A Synopsis of Rational-Emotive Behavior Therapy (REBT); Fundamental and Applied Research

Abstract

The article presents a synopsis on rational-emotive behavior therapy (REBT), its fundamental theoretical framework, its applications,
and future directions. The paper is organized according to the following structure: in part one, REBT fundamental/basic research
is discussed; in the second part clinical/applied research in REBT is presented, including aspects of efficacy and effectiveness,
discrimination of disorders for which REBT works most effectively, and its relations to other therapies. Uses and misuses
of REBT and their impact on research and future developments are presented as well. While it is true that REBT research has
many shortcomings, the overgeneralization and/or magnification of the negative, and the minimization of the positive are dysfunctional
beliefs that maintain the false idea in the field that REBT has few empirical studies and that REBT research is in serious
trouble. A balanced approach, analyzing both the strengths and weakness, suggest that REBT has hundreds of research articles
and that high-quality studies tend to support REBT’s basic theory and efficacy. However, to strengthen this conclusion and
to fully explore the potential of REBT, shortcomings of REBT research need to be corrected, and high-quality studies promoted.
This is particularly important since, although effective, cognitive-behavioral psychotherapies have not yet reached “the desired
standard” of efficacy and effectiveness, as about 30–40% of people are still nonresponsive to these interventions Thus, REBT
could be a platform of reinvigorating empirical studies on the efficacy/effectiveness and theory of cognitive-behavioral models
of psychopathology and human functioning.

Full text

A SYNOPSIS OF RATIONAL-EMOTIVE
BEHAVIOR THERAPY (REBT);
FUNDAMENTAL AND APPLIED RESEARCH
Daniel David*
Aurora Szentagotai
Kallay Eva
Bianca Macavei
Babes-Bolyai University, Romania
ABSTRACT: The article presents a synopsis on rational-emotive behavior
therapy (REBT), its fundamental theoretical framework, its applications, and
future directions. The paper is organized according to the following structure:
in part one, REBT fundamental/basic research is discussed; in the second part
clinical/applied research in REBT is presented, including aspects of efficacy
and effectiveness, discrimination of disorders for which REBT works most
effectively, and its relations to other therapies. Uses and misuses of REBT and
their impact on research and future developments are presented as well.
While it is true that REBT research has many shortcomings, the overgener-
alization and/or magnification of the negative, and the minimization of the
positive are dysfunctional beliefs that maintain the false idea in the field that
REBT has few empirical studies and that REBT research is in serious trouble.
A balanced approach, analyzing both the strengths and weakness, suggest
that REBT has hundreds of research articles and that high-quality studies
tend to support REBT’s basic theory and efficacy. However, to strengthen this
conclusion and to fully explore the potential of REBT, shortcomings of REBT
research need to be corrected, and high-quality studies promoted. This is
particularly important since, although effective, cognitive-behavioral psycho-
therapies have not yet reached ‘‘the desired standard’’ of efficacy and effec-
tiveness, as about 30–40% of people are still nonresponsive to these
Author for correspondence to Daniel David, Department of Psychology, Center for Cognitive and
Behavioral Psychotherapies, Babes-Bolyai University, No. 37. Gh. Bilascu Street, Cluj-Napoca,
Cluj, Romania; e-mail: danieldavid@psychology.ro.
*Mount Sinai School of Medicine, Biobehavioral and Integrative Medicine Programs, New York,
USA.
Journal of Rational-Emotive & Cognitive-Behavior Therapy, Vol. 23, No. 3, Fall 2005 ( 2005)
DOI: 10.1007/s10942-005-0011-0
175
 2005 Springer Science+Business Media, Inc.

interventions Thus, REBT could be a platform of reinvigorating empirical
studies on the efficacy/effectiveness and theory of cognitive-behavioral models
of psychopathology and human functioning.
KEY WORDS: REBT; research; review.
Rational emotive behavior therapy (REBT) is the first form of cog-
nitive behavior therapy (CBT) and was created by Albert Ellis in
1955. The ‘‘ABCDE’’ model is the cornerstone of REBT (Ellis, 1962,
1994) and, with minor adjustments, of all cognitive-behavioral psy-
chotherapies. According to the ‘‘ABCDE’’ model, people experience
undesirable activating events (A), about which they have rational
and irrational beliefs (B). These beliefs lead to emotional, behavioral,
and cognitive consequences (C). Rational beliefs (RBs) lead to func-
tional consequences, while irrational beliefs (IBs) lead to dysfunc-
tional consequences. Once generated, these consequences (C) can
become activating events (A) themselves, producing secondary (meta)
consequences (e.g., meta-emotions: depression about being depressed)
through secondary RB and IBs. Clients who engage in REBT are
encouraged to actively dispute (D) (i.e., restructure) their IBs and to
assimilate more efficient (E), adaptive, and RBs, with a positive im-
pact on their emotional, cognitive, and behavioral responses (Ellis,
1962, 1994; Walen, DiGiuseppe, & Dryden, 1992). Recently, the AB-
CDE model was expanded by including the concept of unconscious
information processing (David, 2003). More precisely, sometimes be-
liefs are not consciously accessible, being represented in the implicit
rather than the explicit memory system (David, 2003). Their impact
on our responses can be controlled (a) by behavioral techniques (e.g.,
altering automatic associations), and (b) by a direct focus on primary
responses generated by unconscious information processing or on sec-
ondary processes produced by these primary responses (e.g.,
conscious beliefs and consequences).
Since its creation, several hundred papers have been published
focusing on the theory and practice of REBT. Some studies (e.g., Dry-
den, Ferguson, & Clark, 1989a; McDermut, Haaga, & Bilek, 1997;
Solomon, Bruce, Gotlib, & Wind, 2003) have confirmed the main as-
pects of the original REBT theory (Ellis, 1962), while others (e.g.,
Bond & Dryden, 2000; Solomon, Haaga, Brody, & Kirk, 1998) have
made critical contributions to its evolution (for details, see David,
2003; Solomon & Haaga, 1995). The theoretical constructs of REBT
(e.g., IBs and RBs) have influenced many research areas in clinical
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psychology and psychotherapy and have also been assimilated by the
psychological mainstream. The construct of IBs for example, is incor-
porated in most handbooks of introduction to psychology (e.g. Sdorow,
1998) and in other forms of cognitive-behavioral psychotherapy (Da-
vid, 2003; Still, 2001). A quick search on PsychInfo and MEDLINE
shows that there are hundreds of studies related to the IBs’ con-
struct, more than studies focusing on cognitive constructs promoted
by other influential schools of CBT (e.g., such as automatic thoughts,
dysfunctional attitudes). The influence of REBT is also reflected by
the fact that its founder is often considered one of the most influen-
tial living psychotherapists, and professional surveys conducted
among USA and Canadian clinical professionals in the Ô80s show him
as being more influential than Sigmund Freud (Smith, 1982). High-
quality research (i.e., comparable with research in other psychologi-
cal fields) exists in REBT, but such research is often conducted out-
side the politically and economically powerful framework of
mainstream cognitive psychology (Still, 2001). This could explain the
fact that in spite of the considerable amount of REBT research and
influence in the clinical field, it is oftentimes less accessible and, con-
sequently, less explored and less visible in the mainstream cognitive
science. Furthermore, meta-analytic studies seem to support the con-
clusion that REBT is an efficacious form of CBT (e.g., Engles, Garnef-
sky, & Diekstra, 1993; Lyons & Woods, 1991).
Generally speaking, the development of REBT research has fol-
lowed two different paths. Basic REBT research, mostly conducted in
academia, has been of high quality from the beginning. Few thera-
pies, if any, have generated such a large amount of basic research in
mainstream psychology as REBT has. Hundreds of papers have
related IBs to feelings, physiological indicators, behavior, and other
cognitions, not necessarily in a therapeutic context but also in experi-
mental context (e.g., for a review see David, 2003; Smith, 1982). Cri-
tiques of the methodology used in this research line (e.g., Haaga &
Davidson, 1989a, 1989b, 1993) have had a favorable impact on the
cumulative development of subsequent research, and on the knowl-
edge base of REBT. Applied REBT research has been less repre-
sented and has fared relatively poorly in terms of generic
methodological criteria. Empirical outcome research in REBT has
developed over three periods: (1) before 1970, (2) between 1970 and
1980, and (3) from the end of the ’80s/beginning of the ’90s to pres-
ent. Prior to 1970, rigorous empirical research regarding REBT
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
177

efficacy (i.e., how REBT works in controlled conditions) and effective-
ness (i.e., how REBT works in ecological conditions), following experi-
mental or quasi-experimental designs, was infrequently conducted.
After 1970 a series of outcome studies were published. These studies
created the basis for a more rigorous quantitative approach to explor-
ing the efficacy of REBT. Several quantitative meta-analyses based
on these studies have shown that REBT is an effective treatment
(e.g., Engels et al., 1993; Lyons & Woods, 1991). However, some
reviewers (e.g., Haaga & Davidson, 1993) have been critical of the
methodological adequacy of research included in these meta-analyses,
suggesting that a more conservative conclusion, based on the
evidence, would be that REBT is probably efficacious, but that more
empirical research is needed. Starting with the end of the ’80s/begin-
ning of the ’90s, REBT outcome studies have more strictly adhered to
relevant methodological criteria (Haaga & Davidson, 1993).
The REBT synopsis presented here, referring to both basic and ap-
plied research, is based on (1) Smith’s (1982) review (a synopsis of
REBT from its inception until 1982), (2) Haaga & Davidson’s (1993)
review (a review of the REBT literature up to the time their article
was published), and (3) our own review of the REBT-related litera-
ture (as available through PsychInfo and MEDLINE).
In the present paper, we attempt to critically evaluate the litera-
ture on basic and applied REBT research. Cumulative developments,
methodological problems in existing REBT research, suggestions for
improvement, and projects for future research are discussed in each
section. The aim of this paper is to offer a critical review of the re-
search literature on REBT, divided into two major sections, the ba-
sics on one hand, and the applied outcome studies on the other. Each
section will cover several topics (e.g., the nature of IBs and RBs), and
each topic will be organized based upon the following structure: (1) a
brief description of the current state, summarizing what has been
done, what has been learned from mistakes, and what we know; (2) a
brief description of future directions, making recommendations for
future research. Following this structure we will progress from past
research to present research, and to recommendations for future
research. We believe that the weak points of REBT research should
be exposed and criticized in order to improve REBT theory and prac-
tice. However, the overgeneralization and/or magnification of the neg-
ative, and the minimization of the positive, typical in the current
literature, are dysfunctional beliefs that may induce a false
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perspective in the clinical field regarding the status of REBT. We will
try to avoid them by explicitly presenting both the strengths and
weakness of REBT; moreover, adopting a constructive approach, we
will make suggestions for correcting weaknesses of REBT research. A
balanced and more scholarly approach such as this one is much more
probable to present a professional perspective, beyond the existing
positive or negative biases, thus stimulating rigorous research in the
theory and practice of REBT.
REBT BASIC RESEARCH
The Nature of Irrational and Rational Beliefs (IBs/RBs)
A Brief Description of the Current State. Following the theoretical
foundations of cognitive psychology (e.g., Marr, 1982; Newell, 1990),
it has become commonplace to analyze IBs/RBs on three different lev-
els: computational, algorithmic-representational, and implementa-
tional (for details see David, 2003). Cognitive psychology is concerned
with the human mind, how it creates meaning, how it processes
information it receives (input) to develop responses (output), and how
these responses (output) can in turn influence subsequent input
(Anderson, 2000). However, cognitive psychology is not only the sci-
ence of human information processing per se, but also an information
processing perspective that can be used in our attempts at under-
standing all of the workings of the human mind, including cognitive
processes, behaviors and emotions (Anderson, 2000).
The Computational Level Theory describes the goal of a given com-
putation and the logic of the strategy through which it is carried out.
Basic questions that research at this level addresses are ‘‘What is the
goal of computation?’’ ‘‘Is it appropriate?’’ ‘‘What is the input and what
is the output?’’ ‘‘What knowledge do we need to transform the input
into output?’’ ‘‘How is the general strategy carried out?’’ ‘‘What is the
interaction between the goal and our knowledge?’’ Suppose that we
watch someone playing chess. A computational theory of what is going
on in the mind of the player will tell us about (1) the input (e.g., the
basic starting positions in the chess game), output (e.g., chess-board
moves), and his/her goals (e.g., to play chess and win); (2) his/her
knowledge (e.g., the rules of chess); and (3) the general strategy the
player uses to transform the input into output (e.g., organizing chess
rules in a way as to help him/her win). A basic question that research
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
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at this level addresses is ‘‘What is the goal/function of computations
based on IBs/RBs?’’ There is a large consensus in the REBT literature
(e.g., Ellis, 1994) that IBs/RBs refer to evaluative or ‘‘hot’’ cognitions,
and therefore they have an evaluative function; Abelson and Rosen-
berg (1958) use the terms ‘‘hot’’ and ‘‘cold’’ cognitions to make the dis-
tinction between appraising (hot) and knowing (cold). Cold cognitions
refer to the way people develop representations of relevant circum-
stances (i.e., activating events), while hot cognitions refer to the way
people process and evaluate cold cognitions (David & McMahon, 2001;
David, Schnur, & Belloiu, 2002). Thus, cold cognitions refer to how
people develop representations of relevant circumstances (i.e., of acti-
vating events) (Lazarus and Smith, 1988). Such circumstances are of-
ten analyzed in terms of surface cognitions, (which are easily accessed
consciously), and deep cognitions (which although consciously accessi-
ble, are more difficult to access). Surface cognitions refer to descrip-
tions, inferences, and attributions, whereas deep cognitions refer to
core beliefs (i.e., schemas) and other meaning-based representations
(for details, see Eysenck & Keane, 2000). As already mentioned, hot
cognitions, also called appraisals or evaluative cognitions, refer to how
cold cognitions are processed in terms of their relevance for personal
well-being (for details, see Ellis, 1994; Lazarus, 1991). Consequently,
during a specific activating event, there seem to be four different pos-
sibilities for how cold and hot cognitions regarding the activating
event are related: (1) distorted representation of the event/negatively
appraised, (2) non-distorted representation/negatively appraised, (3)
distorted representation/non-negatively appraised, (4) non-distorted
representation/non-negatively appraised. According to Lazarus (1991)
and to the appraisal theory of emotions, although cold cognitions con-
tribute to appraisal, only appraisal itself results directly in emotions.
The effect of cold cognitions (conceptualized as distal causes: descrip-
tions, inferences, attributions, schemas) on emotions seems to be med-
iated by hot cognitions (conceptualized as proximal causes: cognitive
appraisal). Although past research has suggested that cold cognitions
are strongly related to emotions (e.g., Schachter & Singer, 1962; Wei-
ner, 1985), it is now generally accepted that as long as cold cognitions
remain unevaluated, they are insufficient to produce emotions (Laza-
rus, 1991; Lazarus & Smith, 1988; Smith, Haynes, Lazarus, & Pope,
1993). Different schools of CBT differ in the emphasis they place on
various levels of cognition (for details, see David, 2003; Wessler,
1982). Since REBT theory (Ellis, 1962, 1994; Wessler, 1982) has
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always been focused on a special type of evaluative/hot cognitions as
proximal causes of emotions (i.e., IBs) rather than on cold cognitions
(e.g., descriptions, inferences, attributions, and schemas), it is congru-
ent with more recent developments in cognitive psychology.
The Algorithmic-Representational Level Theory specifies representa-
tions in detail, as well as the algorithms defined by them. Although
Ellis’ original work (1962) proposes 11 IBs, more recent developments
in CBT/REBT suggest that IBs fall into four categories of irrational
(dysfunctional/maladaptive) cognitive processes: demandingness
(DEM), awfulizing/catastrophizing (AWF), global evaluation/self-
downing (GE/SD), and frustration intolerance (FI) (Campbell, 1988;
DiGiuseppe, 1996). DEM refers to absolutistic requirements expressed
in the form of ‘‘musts,’’ ‘‘shoulds’’ and ‘‘oughts.’’ Furthermore, it in-
cludes an evaluative component (how desirable is this?) and a reality
component (what should I expect?). AWF refers to one evaluating a
situation as more than 100% bad, and considering that it is the worse
thing that could happen to him/her. FI refers to individuals’ beliefs
that they cannot endure, or envision being able to endure, a given
situation, as well as their belief that they will have no happiness at
all if what they demand should not exist, actually exists. GE/SD
appears when individuals tend to be excessively critical of themselves
(i.e., to make global negative evaluations of themselves) and also of
others and life conditions. These four irrational cognitive processes
cover various areas of content (e.g., performance, comfort, affiliation)
and refer to ourselves, others, and life conditions. According to Ellis
(1962, 1994), DEM is the core IB, and all other IBs are derived from
it. It is important to note however, that Ellis’ hypothesis is based
solely on his clinical work, and that there is no rigorous empirical
evidence to support this theory.
This line of research, related to the algorithmic-representational
level, examines how IBs/RBs are represented in our cognitive system.
At least three possibilities have emerged so far:
(1) IBs are evaluative (hot) cognitions that are organized as proposi-
tional representations (Ellis, 1994). A propositional representation
is the smallest unit of knowledge that can stand as a separate
assertion; that is, the smallest unit about which one can make the
judgment of true or false (Anderson, 2000).
(2) IBs are evaluative cognitions that are organized as a special type of
schemas (‘‘evaluative schemas’’) (DiGiuseppe, 1996). A schema
represents the structure of an object or event according to a slot
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
181

structure, where slots specify values that the object or event has on
various attributes (Anderson, 2000); thus, schemas are complex
structures that represent the person’s constructed concepts of real-
ity, and behavioral responses to that reality.
(3) IBs of Demandingeness (DEM) and Global-Evaluation/Self-Downing
(GE/SD) are evaluative schemas while Awfulizing (AWF) and FI
are evaluative cognitions organized as propositional representations
(David, DiGiuseppe et al, in preparation).
The Implementational Level Theory answers the question of how
representations and algorithms are carried out from a physical point
of view. For example, what happens in the human brain when IBs or
RBs are activated? This fascinating field requires interdisciplinary
research with the field of cognitive neuroscience. REBT research on
this topic is still in an incipient phase. This research is usually con-
ducted using the evolutionary psychology framework (Ruth, 1993),
connectionist modeling (Ingram & Siegle, 2001), and/or modern brain
mapping techniques (e.g., MRI).
A Brief Description of Future Directions. Current research on the
nature of IBs/RBs should aim to (a) further develop our under-
standing of IBs/RBs at the computational, algorithmic-representa-
tional, and implementational levels, and to (b) understand the
nature of IBs/RBs as part of a more complex psychological reality,
such as via cognitive–feeling–behavioral interactions. For example,
are IBs organized as schemas or as appraisal? Is DEM the core IB
and are AWF, FI, and GE/SD its derivatives?
The Assessment of IBs/RBs
A Brief Description of the Current State. Many measures of IBs have
been described as outdated (for a review see Smith, 1989) because (a)
they have either been contaminated by affective items, and/or (b)
they reflect Ellis’s earlier theories of irrational thinking. Considering
these criticisms, a new generation of IBs/RBs assessment tools has
been developed.
The new generation of IBs/RBs measures has three major charac-
teristics (for a brief review see Linder, Kirkby, Wertheim, & Birch,
1999): (1) scales contain cognitive items that are not contaminated by
affective items, (2) measures differentiate the process of thought from
the content of thought, and (3) scales have separate scores for
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Journal of Rational-Emotive & Cognitive-Behavior Therapy

rational and irrational thinking. This new generation of measures,
based on self-report items, has proved to have effective psychometric
properties (e.g., it can easily differentiate between clinical and non-
clinical populations). Research (e.g., Bernard, 1998) has also shown
that rational and irrational thinking are not bi-polar constructs; this
means that a high IBs score does not necessarily entail a low RBs
score.
Taking into account these new developments in the assessment of
IBs/RBs, research should rely only on new generation scales that are
not contaminated by affective content, and can offer separate scores
for IBs and RBs (e.g., Bernard, 1998; DiGiuseppe, Leaf, Exner, &
Robin, 1988; Linder et al., 1999).
A Brief Description of Future Directions. Current research in the
assessment of IBs/RBs has focused on developing new methods of
evaluating IBs/RBs, and on better understanding their role in cogni-
tion, emotion, and behavior. This has been done by focusing on (a)
the development of specific and/or individualized measures of IBs
(e.g., Solomon et al., 2003), adapted to specific contexts (e.g., depres-
sion, pain), and (b) measures based on indicators other than direct
self-reports of IBs/RBs (e.g., articulated thoughts during simulated
situations, ATSS, Davidson, Robins, & Johnson, 1983; Solomon et al.,
1998). To date, most measures of IBs are based on self-report scales,
which are sensitive to coping/defense mechanisms (e.g., suppression
of SD may be an impediment in the assessment of SD by self-report
scales). Moreover, it is sometimes difficult to measure the true nature
and extent of IBs using self-report scales (as all studies have), as
there are situations in which IBs are not readily consciously accessi-
ble yet are identifiable by their effects (David, 2003). Measures that
are not based on the awareness and self-report of IBs are needed.
Implicit tasks and priming methodologies might be good candidates
for an indirect measure of IBs.
Relationships between IBs/RBs and Other Types of Cognitions (e.g.,
‘‘Cold Cognitions’’ Descriptions, Inferences, Attributions, Schemas)
A Brief Description of the Current State. To date, a series of seven
experimental studies have tested these relationships in a program-
matic research program initiated by several authors. Consistent with
REBT theory, these experiments demonstrate that people holding a
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
183

typical structure of IBs (DEM plus AWF; DEM plus FI; and/or DEM
plus GE/SD) make descriptions, inferences, and attributions that are
significantly less functional than those that are made by people hold-
ing RBs. These experiments (Bond & Dryden, 1996, 1997, 2000;
Bond, Dryden, & Briscoe, 1999; Dryden et al., 1989a; Dryden, Fergu-
son, & Hylton, 1989b; Dryden, Ferguson, & Teague, 1989c) also sug-
gest that the active component of a pair of IBs (e.g., DEM plus AWF;
DEM plus FI; DEM plus GE/SD) is a secondary IB (AWF, FI, and/or
GE/SD). These results are consistent with recent re-conceptualiza-
tions of DEM as a maladaptive (irrational) primary appraisal mecha-
nism, and of AWF, FI, and GE/SD as maladaptive secondary
appraisal mechanisms (e.g., David, 2003; David et al., 2002); thus,
the effect of DEM on various outcomes (e.g., cognitive, emotional,
behavioral) seems to be mediated by AWF, FI, and/or GE/SD. A main
limitation of these studies is that they artificially separate DEM from
its theoretically related derivatives (i.e., AWF, FI, and GE/SD), al-
though various studies suggest that in ecological and clinical condi-
tions the hypothesized derivates (AWF, FI, and GE/SD) are usually
related to DEM (e.g., Bernard, 1998; David et al., 2002).
A Brief Description of Future Directions. Current research should
aim at a better understanding of these relationships: (a) do func-
tional/dysfunctional inferences become ‘‘functionally autonomous,’’
even though initially generated in connection with IBs/RBs? (b) Do
we need a direct intervention to change the functionality of infer-
ences, or is the change in IBs/RBs accompanied by a change in func-
tional/dysfunctional inferences? (c) What is the impact of IBs/RBs on
other types of cognitions (e.g., response expectancies)? (d) Can we
ecologically have AWF, FI, or GE/SD independent of DEM (e.g., not
derivates of DEM), or is this just an experimental artefact?
The Relationship between IBs/RBs and Feelings/Distress
A Brief Description of the Current State. One of the major topics of
interest in cognitive psychology is the relationship between cognitive
and emotional processes. Some of the early cognitive theories of emo-
tions have focused on the interruption of schemas and goals, or on
linking emotions to schemas, attributions, and goals (‘‘cold’’
cognitions) (Fiske, 1993; Mandler, 1975), while others have consid-
ered the appraisal of stimuli (‘‘hot’’ cognitions) in terms of personal
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significance and emotional consequences to be more important (Laza-
rus, 1991). More recent research and developments in the cognitive
theory of emotions (Lazarus, 1991; Smith & Lazarus, 1993) have
underscored the relevance of cold cognitions in emotion formation
due to the fact that people evaluate data with respect to adaptive sig-
nificance. A characteristic of this line of cognitive research on emo-
tions is that it focuses on cognitive factors that are conscious or
potentially consciously accessible. Another line of cognitive research
on emotions focuses on unconscious information processing involving
cortical and subcortical structures (e.g., LeDoux, 1996). The contem-
porary approach to emotion formation combines both lines of re-
search, thus offering a comprehensive picture of human emotions
(David et al., 2002).
Ellis’ cognitive theory of emotion formation is in line with research
on hot cognitions that are conscious or potentially consciously accessi-
ble (Ellis, 1994; Ellis & Harper, 1961, 1975). However, Ellis also
emphasizes that DEM is sometimes implicit/unconscious, and can
only be inferred from its behavioral and cognitive consequences
(Ellis, 1994). According to the ‘‘ABCDE’’ model of REBT (Ellis, 1994),
Cs that follow IBs about negative As are called dysfunctional (also
unhealthy/maladaptive/inappropriate) negative feelings (e.g., depres-
sion after failing an exam, related to the IB ‘‘I must pass all exams’’).
Cs following IBs about positive As are called dysfunctional positive
feelings (e.g., elation after learning that your work was praised by all
the evaluators, related to the belief that ‘‘Everyone must only say
positive things about me’’). Cs that follow RBs about negative As are
called functional (also healthy/adaptive/appropriate) negative feelings
(e.g., sadness related to the idea that ‘‘I would have liked to pass the
exam but I did not’’), while those following RBs about positive As are
called functional positive feelings (e.g., happiness related to the idea
that ‘‘I would like all the evaluators to say only positive things about
my performance, and this time they did’’). Dysfunctional negative
feelings are associated with psychological problems. Functional nega-
tive feelings, on the other hand, encourage the successful execution of
behaviors necessary to reach a goal. For example, sadness may
motivate one to study harder, and pass the next exam. Dysfunctional
positive feelings orient people to seek only short-term benefits instead
of long-term benefits. Functional positive feelings are associated with
the ultimate fulfillment of people’s desires, wishes, and goals.
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185

Originally, Ellis implied that the dysfunctionality of negative feel-
ings was circumscribed by their intensity: strong feelings (e.g., high
worthlessness, high sadness) were considered dysfunctional and asso-
ciated with IBs, while less strong feelings (e.g., low worthlessness,
low sadness) were considered functional and associated with RB (El-
lis, 1962; Ellis & Harper, 1961) (i.e., a unitary model of distress). In
the revised version of his theory, Ellis (Ellis, 1994; Ellis & Harper,
1975) advances the idea that there are qualitative differences
between certain similar feelings (e.g., depressed/worthless and sad;
anxious and concerned/uneasy); while both functional (e.g., sad) and
dysfunctional (e.g., depressed) feelings can independently range in
intensity from mild to severe, they differ in their quality (i.e., a bin-
ary model of distress). In stressful situations, IBs have been hypothe-
sized to be positively associated with dysfunctional negative feelings
and their accompanying functional feelings (e.g., if one is depressed
he/she is also sad). In stressful situations, RBs (frequently viewed as
reflected in low scores of IBs [Bernard, 1998]) are hypothesized to be
positively associated with functional negative feelings only. According
to the revised theory, a unitary model of distress is not viable (e.g., in
stressful situations, high levels of IBs produce high levels of negative
affect [functional and dysfunctional negative feelings], while low
levels of IBs produce low levels of negative affect [functional and
dysfunctional negative feelings]). Rather, a binary model of distress
is hypothesized: in stressful situations high distress means high
levels of both functional and dysfunctional negative feelings, while
low distress means high levels of functional and low levels of dys-
functional negative feelings. However, Cramer (1985) reported that
IBs were positively correlated with both functional and dysfunctional
negative feelings (as originally described by Ellis and Harper, 1975)
in the context of imaginary, stressful situations. Cramer (1985)
interpreted these data as inconsistent with the binary model, and
consistent with a unitary view of distress (see also Cramer & Fong,
1991; Cramer & Kupshik, 1993).
David et al. (2002) however, have recently proposed a new, more
complex model of emotion formation, based on the binary model,
which involves both appraisal and REBT theory (Table 1) .
Compared to the appraisal theory (Lazarus, 1991), this new model
(see also David et al., 2003; David et al., in press) makes a distinction
between functional and dysfunctional negative emotions (concern vs.
anxiety; sadness vs. depression; remorse vs. guilt; annoyance vs.
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Table 1
Appraisal Theory of Emotion Formation (Left), and a Hypothesized Model of Emotion
Formation Based on Both REBT and Appraisal Theory (Right)
Appraisal theory (Smith et al., 1993) REBT theory in the terms of appraisal theory; a hypothesized model
Emotion Core
relational
theme
Appraisal components Emotion;
Dysfunctional and
Functional
Core
relational
theme
Important appraisal
components
Anger Other-blame Motivationally relevant
motivationally incongruent
other accountability
(e.g., the others, life
conditions)
Anger Other-blame Motivationally relevant,
motivationally incongruent
with DEM, other-accountability
(i.e., the others, life conditions)
Annoyance Motivationally relevant,
motivationally incongruent
with preferences,
other-accountability
(i.e., the others, life conditions)
Guilt Self-blame Motivationally relevant,
motivationally incongruent,
self-accountability
(e.g., myself)
Guilt Self-blame Motivationally relevant,
motivationally incongruent
with DEM, self-accountability
(i.e., myself)
Remorse Motivationally relevant,
motivationally incongruent
with preferences,
self-accountability (i.e., myself)
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Table 1
(Continued)
Appraisal theory (Smith et al., 1993) REBT theory in the terms of appraisal theory; a hypothesized model
Fear-
anxiety
Danger-
threat
Motivationally relevant,
motivationally incongruent,
low or uncertain
emotion-focused potential
Fear-
anxiety
Danger-threat Motivationally relevant,
motivationally incongruent
with DEM, low or uncertain
emotion-focused potential
(i.e., AWF, LFT)
Concern Motivationally relevant,
motivationally incongruent
with preferences, high
emotion-focused potential
(i.e., non-AWF; non-LFT)
Sadness Irrevocable
loss;
helplessness
about harm
or loss
Motivationally relevant,
motivationally incongruent,
low problem-focused
potential, negative future
expectations
Depression Irrevocable
loss;
helplessness
about harm
or loss
Motivationally relevant,
motivationally incongruent
with DEM, low
problem-focused coping
potential (i.e., SD),
negative future expectations
Sadness Motivationally relevant,
motivationally incongruent
with preferences, low
problem-focused coping
potential (i.e., non-SD)
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anger). Compared to the REBT model, the complexity of the new
model is reflected by the fact that it describes specific and sequential
processes associated with each emotion (David et al., 2002).
To summarize, up-to-date in REBT, dysfunctional feelings have
been distinguished from functional feelings in two ways:
(a) Consistent with Ellis and Harper’s (1961) original position: func-
tional emotions differ from dysfunctional emotions in terms of
intensity, with very intense feelings seen as being dysfunctional
(e.g., Cramer, 1985; Cramer & Buckland, 1996; Cramer & Fong,
1991; Cramer & Kupshik, 1993).
(b) Consistent with Ellis and Harper’s (1975) reformulated theory:
functional and dysfunctional feelings differ both qualitatively
(mainly) and quantitatively (e.g., David et al., 2002; David, Schnur,
Birk, & 2003; David, Montgomery, Macavei & Bovbjerg, in press;
Ellis & DiGiuseppe, 1993).
A Brief Description of Future Directions. Based on the available data
(e.g., Cramer & Fong, 1991; David et al., 2002) we can say that IBs
and RBs are involved in emotion formation and distress; however,
whether their impact is quantitative, accommodating a unitary model
of distress or qualitative, accommodating a binary model of distress,
is still unanswered. Therefore, current research should aim to (a)
investigate these two alternative hypotheses: unitary vs. binary mod-
el of distress; (b) elaborate on the relations between cognitions and
emotions in REBT (e.g., specific cognitive components for specific
emotions); and (c) corroborate the REBT theory of emotions with
other theories of emotions (e.g., appraisal theory, bi-factorial theory,
and cognitive/unconscious research). Recently LeDoux (1996) and oth-
ers have argued for another theory of emotion formation. They argue
that certain emotional problems are of subcortical origin (e.g., involv-
ing the amygdala, thalamus, and other non-cerebral structures), and
do not involve appraisal as defined by the appraisal theory (Lazarus,
1991). Although people unfamiliar with basic cognitive psychological
research are tempted to say that these findings are incompatible with
the cognitive approach of emotions, it is certainly not the case. Some
of the connections between the two fields are briefly described below
(for details, see also David, 2003). First, these subcortical processes
are related to the concept of unconscious information processing.
Therefore, these processes preserve the cognitive (computational)
component of emotions and connect the theory of emotions to the con-
cept of cognitive unconscious, a highly investigated topic in current
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
189

cognitive psychology (David, 2003). Second, these subcortical and
automatic processes can be countered by activating more constructive
modes of thinking (David, 2003), and their effects can be controlled
by conscious strategies. Third, cognitive psychology and CBT do not
assume that verbal mediation is the only way of emotional control.
Some very successful behavioral (e.g., exposure) methods work specif-
ically on this type of unconscious information processing involved in
emotion formation (Ellis, 1962, 1994). Fourth, according to REBT
theory, an emotion generated by subcortical mechanisms can become
an ‘‘A,’’ and be consciously appraised, thus generating a secondary
emotional problem (Ellis, 1962, 1994). Unfortunately, the psychother-
apeutic community seems to have received the construct of un-
conscious information processing in a distorted fashion. For example,
Mahoney (1993) wrongly argues that the construct of unconscious
information processing has already penetrated the field of psycho-
therapy, and uses Beck’s concepts of (1976) automatic thoughts and
schema as an example. Mahoney (1993) seems to refer to a segment
of information processing which functions unconsciously, but which
can potentially be made conscious. This is a ‘‘functional dissociation’’
between conscious and unconscious processes, generated by the
automatization of certain conscious processes and/or by coping and
defense mechanisms (e.g., suppression, Wegner & Smart, 1997).
However, modern work in cognitive psychology (e.g., Reber, 1993;
Schacter, 1987; Seger, 1994) argues for a ‘‘structural dissociation’’
between conscious and unconscious processes. Some types of informa-
tion processing (both perceptual and semantic) cannot be made con-
scious by their nature. They are represented in our memory in a
format (e.g., nonverbal associations) that is not consciously accessible
(Schacter & Tulving, 1994). Few works have assimilated this line of
research in psychotherapy yet one notable exception is the work of
Dowd and Courchaine (1996). The appraisal theory (Lazarus, 1991)
and the developments in the neurobiology of emotions (LeDoux, 1996)
can be combined to offer us a more comprehensive picture of human
emotions. By incorporating research on unconscious information
processing and research on the neurobiology of emotions into REBT
theory, we will be able to preserve and extend a useful theory rather
than having to invent a new one. To conclude, the idea that the ‘‘B’’
in the ‘‘ABCDE’’ model has been expanded to include two different
basic components: (1) IBs and RBs as parts of explicit memory,
related to the appraisal theory; and (2) unconscious information
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processing in implicit memory, related to research on the cognitive
unconscious and the neurobiology of emotions should be better
disseminated. Future studies should investigate the interactions
between these two constructs as part of an expanded ‘‘ABCDE’’
model.
The Relationship between IBs/RBs and Physiological Indicators
A Brief Description of the Current State. IBs/RBs have been related
to various physiological indicators. Goldfried and Sobocinsky (1975)
for example, found that high/intense IBs are associated with high/in-
tense physiological/emotional arousal. Other studies found only par-
tial support for this hypothesis. For example, classical conditioning
(i.e., pavlovian conditioning) has been used as a main explanation of
the relationship between IBs and physiological arousal (e.g., Master
& Gershman, 1983). Other studies have also failed to support the IB-
arousal hypothesis (e.g., Craighead, Kimball, & Rehak, 1979; Smith,
Houston, & Zurawski, 1984). However, recent research conducted
with improved methodology supports the idea that high levels of IBs
are indeed associated with anger arousal (e.g., Eckhardt, Barbour, &
Davidson, 1998). These recent findings, along with findings showing
that (1) psychosomatic disorder patients have high levels of IBs (e.g.,
Woods & Lyons, 1990), and that (2) REBT has a powerful impact of
various physiological indicators (see outcome studies below) encour-
age future research on this topic.
A Brief Description of Future Directions. The fundamental questions
for future research are as follows: Under what conditions do IBs/RBs
affect physiological indicators? Which physiological indicators are af-
fected by IBs/RBs? In other words, a much more clear distinction be-
tween physiological arousal and emotional arousal is needed, and
answers to these questions could be best sought via a more general re-
search program on emotions and distress.
The Relationship between IB/RBs and Behavior
A Brief Description of the Current State. Theoretical analyses and
clinical data suggest that while IBs seem to be accompanied by
dysfunctional behavior, RBs are accompanied by functional behavior
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
191

(Ellis, 1994). To date, however, a very small amount of empirical re-
search has attempted to clarify this relationship. For example, one
line of research has focused on behavioral performance on various mo-
tor tasks. Some authors (e.g., Bonadies & Baas, 1984; Kombos, Four-
net, & Estes, 1989) have found that IBs negatively influence
behavioral performance on various tasks. Other authors have found
only partial or no support (e.g., Rosin & Nelson, 1983) for this hypoth-
esis. Another line of research has focused on the impact of IBs on pro-
crastination. Generally, results have been positive in supporting the
idea that IBs are etiopathogenetic factors in procrastination (e.g., Bes-
wick, Rothblum, & Mann, 1988; Bridges & Roig, 1997), with very few
disconfirming results (e.g., Ferrari & Emmons, 1994). A weak rela-
tionship has been found between IBs and measures of social skills
(e.g., Monti, Zwik, & Warzak, 1986) and verbal or nonverbal intellec-
tual functioning (e.g., Prola, 1985). Highly intelligent people seem to
learn RBs easier than people of lower intelligence (e.g., Wilde, 1996a,
1996b). High levels of IBs are also associated with other behavioral
outcomes (e.g., low perception of control––Thomson et al., 1993; high
extrinsic motivation––Harju & Eppler, 1997).
A Brief Description of Future Directions. Future research projects
should concentrate on clarifying the impact of IBs/RBs on the func-
tionality of behavior, focusing on two approaches:
(1) Arousal-performance theory (see Yerkes-Dodson Law of Motiva-
tion); it is hypothesized that the impact of IBs on performance on
complex tasks may be mediated by arousal.
(2) Behavioral operationalization of outcomes (rather than sole reliance
on self-report) and studies rigorously designed to explore the ‘‘cau-
sal’’ rather than correlative role of IBS/RBs in human behavior.
Preliminary Conclusions
Since 1955 REBT theory has evolved by hundreds of research and
theoretical articles and by incorporating many developments in cogni-
tive science:
• irrational beliefs are conceptualized as irrational cognitive processes
that can cover various areas of content, rather than lists established
based on clinical practice;
• IBs are conceptualized as hot cognitions and appraisal mechanisms
in the cognitive architecture of the human mind;
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• the assessment of IBs is taken beyond self-report scales (e.g., ATSS,
Davidson et al., 1983).
It is now time to take REBT theory further by integrating it with
developments in cognitive neuroscience:
• by an analysis of irrational and RBs at implementational level
• by incorporating the construct of unconscious information processing
into the ABCDE model of REBT.
Finally REBT theory should be able to answer the criticisms of being
a monolithic therapy that is less flexible in addressing specific disor-
ders (Beck, Rush, Shaw, & Emery, 1979; Padesky & Beck, 2003).
This can be done by elaborating more individualized models for vari-
ous emotional problems following the paradigm proposed by David et
al. (2002) (see also David, 2003) and by empirically investigating the
way core IBs and their interaction generate particular cognitions in-
volved in specific disorders. By reducing various forms of psychopa-
thology to a few IBs and their combinations, the REBT approach
would be similar to the neurosciences approach where a whole range
of specific psychopathology is reduced to a few basic neurotransmit-
ters and their interactions.
CLINICAL AND APPLIED RESEARCH IN REBT
Outcome Studies in REBT
A Brief Description of the Current State. This section will address the
following questions: ‘‘How effective is rational-emotive behavior ther-
apy? For which disorders is it most effective? And how does it com-
pare to other therapies?’’
Meta-analysis is a statistical approach that allows researchers to
aggregate the results of multiple studies and to describe these results
in a standard unit known as effect size. Effect sizes reported here
represent group differences in standard deviation units. Hence, an ef-
fect size of 0 would indicate no difference between group outcomes;
an effect size of 1 is considered large, and would indicate that the
average REBT patient had an outcome superior to 84% of the com-
parison group. Effect sizes have been categorized along a continuum
of no effect (0–0.2), low effect (0.2–0.5), medium effect (0.5–0.8), and
high effect (higher than 0.8).
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To date several qualitative reviews (e.g., DiGiuseppe, Millet, & Trex-
ler, 1977; Ellis, 1974; Haaga & Davidson, 1989a, 1989b; Zettle & Hayes,
1980) have examined the efficacy (i.e., by rigorously controlled clinical
studies) and effectiveness (i.e., by studies in real clinical settings) of
REBT. Although generally positive, these qualitative reviews have also
pointed to some methodological problems that should be corrected to
strengthen the conclusion that REBT is an effective treatment.
As previously stated, rigorous empirical research on REBT efficacy,
dates back to the end of the ’80s and the beginning of the ’90s. This
outcome research has become the basis for a quantitative approach in
examining the efficacy of REBT, and for allowing meta-analysis to
address many of the criticisms advanced by previous REBT qualita-
tive reviews (Engels et al., 1993; Lyons & Woods, 1991).
Concerning REBT outcome research, quantitative reviews are of
two types: (1) General, focused on cognitive behavioral psychotherapy
overall; and (2) Specific, focused specifically on the efficacy of REBT.
(1) REBT has generally done well in quantitative reviews of psy-
chotherapy. For example, the original psychotherapy meta-analysis
(Smith & Glass, 1977) cited REBT as yielding the second highest
average effect size among 10 major forms of psychotherapy. However,
the number of REBT outcome studies included in general psychother-
apy meta-analyses is small, and most authors place all forms of cog-
nitive-behavioral therapy within a single category (e.g., Wampold
et al., 1997). Although psychotherapy meta-analyses typically find
that cognitive-behavior therapy has the highest overall effect size, as
REBT is included in the general CBT category, the degree to which
REBT independently contributes to these results is unclear. So far,
two rigorous meta-analyses have directly evaluated the efficacy and
effectiveness of REBT (i.e., Engels et al., 1993; Lyons & Woods,
1991). The following synthesis of REBT efficacy is based on these two
quantitative meta-analyses.
A. REBT diagnostic categories and outcome measures (Engels
et al., 1993; Lyons & Woods, 1991)
In general, conclusions about the impact of REBT on various clini-
cal diagnostic categories and outcome measures (see Table 2) can be
summarized as follows:
(1) REBT seems to be useful for a large range of clinical diagnoses and
clinical outcomes (see Table 2). Interestingly, REBT has proved to
have a much larger effect on ‘‘low reactivity’’ outcomes, which do
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Table 2
A Brief Presentation of REBT Outcome Research
Lyons and Woods (1991); Clinical
Psychology Review; 70 Outcome
studies, 236 comparisons; REBT vs.
Control (i.e., baseline, no-treatment,
waiting list, other therapies)
Engels et al. (1993); Journal of
Consulting and Clinical Psychology;
28 Randomized studies; REBT vs.
Control (i.e., no-treatment;
waiting list)
Diagnositic Category
(1) Anxiety (e.g., interpersonal, speech) (1) No information (1) M=1.71 SD=1.5
(2) Phobia (e.g., simple and complex) (2) M=0.8 SD=0.7 (2) No information
(3) Somatic/emotional (e.g., stuttering,
overweight, erectile failure, chronic
heart disease, home dialysis, asthma,
insomnia, migraine)
(3) M=1.92 SD=1.3 (3) M=2.54 SD=1.8
(4) Neurotic (e.g., lack of assertiveness
depression, behavior problems, potential
for dropping out of school, achievement
problems)
(4) M=0.99 SD=1.0 (4) No information
(5) Neuroticism (5) No information (5) M=1.75 SD=1.83
(6) Diverse (e.g., rage, type A behavior,
school children’s emotional adjustment,
well-being)
(6) No information (6) M=1.04 SD=0.8
(7) Unclassified (e.g., sub-clinical problems,
problems that do not fit a well-defined
clinical category)
(7) M=0.95 SD=0.8 (7) No information
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
195

Table 2
(Continued)
Lyons and Woods (1991); Clinical
Psychology Review; 70 Outcome
studies, 236 comparisons; REBT vs.
Control (i.e., baseline, no-treatment,
waiting list, other therapies)
Engels et al. (1993); Journal of
Consulting and Clinical Psychology;
28 Randomized studies; REBT vs.
Control (i.e., no-treatment;
waiting list)
Outcome Measures
(1) Fear/anxiety (1) M=0.77 SD= 0.7 (1) M=1.52 SD=1.4
(2) Performance and behavior (physiological
tests of anxiety-heart rate, EEG, pulse,
electrodermal response-, behavioral tests
of anxiety, number of pounds lost in
weight reduction)
(2) No information (2) M=2.48 SD=1.8
(3) Standard measures (e.g., irrational
beliefs, depression)
(3) M=0.81 SD=0.6 (3) No information
(4) Physiological measures only
(e.g., heart rate, pulse, EEG, electrodermal
response)
(4) M=3.9 SD= 0.5 (4) No information
(5) Neuroticism (5) No information (5) M=1.95 SD=2.6
(6) Rationality (6) No information (6) M=2.15 SD=1.7
(7) Rest category (e.g., self-esteem,
well-being, social desirability)
(7) No information (7) M=1.28 SD=1.4
(8) Unclassified––do not fit the other
categories––(e.g., various behavioral
measures for school/clinical population)
(8) M=1.9 SD=1.2 (8) No information
Note. (M=mean of the effect size; SD-standard deviation). Effect sizes represent the difference between two groups (REBT group vs. various
control groups (e.g., no-treatment, waiting list)). Effect sizes can be categorized along a continuum of no effect (0–0.2), low effect (0.2–0.5),
medium effect (0.5–0.8) and high effect (greater than 0.8). A positive ‘‘M’ indicates that REBT was found to be superior to the other conditions.
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Journal of Rational-Emotive & Cognitive-Behavior Therapy

not have an obvious relationship with the treatment (e.g., physio-
logical measures, grade-point average), than on ‘‘high reactivity’’
measures, which have a direct and obvious relationship with the
treatment (e.g., IBs). This suggests that the effect of REBT is not
due to compliance or task-demand characteristics.
(2) REBT is equally efficient for clinical and nonclinical populations,
for a large age range (9–70), and both for males and females.
(3) In general, there is no difference in efficacy between individual and
group REBT.
(4) In general, the higher the level of training of the therapist, the
greater/better the results of REBT intervention.
(5) Higher numbers of REBT sessions correlate with better outcomes.
Higher quality outcome studies have shown greater REBT effective-
ness.
B. REBT and control groups (e.g., no treatment or waiting list group)
• REBT vs. baseline (88 effect sizes): M (mean of the effect sizes)=1.4
SD (standard deviation) = 0.9
• REBT vs. no-treatment control (31 effect sizes): M=1 SD=0.9
• REBT vs. waiting list (28 effect sizes): M=1 SD=0.9
These data show that REBT has a medium to high effect size com-
pared to control conditions. This effect size is higher than the effect
size of placebo or other therapies compared to control conditions.
C. REBT and Placebo (in most cases placebo is conceptualized as
attention-control or sham therapy)
• REBT vs. Placebo (i.e., attention control) (21 effect sizes): M=0.8
SD=0.7
These analyses show that REBT has a medium to high effect size
compared to Placebo.
• REBT vs. Control (no-treatment, waiting list) (12 studies): M=1.8
SD=1.78
• Placebo vs. Control (no-treatment, waiting list) (12 studies): M=0.90
SD=0.75
When REBT and Placebo are compared with the same type of treat-
ment, the effect of REBT is typically in the upper range of the high
effect size, while placebo is in the lower range of the high effect size.
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197

When directly comparing REBT and Placebo, the effect size for
REBT is in the medium/high range. When comparing REBT and
Placebo with other conditions (e.g., no-treatment) the effect size for
REBT is higher than the effect size for Placebo (but both are in the
high range).
D. REBT vs. other psychotherapies
• REBT vs. Behavior Therapy (38 effect sizes): M=0.30 SD=0.6
• REBT vs. Cognitive-Behavior Modification (13 effect sizes): M=0.14
SD=0.3
• REBT vs. other therapies (e.g., psychodynamic, gestalt, humanistic,
Adlerian, reality therapy, undifferentiated counselling, vocational
and personal development counselling) (17 effect sizes): M=0.80
SD=1.3.
These data show that REBT systematically has a high effect size
when compared with other therapies, and that REBT is as efficient or
even slightly (but not significantly) more efficient than other behavior
therapies.
Based upon these meta-analyses one can conclude that REBT on
the whole seems successful in improving subjects’ well-being, com-
pared to placebo or control (e.g., no treatment, waiting list). Some
words of caution are necessary however, regarding the interpretation
of these results (e.g., Haaga & Davidson, 1993):
(1) More attention should be paid to generic methodological criteria
such as (Kazdin, 2003)
(a) formal clinical assessment of psychopathology
(b) adherence to/adequacy of clinical protocols
(c) measures of the clinical significance of change
(d) collection of follow-up data
(e) subject attrition
(2) Clients participating in many of the clinical trials tend to be the YA-
VIS type (Young, Attractive, Verbal, Intelligent, Sensitive) and some
of their problems are sub-clinical; hence, the generalization of these
results to clinical practice should keep this limitation in mind.
(3) Both REBT and the other therapies have evolved during the last
years, and therefore it is possible that earlier studies contaminate
the conclusion regarding the relative efficacy of REBT and other
therapies. However, the new generation of REBT randomized clini-
cal trials, adhering to the generic methodological criteria, have also
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Journal of Rational-Emotive & Cognitive-Behavior Therapy

offered a positive view on the efficacy of REBT. Overall, these stud-
ies have found that REBT is an effective treatment compared to var-
ious control conditions, and that it has about the same efficacy as
most behavioral treatments for obsessive-compulsive disorders
(Emmelkamp & Beens, 1991; Emmelkamp, Visser, & Hoekstra,
1988), social phobia (Mersch, Emmelkamp, & Lips, 1991; Mersch,
Emmelkamp, Boegel, & van der Sleen, 1989) and social anxiety
(DiGiuseppe et al., 1990). In the case of agoraphobia, however, both
rational emotive therapy and self-instructional training seem less
effective than in vivo exposure (Emmelkamp, Brilman, Kuiper, &
Mersh, 1988). REBT in conjunction with medication has been found
more effective than medication alone for major depression (e.g., Mac-
askill & Macaskill, 1996). In the case of dysthymic patients REBT
has been shown to be as efficient as medication, but a combination of
REBT with medication is much more effective (Wang et al., 1999).
Also, REBT seems to be an effective adjunct in the therapy of inpa-
tients with schizophrenia (e.g., Shelley, Battaglia, Lucely, Ellis, &
Opler, 2001). All these results encourage future clinical research
regarding the efficacy of REBT in various clinical conditions.
It is important to point out that some of the REBT outcome research
has been conducted on normal population having subclinical prob-
lems. This can be seen as one of the strengths of this approach.
REBT is not only a clinical theory useful for clinical populations, but
also an educational system with implications for nonclinical and sub-
clinical populations (e.g., depressed mood, lack of assertiveness, test
or speaking anxiety) who have an interest in self-help materials and
personal development.
A Brief Description of Future Directions. Current research should be
focused on developing two lines of outcome studies.
(1) Efficacy studies based on well-controlled randomized clinical
trials, and (2) effectiveness studies examining REBT in real clinical
settings. Finally, a new quantitative meta-analysis is needed to as-
sess recent empirical studies of REBT efficacy and effectiveness.
REBT Theory of Change
A Brief Description of the Current State. Evidence from outcome
studies presented above indicates that REBT is probably an effective
form of treatment for a large spectrum of problems and populations.
Although additional outcome studies using mainly non-analogue pop-
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199

ulations (to strengthen the conclusion about REBT efficacy and effec-
tiveness in clinical practice), and outcome measures of several as-
pects (e.g., subjective, cognitive, behavioral, and physiological) are
still needed, future research efforts should also be focused on the fac-
tors contributing to the effectiveness of REBT (Lyons & Woods,
1991). Do changes in IBs/RBs underlie the effectiveness of REBT?
Very few studies have directly tested the REBT theory of change.
There is research indicating that changes in IBs mediate observed
treatment effects. Several studies using REBT for anxiety (e.g., Kan-
ter & Goldfried, 1979), depression (Lipsky et al., 1980) and unasser-
tiveness (Hammen, Jacobs, & Mayol, 1980) have shown a reduction
in both IBs and other symptoms measures. However, qualitative re-
views (e.g., Haaga & Davidson, 1989a, 1989b, 1993) have been criti-
cal of the methodological adequacy of much of the research on which
these conclusions are based.
Also, related to the theory of change, REBT is hypothesized (Ellis,
1994) to exceed the efficacy and effectiveness of other cognitive-
behavioral treatments by virtue of (1) focusing on the core beliefs in
psychopathology (e.g., DEM), (2) reducing secondary problems, and
(3) promoting self-acceptance. However, these hypothesized mecha-
nisms of change have not been thoroughly examined in REBT
research (but see Chamberlain & Haaga, 2001a, 2001b).
A Brief Description of Future Directions. Component designs isolat-
ing specific beliefs, and designs examining the association of changes
in beliefs with changes in other outcome measures could provide
important evidence for the basic premises of REBT theory of change.
IBs and RBs as Etiopathogenetic Mechanisms in (Psycho) Pathology
A Brief Description of the Current State. REBT maintains that IBs/
RBs mediate the relationship between environmental events and
emotional distress (REBT diathesis-stress model). IBs are hypothe-
sized to be ‘‘cognitive vulnerability’’ factors in stressful situations,
while RBs are ‘‘protective factors.’’ Three lines of research have been
used to provide support for this conclusion.
1. Correlational and cross-sectional studies (B-C). This line of
research has consistently indicated that measures of IBs are reliably
associated with measures of emotional disorders and symptoms in
both nonclinical and clinical populations. For example, high levels of
IBs have been shown to be associated with general anxiety (Jones,
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1968), social phobia, speech anxiety, test anxiety (e.g., Goldfried &
Sobocinski, 1975), self-reported depression (Nelson, 1977), general
psychiatric symptoms (Jones, 1968), assertiveness deficits (Alden &
Safran, 1978), and type-A coronary-prone behavior (Smith & Brehm,
1981). Upon admission to an inpatient psychiatric unit, individuals
diagnosed as neurotic (based on MMPI scores) showed higher levels
of IBs than non-hospitalized normals (Newark, Frerking, Cook, &
Newark, 1973).
Many of these studies, however, have been criticized as confound-
ing the assessment of IBs with predicted outcomes (e.g., emotional
distress). Also, many of them were contaminated by a ‘‘context ef-
fect,’’ as IBs and other correlated variables were measured in the
same context, a procedure that may have inflated the correlations
(some of these correlations reached values around 0.7).
As a result of these critiques, a new generation of IBs scales has
been developed in which contamination with emotional items was
avoided. Research using these new measures (e.g., Bernard, 1998)
has consistently indicated that high levels of IBs are reliably associ-
ated with a variety of indicators of emotional distress (measured in
the same or in a different context), in both clinical and nonclinical
populations. For example, IBs are associated with anxiety and/or
depressive symptoms in both college populations (e.g., Chang &
Bridewell, 1998; Muran, Kassinove, Ross, & Muran, 1989) and clini-
cal samples (e.g., Nottingam, 1992; Murran & Motta, 1993).
Unfortunately, the correlational nature of these research designs
precludes inferences regarding the causal role of IBs in distress. Do
these studies and their results support REBT theory? Supposing that
one did not find an association between high IBs and various symp-
toms––using this methodology––would that be a disconfirmation of
REBT theory and of the diathesis-stress model? The answer is ‘‘not at
all!’’ in both cases. The results obtained in these correlational and
cross-sectional designs are interesting, but they are not a direct test
of REBT theory. IBs and symptoms are supposed to be correlated
only in stressful situations. One can have high levels of IBs but be-
cause he/she has not faced stressful situations he/she will experience
no symptoms! Therefore, the lack of correlation is not a disconfirma-
tion of REBT theory, unless it is found during a stressful event that
is hypothesized to activate available IBs! A more comprehensive test
is needed, taking into account the presence/absence of activating
events and their influence on the associations found in these studies.
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2. Correlational and cross-sectional studies during stressful events
(A-B-C). By including all three hypothesized factors (i.e., event,
beliefs, response) these studies have provided a more complete test of
REBT theory and of the diathesis-stress model. IBs have been found
to be associated with negative mood during stressful situations in for-
merly depressed persons (Solomon et al., 1998), and with state and
trait anxiety in college students experiencing both high and low
stress (Chang, 1997).
The overall picture of this research is that IBs are associated with
measures of psychological disturbance. In this case too, the correla-
tional nature of the design, precludes inferences about (1) the causal
role of IBs/RBs or (2) the moderating or mediating role (for a distinc-
tion between moderation and mediation see Baron & Kenney, 1986)
of IBs/RBs on the impact of stressful events and emotional/psycholog-
ical disturbance. It is possible, for example, that both stressful events
and IBs are correlated with psychological disturbance, but IBs do not
mediate the impact of stressful events on psychological disturbance,
as the REBT diathesis-stress model would predict. The diathesis-
stress model of REBT (i.e., in stressful situations IBs produce
cognitive vulnerability, while RBs are protective) can be empirically
investigated using a 22 factorial design with stress and IBs as inde-
pendent variables. Research along this line, with stressful events
being induced experimentally (e.g., by imagining various stressful sit-
uations), has resulted in mixed findings. While Goldfried & Sobocin-
ski (1975) found support for the REBT diathesis-stress model,
Craighead et al. (1979) did not. Craighead et al. (1979) found how-
ever, that high IBs subjects produced more negative self-statements
while imagining negative events. This finding is consistent with the
REBT diathesis-stress model where the outcome measures are cogni-
tions rather than feelings. Smith et al. (1984) found no evidence for
the diathesis-stress model of anxiety in a college population when the
stressful event was taking part in an intelligence test.
This type of studies has been criticized for unjustly assuming that
they are testing the REBT diathesis-stress model because often studies
have used artificially induced stressful situations (e.g., by imagery) ra-
ther than real ones. Ellis (1994) has mentioned several times that gen-
eric events may not be relevant primers for IBs. Rather, specific events,
representing a thwarting of one’s goals, or a loss/failure relevant to
one’s psychosocial concerns are needed. Consequently, this type of stud-
ies has provided a minimal test of the REBT diathesis-stress model.
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Another strategy to test the REBT diathesis-stress model has been
to focus on real stressful events retrospectively (e.g., in the last 1 year
or 6 months). Using this framework, Hart, Turner, Hittner, Cardozo,
and Paras (1991) found support for the REBT diathesis-stress model
for hostility but not for anxiety. Chang (1997) found no support for
the REBT model in explaining depressive symptoms in college popula-
tions. However, measuring stressful events retrospectively, after long
periods of time (1 year or 6 months), significantly reduces the likeli-
hood of this type of study to test the REBT diathesis-stress model. A
diathesis-stress effect may exist during the stressful period, but may
become less relevant several months later, as emotional problems
diminish (e.g., as a result of using various coping mechanisms).
When studies have tested the REBT diathesis-stress model using
rigorous methodology, the results have been supportive of the REBT
diathesis-model. Thus, Malouff, Schutte, and McClelland (1992),
using a prospective design with real stressful events (e.g., right
before a final exam), found support for the REBT diathesis-stress
model of anxiety.
To conclude, the results of studies investigating the REBT diathe-
sis-stress model do not, as a group, give us a substantial amount of
clear information. They suggest that the REBT diathesis-stress model
can predict some outcomes (e.g., hostility) but not others (e.g., trait
anxiety). However, they also suggest that when implemented and tes-
ted correctly (e.g., in prospective designs and real stressful events),
hypotheses generated by the REBT diathesis-stress model are empiri-
cally supported. This topic deserves further research.
3. Studies of self-referent speech and self-statements. This line of
research has attempted to establish a causal role of IBs/RBs in gener-
ating various emotions by directly manipulating cognitions.
Studies of this type have systematically shown that self-referent
speech or self-statements—based on experimentally manipulated IBs/
RBs (e.g., Cramer & Fongs, 1991; Cramer & Kupskin, 1993)—are
associated with physiological and emotional indices of stress and de-
creased task performance (e.g., Schill, Monroe, Evans, & Ramanaiah,
1978). Also, studies based on other types of negative self-referent
speech (e.g., cognitions not directly expressing IBs/RBs) (e.g., Hollon
& Kendal, 1980) have provided indirect support for the REBT theory,
as IBs are reliably correlated with such negative self-statements
(Harrel, Chamless, & Calhoun, 1981). The main limitations of these
studies are that they do not address: (1) the conceptual difference
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
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between viewing IBs/RBs as core beliefs or as self-statements
produced during experimental manipulation (e.g., the transitory
nature of self-statements vs. the stability of IBs); (2) the fact that
some self-statements (e.g., cognitions not directly expressing IBs/RBs)
could be involved in emotional disorders without core IBs playing a
direct role; (3) the demand characteristics of the tasks (but see
Cramer & Buckland, 1996).
Summarizing, as a group, results based on these three lines of
research tentatively support some aspects of the REBT diathesis-
stress model. The three main criticisms of previous studies investigat-
ing the etiopathogenetic role of IBs/RBs in health and pathology
(based on the diathesis-stress model) are (1) a diathesis-stress model
can only be tested rigorously in a prospective design with (a) repeated
measures for both IBs/RBs––as mediators––using a variety of other
outcome variables (e.g., distress) and (b) manipulation of really
stressful situations. Only a few studies (e.g., Malouff et al., 1992) are
based on this type of design, and therefore the results supporting the
REBT diathesis-stress model need further replication; (2) most of the
previous studies have assumed that a high RBs score indicates a low
IBs score; as already discussed above, IBs and RBs load on two differ-
ent factors and should be measured by separate scores. None of the
studies investigating the REBT diathesis-stress model has done this;
(3) researchers have often assumed that all outcome measures
(e.g., cognitive, behavioral, physiological, emotional) should reflect the
REBT diathesis-stress model. A more pertinent question would be:
Which outcomes are more or less susceptible to the REBT diathesis-
stress model? Is it possible that some outcomes (e.g., galvanic skin
response) are more related to unconscious information processing
(e.g., conditioning) than to consciously accessible beliefs.
A Brief Description of Future Directions. Future research examining
the role of IBs/RBs in the etiology of psychopathology and emotional
disturbance should focus on
(1) Endorsement of RBs/IBs and physiological, behavioral, cognitive,
and emotional responses in individuals exposed to real-life stressful
situations; this type of research requires longitudinal and random-
ized designs.
(2) Treatment outcome studies with experimental manipulations of suf-
ficient magnitude and duration to influence both core beliefs and
self-statements.
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Preliminary Conclusion
Based on empirical studies conducted so far, we can say that
REBT is an efficacious form of psychotherapy for a large spectrum of
disorders and populations. However, as some of these studies, partic-
ularly earlier ones, have methodological problems, the conclusion
should be ‘‘tempered,’’ and it is safer to say that REBT is very
probably an efficacious form of psychotherapy. One should keep in
mind, however, that both older studies and more rigorous new stud-
ies suggest that REBT is at least as efficient as behavioral or other
cognitive-behavioral therapies. Although REBT proponents suggest
that REBT should be more efficient than other forms of cognitive-
behavioral psychotherapies because it is focused on fundamental
evaluative core beliefs, this assumption has no empirical support
(DiGiuseppe et al., 1990; Warren, McLellarn, & Ponzoha, 1988).
Considering that cognitive-behavioral psychotherapies, although
effective, have not yet reached ‘‘the desired standard’’ of efficacy and
effectiveness, as about 30–40% of people are still non-responsive to
these interventions, the efficacy and effectiveness of REBT should
get more empirical attention in order to come to a definitive answer
regarding its hypothesized superior effect. The fact that much of the
REBT outcome research has been conducted on normal populations
with sub-clinical problems can be seen as one of the strengths of this
approach as REBT is not only a clinical theory applicable to clinical
populations, but also an educational system with implications for
nonclinical and sub-clinical populations (e.g., depressed mood, lack of
assertiveness, test or speaking anxiety). Finally, although IBs seem
to be important etiopathogenetic factors in psychopathology; it is not
yet clear whether the efficacy of REBT can be attributed to the
change of IBs into RBs, as the REBT theory of change is
insufficiently studied.
OTHER REBT RESEARCH/APPLICATIONS
REBT is a general psychological theory, not only a clinical theory.
Therefore, it has stimulated applications and research in several
areas:
(1) Clinical psychology/psychotherapy and health/behavioral medicine
(see the above summary).
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
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(2) Education (e.g., rational-emotive education, rational parent educa-
tion, rational teacher education, rational mentoring). Rigorous re-
search has been conducted to empirically test the REBT theory and
practice in this field (e.g., Wilde, 1996a, 1996b, 1999).
(3) Industrial/organizational psychology (e.g., rational-assertiveness
training) (e.g., Cayer, DiMattia, & Wingrove, 1988).
(4) Pastoral counselling (e.g., Johnson & Ridley, 1992; Johnson et al.,
1994).
(5) REBT has been a prominent source of information regarding self-
help materials and personal development (e.g., Ellis & Harper,
1975). However, little research to date has empirically validated
these applications.
(6) Nonclinical populations: life-problems, optimization of human
potential (e.g., decision making, emotional control, emotional intelli-
gence), occupational stress management, REBT coaching, rational
mentoring etc. (see Johnson, Huwe, & Lucas, 2000; Lyons & Woods,
1991).
All these areas need further research in order to clearly evaluate the
scientific basis and the efficacy/effectiveness of such programs.
MISCONCEPTIONS OR UNFAIR ATTACKS? THE CASE OF REBT
RESEARCH
Lakatos (1970) has stated that mainstream science only exposes
the public to its theories and models and tries to build a protective
belt around its assumptions. Because assumptions are neither
falsifiable nor verifiable, this is an unsound practice, which keeps
debates focused on the theory and driven by empirical evidence.
REBT is a scientific form of psychotherapy, but at the same time it is
philosophically driven. Because REBT as a system exposes its philo-
sophical assumptions about life and human beings, it often arouses
defensiveness in the mainstream. Therefore, although many REBT
ideas have been incorporated into the mainstream, the source of
these ideas is often not cited in order to avoid controversy (Popa,
2001). Also, (a) REBT theory has been often misunderstood in re-
search (see David et al., 2002 for a discussion about how the REBT
theory of emotions has been misunderstood in research); (b) incorrect
predictions have been derived from the REBT theory (see Ellis &
DiGiuseppe, 1993 for a discussion about how the REBT theory of
emotions has been incorrectly tested); and (c) some of the existing
data has not been properly interpreted.
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As an example, a review reflecting all these misunderstandings
was published in the Journal of Behavior Therapy and Experimental
Psychiatry, (1992) by Robert L. Gossette and Richard M. O’Brien
from Hofstra University (a similarly flawed review on rational-emo-
tive education was published by the same authors, see Gossette &
O’Brien, 1993). The authors reviewed several studies in which sub-
jects were assigned to (a) REBT treatment, (b) no treatment, or (c)
‘‘other’’ treatment groups. Both professional studies as well as stu-
dents’ dissertations were included in the review. Each comparison of
outcome measures of REBT treatment vs. other conditions was con-
sidered a test of the efficiency of REBT treatment. A test was consid-
ered positive if the investigator concluded that the REBT treatment
group was significantly different (p<0.05) from comparison groups in
the predicted direction. Proportions (e.g., for dissertations, for publi-
cations, and total) of the outcome tests favoring REBT treatments
compared to control and ‘‘other’’ treatments were computed. At the
risk of stating the obvious, let us point out the most serious flaws in
the design of this review and in its conclusions. First, a combination
of professional papers and dissertations is not acceptable in a serious
review. It is well-known in the academic field that students usually
include several measures in their dissertations (more or less theoreti-
cally related to their main objective) in order to be sure that they get
significant results that are to be discussed in their work; measures
that prove non-significant, and that are not the main focus of the
study but rather additional aspects, can seriously alter the results.
Unless the dissertation is published, it is not considered serious sci-
entific literature. Second, REBT treatments might be very effective
for some disorders (or outcomes) and less effective and/or non-effec-
tive at all for other disorders (or outcomes). But it makes little sense
to evaluate the effects of REBT treatments in general. Instead, one
needs to evaluate the effects of REBT treatments on particular out-
comes and disorders. Third, including only significant outcomes and
disregarding samples sizes is a serious methodological flaw, particu-
larly now that top-quality textbooks on meta-analyses have been pub-
lished (e.g., Hunter & Schmidt, 1990). Fourth, stating that at present
REBT treatment appears to possess neither theoretical nor practical
justification based on the findings, and that it is more efficient than
‘‘other’’ treatments (i.e., behavioral therapy) in only 12% of the cases
(while in most of the other cases there is no statistically and/or clini-
cally significant difference between REBT and behavioral treatments
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
207

on major dependent variables) is a misrepresentation and a misinter-
pretation of the data; the correct conclusion would be that REBT
treatment is at least as efficient as behavioral treatments. Indeed,
less biased and more methodologically sound quantitative reviews
based on the same studies as those used by Gossette and O’Brien
(1992) (e.g., Engels et al., 1993; Lyons & Woods, 1991) have drawn
conclusions similar to those suggested by us, not those of Gossette
and O’Brien (1992, 1993). It is curious that Gossette and O’Brien do
not even mention these quantitative meta-analyses, nor do they
address discrepancies between their conclusions and meta-analyses
results (e.g., Lyons & Woods, 1991)! Although their biased review has
not seriously impacted the scientific community (it has only been
cited six times; one time by the authors themselves), it is unfortunate
that it is so easily accessible on PSYCHLIT and MEDLINE, as it
might bias (1) novices in the field, who are unfamiliar with REBT
and sound scientific methodology and/or (2) professionals who in the
first phase of research often screen the literature by only reading the
abstracts.
Another recent example is related to a ‘‘programmatic’’ review of
MacInnes (2004) with the goal of finding the evidence underpinning
REBT. According to the findings, there is limited evidence to support
the REBT theory. Although we agree that more research is needed to
test the REBT theory, the criteria and the method used by the
author are strange. For example, there seems to be confusion
between a random selection of participants for the study, and a ran-
domized distribution of the participants in various groups. A random-
ized distribution of participants in various groups is fundamental for
testing the REBT theory, while a randomized selection of partici-
pants from the general population would be useful to generalize the
REBT theory. Most REBT studies presented by the author as flawed
for not using randomization, have in fact used a randomized distribu-
tion of participants in various groups to rigorously test the theory
(e.g., Bond et al., 1999; Cramer & Kupshik, 1993).
Another constant criticism of REBT has come from the proponents
of cognitive therapy. Some authors for example (e.g., Padesky &
Beck, 2003) argue that REBT is mainly a philosophical therapy
rather than a scientific one. We believe this to be an epistemological
misconstruction and, again, a false representation of REBT. Let us
explain. Any psychotherapeutic system (including Beck’s cognitive
therapy) can be described at a paradigmatic level (i.e., its philosophi-
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cal assumptions), at a theoretical level (i.e., its empirically testable
hypotheses), and by referring to its models and intervention proce-
dures. In all therapies, assumptions are neither verifiable nor falsifi-
able. They are often assumed simply because an influential founder
of the paradigm has said so; moreover, they are masked and pro-
tected since sometimes they differ widely even within an apparently
homogenous theoretical enterprise. Because REBT as a system
exposes its philosophical assumptions about life and human beings, it
might feel uncomfortable to the more defensive mainstream. Further-
more, Albert Ellis seems to be one of the last psychotherapists of the
old tradition of ‘‘spiritual leaders,’’ and he is a fervent supporter of
the philosophical component of REBT. Thus, REBT seems to be both
philosophical and leader driven. Because of these two factors, REBT
as a system might be incompatible with the way the mainstream
works, and thus has not been able to fully penetrate the mainstream.
Other cognitive-behavioral therapies have had a different fate. For
example, both Aaron Beck’s and Donald Meichenbaum’s approaches
have been better assimilated into the mainstream. However, both
Beck and Meichenbaum have focused on developing theories, and
have created models that are well-supported empirically. With REBT
this is more difficult because REBT proudly exposes its philosophical
assumptions. Although many REBT ideas have been assimilated into
the mainstream (Still, 2001) the source of these ideas is sometimes
not cited in order to avoid debates regarding their philosophical
tinge. As Ellis (Popa, 2001) has noticed, this has happened many
times. However, this does not mean that REBT is philosophically ori-
ented while cognitive therapy is more scientifically oriented; as we
have said before, this is an epistemological misconstruction. Beck’s
cognitive therapy has its own un-testable assumptions (e.g., the
deterministic assumption) beyond the well-validated models and the-
ories, but they are often not exposed; moreover, they are defended by
a protective (conceptual) belt, to use Lakatos’ terms (1970). REBT
has long ago started to change its original approach, and also to
expose its theory and models, not just its philosophical assumptions.
Indeed, meta-analyses of the studies focused on current REBT theory
and intervention models (e.g., Engels et al., 1993) suggest that REBT
is very probably an efficacious form of CBT.
Finally, REBT has also been criticized by proponents of cognitive
therapy that it does not provide a differentiated understanding of the
specific patterns of cognitive processes underlying various forms of
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
209

pathology, being a monolithic therapy that is less flexible in address-
ing specific disorders (Beck, Rush, Shaw, & Emery, 1979; Padesky &
Beck, 2003). A large empirical basis exists for these specific cognitive
models of various cognitive-behavioral psychotherapies; their implica-
tions in anxiety disorders, depression, schizophrenia, and personality
disorders have been well documented (e.g., Beck & Emery, 1985; Ris-
kind, 1999). For example, the cognitive model of depression as
hypothesized by Beck et al. (1976) states that individuals have stable
cognitive patterns that develop as a consequence of early learning.
These cognitive patterns predispose people to negative interpreta-
tions of life events, which, in turn, lead depressed people to engage in
depressive behavior. Ellis (1994) differentiates between inelegant and
elegant REBT. While inelegant REBT is similar to general cognitive-
behavioral therapy in accepting the specific models, elegant REBT is
a unique kind of CBT. While REBT has recently developed specific
models for various emotional problems (e.g., David et al., 2002), the
elegant REBT line of research (Ellis, 1994) hypothesizes that only a
few dysfunctional cognitions are at the root of psychopathology and
are therefore, involved in the development of psychological problems
in stressful situations (Ellis, 1994). More precisely, in elegant REBT,
while recognizing the specific cognitive models, Ellis (1994) describes
the core of psychopathology as consisting of a few basic IBs; both
symptomatology and the specific cognitions described in various
specific models are the product of these core IBs. This reductionistic
approach is similar to the neurosciences approach where a whole
range of psychopathology is reduced to several neurotransmitters and
their interactions! According to REBT challenging the core IBs is
accompanied by a reduction in both symptomatology and in cogni-
tions described in specific models (DiGiuseppe, 1996; Dryden et al.,
1989; but see Bond and Dryden, 2000). In the case of depression for
example, Ellis (1987) has argued that previous specific theories lack a
crucial cognitive component––demandingness (DEM). According to
Ellis (1987), the other cognitive models of depression (e.g., Beck,
1967; Rehm, 1977; Lewinsohn, 1974; Seligman, 1975, 1981) probably
explain how people make themselves sad when suffering major losses
and inconveniences. Only the IB of DEM, however, differentiates peo-
ple’s appropriate feeling of sadness from their dysfunctional feeling of
depression. REBT is focused on this crucial component in depression
(i.e., DEM) and its main derivate (self-downing––SD) that contribute
to an understanding of the causative factors in depression. In a reply
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to Ellis, Marzillier (1987) and then Brown and Beck (1990) argue
that DEM can be a component of depression, but that it is not
specific and sometimes even not necessary. If identified, DEM is dis-
puted in cognitive therapy along with other schemas. According to
CT, DEM is one of the core beliefs sometimes readily recognizable in
depression (Beck et al., 1979). Beck et al., (1979) mention that cogni-
tions recorded by patients as homework, as well as verbalizations
during therapy sessions, contain a high frequency DEM. However,
DEM is not always necessary for depression, and is identifiable by
current CT strategies. On the other hand, Ellis (1987, 1994) insists
that DEM is always a component in depression and that more effort
is necessary to identify it than is made in CT. Sometimes DEM is im-
plicit or is not consciously accessible because of defense mechanisms.
This is why, compared to CT, REBT places a special focus on identi-
fying DEM. Interestingly, recently, Solomon et al. (2003), using indi-
vidualized measures of IBs (i.e., DEM) found that DEM seems to be
the core belief in major depression. Thus, the failure of REBT to
account for different emotional reactions may be a myth. David et al.
(2002) have shown how different IBs are combined in different emo-
tional reactions (see Table 1). Moreover, IBs may refer to the well-
known construct of ‘‘negative affectivity’’ (it has been established that
measures of emotional disturbance factor together see DiGiuseppe,
1996) and thus, core IBs may be involved in generating both symp-
tomatology and specific cognitions described in specific models of
psychopathology.
While it is true that REBT research has many shortcomings (some
of them explicitly presented here) it is unfortunate that they are
sometimes exaggerated and presented in such an unfair and biased
manner. Ironically, Gossette and O’Brien state in their article that
‘‘previous reviews [of REBT] have generally been quite partisan and
subjective, and have not reflected available research’’! We believe
that the weak points of REBT research should be exposed and criti-
cized in order to improve REBT theory and practice. We have tried to
do this in our synopsis. However, the overgeneralization and/or mag-
nification of the negative, and the minimization of the positive are
dysfunctional beliefs that maintain the ‘‘wisdom’’ in the field that
REBT has few empirical studies and that REBT research is in
serious trouble. We have tried to avoid them by explicitly presenting
both the positive aspects and strengths of REBT research and its
weakness. A balanced and more scholar approach such as this is
Daniel David, Aurora Szentagotai, Kallay Eva, and Bianca Macavei
211

much more probable to stimulate rigorous research in the theory and
practice of REBT.
FINAL REMARKS
Based on an extensive review of REBT fundamental and applied
research, we believe that (a) REBT theory has been many times mis-
understood in research, (b) incorrect predictions have been derived
from this research, and (c) some of the existing data has not been
properly interpreted. We do not agree with the ‘‘wisdom’’ in the field
that REBT has few empirical studies and that REBT research is in
serious trouble. As this review shows, this is myth! If one eliminates
the ‘‘noise,’’ a tentative conclusion is that high-quality studies tend to
support REBT basic theory and efficacy. However, to strengthen this
conclusion and to fully explore the potential of REBT, shortcomings
of REBT research presented here need to be corrected, and high-qual-
ity studies better promoted. This is particularly important since
cognitive-behavioral psychotherapies seem to be somewhat stuck, as
although effective, the efficacy and effectiveness of these therapies
has not yet reached ‘‘the desired standard,’’ as about 30–40% of peo-
ple are still non-responsive to these interventions Thus, REBT could
be a platform of reinvigorating empirical studies on the efficacy/effec-
tiveness and theory of cognitive-behavioral models of psychopathology
and human functioning.
ACKNOWLEDGEMENTS
We would like to acknowledge Maria Avellino, Mount Sinai School of
Medicine, USA, and Ryan Fuller, Albert Ellis Institute, USA, for their
assistance in conducting this review. Also, we want to acknowledge the
contribution of reviewers to this final form of the manuscript. Their exposi-
tional and scientific suggestions were very helpful.
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Anderson, J. R. (2000). Cognitive psychology and its implications (5th edn.).
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