Journal of Rational-Emotive & Cognitive-Behavior Therapy

Volume 10, Number 4, Winter 1992

THE R E L A T I O N S H I P S AMONG
THE G E N E R A L ATTITUDE AND
B E L I E F SCALE, OTHER
D Y S F U N C T I O N A L COGNITION
M E A S U R E S , A N D D E P R E S S I V E OR
BULIMIC T E N D E N C I E S
Eleanor H. Wertheim
Zeffie Poulakis
La Trobe University

ABSTRACT: This study assessed the relationships between the General At-
titude and Belief Scale (GABS) and measures of 1) irrational beliefs derived
from Ellis' older and newer theorizing, 2) reasoning errors based on Beck's
theory, and 3) affective and behavioral disorder, specifically depression and
bulimia. Female undergraduates (n = 160) completed the GABS, Irrational
Beliefs Scale, Irrational Beliefs Test, Rational Behaviors Inventory, Dysfunc-
tional Attitude Scale, Cognitive Error Questionnaire and the Beck Depres-
sion Inventory, Center for Epidemiologic Studies - Depression Scale, and Bu-
limia Test. Results supported the internal consistency and construct validity
of the GABS; progressively higher correlations were obtained with measures
more similar to the GABS theoretically.

A l t h o u g h tests to m e a s u r e irrational beliefs have been constructed

in the past, t h e y have been criticized on a n u m b e r of grounds. First,
some scales appear to be i m p u r e m e a s u r e s of cognitions (Bernard,
1990; Malouff & Schutte, 1986; Smith, 1989; S m i t h & Zurawski, 1983;
Z u r a w s k i & Smith, 1987), including instead items reflecting affect or

Dr. Eleanor H. Wertheim is Senior Lecturer at the Department of Psychology, La Trobe Univer-
sity in Melbourne, Australia. Zeffie Poulakis is associated with the Department of Psychology at
La Trobe University where she completed her honours degree, B.B.Sc. (Hons).
The authors thank Christine Brown for helping to recruit subjects and administer measures.
Address correspondence to the first author, Department of Psychology, La Trobe University,
Bundoora, Victoria 3083, Australia.

219 9 1992 Human Sciences Press, Inc,

220 Journal of Rational-Emotive & Cognitive-BehaviorTherapy

behaviors, as in the Irrational Beliefs Test (IBT; Jones, 1968), or Ra-

tional Behavior Inventory (RBI; Shorkey & Whiteman, 1977). A true
cognitive scale should include only cognitive items. If affect or behav-
ior items are included, the use of such a scale to predict emotions or
behaviors becomes simply tautological.
In addition, scales such as the IBT and RBI have been described as
'outdated' (Bernard, 1990; DiGiuseppe, 1990; Smith, 1989) since they
were derived from Ellis's earlier writings, which have since been re-
vised (Dryden & Ellis, 1988; Ellis, 1984a; 1990). In particular, RET
theory has moved away from a typology on the sole basis of a series of
specific irrational beliefs, and has increasingly focused on core irra-
tional processes, involving absolutistic demands ('musts', 'shoulds', etc.).
Some of the older scales include items which would no longer be consid-
ered 'irrational' because they are phrased as preferences or wants, rather
than demands reflecting absolutistic thinking (Burgess, 1990).
In an effort to address some of these issues, a number of newer
scales are being developed, including the General Attitude and Belief
Scale (GABS). This inventory emerged out of research by Burgess
(1986; 1990) who developed items to explore aspects of Ellis' more re-
cent theorizing. Subsequent researchers (Bernard, 1990; DiGiuseppe
& Leaf, 1990; DiGiuseppe, Leaf, Exner & Robin, 1988; Shaw, 1990,
cited in Bernard, 1990) developed a series of new items into a measure
of irrational beliefs including subscales. The items in the GABS are
either rational or irrational, and were designed to each reflect one
thought process and one content area (DiGiuseppe et al., 1988). In ad-
dition, the items in the GABS were designed to refer to the self, and to
centre on a specific event (DiGiuseppe et al., 1988). Factor analyses of
individual items initially suggested four factors: Need for Approval,
Need for Achievement, Need for Comfort and Rationality (Shaw, 1990;
cited in Bernard, 1990). A second factor analysis including additional
items designed to assess demands for fairness, indicated an expanded
factor structure, in which the subscales of Demands for Fairness, Self-
downing and Other-downing were added (Bernard, 1990). In the latter
factor analysis, which was based on 96 items, 41 items failed to load
on any factor and were dropped, resulting in a 55-item version of the
scale. The current paper examined this latter shortened version of the
GABS, although subsequent researchers may wish to examine whether
any of the dropped items contained theoretically important material.
The internal consistency of the various forms of the GABS subscales
appears adequate and subscales correlate highly with each other (Di-
Giuseppe & Leaf, 1990; DiGiuseppe, et al., 1988). Initial attempts to
assess construct validity have indicated that, as expected, subscales
Eleanor H. Wertheim and Zeffie Poulakis 221

correlate moderately with measures of anxiety, life satisfaction, men-

tal disturbance, psychological well-being, depression and anger (Ber-
nard, 1990; DiGiuseppe et al., 1988). Couples receiving therapy, par-
ticipants in a drug rehabilitation program, as well as clinical samples
of anxious, agoraphobic and depressed individuals, have also received
higher GABS scores than controls on some subscales (Bernard, 1990;
DiGiuseppe et al., 1988).
To date the relationships between the GABS and other measures of
cognitive dysfunction have not been explored. Therefore the first aim
of this study is to discover how the GABS relates to a number of other
scales.
Theoretically Ellis and others (Wessler & Wessler, 1980) differenti-
ate between two levels of possibly inaccurate cognitions: the level of
interpretation and the level of evaluation. As an example, if one's boss
says, 'You are a slow worker', a cognitive error in interpretation might
be to overgeneralize, assuming all people will think the same as the
boss, as in 'Everyone will think I am a slow worker'. Whereas Beck
(1967; 1976) primarily describes a variety of such cognitive errors at
the interpretive level, Ellis (1984b) stresses the importance of adding
an absolutistic, evaluative component for the cognition to be consid-
ered irrational, such as in, 'I m u s t not be considered a slow worker by
my boss and coworkers'. Of course, this distinction between theorists
is not pure; for example, Beck describes an error of catastrophising,
and Ellis (1984b) acknowledges that interpretations form part of be-
liefs. Nonetheless, measures designed to assess dysfunctional cogni-
tions have stressed one or the other aspect of cognitions depending on
their theoretical origins. Both types of measures will be included in
this study.
Two scales based on Ellis' older theory will be included, the IBT and
the RBI. A newer scale, the Irrational Belief Scale (IBS; Malouff &
Schutte, 1986), will also be included. Although the IBS is based on
older RET theory, it is nevertheless an improvement on the IBT and
RBI in that it consists of items assessing cognitions, rather than emo-
tions or behaviors (DiGiuseppe & Leaf, 1990; Malouff & Schutte,
1986). Furthermore, most (but not all) IBS items are phrased in abso-
lutistic, rather than preferential, language and reflect the evaluative
aspect of cognitions.
The relationship of the GABS with measures derived from Beck's
theorizing will also be explored. The Cognitive Error Questionnaire
(CEQ; Lefebvre, 1981) is a measure which assesses frequency of infor-
mation processing errors, such as overgeneralization and selective ab-
straction, which lead to inaccurate interpretations. The Dysfunctional
222 Journal of Rational-Emotive & Cognitive-BehaviorTherapy

Attitude Scale (DAS; Weissman, 1979) includes a combination of the

two levels (interpretive a n d evaluative) of cognitive disturbance.
It is expected that the GABS will have the highest correlation with
the IBS, a scale also consisting primarily of items assessing similar
style cognitions. GABS subscales should correlate moderately to highly
with other measures of dysfunctional cognitions. Subscales from dif-
ferent tests that were designed to measure similar constructs should
also have relatively higher intercorrelations.
If it is so that emotional and behavioral difficulties are conse-
quences of dysfunctional cognitions, the GABS should correlate mod-
erately with measures of emotional or behavioral disturbance. Two
forms of such disturbance will be assessed, depression and bulimia,
both of which have been found to exist in relatively high numbers of
female undergraduates.

METHOD

Subjects

Subjects were 160 female undergraduates recruited from first and

second year psychology and social science classes. Mean age was 20.3,
S D = 3.36, range = 18 - 40.

Procedure

In classes, subjects were asked to participate in a study about 'the

relationship between various beliefs, attitudes and behaviours', for
which they would be paid $8. Consent forms and questionnaires were
administered later in small groups. Questionnaires were coded for con-
fidentiality.
Six scales measuring cognitive disturbance were included. The Gen-
eral Attitude and Belief Scale (GABS; DiGiuseppe, et al., 1988) used
here was the 55-item scale of Bernard (1990) consisting of seven sub-
scales derived from factor analysis labelled: Rationality, Self-downing,
Need for Achievement, Need for Approval, Need for Comfort, De-
mands for Fairness, and Other-downing (Bernard, 1990). A Total
GABS Irrationality score was calculated by summing the total scores
of the latter six subscales. The Rationality subscale used here (Ber-
nard, 1990) mostly includes items in which a rational statement is
endorsed in preference to an irrational statement (e.g., 'I want to be
liked and accepted by people whom I like, but I realize they don't have
Eleanor H. Wertheimand ZeffiePoulakis 223

to like me just because I want them to'). This style of item differs from
the Rationality statements in the scales used by Burgess (1986; 1990)
and DiGiuseppe and Leaf (1990) in which items are simply stated in
preferential rather than demand language (e.g., 'I want to be liked by
some people').
The Dysfunctional Attitude Scale - Form A (DAS; Weissman, 1979)
assesses "the presence of !diosyncratic dysfunctional beliefs or as-
sumptions postulated by Beck (1967) to characterize the thinking of
depressed individuals" (Gotlib, 1984, p.22). Items reflect the themes of
"approval, love, achievement, perfectionism, entitlement, omnipotence
and autonomy" (Parker, Bradshaw & Bignault, 1984, p.94). Reliability
estimates have been satisfactory (Dobson & Shaw, 1986; Zuroff, Igreja
& Mongrain, 1990).
The Irrational Belief Scale (IBS) is a single construct measure de-
rived from Ellis's original 11 beliefs (Malouff & Schutte, 1986). Most
items use absolutistic language; those that don't tend to reflect a belief
in an inability to change. The IBS has displayed high internal consis-
tency, test-retest reliability, and ability to differentiate groups as ex-
pected (Malouff & Schutte, 1986; Warren & Zgourides, 1989).
The Irrational Beliefs Test (IBT; Jones, 1968) is a test based on
Ellis' older theory. The original version of the IBT contained 100
items, and 10 subscales. A more recent factor analysis of the 100-item
IBT resulted in modifications to the IBT factor structure and scoring
system (Lohr & Bonge, 1982). This revised IBT scoring technique
(which was used in the present investigation) reduced the IBT to 70
items, with nine subscales: Demand for Approval, High Self-expecta-
tions, Blame-proneness, Problem Avoidance, Dependency, Helpless-
ness and Perfectionism (Lohr & Bonge, 1982). The IBT displays good
internal consistency, test-retest reliability, concurrent and convergent
validity (Jones, 1968), although discriminant validity relating to mea-
sures of emotional distress has been questioned (Smith & Zurawski,
1983; Zurawski & Smith, 1987).
The Rational Behavior Inventory (RBI; Shorkey & Whiteman, 1977)
is a 37-item scale which was also derived from Ellis' older theory of
irrational beliefs. In the present investigation, the Australian version
of the RBI was issued, which is comparable to the American version
(Whiteman, 1979). The RBI consists of 11 factors (or subscales) (Shorkey
& Whiteman, 1977; Whiteman, 1979); these are Catastrophizing, Guilt,
Perfectionism, Need for Approval, Caring and Helping, Blame and
Punishment, Inertia and Avoidance, Independence, Projected Misfor-
tune and Control of Emotions (Sanderman, Mersch, van der Sleen,
Emmelkamp & Ormel, 1987). The RBI displays test-retest reliability,
224 Journal of Rational-Emotive& Cognitive-BehaviorTherapy

split-half reliability, internal consistency, and convergent validity

(Sanderman et al., 1987; Shorkey & Whiteman, 1977; Whiteman &
Shorkey, 1978). Discriminant validity of the RBI in relation to mea-
sures of anxiety and depression has been questioned (Smith & Zuraw-
ski, 1983; Zurawski & Smith, 1987).
The General Cognitive Error Questionnaire (CEQ; Lefebvre, 1981)
assesses four types of cognitive errors: Catastrophizing, Overgeneral-
ization, Personalization and Selective abstraction. Subjects are given
24 vignettes followed by a dysphoric cognition about the vignette
which reflects a cognitive error. Subjects rate on a 5-point scale how
similar the thought is to what they would think. High reliabilities
(test-retest, alternate form and internal consistency) and moderate
correlations with a previously constructed distorted depressive cogni-
tion scale have been found.
Depression was measured via two scales. The Centre for Epidem-
iologic Studies Depression Scale (CES-D; Weissman, Sholomskas, Pot-
tenger, Prusoff & Locke, 1977) was developed to assess depressive
symptomatology in normal, community samples and has good re-
liability and construct validity (Rabkin & Klein, 1987; Weissman et
al., 1977). The Beck Depression Inventory - Short Form (BDI; Beck,
Rial & Rickels, 1974), was designed for more clinical samples, but is
frequently used with university students (Steer, Beck, & Garrison,
1986).
Bulimic tendencies were assessed via the Bulimia Test (BULIT;
Smith & Thelen, 1984; Wertheim, 1991), a screening inventory for
DSM-III bulimia (APA, 1980) which has been shown to satisfactorily
differentiate clinician diagnosed bulimics from normal controls (Smith
& Thelen, 1984).
Subjects also measured their height and weight, and completed
demographic information.

RESULTS

Means and standard deviations of total scales and subscales are pre-
sented in Table 1.
Table 2 displays the intercorrelations among GABS subscales and
correlations between each subscale and the GABS Total Irrationality
score minus that subscale. These moderate to high correlations indi-
cate that the GABS subscales are measuring highly related but not
identical constructs.
Eleanor H. Wertheim and Zeffie Poulakis 225

Table 1

Means and Standard Deviations of the GABS, DAS, IBS, CEQ,

CES-D, BDI, and BULIT Scores

Standard
Variable Mean Deviation
GABS
Total Irrationality 126.14 23.01
Rationality 33.79 3.69
Self-downing 18.53 5.69
Need for Achievement 25.18 5.85
Need for Approval 18.59 4.79
Need for Comfort 25.26 6.45
Demand for Fairness 30.31 5.78
Other-downing 8.29 2.39
IBS 62.39 9.20
RBI total 22.40 5.94
IBT total 204.16 19.45
DAS 119.95 24.58
CEQ 18.48 11.32
CES-D 16.84 10.75
BDI (Short form) 5.38 4.44
BULIT 62.98 19.38

GABS total and subscale scores were correlated with the various
cognitive measures and subscales (see Table 3). The GABS total score
correlated between .55 (CEQ) and .75 (IBS) with the total scores of the
other cognitive scales. When the highest one or two correlations of
each of the IBT and RBI subscales with the GABS was examined,
some evidence of construct validity between subscales was evident,
particularly in relation to GABS Need for Approval, Self-downing, and
Other-downing. The GABS Need for Comfort subscale was strongly
represented in many total scales and RBI and IBT subscales.
The GABS was next correlated with the measures of depression
(CES-D, BDI) and bulimia (BULIT) (see Table 4). All GABS subscales
correlated moderately with measures of disorder.
It was next asked whether the GABS could replace the IBS, DAS
226 J o u r n a l of R a t i o n a l - E m o t i v e & C o g n i t i v e - B e h a v i o r T h e r a p y

Table 2

Intercorrelations among the GABS Subscales

General Attitude and Belief Scale

Total
Irrat
Minus Self Need Need Need Demand
Subscale Rational Down Ach Appr Comf Fair
Rational - .63** . . . . . .
Self-down .53** - .48** . . . . .
Need Achieve .51"* - . 3 8 " * .51"* . . . .
Need Approval .65** - . 4 1 " * .51"* .42** . . . .
Need Comfort .65** - . 3 7 " * .43** .37** .60** - -
Demand Fair .61"* - . 3 8 " * .29** .39** .53** .57** --
Other-down .68** - . 3 5 " * .36** .38** .33** .51"* .53**
Note: The GABS Total Irrationality Scale was correlated with each irrationality subscale minus
t h a t subscale. A simple correlation between GABS Total Irrationality and the Rationality
subscale was computed. ** = p < .01, two-tailed, n = 160.

and CEQ as a predictor of emotional/behavioral disturbance (the IBT

and RBI were omitted due to possible confounding with emotional dis-
turbance). In the case of each of the CES-D, BDI and BULIT, the
seven GABS subscales were first e n t e r e d in one step as predictors in a
multiple regression equation, and the t h r e e other cognitive scales
were t h e n individually e n t e r e d (in t h r e e s e p a r a t e equations) to see
which accounted for significant additional variance. After the GABS
v a r i a n c e was removed, f u r t h e r BDI v a r i a n c e was accounted for by
IBS, t=3.31, p= .001; but not CEQ, t = 1.629, p = .11 or DAS, t -- .65,
p = .52. F u r t h e r CES-D v a r i a n c e was accounted for by IBS, t = 3.38, p
= .0009, and CEQ, t = 2.18, p = .03, but not DAS, t =.60, p = .55.
No f u r t h e r BULIT v a r i a n c e was accounted for by the IBS, t = .46, p =
.64, CEQ, t = 1.48, p = .14 or DAS, t = 1.67, p = .10.

DISCUSSION

In relation to internal consistencyof the GABS, the high correlation

between each subscale and the total GABS score (minus that sub-
 o

Table 3

Correlations between the GABS and Cognitive Measures and Age

General Attitude and Belief Scale

b~
Total Self Need Need Need Demand Other
Irrat Rational Down Ach Appr Comf Fair Down
o
IBS .75** - .43** .54** .53** .59** .68** .49** .50**
IBT total .59** -.43** .52"* .38"* .53"* .57"* .33"* .32"*
D e m a n d App .43** -.38"* .47** .28** .58"* .32** .21"* .08
Self Expect .23"* - .06 .26"* .15 .20" .18" .09 .17"
Blame Prone .33** -.23"* .19" .33** .15 .26"* .17" .33"*
E m o t Irresp -.03 -.05 .03 .00 .01 .07 -.09 -.14
A n x Overcon .48** -.37** .41"* .33"* .34"* .47"* .29** .30"*
P r o b l e m Avoid .22** -.17" .22"* .09 .17" .30"* .08 .13
Dependency .24"* - .14 .14 .02 - .40"* .22"* .28"* .03
Helplessness .35"* - .24** .32"* .17" .22** .37** .20" .26"*
Perfectionism .24** - .14 .11 .22** .22** .17" .19" .13

RBI total -.61"* .31"* -.45** -.37** -.47** -.62** - .35** - .41"*
Catastroph -.42** .29** -.36** -.33** -.33** -.40** - .19" - .23**

b~
b~
 b~
t,D

T a b l e 3 (Continued)

General Attitude and Belief Scale

Total Self Need Need Need Demand Other
Irrat Rational Down Ach Appr Comf Fair Down z~
o
Guilt - .24** .04 -.05 -.22** -.13 - .20* - .21"* - .21"*

Perfection - .30** .23** -.13 -.08 -.26** - .42** - .19" - .20*

Need App -.50** .19" -.36** -.27** -.48** -- .49"* - .35** - .25**

D e m a n d Care -.14 .01 -.10 -.07 - .07 -- .14 - .16" - .06

Blame/Punish - .33** .16" -.21"* -.16 - .16 - .25** - .26** - .38**

Inertia/Avoid - .27** .14 -.23** -.15 - .18" - .34** - .02 - .24**

Independence - .23** .09 -.21"* -.15 - .26** - .20* - .13 - .09

Self Down - .36** .19" -.32** -.21" -.23** - .34** - .17" - .30**

Proj Misfort -.42** .23** -.39** -.27** -.27** - .41"* - .26** - .25**

Control E m o t -.35** .20* -.22** -.17" -.34** - .43** - .14 - .20*

CEQ .55** -.34** .61"* .42** .40** .43** .29** .32**

DAS .64** -.44** .69** .52** .54** .44** .31"* .36**
Age -.06 .02 -.02 - .00 - .13 - .03 - .10 .02
* = p < .05, * * = p < .01, t w o - t a i l e d , n = 160.
E l e a n o r H. W e r t h e i m a n d Zeffie P o u l a k i s 229

Table 4

C o r r e l a t i o n s b e t w e e n t h e GABS a n d M e a s u r e s of D e p r e s s i o n
and Bulimia

CES-Depress BDI B ULIT

GABS
Total Irrationality .45** .55** .45**
Rationality - .46** - .46** - .34**
Self-downing .40"* .57"* .37"*
Need for Achievement .31"* .38** .34**
Need for Approval .33** .37"* .31"*
Need for Comfort .40"* .48"* .36**
Demand for Fairness .33** .35** .33**
Other-downing .23"* .31"* .28"*
* = p < .05, **= p < .01, two-tailed, n = 160.

scale) suggests that the subscales are all measuring a similar central
construct. This suggests that individuals who are prone toward irra-
tional beliefs in one content area (such as need for approval) are prone
to irrational beliefs in other areas (such as demanding fairness). Such
a finding is consistent with the idea that irrational beliefs derive from
a core process, which Ellis proposes to be absolutistic thinking (Ellis,
1984a; DiGiuseppe & Leaf, 1990).
Nonetheless, the subscale score intercorrelations were not uniformly
high, and there was some variation in correlations among GABS sub-
scales and between the GABS subscales and other measures. There-
fore, a number of manifestations of the core construct were suggested,
consistent with Bernard's (1990) previous factor analysis based on in-
dividual items.
In relation to construct validity, as expected the GABS correlated
moderately to highly with other total scale scores of dysfunctional cog-
nitions. Of the total scale scores, the GABS was most highly correlated
with the IBS, which is theoretically most similar, and least highly
correlated with the CEQ, which focuses on reasoning errors leading to
faulty interpretations, rather than the evaluative, demanding compo-
nent of irrational beliefs.
If one GABS subscale correlated highly with a particular cognitive
230 Journal of Rational-Emotive& Cognitive-BehaviorTherapy

measure, the other GABS subscales tended to do so as well. This is

further evidence that the different GABS subscales are measuring a
similar construct. However, there was again some differentiation be-
tween scales consistent with convergent validity across measures. For
example, the Demand for Approval subscale of the IBT correlated
most highly with GABS Need for Approval. IBT Self-expectations and
RBI Self-downing also correlated more highly with the GABS Self-
downing subscale than other GABS subscales. Similarly, the Blame
subscales of the IBT and RBI had their highest correlations with
GABS Other-downing. However, the inter-relations among subscales
did not suggest total convergence between similarly named measures.
GABS Need for Comfort was among the top two GABS subscales to
correlate with another measure in the case of three of nine IBT sub-
scales and seven of 11 RBI subscales, and had the highest correlation
with total scores of all three total scales derived from Ellis' theory.
The Need for Comfort subscale includes items such as 'I can't stand
hassles in my life' and appears to be a central theme of a number of
the other RET based measures.
The GABS had moderate correlations with measures of depression
and bulimia, supporting the idea of a link between cognitions and
emotional/behavioral disturbance. The somewhat lower correlations of
the GABS with depression and bulimia measures as compared to the
correlations of the GABS with the cognitive measures (IBS, RBI, etc.)
is also supportive of the construct validity of the GABS, since cogni-
tion measures should relate most strongly to other cognition mea-
sures.
The lack of correlation between the GABS and age, is further evi-
dence of appropriate discriminant validity.
Multiple regressions were conducted to discover whether the GABS
subscales could replace the three other more purely cognitive mea-
sures included in the study (CEQ, DAS, IBS). When the variance due
to the GABS was removed, other cognitive scales (IBS and CEQ) still
added significantly to the prediction of depression but not bulimia.
This finding suggests that the GABS cannot be used generally as a
sole replacement for other cognitive measures when predicting emo-
tional or behavioral disorder and that the scales needed for optimum
prediction depend on the specific disorder predicted. Further research
is needed into what the separate variance accounted for by different
scales reflects and whether there is a stable combination of cognitive
scales best predicting particular disorders. In addition the usefulness
of the different measures in assessing varied populations, for example,
normal versus clinical, needs to be examined.
Eleanor H. Wertheim and Zeffie Poulakis 231

In s u m m a r y , the GABS d e m o n s t r a t e d substantial i n t e r n a l consis-

tency and construct validity in a female u n d e r g r a d u a t e sample, cor-
r e l a t i n g m o d e r a t e l y to highly with other m e a s u r e s of dysfunctional
cognitions, and m o d e r a t e l y with m e a s u r e s of depression and bulimia.
The GABS appears to be a useful addition to a dysfunctional cognition
assessment package.

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