Rational emotive behaviour therapy (REBT; Ellis, 1994) is the original cognitive-behavioural model of psychopathology. REBT theory built upon Ellis’ “ABC” model of emotional distress that states that cognitive-emotional-behavioural-physiological responses or consequences (C) are not the direct product of the adverse activating events experienced in our internal or external environments (A), but are rather the result of our evaluative or appraisal beliefs (B) about these activating events. According to REBT theory there are two main classes of evaluative beliefs; rational beliefs and irrational beliefs.
Rational beliefs reflect flexible and nonextreme evaluations of the events we experience in our day-to-day lives, whereas irrational beliefs reflect rigid, absolutistic, and extreme evaluations of various kinds of activating events (Dryden & Neenan, 2004). REBT theory predicts that if a person responds to a negative activating event with a set of rational beliefs, a series of functional and adaptive cognitive-emotional-behavioural-psychological consequences will arise. Alternatively, if a person holds a set of irrational beliefs about a given negative activating event, then a series of dysfunctional and maladaptive cognitive-emotional-behavioural-physiological responses will develop.
Contemporary REBT theory (see David, Ellis, & Lynn, 2010) describes four basic irrational belief processes that are hypothesised to interact with each other in a specific manner to bring about a psychopathological response. According to the model, the core psychological process in the emergence of psychopathology is the transformation of flexible “preferences” for goal fulfilment (rational beliefs) into rigid “demands” (irrational beliefs; Ellis, 1994; Wallen, DiGiuseppe, & Dryden, 1992). This process of escalating flexible preference beliefs (e.g., “I want to succeed at this task”) into rigid demandingness beliefs (e.g., “I must succeed at this task”) is hypothesised to represent the core psychological process in the development of psychopathology (David et al., 2010; Soloman, Arnow, Gotlib, & Wind, 2003).
Demandingness beliefs as such are viewed as the primary irrational belief process and are predicted to give rise to a set of secondary irrational appraisal beliefs which are extreme in nature. These include catastrophizing beliefs, which describe the process of evaluating an event in the most extremely negative manner possible, low frustration tolerance beliefs, which involve a person terrifically underestimating his or her own ability to tolerate or cope with the distress of not having their demand met, and depreciation beliefs, which involve a person making overgeneralized, global negative evaluations of the self, others, and/or the world. REBT theory is explicit in stating that demandingness beliefs should affect various states of psychopathology indirectly through catastrophizing, low frustration tolerance, and/or depreciation beliefs (David et al. 2010; Ellis, 1994).
There is a great deal of evidence supporting the role of these irrational belief processes in a variety of psychopathological states (see Browne, Dowd, & Freeman, 2010 for a full review); however, substantially less empirical evidence exists with regards to the organization and interrelationships among irrational belief processes, despite the centrality of this issue in contemporary REBT theory.
David, Schnur, and Belloiu (2002) attempted to examine the interrelations of the irrational beliefs within the paradigm of Lazarus's (1991) Appraisal Theory of emotions and found that demandingness beliefs were highly correlated with primary appraisals, and more strongly associated with primary appraisals than with catastrophizing, low frustration tolerance, and depreciation beliefs. Furthermore, catastrophizing, low frustration tolerance, and depreciation beliefs were highly related to secondary appraisals. Their results suggested that demandingness beliefs are better represented as a primary appraisal mechanism, and catastrophizing, low frustration tolerance, and depreciation beliefs are better represented as secondary appraisal mechanisms. This study was then replicated within both clinical and nonclinical samples and similar patterns of results were observed (David, Ghinea, Macavei, & Kallay, 2005). Such results offered tentative support that the impact of demandingness beliefs on psychological distress may be mediated by catastrophizing, low frustration tolerance, and/or depreciation beliefs.
DiLorenzo, David, and Montgomery (2007) then specifically investigated the proposed mediational relationships between the irrational beliefs using meditational analytic methods suggested by Baron and Kenny (1986). DiLorenzo et al. (2007) conducted their analysis within a longitudinal research design that included 99 students experiencing exam-related anxiety measured at two time periods. Their analysis found that the effect of demandingness beliefs on psychological distress were fully mediated by catastrophizing beliefs and depreciation beliefs at both time periods, while low frustration tolerance beliefs fully mediated the relationship between demandingness beliefs and exam-related anxiety at time 1 but not at time 2.
Past research findings therefore offer support for the predictions of REBT theory regarding the organization of the irrational belief processes; however, given the central nature of this prediction to both REBT theory and therapy, far greater research is warranted. The purpose of the current study is to directly test this key prediction of REBT theory within a sample of trauma-exposed participants who are experiencing symptoms of posttraumatic stress disorder (PTSD), utilizing latent variable modelling techniques. No empirical work could be found that has directly assessed the role of irrational beliefs, as outlined in REBT theory, in the development or maintenance of PTSD symptomology. Given that these cognitive variables are unique and distinct from the types of cognitive variables described in the field of cognitive therapy (CT; see Hyland & Boduszek, 2012), which have informed current cognitive models of PTSD (e.g., Ehlers & Clark, 2000; Clark & Beck, 2011), the current study will add valuable and unique data to the scientific literature regarding the importance of irrational beliefs in PTSD. Additionally, the current study will be the first to utilize latent variable modelling procedures to assess the organization of the irrational beliefs and their direct and indirect effects on psychopathological outcomes.
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The primary objective of the current study was to investigate the theoretical predictions of REBT with regards to the organization of the irrational beliefs hypothesised to be crucial in the pathogenesis of psychopathological symptoms. Moreover, the current study was performed to assess for the first time the importance of the cognitive variables outlined in REBT in the experience of PTSD symptomology.
To test REBT's theoretical model it was necessary to first establish the dimensionality and construct validity of both the PDS (Foa et al., 1997) and the AV-ABS2 using CFA techniques. This analysis was conducted to accommodate the required variables within an appropriate latent variable framework. Results of the CFA indicated that the PDS was best represented by the Simms et al. (2002) four-factor model, a finding consistent with the overall literature regarding the symptom structure of PTSD (Yufik & Simms, 2010). The AV-ABS2 was found to be most accurately explained by an eight-factor solution comprisingthe four irrational belief processes (demandingness, catastrophizing, low frustration tolerance, depreciation) and the four rational belief processes (preferences, noncatastrophizing, high frustration tolerance, acceptance). For the purposes of the current study, however, we considered only the four irrational beliefs within the respective structural model as we are concerned with establishing the organization of these variables in the emergence of psychological distress.
SEM results demonstrated that the REBT model of PTSD was a good fit of the data. The χ2-to-df ratio was less than 2:1, and the CFI, TLI, RMSEA, and SRMR results were all within ranges indicative of good model fit. This REBT model explained an impressive amount of variance in each of the four PTSD symptom groups. The irrational beliefs were found to explain 67% of variance in Intrusive symptoms, 50% of variance in avoidance symptoms, 67% of variance in dysphoria symptoms, and 56% of variance in hyperarousal symptoms. These findings strongly suggest that the cognitive factors described by REBT are critical cognitive constructs in the development and maintenance of PTSD symptomology.
In addition to identifying the importance of irrational beliefs in the prediction of posttraumatic stress symptomology, this study was primarily interested in identifying the organization of the irrational beliefs by investigating the indirect pathways between demandingness beliefs and the various symptom clusters of PTSD. Multiple indirect effects were observed from demandingness beliefs to intrusions, avoidance, dysphoria, and hyperarousal.
In the case of the relationships between demandingness beliefs and the intrusions and hyperarousal symptom clusters, respectively, indirect effects were observed for all three secondary irrational belief processes. Whereas in the relationship between demandingness beliefs and avoidance symptoms, indirect effects were observed for catastrophizing and depreciation beliefs, and in the relationship between demandingness beliefs and dysphoria symptoms, indirect effects were observed for low frustration tolerance and depreciation beliefs. These results are consistent with the predictions of REBT theory (David et al., 2010; Ellis, 1994; Wallen et al., 1992) and are generally in line with previous research findings.
Current results lend support to the view that demandingness beliefs appear to be the primary irrational belief process and affect the various symptom groups of PTSD in an indirect manner via a variety of the secondary belief process. DiLorenzo et al. (2007) previously found the catastrophizing and depreciation beliefs served to mediate the relationship between demandingness beliefs and exam-related anxiety. Past and current results thus indicate that the relationship between demandingness beliefs and various psychopathological states will likely not always be mediated via all three secondary irrational belief processes, but rather unique and distinct patterns of relationships between the primary and secondary are likely to exist depending upon the nature of the psychological distress under investigation.
David et al. (2002) have previously presented theoretical predictions of the nature of the relationship between the irrational beliefs in the development of anxiety and depressive disorders and current results offer novel evidence that each of the four irrational belief types are critical cognitive variables in posttraumatic stress symptomology. Identification of the critical irrational beliefs in the prediction of psychopathology has important clinical implications as clinical strategies can be focused only on the most relevant irrational belief processes. Based on current results, intrusion and hyperarousal symptoms may be best treated through the targeted modification of demandingness beliefs along with all secondary irrational belief processes. Alleviation of avoidance symptoms could be best achieved through the reduction of demandingness, castastrophizing, and depreciation beliefs; while symptoms of dysphoria may well best respond to the reduction in levels of demandingness, low frustration tolerance and depreciation beliefs.
Ellis (1987, 1994) consistently argued that demandingness beliefs lie at the core of all forms of psychological disturbances and should affect various states of psychopathology through catastrophizing, low frustration tolerance, and depreciation beliefs. This hypothesis courted considerable criticism from many within the cognitive-behavioural therapy (CBT) community (e.g., Brown & Beck, 1989; Padesky & Beck, 2003), who asserted that while demandingness beliefs can sometimes play a role in the emergence of some forms of psychopathology, demandingness beliefs by no means represent a core psychological construct in all types of psychopathology. Little evidence currently exists to either support or refute this rather grand claim; however, Soloman et al. (2003) previously produced evidence to support the primacy of demandingness beliefs in the major depressive disorder, and current results provide tentative evidence for the importance of conceptualizing demandingness beliefs as a critical core psychological construct in PTSD.
Currently, cognitive models of PTSD (e.g., Clark & Beck, 2010; Ehlers & Clark, 2000; Resick & Schnicke, 1993) and measures of specific cognitions relevant to PTSD (e.g., Foa, Ehlers, Clark, Tolin, & Orsillo, 1999; Najavits, Gotthardt, Weiss, & Epstein, 2004; Vogt, Shipherd, & Resick, 2012) make no explicit accommodation of demandingness beliefs. Because empirically validated CBT treatment protocols derive directly from these theoretical models, current results suggest the possibility of improving theoretical understandings and potentially developing more efficacious treatment approaches if consideration of demandingness cognitions were included within relevant theoretical and therapeutic models of PTSD; however, substantially greater research would be required to better establish the validity of this possibility.
The current study contains a number of limitations that ought to be considered. The nature of the sample is limited to a very specific strata of the population (law enforcement, military, and emergency service personnel), thus generalizations of current findings to the wider population is problematic. In particular, the professions from which the sample were drawn may have influenced the level of demandingness beliefs observed; therefore, future research efforts should seek to replicate the current study among more diverse population groups to develop more robust and reliable conclusions.
Additionally, a self-report measure of PTSD symptomology was used and although self-report measures of PTSD such as the PDS (Foa et al., 1997) used in the current study have been shown to highly correspond with clinician-administered measures (Griffin et al., 2004), clinician-based measures would have been preferable as they are considered the gold standard method of assessing PTSD symptomology. Given the cross-sectional design of the current study, it was possible to investigate only indirect effects rather than testing mediational pathways, which REBT theory specifically states. Although current findings provide good support for the REBT model, longitudinal research designs will be necessary to more fully establish the mediational effects of catastrophizing, low frustration tolerance, and depreciation beliefs in the relationship between demandingness beliefs and PTSD symptomology.
In conclusion, this study substantially contributes to the scientific literature in a number of important ways. The current study is the first of its kind to apply latent variable modelling techniques to determine the organization and interrelations of the irrational beliefs described in REBT theory, and as such offer additional and methodologically rigorous support for the core predictions of REBT theory. These findings are also the first to provide empirical support for REBT theory regarding the importance of the irrational beliefs in posttraumatic stress responses. Findings from the present study also offer the possibility that theoretical and clinical improvements to current CBT models of PTSD might be obtained by considering the important role played by demandingness beliefs in the development and maintenance of posttraumatic stress symptoms.