REBT and Research
 

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REBT AND RESEARCH

by Dr Jim Byrne 

Updated: 20th March 2014 

Postscript

This page was written before I found out about the 'common factors' theory of counselling and therapy outcomes.  This theory suggests that:

All systems of counselling and therapy are broadly equivalent in terms of the outcomes achieved by clients: “There is no shortage of evidence of the significance of common factors across models of therapeutic practice, and among these the quality of the therapeutic relationship is emphasized as central to therapeutic success.  (Counselling and therapy) depend first and foremost on ‘being-in-relation’, not on technical experts with toolbags of techniques for diagnosing and treating specific problems…”

Strawbridge and Woolfe, 2003, Counselling Psychology in Context, page 15. (42)

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Some attempts to find a baseline

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This page began as the "REBT and Research" page, in 2001 or 2002. At that time I was struggling with some issues to do with the relative efficacy of Rational Emotive Behaviour Therapy (REBT) and Cognitive Therapy (CT).

Later I will present a list of more than 400 research studies that investigate the efficacy of REBT, and broadly support its usefulness as a system of therapy.

Let me now present the brief paper which has been on this page from the beginning; followed by some comments on that paper.

The paper that follows immediately is a review of existing research on Rational Emotive Behaviour Therapy. At the time of writing this little paper, I was asleep to the problems of validating or verifying anything. It was my first ‘baby step’ in trying to get to grips with the issues involved in researching REBT, which at that time was not only my favourite form of counselling and therapy, but I had not yet come up against any obvious limitations to REBT. My baby footprints may be clearly visible to you as you read this next piece.

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And:        Counselling research***

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Jim Byrne's Perspective on REBT Research

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Since 1999, I have been aware that it is very important to be able to answer the question: "Is REBT an effective therapy; and how do you know that?" In fact, REBT was verified in my own life by virtue of the fact that it helped me to get through the very difficult and painful economic, social and personal problems associated with my own very serious career crisis, in 1992-1994. I have often said that "I teach my clients the philosophy that I use to keep myself sane in an insane world!"

Furthermore, I receive frequent messages and communications from my current and former clients to the effect that: "I'd be in a real mess in my life if it were not for what you taught me about managing my irrational beliefs, and sticking to high frustration tolerance, and accepting myself unconditionally, whether or not I do well in my life!" (See the *Client Testimonials* page). For many individuals that is enough validation. But there is a stronger case that can be made for the teaching of REBT to clients in counselling and psychotherapy, or in life-coaching situations. Here is a fairly standard summary of the most important research on outcomes in REBT, extracted from Ellis and Dryden (1997) The Practice of REBT, pages 178-179:

"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:

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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 attempts 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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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 CBTtherapies; 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.

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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, andREBT 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.

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*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 REBTis 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 counselling 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 behavioural therapies (systematic desensitization, behavior modification) and the non-behavioural 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.

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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).


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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".

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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. (Of course, Ellis also played a part in this process, by over-simplifying counselling and therapy sessions into a mechanical A>B>C model.  In CENT, we have abandoned this simplistic notion that all human disturbance are always and only caused by the client's beliefs (or attitudes).  Instead, we use the Stimulus>Organism>Response model, in which the organism (or person) is seen to have emotional and behavioural responses driven by diet, exercise, cultural conditioning, sleep patterns, nutritional deficiencies or dependence upon sugary or fatty foods, prescription or recreational drugs, social and economic stressors, and so on - as well as their rational and irrational beliefs.


CENT 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.

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Dr Jim Byrne, ABC Coaching

For an overview of Rational Emotive Behaviour Therapy in Practice

go to the

What is REBT? page, here...