Question 1

Question 2

Is REBT effective in reducing anger?

Kristene Doyle · Accepted Answer

A recent meta-analysis of REBT outcome studies found that anger was one of the problems for which REBT was effective.  REBT interventions for anger include helping the client do a hedonic calculus of the costs and benefits of their anger to increase their motivation to change, as many angry clients blame others for their problems and do not accept the idea that their beliefs make them anger. REBT would focus on challenging, demanding beliefs in the cognitive part of the therapy. Also, we would include assertiveness and social skills training to help the angry client learn new behaviors to use instead of verbal aggression.

Question 3

Is REBT indicated for individuals with multiple psychological comorbidities?

Raymond DiGiuseppe · Accepted Answer

Most of the clients we see at the Albert Ellis Institute have numerous presenting diagnoses and presenting problems. A recent study using our patients found that more than 60% had a personality disorder in addition to another problem; more than 50% of our patients had more than one personality disorder. Because REBT is a transdiagnostic approach to psychotherapy, it is easily adapted within the course of treatment to multiple problems.

Question 4

Will REBT help a client who believes that the external environment needs to change in order for them to regulate their emotions?

Kristene Doyle · Accepted Answer

A core tenet of REBT is that it is not events, people, or situations (i.e., the external environment) that largely contributes to one’s emotional disturbance, but rather it is the way in which the individual evaluates the environment that results in either an unhealthy or healthy emotional response.  Many individuals come to therapy believing if the external environment changed, they would no longer experience dysfunctional emotions, commonly referred to as A-C connections.  While REBT recognizes that one’s external environment will play a role in contributing to an emotional reaction, it places more emphasis on the thoughts and beliefs one holds about the external environment that will determine the emotional response.  REBT can help clients who hold A-C connections; however, the process may take longer as therapists will need to explain the link between beliefs and emotional and behavioral reactions.  Agreement on the goals and tasks of therapy is established through a process referred to as motivational syllogism, where clients are taught the Beliefs-Emotional/Behavioral Consequences connection.

Question 5

What is the ABC Model?

Raymond DiGiuseppe · Accepted Answer

Albert Ellis’ theory of emotional and behavioral disturbance is described through the ABC framework (Activating Event-Beliefs-emotional and behavioral Consequences).  The ABC model highlights how core irrational beliefs (Demandingness, Frustration Intolerance, Awfulizing/Catastrophizing, Global Rating of self, others, and life) largely contribute to dysfunctional, unhealthy negative emotions (e.g., anxiety, unhealthy anger, depression, guilt, shame, jealousy, hurt) and maladaptive behaviors (e.g., procrastination, abuse of substances, verbally and physically lashing out at others).  Many individuals believe that activating events create one’s disturbed emotions and actions.  The ABC framework is an empowering model in that it highlights the idea that in the face of uncontrollable adversity, individuals have control over their beliefs, and subsequently their emotions and behaviors.

Question 6

Question 7

Is REBT an evidence-based intervention?

Kristene Doyle · Accepted Answer

REBT has a considerable degree of scientific support for the theory and therapy. More than 40 inventories have been developed that assess Ellis’ irrational and rational beliefs. Several meta-analytical reviews have provided evidence that irrational beliefs are positively correlated with emotional and behavioral disturbance and that rational beliefs are negatively correlated with distress and positively correlated with measures of positive well-being.  Mediational statistical analysis has also confirmed Ellis’ hypothesis that demandingness is the core irrational belief that gives rise to awfulizing, frustration intolerance, and self-condemnation irrational beliefs in leading to psychological distress.

The first meta-analysis of psychotherapy outcomes by Smith and Glass in 1977 found REBT to be the second most effective psychotherapy after systematic desensitization. Because REBT is the foundational form of CBT, and often has been called CBT in the literature, many studies that claim to test the effectiveness of CBT have incorporated a combination of classical REBT components with interventions from other forms of CBT. Thus, it is often challenging to know whether a study tests REBT or general CBT.

If we focus on studies that clearly state that they are studying the outcome of REBT, there have been more than 300 outcome studies going back to the 1960s. Six qualitative reviews of the REBT outcome literature have appeared between 1977 and 2005. Also, 4 meta-analytic reviews have appeared that explicitly focused on REBT outcome studies. The most recent meta-analysis of REBT outcome studies has also provided strong support for the therapy.

Much of the REBT outcome research is old and was done before more exacting standards of studies was developed. Recently, several studies have appeared that meet the criteria set by the National Institute for Health and Clinical Excellence Guidelines, and the Research Supported Psychological Treatments List of the Division of Clinical Psychology of the American Psychological Association (APA). These studies offered empirical support for including REBT as a probably efficacious treatment for depression.

Those interested in reviewing the evidence in support of REBT can consult the Albert Ellis Institute website at https://albertellis.org/research-articles/

Question 8

Are there any groups of people or presentations where REBT is contraindicated?

Raymond DiGiuseppe · Accepted Answer

REBT is effective for a wide variety of problems, as it is one of the first transdiagnostic psychotherapies.  However, REBT is unlikely to change the symptoms of some behavioral disorders. These include the symptoms of Attention Deficit-Hyperactivity Disorder, tic disorders, and Tourette Syndrome. But, REBT can help those with such disorders better accept themselves and address their shame and depression about having these problems. REBT will be of limited benefit to those people with severe cognitive impairments who do not have the verbal ability or self-awareness to think about their thinking. We have had no evidence that REBT works with people with Antisocial Personality Disorder or psychopathy.  However, some new approaches to conceptualizing the ABC mode for those who committed criminal acts are being investigated by Chip Tafrate. 
Psychosis is a problem that many people think is unresponsive to psychotherapy. Several studies have attempted to treat psychosis and demand hallucinations with a combination of REBT and beck’s Cognitive Therapy.  This studies and references to several treatment manuals are available at http://albertellis.org/rebtcbt-psychoses-manuals/

Question 9

Is CBT or REBT more effective for anxiety disorders?

Raymond DiGiuseppe · Accepted Answer

This issue represents a very controversial topic. There is a loud voice in the psychotherapy community that claims that all psychotherapies are equally effective. However, others have argued that the data support the superiority of a CBT/REBT approach. We would take the side of this scientific debate that espouses that the CBT therapies are more effective in treating anxiety than other behavioral therapies. From its inception, REBT has been a treatment for anxiety.  The traditional REBT approach would help clients identify the negative automatic thoughts and the irrational beliefs experienced when the clients are anxious.  REBT would not focus on the negative automatic thoughts.  We would see that challenging the probability that unfortunate events might occur as equivalent to a safety behavior.  We would challenge the imperative and evaluative irrational beliefs that led to anxiety. Also, REBT would always include exposure to the feared stimuli as part of the therapy and particularly assess any irrational beliefs concerning discomfort intolerance that would interfere with the client doing exposure homework assignments between sessions.

Question 10

Is there a core effective component of REBT?

Kristene Doyle · Accepted Answer

Several elements of the theory are at the core of REBT. The first of these is the A- B- C model that Ellis developed in the mid-1950s. This identifies that beliefs, not events lead to emotional disturbance. Second, REBT emphasizes what Ellis called the elegant or philosophical solution to psychological distress and behavioral problems. That is REBT focuses on changing the imperative (demands) and evaluative beliefs that people hold rather than trying to challenge their erroneous beliefs and cognitive errors that adverse events might or have occurred. Third, the core of REBT is acceptance; and there are four types of acceptance.  The model stresses that people are more adjusted if they accept reality as it is and plan to cope with it. Self-acceptance of who you are is a central part of REBT. The model does not recommend countering self-condemning beliefs by increasing self-esteem. Unconditional self-acceptance or USA means you acknowledge who you are with your faults and recognize that humans are not ratable.  Unconditional other acceptance means that you realize that condemning others leads to anger and contempt. Finally, REBT teaches that we accept our subjective emotional experience as part of reality. We can learn to tolerate our feelings and to pursue life, even if it is hard and uncomfortable.

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