Byrne's Perspective on REBT Research
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!"
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:
SUMMARY NOTES ON REBT RESEARCH
By Jim Byrne, ABC Coaching
for effectiveness with different types of clients:
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.
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).
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.
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]
Rational emotive therapy (REBT)
60 (NB: based on only 8 measures)
Source: Page 199 of Banyard and Grayson (1996), adapted from Smith and Glass (1977).
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.
and Jarvis (2003) also have produced a summary of the main research on the effectiveness of REBT. (Russell, Julia and
Jarvis, Matt  *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.
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.
of the other therapies were more effective than REBT.
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.
*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
Here is the abstract from Smith
and Glass (1977) Meta-analysis of psychotherapy outcome studies, *American Psychologist*, September
"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)".
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:
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".
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.
Dr Jim Byrne, ABC Coaching