rational emotive behavior therapy: philosophy and application · rational emotive behavior therapy:...

Rational Emotive Behavior Therapy:

Philosophy and Application

Mark S. DeBord, LCSW, LLC

www.markdebord.com

Rational Emotive Behavior Therapy

proposes that psychological disturbance is largely

created and maintained through irrational

philosophies consisting of internal absolutistic

demands. This therapy strives to produce sustained

and profound cognitive, emotive, and behavioral

change through active, vigorous disputation of

underlying irrational philosophies and the

development of rational alternatives.

• Sacks, Susan Bendersky. Rational emotive behavior therapy: disputing

irrational philosophies. Journal of Psychosocial Nursing and Mental Health

Services. (May 2004) Vol. 42 Issue 5.

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Epictetus in 1st Century A.D. – People are

disturbed not by things, but by the views

which they take of them.

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Objectives1.Participants will discuss the philosophical

underpinnings of REBT.2.Participants will understand and be able to

use the ABC model of REBT as a core component of therapy.

3.Participants will consider how REBT is used to address a variety of disorders/ clinical presentations.

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REBT Philosophy• Epistemology – theory of knowledge (search for the

truth)

• Dialectics – art of reasoning – art of logical thinking

• Survival and enjoyment are valued (REBT

encourages long range hedonism vs. short-term)

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Sub-Values1. Self-interest – may give of themselves to some degree for

others, but not completely

2. Social-interest – protecting rights of others helps us survive

together

3. Self-direction – it is best to assume responsibility for ourselves

vs. demanding that we have excessive support from others

4. Tolerance – allowance for our self and others to be wrong or

make mistakes

5. Flexibility – rigidly held beliefs get in the way of happiness

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Sub-Values6. Acceptance of uncertainty – the world is fascinating and full

of probability and chance; absolute certainties do not exist. Order is helpful, but complete predictability is not possible nor necessary.

7. Commitment – people are generally happier when vitally absorbed in something outside themselves – a creative interest and/or significant interpersonal involvement

8. Self-acceptance – unconditional self-acceptance (USA) is more conducive to satisfactory life vs. a constant demand to prove one’s self/ measure / rate – Ellis was against rating one’s self at all, but in favor of rating behaviors. A person is too complex to be given a global evaluation.

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Sub-Values9. Risk-taking – emotionally healthy people are willing to take

risks and live life as adventure whether more conservative or

risky

10. Realistic expectations – healthy people do not strive for what

is not possible – we cannot get all we want

11. High frustration tolerance – lump it when you don’t get what

you want – do what you can, accept the rest

12. Self-responsibility – avoid blaming others - take responsibility

for the solution by being responsible for your own thinking,

emotions and behaviors

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REBT Philosophy• Epistemology – theory of knowledge (search for the

truth)

• Dialectics – art of reasoning (Gift from God) – art of

logical thinking

• Survival and enjoyment are valued(REBT

encourages long range hedonism vs. short-term)

• Will and choice of an individual is important

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REBT does not teach self-discovery,

but rather self-construction. REBT

views the client not as an entity to

be found, but one who is an ever developing being.

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REBT Philosophy• Epistemology – theory of knowledge (search for the

truth)

• Dialectics – art of reasoning (Gift from God) – art of

logical thinking

• Values – survival and enjoyment (REBT encourages

long range hedonism vs. short-term)

• Will and choice of an individual is important

• Ethics – treating others well (contrary to what some

think, REBT is not blindly hedonistic, it does recognize

that when you treat others well, it increases the

likelihood of being treated well)

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REBT Principles• Cognition is the most important proximal

determinant of human emotion.

• Irrational thinking is a major determinant of

emotional distress.

• The best way to conquer distress is to change

irrational thinking.

• Multiple factors impact one’s emotions (biology,

genetics, environment, culture, etc.), but humans

have a tendency to think both rationally and

irrationally. It may be that there are short-term

benefits from irrational thinking.

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REBT Principles• Emotions have purpose. Negative emotions, in

particular, tend to be a cue that there is something wrong – much like physical pain lets us know there is something wrong.

• Although people may have developed dysfunctional patterns of thinking in reaction to experiences or education, the reason people continue in their dysfunctional thinking patterns is continued indoctrination/ rehearsal and refusal to challenge them.

• People can change those dysfunctional thinking patterns, but it generally takes persistent, active practice to think in alternative fashion – one of the ways to cement the new belief is to act on the belief – act as if…..

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Core Irrational Belief• Demandingness

oFrustration Intolerance – choosing short-term comfort or pain avoidance

oHuman Worth Ratings – thoroughly judging ourselves or others based on too little information and ignoring potential

oAwfulizing/ catastrophizing: un-survivable

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Assumption

People generally want to be reasonably happy and/or content and disturbing emotions and behaviors interfere with that goal.

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Modern Philosophical

InfluencesBeara, Vladan. The Contribution of REBT in Addressing the Givens of Existence. Journal of Rational Emotive Cognitive Behavior Therapy (2015) 33:179-197.

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Existentialism• Existentialists focus on the “individual in the world”

• There is no meaning to be found, only that which

we give it. The meaninglessness also encompasses

the amorality or unfairness of the world and it is only

when we ourselves see this and experience the

pain that comes from facing the meaninglessness

that we can begin to live authentically.

• Existence means that individuals are independently

acting and responsible, conscious beings. Existence

has to do with self-making/ constructing. Existence

is free and uncertain.

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Victor Frankl - Logotherapy

• Teaches that human freedom is not

freedom from the conditions of the world,

but free to form an attitude toward the

conditions of the world.

• REBT is in agreement and encourages

people to accept the very things that they

often unacceptable.

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Irvin Yalom – 4 Ultimate Concerns

1. Death

2. Freedom and Responsibility

3. Existential Isolation

4. Meaninglessness of Life

Confront by deep personal reflection that results in

adopted beliefs (assignment of meaning) about these

concerns that lead to a more adaptive, productive,

and satisfying life or one more full of anxiety and

dread.

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Jean Paul Sartre• How do we make sense or make peace with the

fact that other people so often act stupidly,

irresponsibly, sneaky, mean, envious, unwilling to

help, etc.? At a certain point the task is to accept

that other people are fallible and imperfect. But

then we have to face the same in ourselves.

• Finally, we have to face the conflict with God or the

universe. How do we make sense or make peace

with God for making the world as it is?

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REBT thought• REBT teaches clients how to use a strong

preferential rather than imperative; to

unconditionally accept self, others and the world.

• This is important as we often want to believe that

people are basically good, that there is meaning in

the world and it is benevolent, that there is justice,

and there is predictability. Where this does not

match with our reality, suffering results and we do

not like suffering!

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Facing Death• Yalom – death anxiety is the mother of all religions.

• Martin Heidegger – once one is born, they are old enough to die and the awareness of that mortality gives value to life such that we shift to a higher state of mindfulness and authenticity.

• Seneca – no man enjoys the true taste of life but he who is willing and ready to abandon it.

Facing death makes us appreciate life.

Dealing with death carries a great potential for traumatization, but also a potential for post-traumatic growth.

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Viktor FranklThere are no certainties.

We are not free from condition: biological,

environmental, psychological or social.

We are free to take a stand as to how we will respond

to these conditions. The happier people were the

ones who reached out to help their fellow human.

(Man’s Search for Meaning Viktor Frankl – 1945)

(Happiness Is…. Shawn Christopher Shea - 2005)

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Facing Freedom and Responsibility

Existential angst is a negative feeling

arising from the experience of human

freedom and responsibility, while despair

is generally defined as a loss of hope to

be what one defined one’s self to be.

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REBT thoughtAlthough many attempt to deny responsibility,

there is a general assumption that

responsibility for one’s self is a precondition of

therapeutic change.

Unwanted events may have an important role

in how we feel, but the disturbance comes

from our present cognitions, beliefs and

assigned meaning we give those unwanted

events.

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IBs vs. RBs Associated with Freedom and Responsibility

1. that there is an invariably right, precise and perfect solution to human problems and that it is awful if this perfect solution is not found is. REBT teaches that there is no human perfection and no human certainty.

2. that one must be competent, adequate and achieving in all important aspects or else he or she is an inadequate, worthless person. REBT teaches that all of us can and do easily fail.

3. that if there is no absolute certainty in life, then one cannot and must not face life responsibilities and difficulties and that it is easier to avoid them. REBT teaches that just because there is no absolute certainty, humans still have responsibility to make decisions. Actually avoiding being active in our own lives can lead to even greater suffering. It is like being at sea being tossed by the waves without having our rudder and engines at work to navigate our course. Quest for certainty is futile. There are no perfect solutions. It is in the discomfort that we have the opportunity to grow.

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Facing Existential Isolation

Yalom: Interpersonal isolation (loneliness);

intrapersonal isolation (do not understand or may

even deny parts of ourselves); and existential isolation

(separation from others and the world as a whole).

Heidegger: We are birthed into the world alone and

we exit alone. There are times in life when one

experiences de-familiarization – one’s role or situation

changes to the degree that one no longer feels at

home in the world – many phases of life require

adjustments/ redefining in life.

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Facing Existential Isolation

This feeling of aloneness drives us to connect and to be a part.

Unfortunately, we will connect with many things to end that discomfort that may make the long-term consequences worse. But it can also draw us to God and to other worthy pursuits.

But make no mistake, even that does not make a way to avoid suffering, it only makes a way for more meaning and the hope in the suffering.

If we are able to acknowledge our isolated situations and confront them with resoluteness and authenticity, we will be able to turn lovingly toward others.

A relationship at its best involves individuals who relate to one another in a need-free fashion.

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Facing Existential Isolation

• Camus: Isolation must be experienced before it can be overcome/ transcended. It is the ability to recognize the discomfort of aloneness and overcome the longing to flee, that allows us to mature, accepting that existential isolation.

• Believing in a deity that loves us, that takes care of us, that has a plan for us and will never abandon us probably has a potential to diminish the sense of existential isolation. This likely also prompts us to reach out and engage other people who are participating in the same experience. If in nothing else, this binds us together.

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REBT: IBs associated with isolation:

1. that the world should be and must be different

than it is – including feeling isolated/ lonely

2. the world owes us something and should not,

must not frustrate us, especially unnecessarily –

it should and must provide a sense of comfort

and refuge

3. we should and must have a sense of familiarity/

belonging

4. there is a dire necessity to be loved or

approved by virtually every significant person

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REBT: RB associated with isolation:

We would do better to accept that we

may at times be alone in the world and

may find ourselves in unfamiliar territory,

but we are still responsible to self-make

by making choices and redefine our

purpose and meaning as life

circumstances change.

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Facing MeaninglessnessJung: the principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help him to acquire steadfastness and patience in the face of suffering.

Frankl: Humans seem to require meaning. Without it, we tend to be distressed (The Search for Significance – Robert McGee). Jung was in agreement who said that neurosis must be understood as a suffering soul which has not discovered its meaning.

Frankl: Life can be made meaningful by what we contribute (work or creativity); what we take (experiences, sensations) and the stand we take on the destiny that is our reality (tragedies, unfortunate events). Life until its very end is meaningful …..

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Just World HypothesisMelvin J. Lerner: We are deeply threatened by the

possibility of bad things being able to randomly

happen to us. Humans want predictability.

When people experience trauma, they often

want to make sense of the traumatic event by

understanding what happened, how it happened

and why it happened.

At the very least, they want to find personal

significance in the event or gain something for

their present life from the experience.

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REBT Thought

• REBT would ask what kind of life would have

meaning for you. It seems that crises of

meaning are inherent to the normal process of

maturation. Crises of meaning are a threat, but

they also represent a chance for obtaining a

new quality of life and wisdom.

• Life is difficult!

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Session Structure1.brief check on current emotional status

2.review homework

3.set goals for the session

4.assessment of self-defeating (irrational)

beliefs using the ABC model

5.disputation

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Session Structure6. rational alternatives

7. problem-solving and skill building

8. review salient points of session

9. assignment/ agreement on homework

10.client feedback

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REBT General Goal

Acceptance of self, others, and situation are general goals of REBT while working to improve our situation and increase our capacity/ efficacy.

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ABC Model of REBT

Activating Consequence

Event

Situations

Emotionaland

Behavioral reactions

Irritation, disappointment vs. anger, depression,

guilt, anxiety

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ABC Model

Activating Belief Consequence

Event System

Situations

I wish …I desire …I prefer …

Preference not met

I Must have PreferenceI must …

You must …The world must …

Positive Emotional/ Behavioral reaction

Negative Healthy Reaction

Negative Unhealthy Reaction

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Cognitions are wired into various schemas in order

that we might more efficiently function. Therefore,

often our thoughts are functionally unconscious

although may be accessible to the conscious. This is

actually adaptive until we run into difficulties where

the schema no longer works for us – then it pays to

analyze the thinking and processes we are using to

approach life in order that we might formulate new

schemas/ patterns of interacting and interpreting the

world such that we can better reach our goals and

get along more fluidly/ satisfactorily.

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Insights1. Our thinking/belief system has a tremendous influence on

how we react to an event or experience (feelings and

behavior).

2. Regardless of how we came to our belief system (think the

things we do), we keep that belief system alive by repeating

the thoughts to ourselves and acting upon them; thus,

reinforcing them and refusing to challenge their validity and

effectiveness.

3. To change disturbed feelings and behaviors, change the

thinking and practice practice practice!

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REBT

Thinking irrationally is the human condition. We are all born with a tendency to think irrationally and rationally – self-defeatingly and in our self-interest.

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REBT

Our emotional and behavioral

responses are largely caused/

affected by our conscious and

unconscious evaluations,

interpretations and philosophies.

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Distinction between healthy and

unhealthy negative emotions

• Concern vs. anxiety

• Sadness vs. depression

• Remorse vs. guilt/ shame

• Annoyance/ irritation vs. anger/ rage

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Development of an EmotionDevelopment of Emotional and Behavioral Reactions 05/30/2010 Mark S. DeBord, LCSW

Issue/ Event/ Situation

Perception is

Good!

Is

G

Emotional Result

Is Pleasant!

Perception is

Bad!

Perception is

Bad!

What a catastrophe!

This is

unovercomeable!

What a

Loser!

I can’t stand this!

Emotional Pain:

anxiety, guilt,

anger, and

depression.

Ineffective Behaviors:

aggression, inactivity,

distancing, worry, self-loathing

As bad as this may be, blessings

and good remain - now and in

future possibilities!

Although I don’t like it when I

do, everyone makes mistakes.

As bad as this may be and as

much as I don’t like it, I can

stand it and God can handle it!

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Emotional Pain:

concern, remorse,

irritated and sad.

Effective Behaviors: problem-solving, ask

for change, plan for similar events,

connect with others, learn, make choices

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Disputation Strategies

• Cognitive – philosophical persuasion by way of

Socratic questioning and/ or didactic dialogue

• Emotive – Rational Emotive Imagery – forceful

expression of the rational alternative

• Behavioral – bibliotherapy, exposure, response

prevention, role play, journaling, acting as though

giving advice to a friend

• Functional – examining whether or not the thought

or belief works over the long-run

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Should, Ought, Must(Red Flag Words?)

Indications of IBs are often seen in words such as

should, ought and must.

The challenge is to differentiate between what is

advisable vs. what is mandatory!

Therapists new to REBT may find themselves seeking

these words and disputing those statements

indiscriminately which is generally confusing for the

client and may lead to an alliance rupture.

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Replacement/ Alternative Rational Beliefs

It is not enough just to do away with the irrational

belief, but we want to replace it with a rational

alternative.

The alternative belief is to negate the must, affirm the

desire, counter the FI/ catastrophizing/ self-

denigration/ other-denigration; and develop a

behavioral (solution-focused/ problem-solving)

strategy to get more of your desire/ preference met

and accept what is not yet realized.

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Clients often want:• The situation to change.

• A perfect solution.

• A guaranteed outcome upon making a thought-out decision.

• A solution without effort.

• To avoid discomfort of any kind.

• Others to act differently.

• Others to see things the way you or even most people see things.

• The world to give them what they want or at least more of what they want.

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Homework• Homework has always been a big part of

REBT to assist with the continued recovery

and application of therapy outside the

sessions.

• However, people often do not do it! If you

ask about it each time without judgement, it

implies that it is important – at least

important enough for you to ask about it.

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Problem-solving/ Solution-focused

Following disputation, problem-solving and skill

building become the focus with much ebb and flow to

assist with the overall application and prompting of

behavioral change.

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Discontinuation of Services

When client achieves goals and/or is able to be own

therapist using the bibliotherapy and other techniques

taught in treatment.

When there is a change in level of distress (Likert

Scale/ PCOMS/ other outcome measure), a change

in behavior, reports of others, ability to accurately

complete self-help forms, etc. Client perception most

importantly.

Booster sessions may be helpful.

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Random thoughts in conclusion

• Cannot keep thoughts from crossing our minds, but we

certainly can do something with them once they do.

• Basically REBT is a psycho-educational model that teaches

clients to be their own therapists/ how to manage their

emotions and behaviors.

• Get and use feedback. Allow client’s voice to be heard.

Negotiate with them.

• Insight (how one gets to a place) may be nice and even

helpful, but without learning how to change the beliefs or

learning a new helpful thought, it may not be enough.

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Q&AMark S. DeBord, LCSW, LLC

212 Cypress Street

West Monroe, LA 71291

318-381-9070

www.markdebord.com

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