Journal of PrimaryPrevention,5(1),Fall, 1984

Effects of Preventive Cognitive

Self-Instruction Training on
Adolescent Attitudes, Experiences,
and State Anxiety
STANLEY B. BAKER and JAMES N. BUTLER
A B S T R A C T : The effects of teacher-directed cognitive self-instruction {TI} were com-
pared with an instructions-only component control condition {IO) in order to examine
the former's efficacy as a primary prevention strategy. In a quasi-experimental design,
two intact high school psychology classes were randomly assigned to either TI or IO.
Each condition lasted for eight 45-minute class periods, and each group was given an in
vivo homework assignment. P r e t r e a t m e n t equivalence and demand analyses yielded
no evidence of differences. Results of a p o s t t r e a t m e n t measure of a t t i t u d e toward treat-
m e n t s and a pre- and p o s t t r e a t m e n t measure of s t a t e anxiety suggested t h a t trainer-
directed cognitive self-instruction may be a promising primary prevention strategy.

Cognitive self-instruction, sometimes called cognitive restructuring,

as used in this study was adapted from cognitive behavior-
modification methodology developed by Meichenbaum (1977}. The
self-instruction program is based on principles of problem definition,
focused attention and response guidance, self-reinforcement, and self-
evaluating coping skills with error-correcting options (Stone, 1980}.
Meichenbaum hypothesized that some maladaptive behaviors may be
attributed to irrational beliefs that lead to inappropriate self-
verbalization. In his self-instruction paradigm, persons using
maladaptive behaviors caused by inappropriate irrational self-
verbalizations are taught to replace them with more adaptive ones.
For example, an adolescent whose in*ational response to meeting mem-
bers of the opposite sex is to avoid such encounters because "s/he will
Stanley B. Baker is Associate Professor of Education at the Division of Counseling
and Educational Psychology, Pennsylvania State University. J a m e s N. Butler is
Psychology Teacher, Tyrone Area High School, Tyrone, PA.
Requests for reprints should be sent to Stanley B. Baker, Division of Counseling and
Educational Psychology, 313 C E D A R Building, The Pennsylvania State University,
University Park, P A 16802.

17 ©1984 HumanSciencesPress
18 Journal of Primary Prevention

not like me anyway" may be taught to recognize such thinking as

maladaptive and correspondingly to replace it with coping self-
statements such as "How will I know unless I try?" The underlying
goals are to increase awareness of noncoping dialogue and to produce
coping self-statements in their place. Cognitive self-instruction has
been an effective treatment strategy in therapeutic settings, where, for
example, persons suffered from maladaptive self-verbalization leading
to general anxiety, social-interpersonal anxiety, depression, pain-filled
stress, and test anxiety (cf. Altmaier, Ross, Leary, & Thornborough,
1982; Cormier & Cormier, 1979; Gormally, Vervil-Weld, Raphael, &
Sipps, 1981; Wise & Haynes, 1983}.
While therapeutic applications of cognitive behavior-modification
principles have been promoted and tested for nearly a decade, ad-
vocacy of preventive applications has been more recent (cf. Craighead,
1982; Goldfried, 1980}. The potential of using cognitive behavior
modification strategies to achieve preventive goals is analogous to
medical inoculations, in that those who have acquired coping skills
through systematic prevention programs will be less likely to respond
to situations in a maladaptive manner and to be vulnerable to
psychological stress (Jason, 1980; Stone & Noce, 1980}.
Since according to Cowen (1982) the broad goal of primary preven-
tion is helping people to master life's problems with minimum dif-
ficulty or helping them to cope with problems effectively when they
happen, it seems logical that cognitive-behavior modification prin-
ciples may lead to viable prevention strategies. In this investigation,
cognitive self-instruction was studied in a natural classroom en-
vironment. Craighead, Meyers, Wilcoxon-Craighead, and McHale
(1983) argue that using such natural mediators as teachers will in-
crease the likelihood of sustained behavior change. This may be due in
part to new behaviors learned in an environment where they will be
used (Guerney, Guerney, & Andronico, 1966) and in part to the natural
mediators being viewed as nurturant, competent models who are to be
imitated (Bandura, 1969).
The idea to use cognitive self-instruction as a classroom teacher-
directed preventive strategy was formulated by the senior author who,
in this instance, represented a school counselor. Consequently, a con-
sulting relationship existed between the teacher who served as a
trainer and the counselor who served as a consultant sharing his ex-
pertise directly with the teacher and indirectly with the students. This
arrangement resembles the recommended psychoeducator role by
which counselors directly and indirectly share their knowledge in order
to help a large clientele through activities having preventive goals (cf.
Stanley B. Baker and James N. Butler 19

Carroll, 1981; C o t t i n g h a m , 1973; I v e y , 1976). I t w a s h y p o t h e s i z e d t h a t

students receiving teacher-directed cognitive self-instruction training
would score b e t t e r t h a n s t u d e n t s in a control condition w h e r e s t u d e n t s
r e c e i v e d p r i n t e d i n s t r u c t i o n s w i t h o u t t e a c h e r direction on all depen-
dent measures.

~/lethod

Subjects

Students enrolled in two sections of a high school psychology course served

as subjects. All students had been assigned to classes by a computer
programmed to assign the best fit across all students in the school. No special
grouping criteria had been used. One intact class was randomly assigned to
the teacher-directed cognitive self-instruction (TI) treatment while the other
served as a control group. This instructions-only (IO) control condition
received similar printed instructions but no teacher-led training. Most sub-
jects were either high school juniors or seniors, and all had chosen the
psychology course as an elective. All subjects were Caucasian. TI had 17
students (12 female, 5 male) while IO had 19 students (16 female, 3 male}. Two
TI students and three IO students were not included in the analyses because
of excessive absences, leaving 15 TI and 16 IO students. All students at-
tended an area senior high school located in a central Pennsylvania com-
munity of about 7,000 people. The study was conducted in late May and early
June, 1982.

Teacher

Both classes were taught by a 31-year-old male with nine years of teaching
experience. Although informed about behavior modification principles, he
was not familiar with cognitive self-instruction. Using one treatment im-
plementer posed internal validity problems. However, inserting a second
relatively unfamiliar person into this teacher's classroom for the duration of
the study would have counteracted the natural environment and natural
mediator principles cited above. The senior author served as a coun-
selor/consultant. In this way, the teacher merely carried out programs
designed by the consulting counselor.

Measures

In vivo self-monitoring assignment. Students in both conditions received a

self-monitored homework assignment for the seven-day period between the
sixth and seventh classroom sessions. With this assignment, there was an at-
tempt to determine whether the classroom instruction was relevant to the
20 Journal of Primary Prevention

students' chosen real-life experiences (Jacobs & Cochran, 1982}. The self-
monitoring activity proceeded as follows. Using standardized record-keeping
forms, all students were asked to record those instances during the seven-day
homework interim when they experienced irrational, self-defeating thoughts
and then used cognitive self-instruction as a coping strategy. On the forms,
they recorded their irrational self-statements and corresponding coping
statements as well as they could. In so doing, subjects were directed to rate
each irrational self-statement and each corresponding coping strategy on a
five-point Level of Emotion scale. When rating their emotions {e.g., anxiety}, a
1 represented the lowest perceived level and a 5 the highest. All intervening
points were treated as ordinal. Adapted from Cormier and Cormier {1979), the
Level of Emotion scale provides an opportunity to assess whether or not
using cognitive self-instruction reduces subjects' perceptions of the level of
negative emotions associated with irrational, maladaptive self-thoughts. Ac-
cordingly, the Level of Emotion recorded when first experiencing irrational
self-thoughts served as pretest data, and the Level of Emotion experienced af-
ter having used cognitive self-instruction to produce coping self-statements
served as posttest data. Average pre- and posttest ratings for each subject
were used in the statistical analyses with a reduction in Level of Emotion
ratings being the desired direction.
State anxiety. Baker, Thomas and Munson (1983) reported that most
maladaptive self-statements identified by students in a similar study were in-
dlcative of anxieties associated with a variety of events and interpersonal
relationships. It followed that a state anxiety instrument might be a useful
dependent measure for this program since none of the students were entering
the program with specific problems that could be targeted for treatment. The
State-Trait Anxiety Inventory (STAI), A-State scale, by Spielberger, Gor-
such, and Lushene (1970) was used to measure pre- to posttreatment change
in state anxiety levels. Goldfried and Sobocinski {1975} and Himle, Thyer, and
Papsdorf {1982} found significant relationships between specific irrational
beliefs and t h e STAI using two different measures of rationality. State
anxiety refers to an emotional condition reflecting subjective feelings of ten-
sion and apprehension that may vary in intensity and fluctuate over time.
Consisting of 20 'four-point items, the A-State Scale is relatively easy to score.
Cronbach Alpha inte/mal consistencies reliability coefficients range across
samples from .83 to .92. Evidence of construct valadity for the A-State scale
is reported in the STAI manual (Spielberger et al., 1970}.
S t u d e n t attitudes toward the treatment conditions. Adapted from Kazdin's
{undated} Client Expectancy for Change Survey, a self-report measure called
the Attitude Toward Treatment (ATT} scale was developed and used as a
means of determining how confident the students were in the comparative
treatments, how much they liked them, and whether or not one training mode
was preferred over the other. The ATT has 14 seven-point Likert-type items
worded in such as way as to reflect posttreatment attitudes of the trainees.
Its scale ranges from 14 to 98 with higher scores indicating a higher degree of
confidence. Used as a posttest measure, the ATT was administered during the
last classroom session of each group.
Stanley B. Baker and James N. Butler 21

Experimental demand measure. Given at the beginning of the second

classroom instructional session, the Expectations for Success of Treatment
{EfS} served as a measure of whether or not the experimental and control con-
ditions generated differential expectations at the outset. The EfS was also
adapted from Kazdin's tundated} Client Expectancy for Change Survey. It
measures how much confidence students have in their respective training
programs before they begin but after they have been introduced. The EfS has
14 seven-point Likert-type items worded in such a way as to reflect pretreat-
ment attitudes. The scale ranges from 14 to 98 with higher scores indicating a
greater degree of confidence.
Treatment condition equivalency measure. The State-Trait Anxiety In-
ventory ISTAI}, A-Trait scale, was used to determine whether the students'
proneness toward relatively stable anxiety levels was equal between treat-
ment and control groups prior to training activities. Also consisting of 20
four-point items, the A-Trait scale has the same norms as the A-State scale.
Test-retest reliability coefficients for the A-Trait scale range from .73 to .86
and Cronbach Alpha coefficients range from .86 to .92. Reported concurrent
validity coefficients for the A-Trait scale range from .75 to .77 (Spielberger et
al., 1970}.

Procedures

Experimental and control conditions. Since the psychology classes normally

met three times per week, both groups received eight 45-minute periods of in-
class instruction over two and one-half weeks. Both also received a seven-day
in vivo assignment between the 6th and 8th classroom sessions. Participation
was an ungraded classroom activity. Data collection procedures were the
same for both groups.
Teacher-directed cognitive self-instruction {TI}: In the TI program, stu-
dents received printed instructions at the outset and accompanying group ex-
planations, demonstrations, and individual assistance from the teacher
throughout the training. Students were encouraged to participate with an
open mind. The printed instructions consisted of a 10-page booklet, adapted
from earlier work by Cormier and Cormier 11979}, titled Cleaning Up Our
Thinking. This booklet explains each of the cognitive self-instruction steps
and offers suggestions for understanding and using them.1 The major steps in
cognitive self-instruction training are as follows: First, explain the training
program's rationale and respond to questions and concerns. Second, teach
trainees to understand what maladaptive, self-defeating thoughts are and
help them learn to formulate sentences that clearly depict the content and
meaning of those maladaptive thoughts. Third, teach students to formulate
corresponding self-enhancing coping sentences that counter the effect of the
self-defeating thoughts. Fourth, teach students to relax themselves when the
self-defeating thoughts occur and to stop or interfere with the resulting
maladaptive response by immediately thinking of an appropriate self-
enhancing coping thought. Last, teach students to reward themselves
cognitively for having coped, in order to reinforce the learning process {e.g.,
 22 Journal of Primary Prevention

"Nice job."). After training was completed, the in vivo assignment was given
in order to help trainees place simulated training outcomes in the context of
real-world situations. The training procedure prior to the in vivo assignment
covered five 45-minute class periods. Throughout, the training was
systematic and step-by-step, with the teacher leading the entire group from
one component to the next. Posttest data collecting and debriefing occurred
during the last class meeting.
Instructions-only control condition (I0): IO students received the same 10-
page Cleaning Up Our Thinking booklet and were instructed to read excerpts
from it in class that corresponded to what TI students were reading in con-
junction with teacher-led training for any given class period. During the
remainder of each class period, IO students worked on unspecified in-
dividually chosen assignments that reflected their current needs. This allowed
them an opportunity to teach themselves the cognitive self-instruction
methodology independently, if they were so motivated. Given the same in
vivo homework assignment as TI students, IO students were expected to use
their understanding of the booklet's printed instructions when responding.
The same total number of class periods was involved here as was with the TI
groups. IO provided a high-demand control condition against which to com-
pare the efficacy of the teacher-directed cognitive self-instruction treatment
(WI).

Results

Preliminary Analyses

Pretreatment equivalence. A u n i v a r i a t e analysis of v a r i a n c e

(ANOVA} on the p r e t r e a t m e n t S T A I , A-Trait a n x i e t y scores indicated
t h a t neither of the conditions differed on this m e a s u r e [F(1,28)--0.36,
p--0.55]. M e a n s and s t a n d a r d d e v i a t i o n s g e n e r a t e d from this analysis
and all s u b s e q u e n t a n a l y s e s are p r e s e n t e d in Table 1.
Demand analysis. R e s u l t s of an A N O V A on the E x p e c t a t i o n s for
Success of t h e T r e a t m e n t (EfS) m e a s u r e i n d i c a t e d t h a t s t u d e n t ex-
p e c t a t i o n s in b o t h conditions did n o t differ at the b e g i n n i n g of the
second t r e a t m e n t session [F( 1,28)----4.14, p----0.52].

Effects of Treatment Conditions

Student attitudes toward treatments. R e s u l t s of a u n i v a r i a t e

analysis of variance (ANOVA) i n d i c a t e d t h a t s t u d e n t s f a v o r e d T I over
IO a t the end of the t r a i n i n g p r o g r a m s [F(1,18)= 7.29, p = . 0 1 ] .
In vivo experiences. An analysis of variance with r e p e a t e d m e a s u r e s
Stanley B. Baker and James N. Butler 23

(ANOVR) uncovered no differences between TI and IO on the results

of this assignment [F( 1,28) = 0.14, p = 0.71].
State anxiety. Results of an ANOVR on pre- and posttreatment
STAI state anxiety scores indicated that there were interaction effects
[F(1,28)=5.86, p=0.02]. A Wholly Significant Difference (WSD)
follow-up comparison test indicated that the TI group improved more
on state anxiety scores from pre- to posttreatment than did the IO
group.

Discussion

Investigating the effects of cognitive behavior-modification principles

with healthy adolescents in an educative fashion is a new and im-

Table i

Means and Standard D e v i a t i o n s for the Dependent~

Demand, and Equivalency V a r i a b l e s

Condition

Teacher Instruction Instructions Only a

(n = 15) (n : 15)

Measure Mean SD Mean SD

STAl-Trait Anxiety 51.48 5.40 53.44 7.36

E xpectations f o r Success 75.26 9./48 68.19 8.08

STAI-State A n x i e t y (pre) 52.50 5.80 49.69 6.34

STAI-State A n x i e t y (post) /48.60 10.34 51.00 7.56

A t t i t u d e Toward T r e a t m e n t 75./-47 12.93 63.69 10.02

In Vivo Experience (pre) 3.55 0.65 3./49 1.13

In Vivo Experience (post) 2.57 1.01 2.81 1.26

a
One trainee was randomly excluded from the IO data in order to have equal sample

sizes.
24 Journal of Primary Prevention

portant area of primary prevention. It is tempting to assume a

methodology such as cognitive self-instruction is appropriate for
teaching coping skills to large audiences of persons who in turn receive
an opportunity to be prepared (i.e., inoculated} for stressful situations
that are certain to occur in their lives. The temptation, however, needs
to be tempered by careful analysis of empirical studies. Although sub-
ject to methodological limitations, this study suggests some issues
that need to be considered by future researchers. In addition, this
study focuses on only one aspect of cognitive behavior-modification
{i.e., cognitive self-instruction). The focus is narrowed further to treat-
ment effects on high school youth and to dependent measures
clustered into a grouping roughly summarized as attitudes toward
training, emotions experienced during in vivo applications, and state
anxiety.
What suggestive information resulted from this experiment? (a)
Given that no differences existed in student attitudes toward teacher-
directed self instruction (TI) and the instructions-only (IO) condition
at the outset, attitudinal differences favoring the teacher-directed (TI)
mode at posttesting suggest that the trainer-led group approach has
merit. More specifically, there is evidence that a group mode with a
trainer serving as director, model, encourager, clarifier, and the like is
favored by these youth over an independent self-study approach. (b)
The language of cognitive behavior-modification seems appropriate for
high school adolescents with minor modifications (e.g., "maladaptive
self-statements" changed to "self-defeating thoughts," "adaptive self-
statements" changed to "self-improving thoughts," and "cognitive
self-instruction" changed to "cleaning up our thinking"}. (c) Teacher-
directed cognitive self-instruction similar to the group delivery mode
used in this study may have a healthy influence on recipients' feelings
of tension and apprehension that are situation-specific. In this case, it
may very well be that when students generated maladaptive self-
statements during training they experienced corresponding feelings of
tension and apprehension, some of which were reduced by the training
experience. (d) The counselor-as-consultant seemed to be successful in
this situation, given the modest successes of the teacher-directed
group cited in (a) and (c) above. This should serve as encouragement for
counselors to engage in consultation with teachers in an effort to
achieve primary prevention goals.
Methodological limitations related to maintaining a natural
classroom environment led to circumstances which may influence con-
fidence in the apparent treatment effects, perhaps reducing them to a
"shedding-light" category. Readers should be rightly concerned about
Stanley B. Baker and James N. Butler 25

the effect of a single trainer. Readers should also note that the
trainer's predisposition toward either condition may have been con-
trolled by his reliance on receiving directions from the counselor and
the consulant's preconceived effort to disguise the research
hypotheses.
Several suggestions for future programmatic efforts evolved from
this study. First, successful outcomes derived from true experimental
designs with multiple trainers across treatment and control conditions
will likely generate greater confidence in the results of future studies.
Second, studies of longer duration, including periodic follow-up
measures, are needed. Third, different outcome variables need to be
studied {e.g., behavioral observations, measures of nonoccurrence, and
even physiological measures may produce interesting results). A word
of caution is offered in conclusion. Efforts to increase experimental
controls and thus enhance confidence in results of experiments that
also diminish the naturalness of the environmental conditions seem to
run the risk of raising equally important concerns about confidence in
outcomes. What is needed is the best of both worlds.

Note

Copies of the training materials used in this study are available from the senior
author upon request.

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