THE EFFECTIVENESS OF RATIONAL EMOTIVE BEHAVIOUR THERAPY AND PERSON-

CENTERED THERAPY IN REDUCING DEPRESSIVE SYMPTOMS AMONG MEDICAL

BY

OKONKWO, ONYEKACHI OSMOND

DEPARTMENT OF PSYCHOLOGY

FACULTY OF SOCIAL SCIENCES

FORM NUMBER: 20240513663

Introduction
In poor countries, many prospective students often wish to study medicine at the university level. They
imagine themselves as medical students and then as doctors, dressed in white coats. Nevertheless, young
college students dealing with psychiatric challenges are hidden under the white coats (Nwachukwu et al.,
2021). According to a study conducted at the Karolinska Institute Medical University, 12.9% of medical
students exhibited depressive symptoms, which was a much greater incidence than that of students in other
areas (Dahlin et al., 2005). Nigerian medical students have seen a rise in depression cases over the past two
decades, with a prevalence incidence of 23.3%. Suraj et al. (2021) found a 15.1% depression prevalence rate
among Nigerian medical students.
Because of its etymological roots, the word "depression" is extremely simple to comprehend. In the fields of
psychiatry and psychology, it is a widely used term. The Latin term "deprimere," which meaning to press
down or pull down in spirit, is where the word depression originates. It is brought on by depressive feelings
or when someone is feeling gloomy, lethargic, agitated, or apathetic (Musa, Isaac & Abigail, 2019).
According to the World Health Organization [WHO] (2003), depression is a psychiatric disorder and the
prevalent mental illness of the twenty-first century, marked by depressive symptoms, feelings of
crestfallenness, heavy hearts, and terrible surroundings. Depression is typified by profound melancholy
and/or a loss of interest in once-enjoyable activities. It is a severe disorder characterized by emotional,
behavioral, cognitive, and physiological abnormalities severe enough to alter a person's day-to-day
functioning, such as persistent feelings of hopelessness and worthlessness accompanied by insomnia,
appetite loss, difficulty concentrating, and difficulty making decisions (WHO, 2016).
Numerous factors, such as rescheduled lectures frequently, high failure rates in exams for the Bachelor of
Medicine and Bachelor of Surgery, long travel times between hostels and classrooms, and a shortage of dorm
accommodations, all contribute to the varying degrees of depression experienced by Nigerian medical
students (Nwobi et al., 2009). Furthermore, in another Nigerian study, it was shown that 4% of medical
students were susceptible to moderate to severe depression, with gender and age having little bearing on
depression (Tamunosiki et al., 2017). Depression is the primary cause of suicide, accounting for about
800,000 fatalities per year (WHO). Compared to the general population, depression is more common among
medical students (Dyrbye et al., 2006; Cvejic et al., 2017), despite comparable rates of help-seeking
behaviors, which could indicate that they are not receiving enough therapy (Cvejic et al., 2017). There are a
number of explanations offered for why therapy has not been sought. These include the worry of having a
mental health history and how it may affect one's ability to pursue a job in the future, busy schedules, the
stigma attached to seeking mental health treatment, and even the dread of unwelcome interventions (Dyrbye
et al., 2006; Cvejic et al., 2017). Consequently, there could be an increase in the prevalence of suicide
behaviors among medical students. A study conducted across multiple institutions found that 11.2% of
medical students had suicidal ideation (Puthran et al., 2016). The lengthy school years, intense academic
pressure, the strain of clinical practice and professional development, as well as the potential undertreatment
of psychological illnesses in medical students, have all been blamed for this.
Rational emotive behaviour therapy (REBT) considers irrational beliefs to play a significant role in the
development of emotional disorders like depression (David et al., 2019). Among the several cognitive-
behavioral therapies that Albert Ellis created in 1950 is REBT (Froggat, 2005). It argues that an individual's
biology influences their emotions and behaviors, which is a crucial issue since it serves as a reminder to the
psychotherapist that an individual's capacity for change is limited. Belief systems are thought to result from a
person's lifelong learning process as well as their biological heritage (Ellis & Grieger, 1977). According to
Amna and Tazvin (2018), REBT is regarded as a novel approach in the management of psychiatric diseases
since it provides the foundation for behavioral, emotional, and cognitive dysregulation. According to
Muhammad and Rohany (2009), REBT regulates the identification, appraisal, and assessment of an
individual's irrational self-deprecating beliefs and retaliates against them by contesting those beliefs and
creating positive change within oneself. REBT identifies four primary categories of irrational beliefs that are
associated with depression: awfulizing, demandingness, self-downing, and limited frustration tolerance
(Ellis, 1977; Turner, 2016). The unreasonable and unrelenting insistence that things or people go the way one
wants them to is known as demandingness. The act of greatly exaggerating a situation's bad repercussions in
order to make an already regrettable event seem even worse is known as awfulizing. Low frustration
tolerance, sometimes known as "I-can't-stand-it," is the acknowledgement of difficulty coupled with the
claim that difficulty is unbearable or almost unachievable. Depreciation, another name for self-downing, is
the concept that someone makes generalizations based on their initial effort and values themselves depending
on the result (Turner, 2016). For the purposes of this study, REBT is a therapy that aims to alter an
individual's behavior by confronting their irrational beliefs, values, and attitudes that they have internalized
through socialization processes. Research has demonstrated that there are major benefits to using REBT
procedures in the treatment of psychiatric disorders such depression and post-traumatic depression (Ede et
al., 2022; Ray & Monita, 2021). According to Xu and Liu (2017), major depressive disorders and other more
severe mental health symptoms can be prevented in students by participating in REBT intervention
programs. Ugwu et al., (2022) found that participants' depression levels were significantly lower after
receiving exposure to REBT during the posttest and follow-up than they were for participants who did not
receive such exposure. As a result, it appears that conducting research on the effectiveness of REBT is highly
important. For this reason, the current study sought to determine how well REBT works in the treatment of
depression in comparison with other intervention techniques, specifically client centered therapy.
Person-centered therapy, also referred to as non-directive, client-centered, or Rogerian therapy, was
pioneered by Carl Rogers in the early 1940s. The foundation of this type of psychotherapy is the belief that
gaining healthy psychological functioning is a natural motivation for human beings. The therapist adopts a
non-directive rather than a mechanical approach, with the understanding that the client is the expert in their
life and sets the overall course of treatment. The therapist's role is to provide a space conducive to
uncensored self-exploration. As the client explores their feelings, they will gain a clearer perception of
themselves, leading to psychological growth. The therapist attempts to increase the client's self-
understanding by reflecting and carefully clarifying questions. Although few therapists today adhere solely
to person-centered therapy, its concepts and techniques have been incorporated eclectically into many
different types of therapists' practices (Hill & Nakayama, 2000). There is evidence in the literature to support
the efficacy of this non-directive therapy as a treatment for depression. Three meta-analyses conducted
within the past decade concluded that person centered therapy is an effective therapy for adult depression but
may be less effective than other forms of therapy (Cuijpers et al., 2012). A 2021 randomized, non-inferiority
trial comparing person-centered therapy with cognitive behavioral therapy as a therapeutic intervention for
depression found that person-centered therapy was not inferior to CBT at six months; however, person-
centered therapy may be inferior to CBT at 12 months (Barkham et al, 2021). The authors suggest that there
needs to be continued investment in person-centered therapy to improve short-term outcomes.
Objective of the study
The primary objective of this study is to investigate the effectiveness of rational emotive behaviour therapy
and person centered therapy in reducing the depressive symptoms among medical students of Nnamdi
Azikiwe University Awka. Additionally, the study will investigate potential variables that may moderate the
treatment outcomes.
Materials and Methodology
Participants
The study will consist of 400 level and 500 level medical students already in the clinical class. Participants
will be recruited from Faculty of Medicine, Nnamdi Azikiwe University, Awka. Informed consent will be
obtained from the prospective participants of the study.
Instruments
Beck’s depression inventory (BDI) developed by Beck (1961) is a self-administered tool used to screen and
assess the severity of depression in patients. The BDI which is a 21-item self-rated questionnaire consists of
a series of ordered statements relating to particular symptoms of depression. Each statement is scored from 0
to 3 in terms of intensity giving a maximum score of 63. The BDI have been validated and widely used
among the adult population in Nigeria (Awaritefe, 1988).
Intervention procedure
Rational emotive behaviour therapy
Weekly group therapy session focusing on building self-efficacy, positive affirmations, and optimal
psychological wellbeing
Individual therapy session focusing on identification of irrational beliefs, reduction of depressive symptoms,
and elimination of negative emotions
Exercises, where the participants practice newly learnt skills in therapy sessions.
Person centered therapy
Weekly group therapy session focused on stress management, emotion regulation and interpersonal
effectiveness.
Individual therapy sessions focusing on actualizing positive behavioral changes, adherence to medical
treatment, and actualization of set out goals.
Personal exercises to promote behavioral changes
Design
The study will adopt a randomized controlled trial (RCT) design. Three groups will be randomly assigned to
the participants: the control group (waiting list), the person-centered therapy (PCT) intervention group 1, and
rational emotive behaviour therapy (REBT) intervention group 2. Measures of changes in depression
symptoms will be monitored using pre- and post-test evaluations.
Statistics
Analysis of covariance (ANCOVA) will be employed to compare the pre-exposure and post-exposure
outcome of depressive symptoms between the control and treatment groups to observe the comparative effect
of proposed interventions. Additionally, the moderated regression analysis using process macro will be
adopted to test the predictive effect of potential moderators like Age, socio-economic status and gender.
Expected outcome
It is hypothesized that both rational emotive behaviour therapy (REBT) and person-centered therapy (PCT)
will lead to a significant decrease in depressive symptoms among prospective study participants.
Additionally, REBT is more likely to have a superior effect in reduction of depressive symptoms against
PCT, having centered its hallmark on the idea that emotional disturbances are as a result of irrational beliefs
and the elimination of these beliefs will likely result in optimal emotional wellbeing unlike PCT where the
patient explores their emotions and behaviour under the guidance of the psychotherapist. The outcome of
these interventions will inform treatment approaches suitable enough for depression and other forms of
emotional disturbances.
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