ^ 0 2 .

G o ld , S . , & N e u f e l d , I . L . A l e a r n i n g a p p r o a c h t o t h e t r e a t m e n t o f h o m o s e x u a l i t y . B e h a v i o r R e s e a r c h an d T h e r a p y , 1 9 6 5 , 2, 2 0 1 - 2 0 4 .

G o ld ia m o n d , I . S e l f - c o n t r o l p r o c e d u r e s i n p e r s o n a l b e h a v i o r p r o b l e m s . P s y c h o l o g i c a l R e p o r t s , 1 9 6 5 ,17 ( 3 ) , 8 5 1 - 8 6 8 . •

G r e e n , - R . J . M o d i f i c a t i o n o f s m o k in g b e h a v i o r by f r e e o p e r a n t c o n d i t i o n i n g m e t h o d s . P s y c h o l o g i c a l R e c o r d , 1 9 6 4 , 1 4 , 1 7 1 - 1 7 8 .

H a l l , R. V. B e h a v i o r m anagem ent s e r i e s . P a r t I I I .A p p l i c a t i o n i n s c h o o l a n d h o m e . L a w r e n c e , K a n s a s :H & H E n t e r p r i s e s , 1 9 7 1 .

H e a t h , C. W. D i f f e r e n c e s b e t w e e n s m o k e r s a n d n o n s m o k e r s . A m e r i c a n M e d i c a l A s s o c i a t i o n , A r c h i v e s o f I n t e r n a l M e d i c i n e , 1 9 5 8 , 1 0 1 , 3 7 7 ^ 3 W .

H e r s e n , M i c h e l . The c o m p l e m e n t a r y u s e o f b e h a v i o r t h e r a p y an d p s y c h o t h e r a p y : Some c o m m e n ts . P s y c h o l o g i c a lR e c o r d , 1 9 7 0 , 20 ( 3 ) , 3 9 5 - 4 0 2 .


48.

H o g a n , R. A . , & K i r c h n e r , J . H. P r e l i m i n a r y r e p o r t o f t h e e x t i n c t i o n o f l e a r n e d f e a r s v i a s h o r t - t e r m i m p l o s i v e t h e r a p y . J o u r n a l o f A b n o rm a l P s y c h o l o g y , 1967 , 72 ( 2 ) , 1 0 6 - 1 0 9 .

Homme, L. E . C o n t r o l of ' c o v e r a n t s , t h e o p e r a n t s , o f t h e m ind . P s y c h o l o g i c a l R e c o rd . , 1 9 6 5 , 15 ( 4 ) , 5 0 1 - 5 1 1 .

J a c o b s o n , E. P r o g r e s s i v e r e l a x a t i o n . A m e r i c a n J o u r n a l 2 l P sy c h o l o g y , 1 9 2 5 , 2 6 , 7 3 - 8 7 .

J a c o b s o n , E . E l e c t r i c a l m e a s u r e m e n t s o f n e u r o m u s c u l a r s t a t e s d u r i n g m e n t a l a c t i v i t i e s . A m e r i c a n J o u r n a l o f Phy s i o l o g y , 1 9 3 1 , 97 , 2 0 0 - 2 0 9 .

K a n f e r , F . H. I m p l i c a t i o n s o f c o n d i t i o n i n g t e c h n i q u e s f o r i n t e r v i e w t h e r a p y . J o u r n a l o f C o u n s e l i n g P sy c h o l o g y , 1 9 6 6 , 1 3 , 1 7 1 - 1 7 7 - *

K e u t z e r , C. S . , L i c h t e n s t e i n , E . , & M ee s , H. L. M o d i f i c a t i o n o f s m o k in g b e h a v i o r : A r e v i e w .P s y c h o l o g i c a l Bu l l e t i n , 1 9 6 8 , 7 0 , 5 2 0 - 5 3 3 .

K o e n i g , K. P . , & M a s t e r s , J . E x p e r i m e n t a l t r e a t m e n t o f h a b i t u a l s m o k i n g . B e h a v i o r R e s e a r c h a n d T h e r a p y , 1 9 6 5 , 3 , 2 3 5 - 2 4 3 -

L a n g , P. J . , L a z o v i k , A. D . , & R e y n o l d s , D. J . D e s e n s i t i z a t i o n , s u g g e s t i b i l i t y , a n d p s e u d o t h e r a p y . J o u r n a l o f A bnorm al P s y c h o l o g y , 1 9 6 5 , 7 0 , 3 9 5 - 4 0 2 .

L a n y o n , R. K . , P r i m o , R. V . , T e r r i l l , F . , & Wener, A.An a v e r s i o n d e s e n s i t i z a t i o n t r e a t m e n t f o r a l c o h o l i s m . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1 9 7 2 , 3 8 , 3 9 4 - 3 9 8 .

Law son , D. M . , & May, R. B. T h r e e p r o c e d u r e s f o r t h ee x t i n c t i o n o f s m o k in g b e h a v i o r . The P s y c h o l o g i c a l R e c o r d , 1 9 7 0 , 2 0 , 1 5 1 - 1 5 7 .

L e v e n t h a l , A. M. U se o f b e h a v i o r a l a p p r o a c h w i t h i n a t r a d i t i o n a l p s y c h o t h e r a p e u t i c c o n t e x t : A c a s es t u d y . J o u r n a l o f A bnorm al P s y c h o l o g y , 1 9 6 8 , 73 (2 ) , 178 - 1 8 2 .

Malmo, R. B. A c t i v a t i o n . I n A. J . B a c h r a c h ( E d . ) ,E x p e r i m e n t a l f o u n d a t i o n s o f c l i n i c a l p s y c h o l o g y .New Y ork : B a s i c B o o k s , 19&2.


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M a r c i a , J . E . , R u b i n , B. M., & E f r a n , J . S . S y s t e m a t i c d e s e n s i t i z a t i o n : E x p e c t a n c y c h a n g e o r c o u n t e r c o n d i t i o n i n g . J o u r n a l o f A b n o rm a l P s y c h o l o g y , 1 9 6 9 , 7 1 , 3 8 2 - 3 8 7 .

M a r s t o n , A . , & M c F a l l , R. C o m p a r i s o n o f b e h a v i o r m o d i f i c a t i o n a p p r o a c h e s t o sm o k in g r e d u c t i o n .J o u r n a l o f C o n s u l t i n g a n d C l i n i c a l P s y c h o l o g y ,1 9 7 1 , 3 6 , 153-162".

M a r k s , I . M . , & G e l d e r , M. G. T r a n s v e s t i s m and f e t i s h i s m : C l i n i c a l a n d p s y c h o l o g i c a l c h a n g e s d u r i n g f a r a d i c a v e r s i o n . B r i t i s h J o u r n a l o f P s y c h i a t r y , 1 9 6 7 , 1 1 9 , 7 1 1 - 7 3 0 . ------

Max, L . W. An e x p e r i m e n t a l s t u d y o f t h e m o t o r t h e o r y o f c o n s c i o u s n e s s : A c t i o n - c u r r e n t r e s p o n s e s i n d e a f -m u te s d u r i n g s l e e p , s e n s o r y s t i m u l a t i o n , a n d d r e a m s . J o u r n a l o f C o m p a r a t i v e P s y c h o l o g y , 1 9 3 5 , 1 £ , 4 6 9 - 4 8 9 .

Max, L . W. An e x p e r i m e n t a l s t u d y o f t h e m o t o r t h e o r y o f c o n s c i o u s n e s s : A c t i o n - c u r r e n t r e s p o n s e s i n t h ed e a f d u r i n g a w a k e n i n g , k i n e s t h e t i c i m a g e r y , and a b s t r a c t t h i n k i n g . J o u r n a l o f C o m p a r a t i v e P s y c h o lo g y , 1 9 3 7 , 24 , 3 0 1 - 3 4 4 .

M c F a l l , R. M. E f f e c t s o f s e l f - m o n i t o r i n g on n o r m a l -sm ok ing b e h a v i o r . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1 9 7 0 , 3 5 , 135-±%2-

M c F a r l a n d , J . W. How t o s t o p s m o k i n g . Li s t e n : AJ o u r n a l o f B e t t e r L i v i n g , 1 9 6 9 , 22_ T lO ) , 1 0 - 1 3 .

M cG lynn , E. D . , M e a l i e a , W. L . , & Naw as , M. M. S y s t e m a t i c d e s e n s i t i z a t i o n o f s n a k e - a v o i d a n c e u n d e r two c o n d i t i o n s o f s u g g e s t i o n . P s y c h o l o g i c a l R e p o r t s ,1 9 6 9 , 25 , 2 2 0 - 2 2 2 .

McGrow, R. B . , & O l i v e r , J . F . M i s c e l l a n e o u s t h e r a p i e s .I n S . A r i e t i ( E d . ) , V o l . 2 , A m e r i c a n Handbook o f P s y c h i a t r y . New Y o rk : B a s i c B o o k s , 1959*

M c G u i re , R. J . , & V a l l a n c e , M. A v e r s i o n t h e r a p y bye l e c t r i c s h o c k , a s i m p l e t e c h n i q u e . B r i t i s h M e d i c a l J o u r n a l , 1964, . 1 , 1 5 1 - 1 5 2 .


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M cR ey n o ld s , W. T . , & T o r i , C. A f u r t h e r a s s e s s m e n t o f a t t e n t i o n - p l a c e b o e f f e c t s a n d demand c h a r a c t e r i s t i c s i n s t u d i e s o f s y s t e m a t i c d e s e n s i t i z a t i o n .J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y ,1972', " 3 8 T 2 T 7 ' 2"6i - 2M . ----------------------------------------

Meduna, L. J . C a rb o n d i o x i d e t h e r a p y : A n e u r o l o g i c a lt r e a t m e n t o f n e r v o u s d i s o r d e r s . (2nd e d . ) S p r i n g f i e l d : C h a r l e s C. Thomas, 1 9 5 8 .

M ees , H. L. P l a c e b o e f f e c t s i n a v e r s i v e c o n t r o l : Ap r e l i m i n a r y r e p o r t . P a p e r p r e s e n t e d a t a J o i n t M e e t in g o f t h e O r e g o n - W a s h i n g t o n S t a t e P s y c h o l o g i c a l A s s o c i a t i o n s . Ocean S h o r e s , W a s h i n g t o n , May, 1 9 6 6 .

Montgomery, G. T . , & P a r ton , D. A. R e i n f o r c i n g e f f e c to f s e l f - r e w a r d . J o u r n a l o f E x p e r i m e n t a l P s y c h o l o g y , 1 9 7 0 , 84 ( 2 ) , 2 7 3 - 2 7 6 .

M unro , M. M. Modern c a s e w o r k r e c o r d i n g . S o c i a l Worker J o u r n a l , 1 9 5 1 , 3 2 , 1 8 4 - 1 8 7 .

Namenek, A. A . , & S c h u ld t , W. J . D i f f e r e n t i a l e f f e c t so f e x p e r i m e n t e r s ' p e r s o n a l i t y a n d i n s t r u c t i o n a l s e t s on v e r b a l c o n d i t i o n i n g . J o u r n a l o f C o u n s e l i n g P s y c h o l o g y , 1 9 7 1 , 18 ( 2 ) , 1 9 0 - 1 9 2 .

O ber , D. C. The m o d i f i c a t i o n o f sm o k in g b e h a v i o r .( U n p u b l i s h e d D o c t o r a l d i s s e r t a t i o n , U n i v e r s i t y o f I l l i n o i s ) Ann A r b o r , M i c h . : U n i v e r s i t y M i c r o f i l m s ,1 966 , No. 6 8 - 1 8 2 1 .

O b e r , D. C. M o d i f i c a t i o n o f sm oking b e h a v i o r . J o u r n a l o f C o n s u l t i n g a n d C l i n i c a l P s y c h o l o g y , 1 9 6 8 7 32 ( 5 ) , 5^3-5^97 —

O l i v e a u , D. C . , A g r a s , W. S . , L e i t e n b e r g , H . , M oore , R. C ., & W r i g h t , D. E. S y s t e m a t i c d e s e n s i t i z a t i o n , t h e r a - p e a u t i c a l l y o r i e n t e d i n s t r u c t i o n s a n d s e l e c t i v e p o s i t i v e r e i n f o r c e m e n t . B e h a v i o r R e s e a r c h and Th e r a p y , 1 9 6 9 , 7 , 2 7 - 3 3 .

Omwake, K. T. The r e l a t i o n between a c c e p ta n c e o f s e l fand a c c e p t a n c e o f o t h e r s shown by t h r e e p e r s o n a l i t y i n v e n t o r i e s . J o u r n a l o f C o n s u l t i n g P s y c h o l o g y ,1 9 5 4 , 18 ( 2 ) , 1 9 0 - 1 9 2 .

P a u l , G. L. Two y e a r f o l l o w - u p o f s y s t e m a t i c d e s e n s i t i z a t i o n i n t h e r a p y g r o u p s . J o u r n a l o f Abnormal P s y c h o l o g y , 1 9 6 8 , 73 ( 2 ) , 1 1 9 - 1 3 0 .


5 1

P a u l , G. L. Outcome o f s y s t e m a t i c d e s e n s i t i z a t i o n I I : C o n t r o l l e d i n v e s t i g a t i o n o f i n d i v i d u a l t r e a t m e n t , t e c h n i q u e v a r i a t i o n s , and c u r r e n t s t a t u s . In C. M. P r a n k s ( E d . ) , B e h a v i o r t h e r a p y : A p p r a i s a l ands t a t u s . New Y o r k : M c G ra w - H i l l , 1 9 6 9 .

P e l l e t i e r , A. M. The e f f e c t s o f c l i e n t s e l f - r e c o r d i n ga n d o p e r a n t t e c h n i q u e s i n t r e a t m e n t o f d r u g a d d i c t i o n . P a p e r p r e s e n t e d a t U n iv . o f Mo. and Maplewood J u n i o r C o l l e g e , K a n s a s C i t y , Mo., J u l y and A u g u s t , 1 9 7 1 .

P i n n e a u , S . R . , & M i l t o n , A. The e c o l o g i c a l v e r a c i t y o f t h e s e l f - r e p o r t . J o u r n a l o f G e n e t i c P s y c h o l o g y , 1 9 5 8 , 9 3 , 2 4 9 - 2 7 6 .

P o w e l l , J . , & A z r i n , N. The e f f e c t s o f s h o c k a s ap u n i s h e r f o r c i g a r e t t e s m o k in g . J o u r n a l o f A p p l i e dB e h a v i o r A n a l y s i s , 1 9 6 8 , 1 ( 1 ) , 6 3 - 7 1 .

P y k e , S . , Agnew, N. M., & K o p p e ru d , J . M o d i f i c a t i o n o f a n o v e r l e a r n e d m a l a d a p t i v e r e s p o n s e t h r o u g h a r e l e a r n i n g p r o g ra m : A p i l o t s t u d y i n sm ok ing .B e h a v i o r R e s e a r c h a n d T h e r a p y , 1 9 6 6 , 4_, 1 9 7 - 2 0 3 .

Rachman, S. S y s t e m a t i c d e s e n s i t i z a t i o n . P s y c h o l o g i c a l B u l l e t i n , 1 9 6 7 , 67., 9 3 - 1 0 3 -

R e s n i c k , J . H. C o n t r o l o f sm o k in g b e h a v i o r by s t i m u l u s s a t i a t i o n . B e h a v i o r R e s e a r c h and T h e r a p y , 1968 , 6 , 1 1 3 - 1 1 4 .

R e s n i c k , J . H. E f f e c t s o f s t i m u l u s s a t i a t i o n on t h e o v e r l e a r n e d m a l a d a p t i v e r e s p o n s e o f c i g a r e t t e s m o k in g . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1 9 6 8 ,' 32 1 5 ) , 5 0 1 - 5 0 5 .

R u t n e r , I . T. The m o d i f i c a t i o n o f sm o k in g b e h a v i o rt h r o u g h t e c h n i q u e s o f s e l f - c o n t r o l . U n p u b l i s h e d M a s t e r ’ s t h e s i s , W i c h i t a S t a t e U n i v e r s i t y , 1 9 6 7 .

S c h u b o t , E. D. The i n f l u e n c e o f h y p h o t i c a n d m u s c u l a rr e l a x a t i o n i n s y s t e m a t i c d e s e n s i t i z a t i o n o f p h o b i a s . ( D o c t o r a l d i s s e r t a t i o n , S t a n f o r d U n i v e r s i t y ) Ann A r b o r , M i c h . : U n i v e r s i t y M i c r o f i l m s , 1 9 6 6 .No. 6 7 - 4 4 3 0 .


52

S e i t z , F . C. A p s y c h o t h e r a p e u t i c a p p r o a c h t o d e p r e s s i o n : The i m m e d i a t e i m p a c t o f v i d e o - t a p e c o n f r o n t a t i o n a n d / o r p s y c h o t h e r a p e u t i c d i s c u s s i o n o f s e l f - c o n c e p t a n d b e h a v i o r o f n e u r o t i c a l l y d e p r e s s e d p a t i e n t s . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1 9 7 0 , 30 ( 1 0 - B ) , M797-'W9S~-

S o lom on , R. L. P u n i s h m e n t . A m e r i c a n P s y c h o l o g i s t , 1964 ,. 1 9 , 2 3 9 - 2 5 3 .

S t u a r t , R. B. B e h a v i o r a l c o n t r o l o f o v e r e a t i n g .B e h a v i o r R e s e a r c h and T h e r a p y , 1 9 6 7 , 5 ( 4 ) , 3 5 7 - 3 6 5 .

Thompson, G. N. Acute and c h ro n ic a l c o h o l i c c o n d i t i o n s .I n S. A r i e t i ( E d . ) , V o l . I . Am e r i c a n Handbook o f P s y c h i a t r y . New York: B a s i c B o o k s , 1 9 5 9 .

T o o l e y , J . T . , & P r a t t , S . An e x p e r i m e n t a l p r o c e d u r e f o r t h e e x t i n c t i o n o f sm o k in g b e h a v i o r .P s y c h o l o g i c a l R e c o r d , 1 9 6 7 , 17 ( 2 ) , 2 0 9 - 2 1 8 .

T r a u x , C. B. Some i m p l i c a t i o n s o f b e h a v i o r t h e r a p y f o r p s y c h o t h e r a p y . J o u r n a l o f C o u n s e l i n g P s y c h o l o g y ,1 9 6 6 , 1 3 , 1 6 0 - 1 7 0 .

W agner , M. K . , & B r a g g , R. A. C o m p ar in g b e h a v i o r m o d i f i c a t i o n a p p r o a c h e s t o h a b i t d e c r e m e n t - s m o k i n g .J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1 9 7 0 ,3 1 7 2 58 - 2F3 .

Wolpe, J . P s y c h o t h e r a p y by r e c i p r o c a l i n h i b i t i o n . S t a n f o r d : S t a n f o r d U n i v e r s i t y P r e s s , 1 9 5 6 •

W olpe , J . The s y s t e m a t i c d e s e n s i t i z a t i o n t r e a t m e n t o f n e u r o s i s . J o u r n a l o f N e rv o u s a n d M e n ta l D i s e a s e s , 196 1 , 1 1 2 , IF9-203..

W olpe, J . B a s i c P r i n c i p l e s and p r a c t i c e s o f b e h a v i o rt h e r a p y i n n e u r o s e s . A m e r ic a n J o u r n a l o f P s y c h i a t r y , 1 9 6 8 , 125 ( 1 2 ) , 1 2 4 2 - 1 2 5 7 .

W olpe, J . The p r a c t i c e o f b e h a v i o r t h e r a p y . New Y o r k : P e rgam en P r e s s , 1 9 6 9 .


APPENDIX A

S a i n t s t o Open Smoking C l i n i c

Human D e v e lo p m e n t M i n i s t r i e s (HDM), a b r a n c h o r g a n i z a t i o n o f t h e G rand R a p i d s D i s t r i c t o f t h e R e o r g a n i z e d C h u rc h o f J e s u s C h r i s t o f L a t t e r Day S a i n t s j w i l l ad d a n t i - s m o k i n g c l i n i c s t o i t s s e r v i c e s s o o n .

A sp o k e sm a n f o r HDM s a i d t h e c l i n i c t y p i c a l l y would r u n f o r f i v e w eeks w i t h m e e t i n g s a b o u t t w i c e a w e ek . He s a i d s c h e d u l i n g w o u ld be f l e x i b l e , b u t t h a t a t l e a s t f o u r p e r s o n s m us t be i n e a c h g r o u p .

The f e e i s $25» b u t p a r t o f t h e money w i l l be r e f u n d e d i f t h e p e r s o n k i c k s t h e t o b a c c o h a b i t . The HDM o f f i c e s a r e a t 1915 N e l s o n A v e . SE, a n d f o r a d d i t i o n a l i n f o r m a t i o n , c a l l 2 4 3 - 3 4 4 5 o r 2 4 3 - 1 3 2 6 .

HDM o p e n e d t h i s s p r i n g and a l s o o f f e r s i n d i v i d u a l b e h a v i o r a l c o u n s e l i n g , m a r r i a g e and f a m i l y c o u n s e l i n g , p r o v i s i o n s f o r t h e p o o r , s e l f - m o t i v a t i o n c l a s s e s , f i n a n c i a l c o u n s e l i n g , v o c a t i o n a l an d em plo y m en t g u i d a n c e , a n d r e h a b i l i t a t i v e m i n i s t r i e s i n t h e f i e l d o f d r u g and a l c o h o l a b u s e .

G rand R a p i d s P r e s s , J u l y 2 2 , 1 9 7 2 , p . 1 0 - A .

53


APPENDIX B

KICK THE HABIT A d d i c t i o n

C'mon now. You c a n do i t and we w i l l h e l p y o u . S e v e r a l t e s t e d a n d p r o v e n t e c h n i q u e s w i l l h e l p y o u k i c k t h e h a b i t . HDM's D i r e c t o r i s s k i l l e d i n a t l e a s t e i g h t d i f f e r e n t t r e a t m e n t t e c h n i q u e s i n t h i s a r e a an d i s o f f e r i n g t h e r a p y t o a s s i s t y o u i n k i c k i n g t h e h a b i t . We w ork i n g r o u p s o f t h r e e t o f i v e .I t ' s s t i l l n o t t o o l a t e t o g e t i n t o a g r o u p i f you want t o b e h e a l t h i e r , f e e l b e t t e r , s t o p c o u g h i n g , b r e a t h e b e t t e r an d s t o p s m o k i n g .

Give u s a j i n g l e a t 2 4 3 -3 4 4 5 t o d a y . T h e r e i s a s l i g h t f e e f o r e q u i p m e n t and m a t e r i a l s b u t i t i s f a r l e s s e x p e n s i v e t h a n c o n t i n u i n g t o smoke. The s o o n e r y o u s t o p sm o k in g a f t e r t h e r a p y s t a r t s , t h e l e s s i t w i l l c o s t . S ig n up t o d a y . You w i l l h a v e f u n d o i n g i t a n d y o u w i l l b e a new p e r s o n i n j u s t a s h o r t w h i l e . T e l l y o u r f r i e n d s a n d g e t t h e m t o s i g n up b e f o r e a l l s e s s i o n s a r e f u l l .

R a p p o r t , 1 9 7 2 , 2 ( 8 ) , 66 .

54


APPENDIX C

limanG ran d R apids District C enter

1915 N elson. S.E.

C re n d R apids, M ichigan 4 9 5 0 7 Ph. (616) 243-3445

A. M. PELLETIERPRESIDENT

Dedicated to help people discover their living beauty.

\( i c K the rldlttC'mon now you c a n do i t . W e ' l l h e l p y o u . T h e r e a r e

s e v e r a l t e s t e d and p r o v e n t e c h n i q u e s t o h e l p you k i c k t h e h a b i t . HDM's D i r e c t o r i s s k i l l e d i n t e a c h i n g yo u a t l e a s t e i g h t d i f f e r e n t t r e a t m e n t t e c h n i q u e s i n t h i s a r e a . HDM i s p r e s e n t l y e x t e n d i n g i n t o an a d d i t i o n a l s e r v i c e ; i t w i l l o f f e r t h e r a p y t o h e l p y o u k i c k t h e h a b i t . We w i l l w ork i n g r o u p s o f t h r e e t o f i v e and a r e r e a d y t o s t a r t as s o o n a s we h e a r f ro m t h e f i r s t t h r e e who w a n t t o be h e a l t h i e r , f e e l b e t t e r , s t o p c o u g h i n g , b r e a t h e b e t t e r and s t o p s m o k in g . Give us a j i n g l e t o d a y a t 243—3445 . T h e re i s a s l i g h t f e e f o r e q u i p m e n t and m a t e r i a l s , b u t i t i s f a r l e s s e x p e n s i v e t h a n c o n t i n u i n g y o u r s m o k in g h a b i t .The s o o n e r y o u s t o p sm o k in g a f t e r t h e r a p y s t a r t s , t h e l e s s i t w i l l c o s t . S ig n up t o d a y . You w i l l h a v e f u n d o i n g i t a n d yo u w i l l be a new p e r s o n i n j u s t a s h o r t w h i l e . T e l l y o u r f r i e n d s a n d g e t them t o s i g n up b e f o r e o u r s e s s i o n s a r e f u l l .


ANYTIME

Reorganized CHURCH OF JESUS CHRIST o f Latter Day Saint*

55

APPENDIX D

Name B e g i n n i n g D a te

D a te Number o f C i g a r e t t e s Smoked P e r Day

Comments

56


APPENDIX E

PRESCRIPTION FOR SMOKERS

EACH DAY:1 . Keep a n a c c u r a t e r e c o r d o f number o f c i g a r e t t e s ( o r

o t h e r t o b a c c o ) you d e s i r e t o sm oke .

2 . Compute d a i l y c o s t s o f t h e t o b a c c o h a b i t .3 . D r i n k a t l e a s t n i n e g l a s s e s o f w a t e r :

a . Two t h e f i r s t t h i n g i n t h e m o r n i n g ;b . Two b e t w e e n e a c h m e a l ;c . One w i t h e a c h m e a l ( n o o n a n d e v e n i n g ) ;d . One b e t w e e n e v e n i n g m e a l a n d b e d t i m e .

4 . D r i n k l o t s o f f l u i d s t o f l u s h o u t t h e n i c o t i n e .(Avoid a l c o h o l . )

5 . E a t l o t s o f f r u i t .6 . Get enough r e s t .

7 . R e l a x p e r i o d i c a l l y w i t h e y e s c l o s e d . P r a c t i c e r e l a x a t i o n .

8 . Ask f o r G o d ' s h e l p .9 . Upon g e t t i n g up i n t h e m o r n i n g ,

a n d a f t e r e a c h m e a l ,and e v e r y t i m e you w an t t o sm oke ,

R e p e a t ," I c h o o s e n o t t o s m o k e . "

" I c h o o s e n o t t o sm o k e . "" I c h o o s e n o t t o s m o k e . "

(Keep r e p e a t i n g i t . )

1 0 . D o n ' t smoke f o r one w h o le d a y .

1 1 . At n i g h t , r e p e a t ,

" I made i t t h r o u g h t h e w h o le d a y w i t h o u t a s m o k e . "

Thank God an d a s k f o r m ore D i v i n e h e l pj u s t f o r to m o r r o w .

57


extinguishing or modifying smoking behavior: a comparison

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