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Indian Journal of Public Health Research & Development, Jan-March 2021, Vol. 12, No. 1 385
Clinical Application of Rational-Emotive Health Education for Stress Management in Teachers
Adaobiagu N. Obiagu1, Chiedu Eseadi2, Okechukwu O. Nwaubani3, and Paul N. Onwuasoanya4 1Lecturer, Department of Social Science Education, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria, 2Lecturer, Department of Educational Foundations, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria, 3Professor, Department of Social Science Education, University of Nigeria, Nsukka, 410001, Enugu, State, Nigeria, 4Professor, Department of Educational Foundations, University of Nigeria, Nsukka, 410001, Enugu, State, Nigeria.
There is evidence that teachers encounter more stress than people in other professions. Stressors in teaching include students’ misbehaviour, excess workload, and time pressure among others. Teachers in developing countries like Nigeria encounter additional stressors outside common job stressors. Stressors peculiar to teachers in developing countries include transportation issues, cultural challenges, and delays in payment of salary. High level of stress in teaching results to health problems, burnout, absenteeism, attrition, and students’ behavioural and academic underperformance. Stress management is necessary to reduce or escape stress consequences, and rational-emotive behaviour therapy (REBT) has been widely applied to stress management and behavioural issues across contexts. This review presents the finding of a study that clinically applied Rational-Emotive Health Education Intervention (REHEI) Programme, developed from the perspective of REBT principles for stress management in teachers. The finding shows that many teachers undergo a high level of job stress and REHEI significantly reduced stress and irrational beliefs causing stress among teachers. Implications for the study for policy and future studies were pointed out.
Keywords: Clinical applications, irrational beliefs, rational-emotive behaviour therapy, rational-emotive health education, stress management, teacher stress

Stress is one’s response to perceived harm, threat, or challenges. Stress (mental and physical), in most cases, is the precursor of other mental distress such as depression, anxiety, suicidal ideation, etc. It can be caused by lifestyle especially beliefs about and reaction to challenges, threats, demands, and problems. Many people in developing countries especially African countries encounter many threats that could cause stress in their everyday lives. Aside from social issues that can induce stress, teachers in Nigeria encounter universal teachers’ job stressors and peculiar job-related stress. Rational-emotive behaviour therapy (REBT) developed by Albert Ellis[1] have been widely applied for stress management in different contexts. This review articulated the sources of stress in teaching, the consequences of stress, the mediating role of irrational beliefs on the relationship between stressors and stress,

and the effect of clinical application of Rational-Emotive Health Education Programme (developed from the perspective of REBT) on stress management in teachers.
Teachers play essential roles in the social-emotional and cognitive development of students. But, the critical roles of teachers are jeopardized by a high level of stress among teachers. Teachers experience a higher level of job-related stress than other professionals2,3. And stress negatively impacts personal and emotional well-being as well as reduces performance4. In many contexts, over 50% of teachers report a high level of stress5,6. In Nigeria, findings have shown many teachers to report a high level of stress7,8.
The sources of stress in teaching practice is context-dependent. However, existing literature shows teachers in all contexts share a number of sources of stress especially students’ disruptive behaviour9,10, lack of administrative support2, excess workload6,

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and time pressure, low students’ motivation and value dissonance10. These teacher stressors can be said to be universal teachers’ stressors having been identified in various countries as stressing agents. In developing countries, especially Nigeria additional and peculiar teachers’ job-related stressors are identified. They include lack of job satisfaction8, transportation difficulties, lack of power supply, lack of opportunities for professional development, delay in pay7, and cultural limitations such as child marriage that complicates the needs and problems of female students.

The consequences of stress on teachers and teaching practice include mental health problems11,12, teacher burnout3, job absenteeism and attrition13, job dissatisfaction11, physical and psychological absence from work14, job burnout15, and impairment of studentsteacher relationship14. Teachers’ stress also produces students’ disruptive and anti-social behaviours5,16, and poor academic achievement17,18, as well as undermines
the implementation of positive behaviour interventions
and supports – aimed at promoting an effective and
healthy environment for the realization of system’s goals – in the classroom5,17. Irrational beliefs mediate
the relationship between job stressors and stress consequences15,19.

Stress management is important to reduce the effect of stress on teachers’ efficiency, health, and students’ behaviour and academic performance. It involves the reduction of stress or reduction if stress consequences through a change of lifestyle or other procedures. Stress management has been pursued through various coaching models with cognitive behavioural and rational-emotive approaches the most commonly used by practitioners. Of interest to the paper is the clinical application of rationalemotive behaviour therapy approach in teachers’ stress management.



Rational-emotive behaviour therapy (REBT) is a psychological model developed by Albert Ellis1 for stress reduction and management, management and treatment of behavioural and psychological problems for promotion of healthier and happier living. Its basic assumption is that behaviours, emotions, feelings, and stress are the products of beliefs or thoughts (which could

be functional or irrational) held by the person exhibiting a particular behaviour, stress or emotions. REBT can serve as both preventive and curative medicine. It involves cognitive restructuring for emotional and behavioural adjustment. It includes a simple ABCD model with ‘A’ representing Activating Event, ‘B’ standing for Beliefs about the activating event, ‘C’ representing the consequences of the beliefs about the activating event, and ‘D’ representing the Disputation or challenge of the beliefs20,21. REBT procedural activities include (a) identifying the activating events, (b) identifying the beliefs held about identified activating events, (c) identifying the consequences of the identified held beliefs about identified activating events, and (d) working on self or the holder of the identified beliefs to challenge his or beliefs by questioning and restructuring them through understanding feels, differentiating facts from opinions, and understanding self.
A number of studies have shown REBT to be effective in behavioural and stress management. A meta-analysis of studies on the impact of REBT on students’ misbehaviour showed that REBT was effective in reducing disruptive behaviours among them22. Aside from other professional, REBT has been applied on students, parents, and teachers to help manage their relationships and produce positive and desirable emotions, behavioural and academic outcomes in students22,23,26. Despite its usefulness in stress management, is has been shown that Nigerian teachers do not utilize it, but instead rely on inactive behavioural strategies for stress management24. These stress management methods of Nigerian teachers cannot address the problem of irrational beliefs causing stress or solve the burnout, health or students’ performance consequences of stress. Recently, some researchers have applied REBT for stress management in Nigerian teachers and found it effective23,25. Presented in the next section is the review of the study on the effect of rational-emotive health education intervention (REHEI) on teachers’ stress management.
Rational-emotive health education intervention (REHEI) programme is a training programme with

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therapeutic value developed by Ugwoke et al.23 and clinically applied to the management of teachers’ stress and irrational beliefs. The programme was based on REBT principles discussed above and aimed at helping teachers cope with workplace stress and overcome irrational beliefs contributing to their stress. Its contents included cognitive-behavioural skills, therapeutic techniques, and challenging of revealed irrational beliefs about teaching. The cognitive behavioural skills involve Ellis’ ABCD model while the therapeutic techniques include relaxation, stretching, and cognitive restructuring.
The programme lasted for a period of 10-week of 20 therapeutic sessions of 60 minutes each and a 2-week follow-up conducted after four months following the intervention. Participants of the study were 185 college teachers (93 and 92 randomly assigned to intervention group and waitlist control group respectively) – out of the originally randomly sampled 470 teachers – in Southeast Nigeria who met the study’s inclusion criteria which are teaching for up to 1 year, scoring a high level of stress on Teachers’ Stress Questionnaire and scoring a high level of irrational beliefs about teaching on Teachers’ Irrational Beliefs Questionnaire used for that study. A post-test was administered after the intervention and a post-post-test administered after the conduct of the 2-week follow up. Collected data were analysed and correlated using repeated measures analysis of variance, paired t-test, partial eta squared, Mann-Whitney U test, Mean Rank, and Pearson Product-Moment Correlation Coefficient.
The result of the study showed that REHEI, like other REBT intervention programmes, significantly reduced stress and irrational beliefs in teachers exposed to the intervention while teachers in the waitlist control group did not report any stress reduction while also maintain their irrational beliefs. This finding is consistent with findings of other studies that show REBT to effectively and significantly reduce stress in participants25,26.
Structural programmes for effective educational outcomes among students, where they exist in Nigeria, focus largely on students. For example, Federal Government of Nigeria introduced free lunch, free textbooks, free uniform, universal primary education

scheme, and Nigerian Empowerment Scheme recruiting additional teachers to improve students’ enrolment in schools and educational performance. Findings evidencing teachers’ stress to negatively impact students’ educational performance suggest the need for governments’ funding of interventional programmes directed toward teachers’ stress management. Considering the high level of stress involved in teaching practice, there is a need for a policy mandating schools to provide stress management intervention sessions and programmes for their teachers.
Future studies should investigate challenges encountered by REBT trainers in training individuals as well as teachers’ challenges in implementing acquired REBT skills and knowledge in different contexts. This is important in African settings where religion and culture are important players in beliefs held by individuals (e.g. my colleague is diabolic; I’m having difficulties in my career as a result of my colleague’s spiritual attack, i.e. voodoo, against me, etc.). It is important to explore if traditional and religious beliefs present challenges to acceptance of the REBT assumptions by clients. Exploration of REBT implementation challenges could provide insights into advancing REBT to suit contextual peculiarities.
Many teachers in Nigeria undergo stress and hold irrational beliefs about teaching with a high number of these teachers experiencing a high level of job-related stress. Rational-emotive health education intervention programme, developed from the perspective of rational-emotive behaviour therapy, was effective in reducing stress and the irrational beliefs inducing them in teachers. Future studies are encouraged to consider possible contextual challenges that could inhibit teachers’ practice of the skills and knowledge acquired from REHEI and REBT trainings.
Ethical Clearance- Not required
Source of Funding- Self
Conflict of Interest – Nil
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StressTeachersBeliefsNigeriaStress Management