Using vicarious reinforcement to increase client completion of between-session assignments.

Abstract

There is a significant relationship between adherence to psychotherapy between-sessions assignments and treatment outcome (Addis & Jacobson, 2003; Bryant, Simons, & Thase, 1999; Edelman & Chambless, 1995; Kazantzis & Lampropoulos, 2002; Startup & Edmond, 1994). However, clients often do not complete assignments. Thus, it can be good practice for psychotherapists to use methods to maximize the chances that clients will carry out assigned tasks. Although many therapists have offered suggestions about how to increase the chances that clients will complete therapy assignments (e.g., Malouff & Schutte, 2004), only a few studies show that specific methods help. In a noteworthy study, Cox, Tisdale, and Culbert (1988) found that giving clients psychological-medical assignments in writing as well as orally led to more adherence than assignments given only orally. Beyond this one finding, to our knowledge the only evidence supporting the value of any specific strategy to increase rates of mental health assignment completion have come from our studies on vicarious reinforcement. Vicarious reinforcement involves an observer emulating the behavior of another individual (a model) because that individual benefited from performing the behavior (Malouff & Rooke, 2008). Vicarious reinforcement can occur either through direct observation of modeled behavior, or symbolic modeling, such as through a story, told orally or in writing. For example, symbolic vicarious reinforcement may occur when a model tells a personal anecdote about how she or he behaved in a particular way and experienced positive outcomes. The behavior analytic perspective on vicarious reinforcement holds that a focus on mediating cognitive factors is not needed and that the essential element of vicarious learning is the relationship between an individual's learning history and his or her current environment (Deguchi, 1984; Masia & Chase, 1997). Masia and Chase (1997) argued that a behavior analytic approach to vicarious learning is especially useful for clinicians drawing on vicarious learning as part of therapeutic interventions. Research on Vicarious Reinforcement in Increasing Assignment Completion Our first study on vicarious reinforcement found that providing individuals with video models of psychotherapy clients who talked about how they benefitted from treatment led to increases in positive attitude toward obtaining mental health treatment (Buckley & Malouff, 2004). We have since completed the only published studies on the value of vicarious reinforcement in increasing the rate of client completion of assigned tasks. In the first of these studies (Rooke and Malouff, 2006), individuals in the experimental condition received information about how to use expressive writing to reduce distress and received a written anecdote about a person who used the method and benefitted. They also viewed a video of three individuals who described the beneficial consequences expressive writing had for them. Individuals in the control condition received information about how to use the writing to reduce distress and viewed a control video about being creative. The results showed that vicarious reinforcement of the target behavior of expressive writing led to significantly greater levels of use of expressive writing among participants, as measured by self-ratings of adherence and by a count of number of words written. In a study with a group of individuals who wanted to learn a way to reduce their distress levels, we found that three written anecdotes of beneficial use of problem solving methods led to greater use of the methods as measured by the number of words on problem solving forms, by self-rating of adherence, and by observer ratings of adherence in completing problem solving forms (Coates, Malouff, and Rooke, in press). Attributes of Influential Models Several attributes of models tend to increase their effect on an observer's behavior. …