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 2

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. 3

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) ; 4

(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 attentiondeficit 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, solutionoriented 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. 7

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 8

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 9

4- Total Competence Score

HYPOTHESES Hypothesis 1 Rational Emotive Behavior Therapy (REBT) has a positive impact on treatment of Conduct Disorder. Hypothesis 2 Rational Emotive Behavior Therapy (REBT) has a positive impact on treatment of additional variables of DSM Scale. Hypothesis 3 Rational Emotive Behavior Therapy (REBT) has a positive impact on treatment 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 10

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 11

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 DSMOriented Scale

Experimental Groups (N=100)

Control group (N=100)

REBT Therapy for 7 sessions

No Treatment

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. 13

Phase 2: experimental treatment The experimental group was exposed to treatment (Specially designed REBTRational 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 Ican’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. 15

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 17

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 roleplaying 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 21

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 nonsignificant 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 22

(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 nonsignificant 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 (Pre8.80– 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 group wise, (experimental v/s control) a significant F value (F=29.165; P=.000) was obtained.

From the mean scores it is evident that experimental group 23

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 group wise, (experimental v/s control) a significant F value (F=17.124; P=.000) was obtained.

From the mean scores it is evident that experimental group

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 24

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.

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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. Research hypotheses # 4, Rational Emotive Behavior Therapy (REBT) has a 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. Research hypotheses # 5, Rational Emotive Behavior Therapy (REBT) has a 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. Research hypotheses # 6, Rational Emotive Behavior Therapy (REBT) has a 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 26

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.

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References Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad J, Minz S, Abraham VJ, Bose A., (2004) Suicides in young people in rural southern India. Lancet ; 363: 1117 – 18. Achenbach, T.M., Edelbrock C.S. (1978) The classification of child psychopathology: A review and analysis of empirical efforts. Psychological Bulletin, 85, 1275 –1301. American Psychiatric Association.( 1987). Diagnostic and Statistical Manual of Mental Disorders. 3d ed., revised. Washington, DC: American Psychiatric Association. Bandura, A. (1989). A social cognitive theory of action. In J. P. Forgas & M. J. Innes (Eds.), Recent advances in social psychology: An international perspective (pp. 127138). North Holland: Elsevier. Buhler, C. (1927). Die ersten sozialen Verhaltungsweisen des Kindes. In C. Buhler, H. Hetzer and B. Tudor-Hart (Eds.), soziologische und Psychologische Studien uber das Erste Lebensjahr. Jena : Gustav Fischer. Eme, R. F., & Kavanaugh, L. (1995). Sex differences in conduct disorder. Journal of Child Clinical Psychology, 24(4), 406-426. Esser G, Schmidt MH, Woerner W. (1990), Epidemiology and course of psychiatric disorders in school-age children-results of a longitudinal study. J Child Psychol Psychiatry;31: 243-63. Fagot, B., & Levy, L (1998). Gender identity and play. In D.P. Fromberg & D. Bergen (Eds.), Play from birth to twelve an beyond (pp. 187-192). New York: Gartland. Fergusson D.M. & Horwood L.J. (1992) Attention deficit and reading achievement. Journal of Child Psychology and Psychiatry. 33, 375 – 385. Ford T, Goodman R, Meltzer H. (2003). The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM–IV disorders. J Am Acad Child Adolesc Psychiatry, 42: 1203 –11. Kashini, J.H., Beck, N.C., Hoeper, E.W., Fallahi, C., Corcoran, C.M., McAllister, M., Rosenberg, T.K.(1987). Psychiatric disorders in a community sample of adolescents. American Journal of Psychiatry, 144, 584-89.

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Leader, E. (1991). Why adolescents group therapy. Journal of Child and Adolescent Group Therapy, 1, 81-93. Lyon G.R. (1996) Learning disabilities. Future Child. 6, 54-76. Mabey , j., and Sorensen, B. (1995). Counseling for Young People. Buckingham” Open University Press. Registrar General of India (1996). Population projection for India and States, 1996– 2016. Report of the Technical Group of Population Projection. Planning Commission, New Delhi. Ringel, J. S., & Sturm, R. (2001). National estimates of mental health utilization and expenditures for children in 1998. Journal of Behavioral Health Services and Research, 28(3), 319-332. Saxe, L, Cross, T., and Silverman, N. (1988). Children’s mental health: The gap between what we know and what we do. American Psychology, 43(10), 800-807. Srinath S, Girimaji SC, Gururaj G, Seshadri S, Subbakrishna DK, Bhola P, Kumar N.(2005). Epidemiological study of child and adolescent psychiatric disorders in urban and rural areas of Bangalore, India. Indian J Med , 122: 67 –79. U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services. Verghese A, Beig A., (1974) Psychiatric disturbances in children: an epidemiological study. Indian J Med Res 62: 1538 –42. World Health Organization (WHO), (1992). International Statistical classification of diseases and related health problems (10th rev.). Geneva: Author.

Signature of the Guide

Signature of the Research Scholar

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