Question 1

What is Rational Emotive Behavior Therapy?

Kristene Doyle · Accepted Answer

Rational Emotive Behavior Therapy (REBT) is one of the foundational psychotherapies that has come to be commonly known as Cognitive Behavior Therapy. However, REBT maintains several distinctive features.  Developed in 1955 by Dr. Albert Ellis, REBT is a short-term, evidence-based psychotherapy. REBT was the first CBT to emphasize the ABC model of emotional and behavioral disturbance. REBT helps individuals to identify the activating events (A’s), their beliefs about those events (B’s), and the resulting emotional and behavioral consequences (C’s). REBT teaches that disturbed emotional and behavioral consequences primarily result from irrational beliefs (i.e., demandingness about oneself, others, or the world, frustration intolerance, awfulizing/catastrophizing, and global ratings of worth) that individuals hold rather than from activating events. REBT works to alleviate emotional and behavioral disturbance by helping people to identify their irrational beliefs, recognize that their irrational beliefs are maladaptive and self-defeating, restructure and replace dysfunctional beliefs with more adaptive, self-preserving beliefs. This generates more adaptive but still negative emotions and/or behaviors in response to the negative adverse activating event. REBT focuses on underlying irrational beliefs rather than on automatic thoughts, inferences, or cognitive errors, and believes that rigidity in one’s thinking is at the core of psychological disturbance.  REBT is a directive approach that hypothesizes that certain types of beliefs cause or mediate disturbance, whereas other kinds of beliefs promote healthy psychological adjustment. REBT is a psychoeducational approach in that it teaches clients the skills of identifying, restructuring, and replacing their dysfunctional beliefs with healthier, adaptive ones. REBT is a transdiagnostic approach as it uses the A-B-C model to help people with various clinical problems. REBT is multimodal as it recognizes that clients can learn to believe, feel, and act differently through many strategies and methods. REBT utilizes different cognitive, emotive, imaginal, behavioral, and systemic strategies and interventions to affect change.

Question 2

What is Rational Emotive Behavior Therapy used for?

Kristene Doyle · Accepted Answer

REBT is a transdiagnostic treatment used for clinical problems, including anxiety, mood disorders, anger problems, eating disorders, personality disorders, childhood difficulties, procrastination, substance abuse problems, and relationship challenges, to name a few.  REBT provides a positive model of mental health, which helps people attain their personal goals and improve their lives. REBT helps people to promote a philosophy of life that acknowledges one’s responsibility for their emotions and behaviors, tolerate and overcome adversities, and achieve their goals.

Question 3

What are the goals of Rational Emotive Behavior Therapy?

Raymond DiGiuseppe · Accepted Answer

REBT strives to help clients achieve a more flexible philosophy of oneself, others, and living conditions through the scientific examination of beliefs.  REBT teaches individuals to become their own therapists through the active directive process of therapy.  REBT helps individuals reach their goals by addressing cognitive, emotive, and behavioral obstacles.   REBT typically addresses clients’ emotional and behavioral problems before working on practical issues, as it is hypothesized that learning and carrying out practical solutions will be impeded if there is an emotional disturbance.

Question 4

What is the difference between REBT and CBT?

Kristene Doyle · Accepted Answer

CBT is a superordinate term used since the 1970s to describe all of the psychotherapies that focus on changing present thoughts, beliefs, attitudes, cognitions, and schema that influence dysfunctional emotions and behaviors.  The term CBT has been used since 1976 when the Albert Ellis Institute sponsored the first CBT conference. Since then, the name CBT has been expanded to represent both cognitive and behavioral interventions.  The approaches that have historically fallen under CBT include REBT, Beck’s Cognitive Therapy (CT), the social problem-solving approaches to therapy, self-control, self-instructional techniques, Acceptance and Commitment (ACT), Dialectic Behavior Therapy (DBT) and some others. Recently, some people have used the term CBT to refer to Beck’s CT approach.

REBT shares much in common with all these approaches. Ellis referred to classical REBT thought as the focus on evaluative and imperative beliefs that are related to people’s emotional and behavioral disturbance. That is, classical REBT does not challenge the negative distortion that bad things might or have happened. Instead, it helps the client accept that adverse events can and will happen and change their demands that they must not happen, their evaluations that such situations are not catastrophic, and works at building frustration or discomfort tolerance to cope with adverse events.  
The unique aspect of REBT is its position on self and other acceptance. Ellis proposed that people accept that everyone has faults, and we benefit from accepting the fact that ourselves and others are not condemnable for our failures. Building self-esteem to help people think better of themselves is considered a temporary and palliative solution in REBT. We will all make mistakes, and we can accept that we are all just human.

Acceptance has played an essential role in REBT since its inception in the 1950s, and the REBT’s concept of acceptance has become a key component of ACT and DBT. REBT teaches people to accept that the universe can be harsh, that we are all fallible, and that our emotional and uncomfortable experiences can be tolerated.

Question 5

Can you use REBT and CBT together?

Raymond DiGiuseppe · Accepted Answer

Because REBT is one of the original forms of CBT, it includes many of the other types of CBT. REBT almost always includes the social problem solving model of psychotherapy to help people learn to attain their goals, and accept life if they cannot.  REBT always includes behavioral interventions that are appropriate to clients’ problems such as assertiveness training, behavioral activation, exposure, and operant interventions. Ellis theorized that the irrational beliefs of demandingness, awfulizing, frustration intolerance, and global evaluations of human worth (condemnation oneself or others) were more important in eliciting emotional and behavioral disturbance than distorted negative thoughts and cognitive distortion. Therefore, REBT focuses more on replacing the four irrational beliefs with rational alternatives.   However, Ellis and REBT recognize that not all clients will have the deep philosophical shift necessary to change their irrational beliefs to rational beliefs. For such clients, challenging their cognitive errors about the occurrence of adverse events can be helpful. Also, there are cases where it is useful to target both the client’s irrational beliefs and their cognitive distortion(s) to improve their symptoms and life satisfaction.

Question 6

Are REBT interventions appropriate for adolescents/young adults?

Kristene Doyle · Accepted Answer

REBT is often used to treat children and adolescents struggling with anxiety, depression, externalizing disorders such as anger and opposition, and secondary symptoms of ADHD, including frustration intolerance and academic underachievement.  The typical REBT process of debating irrational beliefs does have to be modified according to the young client’s developmental level.  For clients younger than 11 years old, REBT focuses more on teaching children healthy, flexible ways of thinking.  The process of cognitive restructuring through disputation of irrational beliefs can often begin around the age of 11.  One consideration when working with younger clients is their lack of motivation to identify a problem as well as take ownership of the problem.  For such clients, REBT will spend more time at the beginning of therapy working to enhance motivation and agree to the goals and tasks of therapy, thereby enhancing the therapeutic relationship.

Question 7

Is REBT appropriate for clients who don’t want to talk about past and childhood experiences?

Raymond DiGiuseppe · Accepted Answer

REBT is suitable for clients who are motivated and committed to working towards their goals.  REBT is less concerned with how one’s irrational beliefs were acquired, but rather more focused on how one’s irrational beliefs are perpetuated in the present.  For some clients, understanding where their unhelpful beliefs developed is of interest. However, REBT does not believe that insight is enough to affect change.  There may be circumstances where a discussion of the past and childhood experiences could be beneficial for a client.  Such discussions can help clients realize how these thoughts were based on exaggerations and false assumptions. REBT maintains that people remain disturbed by is the re-indoctrination of irrational beliefs in the present.

Question 8

Would REBT be suitable for someone with PTSD?

Kristene Doyle · Accepted Answer

We think that REBT might be the preferred intervention for people who have experienced traumatic events.  For people who have experienced trauma, it is difficult for them to challenge their thoughts that bad things might not happen again, regardless of how unlikely the chance might be.  Bad things have happened to them. REBT would help people who have experienced trauma by teaching them to accept that the bad things have happened, that they are not condemnable because they were the victim of a traumatic event. They can build their discomfort and frustration tolerance to help them survive and cope with difficult and harsh circumstances.

Question 9

How long does it take for REBT to work?

Raymond DiGiuseppe · Accepted Answer

Based on the data we have collected at the Albert Ellis Institute, we see that clients start to make some progress in reducing their emotional disturbance by the eighth to the eleventh session. Most clients have made substantial progress by the 25th session. These numbers vary widely depending on how much homework clients do between sessions. In the early sessions of REBT, we usually see therapists and clients develop a good therapeutic relationship. As a result, very few patients drop out of REBT in the first four or five sessions, which is when most dropouts occur. As with all other psychotherapies, some clients do make progress.

Question 10

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 11

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 12

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 13

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 14

Who was Albert Ellis, and what was his contribution to psychology?

Kristene Doyle · Accepted Answer

Albert Ellis is considered the grandfather of cognitive behavior therapy (CBT) because of his development of REBT, probably the first formal system in the genre.  Ellis was instrumental in transforming psychotherapy to the point where CBT represented a major paradigm for behavioral change.  Ellis wrote operas and other musical scores, authored novels, and spent time as a political activist.  He became enamored with socialism, which was common among intellectuals in the 1930s, and worked to foster a socialist government in the USA.  However, his distaste for dogma interfered with this utopian striving.  Ellis quickly became discouraged with the abuses of personal freedoms and restrictions on intellectual debate imposed by totalitarian socialist states.

Ellis was among the first psychotherapists to advocate actively changing clients’ beliefs to induce emotional or behavioral change.  Ellis was also among the first psychotherapists to use between-sessions homework assignments, including in vivo behavioral exposure.  Ellis provided workshops, lectures, books, and written assignments to identify, challenge, and replace irrational ideas (primary process) and to reinforce the rational ideas (secondary process) that he covered in therapy.  Ellis was amongst the first psychotherapy integrationists.  Although REBT obviously had a strong cognitive component, from the onset of his practice and writings, Ellis (1955) advocated many types of therapy methods to help people change.  He encouraged the use of imagery, hypnosis, group sessions, family sessions, humor, psychoeducational readings, interpersonal support, writing assignments, singing, behavioral rehearsal, exposure assignments, action assignments, metaphors, parables, and cathartic experiences.  According to Ellis, psychotherapy should include any activity that could convince the client to change.

At his death at age 93 (July 2, 2007), Ellis had authored and co-authored more than 80 books and 1200 articles, including more than 800 in peer-reviewed journals (see www.albertellisinstitute.org/ellisbibliography for a complete bibliography).  Ellis saw thousands of clients in hundreds of thousands of sessions.  The Albert Ellis Institute, which he founded, and its affiliated training centers around the world, had trained more than (more by now) 13,000 psychotherapists.

Question 15

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 16

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 17

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 18

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.

Understanding Rational Emotive Behavior Therapy

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