"An unusual
number of outcome studies have been done on REBT that tend to show it is more effective as a form of psychological treatment
than when emotionally disturbed individuals are left on a waiting list, given a placebo form of therapy, or subjected to non-REBT
procedures. There now exist over 500 controlled experiments using REBT and related cognitive-behavioural forms of therapy;
almost all of these experiments show positive results in favour of REBT (DiGiuseppe, Miller & Trexler, 1979; Ellis &
Whiteley, 1979; Haaga & Davidson, 1989; Hajzler & Bernard, 1991; Hollon & Beck, 1994; Lyons & Woods, 1991:
McGovern & Silverman, 1984; Miller & Berman, 1983; Silverman et al., 1992). A good many of the outcome studies that
have shown that REBT and allied cognitive behaviour therapy work effectively have been done with group rather than individual
psychotherapy (Ellis, 1992c; McClellan & Stieper, 1973; Meichenbaum, Gilmore & Fedoravicius, 1971)". "In addition to these studies, a number of other controlled experiments have been published,
indicating that REBT and allied cognitive-behavioural group therapy is effective when used in a classroom situation with children
and adults who are taught rational emotive behavioural methods and, through this psycho-educational group technique, are enabled
to change their self-defeating feelings and behaviours (Hajzler & Bernard, 1991; DiGiuseppe et al., 1979; Ellis &
Whiteley, 1979; Lange, 1979; Lyons & Woods, 1991; Rose, 1980; Upper & Ross, 1979, 1980)".
From: Ellis and Dryden (1997) The Practice of REBT, Furthermore,
in a recent brief paper, ...(which is a summary of published research), I (Jim Byrne) tried to summarize the research situation
within REBT as follows:
~~~
SUMMARY NOTES ON REBT RESEARCH
By Jim Byrne, ABC
Coaching
Research evidence for effectiveness with different types of clients:
REBT is one of the most researched therapies, according to David and Avellino
(2003), as shown in this blog. It has also been shown to be one of the most effective therapies. And, as far as I can tell,
only one therapy has ever been shown to be more effective than REBT. (Smith and Glass, 1977, in David and Avellino, 2003).
Historically, there have been two major attemps to summarize the research on
REBT: one by Ray DiGiuseppe and associates, and one by Daniel David and a colleague.
The
first of these, by DiGiuseppe et al, consists of a list of 14 summary reviews of REBT research studies (based on at least
242 original studies – which I counted on the website list). There is also an additional list of 82 studies which have
not been summarized or considered in any of the 14 review studies. And there is then a list of additional studies found after
June 1, 1998; and these, according to my count, amount to 96 studies. That’s a total of more than 420 studies, in the
form of books, journal articles, papers, dissertations, etc. Plus the fourteen summary reviews.
The second document, by David and Avellino (2003), summarizes various lines of REBT research, and I will present
a summary of just one of these lines - the ‘Outcome studies in REBT’ - from their paper. David and Avellino summarized
part of their work as follows:
"(1) REBT is useful for a large
range of clinical diagnosis and clinical outcomes. Interestingly, REBT proved to have a much larger effect on “low reactivity”
outcomes, which do not have an obvious relationship with the treatment (e.g., physiological measures, grade-point average),
than on “high reactivity” measures, which have a direct and obvious relationship with the treatment (e.g., irrational
beliefs). This suggests that the effect of REBT is not due to compliance or task-demand characteristics. "(2) REBT is equally efficient for clinical and non-clinical populations, for a large age range (9-70),
and for males and females.
"(3) In general, there is no difference in efficacy
between individual and group REBT format.
"(4) In general, the higher the
level of training of the therapist, the greater the results of REBT intervention.
"(5)
Increased numbers of REBT sessions correlates with better outcomes. Higher quality outcome studies have shown greater REBT
efficacy/effectiveness." (David and Avellino, 2003).
~~~
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of building and maintaining it from year to year.
~~~
Summary of REBT Research:
My summation of the key points in David and Avellino (2003), then, would
be this:
Several qualitative reviews have examined the efficacy of REBT, and
these made generally positive appraisals of the quantitative results reviewed. Some methodological problems were identified,
and these had better be addressed in future REBT research. The main implication of the latter finding is this: REBT studies
in the future can be made even more rigorous. Although many studies of REBT date back to the sixties and seventies, rigorous
empirical research into REBT efficacy seems to date from the end of the eighties and the beginning of the nineties.
In addition to qualitative reviews of the type mentioned above, there have also been quantitative
reviews of REBT research data. These types of study have generally shown that REBT has done well relative to other systems
of therapy. For example, REBT achieved the second highest average effect size out of ten major psychotherapies in the original
meta-analysis conducted by Smith and Glass (1977).
That study by Smith and Glass
first appeared in the *American Psychologist*, 32: 752-760, in 1977. It was summarized in Banyard, Philip and Grayson, Andrew
(1996) *Introducing Psychological Research: sixty studies that shape psychology*, Hampshire, MacMillan Press.
The results were as follows:
Table 11.3:
Rank ordering of ten types of therapy
| Type of therapy tested | Median treated person's percentile
status in control group [Or measure of effectiveness] |
| Systematic desensitization | 82 |
| Rational emotive therapy (REBT) | 78 |
| Behaviour modification | 78 |
| Adlerian | 76 |
| Implosion | 74 |
| Client-centred | 74 |
| Psychodynamic
| 72 |
| Transactional analysis | 72 |
| Eclectic | 68 |
| Gestalt | 60 (NB: based on only 8 measures) |
Source: Page 199 of Banyard and Grayson (1996), adapted from Smith and Glass (1977).
One problem with meta-analyses today is that REBT gets bracketed into a collection of general CBT therapies;
and since the number of REBT studies is normally in a minority, it is difficult to figure out the contribution that REBT is
making to the overall positive result. However, this problem does not apply to Engels et al (1993) and Lyons and Woods (1991),
which focused directly on evaluating the efficacy of REBT. The general conclusions to be derived from these two studies include:
(1) REBT is useful for a large range of clinical diagnosis and clinical
outcomes; (2) REBT is equally efficient for clinical and non-clinical populations,
for a large age range (from 9 to 70), and for both males and females;
(3) The
better trained the therapist, the better the therapeutic outcomes;
(4) The more
sessions the client has, the better the outcome is likely to be.
~~~
Russell and Jarvis (2003) also have produced a summary of the main research on the effectiveness
of REBT. (Russell, Julia and Jarvis, Matt [2003] *Angles on Applied Psychology*, Cheltenham, Nelson Thornes).
My summation of the research by Russell and Jarvis (2003) is as follows: There were 31 studies reviewed
by Engels et al (1993), and REBT proved to be more effective for treating anxiety disorders than the two therapies against
which it was compared, one being behaviour therapy.
Eighty-nine outcome studies
were reviewed by Silverman et al (1992) - in Russell and Jarvis (2003) - and REBT was shown to be more effective than the
other therapies (in 49 studies); and equal to the other therapies (in 40 studies). The comparator therapies against which
REBT was tested included systematic desensitization.
None of the other therapies
were more effective than REBT.
What this seems to demonstrate is that, when tested,
REBT proves to be a highly effective treatment. However, as Solomon and Haaga (1995) infer, it is important to ask: Can these
results be generalized to routine clinical practice? And this question applies to all forms of therapy, not just to REBT.
At this stage, my only comment can be this: To the extent that any therapy can be experimentally validated, then REBT has
not only been experimentally validated, but also proved to be more effective, in the main, and sometimes equal to, the therapies
against which it was compared. Of course, it is also important to keep an open mind about future research possibilities, and
to ask if what we are measuring is "real", and what, precisely, is "causing it". But, at the very least,
we have no good reason to doubt the effectiveness of REBT, relative to other therapies, and REBT therapists can be confident
that they are practicing a well validated therapeutic process. In the future, it would be highly desirable to develop a coordinated
programme of research studies on various aspects of REBT, and, in my view, to promote high quality practitioner research,
in counselling settings, related to further developing existing treatments, and new treatments, for specific conditions, such
as anger, depression, anxiety, and so on.
~~~
*Footnote
on preceding paper*. (Date: 11th November 2004).
I misunderstood the implications
of the findings of Smith and Glass, 1977; who found that all the therapies they investigated were "broadly equivalent",
in that they each produced significant gains for the client. So, although the results are listed hierarchically, and REBT
is in the second position on the list, this variation in scores is not in itself sufficiently significant to place REBT in
a league separate and apart from the therapies lower down the list. And there is now broad consent, in some research quarters,
that all the major therapies that are designed to be therapeutic are broadly equivalent in their effectiveness. (See in particular
the work of Professor Bruce Wampold). Therefore, it might be more productive to look at how and what we could each learn from
the other, rather than competing in a zero sum game.
Here is the abstract from
Smith and Glass (1977) Meta-analysis of psychotherapy outcome studies, *American Psychologist*, September
1977, 752-760:
"Results of nearly 400 controlled evaluations of
psychotherapy and counseling were coded and integrated statistically. The findings provide convincing evidence of the efficacy
of psychotherapy. On the average, the typical therapy client is better off than 75% of untreated individuals. Few important
differences in effectiveness could be established among many quite different types of psychotherapy. More generally, virtually
no difference in effectiveness was observed between the class of all behavioral therapies (systematic desensitization, behavior
modification) and the non-behavioral therapies (Rogerian, psychodynamic, rational-emotive, transactional analysis, etc)".
Page 752.
In their conclusion, Smith and Glass say this:
"The results of research demonstrate the beneficial effects of counseling and psychotherapy.
Despite volumes devoted to the theoretical differences among different schools of psychotherapy, the results of research demonstrate
negligible differences in the effects produced by different therapy types. Unconditional judgements of superiority of one
type or another of psychotherapy, and all that these claims imply about treatment and training policy, are unjustified".
Page 760.
~~~
Engels, Garnefski
and Diekstra (1993) had this to say about their meta-analysis of RE(B)T research studies:
"Meta-analysis
of 28 controlled studies on the efficacy of rational-emotive therapy (RET, later called REBT) showed RE(B)T to be superior
to placebo and no treatment but equally effective in comparison with other types of treatment such as combination therapies
and systematic desensitization. No support was found for the view that RE(B)T with a main or balanced emphasis on behavioral
techniques is more efficacious than RE(B)T with a primarily or exclusively cognitive approach..." Page 1083. (Engels,
Garnefski and Diekstra (1993) Efficacy of Rational-Emotive Therapy: A quantitative Analysis, *Journal of
Consulting and Clinical Psychology*, Vol.61, No.6: 1083-1090).
~~~
~~~
If you want to get a wider perspective
on REBT and Research, here is a link to a search on Google Scholar on the search terms: "REBT and Research".
~~~
Beyond
REBT/CBT: The development of Cognitive-Emotive Narrative Therapy (CENT)
Because
of recent developments in REBT internationally, and a growing unease about the role of the 'medical-model' in CBT, I have
begun to develop a way forward into a more productive area of thinking about human disturbance. Cognitive-Emotive Narrative
Therapy (CENT) is based on the profound thinking of Albert Ellis in in the period 1957-1962, which began the generation of
a complex model of the A>B>C's of human disturbance which has since been lost by the failure of his followers to understand
this complex model.
It also includes the models of mind and personality developed
by Freud, Berne, the Object Relations school, John Bowlby, the Buddha, and various moral philosophers.
Recent experience suggests the importance of incorporating morality at the 'ground floor' level
of the development of this CENT. The human individual is assumed to be split from the beginning of life between two tendencies,
called the "good wolf" and the "bad wolf" (which are in some ways echoes of Freud's Eros and Thanatos).
And effective socialization processes are seen to be central to "good mental health", emotional intelligence and
human happiness.
This model is still under development, and will be explored by
the Institute for Cognitive Emotive Narrative Therapy (I-CENT), which can be found by clicking here.
~~~
Jim Byrne, ABC Coaching
