the impact of rational emotive behavior therapy...

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THE IMPACT OF RATIONAL EMOTIVE BEHAVIOR

THERAPY (REBT) ON CONDUCT DISORDER IN

ADOLESCENT STUDENTS

A final Synopsis of Research carried out for the

Degree of Doctor of Philosophy in Psychology

Research Student

Ms Dawoodi Ghazal Esfnayar Nahid

Guide

Prof. G. Venkatesh kumar

Department of Studies in Psychology

University of Mysore,

Manasagangothri

Mysore - 570 006

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Introduction

Adolescence is the stage in a person’s life between childhood and adulthood. It is

the period of human development during which a young person must move from

dependency to independence, autonomy and maturity. The young person moves from

being part of a family group to being part of a peer group and to standing alone as an

adult (Mabey and Sorensen, 1995). Generally, the movement through adolescence from

childhood to adulthood involves much more than a linear progression of change. It is

multi-dimensional, involving a gradual transformation or metamorphosis of the person as

a child into a new person as an adult.

With the start of adolescence the nature and behavior of the adolescent also gets

change. Many of the behaviors of adolescents appear unsocial and unsympathetic.

Buhler (1927) defined this period as a negative phase. During the period of adolescence

the boys and girls feel restless, lack of interest in work, feel shy in appearing before

elders, and entertain fear, doubts and frustration. During adolescence the individual

completing changes.

Chronologically, adolescence comes roughly in between the years from 12 to the

early 20s. As defined by the World Health Organization (1992), adolescence is the

period between 10-19 years. The onset of adolescence varies from culture to culture

depending on the socio economics of the country. In this period, great changes occur in

all developmental aspects of the individual. Adolescence is a period of problems. The

main problems of Indian adolescents are to have some economic independence, to get rid

of parental interference, fulfillment of desires, how to spend leisure, and which

philosophy of life he should adopt.

The adolescent is a period of worry and anxieties because with rapid physical and

mental changes he has to face the problem of adjustment in the new environment. He

appears worried, miserable, stormy, intolerant and a rebel. The adolescent is worried

about his social behavior. He tries to escape from others criticisms. This worry gives

birth to undesirable elements in his character, such as: More careless in behavior than

before, less care of others comfort, giving rude replies, short tempered and express

displeasure, interfering in others conversation, quarrelling with guardians for getting

more freedom, beating the younger children in home, serious in thinking, rejecting other

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people’s advice is acting against it, showing no interest in ideals and principles, getting

irritated on criticism by others.

There are certain problems which are common to adolescents as part of the

developmental processes of this age group; there are also certain kinds of educational,

vocational and social information which can be of help to young people as they grow up.

These may be presented in a group situation and discusses with the realization that their

difficulties are not peculiar to them as individuals, as they often think, but are shared by

fellow students.

Healthy development of adolescents depends on several interactive and complex

factors. They include, the socioeconomic circumstances in which adolescents are born,

the environment in which they grow up, inter-personal relationships within the family,

peer group pressure, value of the community in which they live and opportunities for

education and employment. Despite the multitude of factors, which can influence the

development of adolescents, their mental well being is crucial. Adolescences must learn

to cope with psychological stress, handle peer pressure, deal with their emotions, resolve

conflicts, build bridges with friends and family, develop self-confidence, safeguard

themselves from drug and alcohol as well as cope with other stressors like academic

competition and a hankering for material gains. However, rarely are these sensitive

issues addressed in schools and within families. Psychotherapy in general and group

psychotherapy in particular is a useful way of helping adolescents for whom peer group

values are important.

Emotional and Behavioral Disorders of Adolescents

Although childhood is generally regarded as a carefree time of life, many children

and adolescents experience emotional difficulties growing up.

There are some problems in the social life of adolescents like: rashness of

behavior and un-mindfulness of consequences, desire to reform the society and double

standard of elders. Behavior problems in children and adolescent can be classified into

two major domains of dysfunction, namely externalizing behaviors and internalizing

behaviors (Achenbach & Edelbrock, 1978). The externalizing behaviors are marked by

defiance, impulsivity, hyperactivity, aggression and antisocial features.

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The internalizing behaviors are evidenced by withdrawal, dysphoria and anxiety.

Behavioral and emotional problems in adolescents affect a significant number of young

people, with considerable personal and societal costs. Estimates of mental health

treatment expenditures for adolescents in the United States are substantial, and

considerably more than for younger children (Ringel & Sturm, 2001). Because these

estimates do not include costs associated with the educational, child welfare, and

juvenile justice systems, or indirect costs of adolescent mental illness such as future lost

wages due to lower educational attainment, they likely underestimate the overall costs

associated with behavioral and emotional problems in adolescents.

Children and youngsters with emotional and behavioral disorders (EBD) are a

vulnerable group in society. Their disorder proofs to be stable and long-term (Fergusson

& Horwood 1992). These children run a high risk of being placed in special education

(Lyon 1996) or in semi-residential specialized care (Eme & Kavanaugh1995). More boys

than girls are affected (3:1 or 4:1) (American Psychiatry Association 1987; Fagot & Leve

1998) and boys show a more violent behavioristic pattern and more externalizing

behavior (Eme & Kavanaugh 1995).

Types of mental, emotional, and behavioral disorders that may occur during

childhood and adolescence are known as: Anxiety Disorders, Severe Depression, Bipolar

Disorder, Attention Deficit Hyperactivity Disorder, Autism, Schizophrenia Learning

Disorders, Conduct Disorder, Eating Disorders. All can have a serious impact on a

child's overall health. Some disorders are more common than others, and conditions

range from mild to severe. Often, a child has more than one disorder (U.S. Department of

Health and Human Services, 1999).

Young people (aged 10–19 years) comprise more than a fifth of India’s

population – an estimated 230 million people (Registrar General of India1996). Although

adolescent health has gained increasing prominence in India’s national health policies,

the focus has been on reproductive and sexual health concerns. Despite reports showing

that suicide is a leading cause of death in young people in India (Aaron R, Joseph A,

Abraham S, Muliyil J, George K, Prasad J, Minz S, Abraham VJ, Bose A, 2004), mental

health has been a low priority in health policy for adolescents. The few published studies

from India have reported prevalence of mental disorders from 2.6% to 35.6% (Srinath S,

Girimaji SC, Gururaj G, Seshadri S, Subbakrishna DK, Bhola P, Kumar N 2005) ;

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(Verghese A, Beig A.1974 ) . Although comparability between the findings of these

studies is limited owing to methodological factors (Ford T, Goodman R, Meltzer H,

2003), one reason for the wide variation in rates could be the strong influence of social,

cultural and environmental factors on the risk of mental disorders in adolescents.

Adolescents with Conduct disorder as an Emotional and Behavioral Problem

The term conduct disorder (CD) refers to a persistent pattern of antisocial

behavior in which the individual repeatedly breaks social rules and carries out aggressive

acts that upset other people. DSM-IV mentions CD as one of the most frequently

diagnosed conditions in outpatient and inpatient mental health facilities for children. CD

has been separated from the adult diagnosis of antisocial personality in order to

acknowledge what psychiatrists believe to be a greater potential for change in the young.

CD has been classified along with oppositional defiant disorder and attention-

deficit hyperactivity disorder (ADHD) in the attention-deficit and disruptive behavior

disorders section of DSM-IV-TR. The essential feature of CD is a repetitive and

persistent pattern of behavior in which the basic rights of others or major age-appropriate

societal norms or rules are violated. Since its inception in DSM-III, the diagnosis of CD

has undergone several modifications. DSM-IV-TR lists 15 criteria grouped into 4 major

categories: (i) aggression to people and animals; (ii) destruction of property; (iii)

deceitfulness or theft; and (iv) serious violations of rules. Three (or more) of the criteria

should have been present for the last 12 months, with at least one criterion present in the

past 6 months.

The disturbance in behavior should cause clinically significant impairment in

social, academic, or occupational functioning. If the individual is 18 years or older, the

criteria for antisocial personality disorder should not be met. Since the criteria for the

diagnosis of CD vary widely, its manifestations at different developmental stages differ

and because the databases of different studies are not uniform, the prevalence estimates

reported in various studies vary widely. At one end lies the study of Esser and colleagues

(1990) reporting a prevalence of 0.9%, while at the other end is the study by Kashani et

al (1987), reporting a prevalence of 8.7%. DSMIV reports prevalence in males of 6%-

10% and in females of 2%-9%.

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Psychotherapy

Psychotherapy is an interpersonal, relational intervention used by trained

psychotherapists to aid clients in problems of living. This usually includes increasing

individual sense of well-being and reducing subjective discomforting experience.

Psychotherapy can be defined as a means of treating psychological or emotional

problems such as neurosis or personality disorder through verbal and nonverbal

communication. It is the treatment of psychological distress through talking with a

specially trained therapist and learning new ways to cope rather than merely using

medication to alleviate the distress. It is done with the immediate goal of aiding the

person in increasing self-knowledge and awareness of relationships with others.

Psychotherapy is carried out to assist people in becoming more conscious of their

unconscious thoughts, feelings, and motives. Psychotherapy's longer-term goal is making

it possible for people to exchange destructive patterns of behavior for healthier, more

successful ones.

Group Psychotherapy for Adolescents

Adolescents are social creatures, in the midst of learning their social skills, and

are often more trusting of others their own age than of adults. This makes the group

therapy setting an ideal choice when counseling becomes necessary for this age group.

They are excellent at being able to learn from one another while observing and teaching

appropriate skills as they grow.

The group is a natural setting for adolescents. They are taught in groups, live in

groups, and often play in groups. Group therapy adolescents is an ideal choice, as social

interaction is a key aspect of the developmental process, and as suggested by Bandura

(1989) most social learning takes place by observing others and the results of their

actions. Leader (1991) states that group therapy for adolescence provides the therapeutic

environment where they can work through interpersonal problems and examine the four

basic identity questions: Who am I? With whom do I identify? What do I believe in?

And where am I going?.

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REBT as Psychotherapy for Adolescents

Rational emotive behavior therapy (REBT) is an active-directive, solution-

oriented therapy which focuses on resolving emotional, cognitive and behavioral

problems in clients, originally developed by the American psychotherapist Albert Ellis.

REBT is one of the first forms of cognitive behavior therapy and was first expounded by

Ellis in 1953. Fundamental to REBT is the concept that emotional suffering result

primarily, though not completely, from our evaluations of a negative event, not solely by

the events per se. In other words, human beings on the basis of their belief system

actively, though not always consciously, disturb themselves, and even disturb themselves

about their disturbances.

In the present study conduct disorder (a sub-type of emotional and behavioral

disorder) is taken as a dependent variable to see whether there would be any change in

them through REBT group psychotherapy.

Importance of Present Study

The unique mental health issues of children have long been a public policy

concern as well as a focus of psychological research and practice. It is widely

recognized that children and adolescents’ mental health problems differ from those of

adults, and failure to treat such problems can potentially lead to later difficulties. Based

on this knowledge, it is disturbing to know that a more effective system has not been

developed to treat children and adolescents’ mental health issues (Saxe, Cross, &

Silverman, 1988). General agreement exists that over 11% of children and adolescents

(approximately 6 to 8 million) have a mental health problem requiring treatment.

However, less than half of this population receives the full range of necessary and

appropriate services to treat their mental health problems effectively (Saxe, Cross, &

Silverman, 1988). The purpose of this study was to examine the effect of Rational

Emotive Behavior Therapy (REBT) on treatment of Conduct Disorder, as a disruptive

behavior disorder, on adolescents for a better help in their mental health issues.

Problem

The Impact of Rational Emotive Behavior Therapy (REBT), on Conduct

Disorder in Adolescent Students.

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Purpose of the study

Conduct disorder in adolescents is a serious and common mental disorder. Rarely

studies have been reported on adolescents with conduct disorder in India. No adequate

research data have been reported on the treatment of adolescents with emotional and

behavioral problems.

The present study was designed to assess the effectiveness of group Rational

Emotive Behavioral Therapy (REBT) on the treatment of adolescent students suffering

from conduct disorder. The findings may help us develop a better treatment for

adolescents with conduct disorder.

OBJECTIVES

1- To study the impact of Rational-Emotive Behavior Therapy (REBT) on conduct

disorder.

2- To understand the impact of Rational-Emotive Behavior Therapy (REBT) on

other emotional and behavioral disorders co-morbid with conduct disorder.

3- To understand the Gender (Boys and Girls), and Age difference (Early and Late

Adolescents) if any in response to REBT with the regard to effectiveness of

REBT on Conduct Disorder.

Research design

An experimental/control research design was used to examine the impact of

Rational-Emotive Behavior Therapy (REBT) on conduct disorder. In this study, the

control group (CG) was only observed and was exposed to their day to day usual life.

The experimental group was exposed to intervention of Rational-Emotive Behavior

Therapy for seven sessions in seven weeks. The research hypothesizes were tested

statistically.

VARIABLES OF THE STUDY

Dependent Variables

1. Conduct Disorder

Independent Variable

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1. Rational Emotive Behavior Therapy (REBT)

Biographical Variable

1. Gender- Boys and Girls

2. Age-Early and Late adolescents

Additional Variables Shown by DSM Scales

1- Affective Problems

2- Anxiety Problems

3- Somatic Problems

4- Attention Deficit/Hyperactivity Problems

5- Oppositional Defiant Problems

6- Conduct Problems

Additional Variables Shown by Syndrome Scales

1- Anxious/ Depressed

2- Withdrawn Depresses

3- Somatic Complaints

4- Social Problem

5- Thought Problems

6- Attention Problems

7- Rule-Breaking Behavior

8- Aggressive Behavior

9- Other Problems

10- Internalization

11- Externalization

Additional Variables Shown by Social Competency Scales

1- Activities Scale

2- Social Scale

3- Academic Performance

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4- Total Competence Score

HYPOTHESES

Hypothesis 1

Rational Emotive Behavior Therapy (REBT) has a positive impact on treatment

of Conduct Disorder.

Hypothesis 2


of additional variables of DSM Scale.

Hypothesis 3


of additional variables of Syndrome Scale.

Hypothesis 4

Rational Emotive Behavior Therapy (REBT) has a positive impact on reduction

of Internalizing and Externalizing Groups of Syndromes.

Hypothesis 5

Rational Emotive Behavior Therapy (REBT) has a positive impact on reduction

of scores on Total Problem Score.

Hypothesis 6

Rational Emotive Behavior Therapy (REBT) has a positive impact on increasing

of Total Competency Score.

Hypothesis 7

There is a significant difference of age groups (Early and Late Adolescence) in

response to the REBT with the regard to:

a) Conduct Disorder

b) DSM-Oriented Problems

c) Syndrome Problems

d) Internalizing- Externalizing Groups

e) Total Problem Scores

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f) Total Competency Score

Hypothesis 8

There is a significant difference of gender groups (Boys and Girls) in response to

the REBT with the regard to:

a) Conduct Disorder

b) DSM-Oriented Problems

c) Syndrome Problems

d) Internalizing- Externalizing Groups

e) Total Problem Scores

f) Total Competency Score

SAMPLE

A stratified random sample of 200 students with conduct disorder, of which 100 were

boys and 100 were girls, studying in schools and colleges between the age group of 11 to

18 years from different schools and colleges located in Mysore City.

Experimental group (EG) Control Group (CG)

100 100

Boys Girls Boys Girls

50 50 50 50

TOOLS USED

For the purpose of the present study the researcher has used the following tools.

1- Youth self-Report (2001), for Ages 11-18 to measure conduct disorder, Designed

by ASEBA, (Achenbach System of Empirically Bused Assessment), research

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center for Children, youth, and families. (Using YSR DSM-ORIENTED

SCALES FOR BOYS AND GIRLS and YSR SYNDROME SCALES).

2- PROCEDURE

Randomized experimental control group pretest-posttest design is employed in the

present study which requires the utilization of a control group and random assignment of

subjects to groups.

Following flow chart depicts the procedural aspects of the study:

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FLOW CHART OF THE STUDY

Administration of Youth self Report (YSR: 11/18) (pre-test) to a large sample of

adolescents (Screening)

(N =1142)

Selection of experimental and control groups for the study based on the DSM-

Oriented Scale

Experimental Groups (N=100) Control group (N=100)

REBT Therapy for 7 sessions

Post-Test Post-Test

Experimental Group Control group

STATISTICAL ANALYSIS TO SEE THE EFFECTIVESS OF THERAPIES

Accordingly the experimenter has taken the following steps:

Phase 1: screening phase (pre-test and equating of the groups)

The selected instrument, Youth Self Report (2001), was administered to 1142

students. After the scoring YSR, 100 boys and 100 girls with symptoms of conduct

disorder were selected for further study.

No Treatment

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Phase 2: experimental treatment

The experimental group was exposed to treatment (Specially designed REBT-

Rational Emotive Behavior Therapy). REBT was administered on small groups of 10

subjects. There were 10 experimental groups in total. Each group had one session in a

week and it took seven weeks of intervention duration for one group. No treatment was

given to control group, but was kept under observation including the self-introduction.

With the consent of the student’s parents and the college authority the researcher

scheduled the intervention program. The total duration of the intervention program was 4

months. Each session had duration of 90 minutes to 110 minutes. There were 9 stages in

the intervention program.

Intervention consists of four stages:

Stage 1: Introductory Session:

In this stage the researcher tried to make a rapport and build a relationship with

the subjects. During this time some funny comments are made for establishing a better

rapport between the researcher and the members in the group. The group was asked to

think about roles that might be helpful for their group to follow, and the following rules

were put into documents, distributed amongst the group and reviewed before each

session: (a) respect others, (b) no laughing or teasing, (c) raise hand to speak, (d) option

to “pass” if deciding not to participate and (e) keep information discusses in group

confidential .Then for about 10 minutes the group was asked to interact with each other

and share their feelings and ideas.

Towards the end of the session, the researcher talked about the next session and

gave them a small introduction to the REBT and the program in next session. A small

notebook was distributed among them and asking them to carry it in each session. The

notebook was given to them as a motivation in doing their homework assignment which

will be discussed later.

Stage 2: Using Cognitive Techniques of REBT

I: Active Disputing.

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Here the members are all taught the ABCs of REBT by the researcher, shown

how to find their self-defeating, absolutist should and musts, their awfulizing, their I-

can’t-stand-it-its, their damning of self and of other persons, their over-generalizations,

and their other dysfunctional inferences and attributions, and are shown how to dispute

these with empirical, logical, and pragmatically useful challenges.

ABC Theory of Personality thought to the subjects: A = Activating Event, B =

Belief, C = Emotional and behavioral response, D = Disputing, E = Effect.

Before teaching the member about the ABC, they were asked to talk about their

main emotional problems and their daily difficulties. They mostly talked about having

problems with family, teachers, students, getting angry fast and being hot temper and

getting into fights. As mentioned before they all share four common symptoms,

aggression behavior, destructive behavior, lying or theft and violation of rules. Therefore

the researches focused on the problems which subjects were talking about, and which

was a part of these four symptoms. Then the ABC theory mentioned above is taught to

the students.

Asking for one example from each member about the positions when they were

feeling hurt, the A is assessed and then the B-C connection- the notion that their

emotional problems are determined largely by their beliefs rather than by the activating

event (A) - is shown to them. Then the three major “musts” are taught to them which are:

“I, must do well and get approved”, “you must treat me nicely and kindly”, and “the

word must give me what I want quickly, easily, and with great certainty. After learning

about the irrationality of dogmatic musts, should, outs, and so on, they are learned to

draw a rational conclusion in forms of “anti-awfulizing, e.g. it is bad, but it is not

awful.”, “higher frustration tolerance, e.g “I don’t like it but I can bear it.” and

“acceptance; to accept themselves and others as fallible human beings who cannot

legitimately be given a single global rating”. Then the D which stands for disputing is

worked out by the researcher. Here the therapist helps the client to challenge the

irrational belief (B). Therefore the self-defeating beliefs are dispute and replaced with a

rational one and resulted in an effective philosophy (E).

Although it was more of a theoretical session, students seemed to be more interested

in it when it was explained with the help of examples.

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II: Rational Coping Self Statements

In groups and at their personal level, members are encouraged to prepare

Rational Beliefs (RBs) and coping statements to substitute for their Irrational Beliefs

(IBs), and to keep using them steadily until they consistently believe and act on them.

Such self-statements can be factual and encouraging (e.g. “I am able to succeed on this

job, and I will work hard to show that I can”). Or, preferably, they can be more

philosophical (e.g., “I’d like very much to success but I don’t have to do so; and if I fail I

am never a failure or a worthless individual”).

The researcher explained the coping self-statement technique with two or three

examples. Described the use and effect of the technique; then asked them to write 10 self

statements pertaining to their life situations. Each statement was again rewritten in a

more easy coping style.

III: Cognitive Homework.

Members are now ready to put their rational beliefs into practice. They are

reminded that the rational emotive behavioral theory of change holds that, in order to

deepen their convictions in their rational beliefs, they need to practice questioning their

irrational beliefs and strengthen their rational beliefs in situations that are the same or

similar to the activating event already assessed.

Cognitive homework is given to the subjects in the form of writing assignments

(self-help homework) at the end of each session. It is done on the notebooks which were

distributed to the subjects during the introduction session. The subjects were asked to

labels “A-B-C-D-E” or “what happened- what I felt- what I was thinking- what was

wrong with those thoughts- what thoughts would be more accurate and helpful.” Using

cognitive homework the researcher could determine if the subjects really understand the

A-B-C‘s of REBT. Also the linguistic confusions and misunderstandings of the theory

became clear and the researcher had a chance to do some invaluable teaching when the

assignment is reviewed in the next therapy session.

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Stage 3: Using Emotive Techniques of REBT

I: Rational Emotive Imagery:

Group members do REI, both during group sessions and as homework, by

imagining one of the worst things that could happen to them, letting themselves feel very

upset about this image, imploding this disturbed feeling; and then working on their

feeling, to make themselves have healthy or appropriate negative feelings (such as

sorrow, disappointment, or frustration).

The researcher asked each subject to imagine themselves in the troublesome

situations which make them out of control and make them angry or hot temper; or the

situations which they violate the laws; This may allow the researcher to see if the

emotion has changed. If it has, the researcher asked the subjects what they are now

telling themselves. It was a way to rehearse more rational beliefs. Then they were

instructed to change the feeling from a disturbed emotion to a more constructive negative

emotion (e.g., from angry to disappointed).As it usually takes a minute or two to do REI

members were asked to do this during every session and every day for thirty days as their

homework until they automatically experience their healthy negative feelings when they

imagine, or actually encounter, similar “horrible” happenings.

II: Role-Playing:

Another in-session strategy is the use of role playing. In role playing, under the

tutelage of the therapist, the client rehearses a new behavior that is more consistent with

a rational philosophy. In role-playing group members often role-play with other group

members or with the therapist, as when one plays the interviewee for an important job

and the other plays the interviewer. During this form of behavior rehearsal, the rest of the

group critiques how well the member is doing in the role-play and suggests how she or

he could improve. If either of the role player shows anxiety, the role-play is temporary

stopped and this person is asked what he or she was thinking to create the anxiety and

how he or she could think, instead, to allay it.

Here the researcher worked more on problems which was related to conduct

problems. For example one major problem of the subjects was that they were unable to

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control their anger which resulted in many fights with parents or peers. Role-playing

consisted of two or more individuals acting out a situation in which a group member

experienced anger control difficulties in the past. As the individuals acted out these

situations, they were stopped at key points so that the group members could identify A,

B, and C from the REBT model. They then provided suggestions for D and E so that

similar situations could be handled more rationally in the future.

Role-playing was on the focus of this research as it was more focused on the

behavioral modification of subjects with conduct problems. Subjects participated in role-

playing activities during each session, based on situations in which they personally

experienced anger control problems and other irrational way of solving their problems in

life. Here the researcher worked on the life problems which members were talking about

it regarding to the problems with parents, teachers, friends, getting hot temper and

having low tolerance. Such problems were selected for the role-play. Each group had

five sub-groups. Each sub-group was given 15 minutes for acting out. The exercise was

effective in many ways. They became freer with the group and counselor. They got

insights and solutions for their problems. One who acted and one who observed both

were active in the problem analysis and problem solving in a more rational way.

III: Reverse-Role Play:

In reverse-role play, one group member takes another’s irrational beliefs (e.g.

“so-and so must always love me completely!”) and holds on to it rigidly and forcefully

while playing the irrational member’s role. The person with the irrational belief then has

to talk the other role-player – actually himself or herself- out of this firmly held irrational

beliefs.

The researcher selected the irrational beliefs, (e.g. “they should love me”, “I must

be perfect”, “it is horrible if...” and so on), of each sub-groups and they were worked on

by reverse-role play. This technique was very effective in changing member’s behavior

and accepting the fact that their behavior is irrational and they should react to the

problems in a more rational way.

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Stage 4: Behavioral Techniques of REBT

I: Skill Training:

In this part, group members often learn and practice particular important

interpersonal skills in the group sessions, For example, learning to listen to others,

accepting them with their poor behavior, communicating openly with them, and forming

relationships with them.

As the subjects in this study are having conduct problem, this skill training was

helping them to increase their interpersonal skills therefore they could have a better

relation with their parents, teachers, and friends and so on. One of the main problems of

adolescents with conduct disorder is their impair relation with other people as they show

aggression and destructive behavior. Skill training is a good option of helping these

adolescents to understand the right of others and to respect them in order to make a better

relation with people. During skill training, the members learned a better way of

communicating with others and they report it to be very effective on their social life.

II: Use of Reinforcement:

Being strongly behavioral, REBT shows group members how to suitably

reinforce themselves by doing something enjoyable only after they have done something

onerous- such as working on a term paper well - that they are avoiding. In group itself

they may be allowed to speak up about their own problems only after they have tried to

help other members with their difficulties.

In this study the researcher gave reinforcement to the members who use to do

their homework assignment for every session. They were given small things such as pen,

pencil, notebooks and like vise. Also the members were asked to reinforce themselves by

meeting a friend or someone who they like to spend time with.

This technique was helpful in motivating the members to do their homework

assignments regularly and to teach them a better method of self-management.

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III: Use of Penalties:

Many members won’t stop their addictive or compulsive behavior because it is

too immediately pleasurable or reinforcing; and they will not change it for a normal

reinforcement. Thus they will not give up smoking or problem drinking for allowing

themselves to read or enjoy television. Consequently REBT encourages some group

members to penalize themselves after their destructive indulgences-for example, to spend

an hour with a boring person every time they gamble, or light every cigarette they smoke

with a $50 bill. Members also encourage other group members to enact suitable penalties

and monitor their doing so.

As some of the members were not particular on their home work assignment and

also not cooperating with other members, were penalized by giving 5 rupees to one of

the members who has done his or her homework clearly. This stage was also effective

and made the members to be more active in order to get the reinforcement and to avoid

the penalties.

Phase 3: post-test

Both the experimental group and control groups were measured on the dependent

variables and obtained post-test data for experimental group and post-test data for control

group. Significance of the difference between the two means was ascertained with the

help of appropriate statistical techniques. Also another descriptive and qualitative report

was taken from the teachers regarding to the behavior of the subjects.

Data analysis

The analysis used the application of General Linear Model Repeated Measures of

ANOVA for both subjects within group effects and between group effects. GLM

repeated measure of ANOVA is applied to variables of DSM oriented, syndrome

oriented scales, computation and total competence scores.

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Results

The obtained data was treated with ‘t’ test for pre- test scores of experimental and

control groups to see any significant differences in DSM oriented scale, syndrome

oriented scales, computation and total competence scores. These tests were done to

confirm randomization of subjects in experimental and control groups. There were no

significant differences between experimental group and control group in relation to DSM

oriented, syndrome oriented scales, computation and total competence scores . Both

groups had equal scores in pre-testing. Thus, the equating as well as randomization of the

groups was taken care of during the pre-test.

ANOVA revealed a significant effect of the intervention program on adolescents with

conduct disorder in experimental group.

1. Considering the major objective of the present study which is to investigate the

effectiveness of REBT on adolescents in relation to conduct disorder, the

experimental group is found to have a significant reduction in conduct disorder

compared to the control group after the intervention program. Between pre-test to

post-test scores a significant difference was observed (F=26.939; P=.000) in

conduct disorders where a decrease of 1.12 (pre-10.91, post-9.79) scores was

noticed irrespective of the groups. The result indicates that, there is a significant

decrease in the mean scores of conduct disorder for experimental group with a

decrease of 2.56 as against .32 for control group. The results show that that the

impact of REBT on conduct disorder is positive.

2. The experimental group is found to have a significant reduction in emotional and

behavioral problems co-morbid with conduct disorder showing in DSM Oriented

Scale, compared to the control group after the intervention program. Between

pre-test to post-test scores a significant difference in affective problems was

observed (F=16.164; P=.000) where a decrease of 0.66 (pre-10.04, post-9.38)

scores was noticed irrespective of the groups. Subjects in experimental group

showed a significant decrease in the mean scores of Affective Problems for

experimental group with a decrease of 1.61 as against 0.3 for control group; In

anxiety problems a non-significant difference was observed (F=2.134; P=.146)

where a decrease of 0.14 (pre-4.78, post- 4.64) scores was noticed irrespective of

the groups. However, when the decrease in anxiety problems were analyzed

22

group wise, (experimental v/s control) a significant F value (F=11.148; P=.001)

was obtained. From the mean scores it is evident that experimental group

reduced its mean by 0.53 (Pre- 4.94 – Post-4.41) scores compared to control

group, which changed its scores by only 0.25 scores (pre 4.62 – Post 4.87). In

somatic problems, between pre-test to post-test scores a non-significant

difference was observed (F=.145; P=.704) where a decrease of 0.02 (pre-3.57,

post-3.59) scores was noticed irrespective of the groups. However, when the

decrease in somatic problems were analyzed group wise, (experimental v/s

control) a significant F value (F=4.371; P=.038) was obtained. From the mean

scores it is evident that experimental group reduced its mean by 0.16 (Pre- 3.63 –

Post-3.47) scores compared to control group, which increased its scores by 0.20

scores (pre 3.51 – Post 3.71). In ODD, between pre-test to post-test scores a non-

significant difference was observed (F=.005; P=.942) where a decrease of 0.01

(pre-4.10, post-4.09) scores was noticed irrespective of the groups. However,

when the ODD were analyzed group wise, (experimental v/s control) a significant

F value (F=5.153; P=.024) was obtained. From the mean scores it is evident that

experimental group reduced its mean by 0.28 (Pre- 4.21– Post-3.93) scores

compared to control group, which increased its scores by 0.22 scores (pre 3.98 –

Post 4.20)

3. The experimental group is found to have a reduction in syndromes showing in

Syndrome Oriented Scales (anxiety/depression, withdrawn/depressed, somatic

complaints, social problems, thought problems, rule breaking behavior,

aggressive behavior, and other problems), compared to the control group after the

intervention program. In anxious/depressed subscale significant change was

observed from pre to post test situation (F=15.988; P=.000) where a decrease of

.75 (pre-10.75, post 10.00) scores was noticed irrespective of the groups.

However, when the decrease in anxious/depressed scale were analyzed group

wise, (experimental v/s control) a significant F value (F=25.904; P=.000) was

obtained. From the mean scores it is evident that experimental group reduced its

mean by 1.75 (Pre- 11.40– Post 9.65) scores compared to control group, which

increased its scores by 0.25 scores (pre 10.10 – Post 10.35). In withdrawn

depressed, between pre to post test scores, a significant change was noticed

23

(F=13.327; P=.000) where a decrease of .48 (pre-7.18, post 6.70) scores was

found irrespective of the groups. However, when the decrease in

withdrawn/depressed scale were analyzed group wise, (experimental v/s control)

a significant F value (F=27.292; P=.000) was obtained. From the mean scores it

is evident that experimental group reduced its mean by 1.21 (Pre- 7.35– Post

6.14) scores compared to control group, which increased its scores by 0.18 scores

(pre 6.86 – Post 7.04). In somatic complaints between pre-test to post-test scores

a non-significant difference was observed (F=.172; P=.679) where a decrease of

0.07 (pre-5.73, post-5.66) scores was noticed irrespective of the groups.

However, when the decrease in somatic problems were analyzed group wise,

(experimental v/s control) a significant F value (F=5.325; P=.022) was obtained.

From the mean scores it is evident that experimental group reduced its mean by

0.32 (Pre- 5.95– Post-5.63) scores compared to control group, which increased its

scores by 0.04 scores (pre 5.13 – Post 5.17).

Between pre to post test scores in social problems, a significant change was

noticed (F=7.696; P=.006) where a decrease of .36 (pre-8.48, post 8.12) scores

was noticed irrespective of the groups. However, when the decrease in social

problems were analyzed group wise, (experimental v/s control) a significant F

value (F=16.219; P=.000) was obtained. From the mean scores it is evident that

experimental group reduced its mean by .92 (Pre- 8.78– Post 7.86) scores

compared to control group, which increased its scores by 0.20 scores (pre 8.19 –

Post 8.39). In thought problems, between pre-test to post-test scores a non-

significant difference was observed (F=.172; P=.679) where a decrease of 0.25

(pre-8.43, post-8.18) scores was noticed irrespective of the groups. However,

when the decrease in thought problems were analyzed group wise, (experimental

v/s control) a significant F value (F=5.325; P=.022) was obtained. From the

mean scores it is evident that experimental group reduced its mean by .70 (Pre-

8.80– Post-8.10) scores compared to control group, which increased its scores by

0.18 scores (pre 8.07 – Post 8.25). Between pre to post test scores in rule

breaking behavior, a significant change was noticed (F=18.822; P=.000) where a

decrease of .77 (pre-8.80, post 8.03) scores was noticed irrespective of the

groups. However, when the decrease in rule breaking behavior were analyzed



24

reduced its mean by 1.84 (Pre- 9.10– Post 7.26) scores compared to control

group, which increased its scores by 0.30 scores (pre 8.50 – Post 8.80). As far as

the aggressive behavior is considered, between pre to post test scores a significant

change was noticed (F=27.041; P=.000) where a decrease of 1.27 (pre-14.95, post

13.68) scores was noticed irrespective of the groups. However, when the

decrease in aggressive behavior were analyzed group wise, (experimental v/s

control) a significant F value (F=32.726; P=.000) was obtained. From the mean

scores it is evident that experimental group reduced its mean by 2.68 (Pre- 14.96–

Post 12.28) scores compared to control group, which increased its scores by 0.14

scores (pre 14.94 – Post 15.08). In other problems also, between pre to post test

scores, a significant change was noticed (F=9.006; P=.000) where a decrease of

.39 (pre-7.03, post 6.64) scores was noticed irrespective of the groups. However,

when the decrease in rule other problems were analyzed group wise,

(experimental v/s control) a significant F value (F=18.897; P=.000) was obtained.

From the mean scores it is evident that experimental group reduced its mean by

1.84 (Pre- 7.17– Post 6.18) scores compared to control group, which increased its

scores by 0.30 scores (pre 6.89– Post 7.09).

4. There was a reduction of score on internalizing and externalizing groups of

syndromes in experimental group compared to the control group after the

intervention program. In internalization scores, between pre-test to post-test

scores a non-significant difference was observed (F=.787; P=.376) where a

decrease of 1.52 (pre-66.04, post-64.52) scores was noticed irrespective of the

groups. However, when the decrease in internalization scores were analyzed



reduced its mean by 4.72 (Pre- 66.93– Post-62.21) scores compared to control

group, which increased its scores by 1.68 scores (pre 65.15 – Post 66.83). In

externalization scores, between pre to post test scores a significant change was

noticed (F=17.291; P=.000) where a decrease of 2.26 (pre-66.78, post 64.52)

scores was noticed irrespective of the groups. However, when the decrease in

externalization scores were analyzed group wise, (experimental v/s control) a

significant F value (F=23.626; P=.000) was obtained. From the mean scores it is

evident that experimental group reduced its mean by 4.86 (Pre- 67.07– Post

25

62.21) scores compared to control group, which increased its scores by 0.14

scores (pre 66.48 – Post 66.83)

5. The experimental group showed a reduction in Total Problem Scores compared to

the control group after the treatment. Between pre to post test scores a significant

change was noticed (F=7.894; P=.005) where a decrease of 1.56 (pre-67.03, post

65.47) scores was noticed irrespective of the groups. However, when the

decrease in total T scores were analyzed group wise, (experimental v/s control) a

significant F value (F=13.132; P=.000) was obtained. From the mean scores it is

evident that experimental group reduced its mean by 3.67 (Pre- 67.76– Post

64.09) scores compared to control group, which increased its scores by 0.14

scores (pre 66.30 – Post 66.86).

6. The experimental group did not show a significant differences on Competency

Score compared to the control group after the intervention. In total competency

scores, the intervention did not have any significant change from pre to post test

situation irrespective of the groups, as the obtained F value of .404 was found to

be non-significant (P=.526). No differential change for either groups –

experimental or control groups were observed from pre to post test session

(F=3.43; P=.066).

7. There were no significant differences between age groups in response to the

intervention program on all the variables taken in this study.

8. Also the experimental group showed no significant differences of gender in

response to the intervention program on all the variables taken in this study.

Verification of the Hypotheses

The research hypotheses were developed to investigate the impact of Rational

Emotive Behavior Therapy (REBT) on Conduct Disorder in adolescents, and also with

other problems shown on DSM Scale, symptoms of problems shown on Syndrome scale,

competency of adolescents and internalize externalize symptoms.

26

Research hypotheses # 1, Rational Emotive Behavior Therapy (REBT) has a

positive impact on treatment of Conduct Disorder. This hypothesis is accepted as the

result shows a reduction of 8.61% in conduct disorder in experimental group.

Research hypotheses # 2; Rational Emotive Behavior Therapy (REBT) has a

positive impact on treatment of additional variables of DSM Scale. This hypothesis is

accepted as the results shows a reduction of 6.57% in Affective Problems, 2.92% in

Anxiety Problems, 0.56% in Somatic Problems, and 0.24% in ODD Problems.

Research Hypotheses # 3, Rational Emotive Behavior Therapy (REBT) has a

positive impact on treatment of additional variables of Syndrome Scale. This hypothesis

too is accepted as the results shows a reduction of 5.30% in anxiety/depression, 6.68% in

withdrawn/depressed, 1.22% in somatic complaints, 4.24% in social problems, 2.96% in

thought problems, 8.75 % in rule breaking behavior, 8.49% in aggressive behavior, and

5.54% other problems.


positive impact on reduction of Internalizing and Externalizing Groups of Syndromes.

Hypothesis was supported by the results as there was a reduction of 2.30% in

Internalizing and 3.38% in Externalizing.


positive impact on reduction of scores on Total Problem Score. The hypothesis is

accepted by results showing a reduction of 2.32 % in Total Score.


positive impact on increasing of Total Competency Score. This hypothesis was not

supported by the findings as there were a comparative differences and not a significant

differences between experimental and control group. The hypothesis is rejected.

Research hypotheses # 7, there is a significant difference of age groups (Early

and Late Adolescence) in response to the REBT with the regard of: Conduct Disorder,

DSM-Oriented Problems, Syndrome Problems, Internalizing- Externalizing Groups,

Total Problem Scores, and Total Competency Score. This hypothesis was not accepted as

there were no significant of differences regarding to age groups on response to REBT

intervention on any variables of the study. This hypothesis is also rejected.

Research hypotheses # 8, there is a significant difference of gender groups (Boys

and Girls) in response to the REBT with the regard of: Conduct Disorder, DSM-Oriented

27

Problems, Syndrome Problems, Internalizing- Externalizing Groups, Total Problem

Scores, and Total Competency Score. This hypothesis was not supported by the findings

as there were no significant of differences regarding to gender groups on response to

REBT intervention on any variables of the study. The hypothesis is rejected.

Summary and conclusion of the study

A sample of 1142 students, boys and girls , aged 11 to 18 years old, was

administered the Youth self Report (YSR). Out of this sample 200 adolescents diagnosed

of conduct problems by the help of DSM-Oriented Scale were selected for the study. Out

of 200 students, 100 were taken as experimental group (consist of 50 boys and 50 girls),

and another 100 (50 boys and 50 girls) were taken as control group. Each experimental

group went under seven sessions of REBT in duration of seven weeks. No treatment was

given to control group but it was kept under observation. One month after the last REBT

session, post-test is taken from experimental and control group. Results were analyzed

and hypothesizes were tested.

The results showed that REBT is highly effective on treatment of conduct

disorder with adolescents. REBT was also effective on other emotional and behavioral

problems co-morbid with conduct disorder.

We can conclude that REBT is an effective treatment module for adolescents

with emotional and behavioral problems.

28

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