Rational Emotive Behaviour Therapy (REBT) is based on the concept that emotions and behaviours result from cognitive processes; and that it is possible for human beings to modify such processes to achieve different ways of feeling and behaving. REBT is one of a number of ‘cognitive-behavioural’ therapies, which, although developed separately, have many similarities – such as Cognitive Therapy (CT), developed by Psychiatrist Aaron Beck in the 1960’s.  

In the mid-1950’s Dr. Albert Ellis, a clinical psychologist trained in psychoanalysis, became disillusioned with the slow progress of his clients. He observed that they tended to get better when they changed their ways of thinking about themselves, their problems, and the world. Ellis reasoned that therapy would progress faster if the focus was directly on the client’s beliefs, and thus was born the method now known as Rational Emotive Behaviour Therapy.

Theory of causation

REBT proposes a ‘biopsychosocial’ explanation as to how human beings come to feel and act as they do, suggesting that a combination of biological, psychological, and social factors are involved.

The most basic premise of REBT is that almost all human emotions and behaviours are the result of what people think, assume or believe (about themselves, other people, and the world in general). It is what people believe about situations they face – not the situations themselves – that determines how they feel and behave.

REBT, however (along with most other CBT theories), argues that a person’s biology also affects their feelings and behaviours (an important point, as it is a reminder to the therapist that there are some limitations on how far a person can change). Also involved are the events and circumstances faced by a person as they go through life.

A useful way to illustrate this triple approach to causation is by using Ellis’ ‘ABC’ model. In this framework ‘A’ represents an activating event or experience and the person’s inferences or interpretations about the event; ‘B’ represents their beliefs about the event; ‘C’ repre­sents the consequence – the emotions and behaviours that follow from those thoughts and beliefs.

Here is an example of an ‘emotional episode’, as experienced by a person whose history indicates a biological proneness to low mood and a tendency to misinterpret how he is viewed by other people:

A. What started things off:

Event: friend passed me in the street without acknowl­edging me.
Inferences about the event: “He’s ignoring me; he doesn’t like me.”

B. Beliefs about A:

1. ‘I could end up without friends for ever – and that would be terrible.’

2. ‘For me to be happy and feel worthwhile, peo­ple must like me.’

3. ‘I’m unacceptable as a friend – so I must be worthless as a person.’

C. Reaction:

    Feelings: lonely, depressed.
    Behaviours: avoiding people generally.  

 Note that ‘A’ does not cause ‘C’: ‘A’ triggers off ‘B’, ‘B’ then causes ‘C’. Also, ABC episodes do not stand alone – they run in chains, with a ‘C’ often becoming the ‘A’ of another episode. For instance, the person above may observe their low mood, telling himself: “Oh, no – I’m getting depressed again and I couldn’t bear that”, then feel anxious. Human beings frequently observe their own emotions and behaviours then react anew to them.

Note, too, that most beliefs are outside conscious awareness. They are habitual or automatic, often consisting of underlying ‘rules’ about how the world and life should be. With practice, though, peo­ple can learn to uncover such subconscious beliefs.

What is irrational thinking?

We have seen that what people think determines how they feel. But what types of thinking are problematical for human beings?

A definition

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.

 Contemporary REBT often refers to beliefs as ‘self-defeating’ rather than ‘irrational’, in order to emphasise that the effect on a person’s life is the key criteria for deciding whether a belief is irrational.

The Three Levels of Thinking

Human beings appear to think at three levels: (1) Inferences; (2) Evaluations; and (3) Core beliefs.

Every individual has a set of general ‘core beliefs’ – usually subconscious – that determines how they react to life. When an event triggers off a train of thought, what someone consciously thinks depends on the core beliefs they subconsciously apply to the event.

Let’s say that a person holds the core belief: ‘For me to be happy, my life must be safe and predictable.’ Such a belief will lead them to be hypersensitive to any possibility of danger and overestimate the likelihood of things going wrong. Suppose they hear a noise in the night. Their hypersensitivity to danger leads them to infer that there is an intruder in the house. They then evaluate this possibility as catastrophic and unbearable, which creates feelings of panic.

Here is an example (using the ABC model) to show how it all works:

A. Your neighbour phones and asks if you will baby-sit for the rest of the day. You had already planned to catch up with some gardening. You infer what will happen: ‘If I say no, she will think badly of me.’

B.   You evaluate your inference: ‘I couldn’t stand to have her disapprove of me and see me as selfish.’

Your evaluation comes from the underlying rule: ‘I need love and approval from those significant to me – and I must avoid disapproval from any source.’

C.  You say yes.

 In summary, people view themselves and the world around them at three levels: (1) inferences, (2) evalua­tions, and (3) underlying rules/core beliefs. The therapist’s main objective is to deal with the underlying, semi-permanent, general ‘rules’ that are the continu­ing cause of the client’s unwanted reactions.

REBT places greater emphasis on dealing with evaluative-type thinking than do other cognitive-behavioural approaches, which focus rather more on inferential thinking. REBT especially underscores the centrality of demandingness over other types of thinking.

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). Frequently, the two go together – people may think irrationally about both their ‘selves’ and their circumstances – though one or the other will usually be predominant.

Inferences

In everyday life, events and circumstances trigger off two levels of thinking: inferring and evaluating. First, we make guesses or inferences about what is ‘going on’ – what we think has happened, is happening, or will be happening. Inferences are statements of ‘fact’ (or at least what we think are the facts – they can be true or false). Inferences that are irrational usually consist of the following ‘distortions of reality’:

• Black and white thinking

• Filtering

• Over-generalisation

• Mind-reading

• Fortune-telling

• Emotional reasoning

• Personalising

The seven types of inferential thinking described above have been outlined by Aaron Beck and his associates (see, for example: Burns, David M. Feeling Good: The new mood therapy. Signet, New American Library, New York, 1980). In REBT, a person’s inferences are regarded as part of the ‘A’.

Evaluations

More significantly from the REBT perspective, as well as making inferences about things that hap­pen, we go beyond the ‘facts’ to evaluate them in terms of what they mean to us. Evaluations are sometimes conscious, sometimes beneath awareness. Irrational evaluations consist of one or more of the following four types:

Demandingness. Referred to colourfully by Ellis as ‘musturbation’, de­mandingness refers to the way people use 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 either toward oneself or others. Some REBT theorists see demandingness as the ‘core’ type of irrational think­ing, suggesting that the other three types derive from it

Awfulising. Exaggerating the conse­quences of past, present or future events; seeing something as awful, terrible, horrible – the worst that could happen.

Discomfort intolerance (often referred to as ‘can’t-stand-it-itis’). This is based on the idea that one cannot bear some circumstance or event. It often follows awfulising, and leads to demands that certain things not happen.

People-Rating. People-rating refers to the process of evaluating one’s entire self (or someone else’s). In other words, trying to determine the total value of a person or judging their worth. It represents an overgeneralisation. The person evaluates a specific trait, behaviour or action according to some standard of desirability or worth. Then they apply the evaluation to their total person – eg. ‘I did a bad thing, there­fore I am a bad person.’ People-rating can lead to reactions like self-downing, depression, defensive­ness, grandiosity, hostility, or overconcern with ap­proval and disapproval.

Rules (core beliefs)

Rules, as we saw earlier, are the underlying beliefs that guide how we react to life. What specific events mean to someone (how they evaluate them) depends on the underlying, general ‘rules’ they hold. Ellis proposes that a small number of core beliefs underlie most unhelpful emotions and behaviours. Here is a sample list of such ‘rules for living’:

1. I need love and approval from those significant to me – and I must avoid disapproval from any source.

2. To be worthwhile as a person I must achieve, succeed at whatever I do, and make no mistakes.

3. People should always do the right thing. When they behave obnoxiously, unfairly or selfishly, they must be blamed and punished.

4. Things must be the way I want them to be, oth­erwise life will be intolerable.

5. My unhappiness is caused by things that are out­side my control – so there is little I can do to feel any better.

6. I must worry about things that could be danger­ous, unpleasant or frightening – otherwise they might happen.

7. I can be happier by avoiding life’s difficulties, unpleasantness, and responsibilities.

8. Everyone needs to depend on someone stronger than themselves.

9. Events in my past are the cause of my problems – and they continue to influence my feelings and behaviours now.

10. I should become upset when other people have problems, and feel unhappy when they’re sad.

11. I shouldn’t have to feel discomfort and pain – I can’t stand them and must avoid them at all costs.

12. Every problem should have an ideal solution – and it’s intolerable when one can’t be found.

HELPING PEOPLE CHANGE

The steps involved in helping clients change can be broadly summarised as follows:

1. Help the client understand that emotions and behaviours are caused by beliefs and thinking. This may consist of a brief explanation followed by assignment of some reading.

2. Show how the relevant beliefs may be uncovered. The ABC format is invaluable here. Using an episode from the client’s own recent experience, the therapist notes the ‘C’, then the ‘A’. The client is asked to consider (at ‘B’): ‘What was I telling myself about ‘A’, to feel and behave the way I did at ‘C’? As the client develops understanding of the nature of irrational thinking, this process of ‘filling in the gap’ will become easier. Such education may be achieved by reading, direct explanation, and by self-analysis with the therapist’s help and as homework between sessions.

3. Teach the client how to dispute and change the irrational beliefs, replacing them with more rational alternatives. Again, education will aid the client. The ABC format is extended to include ‘D’ (Disputing irra­tional beliefs), ‘E’ (the new Effect the client wishes to achieve, i.e. new ways of feeling and behaving), and ‘F’ (Further Action for the client to take).

4. Help the client get into action. Acting against irrational beliefs – for example, disputing the belief that disapproval is intolerable by deliberately doing something to attract it, then discovering that one sur­vives – is an essential component of REBT. Its empha­sis on both rethinking and action makes it a powerful tool for change. Such activities are usually referred to as ‘homework’.

The Process of Therapy

What follows is a summary of the main components of an REBT intervention.

Engage client

The first step is to build a relationship with the client. This can be achieved using the core conditions of empathy, warmth and respect.

Watch for ‘secondary problems’ about coming for help: self-downing over having the problem or needing assistance; and anxiety about coming to the interview.

Finally, possibly the best way to engage a client for REBT is to demonstrate to them at an early stage that change is possible and that REBT is able to assist them to achieve this goal.

Assess the problem, person, and situation

Assessment will vary from person to person, but following are some of the most common areas that will be assessed as part of an REBT intervention.

1. Start with the client’s view of what is wrong for them.

2. Determine the presence of any related clinical disorders.

3. Obtain a personal and social history.

4. Assess the severity of the problem.

5. Note any relevant personality factors.

6. Check for secondary disturbance: how does the client feel about having this problem?

7. Check for any non-psychological causative factors: physical conditions; medications; substance abuse; lifestyle/environmental factors.

Prepare the client for therapy

1. Clarify treatment goals.

2. Assess the client’s motivation to change.

3. Introduce the basics of REBT, including the biopsychosocial model of causation.

4. Discuss approaches to be used and implications of treatment.

5. Develop a contract.

Implement the treatment programme

Most of the sessions will occur in the implementation phase, using activities like the following:

• Analysing specific episodes where the target problem(s) occur, ascertaining the beliefs involved, changing them, and developing homework (I call this ‘Rational Analysis’).

• Developing behavioural assignments to reduce fears or modify ways of behaving.

• Supplementary strategies & techniques as appropriate, e.g. relaxation training, interpersonal skills training, etc.

Evaluate progress

Toward the end of the intervention it will be important to check whether improvements are due to significant changes in the client’s thinking, or simply to a fortuitous improvement in their external circumstances.

Prepare the client for termination

It is usually very important to prepare the client to cope with setbacks. Many people, after a period of wellness, think they are ‘cured’ for life. Consequently, when they slip back and discover their old problems are still present to some degree, they are likely to despair and give up working on themselves altogether. To avoid this happening:

• Warn that relapse is likely for many mental health problems and ensure they know what to do when their symptoms return.

• Discuss their views on asking for help if needed in the future. Deal with any irrational beliefs about coming back, like: ‘I should be cured for ever’, or: ‘The therapist would think I was a failure if I came back for more help’.

A typical REBT interview

What happens in a typical REBT interview? Here is how an interview based on the ABC model would usually progress:

1. Review the previous session’s homework. Reinforce gains and learning. If not completed, help the client identify and deal with the blocks involved.

2. Establish the target problem to work on in this session.

3. Assess the ‘A’: what happened, when did it last occur? What did the client infer was happening or would result from what happened?

4. Assess the ‘C’: specifically what unwanted emotion did the client experience, and how strong was it?

5. Identify and assess any secondary emotional problems (inappropriate negative emotions about having the problem, for example shame about feeling grief).

6. Identify the beliefs – ‘B’ – causing the unwanted reac­tions, especially demandingness, awfulising, discomfort-intolerance, and people-rating.

7. Connect ‘B’ & ‘C’ (help the client see that their unwanted reaction resulted from their thoughts).

8. Clarify and agree on the goal – ‘E’: how does the client wish to feel (and behave) when next confronted with a similar ‘A’?

9. Help the client dispute their beliefs, preferably using ‘Socratic questioning’ (‘Where is the evidence ... ?’ ‘How is it true that ... ?’ ‘Where is it written that you must ... ?’ etc. Replace beliefs that are agreed to be irrational.

10. Plan homework assignments – ‘F’ – to enable the client to put their new rational beliefs into practice. Identify and deal with any potential blocks to completion of the homework.

Techniques Used In REBT

Ellis recommends a ‘selectively eclectic’ approach to therapy, whereby there are no techniques that are essential to REBT; rather, one uses whatever works, assuming that the strategy is compatible with REBT theory. Following are some examples of procedures in common use.

Cognitive techniques

Rational analysis: analyses of specific episodes to teach the client how to uncover and dispute irrational be­liefs (as described earlier). These are usually done in-session at first; then, as the client gets the idea, they can be done as homework.

Double-standard dispute: If the client is holding a ‘should’ or is self-downing about their behaviour, ask whether they would globally rate another person (e.g. best friend, therapist, etc.) for doing the same thing, or recommend that person hold their demanding core belief. When they say ‘No’, help them see that they are holding a double-standard. This is especially useful with resistant beliefs which the client finds hard to give up.

Catastrophe scale: this is a useful technique to get awfulising into perspective. On a whiteboard or sheet of paper, draw a line down one side. Put 100% at the top, 0% at the bottom, and 10% intervals in between. Ask the client to rate whatever it is they are catastrophising about, and insert that item into the chart in the appropriate place. Then, fill in the other levels with items the client thinks apply to those levels. You might, for example, put 0%: ‘Having a quiet cup of coffee at home’, 20%: ‘Having to mow the lawns when the rugby is on television’, 70%: being burgled, 90%: being diagnosed with cancer, 100%: being burned alive, and so on. Finally, have the client progressively alter the position of their feared item on the scale, until it is in perspective in relation to the other items.

Devil’s advocate: this useful and effective technique (also known as reverse role-playing) is designed to get the client arguing against their own dysfunctional belief. 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. It is especially useful when the client now sees the irrationality of a belief, but needs help to consolidate that understanding. (NB: as with all techniques, be sure to explain it to the client before using it).

Reframing: another strategy for getting bad events into perspective is to re-evaluate them as ‘disappointing’, ‘concerning’, or ‘uncomfortable’ rather than as ‘awful’ or ‘unbearable’. A variation of reframing is to help the client see that even negative events almost always have a positive side to them, listing all the positives the client can think of (NB: this needs care so that it does not come across as suggesting that a bad experience is really a ‘good’ one).

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. Ask the client to visualise the unwanted event occurring, then imagine going forward in time a week, then a month, then six months, then a year, two years, and so on, considering how they will be feeling at each of these points in time. They will thus be able to see that life will go on, even though they may need to make some adjustments.

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. It involves asking the client to imagine whatever it is they fear happening, then blow it up out of all proportion till they cannot help but be amused by it. Laughing at fears will help get control of them.

Behavioural techniques

One of the best ways to check out and modify a belief is to act. Clients can be encouraged to check out the evidence for their fears and to act in ways that disprove them.

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).

Shame attacking: this type of exposure involves confronting the fear of shame by deliberately acting in ways the client anticipates may attract disapproval (while, at the same time, using cognitive and emotive techniques to feel only concerned or disappointed). For example, you could get the client to switch their shoes to the wrong feet then walk round the office building with you for ten minutes or so, at the same time disputing their shame-inducing thinking.

Risk-taking: the purpose is to challenge beliefs that certain behaviours are too dangerous to risk, when reason says that while the outcome is not guaranteed they are worth the chance. For example, if the client has trouble with perfectionism or fear of failure, they might start tasks where there is a reasonable chance of failing or not matching their expectations. Or someone with a fear of rejection might talk to an attractive person at a party or ask someone for a date.

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

Stepping out of character: is one common type of paradoxical behaviour. For example, a perfectionistic person could deliberately do some things to less than their usual standard; or someone who believes that to care for oneself is ‘selfish’ could indulge in a personal treat each day for a week.

Postponing gratification is commonly used to combat low frustration-tolerance by deliberately delaying smoking, eating sweets, using alcohol, sexual activity, etc.

Other strategies

• Skills training, e.g. relaxation, social skills.

• Reading (self re-education).

• Tape recording of interviews for the client to replay at home.

 Probably the most important REBT strategy is homework. This includes reading, self-help exercises, and experi­ential activities. Therapy sessions are really ‘training sessions’, between which the client tries out and uses what they have learned. At the end of this arti­cle there is an example of a homework format which clients can use to analyse specific episodes where they feel or behave in the ways they are trying to change.

Applications of rebt

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, generalised anxiety, posttraumatic stress disorder, etc.

• Eating disorders

• Addictions

• Hypochondriasis

• Sexual dysfunction

• Anger management

• Impulse control disorders

• Antisocial behaviour

• Jealousy

• Sexual abuse recovery

• Personality disorders

• Adjustment to chronic health problem, physical disability, or mental disorder

• Pain management

• General stress management

• Child or adolescent behaviour 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.

Modalities

The most common use of REBT is with individual clients, but this is followed closely by group work, for which REBT is eminently suited. REBT is also frequently used with couples, and there is a growing literature on REBT family therapy. A newer development is the use of REBT in non-clinical settings in the workplace, as described above.

Suitable client groups

REBT has been developed over the years for use with 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); and with a method of self-observation and personal change that will help them maintain their gains.

• Not all unpleasant emotions are seen as dysfunc­tional. Nor are all pleasant emotions functional. 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.

• Though REBT is a ‘cognitive’ therapy, it gives considerable attention to the emotional life of human beings. Thinking is only analysed in relation to a person’s emotions.

• There is no ‘one way’ to practice REBT. It is ‘se­lectively eclectic’. Though it has techniques of its own, it also borrows from other approaches and al­lows practitioners to use their imagination. There are some basic assumptions and principles, but otherwise it can be varied to suit one’s own style and client group.

• REBT is educative and collaborative. Clients learn the therapy and how to use it on themselves (rather than have it ‘done to them’). The therapist provides the training – the client carries it out. There are no hidden agendas – all procedures are clearly explained to the client. Therapist and client together design homework assignments.

• The relationship between therapist­ and client is very important, but is seen as existing to facilitate therapeutic work – rather than being the therapy itself. The therapist shows empa­thy, unconditional acceptance, and encouragement; but is careful to avoid activities that create dependen­cy or strengthen any ‘needs’ for approval.

• While REBT is active-directive, the therapist almost always works within the client’s value system. New ways of thinking are not pressed onto the client, but rather developed collaboratively.

• An individual’s past is seen as relevant in that this is where much irrational thinking originates; but because uncovering the past is not usually helpful in changing how a person reacts in the present, REBT therapists do not engage in much ‘archaeological’ exploration.

• REBT is brief and time-limited. It commonly in­volves five to thirty sessions over one to eighteen months. The pace of therapy is brisk. A minimum of time is spent on acquiring background and historical information: it is task-oriented and focuses on prob­lem-solving in the present.

• REBT is a method of psychotherapy, so the emphasis is on helping people change how they feel and behave in reaction to life events. However, such personal change may be a prelude to enabling a person to more effectively seek environmental change. Consequently, REBT helps people change themselves and their unwanted circumstances.

• A common criticism of psychotherapy is that it may encourage people to become self-centred. REBT avoids this by teaching several principles, for example ‘enlightened self-interest’ (see Froggatt, 1997) that encourage individuals to attend to both their own interests and those of other people.

• REBT tends to be humanistic, anti-moralistic, and scientific. Human beings are seen as the arbiters of what is right or wrong for them. Behaviour is viewed as functional or dysfunctional, rather than as good or evil. REBT is based on research and the principles of logic and empiricism, and encourages scientific rather than ‘magical’ ways of thinking.

• Finally, the emphasis is on profound and lasting change in the underlying belief system of the client, rather than simply eliminating the presenting symp­toms. The client is left with self-help techniques that enable coping in the long-term future.

Unique features of rebt

REBT has a number of characteristics that are original to the approach – here is a selection:

Absence of Self-Evaluation

REBT has a unique approach to a common therapeutic problem: that of low self-esteem.

Many therapists would try to help people with low self-esteem by encouraging them to regard themselves as ‘worthy’ human beings. REBT therapist takes a radically different approach – encour­aging 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’ (a notion, incidentally, that implies it is possible for them to be ‘unworthy’!); and getting rid of the idea that people somehow need ‘value’ or ‘esteem’.

The client is, instead, urged to (1) aim for uncondi­tional self-acceptance – irrespective of their traits and behaviours or how other people see them; (2) ac­knowledge that they simply exist – and choose to stay alive, seek joy, and avoid pain; and (3) instead of rat­ing their self, to concentrate on rating their actions or traits (and the effects of these) in terms of how they help achieve the client’s goals.

Secondary Problems

REBT postulates that human beings frequently develop problems about their problems. By creating these ‘secondary’ problems, they complicate their emotional and behavioural difficulties.

Guilt is a common secondary problem: for instance, people with anger problems may down themselves because they have trouble controlling their rage. Sufferers of chronic anxiety frequently get anxious about getting anxious (the ‘fear of fear’). Clients in therapy may become despondent because they are not overcoming their problems as quickly as they think they ‘should’ be able to.

For therapy to be effective, these ‘secondary’ problems usually need to be addressed before the primary problem will become accessible.

Discomfort Disturbance v. Ego Disturbance

As noted above, REBT suggests that global evaluation of the ‘self’ will often lead to emotional disturbance. This is referred to as ‘ego disturbance’ – a concept that exists (in various forms) in probably most other therapeutic orientations, under such terms as ‘low self-esteem’, ‘poor self-image’ and the like.

REBT, however, 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 (thus developing ‘secondary’ problems); or will sabotage their therapy because they consciously or subconsciously perceive it as ‘too hard’.

LEARNING TO USE REBT

To practise REBT it is important to have a good under­standing of irrational thinking. This can be gained by a critical reading of the substantial literature available.

The use of REBT in the interview situation is best learned by attending a training course (the Primary Certificate Program is the usual starting point). It can also be observed by reading verbatim records of inter­views or from audio or video tapes of interviews conducted by REBT practitioners.

The most effective way to learn how to help clients uncover and dispute irrational beliefs is to practice REBT on oneself, for example by using writ­ten ‘self-analysis’ exercises (see the last page of this article for an example of a ‘rational self-analysis’).

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Reading List
There are hundreds of books and articles based on REBT.
Here is a small selection of what is available:

Self-Help Books

Bernard, Michael. Staying Rational in an Irrational World: Albert Ellis & Rational-Emotive Therapy. Carlson/McMillan, South Melbourne, 1986.

Calabro, Louis E. Living with Disability. Institute for Rational-Emotive Therapy, New York, 1991.

Dryden, Windy & Gordon, Jack. (1993). Beating the Comfort Trap. London Sheldon Press.

Dryden, Windy. (1996). Overcoming Anger. London Sheldon Press.

Dryden, Windy. (1997). Overcoming Shame. London Sheldon Press.

Ellis, Albert & Abrams, Michael. (1994). How to Cope With a Fatal Illness: the rational management of death and dying. New York Barricade Books, Inc.

Ellis, Albert & Harper, Robert A. (1975). A New Guide to Rational Living. Hollywood Wilshire Book Company.

Ellis, Albert. Anger – How to Live With and Without It. Carol Publishing Group, New York, 1977.

Ellis, T.T. & Newman, C.F. (1996). Choosing to Live: How to defeat suicide through cognitive therapy. Oakland New Harbinger Publications.

Froggatt, Wayne N. Choose to be Happy: Your Step-by-step Guide. HarperCol­lins, Auckland, 1993.

Froggatt, Wayne N. GoodStress: The life that can be yours. HarperCollins, Auckland, 1997.

Hauck, Paul. How to Bring Up Your Child Successful­ly. Sheldon Press, London, 1967.

Hauck, Paul. How To Do What You Want To Do. Sheldon Press, London, 1976.

Hauck, Paul. How to Love and be Loved. Sheldon Press, London, 1983.

Hauck, Paul. Jealousy. Sheldon Press, London, 1981.

Hauck, Paul. Making Marriage Work. Sheldon Press, London, 1977.

Hauck, Paul. Overcoming Depression. The Westmin­ster Press, Philadelphia, 1976.

Hauck, Paul. Overcoming Frustration and Anger. The Westminster Press, Philadelphia, 1974.

Jakubowski, P., & Lange, A.J. (1978). The Assertive Option: Your Rights & Responsibilities. Champaign,Il Research Press.

Klarreich, Samuel H. Work Without Stress. Brunner/Mazel, New York, 1990.

Oliver, Rose & Bock, Fran. (1987). Coping with Alzheimer's: A Caregiver's Emotional Survival Guide. North Hollywood Wilshire Book Company.

Robb, H.B. How to Stop Driving Yourself Crazy With Help From the Bible. Institute for Rational-Emotive Therapy, New York, 1988.

Robin, Mitchell W. & Balter, Rochelle. (1995). Performance Anxiety. Holbrook, Massachusetts Adams Publishing.

Wolfe, Janet. What to Do When He Has a Headache: How to rekindle your man's desire. Thorson's, London, 1992.

Professional Literature

Specific applications of cbt

Addiction

Ellis, A., McInerney, J., DiGiuseppe,R. & Yeager,R., Rational-Emotive Therapy With Alcoholics And Substance Abusers, Pergamon Press, New York, 1988.

Ferstein, Marjorie E. & Whiston, Susan C., Utilizing RET For Effective Treatment of Adult Children of Alcoholics, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 9:1, 39-49, 1991.

Gore, T.A. & Maultsby, M.C., The Rational Alcoholic Relapse-Prevention Method, Alcoholism Treatment Quarterly, Vol 2 (3-4), 243-247, 1985-86.

Anger

Ellis, Albert. (1976). Techniques of Handling Anger in Marriage. 2, 305-315: J. of Marriage & Family Counselling.

Ellis, A. & Greiger, R. (Eds.). (1986). Handbook Of Rational-Emotive Therapy (vol 2). New York: Springer.

Nelson, Hart & Finch. (1993). Anger in Children: A Cognitive-behavioural View of the Assessment-Therapy Connection. 11:3, 135-150: Journal of Rational-Emotive & Cognitive-behaviour Therapy.

Anxiety

Ellis, Albert, A Note On The Treatment Of Agoraphobics, Behaviour Research And Therapy, 17, 162-164, 1979.

Ellis, Albert, Rational Emotive behaviour Therapy Approaches to Obsessive-Compulsive Disorder, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 12:2, 121-141, 1994.

Ellis, Albert, Rational-Emotive Treatment of Simple Phobias, Psychotherapy, 28, 452-456, 1991.

Walen, S., Phrenophobia, Cognitive Therapy & Research, 6, 399-408, 1982.

Warren, Ricks & Zgourides, George, Anxiety Disorders: A Rational-Emotive Approach, Pergamon Press, New York, 1991.

Depression

Ellis, Albert, A Sadly Neglected Cognitive Element in Depression, Cognitive Therapy & Research, 11, 121-146, 1987.

Eating disorders

Woods, Paul J. & Greiger, Russell M., Bulimia: A Case Study with Mediating Cognitions and Notes on a Cognitive-behavioural Analysis of Eating Disorders, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 11:3, 159-172, 1993.

Grief

Malkinson, Ruth, Cognitive Behavioural Grief Therapy, Journal of Rational-Emotive & Cognitive Behaviour Therapy, 14:3, 155-171, 1996.

Personality disorders

Ellis, Albert, The Treatment of Borderline Personalities with Rational Emotive behaviour Therapy, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 12:2, 101-119, 1994.

Physical health

Aeschleman, Stanley R. & Imes, Cheryl. (1999). Stress Inoculation Training for Impulsive Behaviours in Adults with Traumatic Brain Injury. Journal of Rational-Emotive & Cognitive-Behaviour Therapy, 17:1, 51-65.

Psychosis / Inpatients / Severe disorders

Chadwick, P. Birchwood, M. & Trower, P., Cognitive Therapy for Delusions, Voices and Paranoia, Wiley, Chichester, 1996, 0471961736

Kopec, Ann Marie, Rational Emotive Behaviour Therapy in a Forensic Setting: Practical Issues, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 13:4, 243-253, 1995.

Stress management

Ellis, Gordon, Neenan & Palmer, Stress Counselling: A Rational Emotive Behavioural Approach, Cassell (or Springer), London (or New York), 1997 (or 1998).

Morse,C., Bernard,M.E. & Dennerstein,L., The Effects of Rational-Emotive Therapy & Relaxation Training on Premenstrual Syndrome, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 7:2, 98-110, 1989.

Rational Effectiveness Training

DiMattia, Dominic, Rational-Effectiveness Train-ing: Increasing Personal Productivity at Work, Institute for Rational-Emotive Therapy, New York, 1990.

Multiple applications

Dryden, W. & Trower, P. (Eds). Developments in Rational-Emotive Therapy. Open University Press, Milton Keynes,UK, 1988.

Ellis, A. & Bernard, M.E. (Eds.), Clinical Applications Of Rational-Emotive Therapy, Plenum, New York, 1985.

Client groups

Children & Adolescents

Bernard, M.E. & Joyce, M. (1984). Rational-Emotive Therapy with Children and Adolescents. New York: Wiley.

Kinney, Andrew, Cognitive-behaviour Therapy with Children: Developmental Reconsiderations, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 9:1, 51-61, 1991.

Morris, G. Barry, A Rational-Emotive Treatment Program with Conduct Dirsorder and Attention-Deficit Hyperactivity Disorder in Adolescents, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 11:3, 123-134, 1993.

Nelson, Hart & Finch, Anger in Children: A Cognitive-behavioural View of the Assessment-Therapy Connection, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 11:3, 135-150, 1993.

Seasock, John P., Identification of Adolescent Sex Offenders: A REBT Model, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 13:4, 261-271, 1995.

Vernon, Ann, Thinking, Feeling, Behaving - Grades 1-6; An Emotional Education Curriculum for Children, Research Press, Champaign, IL, 1989.

Vernon, Ann, Thinking, Feeling, Behaving - Grades 7-12; An Emotional Education Curriculum for Adolescents, Research Press, Champaign, IL, 1989.

Whitford, Robert & Parr, Vincent, Uses of Rational Emotive Behaviour Therapy with Juvenile Sex Offenders, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 13:4, 273-282, 1995.

Women

Wolfe, J.L. & Fodor, I.G., A Cognitive-behavioural Approach to Modifying Assertive behaviour in Women, Counselling Psychologist, 5(4), 45-52, 1975.

Older adults

Ellis, Albert. (1999). Rational Emotive Behaviour Therapy and Cognitive-Behaviour Therapy for Elderly People. Journal of Rational-Emotive & Cognitive-Behaviour Therapy, 17:1, 5-18.

Oliver, Rose & Bock, Fran. Coping with Alzheimer's: A Caregiver's Emotional Survival Guide. Wilshire Book Company, North Hollywood, 1987.

Oliver, Rose & Bock, Frances A., Alleviating the Distress of Caregivers of Alzheimer's Disease Patients: A Rational-Emotive Therapy Model, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 8:1, 53-69, 1990.

Religious clients

Warnock, Sandra, Rational-Emotive Therapy and the Christian Client, Journal of Rational-Emotive & Cognitive-behaviour Therapy, 7:4, 263-280, 1989.

Modes, Principles & Techniques

Groupwork

Ellis, Albert, Group rational-emotive and cognitive-behavioural therapy, International Journal of Group Psychotherapy, 42(1):63-80, 1992.

Family work

Ellis, A., Sichel, J., Yeager, R., DiMattia, D., & DiGiuseppe, R., Rational-Emotive Couple's Therapy, Pergamon, New York, 1989.

Greiger, Russell M.. (1986). Rational-Emotive Couples Therapy - Special Issue. Journal of Rational-Emotive & Cognitive-behaviour Therapy. 4:1, whole issue.

Huber, C.H. & Baruth, L.G., Rational-Emotive Family Therapy: A Systems Perspective. Springer, New York, 1989.

General practice of REBT

Dryden, Windy & Golden, William L. (Eds.), Cognitive-behavioural Approaches to Psychotherapy, Hemisphere Publishing Corp, New York, 1987.

Dryden, W. & Trower, P. (Eds.), Cognitive Psychotherapy: Stasis and change, Springer Publishing Co, New York, 1989.

Learning to use REBT

Bernard, Michael, Using Rational-Emotive Therapy Effectively: A Practitioner's Guide, Plenum Press, New York, 1991.

Dryden, Windy, Brief Rational Emotive Behaviour Therapy, John Wiley & Sons, Chichester, 1995.

Walen, Susan R., Digiuseppe, Ray, & Dryden, Windy, A Practitioner's Guide To Rational-Emotive Therapy (Second Edition), Oxford University Press, New York, 1992.

Wessler, R.L. & Ellis, A., Supervision in Counselling: Rational-Emotive Therapy., The Counselling Psychologist, 11 (1), 43-49, 1983.

REBT techniques

Bernard, Michael E. & Wolfe, Janet L., The RET Resource Book for Practitioners, Institute for Rational-Emotive Therapy, New York, 1993.

Dryden, Windy (Ed.), Rational Emotive Behaviour Therapy: A reader, Sage Publications, London, 1995.

Nelson-Jones, Richard. (1998). Using the Whiteboard in Lifeskills Counselling. The Rational Emotive Behaviour Therapist. 6:2, 77-88

How to obtain items on this list

Library Interloan

Many of the items listed are available through the interloan system.

Purchase

To purchase any of the books:

1.      Have your local bookseller order it from overseas.

2.      Order via the internet: go to the New Zealand Centre for Rational Emotive Behaviour Therapy’s website (www.rational.org.nz)  and click on ‘BookShop’.

Some of the books, especially those on REBT, can be obtained from the Albert Ellis Institute: 45 East 65^th Street, New York, N.Y. 10021, United States of America. Fax: 001-212-249-3582. E-mail: orders@rebt.org..

REBT on the Internet

There are numerous internet sites related to REBT. A good place to start searching would be the New Zealand Centre for Rational Emotive Behaviour Therapy website at: www.rational.org.nz
(go to the ‘Links’ page).

REBT In New Zealand

Formal REBT training began in New Zealand in 1992 with the presentation of the first Primary Certificate course. Courses were organised on an annual basis from New Zealand, using presenters from Australia and New Zealand, with certification provided by the Australian Institute for Rational-Emotive Therapy.

In 1997, the New Zealand Centre for Rational Emotive Behaviour Therapy was established, in order to promote REBT in this country and provide training for helping professionals that was directly related to the New Zealand situation.

 The Centre can be contacted as follows:

•  Postal: PO Box 2292, Stortford Lodge, Hastings, New Zealand.

• Phone: 64-6-870-9963    Fax: 64-6-870-9964

• E-mail: click here

• Internet: www.rational.org.nz

Rational Self-Analysis

REBT emphasises teaching clients to be their own thera­pists. A useful technique to aid this is Rational Self-Analysis (Froggatt, 1993) which involves writing down an emotional episode in a structured fash­ion. Here is an example of such an analy­sis using the case described earlier:

 A.     Activating Event

The event: Friend passed me in the street without acknowledging me.
My inferences about this event: He’s ignoring me and doesn’t like me. I could end up without friends forever. I’m not acceptable as a friend.

 C.     Consequence (how i reacted):

Feelings: worthless, depressed.
Behaviour: avoiding people generally.

 B.     Beliefs (My evaluative thinking about the ‘A’):

1. It would be terrible to end up without friends for ever.

2. Because I’m not acceptable as a friend I must be worthless as a person.

3. To feel worthwhile and be happy, I must be liked and approved by everyone significant to me. (rule)

 E.     New Effect (how i would prefer to feel/behave): Disappointed but not depressed.

 D.     Disputing (new rational beliefs to help me achieve this new reaction):

1. There’s nothing to prove I’ll never have friends again – but, even if this did happen, it would be unpleasant rather than a source of ‘terror’.

2. There’s no proof I’m not acceptable as a friend – but even if I were, this proves nothing about the total ‘me’, or my ‘worthwhileness’. (And, anyway, what does ‘worthwhile’ mean?).

3. Love and approval are highly desirable. But, they are not absolute necessities. Making them so is not only illogical, but actually screws me up when I think they may not be forthcoming. Better I keep them as preferences rather than demands.

 F.      Further Action
          (what I’ll do to avoid repeating the same irrational/thoughts reactions):

1. Go and see my friend, check out how things really are.

2. If he doesn’t want me as a friend, I’ll start looking elsewhere.

3. Re-read material on catastrophising and self-rating.

4. Challenge my irrational demand for approval by doing one thing each day (for the next week) that I would normally avoid doing because of fear it may lead to disapproval.

Go back to Anapsys Counselling Services to know more about Cognitive Behavioural therapy services and CBT training

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