Final Answer

A Systematic Review of Rational Emotive Behavior Therapy (REBT) Interventions Outline
1. Article Summary
2. Research Question
3. Hypotheses Tested
4. Methods
5. Results
6. Key Implications
7. Conclusion
8. References


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A Systematic Review of Rational Emotive Behavior Therapy (REBT) Interventions

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Rational Emotive Behavior Therapy (REBT) Interventions Systematic Review

REBT, by Albert Ellis, improves emotional and mental health. This data can be applied
in many walled domains, including education, healthcare, or organization, demonstrating that
data is adaptable and robust. A systematic review of 162 studies is performed, using which
researchers combine results to evaluate the efficacy of REBT interventions and identify
characteristic applications that are successful. This paper examines how theory review – in this
case, REBT – helped to develop our thinking about what can be considered 'effective,' the
methodological underpinnings of REBT, and how this could inform future research and practice.

Article Summary

Rational Emotive Behaviour Therapy explores its efficacy in education, healthcare, and
organizations. Measurement of irrational and rational beliefs across 162 studies of interventions
between 1972 and 2023 that used measured interventions and valid measures of irrational and
rational beliefs are reviewed. Results indicate that probabilities of irrational belief decrease and
the probability of rational belief increases dramatically; however, mental health outcomes,
particularly reducing anxiety and depression, are improved. Trained practitioners using the ABC
framework and longer durations are characterized as the most effective interventions. The review
has made its contribution, but we discuss its assessment of methodological limitations in
intervention design, participant reporting, and measurement of rational beliefs, which point to the
necessity for future research to continue to rigorously and impactfully advance these
interventions.

Research Question

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The primary research question addressed in the article is: "What is the methodological
quality, effectiveness, and efficacy of Rational Emotive Behaviour Therapy interventions in
reducing irrational beliefs, increasing rational beliefs, and improving broader outcomes such as
mental health?"

Hypotheses Tested

Specifically, the review hypothesized that REBT interventions reduce irrational beliefs,
increase rational beliefs, and increase mental health outcomes more broadly. The authors also
speculated that specific intervention characteristics, including practitioner training, adherence to
the ABC framework, and intervention length, would show the relationship to higher efficacy.

Methods

Our systematic review followed rigorous PRISMA guidelines and complied with
systematic review guidelines to give a complete and transparent look at Rational Emotive
Behaviour Therapy (REBT) interventions. A literature search was carried out on comprehensive
databases like PsycARTICLES, PsycINFO, Scopus, SPORTDiscus, and PubMed, which earlier
search was done in December 2023. Studies were reviewed to determine whether they used
validated measures of irrational and rational beliefs and pre- and post-intervention assessments to
evaluate REBT's core mechanisms of change. Diverse participants were reviewed, from
nonclinical adults in educational or occupational settings to clinical populations in healthcare
contexts. Interventions were similarly heterogeneous in format and delivery mode (one-on-one
versus group examples, face-to-face versus hybrid, or technology-assisted formats).

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The studies included independent variables, such as crucial intervention characteristics,
including the use of the ABC framework, practitioner training level, and frequency and duration
of intervention. They collected dependent variables of the changes in irrational and rational
beliefs and broader outcomes like improvements in mental health, including reducing anxiety
and depression. The data were qualitatively analyzed to provide insight into the strength of the
interventions' effect, and effect sizes were calculated where sufficient data were available. The
studies were assessed regarding their methodological quality using the Mixed Methods Appraisal
Tool (MMAT), and variations were found across domains, with the sport and exercise fields
identified as having the highest rigor. By incorporating this comprehensive approach, we were
able to synthesize findings in a detailed way and identify gaps in future research attention.

Results

Most studies showed significant reductions in irrational beliefs and increases in rational
beliefs. Such improvements were also seen in reduced anxiety and depression—consistently
more effective interventions involved delivery by trained practitioners using the ABC framework
over longer durations. While the rigor of studies varied, the sport and exercise domain was the
most methodological. Less often than you might imagine, measurements were made of rational
beliefs instead of irrational ones, representing a fundamental gap in the literature.

Key Implications

This finding leads REBT to be effective in the therapeutic modification of beliefs and in
improving mental health. Specifically, they emphasize the need for practitioner training, a
structured framework, and the necessity of a sufficiently long intervention duration to achieve

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success. The few studies to date should focus on developing more robust measures of rational
beliefs, better reporting practices, and using technology-assisted delivery to make the material
more accessible and scalable. By addressing these gaps, researchers and practitioners can
enhance REBT's theoretical foundation and practical application.

Conclusion
This paper’s systematic review of the systematic Rational Emotive Behaviour Therapy
interventions shows that this practice reduces irrational beliefs and enhances reasonable beliefs
and mental health advantages in various sectors. Effective interventions for practitioners involve
practitioner competence, the ABC model, and adequate time for the intervention. The current
study of REBT shows promising results; however, there are some areas for improvement
regarding applied methods, lack of reported findings, and empirical assessment of rational
beliefs. When these challenges are tackled, then and only then can REBT grow to become the
best model of therapy that has significant effects on the clients' lives.

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References

King, A. M., Plateau, C. R., Turner, M. J., Young, P., & Barker, J. B. (2024). A systematic
review of the nature and efficacy of Rational Emotive Behaviour Therapy interventions.
PLOS ONE, 19(7), e0306835. https://doi.org/10.1371/journal.pone.0306835


PLOS ONE
RESEARCH ARTICLE

A systematic review of the nature and efficacy
of Rational Emotive Behaviour Therapy
interventions
Ailish M. King ID1, Carolyn R. Plateau1☯, Martin J. Turner ID2☯, Paul Young ID1, Jamie
B. Barker1☯*
1 School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire,
United Kingdom, 2 Department of Psychology, Institute of Sport, Manchester Metropolitan University,
Manchester, United Kingdom
☯ These authors contributed equally to this work.
* J.B.Barker@lboro.ac.uk

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OPEN ACCESS
Citation: King AM, Plateau CR, Turner MJ, Young
P, Barker JB (2024) A systematic review of the
nature and efficacy of Rational Emotive Behaviour
Therapy interventions. PLoS ONE 19(7): e0306835.
https://doi.org/10.1371/journal.pone.0306835
Editor: Rogis Baker, Universiti Pertahanan Nasional
Malaysia, MALAYSIA
Received: May 10, 2024
Accepted: June 23, 2024
Published: July 9, 2024
Copyright: © 2024 King et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the manuscript and its Supporting
Information files.
Funding: The author(s) received no specific
funding for this work.
Competing interests: The authors have declared
that no competing interests exist.

Abstract
In the absence of a single comprehensive systematic review of Rational Emotive Behaviour
Therapy interventions across all settings, we reviewed the methodological quality, effectiveness and efficacy of Rational Emotive Behaviour Therapy interventions on irrational/rational
beliefs. We explored the impact of Rational Emotive Behaviour Therapy on wider outcomes
(e.g., mental health) and identified the characteristics of successful interventions. PsycARTICLES, PsycINFO, Scopus, SPORTDiscus, and PubMed were systematically searched
up to December 2023 with 162 Rational Emotive Behaviour Therapy intervention studies
identified which included a validated measure of irrational/rational beliefs. Where possible,
effect size for irrational/rational belief change was reported and data was analysed through
a qualitative approach. Using the Mixed Methods Appraisal tool, methodological quality
within the Sport and Exercise domain was assessed as good, whilst all other domains were
considered low in quality, with insufficient detail provided on intervention characteristics and
delivery. Most studies were conducted in the United States, within the Education domain,
and assessed irrational beliefs in non-clinical adult samples. Overall, studies reported significant reductions in irrational beliefs, increases in rational beliefs and improvements in mental
health outcomes (e.g., depression). More successful interventions were delivered by trained
Rational Emotive Behaviour Therapy practitioners, adopted the ABC framework and were
longer in duration. We highlight the importance of designing and conducting rigorous future
Rational Emotive Behaviour Therapy research to generate clearer insights as to its impact
on irrational/rational beliefs and mental health outcomes.

Introduction
Rational Emotive Behaviour Therapy (REBT) was developed by Albert Ellis in the 1950s [e.g.,
1], as arguably the first cognitive behavioural therapy (CBT; [2]). REBT was initially devised as
a psychotherapeutic approach for use within clinical settings. It has since been applied across
numerous domains, such as education [e.g., 3], counselling [e.g., 4], health [e.g., 5],

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occupational [e.g., 6], sport [e.g., 7] and exercise [e.g., 8]. Given the expansion of empirical
research detailing the potential effectiveness and efficacy of REBT interventions globally and
across domains, there is a need to provide a comprehensive and systematic synthesis of REBT
interventions. In doing so, it is hoped to drive innovation and rigour in methods and REBT
intervention development across research and applied practice globally and across domains.
A key premise of REBT is that one’s beliefs are at the heart of their emotional and behavioural reactivity. Beliefs are tacit and evaluative notions or ideas regarded as true, which are
triggered in response to an event [9]. In REBT, there are two superordinate categories of belief,
namely irrational and rational beliefs. Irrational beliefs are rigid, illogical and incongruent
with reality. They underpin unhealthy negative emotions, dysfunctional cognitions, maladaptive behaviours and sabotage goal achievement [9–11]. In contrast, rational beliefs are flexible,
logical and congruent with reality. They result in healthy negative emotions, functional cognitions, adaptive behaviours and facilitate goal achievement [9, 11]. Irrational and rational beliefs
are the proposed primary mechanisms of change within REBT interventions [12]. In REBT,
irrational beliefs are identified, disputed and weakened, whilst rational beliefs are developed
and strengthened [13, 14] for the ultimate goal of emotional, cognitive and behavioural health
and functionality thereby facilitating goal achievement (see [9, 15] for further information).
To date, the effectiveness (i.e., studies conducted in real-world naturalistic settings [16])
and efficacy (i.e., studies conducted in ideal and controlled circumstances, such as randomised
control trials [16]) of REBT interventions have been summarised by five meta-analyses, all of
which reported REBT interventions to be an effective form of psychotherapy for non-clinical,
sub-clinical and clinical populations across a range of outcomes including irrational and/or
rational beliefs, performance and mental health (see [12, 17–20]). The most recent review and
meta-analysis conducted by David et al. [12], included eighty-two empirical studies spanning a
50-year period and a specific mechanism of change inquiry. Overall, the meta-analysis
reported medium, significant effect sizes for REBT interventions on a range of outcomes
including behavioural, cognitive, emotional, health, psychophysiological, quality of life, school
performance and social skills at post-intervention and follow-up. While David et al.’s [12] was
more comprehensive than previous reviews, there are two notable shortcomings. First, the
mechanism of change inquiry on irrational and/or rational beliefs was limited given the large
number of studies included that did not adopt a measure of irrational and/or rational beliefs.
Consequently, this limits the ability to conclude that changes to outcome variables are a direct
result of REBT interventions and specifically, via a change to irrational and rational beliefs.
Second, there has been significant growth in REBT intervention studies in specific parts of the
world (i.e., Africa) and within specific domains (i.e., sport and exercise) since David et al.’s
[12] review. Indeed, David et al.’s [12] systematic review [12] largely omitted the sport and
exercise domain (only one study was included), despite significant growth in REBT’s application within this domain since 2011 [15].
Accordingly, there is a pressing need to systematically synthesise and examine the growing
body of empirical REBT research, specifically with regards to (1) the inclusion of studies which
adopt a validated measure of irrational and/or rational beliefs, (2) to be inclusive of all domains
within which REBT interventions are being conducted and (3) be reflective of the recent
increase in REBT interventions across the globe (see [21], special issue). Further, it is prudent
to comprehensively capture the current and exciting state of the research field as it grows in
popularity across different therapeutic/non-therapeutic contexts. For clarity, the aim of our
systematic review is to review the effectiveness and efficacy of REBT interventions on irrational
and rational beliefs as well as additional outcomes, (e.g., wellbeing), through (a) synthesising
and critiquing existing REBT interventions, (b) identifying and reviewing the characteristics of
successful REBT interventions, and (c) comparing the methodological quality of REBT

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intervention research across domains. In doing so, our landmark review will generate a comprehensive knowledge base to facilitate the accurate transmission of scientific knowledge and
guide researchers and practitioners in enhancing the design, delivery and reporting of future
REBT interventions globally and across domains.

Method
The systematic review followed Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines [22, 23] and the PICO framework. The systematic review protocol was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/3CTGP).
Ethical approval was not required given the nature of the study (i.e., systematic review).

Search strategy
To ensure a comprehensive systematic literature search, four search strategies were employed.
First, a preliminary literature search was conducted by the first author in August 2020 using
the following electronic databases (and platform): PsycARTICLES (EBSCOhost), PsycINFO
(EBSCOhost), Scopus (Elsevier), SPORTDiscus (EBSCOhost) and PubMed (National Library
of Medicine; See S1 File for search strategy).The search strategy consisted of three concepts:
(1) Intervention type (e.g., terms: REBT, RET, and Rational Coaching); (2) mechanism of
change (e.g., terms: Irrational belief and dysfunction thought); and (3) outcome of interest
(e.g., terms: Mental wellbeing and performance) using Boolean operators (i.e., AND and OR).
The specific search terms used varied across each database to reflect their unique MeSH (Medical Subject Headings) and Index Terms. Truncation and wildcards were used with stem
words to ensure variant words and spelling were identified. Searches were re-run at regular
intervals during the review process; the most recent search was conducted in December 2023.
Second, existing REBT theoretical reviews and meta-analyses were searched to identify further
studies. Third, cited and citing reference searches (backward and forward citation searching)
were conducted by the first author on the included articles. Finally, experts in the field were
contacted to retrieve any additional published works that may have been missed.

Inclusion and exclusion criteria
Studies were required to have delivered an REBT intervention based on Ellis’ theory of REBT
[1]. They were required to be written in English; authors of non-English citations were contacted to request access to English versions. Only studies published in peer-reviewed scholarly
journals were included. Studies were excluded if they did not include a validated outcome
measure of either irrational and/or rational beliefs and if they did not measure change from at
least pre-to post-intervention. To reiterate, it is of utmost importance to measure irrational
and/or rational beliefs to be able to conclude REBT made an impact on the intended mechanisms, therefore contributing to the validation of REBT theory.

Selection process
The article selection process is presented in Fig 1. Following searches, all records (n = 4,857)
were imported to Endnote. Duplicates were identified and reviewed before removal (n = 726).
Title and abstract screening was completed manually by the first author on all records
(n = 4,131) and any uncertainties regarding inclusion were discussed by the research team and
resolved by consensus. Forty-nine records were not retrievable, 39 of which were not available
in English (21 articles were pre-2000) and 10 were not available through the inter-library loan
service or other methods (i.e., where possible, authors were contacted to retrieve the article; 7

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Fig 1. A PRISMA flowchart to represent the selection process. Note: Adapted to fit the new version of the flow diagram as the initial search began prior to
publication of the new guidelines.
https://doi.org/10.1371/journal.pone.0306835.g001

articles were pre-2000). All remaining retrievable records (n = 473) underwent full-text screening by the first author. The fourth author reviewed a random sample (10%) of the papers at the
full-text screening stage for consistency. At the full-text screening stage, inter-rater agreement
was 99%. Discrepancies were resolved through discussion until a consensus was reached.

Data extraction and analysis
A data extraction form was developed and piloted based on the Template for Intervention
Description and Replication (TIDieR [24]) and the REBT Competency Scale for Clinical and
Research Applications [25]. The following information was extracted from each study: (a)
Identification data (author[s], publication year, country); (b) sample (N, gender, age, type of
sample including clinical status and retention); (c) study design; (d) outcome measures (mechanism of change [irrational beliefs and/or rational beliefs], additional outcome measures and
assessment points); (e) intervention characteristics (type, frequency, duration, mode of delivery, intervention delivery personnel, setting, components of the intervention, materials, tailoring); (f) descriptive information related to treatment integrity (procedural reliability,
adherence and fidelity); and (g) main study outcomes, which included process evaluation.
Where possible, effect sizes were calculated and interpreted using Cohen’s d [26] which are
reported in S2 File. In incidences of limited information, authors were contacted for additional
information. If this method did not prove fruitful (generally, it was unsuccessful), the information was identified as ‘not reported’. The methodological quality of studies was assessed using
the Mixed Methods Appraisal Tool Version 18 (MMAT [27]). This tool has been used successfully in systematic reviews evaluating interventions [e.g., 28], and enables the critical appraisal
of qualitative, quantitative and mixed methods studies. Studies were rated with a ‘yes’, ‘no’ or
‘can’t tell’ for each criterion resulting in an overall quality score.

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The fourth author reviewed the same random sample (10%) of papers at the full-text screening stage to check for correctness and consistency in the data extraction and MMAT process.
Inter-coder reliability was calculated by dividing the number of agreed items from data extraction and methodological quality appraisal by the total number of items reviewed by both
authors. Inter-rater agreement was 89% for data extraction and methodological appraisal. Discrepancies were resolved through discussion until a consensus was reached. Data was analysed
through a qualitative synthesis adopting descriptive methods. A quantitative synthesis (e.g.,
meta-analysis) was not possible due to wide diversity of included studies and lack of homogenous samples [29].

Results
Please refer to S2 File for a summary of study characteristics and S3 File for methodological
appraisal grouped by domain.

Study characteristics
Please see Fig 1 for the article selection process. A total of 166 reports, reporting on 162 studies
met the inclusion criteria and were included in the review (see S4 File for a reference list of
included studies). Reports on the same study were combined for data extraction (i.e., (a) [30,
31], (b) [32, 33], (c) [34, 35] (d) [36, 37] and (e) [38, 39]. One report detailed two separate
intervention studies and therefore, was split into ‘Study 1’ and ‘Study 2’ f...