REBT....RATIONAL EMOTIVE BEHAVIORAL THERAPY

REBT

Rational Emotive Behavior Therapy

 “Rational emotive behavior therapy focuses on uncovering irrational beliefs which may lead to unhealthy negative emotions and replacing them with more productive rational alternatives” (Dr Greg Mulhauser, 1998).

Rational Emotive Behavior Therapy (REBT), previously called Rational Therapy and Rational Emotive Therapy, is a comprehensive, active-directive, philosophically and empirically based psychotherapy which focuses on resolving emotional and behavioral problems and disturbances and enabling people to lead happier and more fulfilling lives. REBT was created and developed by the American psychotherapist and psychologist Albert Ellis who was inspired by many of the teachings of Asian, Greek, Roman and modern philosophers. REBT is one of the first and foremost forms of cognitive behavior therapy (CBT) and was first expounded by Ellis in the mid-1950s and continues its development to this day.

Quotation of Ellis:

"Failure doesn't have anything to do with your intrinsic value as a person."--Albert Ellis & Robert A. Harper, A Guide to Rational Living, Third Edition, p. 206

Historical Development:

The cognitive therapies developed at a time when BEHAVIOR therapies were at their prime (in the 1960s' and 70s).  From the 1960s on, Albert Ellis’s prominence was steadily growing as the cognitive behavioral therapies (CBT) were gaining further theoretical and scientific ground. From then, CBT, which he was one of the founding fathers to, gradually became one of the most popular systems of psychotherapy in many countries in succeeding years. In the late 1960s his institute launched a professional journal, and in the early 70s established "The Living School" for children between 6 and 13. The school provided a curriculum that incorporated the principles of RE (B) T. Ellis had such an impact that in a 1982 survey, American and Canadian clinical psychologists and counselors ranked him ahead of Freud when asked to name the figure who had exerted the greatest influence on their field. Also, in 1982, a large analysis of psychology journals published in the US, found that Ellis was the most cited author after 1957^. In 1985, the American Psychological Association presented Dr. Ellis with its award for his "distinguished professional contributions".

During the years of  1980’s and 1990’s he held many important positions in many professional societies including of Consulting Psychology of the American Psychological Association, Society for the Scientific Study of Sexuality, American Association of Marital and Family Therapy, the American Academy of Psychotherapists and the American Association of Sex Educators, Counselors, and Therapists. In addition Ellis also served as consulting or associate editor of many scientific journals. During those years many professional societies gave Ellis their highest professional and clinical awards.

In the 1950s Ellis developed what he first called Rational Therapy and then soon changed to rational-emotive therapy (RET).  He changed the name again in 1993 to Rational Emotive Behavior Therapy (REBT) because his approach had always stressed the reciprocal interactions among cognition, emotion, and behavior. In 1994 he also updated and revised his original, 1962 classic book, "Reason and Emotion in Psychotherapy". Over the next years he continued developing his psychotherapeutic approach theoretically and in its practical applications.  Many of his procedures are highly behavioral.  His approach has generated a large number of thinking, feeling, and activity-oriented methods and techniques.

REBT is quite different from other systems such as psychoanalysis, person-centered therapy, and Gestalt therapy.  It challenges many of the basic issues in counseling and psychotherapy. It has been characterized as being highly rational, persuasive, interpretative, directive, and philosophical. 

 It is based on the assumption that cognitions, emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship (Corey, 1996).

Overview:

Rational Emotive Behavior Therapy (REBT) is a school of thought established by Albert Ellis. Originally called Rational Therapy, its appellation was revised to Rational Emotive Therapy in 1959, then to its current appellation in 1992. Rational emotive behavior therapy (' REBT) views human beings as 'responsibly hedonistic' in the sense that they strive to remain alive and to achieve some degree of happiness. However, it also holds that humans are prone to adopting irrational beliefs and behaviors which stand in the way of their achieving their goals and purposes. Often, these irrational attitudes or philosophies take the form of extreme or dogmatic 'musts', 'shoulds', or 'oughts'; they contrast with rational and flexible desires, wishes, preferences and wants. The presence of extreme philosophies can make all the difference between healthy negative emotions (such as sadness or regret or concern) and unhealthy negative emotions (such as depression or guilt or anxiety). For example, one person's philosophy after experiencing a loss might take the form: "It is unfortunate that this loss has occurred, although there is no actual reason why it should not have occurred. It is sad that it has happened, but it is not awful, and I can continue to function." Another's might take the form: "This absolutely should not have happened, and it is horrific that it did. These circumstances are now intolerable, and I cannot continue to function." The first person's response is apt to lead to sadness, while the second person may be well on their way to depression. Most importantly of all, REBT maintains that individuals have it within their power to change their beliefs and philosophies profoundly, and thereby to change radically their state of psychological health.

One of the fundamental premises of REBT is that humans, in most cases, do not merely get upset by unfortunate adversities, but also through how they construct their views of reality through their evaluative beliefs, meanings and philosophies about the world, themselves and others. In REBT therapy, clients usually learn and begin to apply this premise by learning the A-B-C-model of psychological disturbance and change. The      A-B-C model states that it normally is not merely an A, adversity (or activating event) that contributes to disturbed and dysfunctional emotional and behavioral Cs, consequences, but also what people B, believe about the A, adversity. A, adversity can be either an external situation or a thought or other kind of internal event, and it can refer to an event in the past, present, or future.

The Bs, beliefs that are most important in the A-B-C model are explicit and implicit philosophical meanings and assumptions about events, personal desires, and preferences. The Bs, beliefs that are most significant are highly evaluative and consists of interrelated and integrated cognitive, emotional and behavioral aspects and dimensions. According to REBT, if a person's evaluative B, belief about the A, activating event is rigid, absolutistic and dysfunctional, the C, the emotional and behavioral consequence, is likely to be self-defeating and destructive. Alternatively, if a person's evaluative B, belief is preferential, flexible and constructive, the C, the emotional and behavioral consequence is likely to be self-helping and constructive.

Through REBT, by understanding the role of their mediating, evaluative and philosophically based illogical, unrealistic and self-defeating meanings, interpretations and assumptions in upset, people often can learn to identify them, begin to D, dispute, refute, challenge and question them, distinguish them from unhealthy constructs, and subscribe to more constructive and self-helping constructs.

Introduction to the Theory:

REBT is a philosophically-based, humanistic approach that emphasizes individuals’ capacity for creating their own self-enhancing and self-defeating emotions. Ellis borrowed some of the concepts from philosophy and according to him, Epictetus, the Stoic philosopher said, “People are not influenced by things but their view of things.” According to REBT an individual’s belief system affects whether s/he attains maximum pleasure and self-actualization and happiness is the goal of all human beings. REBT is a theory of how people (who want happiness) can inadvertently create personality and emotional disturbance.

Approaches and systems within REBT:

ABC Model:

 A = activating event (actual event, thought or image)

B = belief(s) about the event

C = emotional and/or behavioral consequence 

ABC Model is used to help people understand the B-C connection and suggests that people are influenced by what they tell themselves. People initially only see the A-C connection.

Other Important REBT ideas:

Ellis thinks that people are born with the potential to think rationally and irrationally and emotional disturbance comes largely from irrational thinking (elevating our desires to demands). The REBT therapist helps clients to develop a more “rational,” non-demanding philosophy and thinking style. REBT theory holds that if a person can think more rationally (especially in the face of negative events), s/he will suffer less emotional disturbance and act in less self-defeating ways. Rationality is the key to achieving goals.

Appropriate and Inappropriate Negative Emotions:

Rationality leads to appropriate rather than inappropriate negative emotions in the face of adversity. Appropriate (+) emotions assist us to act in our best self interest. Inappropriate (-) emotions are self-defeating. We should have appropriate emotions rather than the inappropriate ones and the examples of some of them are as follows:

ü  Sadness (I lost something I cared about) rather than depression (I’m bad…no good)

ü  Remorse (I did something I am sorry for) rather than guilt (I did something I should be damned for)

ü  Concern (I need to take care of this) rather than anxiety (I will never be able to handle this ) 

 Definition of Rational Thinking: It should be empirically consistent with reality, logical, goal-facilitating, non-absolutist (flexible) and preferential (expresses a desire not a demand). 

Definition of Irrational Thinking:

It can’t be empirically validated and is inconsistent with the reality, illogical, blocks goals, is dogmatic instead of flexible, demand rather than preference (Ellis calls this masturbation). 

Three Core Demands (Musts) That Contribute to Making People Miserable: It should be kept in mind that when your beliefs are irrational, you also tend toward irrational conclusions. There are the following three demands that lead towards the irrational conclusions:

a)      Self-Demands:- I must do well and/or be approved of by significant others.

b)      Other Demand: - I must be treated fairly by others. Others cannot just afford to treat me badly and they have to suffer from harsh consequences if they don’t treat me fairly.

c)      Demands of the World/Life Conditions: - Life conditions must be absolutely the way I want them to be. 

Four Irrational Conclusions:

a)      Awfulizing: The person believes and acts like some situation is more than 100% bad.

b)      I-can’t-stand it: In this situation the person believes s/he can not be happy or endure a situation if something exists that they don’t demand of in that situation.

c)      Damnation: person is highly critical of self, others or some life condition.

d)     Always and never thinking: person insists on absolutes (e.g., that they will always fail or never be approved of by significant others).

 Three REBT Insights: 

              i.      Beliefs, not events, cause disturbance. We remain disturbed by adhering to irrational beliefs.

            ii.      We keep re-indoctrinating ourselves with these beliefs thereby perpetuating our disturbance

          iii.      It will take hard work to revamp/restructure our misery-producing beliefs.

 Techniques Used by Therapist to Reduce or Eliminate Irrational Thinking: Following are some of the technique that are used up by the therapist which will be discussed in detail afterwards:

Active disputation –asking questions in Socratic Style

·         Why is ______________ so terrible or awful? 

·         Where is it written that you can’t stand the situation? 

·         Is there another way you can think about this?

·         What is preventing you from doing so? 

·         Why must you have it this way?

·         What is the worst that can happen if you give up this belief?  

·         What is the best that can happen?  

Homework: REBT clients are asked to do homework assignments like ABC sheets, bibliotherapy, use humor, etc.

Emotive Techniques: such as role playing, shame attacking exercises, rational emotive imagery are also very useful.

Behavioral Techniques: therapists use relaxation protocols, operant conditioning and reward, and self-monitoring etc. in it.

Difference in REBT and CT and CBT:

It is important to emphasize one of the major differences between REBT and both CT and CBT. This difference is that while CT and CBT dispute the B about the A trying to lessen the emotional upset by lessening the distorted view of the event A. REBT, as Albert Ellis often puts it, more elegantly disputes the B about the A trying to lessen the emotional upset by lessening the inflexible and extreme negative nature of B.

Albert Ellis’s work and contributions towards REBT:

Albert Ellis (September 27, 1913 – July 24, 2007) was born to a Jewish family in Pittsburgh, Pennsylvania  .He was an American psychologist who in 1955 developed Rational Emotive Behavior Therapy. He held M.A. and Ph.D. degrees in clinical psychology from Columbia University and founded and was the president and president emeritus of the New York City-based Albert Ellis Institute^. He is generally considered to be one of the originators of the cognitive revolutionary paradigm shift in psychotherapy and the founder of cognitive-behavioral therapies and especially Rational Emotive Behavior Therapy . Based on a 1982 professional survey of U.S. and Canadian psychologists, he was considered as the second most influential psychotherapist in history (Carl Rogers ranked first in the survey; Sigmund Freud was ranked third)^.

REBT as a Personality Theory and REBT as a Developmental Theory:

According to Albert Ellis, REBT is a theory of personality disturbance (and change) as opposed to being a developmental theory of personality. Ellis has a “hereditarian” bias as well. He states that 80% of the variance of human behavior rests on biology and only 20% on environmental training. Although REBT is incomplete as a development theory, Ellis does have some thoughts. Ellis believes that human beings start developing ideas, expectations and hypotheses about themselves and the world in the first two years of life. These are vague and do not lead to many consistent predictions. From age 2-5 and further into childhood, the child gets better at predicting relationships in the environment. Ellis also says that infants have rational behaviors (e.g., sucking and crying out when in discomfort) that are self-preservative, but these seem largely instinctive. Children develop rational ideas from age 6 onward (e.g., pleasure is good; pain is bad).Probable first irrational idea of childhood is “Because pain is so bad, I can’t stand the feeling.” This leads to low frustration tolerance (LFT). Second likely irrational idea comes from self- evaluation of performance: “I should be doing better than I am doing and I am bad because I am not doing better.” This leads to self-downing. These are tentative hypotheses that need further elaboration and research but it is clear that REBT can be rooted back to personality and developmental theories as well.

   Ellis’s 3 basic tenets:

                    i.            People don't just get disturbed by events, but by the ‘perception’, means how they perceive the event. The B-C connection.

                  ii.            No matter when you developed your belief, you still believe it.

                iii.            There is no way but work and practice the rest of your life!

Applications of REBT:

REBT is used with a broad range of clinical problems in traditional psychotherapeutic settings such as individual-, group- and family therapy. It is used as a general treatment for a vast amount of different conditions and psychological problems normally associated with psychotherapy.

In addition, REBT is used with non-clinical problems and problems of living through counseling, consultation and coaching settings dealing with problems including relationships, social skills, career changes, stress management, assertiveness training, grief, problems with aging, money, weight control etc.

REBT also has many interfaces and applications through self-help resources, phone- and internet counseling, workshops & seminars, workplace and educational programmes, etc. This includes Rational Emotive Education (REE) where REBT is applied in education settings, Rational Effectiveness Training in business and work-settings and S.M.A.R.T. in self management and recovery training. In addition a wide variety of special treatment strategies and applications have been developed for different kinds of specialized groups.

The Rational Emotive Behavior A-B-C Theory of Personality

The basic premise of REBT is that emotional disturbances results primarily from cognitive processes that are fundamentally irrational or illogical in nature. Ellis and Harper (1975) define irrational as anything that inhibits personal happiness and survival.

Irrational or illogical thought processes can be identified with the self defeating statements. Some of the examples of self defeating statements are:

·         I should get all A's, and if I don’t, I am stupid.

·         I must do well at my job, and if I don’t, I am not good

·         I am a worthless good-for-nothing.

A-B-C-D-E Model

The main focus of rational emotive behavior personality theory is the A-B-C model of personality. In part REBT popularity is due to its simplicity. Basic procedures can be taught to client by using A-B-C-D-E model.

Explaining A-B-C-D-E Model

A is for activating experiences, such as family troubles, unsatisfying work, early childhood traumas, and all the many things that point to as the sources of unhappiness. 

B stands for beliefs, especially the irrational, self-defeating beliefs that are the actual sources of our unhappiness.

C is for consequences, the neurotic symptoms and negative emotions such as depression panic, and rage, that come from our beliefs. Although the activating experiences may be quite real and have caused real pain, it is our irrational beliefs that create long-term, disabling problems. But Ellis adds D and E to ABC.

D is disputing the irrational beliefs

 E is for effects of rational beliefs. The ABC model is used in some renditions of cognitive therapy or cognitive behavioral therapy, where it is also applied to clarify the role of mental activities or predispositions in mediating between experiences and emotional responses.

Graphical representation of Model

 

The another important central focus of this theory is the personality change, and now we will describes therapeutic approaches to this model and explain it in more detail.

Rational Emotive Behavior Theory of Psychotherapy

A characteristic of REBT is its combination of philosophical change with cognitive, behavioral and emotive strategies to bring about short range and long range changes. Rational emotive behavior therapy focuses on uncovering irrational beliefs which may lead to unhealthy negative emotions and replacing them with more productive rational alternatives.

REBT is a brief therapeutic intervention, with many individuals being helped in 5 to 12 sessions and sessions are only half an hour in length.

Goals of therapy:

The goals of REBT can be explained by describing them in three separate categories which were given by different psychologist. These categories are given below:

General Goals of REBT by Ellis and Bernard (1985):

General goals of REBT are to assist people in:

ü  Minimizing emotional disturbances

ü  Decreasing self defeating self behaviors

ü  Becoming self actualized so that lives happy life.

Sub goals of REBT by Ellis and Grieger (1986):

Major sub goals are:

ü  Help individual think more clearly and rationally

ü  Act more effectively and efficiently in achieving goals

ü  Individual learn to deal with negative feelings such as sorrow, regret, depression and anxiety etc.

ü  Helps individual minimize and remove emotional disturbances.

Global goals of REBT by Dryden and Ellis (2001):

ü  Global goal of REBT can applied to specific client's goal through the use of A-B-C model of personality theory.

Therapist function and his role in therapy:

The therapist function is to teaches the client how to dispute irrational thoughts and also confronts and even attacks if necessary, clients self defeating belief system. The therapist may take a very directive role, actively disputing the client's irrational beliefs, agreeing homework assignments which help the client to overcome their irrational beliefs, and in general 'pushing' the client to challenge themselves and to accept the discomfort which may accompany the change process.

Clients experiences in the therapy:

The client when identifies the underlying irrational belief which caused the original problem and comes to understand both why it is irrational and why a rational alternative would be preferable. The client challenges their irrational belief and employs a variety of cognitive, behavioral, emotive and imagery techniques to strengthen their conviction in a rational alternative. They identify impediments to progress and overcome them, and they work continuously to consolidate their gains and to prevent relapse.

Therapeutic relationship:

The relationship between client and therapist is important in REBT. Those therapists who have outlined stages of psychotherapy have rapport building and relationship issues at their first stage.

With patients who are unfamiliar with REBT, are firstly introduce the purpose of therapy before working on problems. When working with children, therapist may proceed slowly in developing relationship.

But Ellis (2005) does not believe that warm relationship is a necessary or sufficient condition for personality change. He believes therapist must fully accept clients but must also point out discrepancies in their behavior when necessary.

Assessment:

REBT assessment is of two overlapping types. First one is assessment of cognition and behavior that are source of problem. And the second one is the use of A-B-C theory of personality to identify client's problems. Both these assessment continue in the whole therapeutic process.

The A-B-C-D-E Therapeutic Approach:

The core of REBT is the application of this model to client's problem. This approach is used in first and subsequent sessions. Where therapist prefer to explain these 5 models.

In working with this model, therapist cans issues and difficulties in application to client. Following paragraphs provide some examples of issues involved in applying these 5 models.

A (activating event): it can be divided in to two parts that are what happened and what the patient perceived happened. Often it is helpful to ask for specifics to confirm an activating event. Client may present too many activating events but therapist needs to focus on only one and moreover therapist is needed to be alert when previous experience becomes an activating event. For example, the activating event "My grade in geology is terrible" combines an event with a perception and evaluation. To have a clear and active picture of activating event therapist may ask "What are your grades in geology exams at this point?"

C (consequences): clients often start the first therapy session with their consequences that are "I feel depressed". Sometimes inexperienced therapist can have difficulty in discriminating between beliefs and consequences. When dealing with feelings client may be unclear about their emotions, mislabel them or exaggerate them. Often, but not always, consequences can be changed by altering beliefs.

B (beliefs): as there are two types of beliefs rational and irrational. Irrational beliefs are exaggerated and absolutistic, lead to disturbed feelings, and don’t help individuals attain their goals. Being familiar with them can be helpful in learning to identify beliefs so that they can be disputed.

D (disputing): an important approach in REBT is to help the client in disputing the irrational beliefs. Disputing has three parts: detecting, discriminating and debating irrational beliefs.

·         Detecting the therapist first detects irrational beliefs in the clients and help the client detect irrational beliefs in his perception. Irrational beliefs may underlie several activating events. For example a client may experiences stress on job because he thinks everyone should be impressed by his abilities. Detecting the irrational belief  

"Other must find me intelligent and witty" is first part of disputing.

·         Discriminating irrational beliefs from rational belief is next step. Being aware of must, should, ought and other unrealistic demands help client learn which beliefs are rational and not.

·         A major emphasizes in REBT is on debating irrational beliefs. Therapist questions the client that " Why must you do everything better than everyone else at job?" it will help client change their irrational beliefs in to rational one.

Several strategies of disputing or debating irrational beliefs can be used: the lecture, Socratic debate, humor, creativity and self disclosure etc.

E (effects): when clients have disputed their irrational beliefs, they are then in a position to develop an effective philosophy. It helps individual develop rational thoughts to replace inappropriate irrational thoughts. This new effective philosophy can bring about more productive behaviors, minimize feelings of depression and self hatred, and bring about satisfying and enjoyable feelings.

Techniques:

The techniques that Ellis identifies for therapist to utilize in REBT are cognitive, emotive and behavioral techniques.

Cognitive techniques:

It helps individual to develop new rational beliefs. Many of them are used in adjacrnt to, and in support of, disputing techniques.

·         Coping self statements: by developing it, rational beliefs can be strengthened. For example, an individual who is afraid of public speaking may write down and repeat to himself several times a statement such as " I want to flawlessly or I am articulate person.

·         Cost- benefit analysis: it is helpful for individuals who have addiction or low frustration tolerance. Individuals who addicted to smoking are asked to write benefits of stopping smoking and instructed to think about them seriously for about 20 minutes daily.

·         Psycho educational methods: when session is over, REBT does not stop. There are self help books which are recommended to client, which then help the client in remembering the instructions which were given by therapist.

·         Teaching others: Ellis recommends that client teach their friends and associates, the principles of REBT. When other presents irrational beliefs to client than he try out to point out rational beliefs to their friends.

Emotive techniques:

Emotive techniques are used in sessions and as homework. These techniques are used with the full acceptance of therapist. The therapist not only accepts the client but also tries to communicate this acceptance so that clients accept themselves.

·         Imagery: it is often used in REBT to help the client to change their inappropriate feelings to appropriate one. For example if client thinks that if  he is rejected by women he wishes to date, he will be terribly depressed and unable to do anything and live depressed life. So the therapist will change his view and make him capable to think that after being rejected he will lead a happy life.

·         Role playing: rehearsing certain behaviors to elicit client's feelings often can bring out emotions the client was not aware of. For example by role playing a situation in which a women asks a man for a date, the woman can be aware of strong fears she did not know she had. By repeating it by role playing will help the individual to feel better about his social skills.

·         Shame attacking exercises: the purpose of these exercises is to help clients feel unashamed when others may disapprove them. Although it can be practiced in session, or outside therapy. Examples include minor infractions of social conversations, such as talking loudly to store clerk or engaging strangers in conversations.

·         Forceful statements: statements that combat irrational beliefs in strong and forceful manner can helpful in replacing irrational beliefs in rational beliefs. If a client has told himself that it is awful and terrible to get a C on examination, this self statement can be replaced by a forceful statement such as " I want to get A."

Behavioral techniques:

The behavioral techniques include

·         Activity homework: to combat client's demands and musts, therapist may make assignments that reduce irrational beliefs. When clients are in situation where they feel other should treat them fairly, therapist may suggest that they stay in uncomfortable environment and teach themselves to deal. For example making an attempt to make a report but you fails.

·         Reinforcements and penalties: when client do a task then give reward to him or other wise giving him penalty.

·         Skill training: workshops and groups often teach important social skills. For example workshops on communication skills, job interviewing skills etc.

So these are the techniques which are used by therapist in REBT in order to help the clients.

Evaluation:

Some of the merits and demerits of this approach are:

Merits:

·         REBT recognizes that emotions are helpful and some are hurtful. For instance, it sees extreme negative emotions such as depression and anxiety as hurtful, but also sees mild to moderate negative emotions such as regret or concern as helpful.

·         REBT is a simple approach.

·         It can teach to client in terms as simple as the A-B-C-D-E acronym.

·         Clients can learn easily the tools necessary to become their own self therapist.

Demerits:

·         It overemphasizes the role of cognitions in etiology of mental disorders and emotional disturbances.

·         It also avoids in exploring other factors such as traumatic early life experiences etc.

Summary:

Rational emotive behavior therapy asserts that it is not only events themselves that disturb people but also beliefs about them. So it stresses the cognitive view of personality theory. This therapy applies cognitive, emotive and behavioral approaches to changing irrational beliefs.