DESCRIPTION OF THE STRATEGY

Assertiveness can be defined in a variety of ways, though perhaps most simply as the honest
and appropriate expression of one's thoughts, feelings, and beliefs without violating the rights
of others. As such, assertiveness training (AT) is a cognitive-behavioral technique that has
been primarily used to teach children appropriate ways to express anger. AT is also often used
to help children overcome individual forms of inhibited expression, including difficulty
making requests or expressing opinions. AT is often used as a part of a broader treatment
program (e.g., for impulsive or anxious children) and has also been used in bullying programs
in schools and other settings.
Used alone or in conjunction with other forms of treatment, AT is based on the assumption
that children have personal rights and responsibilities, including, for example, the right to
express their feelings and the responsibility to behave in a way that does not violate the rights
of others. The child is taught alternate responses to situations that have previously resulted in
aggressive or unassertive behaviors. The first step in AT involves increasing the child's
awareness of his or her personal rights and responsibilities toward others. For example,
children learn that they have the right to be safe and not be hurt, to make mistakes, to
experience and express their feelings, to be treated with respect, to say no to others and not
feel guilty, to change their minds, and to ask for what they need. Children also learn that they
have responsibilities, such as to treat others with respect, to allow others to make mistakes,
and to allow others to have ideas and opinions that differ from their own.
The next step in AT is to learn how to exercise these rights and responsibilities in a
nonaggressive and nonpassive manner. Paying attention to both verbal and nonverbal
behavior, children are taught to distinguish between aggressive, passive, and assertive
responses. The child first develops proficiency in identifying the different responses. With
repeated rehearsal and subsequent feedback from the therapist (or via video feedback), the
child develops competency at responding assertively.
Typically, cognitive restructuring techniques are included in the instruction of assertiveness to
address unhelpful beliefs that the child might have, such as No one will be interested in
hearing what I have to say or If I don't yell at the other kids, they won't listen to me.
Teaching children problem solving may also be a necessary part of AT, to enable children to
consider alternative ways of managing a situation.
AT includes a range of specific techniques used to promote behavior change: direct instruction
of the skill, modeling, and behavior rehearsal. The skills can be refined through selfevaluation, self-monitoring, homework assignments, naturalist experiments, therapist or video
feedback, and reinforcement. Structured role plays can be employed to create opportunities
for modeling and behavior rehearsal. In a role play, the therapist and child act out scenarios to
practice the child's newly acquired skills in increasingly difficult situations. Once a level of
proficiency is acquired by the child, assertiveness skills can be practiced within real contexts,
beginning with less stressful situations to optimize successful outcomes, then continuing with
increasingly stressful situations. Practice between sessions (i.e., homework) is assigned to
foster generalization of treatment effects to the real world.

RESEARCH BASIS

Through numerous case studies and controlled trials, AT has been found to be effective in
increasing assertive behavior, decreasing aggressive behavior and anxiety, as well as
improving self-esteem and self-concept. The outcomes of AT on the adaptive social
functioning of children and adolescents are also encouraging: children who receive AT have
demonstrated improvements in school behavior, popularity, and academic achievement.
Research suggests that utilizing a combination of training techniques to teach assertiveness
produces the best outcome. The efficacy of providing assertiveness education is enhanced
with the inclusion of training techniques such as behavioral rehearsal, feedback, and modeling
(overt and covert). With respect to modeling, studies have shown that covert modeling, that is,
having the child imagine someone else acting assertively in situations, has been as effective as
overt modeling. Research has also suggested that models perceived to be similar to the
observer (e.g., in age and competence) may enhance learning. Therefore, using models (live
or video/audio) that are similar in age to the child and have similar competence levels may
improve the efficacy of AT. This is one argument for running AT in a group format. Although
both individual and group format have been shown to produce good outcomes, there are many
advantages to the group format, as it provides multiple opportunities for rehearsal and
modeling with same-aged peers. Finally, there has been some evidence suggesting that
observing a coping model produces better learning and self-efficacy then observing a mastery
model. That is, a therapist presenting a mastery model (completes the task perfectly) may
result in poorer outcomes than a therapist presenting a coping model (performs the task while
handling difficulties that arise).

RELEVANT TARGET POPULATIONS AND

EXCEPTIONS
The rationale for AT is based on a social skills deficit model, that is, the child does not possess
the skills to be appropriately assertive. However, some children who do not act assertively
may do so not because of a skills deficit but instead because their emotions (anxiety,
depression, or anger) play a role in preventing the expression of appropriate feelings and
adaptive acts. When this is the case, an intervention that focuses on anxiety, depression, or
anger management is the preferred treatment option. For many children, however, the lack of
assertiveness may come about as a combination of emotional difficulties and a skills deficit.
AT is recommended for children with a skills deficit when it occurs alone or with emotional
difficulties.
AT has been successfully used with a wide range of child problems and disorders, including
school-related stress, anxiety, depression, autism, aggression, eating disorders, and substance
abuse. AT has also gained popularity as an intervention for the reduction of bullying in
schools for both the victims and aggressors of such behaviors. It has been shown to improve
the self-esteem and coping skills of children who have been sexually abused and children
going through a parental divorce. Programs for specialized populations, such as children with
disabilities, have also been shown to enhance social efficacy and interpersonal skills. AT has
been employed in programs for children with communication impairments (speech, visual,
and hearing), asthma, diabetes, and spinal cord injuries. AT has also been found to be more
pertinent in improving the social functioning of children with physical impairments (e.g., cleft
palate) than has physical rehabilitation.

COMPLICATIONS

Some children, particularly anxious or depressed children, may fear the consequences of
employing their assertiveness skills. Children may fear they will be rejected by others if they
stand up for themselves. Aggressive children may fear that if they act assertively, they will be
perceived as weak. In these instances, cognitive restructuring may prove useful. The therapist
may also encourage the child to test out the child's belief by using new skills and evaluating
the actual consequences of acting assertively.
Changes in the child's assertiveness may come as a surprise to others in the child's
environment. It is possible that a previously unassertive child may be perceived as aggressive
when he or she employs more assertive behavior. While it may be important to inform family
members to expect some changes in the child's behavior, it is also important to inform the
child that the child is not responsible for the way in which others respond to his or her
assertiveness. Reinforcing the child's right to present his or her opinions in an assertive way
and restructuring beliefs regarding the consequences of being perceived as aggressive may
prove beneficial.
AT is reliant upon a Western ideal and is therefore not necessarily appropriate with all ethnic
groups. For some cultural groups, assertive behavior, based on the definition provided here,
may be perceived as aggressive and inappropriate when directed toward older or more
powerful members of society. While AT has its basis on a Western (Euro-American)
perspective of social competence, the extent to which this bias is perpetuated does, however,
vary, depending on individual therapists' sensitivity to diverse perspectives.

CASE EXAMPLE
Mira, a 14-year-old girl, reported a number of social situations in which she experienced
moderate to severe anxiety. These situations included answering questions in class, making
conversations with other kids at lunchtime, and doing class presentations. Mira and her
parents reported that she does not like being the center of attention and so avoids many social
situations. She has only a few friends with which she feels comfortable and rarely goes out
with these friends outside of school. Mira's parents described her as a shy and sensitive girl.
During therapy, Mira was taught a number of skills to manage her social anxiety and began to
face a number of situations that she had been avoiding. Mira was working through a gradual
exposure hierarchy of her social fears.
It became clear during the exposure component of the treatment program that Mira was
experiencing difficulties with one of the other girls in her English class. The girl in her class
had asked to borrow one of her favorite markers. Mira had loaned the marker to her friend but
the friend had not returned it. Mira was very upset about the marker and angry that it had not
been returned. Mira did not feel comfortable asking for it back. The therapist had noticed a
pattern of unassertive behavior with Mira and noticed also in therapy that she was very eager
to please the therapist and did not like to make requests. Mira and the therapist agreed that the
issue with the marker provided a good opportunity to learn a new skillassertivenessto
assist Mira in working through her exposure hierarchy and improve her confidence. In
previous sessions, the therapist had also included a social skills training component to the
therapy. Mira had begun to work on specific social skills, including maintaining eye contact,
using a loud, confident voice, standing up straight, and keeping her hands relaxed beside her
body (rather than fiddling with her hands).

To begin, the therapist described Mira's rights and responsibilities. They constructed a poster
of Mira's rights and responsibilities that she could put up on her bedroom wall. The poster
included the following: Mira had the right to express her feelings and opinions, to have her
opinions heard by others, and the responsibility to listen to other people's opinions and treat
others with respect. Second, the therapist provided an overview of the difference between
passive, assertive, and aggressive responses. The therapist made use of a number of examples
from Mira's life to demonstrate these three response styles. For example, the therapist used an
example where three children were hurt by something that their friend had said about them
behind their back. Passive Patricia responded by becoming really upset and cried. She decided
not to talk about it with her friend at all. Aggressive Angela responded by shouting in a nasty
tone of voice, I hate you. I don't want to be your friend anymore. I am going to tell everyone
something nasty about you! Assertive Ailsa responded by confidently and calmly saying, I
feel hurt by what you said to me. I wish you had talked to me about it first and then maybe we
could have worked it out.
The therapist acted out each of these three responses in a role play, asking Mira to identify the
three different response styles. The therapist then invited Mira to participate in the role plays,
first of all to play the friend and then to play the roles of Patricia, Angela, and Ailsa. The
therapist provided feedback and positive reinforcement to Mira regarding her use of
assertiveness, aggression, and passivity. Mira was asked to keep track of her assertive and
unassertive responses during the week on a monitoring form for homework. From her
homework it was clear that Mira was frequently passive with her friends and teachers at
school.
In the next session, the therapist and Mira decided to act out increasingly difficult situations to
practice her assertiveness. This time Mira was encouraged to remember her social skills (eye
contact, not fiddling, strong voice, good posture) when she practiced the assertive responses.
After a couple of practices, the therapist and Mira decided to videotape the role plays to assist
in providing feedback. The therapist went first, modeling an assertive response to the
situation. The therapist made sure to include a number of obstacles to overcome, such as
feeling really nervous and wanting to get out of the situation. Mira and the therapist then
looked at the recording, providing both positive feedback and constructive criticism. The
therapist modeled the situation again, this time integrating the feedback into the role play.
Next, it was Mira's turn to act out the scenario with the camera. When they watched the
recording of Mira's role play, the therapist provided positive feedback and constructive
criticism. Mira was improving in regard to her use of assertive statements and her eye contact
but was having difficulties using a strong voice and standing up straight without fiddling with
her hands. Mira and the therapist rehearsed the scenario again so that Mira could focus on her
body language and her voice quality.
After a week of continued practice at home, Mira felt ready to practice her assertiveness skills
in real-life situations. In particular, Mira was keen to ask her friend to return her favorite
marker. The therapist discussed any fears or worries Mira might have about putting the skills
into practice. Mira revealed that she was not sure what she would say if her friend ignored her
or was nasty in return. The therapist and Mira together tackled each of these thoughts. First of
all, they discussed what she was concerned would happen if her friend ignored her or was
nasty. Mira replied that she believed this would mean her friend did not like her or did not
care about her. Mira and the therapist were able to generate evidence for these thoughts: It
was more likely that her friend would just return the marker rather than ignore her; her friend
was not a nasty person; Mira recalled other occasions when friends had asked for things back

and nothing bad had happened. Mira considered the worse case scenario: What if she
deliberately ignored her or become nasty, what would happen then? First, if this was to
happen, there might be many other reasons that her friend was being nasty other than because
she did not like Mira. For example, Mira's friend could have had a fight with someone else or
she could have lost the marker and felt guilty about it. But, worst case scenario, if she really
did not like Mira anymore, although Mira would feel hurt, she had other friends with which
she could play, and it was not the end of the world if this one girl did not like her.
The therapist and child brainstormed all the things she could say to herself and all the things
she could do that could help her feel less anxious in the situation, such as doing a lot of
practice beforehand, taking a friend with her, making sure she goes up to her friend when she
was not too busy with something else, and reminding herself that she can handle this. Mira
and the therapist rehearsed the scenario a number of times in the session. The following week
Mira bravely approached her friend and asked for her marker back. Her friend said Oh yeah,
sure. I forgot I had it. I will bring it tomorrow. The friend forgot to bring it in the next day, so
Mira had the opportunity to ask for her marker again. Mira was pleased she was able to face
her fears and act assertively. Mira continued to apply her assertiveness skills and face her
fears in increasingly anxiety-provoking situations.
Jennifer L. Hudson, Katy I. Vidler, Elizabeth Seeley Wait, and Nataly Bovopoulos
Further Reading

Entry Citation:
Hudson, Jennifer L., et al. "Assertiveness Training." Encyclopedia of Behavior Modification
and Cognitive Behavior Therapy. 2007. SAGE Publications. 15 Apr. 2008. <http://sageereference.com/cbt/Article_n2006.html>.