Journal of Rational-Emotive & Cognitive-Behavior Therapy

https://doi.org/10.1007/s10942-021-00417-z

Efficacy of Rational Emotive Behavior Therapy

on Depression Among Children with Learning Disabilities:
Implications for Evaluation in Science Teaching

Gloria C. Ugwu1 · Christian S. Ugwuanyi2,3   · Chinedu I. O. Okeke2   ·

Uchenna Eugenia Uzodinma1 · Anthonia O. Aneke1

Accepted: 10 August 2021

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature
2021

Abstract
Owing to the prevalence of mental health issues among Nigerian in-school children,
the effect of Rational Emotive Behavior Therapy’s (REBT) efficacy on depression
management among children with learning disabilities (LD) in inclusive classrooms
in Nigeria was explored. Using a sample of 48 children with LD, the researchers
conducted true experimental research. The participants were randomised into exper-
imental (n = 24) and control (n = 24) groups. The Wide Range Achievement  Test
and Children’s Depression Inventory were used as instruments for the study. The
intervention program lasted for approximately 3  months. Data were quantitatively
analyzed using analysis of variance of a special case. Hypotheses were tested at a
0.05 level of significance. It was therefore revealed that the level of depression of
the participants who were exposed to CBT decreased significantly at posttest and
follow-up measures than those who were not so exposed. Thus, REBT is very effec-
tive in reducing the level of depression among children with learning disabilities.

Keywords  Rational emotive behavior therapy · Depression · Learning disabilities ·

Science education

* Uchenna Eugenia Uzodinma

[email protected]
1
Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
2
School of Education Studies, University of the Free State, Bloemfontein 9300, South Africa
3
Department of Science Education, University of Nigeria, Nsukka, Nigeria

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 G. C. Ugwu et al.

Introduction

Conceptual Clarifications

Learning disabilities occur when there is a manifestation of reduced ability to

comprehend new information or information that seem to be complex (Depart-
ment of Health, 2001). For the Learning Disabilities Association of Canada
(2012), disorders that affect the possession, organization, retention, as well as
understanding of information, are termed learning disabilities. Orim and Uko
(2017) defined learning disabilities as disorders that impede learning in indi-
viduals who have low abilities that are needed for human reasoning. According
to American Psychiatric Association (APA, 2013), a specific learning disability
(SLD) is a type of Neurodevelopmental Disorder 3 that affects the learners’ abil-
ity to learn. Those specific academic skills are pivot or the foundation for other
academic learning. Learning difficulties manifest in form of difficulties in the
identification of letters or counting of objects may appear in the preschool years
but manifest better after starting formal education (APA, 2013). SLD just like
learning difficulties is caused by a cross-cultural and chronic condition that typi-
cally persists into adulthood as well as developmental changes (APA, 2013).
National Institute for Health and Care Excellence (NIHCE, 2016) opined that
learner with Down’s Syndrome which is a clear genetic cause is unique from all
other children with LD. Moreover, some children need more support at school
to ensure their proper adaptation or adjustment among people with LD (NIHCE,
2016). Research showed that there exist more children with LD than adults as the
former need more supports than the latter (NIHCE, 2016; Hatton et  al., 2016).
Moreover, Zablotsky et  al. (2019) found that there was a significant increase
in the prevalence of learning disability among US children aged 3 to 17  years
between 2009 and 2017. According to the U.S. Department of Education (2020),
children and adolescents within the ages of 3–21 years who received special ser-
vice under the Education Disabilities Act were approximately 7 million, repre-
senting 14% of all children and adolescents in schools. Besides, specific learn-
ing disabilities accounted for 33% of this population of children and adolescents.
There is a high prevalence of learning disabilities among children in Nigeria
(Obani, 2006; Okoye, 2014). According to USA Centre for Learning Disability
(2014), 2% of males had LD while 1.3% of females had the same problem show-
ing that male males had LD than females. Besides, learning disabilities are more
in a population of poor children (2.6%) than the rich children (1.5%). Thus, men-
tal problems are prevalent in a population of children with learning disabilities.
In the Nigerian context, most children are vulnerable to mental health prob-
lems as a result of a lack of proper medical care and adequate provision of nutri-
tion. Belle et al. (2012) found that Nigerian adolescents perceived mental health
issues as a disorder of the brain. This perception of the adolescents was influ-
enced by a lack of mental health knowledge, cultural and superstitious beliefs
(Belle et  al., 2012). The Nigerians perceived mental health issues to be caused
by sorcery, evil spirits possession, divine punishment, and witchcraft (Labinjo

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Efficacy of Rational Emotive Behavior Therapy on Depression…

et al., 2020). According to the WHO (2006), in Nigeria, issues of mental health
are neglected. This can be attributed to the fact that the existing formulated Men-
tal Health Policy document in 1991 as the first mental health policy has not been
reformed to date. WHO noted that there is non-availability of essential medicines
and desk officers for mental health issues at the Nigerian health centers with the
worst situation being that only four percent (4%) of government health expendi-
tures are allocated for mental health issues.
According to Cooper et al. (2007a), Emerson and Hatton (2007), McManus et al.
(2009), about 30% of mental health problems are associated with people having a
problem of learning disabilities than with the rest of the population. Collins et  al.
(2011), and WHO (2008) found that there is a higher percentage (13%) of men-
tal health problems compared to cancer and cardiovascular disease. Cooper et  al.
(2007b) found that depression is the most common type of mental health problem
among children with LD.
Donald and Jing (2007) defined depression as a state of emotional isolation that
one feels at interval. Low mood, negative self-perceptions, irritability, cognitive
problems among others are the major characteristic symptoms of depression (Nardi
et  al., 2013; Orchard et  al., 2017). According to Donald and Jing (2007), depres-
sion in young people has a serious adverse effect on their cognitive development.
Abedini et al. (2007), Eller et al. (2006), Lei et al. (2016), Ovuga et al. (2006) found
that one of the serious public health challenges among students is depression. Stud-
ies show that there is widespread depression among students in Nigeria (Adewuya
et al., 2006; Aniebue & Onyema, 2008; Ibrahim et al., 2013; Peltzer et al., 2013).
Despite the high prevalence of mental health issues, they are often unnoticed among
children with learning disabilities and this leads to prolonged distress for such
class of children (NIHCE, 2016). De Ruiter et  al. (2007), Wallander et  al. (2006)
found that children with learning disabilities in the Netherlands manifest depression
symptoms with hyperactivity at younger ages. Studies have revealed that in differ-
ent populations of subjects, there is a link between irrational beliefs and depression
(Bridges & Harnish, 2010; David, 2015; David et al., 2009). Despite that, empirical
evidence showed that irrational beliefs are significantly associated with symptoms
of depression (Sarracino et al., 2017). There are only a few studies that have investi-
gated the efficacy of CBT on the reduction of depression among children with learn-
ing disabilities. Among the few studies carried out in Nigeria, none investigated the
efficacy of CBT in reducing depression among children with LD.

Impact of Depression on Children with LD’s Science Achievement

According to NIHCE (2016), depression predicts a variety of negative psychoso-

cial outcomes, including low educational attainment. Riglin et  al. (2014) found
that depression is associated with children’s low school grades. Similarly, difficul-
ties in concentration, self-reliant school performance among others are as a result of
depression (Frojd et al., 2008). Thus, depression is highly related to poor school per-
formance (Almquist, 2013; Sznajder-Murray et al., 2015; Caspi et al., 1998; Sorberg
et al., 2018).

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 G. C. Ugwu et al.

Due to the presence of depression in children with LD, they manifest low self-
esteem than their counterparts (Gardner, 1971). Furthermore, there were observed
lower scores on academic achievement tests among depressive children than their
counterparts (Colbert et  al., 1982). According to Brumback and Stanton (1983),
children who had LD, as well as depression, were hypothesized to have an over-
lap in cerebral dysfunction. It was also revealed that there were significantly higher
depression scores among children with LD than their counterparts without LD
(Maag & Reid, 2006). Students with LD often struggle with academic challenges in
their science classes (Grumbine & Alden, 2006). Such students scored one standard
deviation lower in achievement tests in science than their counterparts who do not
have LD (Anderman, 1998 as cited in Grumbine & Alden, 2006). Chow et al. (2015)
found that there was reported lower academic performance among adolescents who
had more depressive symptoms. As a result of those, it was opined that one of the
major public health concerns for children is depression (Wickersham et al., 2019).
Cases of repeating a grade or class and dropping out of school can be attributed
to mental health issues (Schulte-Körne, 2016). This situation calls for school-based
therapies that will help reduce the feeling of depression among children with LD.
Among such therapies is cognitive behavioral therapy.

Cognitive Behaviour Therapy and Theoretical Background

Cognitive behavioral therapy (CBT) is fundamentally an intervention that is psycho-

logically rooted in cognition, emotions, and scientific approaches to human behavior
(Willner, 2007). Choo (2014) defined CBT as a group of psychotherapeutic tech-
niques whose objective is to deemphasize irrational beliefs through changing of cog-
nition and behavior. CBT as a psychotherapeutic intervention is based on cognitive
and behavioral principles (David et  al., 2018). Besides, CBT is an umbrella term
that describes a variety of evidence-based psychological interventions and treat-
ments derived from such principles (David et al., 2018). Under the umbrella term of
CBT are many interventions such as CT, REBT, Problem-solving therapy, and Oth-
ers (DiGiuseppe et al., 2019). According to various international clinical guidelines,
CBT is largely the gold standard in the field of psychotherapy for a large variety of
clinical and non-clinical conditions (David et  al., 2018). CBT includes two major
schools of thought REBT first and then Cognitive Therapy but the treatment in the
context of this study utilized REBT. According to Ellis (1994), REBT is a type of
therapeutic approach that helps a client to identify irrational beliefs (overwhelming
feelings of anger, depression, addictive behavior, anxiety, phobias, procrastination,
etc.) and negative thought patterns that may result in behavioral or emotional issues.
Cognitive behavior theories explain how cognitive and affective aspects of human
functioning interact (Beck, 1976; Ellis, 1994). CBT theories explain how our emo-
tions, behavior, and physiological responses are determined by cognitions (Oltean
et al., 2017). CBT uses the ABC Model (DiGiuseppe et al., 2014; Ellis, 1994). In
the ABC Model; A stands for activating events, B stands for beliefs while C stands
for consequences. According to the ABC Model; life events (A: activating events)
are not directly determined by our emotions and behavior (C: consequences) but

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Efficacy of Rational Emotive Behavior Therapy on Depression…

rather the way events are cognitively processed and evaluated (B: beliefs) (David
et al., 2009). REBT states that our beliefs regarding a life event can be rational or
irrational (Ellis, 1994). Irrational beliefs, according to David and Cramer (2009),
are evaluative cognitions without logical or empirical support. David et  al. (2009)
classified irrational beliefs into four categories: low frustration tolerance, demand-
ingness, catastrophizing, and self-downing. According to Ellis (1994), dysfunctional
feelings and maladaptive behavior are caused by irrational beliefs, while functional
emotions and adaptive behavior as a result of rational beliefs.

Review of Related Empirical Studies

Karen and Jeffrey (2007) revealed that CBT had a significant impact on anxiety
reduction in a sample of children with autism. Susan et al. (2009) found that CBT
reduced anxiety significantly among the participants. Siebke et  al. (2011) proved
the efficacy of cognitive behavioral therapy in a sample of socially phobic children.
Sasha et al. (2016) found that CBT in a modified version had a significant decrease
in depression as well as anxiety. Eseadi et al. (2017) found that there was a signifi-
cant effect of rational emotive cognitive behavioral coaching on depression among
the participants.
Lauren and Kate (2018) found that exposure to the CBT program resulted in a
significant decrease in the client’s feelings of anger and an increase in their self-
esteem. Zafer (2018) found that the cognitive behavioral therapy (CBT) intervention
was effective in managing persons with learning disability illnesses. Onuigbo et al.
(2019) found that rational emotive behavior therapy led to a significant decrease in
the depression scores of students. However, Zafer (2018) noted that there are few
case studies on the use of CBT in treating patients with anxiety and depression.

Gaps in Literature

The current study was necessary because of the lack of literature on the effect of
CBT on depression among children with LD in Nigeria. Thus, the study deter-
mined the effect of REBT on the reduction of depression among children with LD.
The researchers hypothesized that REBT would significantly reduce symptoms of
depression in a sample of children with LD.

Method

Ethical Approval Statements

The University of Nigeria Research Ethics Committee approved the conduct of this
research. Moreover, informed consent forms were served to the children and their
parents as well as their teachers before the recruitment process. The forms were
properly filled and signed by them. Prior to the signing of consent forms by the dif-
ferent parties, the risks and benefits of the intervention were properly explained to

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 G. C. Ugwu et al.

them and room for questions was provided. Further, teachers had to fill the consent
forms because the children were under their care.

Research Design

The researchers adopted a randomized controlled trial (RCT) experimental

research design. A randomized controlled trial is a study that involves the alloca-
tion of people at random to receive one of several clinical interventions (William,
2018). One of these interventions is the standard of comparison or control. In simi-
lar studies, Ogbuanya et  al., (2017a, b), Nwokeoma et  al. (2019), Onyishi et  al.
(2020), Ugwuanyi et al. (2020a) Ugwuanyi et al. (2020b), Ugwuanyi et al. (2020c),
Ugwuanyi et al. (2020d), Ede et al. (2020), Ogba et al. (2020), Okide et al. (2020),
Umoke et al. (2020), Agboeze et al. (2020), Omeje et al (2021), Abiogu et al. (2020),
Ugwuanyi et al. (2021) have adopted this design.

Participants

The participants for the study were 48 primary three pupils in inclusive classrooms
in the South-East States schools in Nigeria. Those pupils are only the ones who met
the set criteria for inclusion in the study. In the Nigerian context, an inclusive class-
room is a classroom setting in which pupils with diverse and different learning and
physical abilities are taught in the same classroom conditions. The following eligi-
bility following criteria were used to screen the participants: (1) must attend school
regularly; (2) must show a low score on the Wide Range Achievement Test (WRAT)
indicating that he/she has a learning disability; and (3) a high score on the children
depression inventory (CDI). Thus, exclusion criteria are (1) not being regular in
school, (2) a high score on WRAT, and (3) a low score on CDI. G-Power, Version
3.1 software was used in arriving at an adequate sample size of 48 which gave a
power of .91 at an effect size (­f2) of .15 which was considered medium, and 5%
probability level. Out of 193 pupils who accepted to take part in the study, 48 pupils
were arrived at after screening for inclusion criteria for eligibility. Thereafter, the 48
pupils were assigned to the experimental group and control group randomly using
a simple randomization procedure. This procedure involved asking participants to
pick one envelope from a container containing papers labeled either E or C. Figure 1
shows the flow diagram for the sampled participants for the study.

Measures

Demographic Questionnaire

A demographic questionnaire was administered to get the demographic information

of the children concerning gender, age, and location as shown in Table 1.
Table 1 shows that there are significant gender, age and tribe differences in the
number of children used for the conduct of the research, χ2(1) = 10.65, p < 0.05;

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Efficacy of Rational Emotive Behavior Therapy on Depression…

Enrolment Assessed for eligibility (n= 193)

Excluded (n=145)
♦ Not meeting inclusion criteria (n=132)
♦ Declined to participate (n= 5)
♦ Other reasons (n=8)

Randomized (n=48)

Allocation
Allocated to experimental group (n= 24) Allocated to control group (n= 24)

Follow-Up
Lost to follow-up (n= 0) Lost to follow-up (n= 0)

Analysis
Analysed (n=24) Analysed (n=24)

Fig. 1  Flow diagram of the sampled participants

Table 1  Demographics of the Demographic Experimental Control n (%) χ2 p

Participants characteristics

Gender
Male 9 10 19(39.58)
Female 15 14 29(60.42) 10.65 .005
Age
5–7 4 3 7(14.58) 8.59 .020
8–9 11 13 24(50.00)
 > 9 9 8 17(35.42)
Tribe
Igbo 18 17 35(72.92) 25.83 .000
Hausa 2 4 6(12.50)
Yoruba 4 3 7(14.58)
2
χ  = Chi-square statistic, p = probability value

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 G. C. Ugwu et al.

χ2(2) = 8.59, p < 0.05 and χ2(2) = 250.83, p < 0.05. The significant gender difference

may be as a result of the fact that the schools used were mainly female-dominated.
Similarly, the significant age difference could be because, in Nigeria’s primary edu-
cation system, children within 8–9 years are mostly found in primary three. Finally,
due to the fact that the South East region of Nigeria, which was used as the study
site, is an Igbo-dominated region, a significant tribal difference was found.

Wide Range Achievement Test (WRAT)

The Wide Range Achievement Test (WRAT) developed by Wilkinson and Robert-
son (2006) was adopted as an identification instrument for children with learning
disabilities. This edition (4th edition) has word reading, spelling, math computation,
sentence comprehension, and a reading composition subtest. The word reading sub-
test help to provide data for decoding and printed word recognition. The math com-
putation subtest allows the researchers to identify errors of inattention to detail. The
sentence comprehension subtest requires individuals to supply a keyword using a
cloze procedure. A low score on WRAT indicates a learning disability. In this study,
the children identified using WRAT were not regarded as underachievers but those
who had specific learning disabilities (SLD).
For the psychometric properties of the WRAT, the items demonstrated good con-
struct validity with factor loadings ranging from 0.5 to 0.8. WRAT is very similar
to Peabody Individual Achievement Test (PIAT). Thus, WRAT correlated with the
PIAT very highly. Further, WRAT correlated with various intelligent quotient (IQ)
tests moderately within the range of 0.40 to 0.70 in a population of children. Also,
the split-half reliabilities for reading and spelling subtests ranged from 0.88 to 0.94
while that of the arithmetic subscale ranged from 0.79 to 0.89 indicating that WRAT
demonstrated good reliability. WRAT was normed on a sample of 50 Class 3 partici-
pants in the three states of South East Nigeria. The sample was stratified by age, sex,
location, and tribe. It was found that WRAT was not influenced by any of the norms.

Children’s Depression Inventory (CDI)

The Children’s Depression Inventory (CDI) developed by Kovacs (1992) was

adopted for the study. Among the frequently used measures of depression in chil-
dren, CDI is mostly used. CDI is 27-item modeled on a 3-point Likert Scale of 0–2,
each evaluating depressive symptoms. Items of CDI are presented on three different
statements indicating varying symptom severity (e.g., I do not do what I am told
most of the time). The internal consistency reliability coefficient of CDI is 0.80,
while the test–retest reliability coefficient is 0.87. The minimum and maximum
scores obtainable using the CDI are 0 and 54 respectively. A cut-off score of 39
appears to be appropriate for detecting depressive symptoms in samples of children.
Thus, any child who had a CDI score of above 39 is regarded as being depressive
while a score below 39 shows no symptom of depression.

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Efficacy of Rational Emotive Behavior Therapy on Depression…

Procedure

The researchers conducted a preliminary survey of primary schools in the South-

East states of Nigeria by paying weekly visitations to the schools. That enabled the
researchers to create a rapport with the various headteachers of the primary schools
used for the study. The researchers on the visitation to the schools explained to the
authorities what REBT intervention program is and the benefit of such intervention
among children with learning disabilities. On approval for the conduct of the study
in some of the schools visited, primary three pupils were screened for participants’
eligibility criteria.
The WRAT and CDI were used for the identification of pupils who had learning
disabilities and showed signs of depression. Further, the main instruments (WRAT
and CDI), as well as a demographic questionnaire, were administered to the pupils
as paper and pencil-based tests in a space of 40 min for the pupils to respond accord-
ingly. Thereafter, completed copies of the WRAT and CDI were retrieved from the
pupils and packaged accordingly for analysis. The analysis was done within two
weeks to enable the researchers to select pupils who had learning disabilities and
showed signs of depression.
At this stage, the intervention program started for the experimental group. The
duration of the intervention was two times in one week. The researchers ensured that
the location of the intervention site was central for easy accessibility by the pupils
from schools located at different places. Friday at 15:00–15:40  h and Saturday at
9:00–9:40 h for the 12 weeks on weekly basis were the schedules for the CBT pro-
gram. That was done to ensure that there was no clash of the program with the nor-
mal school program. The experimental group participants were exposed to 40 min
of the REBT program twice a week. It is worthy to note that the control group
pupils were not exposed to any form of counseling. Two specialists in REBT car-
ried out the intervention program. The researchers had vast experience and exper-
tise in REBT and Randomized Controlled Trial (RCT) experiments. To achieve the
demands of the RCT, the research team is composed of experts in counseling psy-
chology, measurement and evaluation, childhood care, and education. The partici-
pants were assured of the confidentiality of interactions and personal information as
they worked together in self-disclosure before the commencement of the pretesting
vis-à-vis the intervention program.
Posttest assessment was conducted using only CDI at the expiration of the inter-
vention program while the follow-up assessment was done at an interval of 3 months
after the CBT program had stopped.

REBT Intervention Program

The researchers adapted the REBT intervention manual for pupils with depression
from Muñoz et al. (2007) in conjunction with the ABC Model of CBT developed by
Ellis (1994). In this manual, therapy sessions were divided into three modules that
consist of four sessions each.

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 G. C. Ugwu et al.

Module I: Influence of Participants’ Thoughts on their Mood (Sessions 1–4)

Module I explained the influence of participants’ thoughts on their moods. The fol-
lowing were established at the initial session of the module: structure module, the
target of the other sessions, including the sessions’ day, therapy rules, and confiden-
tiality limits. In this module which had four sessions, for the fact that level of con-
fidentiality could have an effect on the type as well as the quality of the therapeutic
relationship, participants were made aware of its limits and scope. Some exercises
in between the sessions were targeted at identifying thinking errors. Participants in
these sessions were also taught how to enhance their thoughts positively to decrease
dysfunctional negative thoughts (depression).

Module II: Influence of Participants’ Activities on their Mood (Sessions 5–8)

Participants in this module II (sessions 5–8), enjoyed a lot of pleasant activities with
depressive symptoms. In the process, the therapist explained to the participants how
the depressive symptom can limit their participation in activities that may be pleas-
ant. Situations that would enable the participants to establish clear goals in order to
decrease depression were made available for them. Coaching sessions pertaining to
the steps in getting reachable goals were set aside for the participants. Those steps
were properly practiced and rehearsed in sessions.

Module III: Influence of Participants’ Relationships on their Mood (Sessions 9–12)

The participants were introduced to how their relationships influence their moods.
This was done by discussing social supports that are needed and how they help in
ameliorating difficult situations. Participants through sessions 9–12, learned how to
strengthen their social support networks by identifying them first. A summary of the
previous themes was done. Further, both the therapist and the participants exam-
ined how thoughts affect participants’ engagement in activities. Through exercise,
the pupils were taught assertive communication skills that aid them in establish-
ing healthy satisfying relationships. The strengths and successes of the intervention
were explored through the evaluation of the therapy experience with the pupils.
In each of the sessions, the ABC Model of REBT was used to facilitate the inter-
vention program where; A stands for Adversity or activating event, B stands for Cli-
ents’ beliefs about the event, and C stands for Consequences, which includes the
behavioral or emotional response of the clients (participants). In this model, B is
the most relevant component among others, and it is assumed that B links A and
C because CBT focuses on changing beliefs (B) in order to create more positive
consequences (C). In using the ABC Model, the therapist helped the participants to
explore the connection between B and C by causing the participants to focus on their
behavioral or emotional responses and the automatic beliefs that might be behind
them. Furthermore, the therapist helped the participants to re-evaluate their beliefs
and learn how to recognize other potential beliefs (B) about adverse events (A).
Through that, the participants had the opportunity for healthier consequences (C)
which helped them move forward.

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Efficacy of Rational Emotive Behavior Therapy on Depression…

Data Analytic Procedure

To ensure data quality, the raw data were screened and cleaned by monitoring
errors, standardizing the processes, validating the accuracy, and scrubbing for
a duplicate before the analysis of the data. Statistically, repeated measures  analy-
sis  of  variance  (ANOVA)  of  mixed  design  was  used  to  determine  the  within-
groups and between-groups effects. An important assumption of repeated-measures
ANOVA is sphericity, which is the condition where the variances of the differences
between all possible pairs of within-subjects conditions are equal. The assumption
of the sphericity was not violated, Mauchly W = .853, p = .418. Also, Chi-Square
statistic was used to analyze the demographic characteristics of the participants
(χ2(2) = 8.59, p < .05).

Results

Table 2 shows that the mean depression rating of the experimental group (M = 51.63,
SD = 9.74) was almost the same as that of the control group (M = 52.37, SD = 5.03)
at the pretest. However, at the posttest, the mean depression rating of the partici-
pants of the experimental group was (M = 23.25, SD = 4.39) while that of the control
group participants was (M = 51.96, SD = 5.12). The mean depression rating of the
experimental group at the follow-up was (M = 21.33, SD = 3.93) while that of the
control group participants was (M = 52.04, SD = 4.83).
Table 3 revealed that across the three-time measures, there were significant dif-
ferences, F (2, 92) = 131.211, p =  < .05, ŋ2 = .740, and between groups, there was
significant difference in depression scores of children with learning disabilities, F
(1, 46) = 264.915, p =  < .05, ŋ2 = .988. Interaction effect of time and treatment was
significant, F (2, 92) = 123.708, p =  < .05, ŋ2 = .729.
Following up the result of the interaction, it was found that the participants did
not differ at the baseline, F (2, 92) = 131.211, p =  < .05, ŋ2 = .740 and the depression
scores of the participants of the control group did not change over time while those
of the intervention group decreased over time. This showed that REBT had a signifi-
cant effect on the reduction of depression among children with learning disabilities
with an effect size of 0.988. This implies that a 98.8 percent reduction in the depres-
sion scores of children with learning disabilities was as a result of their exposure to

Table 2  Mean analysis of the depression scores of the participants at pretest, posttest and follow up
measures
Pretest (1) Posttest (2) Follow-up (3)
Treatment n Mean SD Mean SD Mean SD

Experimental 80 51.63 9.74 23.25 4.39 21.33 3.93

Control 29 52.37 5.03 51.96 5.12 52.04 4.83

SD = Standard Deviation

13


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Table 3  Repeated analysis of variance for the effect of the intervention on participants’ depression levels
Measure Source Type III sum of squares df Mean square F Sig Partial eta
squared

Within-subjects effect
CDI Measure Sphericity Assumed 5188.222 2 2594.111 131.211 .000 .740
Measure * Treatment Sphericity Assumed 4891.556 2 2445.778 123.708 .000 .729
Error(Measure) Sphericity Assumed 1818.889 92 19.771
Between-subjects effect
CDI Intercept 246,595.007 1 246,595.007 3930.728 .000 .988
Treatment 16,619.507 1 16,619.507 264.915 .000 .852
Error 2885.819 46 62.735
2
CDI = Children Depression Inventory, ŋ  = Effect size
G. C. Ugwu et al.
Efficacy of Rational Emotive Behavior Therapy on Depression…

Fig. 2  Interaction plot of time and treatment

Table 4  Post-hoc pairwise Measure (I) Time (J) Time Mean difference (I-J) SE Sig
comparisons test for the
significant effect of time of 1 2 12.250 1.062 .000
measures
3 13.167 1.071 .000
CDI 2 1 − 12.250 1.062 .000
3 .917 .442 .131
3 1 − 13.167 1.071 .000
2 − .917 .442 .131

REBT intervention. Figure 2 shows the interaction plot of time and treatment on the
depression scores of children with learning disabilities.
Table 4 shows that the mean difference for times 1 and 3, contributed most to the
significant effect of time followed by the mean differences for times 1 and 2.

Discussion

This study showed that children with learning disabilities (LD), irrespective of the
treatment condition, showed a high level of depression at the baseline. On the other
hand, the mean depression scores of the intervention group significantly decreased
over time after the intervention period, implying that REBT had a significant effect
on the reduction of depression among children with LD. Furthermore, it was found
that a greater percentage reduction in the depression symptoms among children with
LD was attributed to the effect of the REBT intervention program. These findings

13
 G. C. Ugwu et al.

supported the researcher’s hypothesis for the study that REBT will significantly
reduce signs of depression in a population of children with LD. The children with
LD who were exposed to the REBT intervention program were found to be less
prone to depression after a 12 weeks intervention program while those who were not
so exposed did not change in their high depressive symptoms after the same period
of exposure. These findings must have been this way because of the nature of the
REBT intervention program.
Buttressing these findings, Sasha et al. (2016) found that CBT had a significant
decrease in depression levels among the subjects. Eseadi et al. (2017) and Onuigbo
et al. (2019) found that the rational emotive cognitive behavioral intervention had a
significant effect on the reduction of depression among the participants. Zafer (2018)
found that the cognitive behavioral therapy (CBT) intervention was effective in
reducing the number of persons suffering from learning disability illnesses. Unwin
et al., (2016) indicated that CBT led significantly to reducing symptoms of depres-
sion among adults with mild intellectual disabilities. Sizoo and Kuiper (2017) found
that the CBT intervention program is associated with a reduction in anxiety and
depressive symptoms among adults with disabilities. For Cole et  al. (2021), CBT
had a significant decrease in depression levels and functional impairment among the
staff of an Ebola Treatment Center. Schienle and Jurinec (2021) indicated that com-
pletion of the CBT therapy led to significantly reduced depression symptoms of the
participants. Lawton and Spencer (2021) found that mental health symptom scores
post-intervention had significantly reduced due to exposure to CBT intervention.

Implications for Evaluation in Science Teaching

These findings have educational implications for evaluation in science teaching in

order to enhance the academic activities of children with LD. Maag and Reid (2006)
opined that increased risk for students with LD to experience depression has direct
implications for teachers of science education. Such implications include identify-
ing students who may be depressed by the school personnel. Secondly, carrying out
ongoing scrutiny of students’ behavior as well as academic performance, which is
an important indicator of mood and coping ability in the school environment (Maag
& Reid, 2006). Accordingly, since children spend more time in school than at home,
school personnel should play major role in identifying children with depressive
symptoms (Powers, 1979 as cited in Maag & Reid, 2006). Changes in the school
environment, as well as the implementation of evidence-based school programs, can
help reduce the risk of developing mental health issues (Schulte-Körne, 2016). This
situation calls for school-based therapies that will help reduce the feeling of depres-
sion among children with LD.
Based on these findings, teachers of science education need to collaborate with
counseling psychologists to work out a better counseling approach to reducing
depression among children with learning disabilities. This finding implies that when
the depression among children with LD is significantly reduced, the children will
be better positioned to achieve in their academic pursuits. In order words, when the
level of depression among children with LD is not managed, there is bound to be

13
Efficacy of Rational Emotive Behavior Therapy on Depression…

decreased performance of the children in their academic pursuit. This will hamper
the realization of the enhanced academic achievement of children with LD.
This study has empirically established the effectiveness of the REBT intervention
program on the reduction of depression among children with learning disabilities
in primary schools in South-East Nigeria. This is a novel study/research in South-
East Nigeria in the sense that no such study has been conducted before it. Thus, sci-
ence teachers and counselors in primary schools, as well as educational evaluation
experts in South-East Nigeria and beyond, can leverage the outcomes of this study
in the reduction of depression among children with learning disabilities to enhance
their science learning.

Limitations of the Study

The aim is to infuse music into nearly every aspect of CBT group therapy as a
means for further comprehension and engagement with the material by participants.
This includes the use of critical listening to the musical material, songwriting, play-
ing various musical instruments, and using music as a point of reference in group
discussion and homework assignments. All music playing is geared towards the non-
musician through the use of easily playable instruments (e.g., shakers and bells) that
integrate well together (i.e., all pitched instruments are played in the key of C). The
group adheres to a traditional CBT group structure, including theme weeks (e.g.,
thinking, behavior and emotions), and the use of CBT tools such as behavioral
experiments, thought records, and homework at the conclusion of each session.
This present study as an experimental study has some methodological weak-
nesses. Specifically, this study could not analyze the possible moderating effects of
participants’ demographics such as location, age, and gender, which may cause dif-
ficulty in generalizing the study’s findings. Moreover, the findings of this study may
be limited by the fact that the participants were no subjected to diagnoses of LD but
instead were identified as having LD by scores on the WRAT. Moreover, conducting
this study on a South-East Nigeria population, and not involving parents and teach-
ers in the study, are limitations to the findings. Thus, it was suggested that future
researchers can explore the moderating effect of any of the moderators on the effec-
tiveness of the REBT intervention program on the reduction of depression among
children with LD. Further, subjecting participants of future research to diagnoses
of LD in addition to using WRAT score for identification of participants with LD is
recommended.

Strengths of the Study

This study is the first of its kind to establish empirically the efficacy of REBT
intervention program on the reduction of depression in a population of pupils
with LD in South East Nigeria. The strengths of this study lie in the fact that the
curriculum of science education needs to be reviewed in order to infuse the use of
the REBT intervention program in the management of depression among pupils
with LD. Also, the 100% participants’ retention rate is another strength of the
study.

13
 G. C. Ugwu et al.

Conclusion

The researchers concluded that the REBT intervention program had a significant
effect on the reduction of depression among children with learning disabilities (LD).
This implies that the feeling of depression among children with LD can be reduced
using the REBT intervention program. Based on this, therefore, the researchers rec-
ommended that the use of REBT intervention program in the reduction of depres-
sion among children with LD to maximize their academic outcomes. Also, for
proper teaching and learning of science, teachers of science education should use
REBT as a school-based therapy in managing depression among children with LD.

Acknowledgements  The researchers acknowledged all the participants who made the research to be a
success.

Funding  No funding was provided for this research.

Availability of data and material  The data for this research are at the custody of the corresponding author
and can be made available on request.

Declarations 

Conflict of interest  The authors declared no form of conflict of interest.

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