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A Rational Emotive Behaviour Therapy Perspective On A Rational Emotive Behaviour Therapy Perspective on the Nature and Structure of Posttraumatic Stress Responses: The Mediating and Moderating Effects of Rational and Irrational Beliefs Philip Hyland BA (Hons) School of Psychology Faculty of Life and Health Sciences University of Ulster Submitted for the degree of Doctorate of Philosophy February 2014 I confirm that the word count of this thesis is less than 100,000 words II TABLE OF CONTENTS Acknowledgements IX Summary X List of abbreviations XII List of tables XVI List of figures XVIII Declaration XIX Publications and presentations arising from the thesis XX Awards arising from the thesis XXII III Chapter 1: Theoretical Introduction 1.1 Introduction 2 1.1.1 The Basics of Cognitive Behaviour Theory 2 1.1.2 The Theory of REBT 3 1.1.3 The Role of Irrational Beliefs in Psychopathology 5 1.1.4 The REBT Theory of Emotional Disturbance 11 1.1.5 An REBT Approach to Understanding Posttraumatic Stress 13 Responses 1.1.6 The Nature of Posttraumatic Stress Responses 14 1.1.7 Prevalence of PTSD 15 1.1.8 Partial PTSD or Subsyndromal PTSD 15 1.1.9 The Structure of PTSD: Two-Factor Model 16 1.1.10 Three-Factor Model of PTSD 19 1.1.11 Four-Factor Model of PTSD 20 1.4.11 Alternative Four-Factor Model of PTSD 23 1.4.12 New Directions 26 Chapter 2: Investigating the Factor Structure of the Attitudes and Belief Scale 2 and the Development and Validation of an Abbreviated Version Abstract 30 2.1 Introduction 31 2.1.1 The Basics of REBT Theory 31 2.1.2 The Historical Assessment of Irrational Beliefs 32 2.1.3 The ABS-2 33 2.1.4 Previous Tests of the Factor Structure of the ABS-2 34 2.1.5 Current Research 36 2.2 Methods Section 39 2.2.1 Participants 39 2.2.2 Procedures 39 2.2.2 Measure 40 2.2.3 Analysis 41 IV 2.3 Results 44 2.3.1 CFA Results 44 2.3.2 Descriptive Statistics and Reliability Analysis 52 2.4 Discussion 54 2.4.1 Limitations 56 2.4.2 Conclusion 57 Chapter 3: The Latent Structure and Composite Reliability of the Profile of Emotional Distress Abstract 59 3.1 Introduction 60 3.1.1 The REBT Binary Model of Emotions 60 3.1.2 Distinguishing the Unitary and Binary Models of Emotion 62 3.1.3 Previous Research Findings 63 3.1.4 The Profile of Emotional Distress 65 3.1.5 Current Research 67 3.2 Methods Section 69 3.2.1 Participants 69 3.2.2 Procedure 69 3.2.3 Measure 70 3.2.4 Analysis 70 3.3 Results 73 3.3.1 CFA and Bifactor Model Results 73 3.3.2 Composite Reliability 79 3.4 Discussion 80 3.4.1 Limitations 82 3.4.2 Conclusion 83 V Chapter 4: The Interrelations of the Irrational Beliefs in Posttraumatic Stress Symptomology: an Empirical Investigation of REBT Theory using Structural Equation Modelling Abstract 85 4.1 Introduction 86 4.1.1 The Theory of REBT 87 4.1.2 An Empirical Review of the Organisation of the Irrational Beliefs 88 4.1.3 Current Study 90 4.2 Methods Section 91 4.2.1 Participants 91 4.2.2 Procedure 91 4.2.3 Materials 92 4.2.4 Analysis 93 4.3 Results 95 4.3.1 Descriptive Statistics and Correlations 95 4.3.2 Measurement Models 96 4.3.3 Structural Model 102 4.4 Discussion 107 4.4.1 Limitations 109 4.4.2 Conclusion 110 Chapter 5: The Role of Trauma-Specific Irrational beliefs in the Relationship between General Irrational beliefs and Posttraumatic Stress: A Rational Emotive Behaviour Therapy Approach Abstract 112 5.1 Introduction 113 5.1.1 The Theory of Cognitive Therapy (CT) 113 5.1.2 Distinctions between REBT and CT Theory 115 5.1.3 Cognitive Models of PTSD 116 5.1.4 Specific Irrational Beliefs in Psychopathology 117 5.1.5 Criticisms of REBT Theory 119 VI 5.1.6 Current Research 120 5.2 Methods Section 121 5.2.1 Participants 121 5.2.2 Procedure 121 5.2.3 Measures 122 5.2.4 Analysis 124 5.3 Results 126 5.3.1 Descriptive Statistics and Factor Correlations 126 5.3.2 Measurement Models 126 5.3.3 Structural Model 126 5.4 Discussion 133 5.4.1 Limitations 136 5.4.2 Conclusion 136 Chapter 6: The Role of Trauma-Specific Irrational Beliefs and Sociodemographic Risk Factors in Posttraumatic Stress Responses Abstract 138 6.1 Introduction 139 6.1.1 Controversies Surrounding PTSD 139 6.1.2 Social-Cognitive Models of PTSD 140 6.1.3 Sociodemographic Factors in PTSD 142 6.1.4 Current study 143 6.2 Method 145 6.2.1 Participants 145 6.2.2 Procedure 145 6.2.3 Materials 146 6.3 Results 149 6.3.1 Descriptive Statistics, Correlations and Group differences 149 6.3.2 Binary Logistic Regression 151 6.4 Discussion 154 6.4.1 Limitations 157 6.4.2 Conclusion 157 VII Chapter 7: The Moderating Role of Rational Beliefs in the Relationship between Irrational Beliefs and Posttraumatic Stress Symptomology Abstract 159 7.1 Introduction 160 7.1.1 Rational Beliefs 161 7.1.2 Rational Beliefs as Cognitive Protective Factors 161 7.1.3 Current Study 162 7.2 Methods Section 164 7.2.1 Participants 164 7.2.2 Procedure 164 7.2.3 Measures 165 7.3 Results 167 7.3.1 Descriptive Statistics and Correlations 167 7.3.2 Sequential Moderated Multiple Regressions 169 7.4 Discussion 177 7.4.1 Limitations 180 7.4.2 Conclusion 181 Chapter 8: Conclusion 8.1 Overview of Chapters, Aims, and Findings 183 8.1.1 Chapter One 183 8.1.2 Chapter Two 184 8.1.3 Chapter Three 186 8.1.4 Chapter Four 187 8.1.5 Chapter Five 188 8.1.6 Chapter Six 189 8.1.7 Chapter Seven 189 8.2 Limitations, Strengths and Further Directions 190 8.3 Contribution of this Research 192 VIII References 195 Appendix A 224 Publications 225 IX ACKNOWLEDGEMENTS To my supervisors, Professor Mark Shevlin and Professor Gary Adamson, I send my sincerest thanks and gratitude. A Ph.D student could never hope to have been supervised by two better people, let alone academics. You were both an endless source of knowledge, inspiration, and hope. To have had the opportunity to have worked with and learnt from each of you at the beginning of one’s career is unquantifiable in its importance and influence. If someday I may become a fraction of the academics, educators, and supervisors that you both are it will have been a career well spent. I send unending thanks to all the men and women of the armed services, law enforcement agencies, and emergency services who volunteered their time and energy to participate in this study. This acknowledgement is written on the day it was reported that one veteran of the U.S. armed services commits suicide every hour; that one active- duty officer of the U.S. armed services commits suicide every day; and exactly eight days after Garda Adrian Donohoe was shot dead while on duty in Co. Louth, Ireland. We all live under the freedom defended and protected by these individuals and their sacrifices are what make it possible for work like this to even be considered, let alone completed. They are truly the best of us, and this work is a dedication to them and to their sacrifices, and is presented in the hope that it may have some small impact on improving the quality of their lives. To my friend, my mentor, my colleague, my partner-in-crime, Daniel Boduszek, what can I say? The last three years on this journey together have been some of the most enjoyable, toughest, enlightening, and rewarding of my life. The things we’ve achieved together could never have been achieved alone. Thank you for your friendship. Finally to my family and friends, I love you all more then I could ever express. There’s no way a person makes it through something like this with his sanity intact without the support of family and friends. Thank you for making it possible for me to do this, and thank you for putting up with me through this thing. You know what it’s been like! If it’s possible for a person to be judged by the company that he keeps, I hereby judge myself the luckiest of men. X Summary Rational Emotive Behaviour Therapy (REBT: Ellis, 2001) represents the original cognitive-behavioural therapy (CBT) model of psychopathology. Although there is much empirical support for the basic theory of REBT (see David, Lynn, & Ellis, 2010), the model has never been tested in the context of posttraumatic stress responses to adverse life events. The first empirical chapter of the thesis investigated the construct validity of the Attitudes and Belief Scale 2 (ABS-2: DiGiuseppe, Leaf, Exner, & Robin, 1988). This chapter employed traditional confirmatory factor analysis and confirmatory bifactor modelling to investigate the psychometric properties of the ABS-2. Results indicated that a bifactoral model conceptualisation was found to offer an adequate representation of the underlying factor structure of the scale. Based on these results, an abbreviated version of the ABS-2 with superior psychometric properties was thus constructed. In the second empirical chapter confirmatory bifactor modelling and composite reliability analysis were employed to investigate the psychometric properties of the Profile of Emotional Distress (PED: Opris & Macavei, 2007).
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