EFFECTS OF LECTURE, REHEARSAL, WRITTEN HOMEWORK, AND IQ ON T H E EFFICACY O F A RATIONAL EMOTIVE SCHOOL MENTAL

HEALTH PROGRAM* NORMAN MILLER AND HOWARD KASSINOVE

Hofstra Universit,y

The effect of a rational emotive school mental health program on irrational ideation, neuroticism, and trait anxiety was examined. Ninety-six fourth grade children of high or lower IQ served as subjects. They were given twelve group sessions of rational emotive mental health education (REE) in one of the following conditions: REE lectures, REE lectures plus behavior rehearsal, REE lectures plus rehearsal and “A-B-C” homework sheets, no contact control. The results indicated clear support for the efficacy of rational emotive education, especially with the added behavioral components. There was no indication that intelligence, within the range studied, significantly affects a child’s ability to profit from the program. Implications and suggestions for further research are given.

The growing need for psychological services, combined with the limited number of available professionals, leads to the conclusion that many people will not receive the treatment they need. It is economically unwise to focus on the servicing of an evergrow- ing number of disturbed persons (Harper & Balch, 1975). Primary prevention, rather than treatment, seems to be the most effective way of making an impact on the nation’s mental health problems (Korchin, 1976). Recognizing this, a number of school mental health programs have been developed (DiGiuseppe & Kassinove, 1976; Ivey & Alshuler, 1973; Spivack & Shure, 1974) to help normal children acquire coping skills to deal with life’s frustrations. Because the children are required to attend on a continual basis and because they are programmed to learn in this environment, the schools are an ideal loca- tion for initiating such programs.

The mental health program used in this study is based on a model derived from Rational Emotive Therapy or RET (Ellis, 1962, 1974; Ellis & Harper, 1976). RET postulates that emotional disorders arise from faulty and irrational patterns of thinking. Emotional disturbance is not thought to be caused by external events, as would be postulated by psychodynamic and pure stimulus-response models, but by one’s evalua- tion, attitudes, and beliefs about the external events. Rational therapists have identified 11 commonly held irrational beliefs (Table 1) which are pervasive in school children (Kassinove, Crisci, & Tiegerman, 1977), and which are thought to account for a large number of emotional and behavioral disorders. These beliefs fall into three categories: “awfulizing” statements which exaggerate reality; “shoulds, oughts, and musts,” which reflect unrealistic demands and an absolutistic way of perceiving the world; and statements of blame, aimed at one’s self or others.

Experimental evidence and case studies have indicated that rational emotive therapy is an effective form of intervention for a variety of emotional and behavioral disorders (DiLoretto, 1971; DiGiuseppe, Miller, & Trexler, 1977; Ellis, 197 1; Kassinove, 1972; Meichenbaum, Gilmore, & Fedoravicius, 1971; Moleski & Tosi, 1976; Trexler & Karst, 1972). A number of studies have supported the basic premise that greater endorsement of RET’s 1 1 irrational beliefs is related to increased maladjustment (Laughridge, 1975;

*Reprint requests should be directed to Howard Kassinove, Dept. of Psychology, Hofstra University, Hempstead, N. Y. 11550.

366

EIIICACY OF A R A T I O N A L EMOTIVP S C H O O L M E N T A L H F A L r H P R O G R A M 367

TAHLE 1. RET‘s Irrational Beliefs

People need the love or approval of almost every one they consider important. It’s awful when things are not the way one wants them to be. It’s easier to put off some responsibilities and difficulties rather than face them directly. One should be upset over other people’s problems and difficulties. To be a worthwhile person, we should be thoroughly adequate, achieving, and competent in almost all ways. Unhappiness is caused by people or events around us and we have almost no control over it. We need to be dependent on others and on someone stronger than ourself. It’s awful when we can’t find the right or perfect solution to our problems. People who are bad and wicked should be blamed and punished. When something is dangerous and causing great concern, we should constantly think about the possibility of its occurrence. Many events from our past so strongly affect us that i t is impossible for us to change.

McDonald & Games, 1972; Newmark, Frerking, Cook, & Newmark, 1972). Based on this evidence, rational therapists help their clients to adjust better by decreasing their en- dorsement of irrational ideation.

Rational emotive education (REE) is a direct extension of rational emotive therapy. Because RET is a didactic form of intervention, the concepts, principles, and philosophy are well-suited for classroom presentation. Children are taught to ahallenge the 11 irrational beliefs, and to replace them with constructive alternatives. In addition, they are reinforced for the acquisition of a number of RET concepts and principles (Ellis, 1973) which are thought to lead to increased mental health. These include self-acceptance, acceptance of uncertainty, the belief that all humans continually make mistakes, a risk- taking attitude, etc. Specific lessons are included to help children cope with disappoint- ment and frustration.

The effectiveness of REE has been demonstrated at the elementary school level in a number of studies (DiGiuseppe & Kassinove, 1976; Knaus & Bokor, 1975). However, because R E E is a complex system consisting of behavioral, cognitive, and emotive com- ponents, it is important to determine which of these components lead to the most ef- ficient and effective treatment package.

The present study investigated the efficacy of REE lectures and the components of behavior rehearsal and written R E E homework sheets in children of higher and lower in- telligence. I t was predicted that children who received REE lectures would demonstrate less endorsement of irrational beliefs, less neuroticism, and less trait anxiety than would children in the no-contact control group. It was also hypothesized that the components of behavior rehearsal and written homework sheets would have an additive effect when combined with REE and with each other. Finally, it was hypothesized that higher I.Q. children in the treatment groups would demonstrate greater changes towards more rational thinking, less neuroticism, and lowered trait anxiety than would lower I Q children.

368 NORMAN MILLER AND HOWARD KASSINOVE

METHOD Participants and design. The sample consisted of 96 fourth grade children drawn

from suburban, middle-class neighborhoods. Four intact classes were used. Children in the three experimental groups were drawn from a Catholic elementary school, while the control group children came from a public school.

A 4 X 2 (Treatment X Intelligence) pretest-posttest unequal ns design was used. There were four treatment conditions: (1) Rational Emotive Education (REE), (2) Rational Emative Education plus Behavior Rehearsal (REE + BR), (3) Rational Emotive Education plus Behavior Rehearsal and Written Homework sheets (REE + BR + HW), and (4) no-contact control. The parochial school which was available to the authors had only three fourth grade classes. It was decided to deliver the treatments to those children and to select a no-contact control group from another school with similar community characteristics. Each of the three treatment classes was randomly assigned to one treatment condition.

I.Q. scores were obtained from each child’s school record. Fortunately, both of the schools used the same test (Cognitive Abilities Test, Thorndike & Hagen, 1971) and both had administered it approximately two weeks prior to the pretesting of this study. However, results were not made available to the experimenters until the study was completed. The effect of intelligence was examined by finding the mean I.Q. for the entire sample ( M = 112.4). Children in each of the four classes were then divided into a higher or lower I.Q. group based on this overall mean. Thus, each group had unequal ns. The higher I.Q. groups ( M = 125.2) were significantly different from the lower I.Q. groups ( M = 102.4; F (1, 95) = 9.69, p < .05). However, within each condition there were no significant differences.

Procedure. Children in the three REE conditions were taught by the first author for one hour, one day a week for a total of 12 weeks. The children in the control group remained in their regular class and experienced the normal academic routine. The depen- dent variables were first administered in class prior to the beginning of the study and then after the 12 treatment sessions.

Each of the treatments focused on the basic tenets of RET theory, particularly on the premise that human unhappiness and emotional upset are caused by our own thoughts. Children were led to believe that happiness could be obtained through ex- amination of their own attitudes and beliefs.

Rational emotive education. In this group, a classroom lecture approach was utilized. Each lesson began with a 20-minute lecture, followed by class discussion. The lessons used were developed from the work of Knaus (1974), and DiGiuseppe and Kassinove (1976), with modifications by the first author.*

Major emphasis was placed on acquisition of the basic principles of RET. Children were taught how thoughts control feelings, and were asked to specifically examine RET’s 11 irrational beliefs within the context of how they contribute to self-defeating behavior patterns. They were presented with a philosophy of life based on the concepts of self- acceptance, risk taking, discrimination of wants and demands, acceptance of reality (including mistake-making potentialities), and the uncertainty of life (Ellis, 1973).

To help children acquire these principles, the A-B-C analysis of emotional upset was utilized. That is, children were shown that phenomenologically upsetting experiences can be broken down into three parts: A-the activating event or action; B-some rational or

* A full copy of the lessons is available upon request.

EFFICACY OF A RATIONAL EMOTIVE SCHOOL MENTAL HEALTH PROGRAM 369

irrational belief about the activating event, and C-the consequence, which is usually some emotional and/or behavioral response. Using this paradigm, the children were shown that A does not directly lead to C. Rather, emotional upset arises primarily from their beliefs at point B. Examples of rational and irrational beliefs, and the appropriate or ex- cessive emotions that they are likely to generate were given at each session.

R E E plus behavior rehearsal. In addition to the procedures utilized in group one, these children were also given scripts of emotionally upsetting events to role play and rehearse before the entire class. The plan for each meeting included an REE lecture which was followed by script reading and role playing. During script reading, children were chosen to read lines from a prepared interaction. They would stand before the class and model and rehearse rational thinking and talking. During role playing, the children were given a problem to solve according to REE principles, without a prepared script. Sometimes the experimenter would pretend to have a problem and would ask the children to help him ferret out his irrational self-talk. At all times the experimenter gave guidance and reinforcement for verbalizations appropriate to RET theory.

R E E plus behavior rehearsal and written homework. In addition to the components described for group 2 , these children were required to systematically use A-B-C homework sheets. The homework sheet was originally developed by Ellis (1971) to help clients analyze emotional upset in a concrete, written format. A children’s version, with appropriate language, problem content, and pictorial stimuli was developed for this study. Each child was instructed how to use the sheets correctly and was asked to com- plete one sheet per session, beginning with session four. All homework sheets were cor- rected and written feedback was given at the next session. Particular emphasis was placed on helping the children to properly discriminate between rational and irrational beliefs.

Dependent measures. Four dependent measures were used. Two tests of content acquisition were employed to determine whether the children actually had learned the REE principles. These included the Idea Inventory (Kassinove, Crisci, & Tiegerman, 1977) and the Children’s Survey of Rational Beliefs (Knaus, 1974). The Idea Inventory is a 33-item Likert scale measuring the endorsement of RET’s 11 irrational beliefs. Higher scores indicate disagreement with components of the irrational beliefs and, therefore, better adjustment. The Children’s Survey of Rational Beliefs, an 18-item multiple choice test, measures knowledge of the principles covered in the program. Higher scores in- dicate greater recognition of rational emotive concepts.

To measure the children’s level of adjustment, the neuroticism scale of the Junior Eysenck Personality Inventory (Eysenck, 1965) and the trait anxiety scale of the Children’s State-Trait Anxiety Inventory (Spielberger, Edwards, Montouri, & Lushene, 1973) were utilized. These two tests were included in order to measure changes in emotionality, and because their development was not related to RET. For the treatments to be deemed fully effective, it was hoped that changes would occur not only on measures of adjustment related to RET, but also on those which are not directly related to the rational emotive model.

On each dependent measure, for each child, a pretest to posttest difference score was computed. Each difference score thus represented a change attributed to the passage of time and/or the effects of treatment.

RESULTS The four dependent measures were each analyzed in an unequal ns analysis of

variance. The harmonic mean solution for unequal ns was employed. Table 2 presents the

370 N O R M A N MILLER A N D H O W A R D KASSINOVE

TABLE 2. Differeirce Score Meails aird Standard Deviatioiw oil the Idea Inveiitory, Children’s Survey of Rational

Beliefs, Neuroticism Scale, atid Trait Atixiety Scale

REE plus REE plus Behavior

No-Contact Behavior Rehearsal Control REE Rehearsal and Homework M S D M S D M S D M S D

Idea Inventory Higher IQ Lower IQ Total

Children’s Survey of Rational Beliefs

Higher IQ Lower IQ Total

Neuroticism Higher IQ Lower IQ Total

Trait Anxiety Higher IQ

Lower IQ Total

+2.8 9.0 -3.6 8.5 - .5 8.3

+11.7 + 7.4

+ 9.6

6.6 11.8

10.5

+ 7.2 +11.1

+ 9.2

8.5 9.8

9.1

+ 16.4 +12.4

4- 14.4

9.1 10.1 9.3

-1.5 3.9 - .9 3.1

-1.2 3.5

+ 3.9

+ 1.9 + 2.9

2.8

2.9 2.8

+ 4.1 + 4.4 + 4.3

5.0

2.8 3.9

+ 4.1

+ 4.9 + 4.5

3.7 4.1 4.4

-1.9 3.7

+1.1 6.0

- .5 4.8

- 3.5 - 2.1

- 2.8

2.5 3.8

3.2

- 6.6

- 4.2 - 5.4

6.0 6.0

6.0

- 6.1

- 4.9 - 5.8

4.8

2.3 4.8

+ .6 4.3 - .2 6.1

+ .2 5.1

- 2.7 - 3.2 - 3.0

5.8 7.5 6.5

- 3.1 - 4.9 - 4.0

7.1 4.5 5.7

- 3.6 - 4.5 - 4.1

5.9 5.6 5.1

difference score means and standard deviations for each group on each dependent variable.

The analysis of variance of Idea Inventory difference scores showed a significant main effect for treatment, F (3, 88) = 9.60, p < .01. Duncan’s multiple range test (Winer, 1971) indicated significantly greater difference scores for each of the three treatment groups as compared with the no-contact control. Additionally, a greater change was found in the REE plus behavior rehearsal and homework group when compared with the other two treatments. Thus, while all three treatment groups appear to have acquired rational emotive principles, the full treatment package was most potent. The analysis of variance also showed a significant main effect for intelligence, F (1,89) = 4.14, p < .05. Children with higher I Q s, over time, seemed to have produced greater change scores than did children with lower IQs.

The analysis of variance of difference scores on the Childrens’ Survey of Rational Beliefs also showed a significant main effect for treatment, F (3, 88) = 13.3, p < .01. Duncan’s multiple range test indicated that each of the three REE groups had greater changes than that of the no-contact control. However, there were no differences among the three treatment groups. No other significant sources of variance were found.

EFFICACY OF A RATIONAL EMOTIVE SCHOOL MENTAL HEALTH PKOGKAM 371

The analysis of variance of neuroticism scale difference scores showed a significant main effect for treatment, F (3, 88) = 4.86, p < .01. Duncan’s multiple range test indicated that each of three REE groups had significantly greater reductions on neuroticism when compared to the no-contact control. In addition, the REE plus behavior rehearsal and homework group was significantly different from the REE group. Again, it appears that the total treatment package had the strongest effect in reducing neuroticism, although each of the treatments was effective. The analysis of variance also showed a significant main effect for intelligence, F (1, 88) = 7.8, p < .01. Over time, higher I.Q. children showed greater reductions in neuroticism than did the lower I.Q. children.

The analysis of variance of the trait anxiety scale difference scores showed a significant main effect for treatment, F (3, 88) = 2.95, p < .05. Duncan’s multiple range test indicated that the REE plus behavior rehearsal and homework group, and REE plus behavior rehearsal group were each significantly different from the no-contact control. However, the REE alone group was not different from the no-contact control. On this dependent measure, the addition of the behavioral component was critical if trait anxiety was to be reduced. There were no other significant sources of variance.

DISCUSSION The results of the present study provide clear support for the efficacy of rational

emotive education at the elementary school level. A full REE treatment package, as compared to no treatment or partial treatment, led to significant results on all four dependent variables. This finding is in accord with prior research showing REE to be more effective than no program or an alternate mental health program at the elementary school level (DiGiuseppe & Kassinove, 1976; Knaus & Bokor, 1975).

In the present study the full treatment consisted of rational emotive education lec- tures, behavior rehearsal, and the completion of written homework sheets. On the Idea Inventory and on the Neuroticism scale, this full treatment package led to significantly greater gains than did the presentation of REE lectures alone. In addition, the groups receiving behavior rehearsal, or behavior rehearsal and homework, were significantly better than the no-contact control on all four dependent measures. Thus, schools con- sidering the development of mental health programs based on rational emotive theory are urged to include behavioral components to increase the effectiveness of such programs.

The present results are supportive of the combination of rehearsal and homework, but do not clearly support either of these components taken singularly. In the design we used, for homework to be deemed an effective component, the group receiving behavioral rehearsal and homework would have to be significantly better than the group receiving behavior rehearsal but not homework. That result occurred only on the Idea Inventory. However, it would have been a more direct test of the contribution of homework sheets if there was an REE plus homework group which did not have a behavior rehearsal compo- nent. It is possible that the effects of homework were limited because it was added on to a treatment package which already consumed much of the experimenter’s time and the students’ efforts. Thus, the unique contribution of the sheets may have been masked. A further study with an REE plus homework sheet group is recommended.

For behavior rehearsal to be deemed an effective component, the group receiving it would have to be better than the REE lecture group. That result did not occur on any of

372 NORMAN MILLER AND HOWARD KASSINOVE

the dependent measures. However, on the trait anxiety scale both groups receiving behavior rehearsal (with or without homework) were better than the no-contact group, while the REE lecture group was not better than the no-contact group. Indirectly, this may be interpreted as mildly supportive of rehearsal.

Overall, our findings seem to favor the inclusion of behavioral components in rational emotive school mental health programs. This conclusion is consistent with the original therapy recommendations of Ellis (1962). He noted that for people to improve, psychotherapists would best ferret out their irrational ideas, and help them to act in ways to counterpropagandize those ideas. In rational emotive education, the lectures serve to identify commonly held irrational beliefs, while behavior rehearsal and written homework can help the individual actively challenge them.

The variable of intelligence does not appear to be related to treatment effectiveness. On all four dependent measures, the predicted interaction between treatment and in- telligence was not significant. This finding is inconsistent with the writings of Ellis (1962) who said, “Highly intelligent patients . . . seem to improve more quickly and more significantly. . . than do moderately intelligent or relatively stupid patients” (p. 372). However, it is noteworthy that the intelligence range used in this study is not inclusive of truly low I.Q. children (The lowest I.Q. sampled was 85, and the mean of the lower group was 102). Additional research is called for to investigate the effects of various REE programs on truly low I.Q. children in an effort to determine a score below which the program effects do not hold.

A number of other limitations in the current investigation emphasize the desirability of more research. Since most studies to date have employed self-report measures, the utilization of observational, behavioral, or physiological dependent variables is recommended. REE is a cognitive-humanistic-existential form of intervention. Thus, self-report measures are most appropriate to use. However, if support can be obtained for the efficacy of REE on measures assessing these alternate aspects of the human ex- perience, then the credibility of the program would be significantly enhanced. Similarly, a short- to moderate-term follow-up (impossible to do in the present study because of practical limitations) is also suggested for future research. Preventive mental health is a primary goal of the rational emotive model, and only a longitudinal study could ade- quately assess whether the acquired RET principles endure over time, and whether they actually prevent future emotional disturbance and behavioral dysfunction. Finally, since the emphasis of the present study was on prevention rather than treatment, a “normal” population was utilized. This, of course, provides little data for the support of REE with emotionally handicapped or physically disabled children. While the authors believe that REE would be an effective treatment with maladjusted children, controlled studies in- vestigating the efficacy of REE on special populations are called for.

In general, the results of the present study support the effectiveness of rational emotive education. While further research is desirable, we can recommend rational emotive education as an effective mental health program for elementary school children.

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