Psychologist Dr. Albert Ellis developed Rational Emotive Behavioral Therapy (REBT; though still referred to in some circles as a Rational Emotive Therapy or Rational Behavioral Therapy) in the late 1950s as an alternative to the popular therapeutic schools of the time, Freudian psychoanalysis, and behavioral therapy. Ellis had been formally trained in psychoanalysis and studied behavioral therapy. He found them to be lacking in terms of their approach to understanding people’s problems, how they view the world, and the approach of both paradigms to help people make positive changes.
Ellis’s approach to therapy predated many now popular cognitive and cognitive behavioral therapy approaches by many years, even though REBT is generally considered to be a form of Cognitive Behavioral Therapy. REBT is not a static theory or principal. Ellis continued to work with clients and refine his approaches well into his 90s.
The ABC Acronym
In the late 1950s and early 1960s, behavioral psychology became increasingly more popular. The individual who revolutionized the approach to behavioral psychology and whose theories were widely applied to therapy was B.F. Skinner. Skinner’s approach was to observe, break down, and define the behaviors that animals or people displayed. He was most interested in what triggered a behavior and what the consequences for the actions of the organism were.
Unlike Freudian, Skinner thought he had no use for trying to understand people’s feelings, thoughts, their early past experiences, etc. Skinner’s logic was focused on what could be physically observed and manipulated, and not on specializations about internal states or thinking. This paradigm is associated with the famous reference to the brain as a “black box,” such that scientists can never really know what happens in the brain, but they can observe behavior. Of course, scientists today are learning more about the processes of the brain due to technological advances; however, prior to neuroimaging, the association of thoughts, emotions, and behavior consisted of speculation based on people’s self-reports and inferences made by researchers.
Skinner was simply interested in three observable aspects of the behavioral process:
- A: The antecedents of behavior reflect events that are occurring before the actual behavior occurs. In substance abuse recovery, people typically refer to these as triggers.
- B: The behavior itself – this covers what the organism actually does.
- C: The consequences of the behavior – what happens as a result of behavior? Skinner eventually focused on reinforcements of behavior – the contingencies that occur following the behaviors that are more likely to result in the behavior being repeated.
- A: You have a busy day at work. You expend a lot of energy but with few results. You appear drained and tired at the end of the day.
- B: After work, you go to the bar and drink.
- C: The bar and drinking in a relaxed atmosphere make you feel that you are able to express yourself and be at ease.
Going to the bar is reinforced by giving you back energy and relieving the stress of the day. Drinking soon becomes a general reinforcer for many life instances.
While behaviorism was beginning to gain in popularity in the United States, Freudian psychoanalysis remained a standby approach in therapy. Even as late as the 1970s, over 90 percent of all psychiatrists were still trained in Freudian principles. In Freudian analysis, individuals are encouraged to look back into their early relationships as children, as these are believed to form the basis for later personality and behavior. According to Freud, much of the behavior people display as adults is a result of unconscious mental forces – forces that people were not aware of, but were driven by events experienced in childhood.
As a result, the causes of human behavior in Freudian thought was inferred from mental events that could not be directly observed. Thus, Freudian psychology and Skinnerian behaviorism were polar opposites. Freud concentrated on long-buried perceptions of childhood experiences, whereas behaviorists only concentrated on what was going on in the moment.
Ellis liked the emphasis on observable aspects of behavior in the behaviorist paradigm. Nonetheless, as he was trained in psychoanalysis, Ellis was also convinced that mental events, such as attitudes, feelings, and beliefs drove one’s behavior. However, Ellis eventually became dissatisfied with Freudian thought. While Skinnerian behaviorism relied on experimental evidence to support it, he was dissatisfied with its blatant ignoring of cognition (mental activity) and feelings (emotional activity). The REBT paradigm was his attempt to explain behavior as a result of his experiences with patients in therapy.
In Ellis’s conceptualization of REBT, the ABC acronym used in behavioral psychology remains but it is qualitatively changed:
- A: The activating event includes things that just happen in life (similar to the antecedents in the behavioral model).
- B: This is the belief about the activating event (totally different than the behavioral model).
- C: The consequences refer to either emotional and/or behavioral responses to the interaction of the activating event and one’s belief about the activating event (similar to the behavioral model but not quite the same).
- A: You have a busy day at work. You expend a lot of energy but with few results.
- B: You had another rough day at work. You believe that your boss is unfair, certain coworkers are against you, and no matter how hard you try, you can never truly get ahead. You need to relieve stress and forget your troubles.
- C: The rough day and your beliefs interact to produce stress, and you head to the bar to relieve stress because you know that drinking relieves your stress (or so you believe).
Over time, you generalize these beliefs to yourself, the world, and life in general. You continue to believe that life is stressful and unfair, and drinking is a way to relieve stress and escape from life. Drinking makes everything better (or so you believe).
Of course, there are a number of different scenarios that can occur for different people. However, the general difference is that REBT applies the principles of behavioral psychology to the individual’s belief system and expectations derived from cognitive theories of psychology.
How Beliefs Contribute to Both the Problem and the Solution in REBT
In REBT, the conceptualization of the driving force behind dysfunctional behavior, such as substance abuse, is not a mechanical force, such as reinforcement or unconscious conflicts developed in infancy, but a human failing. According to Ellis, many people develop irrational beliefs and irrational expectations as a result of their upbringing, demands from society, interactions with their peers, and even the educational system. People adhere to these beliefs in order to justify their actions and to explain how the world relates to them. Often, these beliefs and actions are functional and realistic; however, they are sometimes irrational and lead to problems.
REBT recognizes that everyone is different; however, Ellis believed that there were three general categories of irrational beliefs that typically resulted in issues like substance abuse, depression, anxiety, etc. These three categories are:
- Beliefs about oneself
- Beliefs about others
- Beliefs about life or conditions of the world
When these beliefs become irrational or become dysfunctional, Ellis referred to them as the three musts. For example, an irrational belief about oneself might be, “If I make a mistake, I’m a bad (or ineffective) person.” An irrational belief about other people might be, “Other people must treat me the way I want them to treat me.” An irrational belief about life would be, “If things don’t work out the way I want them to it’s a terrible situation.” These beliefs are the result of learned expectations. People can unlearn them if they can first identify and separate their irrational beliefs from their rational ones.
The goal in REBT is for clients and therapists to work together and identify the irrational thoughts/beliefs that clients have about themselves, about other people in their lives, and about the world in general. Once these irrational beliefs are identified, therapists challenge those beliefs, and clients and therapists work together to see just how irrational and dysfunctional these beliefs are. Moreover, these beliefs are tied into the specific issues that clients are having in their lives, such as issues like substance abuse.
Revising the ABC Model
In later REBT writings, Ellis and his students/followers expanded the ABC model to the more comprehensive acronym that offers a simple description of how the process of REBT works:
- A: activating events
- B: beliefs about the activating events
- C: consequences of the interaction of the event and the belief system
- D: disruption of the belief system by the client and therapist working together
- E: effects, emotions, and behaviors change as a result of new beliefs and therapeutic work to implement new consequences that are consistent with new beliefs
One of the biggest issues with explaining the rationale behind any psychological paradigm or therapeutic approach is that once it is simply explained untrained individuals are led to believe that the whole process is simple. Someone might think: “Oh! All I have to do is figure out where my thinking is going wrong and where my beliefs are going wrong; change them and everything will be fine.” The problem with that is, even though the basic assumption of a therapeutic paradigm like REBT can be explained rather simply, it is no simple matter to actually identify irrational thoughts, identify how they interact with behavior, and then actually change them. There are a number of reasons for this:
- Most people actually believe that what they believe is really true even if it seems to others to be totally irrational. People are resistant to changing their beliefs because they actually believe them.
- Irrational beliefs appear to work for the person, and even irrational beliefs sometimes appear to be true (e.g., even a broken clock will tell the right time twice a day).
- When things are partially true, people tend to remember the times when their irrational beliefs seemed true and not to recall or acknowledge the times when they are not (this is a well-known phenomenon called the confirmation bias).
- Even though the basic assumptions and approach can be simply explained, the actual practice of REBT requires extremely hard work, patience, overcoming many failures and setbacks, overcoming disillusionment, and the ability to accept certain things as they are. The therapeutic work in REBT can be emotionally exhausting.
- REBT attempts to have people change their irrational beliefs and also to accept certain facts about the world that are often ingrained in their irrational beliefs. For example, life is unfair at times.
Clients also learn to monitor themselves in the moment, a process commonly referred to as being mindful. One of the goals of REBT is to have clients realistically assess themselves, their motivations, their beliefs, and the world. This means that clients in REBT have to accept the good and the bad, and develop a realistic system to function in an imperfect world as an imperfect person. The process requires that therapists have a comprehensive understanding of general psychological principles, psychological assessments, applications of therapeutic principles, an intrinsic motivation to help people, and an empathetic attitude towards others.
Some Alternatives to REBT
REBT was designed to be used as a time-limited therapeutic approach, unlike Freudian psychology that is expected to last for years on end. Most of the time, the therapist will discuss the client’s presenting issues and then together the two set a general timeframe that will be used to address the client’s issues. More serious issues will require more time. However, therapists who are trained in REBT typically do not expect to have the same client in therapy for extended periods of time. Therapy can last a month to several months, depending on the presenting issues.
REBT can be performed in individual or group sessions, and has a large body of supportive research to attest to its effectiveness for a number of different issues, including depression, anxiety issues, substance abuse, etc. However, some individuals may prefer different therapeutic approaches for different types of situations. There are a number of different types of therapy available. A few options are:
- Cognitive Therapy and Cognitive Behavioral Therapy are both designed to address any number of issues including substance abuse and addiction. These therapeutic paradigms have a large body of research to support their use for many problems.
- Motivational Interviewing is a technique that is designed to help individuals who are resistant to treatment become motivated to change.
- Dialectical Behavior Therapy is a Cognitive Behavioral Therapy that is useful in the treatment of individuals with substance abuse issues who also have issues with suicidal thoughts or feelings of harming themselves. .
- Psychoanalytic Therapy can be used to treat a number of conditions. There is a brief model of psychoanalytic therapy that has been applied to depression, anxiety issues, and substance abuse.
- Gestalt Therapy is a type of therapy where individuals directly address their feelings and emotions.
- Certain behavioral therapies, such as exposure therapies and systematic desensitization, are useful in treating specific issues of anxiety.
- Medication management, such as using antidepressant medications, can assist any therapy program, if appropriate.
Many therapists combine aspects of certain treatments or therapies. Individuals in therapy or considering using therapy can always ask the therapist what approach will be used and discuss the treatment plan with the therapist. Therapy is a joint process, and clients in therapy need to understand therapists’ credentials, training and background, and overall approach. It is important that clients are proactive in their treatment as opposed to being passive and not understanding the therapeutic process.
Who Should Perform REBT?
Good therapists are made through years of training and experience. REBT is a specialized application of Cognitive Behavioral Therapy that can be very confrontational. Because many sensitive issues are addressed in REBT, it is important that an expert trained in REBT apply the principles to the therapeutic situation. Individuals interested in REBT should inquire about a therapist’s training in REBT in order to find those who have formally studied the techniques used.
A version of REBT is used in social support groups known as rational recovery groups. The SMART recovery system is an alternative to formal 12-Step groups, such as Alcoholics Anonymous, that have a strong religious or spiritual component. SMART recovery groups serve as alternative peer support meetings for individuals who want to apply some of the principles of REBT to their recovery.