Cognitive-Behavioral Therapies represent a number of different forms of psychotherapy where the primary focus is on identifying elements of an individual’s irrational and often dysfunctional beliefs, and then changing those beliefs to be more realistic and functional in association with changing some unwanted or undesirable behavior.
Rational Emotive Behavioral Therapy is one of the earliest forms of Cognitive Behavioral Therapy that was developed by the late Dr. Albert Ellis.
According to his own book, Handbook of Rational-Emotive Therapy, Dr. Ellis was a psychotherapist who was originally trained in Freudian psychoanalysis, but he was also exposed to a number of other approaches in training, such as those from the behavioral school of psychology. Ellis was not satisfied with the basic principles and approach of the Freudian model of therapy. Instead, he began to focus more on the individual’s belief system and how this affected behavior as opposed to the Freudian notion that behavior was a result of a number of unconscious motives or drives. While the behavioral paradigm of psychology had started to emerge as a practical alternative to traditional Freudian thought, Ellis believed that both schools were lacking in terms of being complete in their approach.
- This led to him combining a number of techniques that were primarily from the cognitive paradigm in psychology with behavioral methods to develop REBT. Dr. Ellis believed that this approach to treatment was far more pragmatic compared to the lengthy approach used in psychoanalysis and that it got to the root of the individual’s problems in a much more efficient manner. Traditional psychoanalysis was performed over a period of years in as many as 5-7 sessions per week, whereas Ellis’s approach required significantly fewer weekly sessions and a greatly reduced overall time commitment while demonstrating equivalent or even superior efficacy. Ellis used therapy sessions to work on helping the individual change their attitudes and beliefs and then assigned people to actually test these principles out in the real world.
- Ellis’s major assumption is that one must consider the interconnection between the individual’s environment (the emphasis of the behavioral paradigm in psychology) and their mental functions (the emphasis of both the Freudian and cognitive schools). Ellis came to believe that a person’s expectations about the results of their actions, which are often derived from the opinions or perceived opinions of others (especially parents and other early influences), are the most significant factor in their behavior. When an individual behaves in a manner that is consistent with irrational expectations and beliefs, their behavior is also irrational.
Basic Principles of REBT
In the book Rational and Irrational Beliefs: Research, Theory, and Clinical Practice, Dr. Ellis and his colleagues clearly explained how the basic principles of behavioral psychology, often referred to as the “ABC model of behavior,” were modified to fit the theoretical background of REBT. In behavioral psychology, the acronym ABC means:
- Antecedents: The antecedents of behavior describe the conditions that precede any action. These conditions in the behaviorist paradigm refer to the physical environment only and not to any mental processes. For example, the presence of meat (the antecedent condition) results in a dog salivating (the behavior).
- Behavior: This describes the behavior itself.
- Consequences: The consequences are the events that occur after the behavior has been performed and are often perceived to be the result of one’s action. For example, the behaviorist B.F. Skinner developed numerous paradigms demonstrating that reinforcing or rewarding behaviors often results in the probability that the behavior will be repeated, whereas punishment following a behavior would decrease the probability that the behavior would be repeated. Skinner believed punishment to be inferior in changing behavior compared to reinforcement. The consequences of the behavior (the reinforcement or reward) were considered to be the sole reason for this observation.
Dr. Ellis developed a similar acronym (ABCDE) that was expanded from the behavioral school’s ABC to describe his fundamental approach using REBT:
- Activating events: Activating events are similar to antecedents and consist of environmental conditions that occur as a result of interacting with others.
- Beliefs: Beliefs are mental representations that people have regarding whether or not they believe they can deal with a situation in a positive manner.
- Consequences: The interaction between A and B results in these events.
- Disruption: When the consequences of the interaction between activating events and beliefs are dysfunctional or unwanted, the therapist can work with the client to correct irrational beliefs.
- Effects: The process includes identifying the irrational belief, disrupting the process, and reorganizing thoughts to develop new consequences that are functional and realistic.
Ellis devoted quite a bit of time in his development of REBT to trying to understand how irrational beliefs are generally expressed. He came to realize that there are significant differences in how people experience these irrational beliefs and that, in many cases, these irrational beliefs are often based on the person’s expectations about how others perceive them.
He also realized that in order to develop a formal system of intervention, he would need to categorize basic types of irrational beliefs. This categorization would be the basis of a targeted program of intervention while at the same time respecting that people are individuals and express these beliefs in a unique and subjective manner. Thus, while every individual case is different, there also general similarities in the specific type of belief systems that individuals utilize.
The Goals of REBT
A number of writings from Ellis and his students, such as the book Understanding Emotional Problems: A REBT Perspective, clearly lay out the objectives of REBT. In general, these objectives include:
- The development of a collaborative working relationship between the therapist and the client that is based on trust and common goals
- Identification of how a person expresses their irrational beliefs and how the irrational beliefs relate to one or all of the three “musts”
- Understanding how an individual’s behavior relates to their expectations
- Helping the individual identify their irrational belief system and how it affects them
- Helping the individual to develop a more realistic and functional set of beliefs that will result in the individual behaving in a more positive and self-fulfilling manner
- Helping the individual to practice more functional approaches to thinking and acting
At this point, it is important to recognize that summarizing any therapeutic approach is an oversimplification of the complexities of the theories and principles involved in the approach and of the general approach itself. Individuals who are qualified to perform any form of psychotherapy, such as REBT, must meet specific educational requirements and training requirements before they can practice therapy. No one should attempt to use techniques or principles associated with any formal psychotherapeutic intervention unless they are trained, have experience, and are licensed to do so. For example, actually identifying an individual’s system of dysfunctional beliefs and how they relate to the three categories of “musts” requires quite a bit of understanding of human nature, knowledge of psychological principles, and the ability to help the person reveal these in a manner that does not cause the individual to become reactive or oppositional.
REBT therapists attempt to meet their objectives in various ways, as outlined below.
- REBT therapists concentrate on the therapeutic alliance, which is the working bond between the client and the therapist. This alliance can only occur after the therapist instills trust in the client. In REBT, this alliance needs to be especially strong as the therapist will often challenge the client.
- The issues targeted by the therapy will vary depending on the needs of the client. Most often, the client comes to the therapist for general issues, such as feeling anxious, depressed, having issues with relationships, etc. The therapist’s job is to understand how these feelings are related to the client’s overall situation. For individuals with substance use disorders, this can be a complicated issue, as many individuals who enter substance use disorder treatment often believe that their substance use is not their core problem.
- As the therapist begins to understand the client and their own unique belief system, the therapist must challenge the client to identify functional ways to reinterpret their situation. This can often be very challenging.
- Therapists using REBT attempt to instill in the client personal responsibility for their behavior and for the way they feel even though certain events occur in the world that are not within their control. This can often be very challenging.
- REBT is time-limited in its application. Therapists do not plan on years of therapy and often have targeted goals and general timelines to meet these goals. They expect clients to mature over the course of the treatment. This means that an REBT therapist will begin to place much of the responsibility regarding understanding motives, changing behavior, etc., on the client as quickly and effectively as possible while still maintaining the overall working relationship.
The Effectiveness of REBT
Many of the Cognitive Behavioral Therapies are often referred to as “action-oriented therapies.” This means that success in these therapies requires the individual to become actively involved in the process. This is much different than simply expecting the therapist to somehow evoke change or the expectation that many people have regarding treatment based on inaccurate presentations of the therapeutic process presented in films, TV programs, fictional accounts in books, etc. The stereotype of therapy as simply lying on the couch and talking to the therapist (which is more consistent with the lengthy Freudian model of therapy) does not apply to REBT.
According to numerous sources, including the book Kaplan and Sadock’s Synopsis of Psychiatry, therapies like REBT are the preferred approach for treatment of a number of disorders, including substance use disorders. Research evidence for REBT is generally very positive, and it has been demonstrated to be efficacious in the treatment of substance use disorders, depression, trauma- and stress-related disorders, anxiety disorders, and even personality disorders (a category of mental health disorders that is notoriously difficult to treat). While research indicates that REBT is efficacious and has a number of practical uses, it should be understood that the technique is not flawless and will not work in every situation for everyone. Cognitive Behavioral Therapies often work best for individuals who are motivated to change and who are willing to apply the principles discussed in therapy outside of the therapeutic situation.
REBT therapists often assign numerous homework assignments during the course of therapy. As a result, individuals not motivated to actually get out and do the work but who wish to simply change as a result of their interaction with the therapist are more likely to experience less success. Some REBT therapists practice the use of techniques like Motivational Interviewing, another cognitive-behavioral intervention that is designed to assess the individual’s level of motivation to change and then use the therapeutic approach best suited for that situation.
No matter how it is delivered, REBT is not a passive intervention. Clients must be actively involved in the process in order for it to work.