Incorporating Rational Emotive Behaviour Therapy (REBT) into your Counselling

REBT was developed by American psychologist Albert Ellis in the 1950’s and although it is clearly a close relative of CBT, was developed prior to the most popular form of therapy delivered today. It is in fact the first cognitive behaviour therapy developed. Ellis’s theory suggests that humans have both rational (constructive, meaningful, socially promoting) thoughts and behaviours but also irrational (destructive, self-defeating, socially defeating tendencies to go alongside these. An example could be the client who, whilst wishing to be involved in a loving, trusting and meaningful intimate relationship simultaneously, questions and ‘defeats’ all potential suitors by finding flaws in their characters and so avoids the risk of ever being hurt, rejected, and failing at actually being in such a relationship. In REBT we might try to identify the underlying thoughts and assumptions the client has, let’s say these are: ‘People cannot be trusted, they always have another agenda, if someone better comes along, they will always leave me’ and so on. As the REBT counsellor, we are looking for a more rational way of thinking about this situation for our client, something along the lines of: ‘to love truly there is always risk, I cannot be absolutely certain of someone’s fidelity and connection to me, I can only love and accept if they are right for me, we will make it work and worrying about something I cannot control does not help me’.

Rational emotive therapy in laymen’s terms seeks to replace thoughts which are present, in all of us at times, and at the same time irrational. For example, if a client is incensed by careless, selfish drivers who pull out suddenly in front of them, in this scenario they are saying: “I cannot stand it when…’ and by extension: ‘Everyone should be respectful to me’. The thoughts are clear and present but nevertheless irrational. A therapist could ask me: ‘why would you think everyone should be polite to you?’ and ‘can you really not stand it?’. It would make sense for the client to try and work out a realistic, clear, and yet rational alternative. So, using our example, the client might work out some new thoughts, that are more rational e.g.: ‘I can stand it… I just don’t like it’ and ‘although I’d like all people to treat me with respect, I accept that some of them will not’.  Note that here, the essential element of still being annoyed when someone in some way treats you carelessly or even mistreats you is kept in the new thought. We are attempting here to modify the thinking into a more rationale form only- not to deny annoyance as if it didn’t exist. In practical terms, many clients will find this a very useful and repeatable way of tackling an affecting issue such as road rage/anger management.

In terms of the evidence, we could take a look at generalised anxiety disorder (GAD) and REBT as a treatment modality. Schenk and colleagues (2020) studied GAD in medical students and the effects of 8 sessions of REBT on irrational beliefs and level of anxiety amongst the students. Both were both practically and statistically significantly lowered in the participants. The applications of REBT research present some other interesting possibilities in relation to the therapy’s anxiety lowering effects, for examples: amateur student athletes (Karar et al, 2023), golfers (Turner et al, 2020), rugby match officials (Maxwell-Keyes et al, 2022) and inmates adjusting to incarceration (Junaedi et al, 2022). It would seem that given the diversity of these research context and the positive results where anxiety exists, the notion of REBT may well have a place in treatment.

Moving away from anxiety, REBT has also been employed in post-traumatic stress resulting from natural disasters (e.g., Ede et al, 2022). In Ede et al’s work, around a hundred victims from flooding in Nigeria were treated with manualised REBT, and subsequently their levels of PTSD were significantly reduced compared to waitlist controls.  Work has also been carried out suggesting that treating teens with REBT for depression may well be an effective modality.

Still further and diverse applications include REBT (compared with Acceptance Commitment Therapy) for reducing hoarding behaviour and problems associated with hoarding, i.e., hoarding is considered a sub-type of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD), and REBT may well fit the bill for treatment in this area as well (Fang et al, 2023).

It is Interesting to consider that the number of potential problems affected by human interpretation of a given situation and our underlying personality traits are likely to pave the way for an effective treatment which essentially seeks to help us accept that we often have irrational thinking and that we can also adjust this thinking somewhat to develop similar yet more rational and helpful thoughts to effect positive outcomes for many areas of ‘adversity’ and ‘psychological disturbance’.

In REBT the basic premise is that psychological disturbance or adversity are tackled using the ABCDEF/model. An example is presented in the table below:

A key component here is making sure the beliefs that underly any disturbance or adversity are made clear before you move onto disputations and creating effective new beliefs.

Ellis was far from thinking that REBT was the answer to everything:

‘I hope I am also not a devout REBTer, since I do not think it is an unmitigated cure for everyone and do accept its distinct limitations’.  Albert Ellis (2005)

Additionally, Ellis proposed four core irrational beliefs to which clients (humans) often fall prey:

• Demands: The tendency to demand success, fair treatment, and respect (e.g., I must be treated fairly).
• Awfulizing: The tendency to consider adverse events as awful or terrible (e.g., It’s awful when I am disrespected).
• Low Frustration Tolerance (LFT): The belief that one could not stand or tolerate adversity (e.g., I cannot stand being treated unfairly).
• Depreciation: The belief that one event reflects the person as a whole (e.g., When I fail it shows that I am a complete failure).

When you read the above, naturally some more rational versions of these beliefs may occur, ‘I would like to be treated fairly but accept sometimes I will not be’, ‘It is not nice when I am disrespected but it happens and I can move on’, ‘I can stand it, I just don’t like it’, and ‘I do not get everything right, like other people, but it does not mean I fail at everything’ and so on. The idea here you will note is to make sure the new belief is rational and helpful- it does not deny the client’s feelings.

How is REBT juxtaposed with CBT?

As we state earlier, REBT predates CBT (by about ten years). Five distinguishing factors are highlighted below which point out the philosophical difference between the two approaches, For example, the client suffering anxiety over asking someone out on a date. The client might be nervous because they’re not sure she’s interested, i.e., ‘she didn’t smile much at me so she’s not interested’ which would be described as ‘Mind reading’ in CBT. In REBT, we would look at the underlying reason you jump to such a conclusion, i.e., ‘I absolutely must not fail at getting this date and I could not stand it if she did, I would be a loser’. Yet giving up the absolute need to have to be accepted would lower fears of social rejection all around and this, of course, is different to just avoiding mind-reading.

REBT also acknowledges ‘secondary disturbance’ essentially, the notion that in secondary disturbance we are worried about worrying. Arguably, this is ignored in CBT but focussed on in REBT.

Thirdly, unconditional self-acceptance is part of REBT (CBT is more likely to rate and compare) and where unconditional self-acceptance is employed the client is encouraged to accept themselves as flawed; they are imperfect and asking a girl on a date is contextual it does not translate into the rest of you being a failure.

A fourth difference is embracing helpful negative emotions. REBT is arguably unique in the CBT therapies for dividing emotions into unhelpful negative and helpful negative feelings: Anxiety, depression, and anger are examples of unhelpful negative and intense sadness, deep sorrow, concern, and regret are examples of helpful negative emotions.
Finally, CBT views anger, in certain circumstances, as healthy and REBT does not. REBT works on absolutes, ‘I must never’ ‘they must never’ i.e., ‘no one should ever treat me badly or I cannot stand it’. In REBT the focus is on alternatives to anger, assertiveness, problem solving for examples.

The similarity then, is that both approaches focus on the way feelings and emotions and behaviours interact. Both are cognitive therapies and follow on from the idea first encapsulated by the stoic philosophers (Epictetus and Marcus Aurelius for examples) that, it is not the situation that causes X, it is our interpretation and processing/handling of the situation. This in turn doesn’t mean that either CBT or REBT practitioners are failing to acknowledge the difficulty many clients face, merely that the focus is on how to handle thinking in a more productive and helpful way then the position they are often in, when they arrive for counselling.

References

1. Ede, M. O., Adene, F. M., Okeke, C. I., Mezieobi, D. I., Isiwu, E. N., & Abdullahi, Y. (2022). The effect of rational emotive behaviour therapy on post-traumatic depression in flood victims. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 40(1), 124-143.
2. Edelstien, M. (2017). 5 Major Differences Between REBT & CBT. Psychology Today, https://www.psychologytoday.com/us/blog/the-three-minute-therapist/201703/5-major-differences-between-rebt-cbt.
3. Ellis, A. (1996). Reason and Emotion in Psychotherapy: A Comprehensive Method of Treating Human Distrubances. Citadel.
4. Ellis, A. (2005) The Myth of Self-Esteem, 2005, p258
5. Fang, S., Ding, D., Zhang, R., & Huang, M. (2023). Psychological mechanism of acceptance and commitment therapy and rational emotive behavior therapy for treating hoarding: Evidence from randomized controlled trials. Frontiers in Public Health, 11.
6. Kara, E., Türküm, A. S., & Turner, M. J. (2023). The Effects of Rational Emotive Behaviour Therapy (REBT) Group Counselling Program on Competitive Anxiety of Student-Athletes. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 1-18.
7. Maxwell-Keys, C., Wood, A. G., & Turner, M. J. (2022). Developing decision making in Rugby Union match officials using rational emotive behavior therapy (REBT). Psychology of Sport and Exercise, 58, 102098.
8. Schenk, A., Popa, C. O., Olah, P., Suciu, N., & Cojocaru, C. (2020). The efficacy of rational emotive behavior therapy intervention in generalized anxiety disorder. Acta Marisiensis-Seria Medica, 66(4), 148-151.
9. Turner, M. J., Ewen, D., & Barker, J. B. (2020). An idiographic single-case study examining the use of rational emotive behavior therapy (REBT) with three amateur golfers to alleviate social anxiety. Journal of Applied Sport Psychology, 32(2), 186-204.
10. Junaedi, F., Hanurawan, F., JanuSetiowati, A., & Ramli, M. (2022). Reducing the new inmates’ anxiety through rational emotive behavior therapy with patronage counseling technique. Emerging Science Journal, 6(2), 306-321.