Vol XI, No. 2, 2011 Comments (0)


Babes-Bolyai University, Cluj-Napoca, Romania



There is a large body of literature on the effectiveness of psychological programs on reducing emotional distress and its consequences. More specifically, there is evidence showing that Cognitive Behavioral Therapy (CBT) based intervention programs are the most frequently used in reducing emotional distress and its consequences in occupational settings. We conducted a meta-analysis to determine the effectiveness of CBT-based interventions in this setting. Twenty-three (23) studies were included in our analysis, with 1282 participants. The overall weighted effect size (Cohen’s d) for all studies was -0.81 (95% CI -1.72 to -0.45). Furthermore, we analyzed separately the effectiveness of programs based on Rational Emotional Behavioral Therapy (REBT) and other CBT programs. When we separated the studies in these two categories the effect size increased for REBT based intervention programs (D = -1.14), while the effect size for the rest of CBT based programs slightly decreased (D = -0.52).  In addition, we calculated effect sizes for irrationality (D = -1.6), direct evaluation of emotional distress (D = -0.73), and for measures of distress consequences (D = -0.69). Results demonstrate the effectiveness of CBT-based intervention programs in reducing emotional distress, distress consequences and in reducing the level of irrationality in occupational settings.


Keywords: distress management, REBT and distress, CBT and distress, irrational cognitions



The American Institute of Stress reported that distress is a major factor in up to 80% of all work related injuries and 40% of work place turnover (Richardson & Rothstein, 2008). Also, in Europe, according to the European Agency for Safety and Health at Work, work-related distress affects 28% of workers in the European Union (EU) (Greiner, 2008). Individuals will experience distress in almost all areas of their lives from work to family and society, higher levels of distress having a direct impact on the immune system, exacerbating various medical conditions (Beriman, 2007). Regarding work related distress, employees exposed to high levels of job distress tend to report more frequent illness symptoms, require more time off work for medical complaints, and increase the company’s health care costs (Lazuras, Rodafinos, Matsiggos, & Stamatoulakis, 2009). Besides direct health costs, work-related distress leads to different secondary costs for organizations due to absenteeism and poor performance. Thus, distress has become a significant issue in terms of reduced productivity, lost time through sickness, absence and disruption to business (Beriman, 2007). Due to its implication in organizational life, distress is often evaluated indirectly, through its effects on job satisfaction, burnout, absenteeism and so on. Any intervention model on distress in organizations will focus on three key aspects of the distress cycle: a. the intensity of the stressors in the workplace; b. the employee’s appraisal of the situation or c. the employee’s abilities to cope with the outcomes (Richardson & Rothstein, 2008).

The structure of distress intervention programs varies widely, depending on the theoretical framework in which they are anchored, focusing on organization, individuals, and/or a combination of the two. Interventions designed to reduce distress in organizations can be categorized as (1) aiming to increase individual psychological resources and responses (e.g., coping) and/or (2) aiming to change the environment (van der Klink, Blonk, Schene, & van Dijk, 2001). Ong, Linden, and Young (2004) in a review of 153 studies showed that most intervention studies (77%) were based on cognitive-behavioral therapies (CBT), 85% included some form of relaxation, 15% used at least one form of biofeedback, 10% were classified as based on a systems model, and 6% could not be classified. As we can see these percentages add up to more than 100%, which can be explained by the multiple techniques used within the same program (Ong et al., 2004).

Besides being the most frequently used, programs based on Cognitive Behavioral Therapy (CBT) were also most effective in reducing the distress levels in organizations (Richardson & Rothstein, 2008). Cognitive Behavioral Therapy is based on Albert Ellis’s (1962; 1994) ABC model of human disturbance (David, 2006).  Ellis proposed that beliefs (B) mediate the impact of activating events (A) on emotions and behavior (C). Irrational beliefs are one of the main long-term sources and factors that  maintain the distress and, as a consequence, may lead to many anxiety and mood disorders (David, Szentagotai, Lupu, & Cosman, 2008). For this reason, early assessment and diagnosis of distress-related beliefs is one of the fundamental components of distress management and other psychological therapies oriented towards reducing distress (David, 2006). Rational Emotional Behavioral Therapy (REBT; Ellis, 1962, 1994) was developed based on this model. Numerous studies using REBT, which can be viewed as promoting an appraisal theory of emotions (see David, Schnur, & Belloiu, 2002; David, Montgomery, Macavei, & Bovbjerg, 2005) have examined the relationship between irrational beliefs and emotional distress in organizations, indicating strong correlations between irrationality and various measures of distress, such as: emotional distress, anxiety, depression, self-esteem, job satisfaction etc. (e.g., Daly & Burton, 1993; DiLorenzo, David, & Montgomery, 2002; Goldfried & Sobocinski, 1975; Harris, Davies, & Dryden, 2006; Nelson, 1977; Sporrle & Welpe, 2006).

There is a large body of literature on the effectiveness of distress intervention programs and outcome variables. However, there are debates as to which of these interventions is the most effective.  A study by van der Klink et al. (2001) using meta-analytic techniques examined the effectiveness of distress interventions in organizational environment. Their analysis was conducted on studies published up to 1996. A mean effect size of d = 0.34 was found. Concerning intervention type, cognitive behavioral interventions have been found to have the largest effect size, d = 0.68, while the other had smaller effect sizes (multimodal d = 0.51; relaxation d = 0.35; organization focused programs d = 0.08). Another meta-analysis conducted by Richardson and Rothstein (2008) extended the analysis including studies published up to 2006. A significant effect size across all studies was found (d = 0.52). Based on the intervention type, again cognitive behavioral based interventions had the larger effect size, d = 1.11, followed by relaxation, d = 0.49; organizational, d = 0.14, multimodal, d = 0.23, alternative interventions, d = 0.90. Both meta-analytical studies presented above showed that cognitive behavioral-based techniques are the most effective techniques, but none of them made a distinction within this category (i.e., CBT versus REBT).

The results presented above are conclusive, and there is not enough literature to justify another large meta-analysis comparing different types of approaches to reduce distress. Rather than that, we will focus our analysis on CBT (on which most studies were published; see below) and inside the CBT general category, on programs based or including REBT. We make this distinction, because in the previous meta-analytical studies, interventions based on the REBT were included in the general category of CBT based interventions. Why is this analysis relevant?  There is an increasing body of literature showing the strong relation between emotional distress and irrational cognitions in organizations, which in turn have increased the interest in developing intervention/coaching programs based on the principles of this theoretical framework (DiLorenzo et al., 2002; Grant, 2001; Sporrle, 2006). Moreover, Ellis (1994) argued that REBT could be more efficacious than standard CBT because it targets core beliefs, thus favoring not only “feeling better” but also “getting better” (Ellis, 1994). Thus, we will run a separate set of analyses, calculating the general effect size for the studies based on CBT and another set of analyses separating the intervention programs using or including REBT. In addition, as we mentioned above, there are many programs including various techniques and various methods of evaluating emotional distress, directly, with specific instruments, or indirectly, through its consequences such as absenteeism, burnout, job satisfaction, well being etc. Therefore, we will make this distinction in our analyses, calculating the effect size separately for direct evaluation of distress and evaluation through its consequences. In addition, considering the relation between emotional distress and irrational cognitions (Ellis, 1994), we will run a separate set of analyses to calculate de effect size for the effectiveness of CBT intervention programs in reducing the levels of irrationality.

The present paper investigates the interventions based on a cognitive behavioral approach (CBT and REBT) designed to reduce the level of emotional distress and its organizational consequences, through modification of people’s beliefs. Therefore, the aims of the present study are to conduct a multi-level analysis: 1. A quantitative estimate of the overall effect size of CBT-based intervention techniques in controlling and modulating the responses to different distress agents in occupational settings (there has been an increase in the number of studies using the cognitive behavioral approach as twelve more studies were published since Richardson and Rothstein’s meta-analysis, published in 2008). 2. A quantitative estimate of the overall effect size of REBT-based intervention techniques 3. Analysis of effect sizes by method of evaluating distress (i.e., distress versus its consequences). 4. Analysis of the effect sizes on measures of irrationality (as one of the key mechanisms of distress).




Our goals were addressed using meta-analytic techniques according to the published procedures (Hunter & Schmidt, 1990), with available data from the published literature. The studies included in the present paper were identified through a computer search using the following databases: Medline, PsycInfo, PsychLIT, Science Direct. The search was conducted for studies in English using the following keywords: “irrational beliefs”, “irrational beliefs and distress management”, “CBT and distress management”, “REBT and distress management”, “irrational beliefs and occupational distress”. Based on this search algorithm, we identified 36 studies that circumvented the chosen keywords. Next, we analyzed the references in order to include other relevant studies for our purpose. Six more studies were included in our preliminary analysis, adding up to a total of 42 studies retained for analysis.

Inclusion criteria were as follows: 1. Experimental studies investigating the effects of cognitive behavioral interventions on emotional distress 2. Studies focused on populations without clinical symptoms 3. Intervention method clearly defined as based on CBT and/or REBT techniques 4. Studies including a control group. 5. Studies reporting sufficient data (e.g., means, SD, and/or inferential statistics) to allow for calculation of effect sizes.

For the purpose of the present study, the “Method” section of published studies was carefully screened to determine that the authors were specifically describing a cognitive behavioral intervention on irrational beliefs. Based on these criteria we selected and retained 23 studies to be included in our meta-analysis. Out of these, only one study reported follow-up results. Therefore, only post intervention measures from 23 selected studies were included in the present paper (see Figure 1).

Figure 1. QUORUM Flow Chart

Figure 1. QUORUM Flow Chart

All studies included a control group and were conducted on participants with no identified clinical symptoms, belonging to different types of organizational environments. In some studies, the participants were not part of a specific organization (e.g., unemployed at the time or students) but we included the results in our analysis because the intervention program was designed to reduce work-related distress. The selected studies described the intervention strategy as based on cognitive behavioral approaches. Using standardized methods, 23 mean effect sizes were calculated (see Table 1). Overall, effect sizes were based on the report of 1282 subjects. To avoid the possibility that studies with larger number of dependent variables would influence the final overall estimate of the impact of cognitive behavioral intervention, effect sizes were calculated as the mean effect for each paper. We calculated an overall effect size for the 23 studies included. A second set of analyses were conducted in order to calculate the effect size for REBT (we included in this category studies that described the intervention as being based on REBT or that specifically described the procedure according to REBT principles (Ellis, 1994)). In order to assess the effectiveness of the intervention programs in reducing the level of irrationality, we calculated the mean effect size from the studies that included evaluations of irrational beliefs.

The effectiveness of the interventions was assessed by different types of distress evaluations.  Since various outputs were reported, we coded them under the following categories: 1. direct evaluations of emotional distress; 2. consequences of emotional distress (e.g., self-esteem, indifference, absenteeism, and burnout).  Coding was done by two trained specialists in Psychology. An inter-rater agreement of k = 0.93 was obtained. Effect sizes were calculated according to published procedures (Hunter & Schmidt, 1990). Mean differences between the cognitive behavioral intervention groups and control groups were calculated for each study and then divided by the SD of the control group. The strength of the various effect sizes were interpreted using Cohen’s d criteria (i.e., 0.2-0.5 = small; 0.5.-08 = moderate; higher than 0.8 = large). To estimate the overall effect of cognitive behavioral interventions the 95% confidence interval (CI) was calculated.  If the 95% CI included zero, there would be no significant effect of the intervention. Next, effect sizes and 95 % CIs were calculated for each outcome category. CIs were assessed for the inclusion of zero to test the significance of the individual category effects, and a between group analyses of variance (ANOVA) was conducted to determine if the categories differed from each other. Taking into consideration that the decrease in emotional distress is a positive outcome, the “-“ sign in our analyses indicates an effect in favor of  the intervention (see Table 2).




The meta- analysis revealed a significant benefit of cognitive behavioral interventions in reducing distress in organizational settings. Mean effect sizes averaged within studies, type of intervention, type of control condition, and 95% CIs are presented in Table 1.

The analysis of this data shows a large mean effect size due to cognitive behavioral interventions. A large average effect size of d = -0.92, 95% CI (-1.32 to -0.64) was obtained (see Table 2).



Table 1. Effect sizes and study characteristics


Crt. No




(no. of subjects)

Type of intervention


Mean effect size (d) / study

No. of effect sizes/ study

1 Forman, S. 1982


REBT Wait list -1.09 3
2 Thurman, C. 1985


CBT based No intervention -1.1 3
3 Sharp, J. & Forman, S 1985


REBT control -2.05 3
4 Tunnecliff, M. et al. 1986


CBT based Control -1.65 1
5 Cecil, M. & Forman, S. 1990


CBT based control -0.35 12
6 Hains, T.  et al. 1992


CBT based Waiting list -0.91 8
7 Kirkby, R. 1994


REBT based Waiting list -0.81 3
8 Lee, S. & Crocket, M. 1994


REBT based control -0.64 3
9 Kushnir, T. 1995


REBT based Waiting list -2.5 2
10 Malkinson, R. et al. 1997


REBT based Waiting list -0.83 4
11 Kushnir  et al. 1998


REBT based Waiting list -1.66 2
12 Maynard, W.I. 1998


CBT based No intervention -1.61 6
13 Bond, F. & Bunce, D. 2000


CBT based No intervention -0.12 2
14 Grime, P 2004


CBT based No intervention -0.63 2
15 Flaxman, P. & Bunce, F. 2004


CBT based Control -0.23 3
16 Gardner, B.  et al. 2005


 CBT based Waiting list -0.61 2
17 Main, N. et al. 2005


CBT based Wait list -0.43 2
18 Shimazu, A. et al 2005


CBT based No intervention -0.21 4
19 Adomeh, O.C.I. et al. 2006


REBT based No intervention -0.52 2
20 Grant, M.A. 2006


CBT based No intervention -0.79 3
21 Granath, J. et al. 2006


CBT based  No intervention -0.93 5
22 Ruwaard, J. et al 2007


CBT based No intervention -0.48 4
23 deVente, W.  et al. 2008


CBT based No intervention -0.92 6

Note: CBT based – programs based on Cognitive Behavioral Therapy; REBT based – programs based or including components of Rational Emotive Behavioral Therapy.


Table 2. Mean effect size for each  outcome category




No. of effect sizes/ category

95% CI

CBT – general



(-1.32 to -0.64)




(-2.68 to -0.79)

Direct evaluations of emotional distress



(-1.2 to -0.52)

Consequences of emotional distress



(-1.16 to -0.54)

Note: d- effect size on the specified category;



Because effect size calculations can be biased by variations in individual study sample sizes, we run another analysis, correcting for sample size, based on published procedures (Hunter & Schmidt, 1990). Specifically, both the mean difference and the variation of difference were adjusted for variation in the study sample size (D and VarD, respectively).  Results indicate a large weighted effect size (D = -0.81, VarD = 0.24) while the 95% CI shows that D differs significantly from zero (-1.72 to -0.45) (see table 3).

Table 2 illustrates the medium effect sizes and 95 % CI for each category. Analysis of these results shows that cognitive behavioral interventions are effective both for reducing the level of irrationality and the level of distress evaluated either directly or through its consequences. We run the analysis again for correction of d for each category. For irrationality, a corrected D = -1.6, Var D = 0.4 and 95% CI (-2.35 to -0.85) emerged (see Table 3).


Table 3. Corrected mean effect size for each outcome category




Var D

95% CI

CBT – general



(-1.72 to -0.45)




(-2.35; -0.85)

Direct evaluations of emotional distress



(-1.23 to -0.55)

Consequences of emotional distress



(-1.12 to -0.33)

Note: corrected effect size on the specified outcomes



This is a significant effect size, which confirms the effectiveness of cognitive behavioral interventions in reducing irrationality. For direct evaluations of distress we obtained a D = -0.73, VarD = 0.04, 95% CI (-1.23 to -0.55). For evaluations of emotional distress consequences we obtained D = -0.69, VarD = 0.02, 95% CI (-1.12 to -0.33) (see table 3). These values show the effectiveness of the cognitive behavioral interventions in reducing distress, with a larger effect size when the outcome was evaluated directly. An ANOVA approach failed to reveal any differences in effectiveness (F [1, 78] = 1.52, p > 0.05) based on outcome categories. Rather, the examination of the effect sizes and CIs for each category revealed that cognitive behavioral interventions had significant effects on all outcomes, in the expected direction. These results support the view that there is a broad beneficial impact of cognitive behavioral interventions in organizational settings across outcome categories. The same pattern of results was found for unadjusted effect sizes. In the next step, we run an analysis separating studies based (or including a core component) on the REBT theoretical framework from other CBT-based intervention programs. We found a total of 8 studies that circumvented our inclusion criteria, being included in the REBT-based category. Results are detailed in Table 4 and Table 5.


Table 4. Mean effect size for each CBT based and REBT based interventions




No. of effect sizes/ category

95% CI

CBT based




REBT based



(-1.65; -0.68)-

Note: CBT based – programs based on Cognitive Behavioral Therapy; REBT based – programs based or including components of Rational Emotive Behavioral Therapy.



Table 5. Corrected mean effect size for each CBT based and REBT based interventions




Var D

95% CI

CBT based



(-0.68; -0.35)

REBT based



(-1.59; -0.69)

Note: CBT based – programs based on Cognitive Behavioral Therapy; REBT based – programs based or including components of Rational Emotive Behavioral Therapy.



We calculated the effect size for each category (i.e., REBT-based and CBT-based) of intervention programs. For CBT-based programs (15 mean effect sizes) the mean effect size, calculated according to the described procedure, was d = -0.73, 95% CI (-1.41 to -0.55), while for the REBT category (8 mean effect sizes), it was d = -1.16, 95% CI (-1.65 to-0.68). The range of d values (based on Cohen ‘criteria) indicates a difference between the two categories. In the case of REBT-based intervention programs a strong effect size emerged, while in the case of CBT-based intervention programs, the effect size fell only into the moderate range. A further analyses using ANOVA was conducted yielding a significant difference between the two categories (F [1, 21)] = 4.57, p < 0.05). The difference between the two effect sizes is maintained even after correcting d for variation in study sample size. For CBT-based intervention programs we obtained a D = -0.52 (moderate effect size), Var D = 0.1, and 95% CI (-0.68 to -0.35), while for REBT-based intervention programs, we obtained a D = -1.14 (large effect size), Var D = 0.11, and 95% CI (-1.59 to -0.69) (see Table 4 and Table 5). Thus, the results show the efficiency of both types of intervention in reducing distress, with a stronger effect in favor of REBT-based intervention programs.


Discussion and conclusions


Distress responses and interventions on distress are hot topics in current research. However, approaches are heterogeneous and so are various distress response measures. On one hand, we have approaches coming from a clinical perspective, where participants are patients identified with different clinical symptoms. On the other hand, we have approaches from an organizational perspective, where we find differences regarding the specific nature of the organization and the personal characteristics of the participants included in the study.

Measures of distress response also differ between the two categories of approaches. While in the clinical environment distress is evaluated mainly directly, through modifications in anxiety levels, depression etc., in the organizational environment, distress can be evaluated both directly and indirectly, by assessing the effects of distress on behaviors such as absenteeism, indifference, fatigue, burnout etc.

Given this rich literature on the topic, as well as the heterogeneity of approaches and distress measures, we conducted a quantitative meta-analysis of studies discussing CBT-based interventions on distress in organizational settings. Results revealed that cognitive behavioral interventions have a significant effect in reducing distress. Indeed, the overall mean effect size (calculated for all the studies) indicates a strong effect of cognitive behavioral interventions on reducing distress (d = -0.92). This is in accord with previous results reported by Richardson and Rothstein (2008), (d = 1.16). For a more detailed analysis, we coded results into two categories, based on inter-rater agreement (k = 0.93): direct evaluation of emotional distress and evaluation of distress through its consequences. In both cases, the mean effect size was significant (d = -0.73, though in the case of evaluation through its consequences the effect size is slightly smaller, d = -0.69).

Given the numerous reports in the literature showing strong correlations between irrationality and various measures of distress in organizational settings (DiLorenzo et al., 2002; Grant, 2001; Sporrle, 2006), we ran a separate set of analyses including only the measures of irrationality. We found a strong mean effect size (d = – 1.6), showing the effectiveness of these interventions on reducing irrationality levels among people from different organizational settings. However, future studies, looking more thoroughly into the specific mechanisms that govern this relation are needed.

Another distinction in our study was made between studies based on the CBT theoretical framework and those based on the REBT framework. We have explained the reasons of this analysis in the introduction. On both categories (CBT and REBT), we obtained significant effect sizes. Even though the overall effect size for the general CBT category was in the “strong” category (d = -0.81), after separating the studies in REBT-based and other CBT-based, the strength of the effect sizes fell into the “moderate” category (d = -0.52) for CBT programs and remained in the “strong” category (d = -1.14) for REBT programs. The strong effect size for REBT supports the results reported in the literature regarding the high correlations between irrationality and distress. The mean effect size for the CBT category, situated in the moderate range, is consistent with the previous meta-analyses (van der Klink et al., 2001; Richardson & Rothstein, 2008). Richardson and Rothstein (2008) showed that single-mode cognitive–behavioral interventions have a stronger effect size than cognitive–behavioral interventions with more components (e.g., including relaxation, assertiveness training etc). This could explain the smaller (but  still significant) effect size for the CBT category in our analysis,  given the fact that most of the studies included in this category reported more than one component in the structure of the program. However, even the studies in the REBT category contained a core REBT component along with other techniques. Therefore, maybe this difference could be explained by Ellis’ argument that REBT targets more core beliefs (i.e., irrational beliefs) as compared to general CBT, and thus, it is faster and sometimes more efficacious; however, future studies should directly investigate this supposition, by directly comparing REBT and CBT in organizational settings, in the same experimental design.

As most meta-analytic research, the present study has several limitations. We excluded a number of studies where the intervention method was not clearly defined, retaining only those where the intervention was explicitly described as being based on cognitive behavioral principles. However, we have done this explicitly, arguing our decision (see also the file-drawer analysis below). Another limit of the present study is the wide range of settings from where data were collected.  Even though the overall effect size is in favor of CBT/REBT-based programs, the intervention procedure differed across studies according to their aims and the characteristics of the population included. This led to various measures of distress across the studies included in our meta-analysis. We tried to overcome this limitation by categorizing the results based on the method of assessing emotional distress. Nevertheless, there is a wide range of measures to evaluate distress in the literature, making it difficult to combine the studies. On the other side, this increases the generalizability of the results and their robustness across distress evaluations methods. The third limitation refers to follow-up measures. Because only one study reported follow-up data, we were not able to include this aspect our research. Consequently, our analysis is based only on post-intervention measures. Finally, because of the wide diversity in organizations and participants characteristics, we did not include socio-demographic analyses in our study.

As with any meta-analysis, there is what is referred to as the file-drawer problem. Investigators who obtained no significant results may have not published their findings, thus biasing the sample of studies in the expected direction. To overcome this limitation, we calculated, using published procedures (Hunter & Schmidt, 1990), the number of studies with effect sizes of zero that would be needed to annul our results. In this case, 1194 studies indicating no effect should be published to affect the results presented here.

In summary, CBT programs are efficient in approaching emotional distress in organizational settings. Out of these, REBT based intervention programs seems to be the most efficient, as supported by a mean effect size situated in the “strong” range according to Cohen’s criteria. However, even if the mean effect size for CBT-based intervention programs, after removing studies based on REBT, decreased into the “moderate” range, it still remained significant. Overall, CBT interventions are efficient in reducing distress and its job related consequences, with a higher effect when the program is based or includes a core component of REBT. These findings strongly support the development of future programs that emphasize the importance of REBT and irrational cognitions by including them as a core components of the intervention. Indeed, our findings suggest that effective interventions should focus on the modification of core irrational beliefs as precursors of dysfunctional emotions in order to modulate the response to stressors in organizational environment.

Considering these results and other findings reported in the literature regarding the relation between irrationality and distress, future studies should further explore the interactions between irrationality and distress in organizational setting. In addition, specific programs, based on the REBT theoretical framework can be designed for the modification of irrational beliefs and for the evaluation of the impact of irrationality on distress and other constructs such as performance, motivation, perceived quality of life, which we know to be highly correlated with distress. This can be the basis of a comprehensive intervention model in organizations with implications and benefits at both individual and organizational level.



Investing in people!

Ph.D. scholarship, Project co-financed by the SECTORAL OPERATIONAL PROGRAM FOR HUMAN RESOURCES DEVELOPMENT 2007 – 2013

Priority Axis 1. “Education and training in support for growth and development of a knowledge based society”

Key area of intervention 1.5: Doctoral and post-doctoral programs in support of research.

Contract nr.: POSDRU 6/1.5/S/4 – “Doctoral studies, a major factor in the development of socio-economic and humanistic studies”

Babeş-Bolyai University, Cluj-Napoca, Romania



Note: studies marked with * represent the studies included in our meta-analysis


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*Hains, T. (1992). Comparison of cognitive behavioral distress management training with adolescents boys. Journal  of Counseling and Development, 70, 600-605.

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