REBT

A Practitioner's Guide to Rational Emotive Behavior Therapy (DiGiuseppe, Doyle, Dryden, Backx)

Ellis and the Philosophy of REBT

Ellis. Ellis "credited classical and modern philosophers as the source of his ideas." Though Ellis tended to be brash in his lectures, "[i]n the clinical context he behaved in a manner inconsistent with his stage personality, and his clients perceived him as attentive, empathic, and dedicated to helping them." Unlike psychoanalysis and Rogerian therapy, REBT did not prescribe "a passive, nondirective role for the therapist."

Philosophy. Constructivism. We all create "ideas of how the world is or ought to be. Scientific Method. Popper said that we should develop hypotheses and should constantly by looking to falsify them. It is "through the methods of science that we can best obtain knowledge about the self, others, and the world." When a client expresses a belief, the therapist answers, "Where is the evidence that what you believe is true?" We know a belief is true by conducting empirical observations and examining the logical consistency of that belief. Global Evaluations. Korzybski invented a language that excluded all forms of the verb to be. Instead of saying, "He is a failure," we would say, "He failed at [enter specific task]." Stoicism. REBT is not Stoicism, as Stoicism encourages people to "develop immunity to feelings."

REBT Overview

Seven Principles of REBT. (1) "Cognition is the most important, though hardly the only, determinant of emotion." (2) Irrational thinking often causes emotional distress. (3) The best way to conquer distress is to change irrational thinking. (4) Different factors -- including genetic and environmental factors -- cause irrational thinking. (5) "Emotions exist to signal people that they have a problem that requires attention and action. (6) Although childhood factors might have initially caused emotional disturbance, this disturbances are maintained by present factors . (7) Beliefs can be changed, although this process is not easy.

SUDS. Subjective Units of Distress measure if a maladaptive emotion decrease. REBT measures both (a) if maladaptive emotions decrease and (b) if adaptive emotions increase.

Levels of Cognitions and Disturbance

Level I: Inferences (Negative Automatic Thoughts). These are our perceptions of reality and the inferences we draw from them.

Level II: Evaluation Cognitions. These are evaluations of your inferences. Disturbances occur when you evaluate inferences as horrors.

Level III: Schematic Demands. Demands about self, others, and world (I must... You must... The world must...).  Tacit, unconscious.

Example: Level I: You're walking down street and wave at coworker, but the coworker does not wave back. You infer that the coworker saw you and decided not to greet you. Level II: You evaluate the inference and conclude that your coworker didn't greet you because she doesn't like you. You further evaluate this event as being horrible. Level III: You evaluate that event as being horrible because you believe that others must like you, must treat you with kindness, etc.

Irrational Beliefs

Characteristics of an irrational belief: rigid, illogical, inconsistent with reality, does not help achieve your goals, leads to dysfunctional emotions. Emotions that come with IBs/RBs: depression/sadness, anxiety/concern, shame/disappointment, guilt/remorse.

The core IB is demandingness (expecting that things be the way you desire them to be). The four derivative IBs are awfulizing (exaggerated the negative consequences of a situation so much so that things that don't go your way become terrible), frustration intolerance (demanding ease and comfort), and self-condemnation and other-condemenation (believe that humans can be rated and that some people are worthless or at least less valuable than others). Example: Your romantic partner leaves you for someone else.

1. Demandingness. "This must not happen. She has no right to leave me. She must not leave me." / "This is a great loss and I will miss my lover intensely, but these things happen to people all the time."  
2. Awfulizing. "This is the worst thing that could happen to me" / "Although this is bad, it is not the end of the world. I will cope the best I can." 
3. Frustration intolerance: "I just cannot survive this. I cannot stand living without my partner." / "I do not like this, but I can stand the loss and I will survive this." 
4. Self-downing. "This must mean that I am a worthless and unlovable person." / "I will look to see if there was anything I did to cause the breakup and try to improve that, but I am not a worthless person because of the breakup." 
5. Other-downing. "My partner fooled me all along. She is a despicable person." / "My partner did something that was hurtful to me, but that does not make her condemable." 

More on each IB:

1. Demandingness. Demands often recognized by such cue words as must, ought, should, and have to. It's okay to have preferences, but disturbances arise when preferences become demands. When there's a discrepancy between our schema of the world and reality, we experience emotional arousal; we can resolve this discrepancy through accommodation (seeking out more information, revising one's schema) or assimilation (maintaining old schema "in spite of the discordant information"). 
2. Awfulizing. Rational thinking tells us that thing can be bad but survivable. 
3. Frustration Intolerance. Four types: emotional intolerance (intolerance of emotional distress), entitlement intolerance (intolerance of unfairness), discomfort intolerance (refers to the idea that life should be easy, comfortable, and free of hassle), and achievement intolerance (reflects the frustration following failure to achieve a goal). 
4. Global Evaluation of Human Worth. A person "cannot be rated as either good or bad, as it is not possible for one to be completely good or bad due to the complexity of human beings." 

The ABC Model

Can start with children as young as eight. A = Activating event, usually one's perception of an event. When a bad A occurs, it's okay to feel negative emotions, just not maladaptive emotions. It's helpful to take notes as clients talk -- one column for A, one for C, and a bigger one for B -- and then review notes with client. Teaching clients that thoughts, not events, cause emotions: (a) ask how 100 other people would react to the same situation, (b) talk about free will (if you're free, then you can control how you react to A).

Must emphasize to clients that correcting their current thinking is the focus of therapy, as many clients assume that it's necessary to work through past events. Can say: "If you had a cold, would it be helpful to learn where you caught it, or do you want to get over it?" Freud himself said: "The past is only important because you continue to carry it around with you." Past events might have contributed to past distress, but "they continue to be a problem only because the client continues to think about them in the same way."

Getting Therapy Off to a Good Start

Some begin by asking if the client has been in therapy before and if so what was helpful and what wasn't. The therapist should outline REBT and how the therapy will work -- e.g., what you expect from the client and what they can expect from you. "...Your active role in therapy is what is most important for you to reap the most benefits. I can help you and I can advise you, but you will be required to do the work." It's also important to encourage clients to express their disagreements.

Clients often think that therapy consists of pouring out one's heart to the therapist and receiving sympathy. "Sympathy from a therapist or cathartic expression of one's emotions can help clients feel better, but it does not teach them the skills to get better... [Y]ou have friends to help you feel better, and you have a rational emotive behavior therapist to help you get better."

Establishing Rapport. Rapport "can be developed when the therapist behaves directively." Ellis was directive but his clients reported feeling warmth and respect for him, saying that "he demonstrated his concern by his many questions, his complete attention to their problems, his advocacy of an accepting and tolerant philosophy, and by teaching them something immediate that they could do to reduce their distress."

Assessment. Several formal assessments, see page 74.

Must agree on problem and goals. Share our conceptualization; in so doing, "we are modeling self-disclosure, willingness to test out thinking and to be wrong, and the use of the scientific method. Sharing hypotheses builds collaboration and respect. It is advisable not to state hypotheses in declarative sentences." Rather state it as a supposition and elicit their feedback.

* * * * *

Rational Emotive Behavior Therapy: It Works for Me -- It Can Work for You (Albert Ellis):

• We at times act responsibly and at times act irresponsibly. So we are not irresponsible (bad) people. To rate ourselves as bad people, we would have to show that we consistently, practically always, refuse to play ball, refuse to throw the ball back, when it is our turn to do so, deliberately get drunk before the game, and constantly throw the ball badly whenever it is our turn to throw it. This is very unlikely. 
• [Y]ou can't be what you do. A bad person would always and only behave badly -- which of course no one does. 
• One solution to potential worldwide holocausts -- if indeed we can arrange it -- is to effectively teach the principles and practices of UOA [Unconditional Other-Acceptance] from infancy onward to everyone and hope like hell they will work. If all citizens of the world are convinced that they can nonviolently disagree with but not violently extirpate one another, they will presumably stop working to produce Armageddon.
• The first REBT theory, which virtually all my clients are actively shown to accept, is that humans are irretrievably human -- fallible, fucked-up, and full of frailty -- and that they therefore had better never damn nor devilify themselves no matter what they foolishly do. The second mainstay of REBT is that, because of this same human errancy, one had better not condemn, decry, or cast into hell any other person than oneself -- no matter what he or she nastily does to you or others. 
• The more I practice REBT with others, the more I automatically tend to use it with myself. This is why I favor group therapy so much... I train most of the group members not only to use the REBT philosophy of tolerance, scientific validation, and openness with themselves but also to actively, determinedly employ it with other group members. My theory states that if they thereby keep talking others out of their bullshit, they will automatically and unconsciously tend to talk themselves out of their own. 
• [Q: You are widely known "as a kind of character. Do you agree?] Yes, compared to most therapists, and probably to the general population, because I usually tell it like it is. And I don't give that much of a dman what people think of me for saying it. That's unusually, since the world consists mainly of love slobs who need other people's approval.
• When I started to get disillusioned with psychoanalysis I reread philosophy and was reminded of the constructivist notion that Epictetus had proposed 2,000 years ago: "People are disturbed not by events that happen to them, but by their view of them." 
• [Carl Rogers and I] both had the idea -- which I think we both got from Paul Tillich's book The Courage to Be -- that humans can accept themselves unconditionally. But Rogers thought he could get people to accept themselves just by listening to them and being nice to them, and I don't think that's enough. I think nine out of ten people who go through Rogerian therapy conclude wrongly that "I'm okay because my therapist approves of me." But that's conditional love. I get people to truly accept themselves unconditionally, whether or not their therapist or anyone loves them. Self-esteem is the greatest sickness known to man or woman because it's conditional. "When I do well and am loved by significant others, then I'm okay"... In REBT, we give clients unconditional acceptance but we also teach them how to give it to themselves. 

* * * * *

A Primer on Rational Emotive Behavior Therapy (Dryden, DiGiuseppe, Neenan)

ABC (Adversity, Beliefs, Consequence). A, B, and C "frequently react in quite complex ways," a phenomenon known as psychological interactionism. 

Rational means (a) flexible and nonextreme, (b) pragmatic, (c) logical, (d) reality based. "Thus rationality is defined as that which is adaptable and moderate, helps people to achieve their basic goals and purposes, is logical, and is empirically consistent with reality." 

Irrational Beliefs:

1. Rigid Beliefs. Take the form of musts and shoulds. Three basic rigid beliefs. (a) Demands about self -- e.g., "I must do well on my test." (b) Demands about others -- e.g., "You must treat me well when I come to see you tomorrow." (c) Demands about the world -- e.g., "My homework must not be as difficult as it is." 
2. Extreme Beliefs. (a) Awfulizing Beliefs -- e.g., "I must do well on my test, and it will be awful if I don't," "You must treat me well when I come to see you tomorrow, and it will be terrible if I don't." (b) Discomfort-Intolerance Beliefs -- e.g., when you believe that you "cannot endure situations or have any happiness at all" if what you expect doesn't happen. (c) Depreciation Beliefs -- e.g., when you disparage yourself, others, and/or the world. 

Rational Beliefs:

1. Flexible Beliefs ("these beliefs are not transformed...into dogmatic musts, shoulds, oughts, and so on"; you assert what you want but acknowledge that you do not have to get what you want). (a) Nondogmatic preferences about self -- e.g., "I would like to do well on my forthcoming test, but it's not necessary for me to do so." These beliefs can lead to concern (not anxiety), sadness (not depression), disappointment (not shame), and remorse (not guilt). (b) Nondogmatic preferences about others -- e.g., "I would like you to treat me well when I come to see you tomorrow, but sadly and regretfully you don't have to do so." (c) Nondogmatic preferences about the world -- e.g., "I would like my homework not to be as difficult as it is, but unfortunately it doesn't have to be the way I want it to be." 
2. Nonawfulizing Beliefs. You believe that things could always be worse, that your adversity is less than 100 percent bad, and that good could come from the adversity. 
3. Discomfort-Tolerance Beliefs. You believe that you will "struggle if the discomfort continues to exist" but will "neither die nor disintegrate," that you "will not lose the capacity to experience happiness if the discomfort continues to exist, although this capacity will be temporarily diminished," and "that the discomfort is worth tolerating." 
4. Acceptance Beliefs. You accept yourself and others as "fallible human beings who cannot legitimately be given a single global rating." You also "refrain from giving the world a global rating." 

Healthy Negative Emotions (HNE): concern (not anxiety), sadness (not depression), remorse (not guilt), disappointment (not shame), sorrow (not hurt), nonproblematic anger (not problematic anger), nonproblematic jealousy (not problematic jealousy), nonproblematic envy (not problematic envy).

Two fundamental human disturbances: ego disturbance and discomfort disturbance. Ego disturbance: our rigid beliefs about ourselves leads to self-depreciation when we fail to live up to these self-imposed demands. Discomfort disturbance: "when we hold rigid beliefs about comfort and comfortable life conditions and demand that they must exist."

Theory of change: (a) adversities do not cause our disturbed emotional and behavioral consequences but "our disturbed feelings and behaviors are largely created by our rigid and extreme irrational beliefs about these adversities," (b) we remain disturbed "because we maintain our conviction in our irrational beliefs and act and think in ways that are consistent with them," (c) we can "overcome our disturbances in the long run, but only by working hard and repeatedly questioning our irrational beliefs and the effects of these beliefs."