THE COMPARATIVE EFFICIENCY OF A RATIONAL-

EMOTIVE EDUCATIONAL INTERVENTION FOR

ANXIETY IN 3RD GRADE CHILDREN: AN ANALYSIS
OF RELEVANT DEVELOPMENTAL CONSTRAINTS
From:
Cognitie, Creier, Comportament
Date:
December 1, 2006
Author:
Benga, Oana; Opre, Adrian; Cristea, Ioana-Alina
More results for:
APPLICATION OF REBT AND SELF ESTEEM publication:["Cognitie Creier
Comportament"]

http://www.highbeam.com/doc/1P3-
1204461161.html
ABSTRACT

We tested the efficiency of a rational-emotive behavioral intervention to

reduce the level of anxiety (emotional and behavioral) and remedy the
irrational thinking in children (ages 9-10). The participants were 63
schoolchildren (3 classes), boys and girls. They were initially evaluated with
the Spence Anxiety Scale (for the general and specific anxiety level) and the
CASI questionnaire (for the level of irrational beliefs). Their parents
completed the Spence Anxiety Scale (parent version). There were 3 groups
(classes): rational-emotive behavioral education (REBE), sham intervention (a
Placebo type group), no intervention. The intervention lasted for 20 sessions
and we assessed the level of irrational beliefs (CASI) and the general and
specific anxiety (Spence Anxiety Scale) before and after the intervention.
Results did not show a significant improvement of the REBE group compared
to the others, neither in measures of anxiety, nor in those of irrationality. The
level of REBE specific knowledge (tested with a knowledge questionnaire)
after the intervention was significantly higher in the REBE group than in the
other two groups. Parents' evaluations differed from children's own
evaluations: they tended to overlook the existence or frequency of anxiety
symptoms in their children. Possible implications and explanations are
discussed. Implications envisage the efficiency of REBE in reducing the
anxiety and irrational thinking of school-children and possible problems
regarding its applications in the classroom.

KEYWORDS: anxiety, children, rational-emotive behavioral education,

irrational beliefs

THEORETICAL BACKGROUND

Growing up as a child is turning out to be increasingly hard. In a world

expanding its complexity in an amazing rhythm, lots of children find
themselves having to deal with "adult" problems, such as socio-economic
problems, abuse, problems of relating to others. Their developmental
equipment (their level of cognitive, emotional and social development) is not
sufficiently advanced to keep up with the racing complexity and difficulty of
their everyday world (Vernon, 2004). It has become clear that we need to
provide children with instruments that would supplement and sometimes
compensate the abilities they have due to their developmental paths (typical
or atypical), in order to ensure their efficient adaptation to this complexity.
These instruments can be regarded as skills (emotional, cognitive) that
children might acquire from an educational intervention.

Rational-emotive and behavioral education: general principles and empirical

data for anxiety problems in children

It is generally accepted that the prevention of problems is an easier task to

tackle than the intervention in cases where the problems have already set up.
In other words, we don't have to and should not wait for the onset of clinical
or subclinical psychological problems (anxiety) to intervene. Rather we
should teach children the abilities they need to attenuate the risk of
developing these problems.

The present paper is focalized on such an intervention, namely the rational-

emotive and behavioral education (REBE), designed to provide children with
an equipment of abilities for emotional and cognitive regulation. That refers
to a rational, less distorted way of thinking instead of the irrational one that
leads to dysfunctional negative emotions, which in their turn can lead to
psychological conditions, such as anxiety or depression. REBE endorses the
principles of rational-emotive behavior therapy (REBT), initiated by Albert
Ellis at the middle of the last century, and from which it derived. These can
be synthesized as the ABC cognitive model (for a more detailed description
of these principles and the ABC model, see David, 2006). Briefly, the ABC
model states that it's not the event itself that causes our emotional states,
but our cognitions related to that event. This idea is of course not new, as it
can be traced back to Greek philosophers as Epictetus (Bernard, Ellis, &
Terjesen, 2006). "A" refers to the activating event (internal and external
stimuli). The "B" in the model represents the beliefs the person holds about
the event. There are three major categories of beliefs: descriptions,
inferences and evaluations. The ABC model focuses mainly on evaluations
and distinguishes between two key evaluation "styles": irrational and rational.
The irrational evaluations are not logical, don't have factual support in reality
(are not concordant with reality) and hinder the person from achieving
his/hers goals. The rational evaluations are their complete opposite, being
logical, concordant with reality and helping the person achieve his/hers goals.
There are 4 basic types of irrational evaluations: absolute demand ("musts"),
awfulizing, low frustration tolerance and self/others downing. Each of these
has rational counterparts. According to the ABC model, our evaluations
towards an external or internal event cause the "Cs" (emotional and
behavioral consequences). The Cs can consist of dysfunctional emotions and
behaviors, which are brought about by irrational evaluations or functional
ones, brought about by rational evaluations. While the valence of functional
and dysfunctional emotions can be the same (e.g. both are negative when
the event is the person finding out he/she has a serious illness), the
differences lie in intensity and their impact upon behavior. In contrast to
functional emotions, dysfunctional ones are more intense and prevent us
from trying to act on the situation and improve it (in the previous example,
depression would be a dysfunctional emotion, and sadness a functional one).
The basic approach of rational-emotive behavioral education is to try to
flexibilize the irrational evaluations, changing them into rational ones, thus
correcting and/or preventing dysfunctional emotions and behaviors. When
working with children and adolescents, this is not carried out directly, but
through a series of activities and follow-up discussions. Vernon (2004)
considers that, in contrast with other emotional education programs, REBE
offers its beneficiaries the "power" to assume control over their own lives.
This is achieved firstly through their understanding of the link between their
thoughts, feelings and actions. Secondly it is accomplished by the grasp that,
even though they have no means of changing the other people or events in
their lives, they can exert control over themselves, their thoughts, emotions
and behaviors.

Moreover, studies show that approximately 70% of the young people who
benefit from mental health services do so only at school, which turns the
educational system into a privileged system for offering these types of
services for young people (Farmer, Burns, Philips, Angold, & Costello, 2003;
Gonzales et al., 2004). But as the number of young people that could benefit
from such services increases, so does the need of implementing empirically
sustained interventions in schools (evidence-based interventions) (Gonzales
et al., 2004; Stoiber & Kratochwill, 2000). REBE is one such intervention, as
we see later on.

Anxiety disorders are among the most prevalent forms of psychopathology in

children. Studies with community samples showed that approximately 8-12%
of children satisfy the criteria for a form of anxiety disorder that is serious
enough to interfere with their daily functioning (Anderson, Williams, McGee, &
Silva, 1987; Costello, 1989; Spence, 1998). Anxiety problems in children are
associated with a range of negative consequences in terms of school, social
and personal adaptation (Messer & Beidel, 1994; Spence, 1998). There is
evidence showing that anxiety problems are not merely temporary problems
for children. If left untreated, they can persist in adolescence and adulthood
(Keller et al., 1992; Pfeffer, Lipkins, & Plutchik, 1988; Spence, 1998) and can
also be predictors for other clinical disorders (e.g. depression).

One of the first studies regarding rational-emotive education (REE - a form of

education which was later on enriched with behavioral elements, thus
resulting in rational-emotive behavioral education or REBE) was carried out
by Knaus and Bokor (1975). They designed a pilot study to measure the
efficiency of a REE intervention to influence children in developing a more
positive self-concept and reducing test anxiety. The results sustained the
greater efficiency of REE compared to a program of enhancing self-esteem,
but both approaches were superior to no intervention.

DiGiuseppe and Kassinove (1976) examined the effect of a REE intervention,

with a duration of 15 weeks, on the emotional regulation mechanisms of 204
students, grades 4 to 8. The experimental group was compared both to a
group that received alternative treatment and to a control group. The results
sustained the idea that rational-emotive principles could be acquired by
students and that this acquisition was considered to be conducive to a
reduction in the anxiety and neuroticism scores.

Miller (1978) compared REE with a condition combining REE with behavioral
reinforcers, another one combining REE and homework, and a control
condition. The subjects were 96 children, with low and high IQ levels. The
dependent variables were the children's knowledge, neuroticism and trait-
anxiety. The results of the three experimental groups were significantly
superior in comparison to the control group. Intelligence did not prove to
have an effect on the results (see also Silverman, McCarthy, & McGovern,
1992).

Greenwald (1985) addressed his intervention to 4th grade students, with

ages between 10 and 12 years. They were randomized in 4 groups - one
control and 3 experimental groups. These were as follows: REE, REE plus
rational-emotive and behavioral bibliotherapy, REE plus rational-emotive and
behavioral imagery. The results showed that students in the third
experimental group (REE + imagery) displayed the most significant
improvements in self-concept and rational thinking, compared to the other
groups. The reduction in anxiety was greater for the first group (REE) than for
the second one (REE + bibliotherapy). It was concluded that rational-emotive
imagery could bring additional benefits to REE (see also Silverman, McCarthy,
& McGovern, 1992).

Grassi (1985) investigated the efficiency of REE and self-instruction training

on children with medium and high anxiety, from grades 4 to 6 (36 subjects in
grade 4 and 36 in grade 6). Emotional evolution was monitored through 2
questionnaires filled in by the children, a behavior evaluation scale, filled in
by the parents, and another one completed by teachers. Compared to the
control group, both experimental groups attained the content of the two
types of training, but only the effects of REE were maintained in the follow-
up phase. They both contributed to the reduction of anxiety, but REE was
more efficient in reducing neuroticism.

Cardenal Hernaez and Diaz Morales (2000) studied the effect of three months
of REE versus relaxation techniques on self-esteem and anxiety level, in 12-
14 years old children from Spain. 93 students were randomized in the 2
experimental groups and the control group. The measures applied consisted
of the Piers-Harris self-concept scale, a body attraction scale and STAI.
Measures were carried out for pretest, posttest and at three months follow-
up. Results showed that both experimental conditions equally contributed to
the global increase in selfesteem and the reduction of anxiety.

Meta-analytical research concerning the efficiency of REBE for anxiety

problems is not consistent. Gossette and O'Brien (1993), in a metaanalysis
that took into account 33 unpublished dissertations, found an efficiency of
25%. DiGiuseppe and Bernard (1990), in a metaanalysis conducted on 23
studies, found an efficiency of 50%, whereas Hajzler and Bernard (1991),
analyzing 21 studies, found an efficiency of 80% (see also Popa, 2004).

One of the most recent meta-analysis (Gonzales & al., 2004) regarding the
efficiency of rational-emotive behavioral therapy (REBT) in a wider range of
emotional and behavioral problems (including anxiety) highlights some
important discoveries. It was carried out on 19 peer-reviewed studies and it
analyzed 5 domains of results (disruptive behavior, impropriation of
rationality, GPA -grade point average, self-concept and anxiety). Their first
and more general conclusion is that, subsequent to a REBT intervention, the
modal child or adolescent had better performances, regardless the type of
result considered, than approximately 69% of the control, no treatment
groups. But another conclusion proves very interesting and can also act as a
justification for the current study: REBT intervention seems to be efficient
both for children and adolescents with an identified clinical problem, as well
as for those without one. This motivates preventive interventions, targeting
sub-clinical problems or problems that have not yet manifested, but for which
we know the child to be vulnerable. Another important conclusion of this
meta-analysis, which contributes even more to justifying the current study,
states that the efficiency of a REBT intervention is much higher, IF it
addresses younger children (primary school) than older ones (secondary
school or high-school). Another conclusion warns about the danger of the
intervention not being effective because of its too short duration: REBT
efficiency is higher in conditions with a medium (675-770 minutes) or high
(1200-2115 minutes) duration of the intervention. Regarding anxiety, effect
sizes for these measures are presented in 6 of the 19 studies (12 effect
sizes), leading to a .48 effect size.

Developmental considerations regarding children's emotional and behavioral

problems and the implementation of REBE for these problems

As we mentioned before, many young people are not "ready",

developmentally speaking, to deal with the "adult" challenges they often
face. One of the factors contributing to this is the fact that their level of
cognitive development predisposes them to irrational thinking, in the form of:
1) suprageneralizations, 2) demandigness, 3) low frustration tolerance, 4)
awfullizing and 5) global evaluation (Vernon, 2004).

Bernard, Ellis and Terjesen (2006) express a similar opinion, drawing the
attention to the close relations that exist between children's emotional and
behavioral problems and certain developmental problems in the domain of
cognitive processing of emotional or social aspects. It becomes obvious that
any therapeutic approach of children, be it preventive or corrective, has to
take into account the fact that they are developmentally vulnerable to some
cognitive processing errors (Bernard, et al., 2006). Many of these errors are
due to the ontogenetic features of the cognitive development of 9-10 years
old children.

Typical cognitive errors (according to Bernard, et al., 2006) include: 1.

drawing arbitrary inferences (conclusions that are not based on evidence or
that contradict the evidence); 2. selective abstraction (focusing on a detail,
taken out of context, ignoring essential characteristics of the situation);

3. maximization/minimization (errors in evaluating the significance of the

event); 4. personalization (the tendency to relate external events to
themselves when there is no basis for making this connection); 5.
overgeneralization (drawing a conclusion based on limited and isolated
elements); 6. dichotomous thinking (tendency to place events in opposite
categories, e.g. good-bad).

These errors become even more poignant and can develop into dysfunctional
processing styles, when the information to be processed has an increased
emotional valence. A relevant example to sustain the idea that cognitive
development cannot be ignored in the study of emotional and behavioral
problems comes from the studies of social cognition. Research in this domain
show that family factors (e.g. exposure to problematic parental factors) that
predict adaptation problems, also predict social cognition deficits (Barahal,
Waterman, & Martin, 1981; Downey & Walker, 1989; Pettit, Dodge, & Brown,
1988; Smetana, Kelly, & Twentyman, 1984,). This suggests that social
cognition abilities could mediate the relationship between family risk factors
and child's adaptation. On the other hand, if children from high-risk families
are exposed to competent models, they can develop social cognition abilities
that can compensate the increased risk for adaptation problems, related to
parental psychopathology and abuse (Downey & Walker, 1989). Thus the
developmental level of social cognition is an important element in the
relation between the risk factors the child is exposed to and the emergence
of emotional disorders. We can notice a fairly transparent symmetry with
irrational beliefs (the Bs in the ABC model, for details about the model, see
David, 2006) and the emergence of dysfunctional negative emotions (which
by repetition can turn into a dysfunctional emotional pattern, the premise for
the development of emotional and behavioral problems, such as those from
the anxiety spectrum). An interesting research topic would envisage the
conceptual and empirical relations between these constructs (irrational
beliefs and social cognition).

One of the fundamental reasons for considering REBE as a privileged

modality to approach children's emotional and behavioral problems is the fact
that it uses a perspective consistent with that of developmental psychology.
More precisely, REBE satisfies the existent criteria for determining a theory's
developmental potential (Bernard, et al., 2006; Holmbeck & Updegrove,
1995). Among these criteria, according to Bernard, et al., (2006), we can
mention: keeping up-to-date to the most recent discoveries in developmental
literature; taking into account the critical developmental periods and tasks,
relevant for the child's problem; the flexible prioritizing of the symptoms, as
a function of the degree in which each symptom is atypical from a
developmental standpoint. In addition, REBE follows a developmental
perspective also because of its evaluation and intervention modalities, which
are projected so they would take into account the developmental level
(physical, cognitive, emotional, and social) of the child or adolescent
(Bernard & Joyce, 1984; Bernard, et al., 2006). A lot of its techniques and
activities are specific ones, developed together with educators and teachers,
who work in direct interaction with young people.

OBJECTIVES OF THE PRESENT STUDY

The main objective of the current study is the evaluation of a REBE

educational intervention in children of 9-10 years of age for emotional (e.g.
intense worry) and behavioral problems (e.g. avoidance of anxiety-inducing
stimuli) from the anxiety spectrum. Our goal is to see whether through REBE
interventions we can improve the mental (reduction of the irrationality level)
and emotional (reduction of the anxiety level) functioning in these children.
Also we attempt to clarify the efficiency and problems that can arise in
implementing a specific REBE program in the ecological context of the
classroom.

The comparative evaluation refers to determining the efficiency bonus that a

specific REBE intervention can bring over: 1) a sham intervention (where the
improvement would be caused by Placebo mechanisms, the results being due
to the mere presence of an intervention and not to the technique) and 2) no
intervention. The improvements regard the reduction of the irrationality level
and the anxiety level, measured by specific instruments.

We must mention that the study has an exploratory character. Therefore we

cannot formulate precise hypotheses, so the following are more likely
suppositions that should be taken with some degree of caution.

1. Children who benefit from the REBE intervention will present a more
significant reduction of irrationality than those who benefit from the sham or
no intervention.

2. Children who benefit from the REBE intervention will present a more
significant reduction of anxiety (global score as well as specific problem
categories) than those who benefit from the sham or no intervention.

METHOD

Subjects: Subjects were 63 children, aged between 9 and 10 years from three
3rd grade classes, selected from 2 schools in Cluj-Napoca. 36% of all children
were girls and 64 % boys. Participation in the program was voluntary and
school, teachers' and parents' agreement for the program were previously
secured. We could not in this case ensure a random selection and distribution
in groups. Even if the schools were randomly selected, in order to carry out
the intervention we depended on the availability of the school-principle,
teachers and parents. Moreover, we were interested in seeing how the
intervention works in an ecological environment, because that will be the
setting for structured mental health programs dealing with children's
emotional difficulties. To prevent some of the problems that arise from the
lack of randomized selection, we controlled for the existence of significant
differences between the 2 groups on measures of anxiety and irrational
beliefs.
Experimental design: The research method was quasi-experimental, in the
form of a pre- and posttest groups design, because we have no means of
controlling the various environmental influences the children are subjected
to, outside the limited weekly duration of the intervention. The independent
variable consisted in the type of intervention and has 3 modalities (rational-
emotive intervention, sham intervention, no intervention), which will be
detailed in the procedure section. The dependent variables circumscribed the
level of irrational beliefs, the anxiety level (both general level and specific
types) and the degree of rational-emotive knowledge following the
intervention. These were measured by specific tests and a knowledge
questionnaire.

We decided to include a sham intervention group so that, should the

intervention be efficient, we could extract some information about the
mechanisms that lead to its efficiency. This group benefited from an
intervention with the same duration and the same person as the REBE group,
children and their parents being told that the person is certified in such an
intervention. The activities and discussions had the same structure and set of
rules (non-evaluative). What differed was the content of the sessions
(astronomy - things about universe, stars, planets), constructed in such a way
that the mechanisms assumed to operate in the rational-emotive intervention
are, in as much as possible, inactive. Thus, the mentioning of people, their
emotional problems, cognitions, relationships was suppressed from the
content of the sham intervention. If this particular REBE intervention is
efficient and operates on the basis of the general mechanism presented by
the REBT theory, then it should lead to a reduction of anxiety significantly
more substantial than what could have been achieved by the mere
maturation of the subjects (check control group) or on the basis of a different
intervention, in which the REBT change mechanism is kept inactive (check
sham group).

Procedure: The testing phase was individual for all subjects. The same
instruments were used in the pre- and posttest phase (after the intervention).
The intervention phase lasted for 3-4 months, with 2 regular sessions of
about 45 minutes per week (20 sessions of actual intervention for the REBE
group and the sham group).

The REBE group benefited from an intervention structured in 4 modules:

1. Emotions (development of vocabulary and knowledge about emotions)

2. Beliefs and behaviors (understanding what beliefs are and how they
determine our emotions and behavior - the ABC model)

3. Self-acceptance (learning to accept themselves and others as imperfect

human beings, with positive and negative features, avoiding global
evaluations).

4. Problem solving (developing problem solving strategies and approaching

specific problems for anxious behavior)
The material used consisted of the book "Programul de dezvoltare a
inteligentei emotionale prin educatie rational-emotiva si comportamentala,
clasele I-IV"/ Thinking, Feeling, Behaving. An emotional education Curriculum
for Children (author Ann Vernon, translated and adapted in Romanian by
Opre, David, Baltag, & Vaida, 2004). Each session comprised an activity part
(stories, games or other activities), followed by discussions.

The sham intervention group benefited from an intervention of the same

frequency and duration and with the same person. The content however
envisaged the enrichment of the knowledge about Earth and Universe and
avoided as much as possible discussions involving animate beings (humans,
their relations, beliefs, emotions). The structure was identical to that of the
REBE group, images, texts and games were used, interactions were
encouraged, the discussions stage was present, but these were all focused on
the specific information presented. In the no intervention group, there was
only a pre- and posttest phase.

Instruments:

For measuring anxiety we used to the following instruments:

* The Spence Children' Anxiety Scale - SCAS (Spence, 1994). The scale is
composed of 38 items, 6 filler items and an open question. The child is asked
to read each statement and appreciate how often that particular thing
happens to him on a 4-point scale. The questionnaire offers a global anxiety
score, as well as scores for specific clusters of anxiety related problems.
These clusters are represented by the subscales of the SCAS: panic attack
and agoraphobia, separation anxiety, physical injuries fear, obsessive-
compulsive behavior, generalized anxiety. It is constructed following the DSM-
IV criteria, which enhances its precision in accurately identifying anxiety
problems and it is meant to be an indicator of the number and severity of
anxiety symptoms. The authors also establish cut-off points, circumscribing
three problematic categories in which the subject could be placed: at risk
(16% of the population), borderline clinical (7%), clinical (2-3%). The SCAS is
in the final stage of its adaptation for the Romanian population (Benga, 2006,
in progress), and the preliminary date indicate good reliability, both for the
global scale and for its subscales. Data from other populations (German,
Dutch) indicated very good reliability for the scale and its subscales and good
discriminate validity, using a clinical anxiety diagnosis as criterion (Spence,
1998).

* The Spence Children' Anxiety Scale (SCAS) - Parent version (Spence, 1994).
The content, cotation and interpretation are almost identical to the SCAS. It
consists of 38 items and an open question. There are fewer studies regarding
it, but the data indicate satisfactory to very good reliability for the scale and
its subscales and good discriminant validity regarding the clinical anxiety
diagnosis (except for the generalized anxiety subscale)- Nauta et al., 2004. It
is also being adapted on the Romanian population (Benga, 2006, in progress).

For measuring irrational beliefs we used:

* The Child and Adolescent Scale of Irrationality - CASI (Bernard & Laws,
1999): It is addressed to children and adolescents between 9-18 years of age
and is comprised of 28 items, formulated as statements about which the
subjects to express their agreement on a 5-point Likert scale (1- strongly
disagree, 5- strongly agree). CASI overcomes the problems presented by the
other existent irrational beliefs scales, as the theoretic model it was based on
takes into account the recent theoretical and empirical discoveries in REBT
and REBE research, and the items are exclusively cognitive ones. The scale
was adapted on Romanian population (Popa, 2006). The validation study used
factorial analysis and 4 factors were identified (consistent with the ones in
the initial validation study). These are: low tolerance to frustration brought on
by rules, global evaluation of the self, demands for fairness, low tolerance to
frustration brought on by work (Popa, 2006). The scale has good global
fidelity (α Cronbach= 0.84) and its subscales have satisfactory to good
fidelity (Popa, 2006).

We also resorted to an evaluation of the knowledge attained subsequently to

the rational-emotive behavioral intervention by means of a knowledge
questionnaire. This comprised of 20 questions, formulated from the content
of the REBE lessons and it was administrated to all 3 groups. We wanted to
see whether there were any significant differences after the intervention in
the level of declarative knowledge between the 3 groups, in other words to
see whether or not at least declaratively (even if that doesn't express in a
reduction of anxiety or irrational beliefs), the REBE group has attained data
that has not been acquired by the other groups.

RESULTS

Descriptive data

In the table above, we display the means and standard deviations for the
anxiety measures (pre and post-test).

If we compare these scores to the normative values (from validation studies

carried out on other populations), we can see that for the REBE group, the
pretest mean values for separation anxiety (cut-off points: 7-9), physical
injuries fears (cutoff points: 5-6), as well as global anxiety (cut-off points: 40 -
51), can be placed in the at risk category for clinical anxiety problems
(according to the cut-off values previously described). Also the pretest mean
value for obsessive compulsive behavior for this group can be located in the
borderline clinical domain (cut-off points: 11-12). For the sham group, none
of the pretest mean values can be located in the at risk, borderline clinical or
clinical spheres. For the control group, only the pretest mean values for
physical injuries fears (cut-off points: 5-6) and obsessive compulsive behavior
(cut-off point: 10) can be located in the at risk area. None of the posttest
mean values, for any of the three groups, can be located in the at risk,
borderline clinical or clinical domains. Where more than one value is
displayed for cut-off points, it is because the values are different for boys and
girls.
In table 2, we present the measures for irrational beliefs. As the normative
values reported in the initial validation study (Popa, 2006) are general ones
for young people with ages between 9 and 17 years, we didn't view them
reliable enough for reporting the mean values we obtained to them. It is clear
that, given the developmental differences among children of these ages, the
normative values for high and very high irrationality cannot be indifferent to
age.

Intra-group comparisons

We used the t test for paired samples. Significant values are marked with an
asterisk (p<.01). We chose an alpha threshold of .01 (even though the
commonly accepted value for alpha in psychology research is .05), because
in this case we wanted to keep the type I error as small as possible. An
educational intervention as the one employed here requires a significant
quantity of resources (time, materials, human resources) and we have to be
sure about its efficiency before engaging all these resources to implement it.
Therefore, we have to be more strict in assessing its efficiency and should
recommend its implementation only on the basis of a clearly distinguishable
effect. So we chose a lower alpha threshold than it is usually accepted in
order to prevent false positives (finding a significant effect when in fact there
is none) as much as possible.

We can see that the effect of the intervention in each group concerning
irrational beliefs is practically insignificant. Regarding the anxiety level, we
must first notice that the REBE group displays significant improvements on
the panic attack and agoraphobia subscale, improvements that are not
present in the other groups. An interesting result is that both the REBE group
and the sham group show significant improvements on the measures of
generalized anxiety. Also both the REBE group and the control group show
significant improvements on the obsessive compulsive disorder subscale.
However the most important result for the present study involves the level of
specific REBE knowledge, which has significantly improved only in the REBE
group.

Inter-groups comparisons

We must note that in the pretest phase the differences among the 3 groups
are not significant at p<.01 for irrationality (F=2.66) and anxiety (F=4.93)
both as global scores and subscale scores. However, we must acknowledge
that the means of the REBE group (for anxiety) are consistently higher
(although not significantly so) than those in the other groups, which was also
an ethical consideration that oriented us to using that particular group as the
target group. At posttest, there are still no significant differences at p<.01
among the 3 groups for anxiety (F=3.67) or irrationality (value for F=0.53).
For a more precise assessment of the potential change we also compared
effect sizes (the magnitude of change) for each group. In this case we again
had no significant differences among the groups at p<.01 on measures of
anxiety (F=0.51) or irrationality (F=2.54). All the above, correlated with the
intra-group comparison data, allow us to conclude that in the particular case
of these classes of students, the REBE intervention did not have a significant,
consistent, transparent effect on irrationality and anxiety. However, when we
look at the data regarding the REBE knowledge, we notice that at posttest
they are significantly different in the REBE group from the sham group
(F=3.70, p<.01) and the no intervention group (F=5.26, p<.01). Moreover,
the REBE group has significantly better knowledge than the other 2 when we
look at the magnitude of change (F=5.78, for comparison to the sham group
and respectively F=5.81 to the control group, p<.01).

Data from parents

A number of 42 parents from all three groups completed the parent version
of the Spence scale (at pretest). We computed Spearman correlation
coefficients for the evaluations of parents and those of their children. The
parents' evaluation of the anxiety problems of their children and the
children's own evaluations differ in the sense that the parents tend to
overlook the existence or severity of anxiety problems. We have found
positive medium correlations at the subscales of separation anxiety
(r=0.463, p<.01) and physical injuries fears (r=0.488, p<.01). The
correlations for global anxiety and the other anxiety subscales were not
significant at p<.01.

DISCUSSIONS

Intra-group comparisons

Regarding the intra-group comparisons for irrational beliefs, the significant

result at the demand for fairness subscale in the control group could be
accounted for by the evolution of subjects, but more likely by procedural
aspects regarding the problematic application of the CASI questionnaire
with children this age (will be detailed in the limits section) or social
desirability (children remembered having filled in the scale before and feel
they are expected to offer different answers, even though in this case they
were specifically instructed that the second application has nothing to do
with the first). Regarding anxiety, the REBE group displays significant
improvements on the panic attack and agoraphobia subscale, improvements
that are not present in the other groups. However, we should be very careful
before asserting a specific effect of this intervention on this problem
category. We should first look at the inter-groups comparisons to see if there
really is a consistent effect of the intervention, which cannot be accounted
through other mechanisms (maturation, procedural aspects). We must also
mention that for this subscale, the initial mean values were very low (even
much more so for the sham and control groups), so the significant difference
can be an epiphenomenon of these small means, reported to which any small
change can count. Both the REBE and the sham group show significant
improvements on the measures of generalized anxiety. A possible
explanation could be that, for children this age, a big part of the generalized
anxiety problems are generated by school pressure, evaluation, friendship or
competitive relations with peers. Both the REBT and the sham intervention
indirectly approach these problems by using activities in which children are
not evaluated, trying to get everyone involved, making them work in groups.
Another possible explanation is procedural and refers to the fact that the
items measuring generalized anxiety are more general and vague (e.g. I feel
scared), so they could be interpreted differently by children in different
moments, which could partly explain the fluctuation of answers. Also both
the REBE group and the control group show significant improvements on the
obsessive compulsive disorder subscale. The differences could be due to the
natural evolution of the subjects (maturation). Another explanation could be
a procedural one: the items for obssesive compulsive behavior on the Spence
scale are more difficult to understand for the child (e.g. "I have to think of
special thoughts to stop bad things from happening (like numbers or
words)"). It might be that at posttest they are more familiar with them and
with the way they should be interpreted and so their answers would reflect
reality more accurately. The fact that there is a significant increase in the
level of REBE knowledge only in the REBE group can allow us to safely
assume that, at least at a declarative level, the children in the REBE group
have impropriated some of the specific knowledge, even more so as this
process seems to be absent in the other groups.

Efficiency of the program (intra-group and inter-groups comparisons)

Starting off from this data, we came up with 2 major interpretative ways: a
procedural perspective and a developmental perspective.

From a procedural perspective, explanations should be searched in problems

specific to working in a classroom, which can be confounding variables and
could account for these results. The context is an ecological one and can offer
an accurate image of the way such an intervention could really work, in an
educational program implemented in school (increased external validity). But
problems arise with regard to the internal validity, due to the fact that we
can't exclude the distorting influence of other variables than those of
interest. Many studies have discussed the role of parents' and teachers'
irrational beliefs in inducing and reinforcing an irrational thinking style in the
child (Bernard, Ellis, & Terjesen, 2006). Parents and their behaviors may have
a double role, both as models and reinforcers. Their action could go in the
opposite direction to the REBE intervention. We tried to diminish this source
of error by explaining to the parents, in a preliminary meeting, that they
should not contradict and instead try to encourage the new ideas and
behaviors the child acquires from the intervention. Still, we can't exclude the
fact that some of them have acted, consciously or not, in the opposite
direction of our intervention. A frequently documented example is that of
perfectionism: the child is taught that he/she can't possibly do things
perfectly and that's it's not sound to ask that from himself. A better version is
for him to try as much as he can to do everything very well, but without
thinking that a potential failure would make him a worse human-being.
However, many parents demand perfection from their children and punish
them if they don't succeed in doing everything perfectly (for example always
get the highest grades, at all subjects) (Bernard, et al., 2006). It is also
evident that the parents' influence on their children is much greater than any
influence we would hope to achieve in weekly sessions, during a few months.
The teachers could represent another source of error, similar in its action
mechanism. They too have got more time with the children and more control
and reinforcement possibilities to make their influence more consistent than
that of the intervention. We tried to control this problem since the teacher of
the REBE group had attended REBE training. Still, she was present during all
the sessions, although we specifically requested her not to intervene. It is
however possible that her presence could have acted as an inhibitor for the
adequate involvement of children in the proposed activities (especially those
that required personal examples).

Still, procedural aspects are not by themselves enough to explain our results.
The activities used were taken from a manual and were specifically conceived
for group work. We need to consider explanations at a deeper level; therefore
it would be useful for us to look at the developmental characteristics of the
children involved in this program. So the second perspective for data
interpretation is a developmental perspective. We will start off from the
observation that in the REBE group, although there is no effect in the
direction of ameliorating anxiety and irrational beliefs, there is a significant
and consistent effect on REBE knowledge. Children seem to have acquired
the knowledge being discussed, but this doesn't seem to impact their way of
thinking and their emotional problems.

The main objective of our intervention referred to the fact that, subsequently
to the activities and discussions, children would extract ideas about certain
concepts (emotions, beliefs, behaviors) and then generalize and apply these
concepts in their daily lives. However, as we have pointed out in the
theoretical part, their cognitive development is impinged on by some typical
processing errors (Bernard, et al., 2006). It may be that, in the context of this
intervention, all these translated into a limited capacity of transferring the
acquired information in real life situations, especially when dealing with
emotionally loaded content. For example a cognitive error such as that of
selective abstraction (focusing on details and ignoring essential features of
the situation) (Bernard, et al., 2006) could lead children to see the activities
used as simple games, without extracting general principles (which was the
real purpose of the activity). Even in the cases when they did extract some
regularity, another cognitive error specific to their point of cognitive
development is the situated, localized nature of their inferences and concept
application (a concept's area of application is circumscribed to the context
it was learned in). In other words, it could be that what is learned in the
classroom is only applied in the classroom and not transferred to other life
situations (e.g. family problems, problems with peers). These issues could be
even more significant as the similarities between contexts (class situation -
other life situations) are not really transparent to children. The problem
situations that are outside the actual intervention sessions may not
automatically activate the idea of applying the learned concepts. Even
though they have the declarative knowledge, it is possible that children
cannot explore the benefits of this knowledge because of their
developmental particularities. A mental health educational program should
take these issues into account.
An additional observation should also be made. It regards the specific action
mechanisms of rational-emotive education: the modifications of irrational
cognitions lead to the correction of dysfunctional emotions. The present
research does not offer enough data to extract inferences about the validity
and applicability of this mechanism in the case of anxiety. Anxiety problems
in children this age have, as we have previously said, a resilient behavioral
component (Keller et al., 1992; Spence, 1998). It could be that a general
action mechanism, such as the one postulated by the REBT theory, may not
be sufficiently efficient in the case of anxiety. Intervention might have to be
specifically targeted on the particular aspects of anxiety behaviors.

Data from parents

The results are consistent with other data obtained using the Spence scales
with other populations. Nauta et al. (2004) indicate inter-correlations in the
range of 0.41-0.66 in the group of children with diagnosed anxiety disorders
and in the range of 0.23-0.60 in the group without diagnosed anxiety
disorders (our results fit in that range). The highest degree of agreement is
met for subscales that envisage behaviors easily observable (Nauta et al.,
2004). In our case, the significant, positive correlations were medium sized
and obtained in the cases of separation anxiety and physical injuries fears,
which enclose observable behaviors.

A series of studies from other domains, such as temperament research, raise

the issues of the credibility and accuracy of parental evaluations. Studies
reveal the different biases and errors that can mark the parental evaluations:
in their answers parents project the image they have constructed about the
child and his/her actual behaviors (Benga, 2002); they don't understand the
items or the instructions; they don't know the child's behaviors and their
significance; their recollections can lack accuracy (Benga, 2002; Rothbart,
Chew, & Gartstein, 2001); they want to offer socially desirable answers. All of
these can be possible explanations for the reduced correlations between the
parents' evaluations and the child's selfevaluations in the current research.

Other possible reasons have to do with the specificity of some clusters of

problems. The anxiety problems for which the evaluations are more
concordant are separation anxiety and fears of physical injuries. These
include behaviors that are more easily observable, more frequent and upon
which parents are used to direct their attention (e.g. "my child is scared of
dogs", "my child is scared if (s)he has to sleep on his/her own"). Moreover,
these are behaviors that are usually verbalized or clearly expressed by the
child (e.g. cries, yells, verbally protests to sleeping alone). However, parents
are less equipped in noticing problem behaviors of a different nature (social
phobia, obsessive-compulsive behavior). These are much less transparent
and less frequently verbalized by the child because it is often difficult for
him/her to identify the source of the problem or he/she simply does not
perceive them as problems (e.g. a child who often repeats a number or
phrase to him in order to prevent bad things might not see it as a problem).
Also we cannot omit the sociological explanation, which is the fact that
parents spend less and less time with their children and thus don't have
sufficient time to observe such problem behaviors. Actually the parents
expressed this point in the preliminary discussions (e.g. "I barely see my
child, I don't now what he does most of the time").

IMPLICATIONS FOR FUTURE RESEARCH

Based on the data obtained and the analysis carried out, possible future
research could approach:

* The modalities through which cognitive development particularities of

children of different ages can be approached in educational programs for
mental health and how this can enhance the efficiency of these programs
(through the generalization and transfer of knowledge by children).

* The identification of specific mechanisms that operate in determining

anxiety problems in children (especially discovering the mechanisms that
come into action before these problems achieve clinical intensity) and how
we can counteract these in preventive interventions.

* The development and adaptation of instruments of evaluating children's

irrational beliefs, instruments with items that are more comprehensible and
adequate for the particular age group.

Regarding the limitations, the first one refers to the lack of randomized
selection and distribution of subjects. We detailed this in the methodology
section, so we will not dwell on it again. Another limitation, resulting from
this, is the fact that the anxiety means of the REBE group are consistently
higher (although not significantly so) than those in the other groups. This
could also have been a factor influencing the results of the intervention. We
will also detail another important limitation which refers to the CASI and its
adaptation on the Romanian population. We chose this scale because, among
the ones that measure irrational beliefs, it is the most robust one
(theoretically and empirically). However we can't ignore the problems
presented by the Romanian version of the CASI, especially with children this
age. These could have seriously impaired the results. In brief, some of the
problems are: the use of a 5-point scale, as it is hard for children to operate
with these distinctions and they usually go for the extreme values;
negatively-worded items, that are difficult to interpret and the children have
to resort to complicated logical deductions about denying a negative
statement; the use of some terms that are hard to understand or vague, such
as "frustrated", "desperate"; the lack of age differentiated norms.

The present research raises more questions than it gives answers. But if we
were to quote Einstein "formulating a problem is often more important than
solving it". This research cannot offer clear and definitive answers on the
ecological efficiency of REBE in reducing anxiety in 9 to 10 years old children.
Yet we hope to have been able to provide some empirical data and
interpretations that can contribute to a more exact formulating of the
problem.
ACKNOWLEDGMENTS

This research was supported by CEEX-M1 Grant no. 124 (AnxNeuroCog) from
the Romanian Ministry of Education and Research.

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[Author Affiliation]

Ioana-Alina CRISTEA*, Oana BENGA, Adrian OPRE

Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania

* Corresponding author:

E-mail: ioana.alina.cristea@gmail.com

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