Outcome Studies of Rational-Emotive Therapy David A. F Haaga Gerald C. Davison INTRODUCTION This chapter provides a qualitative review of treatment outcome studies of rational-emotive therapy (RET; Ellis, 1962) and a variant of RET, systematic rational restructuring (SRR; Goldfried, Decenteceo, & Weinberg, 1974). We have organized studies according to the type of problem or dis- order being treated. This should maximize the utility of the information for clinical decision-making. Confronted with a client of Type X, what can existing data say about the likely utility of a rational-emotive treatment? Although communication might be best served by fitting problems into DSM-III (American Psychiatric Association, 1980) categories (Kazdin, 1986b), many outcome studies of RET and SRR resist such classification, either because the subjects were subclinical or because the target problem is not a DSM-III category. A Caveat Unlike systematic desensitization and even the more complex cognitive therapy of Beck, Ellis's rational-emotive therapy is less clearly operationally I NSIDE RATIONAL-EMOTIVE THERAPY 155 Copyright © 1989 by Academic Press, Inc. All rights of reproduction in any form reserved. 9 156 David A. F. Haaga and Gerald C. Davison specified than one might hope for in making in-depth outcome com- parisons as we do in this chapter. Another way to formulate the problem is that the independent variable of RET is very variable indeed. Clinical supervisors have long been aware of this, and Ellis himself is certainly not unaware. The consequence for this review chapter is that the com- parison of results from Study A and Study B will necessarily suffer from the strong possibility that Ellis's principles were not implemented in the same or even closely similar fashion. What we do know and understand is that RET is much more than just telling the client that she or he is thinking irrationally and would be better off thinking differently. Assuming that Ellis is correct in his theory of personality and personality change, we would expect that anyone who could change his or her thoughts (and therefore emotions and behavior) only upon being explained the theory and told what changes to make is a person who does not have the kind of psychological problem that brings people to see a mental health professional. Wherever possible we specify aspects of the therapy conducted. But we are more often unable to go much beyond statements of how many ses- sions of RET clients had. Indeed, most of the published articles themselves contain little operational information. QUALITATIVE REVIEW OF OUTCOME RESEARCH General Problems (Children) Nonclinical Subjects RET has been adapted to a psychoeducational format for children and adolescents in the form of rational-emotive education (REE; Knaus, 1974). REE tries to teach the general cognitive rationale that thoughts influence feelings, the distinctions between rational and irrational thinking, some common irrational beliefs, and ways to handle difficult situations such as being teased by peers or making mistakes. Class discussions, lectures, and stories help to convey concepts such as that situations evoke different feelings in different people (and therefore cannot be the only cause of our reactions), and that to make mistakes is human and does not justify global negative self-evaluations. First we consider REE studies involving unselected samples but using clinically relevant dependent measures such as anxiety and self-concept. Cangelosi, Gressard, and Mines (1980) found a 24-session "rational think- ing group" treatment superior to a placebo treatment (loosely structured group discussions) and no treatment in improving self-reported self-