Rational Emotive Therapy with Children and Adolescents

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NICHCY’s Structured Abstract 8 describes the following:

Title | Rational Emotive Therapy with Children and Adolescents

Authors | Gonzalez, J.E., Nelson, R.J.,Gutkin, T.B., Saunders, A., Galloway, A. & Shwery, C.S.

Source Journal of Emotional & Behavioral Disorders, 12(4), 222.

Year Published | 2004

Abstract
This article systematically reviews the available research on rational emotive behavioral therapy (REBT) with children and adolescents. Meta-analytic procedures were applied to 19 studies that met inclusion criteria. The overall mean weighted effect of REBT was positive and significant. Weighted zr effect sizes were also computed for five outcome categories: anxiety, disruptive behaviors, irrationality, self-concept, and grade point average.

In terms of magnitude, the largest positive mean effect of REBT was on disruptive behaviors. Analyses also revealed the following noteworthy findings:

  1. There was no statistical difference between studies identified low or high in internal validity.
  2. REBT appeared equally effective for children and adolescents presenting with and without identified problems.
  3. Nonmental health professionals produced REBT effects of greater magnitude than their mental health counterparts.
  4. The longer the duration of REBT sessions, the greater the impact.
  5. Children benefited more from REBT than adolescents.

The findings are discussed in terms of several important limitations along with suggestions for future research.

Background
Rational Emotive Behavior Therapy (REBT) is a popular form of therapy in child and adolescent psychotherapy. It was initiated by Albert Ellis in the mid- 1950s and it is considered the first modern cognitively based therapy used for the treatment of school-age children and adolescent misbehavior. Its basic fundamental principle is that emotional disturbances appear from flawed thinking about events rather than the events themselves.

Treatment begins by building a relationship between the practitioner and the young person followed by problem solving strategies. The next step is to develop treatment goals for the purposes of reducing the intensity, duration, and frequency of disturbed emotions that often lead to problematic results. Cognitive change is brought through a process of systematically examining one’s thoughts and beliefs to asses the degree in which they are true, logical and helpful.

This approach leads to the amelioration of disturbances producing a rational and effective outcome. Previous research has studied the effectiveness of REBT, but the results did not provide quantitative estimates of treatment effects or an understanding of the characteristics that either promote or reduce the effectiveness of REBT with children and adolescents.

Research Questions
The major purpose of this meta-analysis was to evaluate the impact of REBT on treatment outcomes for children and adolescents and to identify and evaluate variables that moderate study outcomes.

Research Design
Meta-Analysis*

  • Number of Studies Included | 19
  • Number of Subjects | 1,021
  • Years Spanned | 1975-1998

Research Subjects
Children under age 18 who received REBT regardless of the setting (e.g., school or clinic-based).

Age/Grade of Subjects
Children and adolescents under age 18.

Specified Disability
Conduct disorders, aggression, test anxiety, disruptive classroom behaviors, attention-deficit/hyperactivity disorder, low self-esteem, low self-concept, irrationality, general anxiety, and low academic achievement

Intervention
Rational Emotive Behavioral Therapy (REBT): REBT was born out of the practice of cognitive behavioral therapy (CBT)* as a means for regulating behavior by training individuals to adjust their illogical and harmful though processes. REBT is based on the idea that emotional disturbance comes from faulty thinking about events, rather than the events themselves. REBT uses cognitive mediation strategies to adjust irrational thinking and regulate behavior.

Duration of Intervention
Time was calculated for each study by multiplying the number of sessions by session length:

  • Low (60-375 minutes)
  • Medium ( 675-770 minutes)
  • High (1,200-2,115 minutes

Findings

1. REBT is an effective treatment for children and adolescents with and without identified problems.

2. REBT has the greatest impact in decreasing disruptive behaviors in children and adolescents.

3. Non-mental health professionals were more effective at delivering REBT than their mental health counterparts.

4. The longer the duration of the REBT session, the greater the positive affect it had on the child.

5. Children benefit from REBT more than adolescents.

Combined Effects Size
The mean (average) effect size was 0.50. For the outcome domains the effect sizes* were:

  • Anxiety 0.48
  • Disruptive behaviors 1.15
  • Irrationality 0.51
  • Self-Concept 0.38
  • Grade point average 0.49

Conclusion/Recommendations

1. The limitations of this study should be considered when generalizing the results.

2. The number of studies found that met the criteria was small in comparison to meta-analyses of REBT with adults. It is possible that a relevant study may have mistakenly left out.

3. The studies included did not provide sufficient information on the characteristics of the children and adolescent beyond their age and, to a limited degree, gender; for that reason it was difficult to assess which children and youth were more likely to benefit from REBT.

4. It was not possible to generalize and assess maintenance of treatment effects, therefore it was difficult to determine if the beneficial effects of REBT could be extended beyond the treatment settings or maintained beyond the initial treatment phases.

5. Just a few of the studies provided sufficient information to determine if the treatments were implemented with integrity to each component in the REBT framework.

6. Peer reviewed studies were only included as a way of addressing the need for a standard of study quality; consequently, dissertations, professional presentations, and ERIC documents were excluded.

7. Almost all the studies took place in school settings with children and adolescents that were not referred.

8. Several of the studies used a relatively limited variety of outcome assessment measures.

9. Further research should explore in more depth the maintenance effects of REBT to determine whether children and youth may need follow-up sessions to reinforce the effects of REBT overtime.

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* Terms Defined

Cognitive-Behavioral Interventions (CBIs) | CBI is a broad term that encompasses Cognitive-Behavioral Modification (CBM) and Cognitive-Behavioral Therapy (CBT). It is a behavior modification approach that promotes self-control skills and reflective problem-solving strategies. Interventions combine elements of behavior therapy (modeling, feedback, reinforcement) with cognitive approaches (problem solving, self-monitoring, self-instruction, communication skill building, relaxation, and situational self-awareness training) to teach individuals to recognize difficult situations, think of possible solutions, and select the most appropriate response.

Effect Size (ES or d) | A statistical calculation, often represented as ES or d, that measures the impact of an intervention. An effect size below d = 0.20 suggests that a treatment did not have a significant effect. An effect size of  d = 0.20 is considered small or low; and effect size of d = 0.50 is considered moderate; an effect size of  d = 0.80 or above is large.

Meta-Analysis | A widely-used research method in which (1) a systematic and reproducible search strategy is used to find as many studies as possible that address a given topic; (2) clear criterion are presented for inclusion/exclusion of individual studies into a larger analysis; and (3) results of included studies are statistically combined to determine an overall effect (effect size) of one variable on another.

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