Cbnrcnl f&~lo~ Rrwu,, Vol. 11, pp. 397-369.

1991
Printed in the USA. 411 rights reserved.
0272.7358191 $3.00 + .OO
Copyright 0 1991 Pergamon Press plc
THE EFFICACY OF
RATIONAL-EMOTIVE THERAPY:
A QUANTITATIVE REVIEW OF
THE OUTCOME RESEARCH
Larry C. Lyons
Paul J . Woods
Hollins College
ABSTRACT. The results from a meta-analysis of 70 Rational-Emotive Therapy (RET)
outcome studies are reported. A total of 236 comparisons of RET to baseline, control groups,
Cognitive Behavior Modification, Behavior Therapy, or other psychotherapies are examined.
The results indicate that subjects receiving RET demonstrated significant improvement over
baseline measures and control groups. Eff t- cc size was significantly related to therapist
experience and to duration of the therapy, but there were no significant differences in
effect-size between those studies that used psychotherapy clients compared to those using
students as subjects. Those comparisons that were rated high in internal validity {random
assignment, low attrition, and outcome measures low in reactivity), had significantly higher
effect-sizes than medium validity studies. Outcome measures rated as low in reactivity (i.e.,
those measures which did not have an immediately discernable relationship with the
treatments being assessed) had significantly higher effect-sizes than more reactive measures.
Contrary to other reviews using the narrative review method, RET was found to be an
effectizre form of therapy. This conclusion, however, was tempered by methodological flaws in
the studies reviewed, such as lack of follow-up data and information regarding attrition
rates.
We thank Ms. Wendy A. Morris for her assistance in preparing this manuscript.
Larry C. Lyons, MA, is a Research Associate at the Hollins Communications Research
Institute. Paui J. Woods, PhD, is a Professor of Psychology at Hollins College, a Licensed
Psychologist in private practice, and a Fellow of the Institute for Rational-Emotive
Therapy.
Correspondence and reprint requests of this article, coding manual, or list of studies used
in this quantitative review should be addressed to Paul J. Woods, P.O. Box 9655, Hollins
College, Roanoke, VA 24020.
357
358 L. C. Lyons nnd P. J. Woods
Reviews of outcome studies of Rational-Emotive Therapy (RET) have been
published on a number of occasions. The most recent was that by Haaga and
Davison (1989), which reviewed a number of studies classified by the nature of the
problem or disorder under treatment. This review also included an adaptation of
RET, Rational-Emotive Education, and a variant of RET, Systemat,ic Rational
Restructuring. The studies were organized according to general problems, stress
reduction, various categories of anxiet.y disorders, assertiveness, headaches. stut-
tering, psychosexual dysfunctions, Type A Behavior Pattern, anger, obesity,
depression, and antisocial behavior. In commenting upon this review, Ellis (1989)
noted that it is probably the most comprehensive review of this area that has yet
been done (p. 228). Even so, large numbers of dissertations and published studies
were omitted from the review. More importantly, Ellis (1989) argued, many of the
outcome studies utilized only one of RETs main features, that of cognitive
restrLlcturing or systematic rational l-estrLlct~lring. But even with just this one
aspect of RET being studied, many clinically important effects were found.
This most recent review has been preceded by a number of others, some large
and some small. McGovern and Silverman (1984) reviewed 47 RET outcome
studies that were published since an earlier comprehensive attempt (DiCiuseppe &
Miller, 1977). This earlier review covered 22 studies. Other reviews of outcome
studies include Ledwidge (1978) ( rr = t?), Prochaska (1984) (~2 = 81, and Zettle
and Hayes (1980) (71 = 16).
For the most part, despite a variety of methodological problems, the aspects of
RET that have been studied generally hold up as being effective for therapeutic
and educational interventions. All of these previous reviews, however, have been
q~u~~tat~zle in nature. In contrast, the present review examines the efficacy of RET
with the qua?7t~tut~~e review method of meta-analysis and addresses many of the
criticisms advanced by previous reviews of RET.
METHODS
Selection of Studies
Psychological Abstracts and Dissertation Abstracts International from 1972 to 1988 were
searched for relevant studies. Also, the references in the obtained studies and the
previously mentioned reviews were scanned for additional material. A list of
studies used in this meta-analysis is available on request.
Each study was required to meet the following criteria for inclusion in the
present review:
1. At least one treatment group received Rational-Emotive Therapy, or a
treatment which used elements of RET.
2. The study compared RET to a baseline measure, a control group, or other
type of therapy.
A complete list of the articles and dissertations, and the coding manual used in the present
meta-analysis is available from the second author for a $5 fee to cover printing, postage,
and handling. A BASIC program (in both MAC and MS-DOS formats) for coding the study
data, converting the individual study statistics, and performing limited accumulation
procedures is also available upon receipt of a stamped self-addressed envelope, and a blank,
formatted diskette in the appropriate formats (3% for MAC/ OS; 5% for MS-DOS).
The Efficacy of Rational-Emotive Therapy 359
3. The study used a quantitative statistic that could be converted to an effect-
size estimate.
4. The study gave the number of subjects in each treatment or control group.
Studies were rejected because of uninterpretable statistics, or because insuffi-
cient information regarding treatments or experimental procedures were pre-
sented. Single-subject designs and case studies were also excluded. With these
criteria and exclusions, 70 studies were found, yielding 236 comparisons between
RET and a baseline measure, a control group, or other form of therapy.
Effect-Size Estimation
Each comparison of RET to a baseline measure, a control group, or a treatment
group was expressed in terms of the standardized difference between mean scores,
d (Cohen, 1977).
Because of limitations in the data reported it was not always possible to calculate
d directly. In some of these cases it was possible to calculate d from t, F, r or a
probability value. In others, where a two-way ANOVA was used, the F was first
converted to ETA using an algorithm presented by Haase (1983), and then to d.
When the study merely stated that a significant difference was found, the
probability was set at .05 and d was calculated using conversion algorithms.
Procedures for these indirect calculations of d are described by Cohen (1977);
Hunter, Schmidt, and Jackson (1982); Smith, Glass, and Miller (1980); and Wolf
(1986).
The majority of the studies used more than one outcome measure. To avoid
biasing the data, the present study averaged the effect-sizes in multiple outcome
studies to produce a single statistic, thereby preserving the independence of each
comparison. For a discussion of the issue of averaging multiple outcome results,
see Hunter et al. (1982) or Wolf (1986).
Coding Procedures
After converting the study statistics to effect-sizes, study characteristics were
examined and coded using a 28-variable coding scheme (see footnote 1). These
coding variables included the year of the comparison (either publication or
acceptance date), level of therapist training, and client or subject problem diagno-
sis, based on a coding procedure originally presented by Smith et al. (1980).
1. Neurotic: subjects had problems such as the following: personal growth
problems, achievement problems, social anxiety, excessive anger, lack of
assertion, depression, behavior problems, speech anxiety, potential for drop-
ping out of school.
2. Phobic: subjects were diagnosed as suffering from some form of phobia,
including simple and complex phobias.
3. Normal: subjects had no immediately discernible problem.
4. EmotionallSomatic: subjects suffered from either asthma, sexual dysfunction,
insomnia, obesity, migraine headaches, chronic heart disease, or were on
home dialysis.
5. UnknownlUnclassified: subjects could not be classified into any of the previous
360 L.. C. Lyons and P. J. Woods
categories. (This category also included those problems where the incidence
was too small to merit a separate classification group.)
Comparison groups were coded according to conditions or therapies as follows:
1. Baselive: pretreatment measure taken at the start of therapy.
2. ,Vo Treatment Corltrol (NTC): not receiving therapeutic intervention.
3. Waiting List Control (MLC): not receiving therapy but given the expectation of
being on a waiting list for treatment.
4. Attention ControllPlacebo (ACP): a placebo treatment given.
5. Cognitiw Behavior Modification (CBM): given therapy using the techniques and
theories of behavior and personality change based on Bandura (1977),
Meichenbaum (1977), Mahoney (1974), and others.
6. Behazlior Therapy: given therapy using principles and procedures based on
Learning Theory, including treatments based on systematic desensitization,
exposure techniques, behavior modification, and other conditioning-based
procedures.
7. Otheriljnclassified: given other therapies including psychodynamic, Gestalt,
humanistic, Adlerian, Reality Therapy, vocational/ personal development coun-
seling, and undifferentiated counseling. This category also included those
therapies whose numbers did not merit a separate category.
To 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 meth-
ods; Systematic Rational Restructuring, or other similar therapy; or CBM treat-
ment procedures, which relied on many RET techniques. Second, a rating scheme
was derived to assess the degree of similarity of the treatment groups 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 irratio-
nal beliefs, homework assignments, and collaborative empiricism between thera-
pist and client, etc. Both the treatment and comparison groups were coded in this
manner.
Subject and therapist assignment to treatment and comparison groups were also
coded. For the subjects, the categories included:
1. Random assignment: participants assigned randomly to treatment and compar-
ison groups;
2. Matching: participants matched between groups;
3. honrandom assignment: ex-post facto matching, covariance adjustments, or
equating on pretest scores, or where participants were assigned to groups
based on the order of their appearance at the clinic or studys facility; and
4. Unknown: the method of subject assignment was not mentioned.
Therapist assignment used the same coding procedure with the additional
category of Single Therapist.
Subject recruitment was also coded, using procedures adapted from Smith et al.
(1980). The participants were classified according to the following:
The Efficacy of Rational-Emotive Therapy ?61
1.
2.
3.
4.
5.
A
sought help on their own;
responded to an advertisement;
were directly solicited by the therapist, typically by offering treatment to
psychology students with extreme scores on a criterion measure;
were referred for treatment by a third party; or
were committed for therapy with no choice, as in court-ordered treatments.
rating scheme was developed to assess the effect of variations in internal
validity on effect-size, and was as follows:
1. High validity: random assignment for subjects and therapists, a low estimated
attrition rate (5 IS%), and used outcome measures deemed low in reactivity;
2. Medium internal validity: random assignment, or matching for participants and
therapists, but did not mention, or had a high estimated attrition rate
(>lS%), and used outcome measures rated medium or low in reactivity;
3. Low internal validity: nonrandom assignment (other than matching), a high
estimated attrition rate, (or did not mention attrition), and medium or highly
reactive outcome measures.
To 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:
1.
2.
3.
4.
fear and anxiety measures, such as Behavioral Approach Tests, and anxiety
questionnaires;
standardized tests and measures in common use, such as the Irrational
Beliefs Test (Jones, 1968), and the Beck Depression Inventory (Beck, 1978);
physiological measures, such as the electrodermal response, heart rate, and
EEG;
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.
TABLE 1. Demographic Characteristics
of the Sample
Variable M SD Range
rd
Number of therapists 2.3 1.8 1-8 - ,025
Therapist training 5.2 0.6 4-6 .296**
Number of subjects 26.7 18.8 5-115 -.221*
Age 25 11.3 9-70 ,052
% male subjects 42.4 20.4 O-100 .091
Therapist training ratings: 4 = MA degree, 5 = PhD
candidate or psychiatry resident, 6 = PhD therapist or
psychiatrist with at least 1 year experience beyond the
granting of a degree.
*p<.o1.
**p<.oo 1.
362 L. C. Lyons and P. J. Woods
TABLE 2. Type of Subjects in RET
Outcome Studies
Subject Category IV,, Z of Sample d
SC,
Students 142 60.2 ,914 ,917
Therapy clients 94 39.8 1.002 ,959
Number of effect-sizes.
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).
High 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.
Medium reactive measures were defined as standard tests and measures with
a minimal connection to the therapy. Examples included the MMPI, Beck
Depression Inventory and the State-Trait Anxiety Inventory (Spielberger,
Gorsuch, & Lushene, 1970) for therapies not explicitly treating depression or
anxiety.
Low reactive measures included those tests and measures not easily influ-
enced by the parties involved. These measures did not have an immediately
discernable relationship with the treatments being assessed. Examples in-
cluded the electrodermal response and other physiological measures, grade-
point average, blind ratings and decisions, and blind discharge from hospital.
RESULTS
Table I presents several demographic characteristics of the studies examined in
the present quantitative review. Year of publicatio1~ 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 five years (PhD candidate or psychi-
atric resident). Therapist training was significantly related to effect-size. The
number of subjects per comparison was also significantly related to effect size:
smaller numbers of participants in each comparison group was related to larger
TABLE 3. Subject Diagnosis
l\, *
cs
%a of Sample d
SC,
Neurotic** 105 44.5 .989 1.022
Phobic 85 36.0 .821 .725
Normal 21 8.9 .523h .287
Emotional/ somatic 16 6.8 1.924 1.260
Unclassified 9 3.x C453 ,836
*Number of Effect-sizes.
**Effect-sizes with different superscript letters are signifi-
cantly different at the p<.O5 level using Duncans Multiple
Range Test.
The Efficacy of Rational-Emotive Therapr 363
TABLE 4. Other Treatment
Characteristics
Variable M S Range rd
Experimental group 4.16 .99 l-5 .097
similarity to RET rating
Comparison group 0.20 .74 O-5.0 -.152*
similarity to RET rating
Duration of therapy 10.2 9.0 I-45.0 .299t
(in hours)
Duration of therapy 6.2 4.1 1-18.5 .172**
(in weeks)
*p<.o5; **p<.o1; ?P<.OOl
effect-sizes. The mean age of the subjects and the percentage of male subjects were
not related to effect-size.
No significant differences were found in terms of effect-sizes between studies
using psychotherapy clients or students as participants (t (234) = 0.708,ns) as
shown in Table 2.
Significant differences were found among the different diagnostic groups
(F (4,231) = 6.460, p < .OOl) 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 differences among comparisons were significant.
Table 4 shows other study characteristics associated with the sample. The degree
of similarity to RET for the treatment group therapy was found not to be related
to d. Effect-size was found to be minimally related to the degree of similarity to
TABLE 5. Comparison Group Therapies
RET Versus N,,* 7c of Sample d
S,
Baseline** 88 37.3 1.371
NTCt 31 13.1 .975b
WLC 28 11.9 1.024
ACP 21 8.9 .803h
CBM 13 5.5 .137
Behavior Therapy 38 16.1 .298d
Unclassified 17 7.2 .848bc
Overall d 236 100 ,949
.873
.915
.853
,738
,349
.580
1.310
.933
*Number of effect-sizes.
**Effect-sizes with different superscript letters are signifi-
cantly different at the $1~.05 level using Duncans Multiple
Range Test.
tNTC = No treatment control, WLC = waiting list con-
trol, ACP = attentional control placebo, CBM = cognitive
behavior modification.
364 L. c. Lyl~ls nrcd P. J. 12ood.s
TABLE 6. Treatment Mode
Individual 29 12.3 1.102 ,826
GroLlp 207 87.7 .927 ,947
Number of effect-sizes.
RET for the comparison groups. Duration of therapy was found to be significantly
related to effect-size.
Table 5 presents the effect-size estimates broken down bv comparison groups.
To facilitate the analysis and understanding of these results a Binomial Effect-Size
Display (BESD: Rosenthal & Ruben, 1982) was also employed.
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 postint.er-vention. It is defined as
BESD = j.50 - r/Z) to (.50 + r/ Z), where r is a point biserial correlation. For
example, an effect-size of d = .872 (r = .40), when expressed as a BESD, shows
that the improvement , or improvement rate prior to intervention is 3Oci;, while
after the intervention the improvement rate increases to 707~.
The overall effect-size was .949. In terms of collapsing across all comparisons,
using the BESD, 27.2? c of the sample would have demonstrated significant
improvement without KET intervention. fn contrast, 72.5% of the sample who
received RET demonstrated significant clinical improvement over those partici-
pants not receiving RET.
TABLE 7. Subject and Therapist Assignment to
Treatment and Control Groups
Assignment
Category
Random
Matching
~onrandnm
Unknown
Subject Assignment
7r of
lu,,- Sample
189 80.1
19 8.1
17 7.2
11 4.7
d
S</
.988 ,970
.746 .85X
.840 .#06
.803 ,478
Therapist Assignment
Assignment % of
Category
N,,
Sample d
&
Random 31 13.1 1.250 1.420
Matching 33 14.0 1.062 1.237
Nonrandom 16 6.8 .816 ,334
One therapist 77 32.6 ,991 ,676
Unknown 79 33.5 .769 ,799
Kumber of effect-sizes.
The Efficacy of Rational-Emotive Therapy
TABLE 8. Subject Solicitation
365
Solicitation Category
N,S*
7c of Sample d
Xl!
Sought help** 26 11.0 .859 ,835
Advertisement response 89 37.7 .987 ,931
Solicited by E 72 30.5 .76&Y ,695
Third-party referral 26 11.0 1.486 1.446
Committed to therapy 18 7.6 .894 ,843
Missing Data/ No Information 5 2.1 - -
*Number of effect-sizes.
**Effect-sizes with different superscript letters are significantly different at
the pc.05 level using Duncans Multiple Range Test.
In comparing RET to all other treatment conditions, a one-way ANOVA
indicated significant differences in effect-sizes among the various comparisons (F
(6,229) = 9.617, p < .OOl). A Duncans Multiple Range Test indicated that, except
for those comparisons with a waiting list control group, comparisons of RET
against baseline conditions had significantly higher effect-sizes than all other
comparison groups. Compared to baseline, the mean effect-size was 1.371. Using
the BESD indicator, the pretherapy clinical improvement rate was 21.5%. Follow-
ing RET intervention, the improvement rate was 78.5%.
Comparisons with therapies using CBM or Behavior Therapy demonstrated the
lowest mean effect-sizes of the sample. A Duncans Multiple Range Test indicated
that CBM and Behavior Therapy had significantly lower effect-sizes than any of
the other treatment conditions.
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) = 0.946, ns).
Tables 7, 8, and 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) = 0.573, ns) or therapist assignment categories (F (4,231) =
1.807, ns).
Table 8 presents the subject solicitation data. Significant differences among
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
TABLE 9. Internal Validity Rating
Validity Rating
N,S*
% of Sample d
s,
Low** 31 13.1 .81 lab .670
Medium 108 45.8 ,818 ,778
High 97 41.1 1.138b 1.119
*Number of effect-sizes.
**Effect-sizes with different superscript letters are signifi-
cantly different at the pc.05 level using Duncans Multiple
Range Test.
366 L. C. Lyons and P. J. Woods
TABLE 10. Type of Outcome Measures
Outcome Measure N,,* % of Sample d
&
Fear/ anxiety** 144 61.0 ,767 ,740
Standard text measures 67 28.4 .813 612
Physiological measures 6 2.5 3.883h ,494
Unclassified 19 8.1 1.877 1.207
*Number of effect-sizes.
**Effect-sizes with different superscript letters are signifi-
cantly different at the $1~.05 level using Duncans Multiple
Range Test.
solicitation category. No other differences were found to be significant.
Table 9 presents the internal validity rating of the sample (with high internal
validity defined by random assignment, low attrition rate, and outcome measures
which did not have an immediately discernible relationship with the treatments
being assessed) and the associated effect sizes. Significant differences were found
among the internal validity categories (F (2,233) = 3.472, p = < .05). A Duncans
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.
Table 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) = 43.873, 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 Mea-
sures were not significantly different from each other.
Table 11 presents the breakdown of effect-sizes by the reactivity of the outcome
measure (where low reactivity means the outcome measures did not have an
immediately discernible relationship with the treatments being assessed). Signifi-
cant differences were found among reactivity ratings (F (2,233) = 14.886, p = -=c
.OOl). A Duncans Multiple Range Test indicated that outcome measures rated low
TABLE 11. Reactivity of the
Outcome Measures
Reactivity Rating NeS* % of Sample d
S,
Low 36 15.3 1.686 1.492
Medium 125 53.0 .802b .700
High 75 31.8 .83gb .759
*Number of effect-sizes.
**Effect-sizes with different superscript letters are signifl-
cantly different at the PC.05 level using Duncans Multiple
Range Test.
The Efficacy of Rational-Emotive Therapy 367
in reactivity had significantly higher effect-sizes than measures rated medium or
high in reactivity.
DISCUSSION
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 among comparisons of RET to CBM and
Behavior Therapy were not significant.
One general criticism of RET outcome studies has been the great number of
analogue studies. Ledwidge (1978) and Zettle and 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.
Reviews with a definitive allegiance to RET (e.g., DiGuiseppe & Miller, 1977)
criticized many RET outcome studies for using postgraduate students as thera-
pists. 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 impor-
tant variable in influencing the effectiveness of RET.
These results with therapist experience vary somewhat from Miller and 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 and
Berman (1983) assessed therapist experience, measured in years. In contrast, a
rating scheme was used in the present study because information regarding exact
clinical experience was generally not available. If more detailed information had
been readily available, results similar to the Miller and Berman (1983) may have
been found.
Given this difference with previous results, the findings of the present quanti-
tative 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. No relationship between effect-size and the number of RET
principles actively used during the treatment was found. Thus, the true relation-
ship between similarity of the treatment to RET may be somewhat obscure. One
recommendation is that researchers 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 or inelegant RET (Ellis, 1980).
368 L. C. Lyons and P. J. Woods
One of the criticisms made by DiGiuseppe and Miller (1977), and McGovern
and 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 8.9% of the variance in effect-sizes for duration in hours, and 35% of the
effect-size variance for duration in weeks. Given this limitation, there Zs a relation-
ship 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.
This 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 any attrition rates, thereby biasing the results of the present quantitative
review. It is obviously not defensible to assume that all 61 of the studies that 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.
Next, 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 comparing the effectiveness of RET to other treatment modes
most clearly demonstrate the effectiveness of RET procedures.
Another methodological factor that was neglected by many studies was the
follow-up status. But the majority of studies (81.4%)) did not report on follow-up
data and, therefore, any determination of the long-term effectiveness of RET
could not be made.
Contrary 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, and Schroeder (1983). They examined this
variable in the context of a meta-analysis of studies that 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. One 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.
Given 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 demon-
strated significant improvement. These results do not support the Zettle and
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.
The Efficacy of Rational-Emotive Therapr 369
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Received May 14, 1990
Accepted July 27, 1990