Module-4 Rational Emotive Behavior therapy

I. History

A Brief History REBT, the first of the modern cognitive behaviour therapies and a pioneering philosophy,
was developed in 1955 by Albert Ellis in Eastern USA, in New York. Coming and strongly influenced by
the perspective of a Freudian Sexual Therapist Ellis is still modifying and updating his theory and
methods even up to nowadays. Today REBT is used also for the treatment of personal disorders,
posttraumatic stress and addiction.

The chronological development of REBT, following the activities of Ellis, can be resumed by the following
way :

 Presenting of the Rational-Therapy (RT) on a Conference in 1955. The emphasis lay on cognitive-
behavioral aspects.

 Publication of his Rational-Emotive-Therapy (RET) in his book “Reason and Emotion in Psychotherapy”
in 1962. Formulation of the ABC-model and pointing out the importance of emotions.

 “Compulsion” as a characteristic of irrational thinking and formulation of the 11 occidental irrational

believes in the 1970s.

 Extension of his model in “Essence of RET” in 1984. Irrational thinking is nonlogic, non-objective, and
absolutistic versus conditional compulsion.

 Publication of “Expanding ABC of RET” in 1985. Description of secondary disturbing symptoms

(emotional problems beyond emotional disturbances).

 In 1993 Ellis proposes the new name “Rational Emotive-Behaviour Therapy” (REBT). Update of his
book “Reason and Emotion in Psychotherapy” in 1994. Emphasing of humanistic aspects of REBT (how
to live a happy life and development of the human potentials).

A metaphor shows the main difference between the classical RET and the modern REBT programs:
RET: Patient: “I need a table”. Therapist: “Here you got one.” REBT: Patient: “I need a table”. Therapist:
“Let’s make one together“

II. Assumptions/Principles

View of human nature

1) DUAL POTENTIAL
a) Rational emotive behavior therapy is based on the assumption that human beings are born with a
potential for both rational, or “straight,” thinking and irrational, or “crooked,” thinking.
2) DUAL PREDISPOSITION
a) People have predispositions for self-preservation, happiness, thinking and verbalizing, loving,
communion with others, and growth and self-actualization.
b) They also have propensities for self-destruction, avoidance of thought, procrastination, endless
repetition of mistakes, superstition, intolerance, perfectionism and self-blame, and avoidance of
actualizing growth potentials.
3) FALLIBILITY, YET GROWTH
 a) Taking for granted that humans are fallible, REBT attempts to help them accept themselves as
creatures who will continue to make mistakes yet at the same time learn to live more at peace
with themselves.

View of emotional disturbance

1) REBT is based on the premise that although we originally learn irrational beliefs from significant
others during childhood, BUT it is largely our own repetition of early-indoctrinated irrational thoughts,
rather than a parent’s repetition, that keeps dysfunctional attitudes alive and operative within us.
2) Ellis contends that people do not need to be accepted and loved, even though this may be highly
desirable. The therapist teaches clients how to feel undepressed even when they are unaccepted and
unloved by signifi cant others.
3) Ellis insists that blame is at the core of most emotional disturbances. Therefore, to recover from a
neurosis or a personality disorder, we had better stop blaming ourselves and others. Instead, it is
important that we learn to fully accept ourselves despite our imperfections.
4) Ellis (Ellis & Blau, 1998; Ellis & Harper, 1997) hypothesizes that we have strong tendencies to
escalate our desires and preferences into dogmatic “shoulds,” “musts,” “oughts,” demands, and
commands. When we are upset, it is a good idea to look to our hidden dogmatic “musts” and
absolutist “shoulds.” Here are three basic musts (or irrational beliefs) that we internalize that
inevitably lead to self-defeat (Ellis, 1994, 1997, 1999; Ellis & Dryden, 1997; Ellis & Harper, 1997):
a) • “I must do well and win the approval of others for my performances or else I am no good.”
b) • “Other people must treat me considerately, fairly, kindly, and in exactly the way I want them to
treat me. If they don’t, they are no good and they deserve to be condemned and punished.”
c) • “I must get what I want, when I want it; and I must not get what I don’t want. If I don’t get what I
want, it’s terrible, and I can’t stand it.”

6 Principles of RET

1. Cognition is the most important and proximal determinant of human emotion.

2. Dysfunctional thinking is the major determinant of human distress.
3. Changing thinking is the best way to change determinants.
4. Multiple factors are related to the etiology of rational and irrational thinking.
5. RET emphasizes the present rather than historical influences on behavior.
6. Beliefs can be changed.
III. Therapeutic Goal
a. Self-interest: Sensible and emotionally healthy people tend to be first or primarily interested in
themselves. They tend to put their own interests at least a little above the interests of others.
They sacrifice themselves to some degree for those for whom they care, but not overwhelmingly
or completely.
b. Self-direction: Healthy people tend to mainly assume responsibility for their own lives while
simultaneously preferring to cooperate with others. They do not need or demand considerable
support or succoring from others.
c. High frustration tolerance: Rational individuals have the ability to tolerate or withstand a great
deal of difficulty or discomfort in their lives without making themselves emotionally disturbed
about it. From this perspective, they are prepared to tolerate frustration because it is worth doing
so to obtain their goals. They are able to accept grim reality and seek to distinguish between
adverse events they can change and those they cannot.
d. Acceptance of uncertainty: Healthy men and women tend to acknowledge and accept the idea
that we live in a world of probability and chance where absolute certainties do not, and probably
never will, exist. They enjoy a good degree of order but do not demand to know exactly what the
future will bring or what will happen to them.
 e. Unconditional self-acceptance: Healthy people are usually glad to be alive and accept
themselves just because they are alive and have some capacity to enjoy themselves. They refuse
to measure their intrinsic worth by their extrinsic achievements or by what others think of them.
They frankly choose to accept themselves unconditionally, and they try to completely avoid rating
themselves, their totality or being. They attempt to enjoy rather than to prove themselves.
f. Risk-taking: Emotionally healthy people tend to take a fair amount of risk and to try to do what
they want to do, even when there is good chance that they may fail. They tend to be adventurous
but not foolhardy.
g. Long-range hedonism: Well-adjusted people tend to seek both the pleasures of the moment
and those of the future and do not often court future pain for present gain. They are hedonistic,
that is, happiness-seeking and pain-avoidant, but they assume they will probably live for quite a
few years and that they had therefore better think of both today and tomorrow. They are not
obsessed with immediate gratification.
h. Self-responsibility: Healthy individuals tend to accept a great deal of responsibility for their own
disturbance. They do not defensively blame others or social conditions for their own self-defeating
thoughts, feelings and behaviors.

IV. Techniques

What is irrational thinking?

To describe a belief as ‘irrational’ is to say that:

1. It blocks a person from achieving their goals, creates extreme emotions that persist and which distress
and immobilise, and leads to behaviours that harm oneself, others, and one’s life in general.

2. It distorts reality (it is a misinterpretation of what is happening and is not supported by the available
evidence);

3. It contains illogical ways of evaluating oneself, others, and the world: demandingness, awfulising,
discomfort-intolerance and people-rating

Two Types of Disturbance REBT suggests that human beings defeat or ‘disturb’ themselves in two
main ways:

(1) by holding irrational beliefs about their ‘self’ (ego disturbance) or

(2) by holding irrational beliefs about their emotional or physical comfort (discomfort disturbance).

Ego disturbance represents an upset to the self-image. It results from holding demands about one’s
‘self’, e.g. ‘I must … do well / not fail / get approval from others’; followed by negative selfevaluations
such as: ‘When I fail / get disapproval / etc. this proves I am no good’ and so on. These beliefs create
‘ego anxiety’.

Discomfort disturbance results from demands about others (e.g. ‘People must treat me right’) and
about the world (e.g. ‘The circumstances under which I live must be the way I want’).

Four types of evaluative belief

REBT proposes that there are four types of evaluative thinking that are dysfunctional for human beings:
  Demandingness. Referred to colourfully by Ellis as ‘musturbation’, demandingness refers to the
way people hold unconditional shoulds and absolutistic musts – believing that certain things
must or must not happen, and that certain conditions (for example success, love, or approval)
are absolute necessities. Demandingness implies certain ‘Laws of the Universe’ that must be
adhered to. Demands can be directed both internally and outwardly. REBT suggests that there
are three basic musts: 1. Demands about the self; 2. Demands about others; 3. Demands about
the world.
 Awfulising occurs when we exaggerate the consequences of past, present or future events;
seeing them as the worst that could happen. Awfulising is characterised by words like ‘awful’,
‘terrible’, ‘horrible’.
 Discomfort intolerance often referred to as ‘can’t-stand-it-it is’, is based on the idea that one
cannot bear some circumstance or event. It often follows awfulising, and can fuel demands that
certain things not happen.
 People-rating refers to the process of evaluating one’s entire self (or someone else’s); in other
words, judging the total value or worth of a person. It represents an overgeneralisation whereby
a person evaluates a specific trait, behaviour or action according to some standard of desirability
or worth. They then apply the evaluation to their total person – eg. ‘I did a bad thing, therefore I
am a bad person.’ People-rating can lead to selfdowning, depression, defensiveness, grandiosity,
hostility, or overconcern with approval and disapproval, and is a key factor in ego disturbance.

BEHAVIORAL TECHNIQUES

Exposure: possibly the most common behavioural strategy used in REBT involves clients entering feared
situations they would normally avoid. Such ‘exposure’ is deliberate, planned and carried out using
cognitive and other coping skills. The purposes are to (1) test the validity of one’s fears (e.g. that
rejection could not be survived); (2) de-awfulise them (by seeing that catastrophe does not ensue); (3)
develop confidence in one’s ability to cope (by successfully managing one’s reactions); and (4) increase
tolerance for discomfort (by progressively discovering that it is bearable).
Role playing. Rehearsing certain behaviors to elicit client feelings often can bring out emotions the
client was not previously aware of. For example, by role playing a situation in which a woman asks a
man for a date, the woman can be aware of strong fears she did not know she had

Shame-attacking exercises. The purpose of these exercises is to help clients feel unashamed when
others may disapprove of them. Examples include minor infractions of social conventions, such as
talking loudly to a store clerk or engaging strangers in conversations. Asking silly questions to
receptionists or teachers is another example. Such exercises are continued until one stops feeling sorry
and disappointed about others’ disapproval and ceases putting oneself down and feeling ashamed.

Postponing gratification is commonly used to combat low frustration-tolerance by deliberately delaying

smoking, eating sweets, using alcohol, sexual activity, etc.

Paradoxical behavior: when a client wishes to change a dysfunctional tendency, encourage them to
deliberately behave in a way contradictory to the tendency. Emphasize the importance of not waiting
until they ‘feel like’ doing it: practicing the new behavior – even though it is not spontaneous – will
gradually internalize the new habit.

IMAGERY TECHNIQUES

Time projection: this technique is designed to show that one’s life, and the world in general, continue
after a feared or unwanted event has come and gone.

The ‘blow-up’ technique: this is a variation of ‘worst-case’ imagery, coupled with the use of humour to
provide a vivid and memorable experience for the client.

Homework

Probably the most important REBT strategy is homework. This can include such activities as reading, self-
help exercises, and experiential activities.

Teaching and Disputing (Counseling book)

V. Applications

REBT has been successfully used to help people with a range of clinical and non-clinical problems, using
a variety of modalities.

Clinical applications Typical clinical applications include

• Depression

• Anxiety disorders, including obsessive compulsive disorder, agoraphobia, specific phobias, generalized
anxiety, posttraumatic stress disorder, etc. • Eating disorders, addictions, impulse control disorders

• Anger management, antisocial behavior, personality disorders

• Sexual abuse recovery

• Adjustment to chronic health problem, physical disability, or mental disorder • Pain management •
General stress management

• Child or adolescent behavior disorders

• Relationship and family problems

Non-clinical applications

• Personal growth – REBT theory contains detailed principles (for example, enlightened self-interest,
self-acceptance, risk-taking) which can be used to help people develop and act on a more functional
philosophy of life.

• Workplace effectiveness – DiMattia (DiMattia & Ijzermans, 1996) has developed a variation of REBT
known as Rational Effectiveness Training which is increasingly being used in the workplace to aid worker
and managerial effectiveness.

Brief therapy

1) A distinguishing characteristic of REBT that makes it a brief form of therapy is that it is a self-help
approach (Vernon, 2007).
2) The A-B-C approach to changing basic disturbance-creating attitudes can be learned in 1 to 10
sessions and then practiced at home.
3) Ellis has used REBT successfully in 1- and 2-day marathons and in 9-hour REBT intensives (Ellis, 1996;
Ellis & Dryden, 1997).

Self Management

People with specific problems, such as coping with the loss of a job or dealing with retirement, are
taught how to apply REBT principles to treat themselves, often with supplementary didactic materials
(books, tapes, self-help forms, and the like).

Group Counseling

REBT is also suitable for group therapy because the members are taught to apply its principles to one
another in the group setting.

This form of group therapy focuses on specific techniques for changing a client’s self-defeating thoughts
in various concrete situations. In addition to modifying beliefs, this approach helps group members see
how their beliefs influence what they feel and what they do.