The Efficacy of Rational Emotive Therapy
作者: Larry C. Lyons / 8924次阅读 时间: 2010年2月26日
来源: Paul J. Woods 标签: RET
www.psychspace.com心理学空间网
The Efficacy of Rational Emotive Therapy:
2SD-\'GlX0A Quantitative Review of
0JB1{ L}0the Outcome Research.
Larry C. Lyons
KjgZy0Paul J. Woods,
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Hollins College, Virginia.

M:N]9P%W^5|:l0From:Lyons, Larry C. & Woods, Paul J. (1991).The efficacy of rational emotive therapy: A quantitative review of the outcome research.Clinical Psychology Review, 11, 357-369.

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Author Notes

^M8Z0ZbU8bS?0We thank Wendy A. Morris for her assistance in preparing this manuscript. Without her inestimable help, this project would not have come to fruition.

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!l"jU1u2{%[1b }q0Larry C. Lyons, MA was a Research Associate at the Hollins Communications Research Institute when this article was published in Clinical Psychology Review. He is currently both a consultant and with a private firm in Manassas, Virgina.心理学空间x3b_.^)e.y

;E&UEiW`,{-`0Paul J. Woods Ph.D.is a Professor of Psychology (Emeretus) at the Department of Psychology at Holllins College, and director of the Institute for Rational Therapy and Behavioral Medicine in Roanoke Virginia心理学空间+]&}y C@8|

`x-_QO\0Address request for reprints of this article, coding manual or list of studies used in this quantitative review to the second author at:心理学空间5\"a,S*jf fb

*g"]2Tg;Ls0Paul J. Woods Ph.D. Institute for Rational Therapy and Behavioral Medicine, 5541 Florist Road Roanoke, Virginia心理学空间4~)X6pW!f1C+yY#i!W

Abstract心理学空间y xR4n+oo+j

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The results from a meta-analysis of 70 Rational Emotive Therapy (RET) outcome studies were reported. There were 236 comparisons of RET to baseline, control groups, Cognitive Behavior Modification, Behavior Therapy, or other psychotherapies were examined.心理学空间A6I Pv@^B Gf

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The results indicated that subjects receiving RET demonstrated significant improvement over baseline measures and control groups. The results showed no significant differences in effect size between those studies which used psychotherapy clients or students as subjects. Effect size was significantly related to therapist experience and to duration of the therapy. The results indicated that those comparisons which were rated high in internal validity had signficantly higher effect sizes than medium validity studies. Outcome measures rated as low in reactivity had significantly higher effect sizes than more reactive measures.

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,`K6L&VC8g!Fj0Contrary to other reviews using the narrative review method, RET was found to be an effective form of therapy. However, this conclusion was tempered by methodological flaws of the studies reviewed, such as lack of follow-up data and information regarding attrition rates.

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Rational Emotive Therapy (RET) has become one of the most accepted forms of Cognitive Behavior Modification since its initial development in the late 1950's and early 1960's. (Ellis, 1957; 1962; Gregg, 1973). Narrative reviews have either supported RET's efficacy or criticized its usefulness. Using a quantitative review method (meta-analysis), this study examines the efficacy of RET and addresses many of the criticisms advanced by previous reviews of RET.心理学空间&]-W%`~6Fj$v/HI

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Ledwidge (1978) reviewed 13 outcome studies comparing Cognitive Behavior Modification (CBM) to Behavior Therapy. Of the 13 studies, six were based on either RET or Systematic Rational Restructuring. He concluded that although these studies suggest no differences between behavior therapy and Cognitive Behavior Therapy (and by extension RET), this was only apparent because none of these studies used a clinical sample. On the basis of these findings, Ledwidge concluded that behavior therapy was the superior form of treatment.心理学空间0d6i"S7G:eu

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DiGiuseppe and Miller (1977) reviewed 22 studies which examined the effectiveness of RET or a closely related therapy. These studies were categorized in two sets: comparative studies, which compared RET to some other psychotherapy; and non-comparative research which examined RET to baseline scores or against some form of control. DiGiuseppe and Miller concluded that many of the studies had a variety of methodological problems typical of most psychotherapy research. They found RET to be considerably more effective than no treatment control and baseline scores.

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Oq*aG)];N+?`9p'_z0Zettle and Hayes (1980) reviewed 35 studies which investigated the theoretical assumptions, individual treatment components, and overall effectiveness of RET. They claimed all available outcome research were either unsystematic case studies or consisted of analogue research. Less than half (16) of the 35 studies were outcome experiments. Based on these 16 studies, the authors concluded that the clinical efficacy of RET was not demonstrated. Prochaska (1984) surveyed eight studies which examined the effectiveness of RET. From this limited sample, he concluded that these studies demonstrated only equivocal results and the most positive application of RET was for reducing common anxiety. Based on their review of 47 RET outcome studies, McGovern and Silverman (1984) concluded that these studies supported the efficacy of RET.

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Reviewers of RET outcome literature have raised many criticisms regarding RET outcome research. One such criticism involves the issue of "elegant" vs. "inelegant" RET (Ellis, 1980). Ellis describes inelegant RET as other forms of cognitive behavior modification, while "elegant" RET refers to the specific approach advocated by Ellis and others. Similarly, Wessler (1983) claimed the researcher frequently misunderstands the therapeutic approaches of RET, or else mislabels or misrepresents the procedure until it is no longer RET. Thus, the question to be investigated is : Does the degree of similarity of the treatment to RET influence effect size.

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Several reviewers have criticized the methodological quality of RET outcome studies (e.g., DiGuiseppe and Miller, 1977; Ledwidge, 1978; Prochaska, 1984; Zettle and Hayes, 1980). Their concerns include low percentage of male subjects; subject solicitation; students vs psychotherapy clients; the number of subjects per comparison; subject and therapist assignment to treatment or control groups; therapist training; treatment duration; individual vs group therapy; and reactivity and type of outcome measure.心理学空间/p(E9Qr4oV5o

`%@*C'@uW0Another area of investigation is the issue of using students versus clinical subjects. Ledwidge (1978) and Zettle and Hayes (1980) note in their reviews that most RET studies used students volunteers as subjects. They question the external validity of these studies, since the problems assessed may not be applicable to the typical client. While RET may indeed prove effective with students suffering from test anxiety, it is possible that RET may be relatively ineffective when dealing with more serious clinical problems, like depression, or agoraphobia. In other words, are there differences in effect sizes among studies which use students as opposed to psychotherapy clients?

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5r,n!d4vca8Ji7H/L0Reviewers disagree on the therapeutic effectiveness of RET. This point constitutes the core of the present review, what is the therapeutic efficacy of RET? This point is difficult to answer in the context of an individual study or the narrative review, because reviewers can reach very different conclusions given the same evidence. The quantitative review format directly address the question of the therapeutic efficacy of RET without reviewer bias.

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Method心理学空间T#d"b D8G:s*FRZ

$G6i)kbK0SelectionofStudies:心理学空间3llRN6p,h'g,@P

"|5C6z5B4B:{9H3|T0ThePsychologicalAbstractsandDissertationAbstractsInternationalfrom 1972 to 1988 were searched for relevant studies. In addition, the reference lists of the obtained studies and the previously mentioned reviews were scanned for additional material. A list of the studies used in this meta-analysis can be seen in the appendix following this article.

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,kZ+\L;rdo*J#D0Each study had to meet the following inclusion criteria:

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(1) At least one treatment group received Rational Emotive Therapy, or a treatment which used elements of RET.心理学空间kOXMy&b|

[&fR ha0(2) The study compared RET to a baseline measure, a control group, or other type of therapy.

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(3) The study used a quantitative statistic which could be converted to an effect size estimate.心理学空间VL"j/bhQ;wC

}{"dGQ0(4) The study gave the number of subjects in each treatment or control group.心理学空间+`6a:[4p_}f9r

.^&D x9q}}Z4f5G7e0Seventy studiesmet these criteria, yielding236 comparisonsbetween RET and a baseline measure, a control group, or other form of therapy.

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Studies were rejected because of uninterpretable statistics, or because insufficient information regarding treatments, or experimental procedures were presented. Single subject designs and case studies were also excluded.

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`6[*k ke#UVH0EffectSizeEstimation心理学空间+il6wexwz

*y ZKk,W0Each comparison of RET to the baseline assessment, control, or treatment groups was expressed in terms of the Standardized Difference between Mean Scores (d; Cohen, 1977). Some researchers (e.g., Glass 1976, 1977; Smith & Glass, 1977; Smith et al, 1980) advocate using the comparison group standard deviation as the denominator ford. However, there are two reasons against using the comparison group standard deviation, first, the within-subjects standard deviation has approximately half the sampling error of the comparison group; second, the within-subjects standard deviation generally provides a more accurate estimate of the populations(Hunter et al, 1982). Afterdis calculated for each study, the effect sizes are averaged.心理学空间6T%{t'T J s

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Where possible, effect sizes were obtained by directly calculatingdfrom the means and standard deviations reported in the individual study. Otherwisedwas calculated fromt,f,r, or a probability value using procedures taken from Cohen (1977) or Hunter et al (1982). If the comparison was taken from a two-way ANOVA, the statistic was first converted to theetastatistic using an algorithm taken from Hasse (1983). This correlation coefficient was then converted todusing procedures outlined by Cohen (1977) and Hunter et al (1982).

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When the exact probability level was given, this value was converted into azscore and then converted to a point-biserial correlation. Adwas then estimated using the previously mentioned procedures outlined by Cohen (1977) and Hunter et al (1982). Unfortunately in some studies, an exact statistic was not available. An approximation procedure was used to estimated. Where nonparametric statistics or multiple comparison procedures (e.g., Duncan's Multiple Range test or Newman-Keul's test) were used, the associated probability value (.05, .01, or .001) was converted first to azscore and then to adstatistic using the previously discussed procedures.

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If the study only stated a significant difference, the associated probability value was set to .05, and the appropriatedstatistic was calculated using the above conversion algorithms. Similarly, where the term no significant difference was reported, the effect size was assumed to be 0.心理学空间#e|sl~y5r@}

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In comparisons ofd's derived from test statistics (e.g.,t,F, or means and standard deviation) to those derived from probability values taken from the same statistics, the effect size estimates of the test statisticdwere less conservative estimates than those derived fromp.

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The majority of the studies included in this meta-analysis used more than one outcome measure. Other meta-analyses (e.g., Smith et al, 1980) included all nonredundant measures in the analysis. The main problem with this approach is the analysis is based on on dependent effect sizes biasing the results by giving more weight to those studies with multiple effect sizes. To avoid this bias, the present study averaged the effect sizes to produce a single statistic within each comparison of RET, preserving the independence of each comparison.心理学空间Y|:z$N&g

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CodingProcedures

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%m:?y,k%p#s0e0After converting the study statistics to effect sizes, study characteristics were examined and coded using a 28 variable coding scheme. A complete list of the articles and dissertations used in the present meta-analysis is available from the author for a $5 fee to cover printing, postage, and handling. These coding variables included the year of the comparison (either publication or acceptance date), and level of therapist training.心理学空间M?Ht#]"a],T[

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Client or subject problem diagnosis was also coded, based on a coding procedure originally present in Smith et al (1980).心理学空间1| RM? b A:W,j%T"v!bR

  1. Neurotic: subjects had the following problems: personal growth, achievement problems, social anxiety, excessive anger, assertion, depression, students with behavior problems, speech anxiety, potential school and college, dropouts, etc.
  2. Phobic: subjects were diagnosed as suffering from some form of phobia, including simple and complex phobias, agoraphobia, etc.
  3. Normal: participants had no immediately discernible problem
  4. Emotional/Somatic: subjects with asthma; sexual dysfunction; insomnia; obesity; migraine headaches; chronic heart disease; and individuals on home dialysis
  5. Unknown/Unclassified: participants who could not be classified into any of the previous categories, it also included those problems where numbers did not merit a separate classification group.
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To determine the effectiveness of RET against other therapies, comparison groups were coded according to the therapies they received:

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  1. Baseline comparison: the pretreatment measure taken at the start of therapy.
  2. No Treatment Control (NTC): comparison against a group not receiving therapeutic intervention.
  3. Waiting List Control (WLC): groups whose participants did not receive therapy but who were given the expectation they were on a waiting list for treatment.
  4. Attention Control/ Placebo (ACP): groups where relaxation or a placebo treatment was given in order to control for non-specific treatment effects.
  5. Cognitive Behavior Modification (CBM): therapies using the techniques and theories of behavior and personality change based on Bandura (1977), Meichenbaum (1977), Mahoney (1974) and others.
  6. Behavior Therapy: therapies using principles and procedures based on Learning Theory, including treatments based on Systematic Desensitization, exposure techniques, behavior modification, and other conditioning based procedures.
  7. Other/Unclassified: other therapies including psychodynamic, Gestalt, humanistic, Adlerian, Reality therapy, vocational/personal development counseling, and undifferentiated counseling. There were very few studies using these therapies, making it impossible to discern any reliable difference between groups.

B:I7c7s L!v9_7f'\5c0To determine whether the effectiveness of RET was a function of the degree of similarity to strict Rational Emotive Therapy, two separate coding schemes were used. First, RET studies were classified into comparisons using strict RET methods; Systematic Rational Restructuring or other similar therapy; or CBM treatment procedures which relied on many RET techniques. Second, a rating scheme was derived to assessed the degree of similarity of the treatment group's therapy to RET. This rating scheme was a six point likert scale from 0 (no elements of RET), to 5 (all elements of RET). The studies were rated on various salient features of RET, such as identification, disputation, and modification/replacement of irrational beliefs, homework assignments, and collaborative empiricism between therapist and client, etc. Both the treatment and comparison groups were coded in this manner.心理学空间 a,e7v)f OUz

#X9V/sL|0Subject and therapist assignment to treatment and comparison groups were also coded. For the subjects, the categories included心理学空间?*[)aY"\FuP[

  1. Random Assignment, where the participants were assigned randomly to either the treatment or comparison groups
  2. Matching, where a subject was matched with another from the opposite group
  3. Non-Random Assignment, where ex-post facto matching, covariance adjustments, and equating on pretest scores, or order of participation in the study was used
  4. Unknown, including those studies which did not mention the method of subject assignment to groups.

s#C l _ j/_/qZ m0Therapist assignment used a similar coding procedure with an additional category of comparisons using a Single Therapist for each treatment condition.

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Subject recruitment was also coded, using procedures adapted from Smith et al (1980). Studies were classified according to the following criteria:

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  1. The participants recognized the existence of a problem and sought help
  2. The subjects responded to an advertisements
  3. Subjects were directly solicited by the therapist, typically by offering treatment to psychology students with extreme scores on a criterion measure
  4. Individuals were referred for treatment by a third party
  5. Participants were committed for therapy, with no choice, as in court ordered treatments.
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A rating scheme was developed to assess the effect of variations in internal validity on effect size.心理学空间\Y)J g p

  1. High validity: random assignment, for subjects and therapists, had a low estimated attrition rate (¾ 15% dropout rate), and used outcome measures deemed low in reactivity
  2. Medium internal validity: random assignment, or matching for participants and therapists, but had high estimated attrition rates (>15%), or did not mention the dropout rate, and used outcome measures rated medium or low in reactivity
  3. Low internal validity: non-random assignment (other than matching), had a high estimated dropout rate or did not mention the attrition rate and medium or highly reactive outcome measures.

;PO C0d1Q0{is0To assess outcome measure characteristics of the sample, two coding schemes were used according to the type of test used for assessment. Coded outcome measures included:心理学空间-Io%JF x F-~

  1. Fear and anxiety measures, like Behavioral Approach Tests, and anxiety questionnaires
  2. Standardized test and measures in common use, like the Irrational Beliefs Test (Jones, 1968), and the Beck Depression Inventory (Beck, 1978)
  3. Physiological measures, like galvanic skin response, heart rate, and EEG;
  4. Unclassified including those measures which could not be assigned to any of the previous categories, or there were not enough comparisons to merit a separate classification.
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Test reactivity refers to the degree of similarity between the treatment and the test measures. The reactivity of the outcome measures was assessed using a rating scheme adapted from Smith et al (1980).心理学空间R:^_)rJ+ni*v;d

  1. Highly reactive measures revealed or had a direct and obvious relationship with the treatment. This category also included nonblind symptom ratings by the therapist ; behavioral approach tests assessed by the experimenter, and in the case of RET oriented treatments, irrational beliefs tests
  2. Medium reactive measures were defined as standard test and measures with a minimal connection to the therapy. Examples included the MMPI and the Beck Depression Inventory and the State-Trait Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970) for therapies not explicitly treating depression or anxiety
  3. Low reactive measures included those test and measures not easily influenced by the parties involved. Examples include galvanic skin response and other physiological measures; grade point average; blind ratings and decisions; and blind discharge from hospital.

Results心理学空间!Ql-pY pm%|C0I ?O

C)McqO~o|\2o0Table 1 presents several demographic characteristics of the studies examined in the present quantitative review. Year of publication ranged from 1970 to 1988, with a median of 1978.5. Publication year was not related to effect size. The median training level for the therapists was 5.000 (PhD candidate or psychiatric resident). Therapist training was significantly related to effect size. The number of subjects per comparison was also significantly related to effect size, smaller number of participants in each comparison group was related to larger effect sizes. The mean age of the subjects, and the percentage of male subjects were not related to effect size

+y+j!o7w1X*g0Table 1.心理学空间+i4YG#W;_L
DemographicCharacteristicsoftheSample
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Variable

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SD心理学空间(Xo P4d4Qu!{

Range心理学空间d'~}yQ9fq

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Publication Year1978.9753.3451970 - 1988.002
Number of Therapists2.2611.7631 - 8.031
Subjects26.65718.8415 - 115-.224**
Therapist Training15.220.6194 - 6.313***
Age25.01411.2809 - 70.059
% Male Subjects42.3853.3450 - 100.082
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1
Therapist Training Ratings: 4 = Master of Arts degree; 5 = PhD Candidate or Psychiatry Resident;心理学空间xy8h[Cbl1^C"g
6 = Phd therapist or Psychiatrist with at least 1 year experience beyond the granting of a degree.心理学空间5f b ]J;I/EsGK
**p< .01 ***p< .001
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No significant differences were found in terms of effect sizes between studies using psychotherapy clients or students as participants (t(234) = 0.710, ns), as shown in Table 2.心理学空间"H,dz_ A3Y+? VyS

j[8AF/zn Dn f0Table 2.心理学空间X&m:C X,p'e
TypeofSubjectsinRETOutcomeStudies

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Subject Category

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Percentage of Sample

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d2

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Student14260.2.914a.914
     
Psychotherapy    
Client9439.81.002a.959
     
1Number of Effect Sizes心理学空间i`7oHtJ:M7N+K6FM wH
2Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.
 

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(x6b%B0c;w/q0Significant differences were found between the different diagnostic groups (F(4,231) = 6.443,p< .001). as shown in Table 3. Comparisons using participants with emotional-somatic problems tended to have significantly higher effect sizes than those comparisons in the other diagnostic categories. Comparisons in the neurotic category had significantly higher effect sizes than those comparisons using normal subjects. No other difference between comparisons was significant.

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Table 3.
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Diagnosis

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Percentage of Sample

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d2

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Sd心理学空间d)tX[$j w"E#M'^)h

     
Neurotic10544.5.989a1.022
Phobic8536.0.821ab.725
Normal218.9.523b.287
Emotional/    
Somatic166.81.922c1.260
Unclassified93.8.953ab.836
1Number of Effect Sizes
[#G2w#j(O q-F1xG02Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.
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Table 4 shows other study characteristics associated with the sample. The degree of similarity of the therapy to RET was found not to be related tod, for both the treatment and comparison groups. Duration of therapy was found to be significantly related to effect size, in terms of the number of hours and weeks of therapy .

i.LB!e X!X'_Y0Table 4.
O3{B%W+t9i|8h1x0OtherTreatmentCharacteristics心理学空间JC~'~ i LFS
 

Variable心理学空间Pa^aJ

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Range

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Experimental    
Group Similarity4.165.9642 - 5.101
to RET Rating    
     
Comparison    
Group Similarity0.199.7430 - 5.0.135
to RET Rating    
     
Therapy Duration10.2059.0181 - 45.0.335***
(Hours)    
     
Therapy Duration6.1714.0781 - 18.5.188**
(Weeks)    
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Table 5 presents the effect size estimates broken down by comparison groups. To facilitate the analysis and understanding of these results a Binomial Effect Size Display (BESD; Rosenthal & Ruben, 1982) was also employed.

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The BESD displays the change in improvement rate (or success rate, survival rate, etc.) attributable to a certain treatment intervention. In other words, the BESD is the estimated difference in the probabilities of improvement between the treatment and control, or between pre- and post intervention. It is defined as BESD = (.50-r/2) to (.50+r/2), whereris a point biserial correlation. For example, an effect size ofd= .872, (r= .40), when expressed as a BESD, shows that the improvement, or improvement rate prior to intervention is 30%, while after the intervention the improvement rate increases to 70%.心理学空间Cv]7?.k

RET Vs.心理学空间3PD4B0P n1K

Nes1心理学空间}OA4gdm

Percentage of Sample心理学空间)kKC#x)j VZ%{

d2

RMxJ1E-C0

Sd心理学空间]$r'^%Tdv0lK,VX

     
Baseline8837.31.371a.874
     
NTC33113.1.975bc.914
     
WLC2811.91.024bc.852
     
ACP218.9.803bc.738
     
CBM135.5.137d.347
     
Behavior Therapy3816.1.298d.580
     
Unclassified177.2.848bc1.309
     
Overall d236100.949.933
1Number of Effect Sizes
4D5w Xl4Jf"T02Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.
3NTC = No Treatment Control; WLC = Waiting List Control; ACP = Attentional Control/ Placebo;
-G6Z bA-I)c|5U0CBM = Cognitive Behavior Modification
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The overall effect size was .949. Using the BESD, 27.2 % of the sample would have demonstrated significant improvement before therapy. Following RET, 72.8 % of the sample demonstrated significant improvement over those subjects not receiving RET.

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In comparing RET to all other treatment conditions, a one way ANOVA indicated significant differences in effect sizes between the various comparisons (F(6,229) = 9.624,p< .001). A Duncan's Multiple Range test indicated that comparisons with baseline conditions had significantly higher effects sizes than all other comparison groups, except for those comparisons with a waiting list control group. Compared to baseline, the mean effect size was 1.371. Using the BESD indicator, the pretherapy clinical improvement rate was 21.5 %. Following RET intervention the improvement rate was 78.5 %.

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Comparisons with therapies using CBM or Behavior Therapy demonstrated the lowest mean effect sizes of the sample. A Duncan's Multiple Range test indicated that CBM and Behavior Therapy had significantly lower effect sizes than any of the other treatment conditions.心理学空间|}7FU(Z6~/Hv

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Table 6 shows the mean effect sizes for individual and group therapy formats. No significant differences were found between comparisons using an individual or a group therapy format (t(234) = 0.940, ns).心理学空间3^4q3r"K4~u fI

Table 6.TreatmentMode

Mode心理学空间:F7cQ/Jq@.w2h

Nes1心理学空间l7[fr/m'z }}(V

Percentage of Sample

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d2心理学空间1l.~@u0u%J

Sd心理学空间+a$IS7|n

Individual2912.31.102a.826
Group20787.7.927a.947
1Number of Effect Sizes心理学空间.vxN0IU
2Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.

e ZBX0sJ'e0Tables 7 to 9 present the analyses of the methodological characteristics of the sample. Table 7 presents the subject and therapist assignments to treatment and comparison groups. No significant differences were found among any of the subject (F(3,232) = 0.580, ns). or therapist assignment categories (F(4,231) =1.804,ns).

/M^!B Cp0Go0Table 7.SubjectandTherapistAssignmenttoTreatmentandControlGroups

Assignment Category心理学空间8~!V Y)Y |*En

Nes1

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Percentage of Sample心理学空间#L&V:y9jFG

d2心理学空间Q.v N.a&l

Sd

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A) Subject Assignment心理学空间R+{)i%s8M"y:Kl

Random18980.1.988a.970
Matching198.1.746a.858
NonRandom    
Assignment177.2.838a.806
Unknown114.7.801a.478
     

B) Therapist Assignment

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Random3113.11.250a1.420
Matching3314.01.062a1.236
NonRandom166.8.816a.534
One Therapist7732.6.991a.676
Unknown7933.5.770a.800
1Number of Effect Sizes心理学空间7X@D1wg*Pnf6q
2Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.
心理学空间-YJ;]w:U8L(~ q.}j

Table 8 presents the subject solicitation data. Significant differences between solicitation categories were found (F(4,226) =3.020,p< .02). Participants referred by a third party had significantly higher effect sizes than any other solicitation category. No other differences were found to be significant.心理学空间_;b U^'o*D5^)y

Table 8.SubjectSolicitation.

Solicitation Category心理学空间4BZP J Zr$p@

Nes1心理学空间 u8DJqI ^;?

Percentage of Sample心理学空间.{8Ka^Q+D q

d2

|%~/k,\kf9OO0

Sd心理学空间7oe/L'R(C#\W5m/j-c1p

     
Ssought help2611.0.860a.835
     
Responded to    
an Advertisement8937.7.987a.931
     
Solicited byE7230.5.767a.695
     
Referred2611.01.486b1.446
     
Committed to Therapy187.6.896a.843
     
Missing Data/    
No Information52.1----
1Number of Effect Sizes
&GyL7d | n(`iW[#E02Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.

L9W'u*Ht+LO2IX0Table 9 presents the internal validity rating of the sample and the associated effect sizes. Significant differences were found between the internal validity categories (F(2,233) = 3.472,p< .05). A Duncan's Multiple Range Test indicated that comparisons with high internal validity rating had significantly higher effect sizes than comparisons with medium internal validity ratings. No other comparison was found to be significant.心理学空间 ?D3h`yL ?~

Table 9.InternalValidityRating

Validity Rating心理学空间%c;P fT.ha

Nes1

}A~1zH0

Percentage of Sample

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d2

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Sd心理学空间uz8K|1g(]I aH

     
Low3113.1.809ab.670
Medium10845.8.819a.778
High9741.11.138b1.119
1Number of Effect Sizes心理学空间\H9cU0y U$g
2Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.

aaaY V0table 10 presents the breakdown of effect sizes by the type of outcome measure. Significant differences were found among the effect sizes associated with different outcome measures (F(3,232) = 31.064,p< .001). Physiological measures had significantly higher effect sizes than all other outcome measures. The Unclassified category had a significantly greater mean effect size than either Fear/Anxiety, or Standard Test Measures. Fear/Anxiety and Standard Test Measures were not significantly different from each other.

QW-pB G!rR0Table 10.TypeofOutcomeMeasures
(w%`E/LB_T9Sm0 

Outcome Measure心理学空间O Xru0r|;Y-\"Eq"e

Nes1心理学空间__&p+@#g)a F

Percentage of Sample心理学空间g@Y,R k~v6E

d2心理学空间l:BH)QG] b

Sd心理学空间U ? D7L~)}D

     
Fear/Anxiety14461.0.767a.740
     
Standardized Test Measures6728.4.814a.612
     
Physiological Measures73.02.907b1.195
     
Unclassified125.12.145c1.419
1Number of Effect Sizes
l/]4rL.| M5r XP02Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.

Bgn0X tO!R {3F0Table 11 presents the breakdown of effect sizes by the reactivity of the outcome measure. Significant differences were found between reactivity ratings (F(2,233) = 14.896,p< .001). A Duncan's Multiple Range Test indicated that outcome measures rated low in reactivity had significantly higher effect sizes than measures rated medium or high in reactivity.

/B} H [b lJ0Table 11.ReactivityoftheOutcomeMeasures

Reactivity Rating心理学空间l5LJ4ye/hJIuZ

Nes1心理学空间'LMb"@~lK

Percentage of Sample心理学空间}S.`)O PO-Fj B,`

d2

;aO4^3Hcvo,{8l0

Sd心理学空间R f V8[7j^

     
Low3615.31.687a1.491
Medium12553.0.802b.700
High7531.8.839b.759
1Number of Effect Sizes
#K;l#DFI)Rh2]*FP%WFa02Effect sizes with different superscript letters are significantly different at thep< .05 level using Duncan's multiple Range Test.
心理学空间g1Aj h ]%al

The results demonstrated that RET is an effective form of therapy. The efficacy was most clearly demonstrated when RET was compared to baseline and other forms of controls. The differences between comparisons of RET to CBM and Behavior Therapy were not significant.心理学空间}3P8w-s-n7P

@$Q~xZ;i d3SHg0One general criticism of RET outcome studies have been the great number of analogue studies. Ledwidge (1978) and Zettle & Hayes (1980) claimed that by using student volunteers, the therapeutic efficacy of RET was not demonstrated. Based on the present results this criticism is not warranted. No significant differences were found between comparisons of student and clinical subjects. Most of the studies involving students were investigating genuine problems. While these problems may not be as severe as those seen in clinical settings, if RET was not an effective form of therapy, or was not effective for more severe problems, a disparity between results found with students and psychotherapy clients would have been found.心理学空间2n'wm/gQD!X:l]A

心理学空间?1M\)`~v

Reviews with a definitive allegiance to RET (e.g., DiGuiseppe & Miller, 1977) criticized many RET outcome studies for using postgraduate students as therapists. This clearly remains a problem. The majority of therapists in the studies reviewed were PhD Candidates, with relatively little experience compared to professional therapists. The results suggest that therapist experience is an important variable in influencing the effectiveness of RET.心理学空间[Pvrl DT

心理学空间;[-V u(@`\1M4B!c

These results with therapist experience vary somewhat from Miller & Berman (1983). In their quantitative review of CBM studies, therapist experience was not related to effect size. One explanation of this difference lies in how Miller & Berman (1983) assessed therapist experience, which was measured in years, whereas a rating scheme was used in the present meta-analysis. A rating scheme was used in the present study was used because information regarding exact clinical experience was generally not available. If more detailed information was readily available, results similar to the Miller & Berman (1983) may have been found.

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Given this difference with previous results, the finding of the present quantitative review indicate that the more experienced the therapist, the more effective the treatment. There is, however, one qualification of this statement, there is no real guarantee that the therapy being used was actually RET as practiced and taught by the Institute of Rational Emotive Therapy. As Wessler (1983) noted, it is very possible that procedures thought to be RET may not have been strict RET, but rather methods subject to experimenter interpretation. An attempt was made to control for this factor by using RET similarity ratings of both the treatment and comparison therapies. However no relationship between effect size and the number of RET principles actively used during the treatment was found. It should be noted that the range of the ratings was restricted. The majority of treatment therapies having at least several elements used in strict RET procedures. Thus the true relationship between similarity of the treatment treatment to RET may be somewhat obscure. One recommendation is that researchers should publish more detailed descriptions of their procedures, or at least make available to reviewers, detailed treatment manuals. This allows a reviewer to determine whether the procedures involved were actually "elegant" RET or "inelegant" procedures.

0F f kl+~_9Mb'Ww7bX0

egOnm u{l0One of the criticisms made by DiGiuseppe & Miller (1977), and McGovern & Silverman (1984) was that the short duration of the treatments may limit the effectiveness of RET. The results confirm this criticism. Larger effect sizes were related to therapy duration. The longer the therapy, the larger the effect size. However, the magnitude of the correlations was not very large, accounting for only 11.3% of the variance in effect sizes for duration in hours, and 3.5% of the effect size variance for duration in weeks. Given this limitation, there is a relationship between duration and therapy effectiveness. This is clearly demonstrated with those studies which used only one or two treatment sessions, these studies had the lowest effect sizes.

0p \M8Lsx b+Wjo0

z5Y!g:dF0The present study attempted to examine methodological criticisms in several ways. First, an attempt was made to relate effect size to attrition or dropout rates. However, no detailed analysis of the attrition rates was possible since only nine of the studies reported attrition rates, thereby biasing the results of the present quantitative review. It is not defensible to assume that all 61 of the studies which did not report on attrition had zero dropout rates. Therefore the conclusion that RET is an effective form of therapy must be tempered with the consideration that this conclusion is only tenable for those individuals who manage to complete therapy.

r1E9?3GL#@)` D0

E\'qjwPUP5~L0It should be noted that in order to use a coding procedure based on Smith et al (1980)'s internal validity rating scheme, it was necessary to have a rough approximation of attrition rates. Attrition was estimated by examining the degrees of freedom and sample sizes for the RET and comparison groups before and after therapy.心理学空间 A5j.DtE |R4ei

心理学空间f4j4bO XT3PP/l1?

This estimate was considered adequate for judging internal validity, since there were other factors involved in the validity ratings, for example subject and therapist assignment,and test reactivity. It is invalid to use these attrition estimates as data in a separate analysis. Differing results could have occurred if the actual attrition rates had been reported.心理学空间 Dt ^Dm$vt$S

心理学空间6KA4p.AoP|3P

It is of interest to note that those studies judged high in internal validity also tended to have high effect sizes. The obvious implication is that well conducted studies most clearly demonstrate the effectiveness of RET procedures.心理学空间^ WQVMP*F}]

心理学空间 W EQf1zsL

Another methodological factor which was neglected by many studies was the follow-up status. The majority of studies (81.4%) did not report on follow-up data. Therefore any determination of the long term effectiveness of RET could not be made.

,X-c"~n/`"h;@,Xx!Y0心理学空间Aq`5^(Q_|

It is critical to report the previously mentioned factors. Not only does this give an indication of what the long term effectiveness of a therapy, it also gives indication of how difficult the therapy is to complete. One cannot truly determine the effectiveness of a therapy if a significant percentage of the clients drop out before completing therapy.心理学空间$d#Z0~#N H$G^

E,X0M-{B`2tzoy4[O0Contrary to what was expected, the reactivity of the outcome measures indicated that larger effect sizes were associated with measures low in reactivity. These results are different from Dush, Hirt & Schroder (1983). They examined this variable in the context of a meta-analysis of studies which used some form of self statement modification. These results are also different to what was found by Smith et al (1980). Both of these studies found positive relationships between test reactivity and effect size.

q y5YV:o'kV3fin0

"W`c s'bf0One explanation of the differences is that while RET studies used reactive measures of irrational beliefs, they also included less reactive measures of adjustment, such as locus of control,and anxiety measures. The net outcome was that the average reactivity for the present analysis was lower than in the previously mentioned quantitative reviews.

7wV w-C wnY(uNX8n0

0Oo:e$\p9\y5xSF0Given the previously mentioned limitations to the present quantitative review, these results suggest that RET is an effective form of therapy. Compared to baseline assessments, and control groups, those individuals receiving RET demonstrated significant improvement. These results do not support the Zettle & Hayes (1980) conclusion that there is little evidence for the clinical efficacy of RET. In contrast, RET was shown to be an effective form of therapy. Perhaps it is time to stop the needless and inefficient discussion of the efficacy of this therapy. Rather, a better focus of investigations and reviews would be to determine which factors, or combinations thereof contribute most to the effectiveness of RET.

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心理学空间!u(AaM)Wcq

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.Psychological Review, 84, 191-215.心理学空间8OPJ s8~U? ^

"\+`]Z CT`0@0Beck, A. T. (1978)The beck depression inventory. San Antonio, Texas: Psychological Corporation.

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Cohen, J.(1977).Statistical power analysis for the behavioral sciences. New York: Academic Press.心理学空间3a&P,h#`K0o'pA@

\:p PV`:a*[ b:Wh5d0DiGiuseppe, R. A. & Miller, N. J.(1977). A review of outcome studies on Rational-Emotive Therapy. In A. Ellis & R. Grieger (1977)Handbook of Rational-Emotive Therapy. New York: Springer.

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H V(z T6H XB0DiLorento, A. O.(1971)Comparative psychotherapy. Chicago: Aldine.

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Dush, D. M.; Hirt, M. L.; & Schroeder H.(1983). Self-statement modification with adults: A meta-analysis.Psychological Bulletin, 94, 408-422.

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Ellis, A. (1957).Outcome of employing three techniques of psychotherapy.Journal of Clinical Psychology, 13, 344-350.

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$s4rqz:N onv0Ellis, A. (1962).Reason and emotion in psychotherapy. New York: Lyle Stuart.心理学空间h \ r)Ze:K

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Ellis, A. (1980)Overview of the clinical theory of Rational-Emotive Therapy Chapter in R. Grieger & J. Boyd (1980)Rational-Emotive Therapy: A skills based approach. New York: Van Nostrand Reinhold.

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Glass, G. V. (1976). Primary, secondary, and meta-analysis of research. Educational Researcher,5,3-8.

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nCL3bB"M h/m5j0Glass, G. V. (1977). Integrating findings: The meta-analysis of research.Review of Research in Education, 5,351-379.

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"o@3c@ kKs ok0Gregg, G. (1973).The rational therapist: Epictetus, not Freud.Psychology Today, 1, 61.心理学空间*J _ y ^9@0v

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Haase R. F. (1983).Classical and partial eta square in multifactor ANOVA designs.Educational and Psychological Measurement, 43, 35-39.心理学空间Ah.s~T~

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Hunter, J. E. ; Schmidt, F. L.; & Jackson, G. B.(1982).Meta-Analysis: Cumulating research findings across studies. Beverly Hills CA: Sage.心理学空间?"Z#b0q&bG1A _

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Jones, R. A.(1968).A factored measure of Ellis' irrational belief system with personality and maladjustment correlates. Unpublished doctoral dissertation, Texas Technical College.心理学空间;D+v0VP(P w2f(q

u3Az(T_jP EO+l0Ledwidge, B.(1978). Cognitive behavior modification: A step in the wrong direction?Psychological Bulletin, 85,353-375.心理学空间*z Ymx+[cbjT-p

-huu0Q/O0Y0Mahoney, M. J.(1974).Cognition and behavior modification. Cambridge, Mass.: Ballinger.心理学空间%o]P"WD

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McGovern, T. E. & Silverman, M. S.(1984) A review of outcome studies of Rational-Emotive Therapy from 1977 to 1982.Journal of Rational Emotive Therapy, 2, 7-18.心理学空间r8Z!I rAZ

5PQk B)GCu3f*Y0Meichenbaum, D. H.(1972). Cognitive modification of test anxious college students.Journal of Consulting and Clinical Psychology, 39,370-380.

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2Nqz#A$bjH5Q!iR0Meichenbaum, D. H.(1977).Cognitive behavior modification. New York: Plenum.心理学空间;]A%JR[Q J lj

+E5ze Aw5z0Miller, R. ; & Berman, J.(1983). The efficacy of cognitive behavior therapies: A quantitative review of the research evidence.Psychological Bulletin, 94(1), 39-53.

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Prochaska, J. O. (1984).Systems of psychotherapy: A transtheoretical analysis. Homewood, Illinois: The Dorsey Press.心理学空间)|{TtQ

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9r(EAqr0Smith, M.L.; & Glass, G. V.(1977). Meta-Analysis of psychotherapy outcome studies.American Psychologist, 32,752-760.心理学空间k$U7bW+N B

/Y|!e@i`0Smith, M. L.; Glass, G.V. ; & Miller, T. I.(1980).The benefits of psychotherapy. Baltimore: The John Hopkins University Press.

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d;O2H9Vwfk0Spielberger, C.D.; Gorsuch, R. ; & Lushene, R.(1970).Manual for the State Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

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G5_b%y^(v0Wessler, R. L.(1983). A critical appraisal of therapeutic efficacy studies.British Journal of Cognitive Psychotherapy, 1, 39-46.心理学空间3VYE%\R$a}7yV

心理学空间#u{8K-u4@t

Zettle R. D. & Hayes, S. C.(1980) Conceptual and empirical status of Rational-Emotive Therapy.Progress in Behavior Modification, 9, 125-166.心理学空间/w.e*^2p \ I~

8g q9t,G#Xo ` X0www.psychspace.com心理学空间网

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