The relationship between expressed social fears and assertiveness and its treatment implications

Behavior therapists have speculated about the relationship between social fears or social anxieties and lack of assertive behavior. Wolpe (1958) perhaps most clearly suggested such a relationship. “If he [the patient] has been ineffectual in such situations—unable, for instance, to return a faulty garment—I explain how unadaptive fears are at the bottom of this ineffectualness. … p. 116.” Wolpe further assumed that engaging in assertive behavior reciprocally inhibited fear in these same social situations and that assertive responses can be programmed for use in overcoming these fears.In later writings (Wolpe. 1969; Wolpe and Lazarus, 1966) Wolpe seems to have broadened his position concerning the cause of non-assertive behavior. Specifically, he now allows that an individual also may be non-assertive, “… not because of anxiety but because they have never had the opportunity of acquiring the necessary habits. p. 40” (Wolpe and Lazarus, 1966). For these individuals direct efforts in assertive training such as behavior rehearsal, operant conditioning or direct instruction are in order. For these individuals whose lack of assertiveness is due to a ‘phobic reaction’ or strong extrinsic fears, systematic desensitization is recommended in addition to assertive training.Despite this apparent change in position, the intuitively appealing notion that the more socially fearful an individual is the more non-assertive he is likely to be has not received the empirical attention it deserves. Rathus (1973) seems to have provided some indirect evidence pertaining to the relationship between social fears and assertiveness. In the context of evaluating the efficacy of an assertive training method he administered both the 100-item Temple Fear Survey Inventory (TFSI) (Braun and Reynolds, 1969) and the Rathus Assertiveness Schedule (RAS) (Rathus, 1973) to groups of female students receiving either assertive training, a placebo treatment or no treatment. He found that at post-test the assertive training group scored significantly higher than either the placebo or no treatment groups on the RAS and that there were no significant differences in post-test Full Scale TSFI Scores. Fear of Social Criticism Factor Scores or Fear of Social Incompetence Factor Scores although in each case the mean changes toward less fear were greater for the group receiving assertive training. This finding gives little support to the reciprocal relationship between social fears and assertiveness. What is needed is a direct determination of the degree to which social fears and assertiveness are related in a sizeable sample of subjects.     

Fear survey schedule-III: Oblique and orthogonal factorial structures in an American college population

The 78-item Fear Survey Schedule-III (Wolpe and Lang, 1964) was administered to 474 men and 545 women, ages 17–27, from the University of Wyoming and the scores were evaluated in orthogonal and oblique factor analyses using stringent criteria. Four main factors, similar in both genders, were identified, relating to fear of interpersonal events, animals and insects, medical and surgical procedures and bodily insults, and environmental concerns (agoraphobia-like). A majority of both men (59%) and women (78%) reported one or more extremely intense fears (rated “very much”), ranging in number from 1 to 40. This has not been reported in previous literature, yet is shown to have relevance for psychological research. The mean score on the majority of fear items was higher for women than men. Needs for additional items that are more male-oriented in the FSS-III and a greater theoretical grounding in FSS-III research are discussed.     

Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population

This study aimed to clarify how manifestations and acquisition relate to diagnostic categories of dental fear in a population of self-referred dental fear patients, since diagnostic criteria specifically related to dental fear have not been validated. DSM III-R diagnostic criteria for phobias were used to compare with four existing dental fear diagnostic categories, referred to as the Seattle system. Subjects were 208 persons with dental fear who were telephone interviewed, of whom a subsample of 155 responded to a mailed Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory and a modified FSS-II Geer Fear Scale (GFS). Personal interviews and a Dental Beliefs Scale of perceived trust and social interaction with dentists were also used to evaluate a subsample of 80 patients selected by sex and high dental fear. Results showed that the majority of the 80 patients (66%), suffered from social embarrassment about their dental fear problem and their inability to do something about it. The largest cause of their fear (84%) was reported to be traumatic dental experiences, especially in childhood (70%). A minority of patients (16%) could not isolate traumatic experiences and had a history of general fearfulness or anxiety. Analysis of GFS data for the 155 subjects showed that fear of snakes and injuries were highest among women; heights and injections among men. Fear of blood was rarely reported. Spearman correlations between GFS individual items and DAS scores indicated functional independence between dental fear and common fears such as blood, injections and enclosures in most cases. Only in specific types of dental fear did these results support Rachman and Lopatka's contention that fears are thought to summate.(ABSTRACT TRUNCATED AT 250 WORDS)     

General and specific fears in referred and self-referred adult patients with extreme dental anxiety.

The levels of, and relationships between, dental fear and general fears and phobias were studied in 109 adult patients at a specialized dental fear clinic using two dental fear scales (the Dental Anxiety Scale and the Dental Fear Survey) together with the Fear Survey Schedule II (FSS-II) and some additional fear items. Referred and self-referred fearful dental patients answered mailed questionnaires in conjunction to being put on a 1 yr waiting list for treatment. Among feared objects and situations the separate item 'pain' revealed the highest mean scores for both men and women, followed by fear of suffocating, death of a loved one and sharp objects among women, and death of a loved one, suffocating and hypodermic needles among men. With few exceptions, women scored higher than men. The frequencies of extreme fears (6 and 7 on a 7-point scale) were high and 92.7% of the patients reported at least one extreme fear. Half of the subjects (49.5%) reported five fears or more. It was also shown that a number of FSS-II items correlated to dental fear indicating a relationship between general and dental fear. These results indicated that a large proportion of these dentally fearful individuals were prone to fear-associated reactions and behaviors, which has previously been shown to negatively influence the prognosis of treatment.     

Factor analysis of the responses of British University students to the Fear Survey Schedule (FSS-III)

An 88-item version of the Fear Survey Schedule-III (Wolpe, 1973) was administered to 547 students from Bedford College (University of London) and the scores were factor analysed. Four main factors were identified, relating to fear of social inadequacy, tissue damage, travel and animals. The relative importance of the factors is compared with that found in other studies: fears of social inadequacy and of tissue damage are generally found amongst the major factors, although their relative order may be reversed. The order of the fear ratings of 72 of the items is found to correlate highly with that found in Natal Indians. The scores on some of the items and the total fear scores are higher in females than males and possible explanations of this findings are discussed.     

The Mutilation Questionnaire as a predictor of blood/injury fear and fainting

The Mutilation Questionnaire, (MQ) was examined in terms of its psychometric characteristics, its relation to Fear Survey Schedule-II Blood/Injury items, its ability to predict B/I-related fainting, a response common to many B I fearful persons, and its factor structure. In two separate samples of college subjects, females reported greater B/I fear than males, the distributions were positively skewed and negatively kurototic but internal consistency was adequate in both. The MQ correlated 0.75 with five B/I items taken from the FSS-II. While these two scales were comparable in assessing self-reported B/I fear, the MQ was more predictive of fainting. Discriminant analyses of the 30 MQ items in relation to prediction of subjects' faint histories resulted in 77% correct classification of faint history. However, responses to a single question concerning subjects' self assessment of B/I fear was equally as capable of classifying fainting status as the full MQ scale. Responses to the single fear question correlated 0.55 with faint history while MQ scores correlated only 0.45. Factor analyses of the MQ revealed two factors described as 'revulsion of B/I stimuli', accounting for 19% of item variance and 'fear of bodily damage', accounting for 7%. Implications of these results are discussed in terms of the FSS-II, the MQ and alternative means of B/I fear assessment.     

The relationship between attitude,assertiveness and condom use

The Australian study investigated condom-specific assertiveness and condom use as a means of prevention infection from sexually transmitted diseases. 211 men participated including 83 homosexual men (aged 19-62 years) and 128 heterosexual men (aged 17-49) who completed a questionnaire that comprised demographic details such as age, monogamy, and sexual activity as well as attitudinal and assertiveness measures. General assertiveness was measured by the Rathus Assertiveness Schedule (RAS) which had been widely used across a wide range of social situations. Assertiveness relating specifically to situations involving condoms was measured by the Condom Assertiveness Scale (CAS). Intention to use condoms was positively related to favorable attitudes, which were related to condom-specific assertiveness for both groups. For the heterosexual men only, general social assertiveness was negatively related to attitudes toward condoms. For both groups, the condom-specific measure of assertiveness was positively correlated with attitudes toward condoms. Condom-specific assertiveness was positively related to general social assertiveness as measured by the Rathus Assertiveness Schedule for the homosexual, but not for the heterosexual men. The negative relationship between general assertiveness and attitude to condoms among the heterosexual men implies that the risk reducing behavior of condom use did not seem to accord with the perceptions of masculinity and social assertiveness among heterosexual men. Thus, female partners of such heterosexual men exhibiting negative attitudes toward condom use combined with assertiveness would have to overcome resistance to insist on the use of condoms. Recently some advertising campaigns have been directed at women. The promotion of condom use among heterosexual men has to deal with the perceptions of condom use as unmasculine behavior.     

A note on the effects of anonymity,response consequence information,and sex on the self-assessment of fear

Despite an increasing emphasis on the direct observation and measurement of behavior in the assessment of fear (e.g. Bernstein, 1973. Goldfried and Sprafkin, 1974: Hersen, 1973). the Fear Survey Schedule (FSS; Geer, 1965: Wolpe and Lang, 1964) has remained popular as a paper-and-pencil instrument for screening large populations of potential treatment subjects prior to behavior avoidance tests (BATs; e.g. Bernstein and Nietzel, 1973). The utility of the FSS for this purpose is largely dependent upon its ability accurately to predict avoidance behavior in the presence of specific fear targets (Hersen, 1973) but. unfortunately, correlations between self-reported fear intensity on the FSS and overt behavior during BATs usually range from low to moderate (Lang, 1968; Schroeder and Craine, 1971). There is evidence that this disparity between FSS reports of fear and subsequent avoidance behavior are due in part to the operation of situational and contextual variables within the BAT which affect overt responses (Bernstein, 1973). and it seems reasonable to suspect that procedural variations in the self-assessment situation (e.g. method of test administration, instructions regarding the nature and purpose of testing, test form. and physical/interpersonal context) could modify FSS responses in a similar fashion. While research on projective and other assessment instruments has clearly established the influence of such variables on test responses (e.g. Azrin, Holz and Goldiamond, 1961; Henry and Rotter, 1956; Page and Yates, 1975). it is presently unknown to what extent ‘impression management’ strategies (Braginsky, Grosse and Ring, 1966) based upon cues in the testing situation bias verbal reports of fear. Preliminary investigation of this problem was undertaken in the present experiment by directly manipulating (a) the degree to which subjects could be identified with and held ‘accountable’ for their reported levels of fear and (b) the amount of information provided about the probable consequences of their responses.     

Sex Roles,Gender, and Fear

Male and female college students classified as masculine, feminine, androgynous, or undifferentiated on the Bern (1974) Sex Role Inventory (N = 199) were given the Wolpe (1969) Fear Inventory. Significant differences in average fear scores were seen between men and women and between the four sex-role categories, with sex role and gender contributing equally to the variability. The argument is raised here that excessive fearfulness or fearlessness might be as much a product of sex-role conditioning as a product of gender.     

Sex roles, gender, and fear

Male and female college students classified as masculine, feminine, androgynous, or undifferentiated on the Bem (1974) Sex Role Inventory (N = 199) were given the Wolpe (1969) Fear Inventory. Significant differences in average fear scores were seen between men and women and between the four sex-role categories, with sex role and gender contributing equally to the variability. The argument is raised here that excessive fearfulness or fearlessness might be as much a product of sex-role conditioning as a product of gender.     

The Effects of Assertive Training on Sex Role Concept in Female Agoraphobics

Agoraphobia in women has often been associated with a restricted, "overly-feminine" sex role definition. We investigated whether assertiveness training from a female therapist would benefit agoraphobic women not only by teaching skills but incidentally by modeling a broader feminine gender role. Of 14 clients from an agoraphobic treatment program seven received assertiveness training as an adjunct to regular therapy. Sex role definition and assertiveness attitudes were measured with the Personal Attributes Questionnaire (Spence, Helmreich, & Stapp, 1974) and the Rathus Assertiveness Schedule (Rathus, 1973), administered before and following a 7-week treatment period. All the agoraphobics initially had significantly lower Masculinity scores on the PAQ than did large normative samples. T-tests performed on the data indicated that the assertiveness group's Masculinity scores increased after treatment to the level of the normative samples, while the comparison group did not change. Results supported the clinical observation that many agoraphobic women have limited gender role definitions, and indicated that this limitation consists of a deficit of masculine traits rather than a surplus of feminine ones.     

Fear survey schedule (II): Normative data and factor analyses based upon a large college sample

A fear survey schedule (FSS-II) was administered to 1814 undergraduates at the University of Illinois. Females reported significantly more fear than males. Factor analyses indicated that FSS-II taps the following major fear areas: Live Organisms, Death and Illness, Social Interaction, and Social Evaluation. Problems associated with the use of FSS-II total scores for subject selection purposes and with the unsupplemented use of verbal report fear measures were discussed.     

Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: psychometric properties of a new measure

Three studies were conducted to assess the reliability and validity of a measure that we developed using a non-clinical sample of university undergraduates, the Driving and Riding Avoidance Scale (DRAS). Study 1 indicated that the scale was internally consistent (α=0.92) and that a four-factor model (general avoidance, avoidance of traffic and busy roads, avoidance of weather or darkness, and riding avoidance) provided the best fit to the data in a sample of 386 crash survivors. This study also revealed that survivors who received medical treatment for their crash-related injuries reported significantly greater avoidance than people who were uninjured or injured and not medically treated. Study 2 revealed that the DRAS possessed acceptable test-retest reliability (r=0.83) over a 4-week interval in a sample of 67 crash survivors. Using a sample of 118 survivors, study 3 examined the instrument’s convergent and divergent validity through correlations with the Accident Fear Questionnaire (AFQ), the Mobility Inventory (MI), the Fear Survey Schedule-II (FSS-II), and the Fear Questionnaire (FQ). The strongest relationships were observed between the DRAS and the AFQ and with a driving subscale created from the MI items. The DRAS exhibited significantly weaker relationships with the FQ subscales that assessed other kinds of phobic avoidance.     

Specific fears as predictors of generalized anxiety

Three hundred thirty-seven female undergraduates completed the Trait Form of the State-Trait Anxiety Inventory (STAI) and the Fear Survey Schedule-II (FSS) to determine if any specific fear factor was significantly related to STAI score. All fear factor scores and the total FSS-II score were significantly correlated with the STAI score and with each other. A stepwise regression procedure indicated that Factor 1, Fear of Social Interaction, accounted for 25.2% of the variance in STAI scores (p <.001), while Factor 4, of Negative Social Evaluation, accounted for an additional 1.8% of the variance (p <.01). The implications for theory, assessment, and intervention are discussed.     

Fears of phobic patients: Factor analyses of self-report data

Fear questionnaires completed by 171 phobic patients were factor-analysed. Factors previously identified in student and non-phobic patients were replicated, and in addition an agoraphobia factor was found. Separate analyses of (i) a group of psychiatrically diagnosed agoraphobics and (ii) a group of miscellaneous phobics revealed that agoraphobics are generally more fearful and depressed than other phobics, and score more highly on a cluster of items which include ‘breathing difficulties’ and ‘dizziness’. A distinct agoraphobia factor was not identifiable in the group of miscellaneous phobics, pointing to the all-or-none nature of this fear.     

Dimensional structure and psychopathology correlates of the fear survey schedule (FSS-III) in a phobic population: A factorial definition of agoraphobia

The responses of 703 non-institutionalized phobics to the Fear Survey Schedule (FSS-III) were factor-analyzed utilizing a principal components procedure. Factors previously identified in student, adolescent and ‘non-phobic patient’ populations—(I) Social Anxiety, (III) Fears related to Bodily Injury, Death and Illness. (IV) Fear of Display to Sexual and Aggressive Scenes, (V) Small Animal Fears—were replicated. Additionally, an Agoraphobia (II) factor, corroborating recent findings by Hallam and Hafner (1978), and pointing to the specificity of this fear, emerged. Due to substantially high intercorrelations found, the Social Inadequacy dimension of the Symptom Checklist (SCL-90) and the Social Anxiety scale (I), on the one hand, and the Agoraphobic dimension of the SCL-90 and the Agoraphobia scale (II), on the other, could be used interchangeably with phobic populations. A higher-order factor analysis run on psychopathology scales employed, including factored FSS scales, yielded three components, (1) Neuroticism, (2) Phobia and (3) Agoraphobia. Opportunity was taken to define the Agoraphobic Syndrome empirically. A specific Somatization dimension was as highly related to Neuroticism, as to the higher-order Agoraphobic cluster, clearly supporting clinical observations with regard to the Agoraphobic syndrome. Some interesting findings are focused upon and discussed.     

Validity of the Fear Survey Schedule in phobia research: A laboratory test

The Fear Survey Schedule III, developed by Wolpe and Lang (1969, 1977), is used frequently to classify subjects as phobic or nonphobic. Subjects selected for their intense-fear scores on blood, fire, bat, and snake items did not significantly differ from no-fear subjects on an objective behavioral assessment test. Analyses of subject verbal reports suggest several possibilities for the inability to discriminate between fearful and nonfearful subjects. Researchers are cautioned about the use of the Fear Survey Schedule for selecting phobic subjects without supporting evidence.     

Phobic anxiety in 11 nations. Part I: Dimensional constancy of the five-factor model

The Fear Survey Schedule-III (FSS-III) was administered to a total of 5491 students in Australia, East Germany, Great Britain, Greece, Guatemala, Hungary, Italy, Japan, Spain, Sweden, and Venezuela, and submitted to the multiple group method of confirmatory analysis (MGM) in order to determine the cross-national dimensional constancy of the five-factor model of self-assessed fears originally established in Dutch, British, and Canadian samples. The model comprises fears of bodily injury-illness-death, agoraphobic fears, social fears, fears of sexual and aggressive scenes, and harmless animals fears. Close correspondence between the factors was demonstrated across national samples. In each country, the corresponding scales were internally consistent, were intercorrelated at magnitudes comparable to those yielded in the original samples, and yielded (in 93% of the total number of 55 comparisons) sex differences in line with the usual finding (higher scores for females). In each country, the relatively largest sex differences were obtained on harmless animals fears. The organization of self-assessed fears is sufficiently similar across nations to warrant the use of the same weight matrix (scoring key) for the FSS-III in the different countries and to make cross-national comparisons feasible. This opens the way to further studies that attempt to predict (on an a priori basis) cross-national variations in fear levels with dimensions of national cultures.