Rather than being submissive or aggressive, the goal of assertiveness training is to help patients become better able to openly verbalize what they want in various life situations. Assertiveness training, which uses a variety of cognitive behavioural techniques, can be conceptualized as a component of social skills training, which broadly aims to help individuals reduce any anxiety-based inhibitions and learn specific skills to develop more competent social functioning (Speed et al., 2017).
Within this framework, unassertiveness may result from genuine skills deficit (e.g., inability to understand and effectively communicate wants/needs), performance deficits, possibly due to anxiety, or both (Heimberg & Becker, 1981). Therefore, assertiveness training involves cognitive and behavioural techniques aimed at increasing patient expressiveness, including cognitive restructuring of negative thoughts about asserting oneself, and behavioural rehearsal, role playing, and modeling to reduce anxiety. It also includes teaching communication skills and enhancing self-efficacy (Speed et al., 2017).
As communication is a significant neurophysiological function that not only affects our relationship with others, but also our relationship with ourselves, its effect can be felt internally. As such, assertiveness is considered a stand-alone, transdiagnostic (i.e., meaning, it can be used for many different diagnosis) intervention.
There exists considerable basic research evidence linking unassertiveness to specific clinical problems, as well as findings from outcome research indicating that assertiveness training can improve various clinical symptoms above and beyond assertive behaviour.
Socially anxious patients often display difficulties in assertiveness through submissive or avoidance (Walters & Hope, 1998). There is evidence that social anxiety is positively associated with anger and hostility, therefore indicating that assertiveness may be beneficial in reducing anger in these patient (Allan & Gilbert, 2002). Many studies have shown that assertiveness training, group and individual assertiveness training, result in significantly reduced depression and anxiety symptoms and decreased clinical symptoms (Lomont et al., 1969; Linehan et al., 1979; Hammen et al., 1980).
There are some professionals that purport that depressed patients have social skill deficits, resulting in interactions that are unlikely to be reinforcing and are more likely to highlight perceived deficits in social support (Windle, 1992). Those at higher risk of developing depression may experience higher rates of depression in part due to an interaction between experiencing more negative events and engaging in dysfunctional cognitive styles (Hankin & Abramson, 2001). One study found that the type of assertiveness problem varies between genders; depression is positively associated with hostility in men and agreeableness in women (Maier et al., 2009). Furthermore, low assertiveness may be an indicator of poor prognosis for women if unaddressed (Bouhuys et al., 1999). There is evidence that low assertiveness is predictive of increases in depression symptoms or disorder onset (Ball et al., 1994).
Many studies have shown that group assertiveness training helped depressed women become significantly more assertive and that these gains are enduring for longer than the termination of the training (Hayman & Cope, 1980). Assertiveness group therapy was found to increase patients’ comfort with assertiveness and increase their likelihood of engaging in assertive behaviour. Assertiveness training resulted in significantly less depressive symptoms and patients displayed more rational thinking and acceptance, and were significantly less likely to seek out further treatment at follow-up (Sanchez et al., 1980).
Assertiveness has been positively correlated with measures of self-esteem (Riggio et al., 1990). Assertiveness training improves general self-esteem, self-concept, and internal locus of control (Hammen et al., 1980). As individuals become less worried about the opinion of others and become more comfortable in asserting themselves, they seem to become more self-confident in the legitimacy of what they want, think and feel.
Unassertiveness in either partner (in a couple) was found to be associated with negative outcomes for the couple, including hostility in the husband and increased guilt and anxiety in the wife (Hafner & Spence, 1988). When either individual men or women from a couple participated in assertiveness training, self-reported levels of trust and intimacy improved (Gordon & Waldo, 1984).
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