A Brief Introduction to Rational Emotive Behavior Therapy (REBT)

Rational Emotive Behavior Therapy (REBT)

REBT is a cognitive-behavioral therapy based on the idea that emotions and behaviors stem from cognitive processes.
It posits that individuals can modify these processes to alter their feelings and behaviors.
REBT is under the umbrella of cognitive-behavioral therapies.

History of REBT

Mid-1950s: Albert Ellis, a psychoanalysis-trained clinical psychologist, noticed clients improved when they changed their thinking about themselves, their problems, and the world.
Ellis shifted the focus to clients' beliefs, leading to the development of REBT.
Originally called ‘Rational Therapy’, then ‘Rational-Emotive Therapy’, and later ‘Rational Emotive Behavior Therapy’ in the early 1990s.
Cognitive Therapy (CT), developed by Aaron Beck in the 1960s, shares similarities with REBT.
REBT and CT form the foundation of Cognitive-Behavior Therapy.
REBT has evolved significantly over the past half-century.

Theory of Causation

REBT is a comprehensive theory of human behavior, proposing a biopsychosocial explanation.
Biological, psychological, and social factors influence how humans feel and behave.
Basic premise: emotions and behaviors result from thoughts, assumptions, or beliefs about oneself, others, and the world.
Beliefs about situations, not the situations themselves, determine feelings and behaviors.
Biology also plays a role, reminding therapists of the limitations of change.
A person's belief system is influenced by both biological inheritance and learning throughout life.

ABC Model

The ABC model illustrates the role of cognition.
A: Activating event or experience, including inferences about what is happening.
B: Evaluative beliefs that follow from these inferences.
C: Emotions and behaviors that result from those evaluative beliefs.
Example:
- A1: Friend passed me in the street without acknowledging me.
- A2: Inferences: He’s ignoring me. He doesn’t like me.
- B: Beliefs: I’m unacceptable as a friend – so I must be worthless as a person.
- C: Reaction: Emotions - depressed; Behaviors - avoiding people generally.
'A' alone doesn't cause 'C'; 'A' triggers 'B', which causes 'C'.
ABC episodes form chains, with 'C' often becoming the 'A' of another episode.
Most beliefs are subconscious, habitual, and consist of underlying ‘rules’ about how the world should be.
With practice, people can uncover these core beliefs.

Theory of Change

Change can occur at different levels.
Example: Anxiousness due to perceived disapproval.
- Superficial level: alter body chemistry, change the situation, or change inferences.
- Fundamental change: modify underlying core beliefs.
Accept that disapproval might happen and address the core belief that you need approval and must not receive disapproval.
REBT therapists aim for fundamental change, using cognitive, emotive, and behavioral strategies.

Irrational Thinking

Irrational beliefs block goal achievement, create extreme emotions, and lead to harmful behaviors.
They distort reality and are unsupported by evidence.
They involve illogical evaluations: demandingness, awfulising, discomfort-intolerance, and people-rating.
Beliefs are often referred to as ‘self-defeating’ rather than ‘irrational’.

Two Types of Disturbance

REBT identifies two main ways people 'disturb' themselves.
Ego disturbance: irrational beliefs about ‘self’. Example: 'I must do well / not fail / get approval from others.'
Discomfort disturbance: irrational beliefs about emotional or physical comfort. Example: 'People must treat me right' or 'The circumstances under which I live must be the way I want'.
Ego and discomfort disturbance often occur together.

Ego Disturbance

It represents an upset to the self-image, stemming from demands about the self.
Negative self-evaluations result, such as: ‘When I fail / get disapproval / etc., this proves I am no good.’
Creates ‘ego anxiety’ + avoidance of situations where failure or disapproval might occur; seeking acceptance from others; unassertive behavior.

Discomfort Disturbance

It results from demands about others and the world.
- Low frustration-tolerance (LFT): demands that frustration not happen, followed by catastrophizing. Beliefs include: ‘The world owes me contentment and happiness’ or ‘Things should be as I want them to be, and I can’t stand it when they are not.’
- Low discomfort-tolerance (LDT): demands that one not experience emotional or physical discomfort, and catastrophizing when it does occur. Beliefs include: ‘I should be able to feel happy all the time’ or ‘I must be able to feel comfortable all of the time.’
LFT and LDT are closely related.

Problems from Discomfort Disturbance

'Discomfort anxiety': emotional tension because one's comfort is threatened.
Worrying: believing something would be awful and intolerable, and needing to worry about it in case it happens.
Avoidance of events seen as ‘too hard’ to bear.
Secondary disturbance: upsetting oneself about having a problem.
Short-range enjoyment: seeking immediate pleasure at the cost of long-term stress (e.g., substance abuse).
Procrastination: putting off difficult tasks.
Negativity and complaining: distressed over small setbacks, overconcerned with unfairness, and prone to making comparisons.

Core Beliefs

Underlying thoughts are 'core beliefs': underlying rules that guide reactions to events.
Ellis suggests a small number of core beliefs underlie most unhelpful emotions and behaviors.

Examples of 'Rules for Living'

I need love and approval from those significant to me – and I must avoid disapproval from any source.
To be worthwhile as a person I must achieve, succeed at whatever I do, and make no mistakes.
People should always do the right thing. When they behave obnoxiously, unfairly or selfishly, they must be blamed and punished.
Things must be the way I want them to be, otherwise life will be intolerable.
My unhappiness is caused by things that are outside my control – so there is little I can do to feel any better.
I must worry about things that could be dangerous, unpleasant or frightening – otherwise they might happen.
Because they are too much to bear, I must avoid life’s difficulties, unpleasantness, and responsibilities.
Everyone needs to depend on someone stronger than themselves.
Events in my past are the cause of my problems – and they continue to influence my feelings and behaviors now.
I should become upset when other people have problems, and feel unhappy when they’re sad.
I shouldn’t have to feel discomfort and pain – I can’t stand them and must avoid them at all costs.
Every problem should have an ideal solution – and it’s intolerable when one can’t be found.

Four Types of Evaluative Belief

Core beliefs often have a germ of truth, but problems arise when they are stated as demands using words like ‘should’, ‘must’, ‘need’.
Four types of evaluative thinking are dysfunctional.

1. Demandingness

Referred to as 'musturbation'.
Holding unconditional shoulds and musts - believing things must or must not happen.
Implies ‘Laws of the Universe’ that must be adhered to.
Demands can be directed internally (about the self) and outwardly (about others and the world).
Three basic musts:
1. Demands about the self: lead to ego disturbance.
2. Demands about others: lead to discomfort disturbance.
3. Demands about the world: lead to discomfort disturbance.
Demands also occur with beliefs about specific situations. For example, a general core belief like: ‘People should always behave in a correct and right fashion’ may lead to the specific belief: ‘He should not have done what he did’.

2. Awfulising

Exaggerating the consequences of events, seeing them as the worst that could happen.
Characterized by words like ‘awful’, ‘terrible’, ‘horrible’.

3. Discomfort Intolerance

Often referred to as 'can’t-stand-it-itis'.
Based on the idea that one cannot bear some circumstance or event.
Often follows awfulising, and can fuel demands that certain things not happen.

4. People-Rating

Evaluating one’s entire self (or someone else’s).
Judging the total value or worth of a person.
Overgeneralization whereby a person evaluates a specific trait, behavior or action according to some standard of desirability or worth.
Example: ‘I did a bad thing, therefore I am a bad person.’
Leads to self-downing, defensiveness, grandiosity, hostility, or overconcern with approval.
A key factor in ego disturbance.

Note:

Demandingness has been traditionally seen as the main type of irrational thinking, with the other three deriving from it.
One is only likely to rate themselves as ‘worthless’ for failing if they believe that they ‘must’ always succeed; or they would only be prone to regarding discomfort as unbearable because they believe that they ‘must’ not be uncomfortable.
There is almost always a demand at the root of a person’s emotional or behavioral problems.

Three Levels of Thinking

Human beings think at three levels: (1) Inferences; (2) Evaluations; and (3) Core beliefs.
Individuals have general ‘rules’ that determine reactions to life.
Conscious thoughts depend on the subconscious rules applied to an event.
Example:
- Core belief: ‘For me to be happy, my life must be safe and predictable.’
- Event: Hearing a noise in the night.
- Inference: There is an intruder in the house.
- Evaluation: This possibility is catastrophic and unbearable.
- Result: Feelings of panic.
REBT focuses on helping people identify their core beliefs, going beyond surface inferences to their evaluations.

1. Inferences

Events trigger inferences about what is 'going on'.
Guesses about what has happened, is happening, or will be happening.
Inferences are statements of ‘fact’ (can be true or false).
REBT spends little time on inferences, regarding them as a window to evaluative thinking.

2. Evaluations

In addition to inferences, we evaluate events in terms of what they mean to us.
Evaluations can be conscious or subconscious.
Irrational evaluations consist of demandingness, awfulising, discomfort-intolerance, and self/other-rating.
Example Evaluation following an inference: ‘I need her to love me – because if she didn’t, this would prove I was worthless.’

3. Core Beliefs

Underlying, general beliefs that guide inferences and evaluations.
Example: ‘For me to be worthwhile as a person I must have someone who loves me unreservedly.’

Putting It All Together

Example (ABC model):
- A: Neighbor asks you to babysit for the rest of the day. You planned to do gardening. Inference: ‘If I say no, she will think badly of me.’
- B: Evaluation: ‘I couldn’t stand to have her see me as selfish.’ This results from holding the core belief: ‘To feel OK about myself, I need to be liked, so I must avoid disapproval from any source.’
- C: You feel anxious and say yes.
In summary, people view themselves and the world at three levels: inferences, evaluations, and core beliefs.
Therapist’s main objective: deal with underlying core beliefs that cause unwanted reactions.
REBT emphasizes evaluative thinking, while other cognitive-behavioral approaches focus more on inferential thinking.
REBT underscores the centrality of demandingness.

Secondary Disturbance

Problems about problems (e.g., feeling guilty about being angry).
More about this later.

Helping People Change

Steps:

Help the client understand that emotions and behaviors are caused by beliefs and thinking. Provide explanations and assign reading.
Show how to uncover relevant beliefs using the ABC format. Ask: ‘What was I telling myself about ‘A’, to feel and behave the way I did at ‘C’?
Teach the client how to dispute irrational beliefs and replace them with rational alternatives. Extend ABC to include ‘D’ (Disputing irrational beliefs), ‘E’ (new Effect), and ‘F’ (Further Action).
Help the client get into action. Act against irrational beliefs through homework assignments.

The Process of Therapy

Components of an REBT Intervention:

Engage client:
- Build a relationship using empathy, warmth, and respect.
- Watch for secondary disturbances.
- Demonstrate that change is possible early on.
Assess the problem, person, and situation:
- Start with the client’s view of what is wrong.
- Check for secondary disturbance.
- Carry out a general assessment.
Prepare the client for therapy:
- Clarify treatment goals.
- Introduce the basics of REBT, including the biopsychosocial model.
- Discuss approaches, implications, and develop a contract.
Implement the treatment program:
- Analyze specific episodes to ascertain beliefs and change them (‘Rational Analysis’).
- Develop behavioral assignments.
- Use supplementary strategies and techniques.
Evaluate progress:
- Check if improvements are due to changes in thinking or circumstances.
Prepare the client for termination:
- Prepare for setbacks.
- Discuss views on asking for help in the future.
- Deal with irrational beliefs about coming back.

A Typical REBT Interview

Progresses Based on the ABC Model:

Review the previous session’s homework. Reinforce gains and learning.
Establish the target problem.
Assess the ‘A’: what happened, when did it last occur? What did the client infer?
Assess the ‘C’: what unwanted emotion did the client experience?
Identify and assess any secondary emotional problems.
Identify the beliefs (‘B’) causing the unwanted reactions.
Connect ‘B’ & ‘C’.
Clarify and agree on the goal (‘E’).
Help the client dispute their beliefs.
Plan next homework assignments (‘F’).

Techniques Used In REBT

Ellis recommends a ‘selectively eclectic’ approach, using strategies from REBT and other approaches that are compatible with REBT theory.

Cognitive Techniques

Rational analysis: analyze specific episodes to uncover and dispute irrational beliefs.
Double-standard dispute: ask if the client would rate another person the same way for the same behavior, or recommend holding their demanding core belief.
Catastrophe scale: rate whatever it is they are catastrophizing about to get awfulising into perspective.
Devil’s advocate: the therapist role-plays adopting the client’s belief and vigorously argues for it while the client tries to ‘convince’ the therapist that the belief is dysfunctional.
Reframing: re-evaluate events as ‘disappointing’, ‘concerning’, or ‘uncomfortable’ rather than as ‘awful’ or ‘unbearable’.

Imagery Techniques

Time projection: visualize the unwanted event occurring, then imagine going forward in time to see that life goes on.
The ‘blow-up’ technique: imagine whatever it is they fear happening, then blow it up out of all proportion till they cannot help but be amused by it.

Behavioral Techniques

Exposure: enter feared situations, testing the validity of fears.
Shame attacking: confront the fear of shame by deliberately acting in ways that may attract disapproval.
Risk-taking: challenge beliefs that certain behaviors are too dangerous to risk.
Paradoxical behavior: deliberately behave in a way contradictory to the tendency.
Stepping out of character: do things to less than usual standards.
Postponing gratification: delay smoking, eating sweets, using alcohol, sexual activity, etc.

Homework

The most important REBT strategy. Activities include reading, self-help exercises, and experiential activities.

Applications of REBT

Clinical and non-clinical problems, using a variety of modalities.

Clinical Applications

Depression
Anxiety disorders
Eating disorders, addictions, impulse control disorders
Anger management
Sexual abuse recovery
General stress management
Relationship and family problems

Non-Clinical Applications

Personal growth
Workplace effectiveness

Modalities

Individual clients, group work, couples, and family therapy.

Suitable Client Groups

Individuals, couples, and families; adults and children; people with mental health problems; people with physical illnesses, disabilities, and terminal illnesses; different cultural groups; and people of varying intellectual ability, including those with learning impairments.

Practice Principles of REBT

The basic aim of REBT is to leave clients at the completion of therapy with freedom to choose their emotions, behaviours and lifestyle (within physical, social and economic restraints).
Not all unpleasant emotions are seen as dysfunctional. REBT aims not at ‘positive thinking’; but rather at realistic thoughts, emotions, and behaviours that are in proportion to the events and circumstances an individual experiences.
There is no ‘one way’ to practice REBT. It is ‘selectively eclectic’.
REBT is educative and collaborative. Clients learn the therapy and how to use it on themselves.
The relationship between therapist and client is very important, but is seen as existing to facilitate therapeutic work.
While REBT is active-directive, the therapist almost always works within the client’s value system.
An individual’s past is seen as relevant in that this is where much irrational thinking originates.
REBT is brief and time-limited.
REBT is a method of psychotherapy, so the emphasis is on helping people change how they feel and behave in reaction to life events..
A common criticism of psychotherapy is that it may encourage people to become self-centred. REBT avoids this by teaching several principles
REBT tends to be humanistic, anti-moralistic, and scientific.
Finally, the emphasis is on profound and lasting change in the underlying belief system of the client, rather than simply eliminating the presenting symptoms.

Unique Features of REBT

Absence of Self-Evaluation

Encourage the client to throw out the idea of self-esteem entirely! This involves giving up the practice of trying to judge human beings as ‘worthy’.
The client is, instead, urged to:
1. Aim for unconditional self-acceptance.
2. Acknowledge that they simply exist.
3. Instead of rating their self, to concentrate on rating their actions or traits

Secondary Disturbances

Human beings frequently develop problems about their problems.
To be effective, the secondary disturbance needs to be addressed before the primary problem becomes accessible to change.

Discomfort Disturbance v. Ego Disturbance

In addition to ‘ego disturbance’, REBT uniquely argues that there is another type of disturbance of equal or even greater significance: ‘discomfort disturbance’, usually referred to as ‘low discomfort-tolerance’ (LDT), or ‘low frustration-tolerance’ (LFT).
This concept explains why people may overreact to unpleasant life experiences, to frustration, and to their own bad feelings.

Learning to Use REBT

Gain a good understanding of irrational thinking through critical reading.
Attend a training course.
Observe interviews conducted by REBT practitioners.
Practice REBT on oneself.