Journal of Consulting and Clinical Psychology

1979, Vol. 47, No. 1, 140-146

Effects of Enhanced Psychological Test Feedback on

Treatment Outcome: Therapeutic Implications
of the Barnum Effect
Keith M. Halperin and C. R. Snyder
University of Kansas

The Barnum-effect literature has consistently shown that the recipients of

diagnostic feedback tend to accept such feedback. The present study sought
to expand the potential impact of this phenomenon by ascertaining whether
diagnostic feedback not only may be accepted, but also may have a positive
influence on treatment outcome. Snake-fearful females (N = 48) initially
took psychological tests and were then randomly assigned to one of three
conditions: (a) a no-treatment control group, (b) a treatment-only group,
and (c) an enhanced-personality-feedback-with-treatment group. Two ma-
nipulation check items indicated that the enhanced-personality-feedback ma-
nipulation was successful. As hypothesized, the greatest therapeutic improve-
ment, as measured by change in pre- to posttest self-report and behavioral
measures, resulted for the enhanced-personality-feedback-with-treatment
group as compared to the treatment-only group; in turn, the treatment-only
group improved significantly more than the no-treatment control group.
Implications are drawn for the clinical setting, and the potential importance
of the person's expectations that he or she is the source of positive ther-
apeutic change is discussed.

Recent research has shown that the recip-
ients of psychological test feedback report a
consistently high acceptance of such feed-
back. This growing body of literature is best
known under the term Barnum effect, which
has come to stigmatize the relatively undis-
cerning acceptance of psychological-test-
based feedback by clients. After reviewing
the variety of factors that contribute to the
The authors acknowledge the comments of
Sharon S. Brehm, B. Kent Houston, Douglas R.
Denney, Raymond L. Higgins, and Dennis H.
Karpowitz on earlier versions of this article. The
assistance of James Butcher, Vern Devine, Paula
Savage, and Liz Voss on various aspects of the
present project is also gratefully acknowledged.
The first author is now at Personnel Decisions,
Inc., 821 Marquette Avenue, Foshay Tower, Min-
neapolis, Minnesota 55402.
Requests for reprints should be sent to C. R.
Snyder, Graduate Training Program in Clinical
Psychology, 305 Fraser Hall, Department of Psy-
chology, University of Kansas, Lawrence, Kansas
66045.
Barnum effect, Snyder, Shenkel, and Lowery
(1977) caution clinicians that clients' ac-
ceptance of diagnostic feedback should not
be interpreted as validation of either the
psychologist or the assessment tools used.
While the Barnum-effect literature certainly
provides precautions to clinicians, it need not
have totally negative implications for the
diagnostic/therapy process. On the con-
trary, it has been suggested that the clinician
may purposefully use the Barnum effect to
help facilitate change in the client (Snyder,
1976; Snyder & Clair, 1977). That is, the
clinician could deliver psychological-test-
based feedback to the client that he or she
has the positive potential for change, and in
the process of accepting such feedback, the
person may actually initiate therapeutic
change. The present study sought to test this
theorization by examining the effects of en-
hanced psychological test feedback on treat-
ment outcome.
The present research may be conceptual-

Copyright 1979 by the American Psychological Association, Inc. 0022-006X/79/4701-0140$00.75

140
 BARNUM EFFECT AND THERAPY
ized within the general framework of previ-
ous research related to "placebo" or "non-
specific" factors in psychotherapy. Placebo
or nonspecific factors refer to the supposedly
inert by-products of psychotherapy that have
beneficial effects for clients. In this regard,
it has been suggested that treatment effec-
tiveness may be enhanced by such placebo or
nonspecific factors as client expectations,
suggestibility, and so on (Frank, 1963;
Rosenthal & Frank, 1956; Shapiro, 1964).
Bloom, Weigel, and Trautt (1977) have re-
cently asserted that such placebo factors are
not merely inert by-products of therapy,
but rather may be considered as factors that
serve an active treatment function. These
authors suggest that "therapeugenic" fac-
tors, as they term them, should be fully
utilized by clinicians to help foster client
change. Indeed, several theorists have im-
plied that the clinician may purposefully em-
ploy all forms of social influence to increase
client expectations and, in turn, successful
treatment outcome (Brehm, 1976; Fish,
1973; Gillis, 1974; Goldstein, Heller, &
Sechrest, 1966).
Farly research in the area of placebo ex-
pectancies produced inconsistent results
(Friedman, 1963; Goldstein, 1960; Gold-
stein & Shipman, 1961; Lipkin, 1954). This
research is difficult to interpret because it is
not clear whether expectancy emphasizing
treatment efficiency or expectancy related to
the client's own personal ability to change
was manipulated. Likewise, these early
studies have been criticized because expec-
tancy was not correlated with any objective
measures of improvement (Wilkins, 1973a,
1973b). A more recent body of placebo
literature has examined the effects of manip-
ulated treatment expectancies on behavior
therapy outcome studies. Results for this
body of research are mixed (see Rosen,
1976, for a review). To date, therefore,
placebo studies have evolved to emphasize
manipulated treatment expectancies. Unfor-
tunately, however, the manipulated enhanced
treatment expectancies have not consistently
elicited improved treatment outcome.
Given the previous inconsistent results
related principally to enhanced client expec-
141
tations of treatment, it may be useful to
examine the therapeutic effects of feedback
that enhances the clients' expectations of
their own potential for change. In this re-
gard, Cartwright and Cartwright (1958)
have reasoned that enhanced expectations
related to personal potential for change
should prove most effective because such
expectations result in an active, independent,
and responsible client; J conversely, en-
hanced expectations related solely to treat-
ment may be symptomatic of a passive, de-
pendent, and irresponsible client who need
not be fully invested in therapy. In a similar
vein, it has been suggested that the process
and content of diagnostic feedback can facil-
itate therapeutic improvement by positively
influencing clients' self-perceptions (Mosak
& Gushurst, 1972). The aforementioned rea-
soning suggests that the Barnum-effect
phenomenon may be utilized to enhance
clients' personal belief in change and, in
turn, facilitate therapy improvement.
Tn order to test the therapeutic effects of
psychological test feedback, three groups of
subjects were employed in the present study.
Subjects were snake-fearful individuals
whose changes in snake avoidance were
tested by self-report and behavioral measures
taken at the beginning and the end of the
experiment. All subjects were initially ad-
ministered a battery of psychological tests.
Subjects in the first group, the enhanced-per-
sonality-feedback-with-therapy group, were
given feedback that their psychological
1
Cartwright and Cartwright (1958) note that
client expectancy is made up of the following four
sets of beliefs: (a) belief that positive changes will
occur, (b) belief in the therapist as the primary
source of help, (c) belief in the therapeutic proce-
dures as the primary source of help, and (d) belief
in oneself as the primary source of help. The
present study sought to emphasize the last kind of
expectancy—the belief in oneself as the primary
source of help. Technically, however, in accentuat-
ing a person's belief that he or she is the primary
source of change, it is also probable that the other
aforementioned beliefs may be influenced to a lesser
degree. Overall, the present study sought primarily
to enhance the person's belief in himself or herself
as the source of change and secondarily to enhance
the person's belief that change would occur.
142 KEITH M. HALPERIN AND C. R. SNYDER
test results indicated they had the personal
potential to facilitate positive change. These
subjects then received the treatment. A sec-
ond group did not receive any feedback
based on the psychological tests but did re-
ceive the treatment. A third group did not
receive either diagnostic test feedback or
treatment and thus represented a no-treat-
ment control group. It was predicted that
therapeutic improvement, from highest to
lowest, would result from the enhanced-
personality-feedback-with-treatment group,
treatment-only group, and the no-treatment
control group.
Method
Materials
The self-report change measure employed was
the Snake Questionnaire (Klorman et al., 1974),
a 30-item true-false test tapping fear of snakes.
The behavioral change measure was the Behavioral
Avoidance Test (Nawas, 1971), which taps sub-
jects' objective fear level of snakes. This measure
consists of 20 steps ranging from "standing 10 feet
[3.05 m] away looking at the cage" to "reaching
into the cage, picking up the snake, petting it, and
allowing it to crawl up your arm." A 4i-foot
(1.37 m) corn snake was used for the Behavioral
Avoidance Test.
Subjects and Design
The experimenter randomly telephoned female
introductory psychology students from the Uni-
versity of Minnesota's research pool asking them
to participate in the experiment's screening proce-
dure. Since Klorman et al. (1974) found that female
students had a greater fear of snakes than males,
only females participated in this study to assure a
more fearful sample. Forty-eight subjects who were
unwilling to touch the corn snake with a gloved
hand on the Behavioral Avoidance Pretest (the
criterion as established by Borkovec, 1973) were
included in the study. All subjects participated in
this experiment as one means of fulfilling their
course requirements for introductory psychology.
These 48 subjects were randomly assigned to one
of the three conditions: a no-treatment control, a
treatment-only group, and a positive-personality-
feedback-with-treatment group. The dependent
measures of change taken before and after the
treatment period were (a) self-reported fear of
snakes (Snake Questionnaire) and (b) behavioral
approach to a live snake (Behavioral Avoidance
Test).
Procedure
Pretesting. The pretest consisted of three parts.
First, the experimenter told subjects "this investi-
gation is looking at the relationship between the
common irrational fear of snakes and personality
factors." Subjects, in individual sessions, completed
the Snake Questionnaire, and a bogus "personality
test" comprised of approximately SO objective ques-
tions taken from various presently existing per-
sonality scales. The personality test was not scored,
but rather administered to make the subsequent
personality interpretation credible to subjects in the
personality feedback condition. Following this test
battery, a female research assistant administered
the audiotaped Behavioral Avoidance Test as the
second part of the pretest. The taped instructions
stated that subjects should try to approach the
snake as closely as possible but stop whenever they
become too uncomfortable. The female research
assistant remained behind the subject while the
subject attempted as many steps of the Behavioral
Avoidance Test as possible. The point at which the
subject was unwilling to continue this procedure
was recorded as the subject's pretest behavioral
level of fear.
Experimental manipulation. The experimental
manipulation occurred during the third part of the
pretest. First, all subjects were randomly assigned
to one of the three conditions. The researcher told
subjects in the no-treatment control group that
their personality test batteries would be correlated
and validated with the Behavioral Avoidance Test
score. Subjects in this no-treatment control group
were not informed that they were members of a
control group, nor were they told that they would
receive treatment at a later point in time. They
were instructed to return in 5 weeks for posttest-
ing. Subjects in either the treatment-only group
or the enhanced-personality-feedback-with-treatment
group were told that for the next few weeks they
would receive a treatment previously used with
people who were uncomfortable around snakes.
Subjects in the enhanced-personality-feedback-
with-treatment condition read a handwritten bogus
personality interpretation purportedly derived from
their bogus personality test. This feedback at-
tempted to enhance subjects' belief that they could
be a source of change because they had a personal-
ity suitable for change in treatment (see Footnote
1). The interpretation stated:
The personality test you have taken has been
found to predict inner potential for change in
treatment. In the past, it has been shown that
people with similar personality scores as yours
have a strong capacity for change. This profile
shows that you have inner resources enabling
you to learn effective means of adapting to the
environment. You have a great deal of unused
potential you have not yet turned to your ad-
vantage, and thus you have the personality to
successfully utilize this treatment.
 BARNUM EFFECT AND THERAPY
The test also suggests that you display ability for
personal integration and many latent strengths,
as well as the ability to maintain a balance be-
tween your inner impulses and the demands of
outer reality. Therefore, your personality is such
that you have a strong potential for improvement
during this treatment.
After reading this interpretation, each subject in
this enhanced-personality-feedback-with-treatment
condition rated the extent to which the interpreta-
tion described her own personality on an 8-point
scale (l = very poor to 8 = excellent). The mean
acceptance rating for this feedback was 6.15, indi-
cating that the members of this group accepted the
feedback, a finding that is consistent with the
Barnum-effect literature (see Snyder et al., 1977).
Subjects in the treatment-only condition received
no interpretation and were told that the personality
test was being validated for populations afraid of
snakes.
Finally, a manipulation check was administered
asking subjects in the two experimental conditions
to respond to the following question: "Judging
only from your own personal characteristics, how
much change do you think you will make?" (For
this question, 1 = no change in problem to 10 =
extreme improvement in the problem.) To reduce
both response demand characteristics and sensitiza-
tion to the true nature of the experiment, this ques-
tion was incorporated into a purportedly unrelated
questionnaire mailed to the University Ethics Com-
mittee.
Treatment. All subjects (except the no-treat-
ment control group) received the same desensitiza-
tion treatment, which was held once a week for 3
consecutive weeks. Each session lasted 45 minutes,
and subjects were randomly assigned to small group
sessions (4 or 5 subjects per group). All three
desensitization sessions were recorded on audiotape,
and the experimenters were not present during
these sessions. Each of the three tape sessions be-
gan with a therapeutic explanation of the procedure,
followed by 15 minutes of training in Lazarus's
progressive muscle relaxation, and finally proceed-
ing through the same 20-step hierarchy used in the
Behavioral Avoidance Test. One third of this hier-
archy was presented at each weekly session. Sub-
jects were asked to imagine each step for 15 sec
and then relax for 30 sec. This procedure was com-
pleted twice for each hierarchy step (Schneider,
1973).
Posttesting. Individual posttesting sessions were
scheduled for all subjects approximately 1 week
following the third treatment session. Forty sub-
jects (12 in the control group, 15 in the treatment-
only group, and 13 in the personality-feedback-with-
treatment group) successfully completed the experi-
ment; the other 8 subjects dropped out of the
study at various points. The Snake Questionnaire
and Behavioral Avoidance Test were readministered
to these 40 subjects by the female research assist-
ant who was blind to subjects' experimental condi-
143
tions. All but the no-treatment control group sub-
jects rated their current assessment of "How suit-
able are your personal attributes for change in
treatment?" (For this question, 1 = not at all suit-
able to 10 = extremely suitable.) This served as a
postexperimental check on the enhanced personality
manipulation.
Finally, subjects were debriefed carefully and
told the true nature of the experiment. Subjects in
the no-treatment control were offered the desen-
sitization treatment.
Results
In order to ascertain whether the per-
sonality feedback enhanced clients' expecta-
tions, comparisons were made between the
manipulation check items for the treatment-
only condition as compared to the enhanced-
personality-feedback-with-treatment condi-
tion. On the first manipulation check item
("Judging only from your own personal
characteristics, how much change do you
think you will make?") taken after the
manipulation but prior to treatment, the en-
hanced - personality - feedback - with-treatment
condition subjects reported significantly
higher expectations than the treatment-only
condition subjects : Ms = 7.88 and 6.00, re-
spectively; t(26) - 3.77, p < .001. Similar-
ly, on the manipulation check item taken
during the posttesting period ("How suit-
able are your personal attributes for change
in treatment?"), the enhanced-personality-
feedback-with-treatment condition subjects
again reported significantly higher expecta-
tions than the treatment-only condition sub-
jects : Ms = 7.58 and 5.50, respectively;
t(26) = 3.53, p < .002.
A base-free measure of change (cf. Ben-
jamin, 1967; Tucker, Uamarin, & Messick,
1966) was employed in the present study in
order to account for the influence of pretest
responses on subsequent posttest responses
(i.e., the "law of initial values"; Wilder,
1962). Thus, residualized change scores (cf.
Cronbach & Furby, 1970) were calculated
for both the self-report (Snake Avoidance
Questionnaire) and behavioral (Behavioral
Avoidance Test) dependent measures for
subjects in each of the three conditions of the
independent variable. These residualized or
adjusted scores reflect the difference between
the actual obtained posttest score and the
144 KEITH M. HALPERIN AND C. R. SNYDER
predicted posttest scores based on a linear
regression adjusted for treatment conditions
from pretest scores. Even though the differ-
ences in pretest scores for groups may not he
statistically significantly different, these in-
itial differences may contribute to either a
main effect of interaction in a pre-post
analysis of variance procedure. This is espe-
cially true when there are significant differ-
ences in pretest scores of groups, as was the
case in the Snake Questionnaire data for the
present experiment. For these reasons,
therefore, the adjusted scores are preferable
because they measure change independently
from (or correcting for) initial pretest level
of response on self-report and behavioral
measures.
A one-way analysis of variance (control,
treatment-only, and enhanced-personality-
feedback-with-treatment) on the adjusted
Snake Questionnaire was significant, F(2,
37) = 16.77, p < .0001. The raw pretest
and posttest Snake Questionnaire scores
reflecting this effect for each of three
groups are as follows: (a) For the control
group (n = 12), Ms = 12.58 (SD = 3.63)
to 12.67 (SD = 3.17); (b) for the treat-
ment-only group (n = 15), Ms= 14.07
(SI) = 3.33) to 18.27 (SI) = 2.76) ; and
(c) for the enhanced-personality-feed-
hack-with-treatment group (n = 13), Ms =
16.38 (SD = 5.28) to 22.31 (SD = 4A6).
The enhanced - personality - feedback - with -
treatment group (adjusted M = 20.68)
showed significantly greater self-reported
improvement than the treatment only (ad-
justed M = 18.51) and controls groups (ad-
justed M = 14.11), t(26) = 1.73, p < .05
and t(23) = 5.66, p < .0001, respectively.
The treatment-only group also showed sig-
nificantly greater self-reported improvement
than the control group, if(25) = 5.06, p <
.0001. The one-way analysis of variance on
the adjusted Behavioral Avoidance Test was
also significant, F(2, 37) = 14.32, p < .001.
The raw pretest and posttest Behavioral
Avoidance Test scores reflecting this effect
for each of the three groups are as follows:
(a) For the control group (n = 12), Ms =
6.00 (SD = 2.66) to 6.67 (SD = 3.23) ;
(b) for the treatment-only group (n = 15),
Afs = 6.07 (SD=1.98) to 11.20 (SD =
4.38) ; and (c) for the enhanced-personality-
feedback-with-treatment group (n = 13),
Ms= 5.77 (SD = 2.35) to 13.62 (SD =
4.35). The enhanced-personality-feedback-
with-treatment group (adjusted M = 13.84)
evidenced significantly more behavioral im-
provement than the treatment-only group
(adjusted M = 11.05) or the control group
(adjusted M = 6.60), t(26) = 1.82, p <
.04 and / ( 2 3 ) = 5 . 5 1 , p < .0001, respec-
tively. The treatment-only group showed
significantly greater behavioral improvement
than the control group, 1(25) =4.65, p <
.0001. Since it was hypothesized on an a
priori basis that the treatment-plus-en-
hanced-personality-feedback group should
evidence more improvement than the treat-
ment-only group, which in turn should
improve more than the control group, all
post hoc t tests are one-tailed.
Discussion
Both manipulation check items indicated
that the enhanced-personality-feedback-with-
treatment group had a significantly greater
expectation for change than the treatment-
only group. Unlike previous studies that em-
phasized manipulating treatment expectan-
cies, the present study manipulated peoples'
expectancies in order to emphasize that they
had the potential to facilitate change (see
Footnote 1). Based on these results, it does
appear possible to enhance the client's belief
that she can be an effective source of change
with regard to a particular problem. This
finding should not be surprising when con-
sidered in light of Barnum-effect results
showing that the recipients of diagnostic
feedback are highly acceptant of such infor-
mation.
Beyond simply demonstrating that per-
sonal beliefs in potential for self-change may
be enhanced, the present study indicates
that enhanced personal expectations may
actually facilitate therapeutic improvement.
Several precautions need to be carefully ex-
amined, however, before considering the im-
plications of the present therapy outcome
results. First, it cannot be discerned from the
present data whether the relatively superior
 BARNUM EFFECT AND THERAPY
performance of the enhanced-personality-
feedback-with-treatment groups was due to
the enhanced content of the information or
merely the fact that they received diagnostic
feedback information. Comparison groups in
which subjects received either neutral or
negative feedback would be needed to address
this question. Although the content of psy-
chological test feedback may be rather nega-
tive in the actual clinical setting, it would not
be ethically plausible to give one group of
subjects negative feedback in an experi-
mental analogue setting.
A second set of precautions relates to the
subject sample employed in the present
study. The present subjects evidenced only
mildly fearful behavior. Previous research
reveals that highly fearful subjects may be
less susceptible to expectancy manipulations.
Likewise, mildly fearful people appear to be
especially sensitive to demand characteristics
(Borkovec, 1973), and thus the superior
performance for the enhanced-personality-
feeclback-with-treatment group may be re-
lated to such demand characteristics alone.
Other precautions related to the present sub-
ject sample are that only females with mild
snake fears were employed. Obviously, infer-
ences for male samples, other phobias, and
other potential problems that a client may
bring to therapy are tenuous at best.
A third precaution stems from the fact
that subjects in the present study performed
the behavioral avoidance test in the presence
of an experimenter. As such, the present
change in snake fear results are consistent
with previous studies suggesting that be-
havioral improvement occurs when the ex-
perimenter is present for the behavioral
avoidance test, but improvement does not
occur when the experimenter is not present
for this test (Bernstein & Nietzel, 1973).
Therefore, the fact that the experimenter
was present during the behavioral avoidance
test needs to be considered as one contextual
parameter that limits the inferences derived
from the present study. A fourth precaution
is that the present results represent findings
from only one study, and thus replications
with other target problems and clientele
samples are needed. For these various rea-
145
sons, one needs to be extremely cautious in
generalizing beyond the present sample.
Because of the aforementioned precau-
tions, it is most accurate to view the present
experimental analogue as providing a prom-
ising first piece of supporting evidence with
regard to the potentially positive therapeutic
effects of enhanced personal expectations for
change. While both the treatment-only
and the enhanced-personality-feedback-with-
treatment group improved significantly more
than the no-treatment control group,
the enhanced - personality - feedback - with -
treatment group showed improvement be-
yond that attained by the treatment-only
group. Since diagnostic testing is typically
part of the process of receiving psychological
help (Wade & Baker, 1977), the present
results suggest that diagnostic test feedback
may be utilized to facilitate improvement.
Perhaps clinicians may be advised to espe-
cially emphasize the strengths of the person
as revealed through diagnostic testing. In
the process of accepting such positive feed-
back, the person may in turn initiate thera-
peutic change. This change may be achieved
because the individual comes to perceive him-
self or herself as an active, responsible per-
son who is capable of effecting a change
(Cartwright & Cartwright, 1958). This is a
goal that most all clinicians would hold for
their clients. One is reminded of the classic
children's story about a train trying to strug-
gle up a hill. The train tells itself, "I think
I can, I think I can." Psychological test feed-
back may be one of many potentially effec-
tive means of generating such enhanced ex-
pectations of personal power for change.
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Received May 17, 1978 •