frenz another arrow for your quiver 2017-1101...another arrow for your quiver rebt for sud marrch...
TRANSCRIPT
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AnotherArrowforYourQuiver
REBTforSUD
MARRCHAnnualConference|1November2017
DavidA.Frenz,M.D.Diplomate,AmericanBoardofAddictionMedicineDiplomate,AmericanBoardofFamilyMedicine
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Disclosures
• I’maphysicianinprivatepractice• Iwaspreviouslyemployedby– HealthEastCareSystem(medicaldirector)– NorthMemorialHealth(vicepresident)
• I’monfacultyattheUniversityofMinnesota– Evidence-basedmedicine
• Idon’thaveanyfinancialrelationshipswiththepharmaceuticalormedicaldeviceindustries
• Idon’tintendtodiscussinvestigationaldrugsorthe“offlabel”useofmedications
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SessionObjectives
1. TheaudiencewillunderstandREBT’sA-B-Cmodelforconceptualizingunhealthynegativeemotionsandself-defeatingbehaviors
2. Theaudienceappreciatehowirrationalbeliefsdriveunhealthynegativeemotionsandself-defeatingbehaviors,includingaddiction
3. Theaudiencewilllearnvariouswaystodisputetheirclients’irrationalbeliefsconcerningsubstancecravingsandsubstanceuse
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Preliminaries
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WhyILikeREBT
• Simplemodel• Efficient• Effective• ConnectswellwithSMARTRecovery– www.smartrecovery.org
• Generalizestootherareasoflife
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CounselingToday
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ALBERT ELLIS INSTITUTE**t f, & U..l * rlaaer.l * <ak.llLqd
CERTIFIES THAT
DAVID A. FRENZ,M.D.T{AS COMPLETED A PRIMARY TRAINING CO{.]RSE
IN RATIONAL-EMOTIVE & COGNITIVE.BEHAVIORAL TI{EORY AND TECHMQUES
l,-u. *DATE JUNE 2OI7
DIRECTOR
Gr"AuA;*.NO. 13247
DIRECTOR OF PROFESSIONAL EDUCATION
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AlbertEllisInstitute
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ThinkingAboutThinking
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EvanSiegle |packers.com
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Epictetus
“ Itisn’tthethingsthemselvesthatdisturbpeople,butthejudgementsthattheyformaboutthem.”
Handbook
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Shakespeare
“ Forthereisnothingeithergoodorbad,butthinkingmakesitso.”
Hamlet
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JohnMilton
“ Themindisitsownplace,andinitselfCanmakeaHeav'nofHell,aHellofHeav'n.”
ParadiseLost
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MarcusAureliusAntonius
“ Itispossibletoformnoopiniononthismatterandnotbetroubledinone’smind;forthingsthemselvesarenotofsuchanaturethattheycancreatejudgementswithinus.”
Meditations
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RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.352
REBT Self-help Form
Examples:- A can be internal or external, real or imagined- A can be an event in the past, present, or future
• Situation: “My wife and I disagreed about something”• Critical A: “She criticized me badly”
Bs (Beliefs): Irrational (Unhelpful/Dysfunctional) Beliefs
Ds (Disputation): Debate Your Irrational (Unhelpful/Dysfunctional) Beliefs
Es (Eff ective): Rational (Helpful/Functional) Beliefs
Fs (Functional): Major Functional/Healthy Emotion and Adaptive/Helpful Behaviors
(Goal): New Functional/Healthy Negative Emotion:
(Goals): New Adaptive/Helpful Behaviors:
Maladaptive Behaviors include:- Social avoidance- Not taking care of yourself GOALS(e.g. not exercising, not resting)- Being aggressive
Dysfunctional Negative Emotions include:- Anxiety/fear - Problematic jealousy- Shame/embarrassment - Problematic envy- Rage/anger - Hurt- Guilt- Depression (depressed mood)
To Th ink More Rationally, Strive For:1) Flexible Preferences
(e.g. I want to do well, but I don’t have to do so.)2) Anti-Awfulizing
(e.g. It may be bad or unfortunate, but it is not awful, and I can still enjoy some things.)
3) High Frustration Tolerance(e.g. I don’t like it, but I can stand it, and I can still enjoy many things.)
4) Self-Acceptance, Other-Acceptance, Life-Acceptance (e.g. I can accept myself as a fallible human being.)
Functional/Healthy Negative Emotions include:
x� Concernx� Disappointmentx� Healthy anger/annoyancex� Remorse/regretx� Sadnessx� Healthy concern for relationshipx� Healthy envyx� Sorrow
Adaptive/Helpful Behaviors include:x� Meeting friends or seeking supportx� Exercisingx� Assertive behaviors
To Identify Irrational Beliefs, Look For:
1) Demands (musts/absolute shoulds/oughts)2) Awfulizing/Catastrophizing
(It’s awful, terrible, horrible!)3) Frustration Intolerance
(I can’t stand it!)4) Self-Downing, Other-Downing, or Life-
Downing (I’m bad or worthless, He/she is bad or worthless, or Life is not worthwhile)
© Windy Dryden and Jane Walker, 1992. Revised by Albert Ellis, 1996. Revised by Windy Dryden and Daniel David, 2009.
To Change Irrational Beliefs, Ask Yourself:■ Where is holding this belief getting me?
Is it helpful or getting me into trouble? ■ Where is the evidence to support my
irrational belief?º Is it really awful (as bad as it could be)?º Can I really not stand it?º Am I really a totally bad person?
■ Is it logical? Does it follow from mypreferences?
■ Use metaphorical disputation (e.g. metaphors, stories, humor)
Major Dysfunctional/Unhealthy Negative Emotion (Feeling):
Maladaptive/Unhelpful Behaviors (and/or Action Tendencies):
Briefl y Summarize the Situation as Objectively as Possible:
Critical A (What I Was Most Disturbed About):
A (Activating Events or Adversities) C (Consequences)
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0YGPSE�$MJOJDBM�1TZDIPMPHZ�]�0YGPSE�6OJWFSTJUZ�1SFTT
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IrrationalBeliefs
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B—S
“ Everytimeahumanbeinggetsupset—exceptwhenshe’sinphysicalpain—shehasalwaystoldherselfsomebullshit thesecondbeforeshegetsupset.”
AlbertEllis.GrowthThroughReason.PaloAlto:ScienceandBehaviorBooks,1971,p.228
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Love&Approval
“ Theideathatitisadirenecessityforanadulthumanbeingtobelovedorapprovedbyvirtuallyeverysignificantotherpersoninhiscommunity.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.61
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Competence
“ Theideathatoneshouldbethoroughlycompetent,adequate,andachievinginallpossiblerespectsifoneittoconsideroneselfworthwhile.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.63
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Condemnation
“ Theideathatcertainpeoplearebad,wicked,orvillainousandthattheyshouldbeseverelyblamedandpunishedfortheirvillainy.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.65
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Awfulizing
“ Theideathatitisawfulandcatastrophicwhenthingsarenotthewayonewouldverymuchlikethemtobe.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.69
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Victimization
“ Theideathathumanunhappinessisexternallycausedandthatpeoplehavelittleornoabilitytocontroltheirsorrowsanddisturbances.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.72
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Rumination
“ Theideathatifsomethingisormaybedangerousorfearsomeoneshouldbeterriblyconcernedaboutitandshouldkeepdwellingonthepossibilityofitsoccurring.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.75
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Avoidance
“ Theideathatitiseasiertoavoidthantofacecertainlifedifficultiesandself-responsibilities.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.78
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Dependence
“ Theideathatoneshouldbedependentonotherandneedssomeonestrongerthanoneselfonwhomtorely.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.80
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Determinism
“ Theideathatone’spasthistoryisanall-importantdeterminerofone’spresentbehaviorandthatbecausesomethingoncestronglyaffectedone’slife,itshouldindefinitelyhaveasimilareffect.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.82
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Reactivity
“ Theideathatoneshouldbecomequiteupsetoverotherpeople’sproblemsanddisturbances.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.85
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Perfectionism
“ Theideathatthereisinvariablyaright,precise,andperfectsolutiontohumanproblemsandthatitiscatastrophicifthisperfectsolutionisnotfound.”
AlbertEllis.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962,p.86–87
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Characteristics
1. Itisabsolute,dichotomous,rigid,andunbending;2. Itisnotlogical;3. Itisnotconsistentwithreality;4. Itdoesnothelptoachieveone’sgoals;5. Itleadstounhealthy/dysfunctionalemotions
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.33
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Demandingness
“ Anunrealisticandabsoluteexpectationofeventsorindividualsbeingthewayapersondesiresthemtobe.”
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.34
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Awfulizing
“ Anexaggerationofthenegativeconsequencesofasituationtoanextremedegree,sothatanunfortunateoccurrencebecomes‘terrible.’”
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.34
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FrustrationIntolerance
“ Demandsforeaseandcomfort”
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.34
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GlobalEvaluationsofHumanWorth
“ [Theideathat]humanbeingscanberated,andthatsomepeopleareworthless,oratleastlessvaluablethanothers. ”
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.34
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BeliefContent
• Socialrelationships– Demands,awfulizing,frustrationintolerance,globalevaluations
• Achievement• Comfort• Fairness
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.35
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AddictioniBs
• Icannotstandavoidingadrink• Icannotfunctionwithoutadrink• Iamnotstrongenoughtoresistalcohol• Icannotstandthedeprivationofmydesireforadrink• IamahorriblydeprivedpersonifIcannothaveadrink• LifeistoohardsoIamentitledtohaveadrink• Tomakeupformydifficultlife,Imusthaveadrink
AlbertEllis,etal.Rational-EmotiveTherapywithAlcoholicsandSubstanceAbusers.NewYork:Pergamon Press,1988,p.25
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AddictioniBs
• ImusthaveadrinkorIcan’tgoon• Imustnotabstainwhenit’ssoenjoyabletoimbibe• Imustnotabstainwhenitissopainfultodoso
AlbertEllis,etal.Rational-EmotiveTherapywithAlcoholicsandSubstanceAbusers.NewYork:Pergamon Press,1988,p.25
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Consequences
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• Unhealthynegativeemotions– Anxiety– Depression– Clinicalanger– Guilt– Shame– Hurt
• Unhealthymaladaptivebehaviors– Socialavoidance– Poorself-care– Aggression– Chemicalcoping
Consequences
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.113,352
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RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.352
REBT Self-help Form
Examples:- A can be internal or external, real or imagined- A can be an event in the past, present, or future
• Situation: “My wife and I disagreed about something”• Critical A: “She criticized me badly”
Bs (Beliefs): Irrational (Unhelpful/Dysfunctional) Beliefs
Ds (Disputation): Debate Your Irrational (Unhelpful/Dysfunctional) Beliefs
Es (Eff ective): Rational (Helpful/Functional) Beliefs
Fs (Functional): Major Functional/Healthy Emotion and Adaptive/Helpful Behaviors
(Goal): New Functional/Healthy Negative Emotion:
(Goals): New Adaptive/Helpful Behaviors:
Maladaptive Behaviors include:- Social avoidance- Not taking care of yourself GOALS(e.g. not exercising, not resting)- Being aggressive
Dysfunctional Negative Emotions include:- Anxiety/fear - Problematic jealousy- Shame/embarrassment - Problematic envy- Rage/anger - Hurt- Guilt- Depression (depressed mood)
To Th ink More Rationally, Strive For:1) Flexible Preferences
(e.g. I want to do well, but I don’t have to do so.)2) Anti-Awfulizing
(e.g. It may be bad or unfortunate, but it is not awful, and I can still enjoy some things.)
3) High Frustration Tolerance(e.g. I don’t like it, but I can stand it, and I can still enjoy many things.)
4) Self-Acceptance, Other-Acceptance, Life-Acceptance (e.g. I can accept myself as a fallible human being.)
Functional/Healthy Negative Emotions include:
x� Concernx� Disappointmentx� Healthy anger/annoyancex� Remorse/regretx� Sadnessx� Healthy concern for relationshipx� Healthy envyx� Sorrow
Adaptive/Helpful Behaviors include:x� Meeting friends or seeking supportx� Exercisingx� Assertive behaviors
To Identify Irrational Beliefs, Look For:
1) Demands (musts/absolute shoulds/oughts)2) Awfulizing/Catastrophizing
(It’s awful, terrible, horrible!)3) Frustration Intolerance
(I can’t stand it!)4) Self-Downing, Other-Downing, or Life-
Downing (I’m bad or worthless, He/she is bad or worthless, or Life is not worthwhile)
© Windy Dryden and Jane Walker, 1992. Revised by Albert Ellis, 1996. Revised by Windy Dryden and Daniel David, 2009.
To Change Irrational Beliefs, Ask Yourself:■ Where is holding this belief getting me?
Is it helpful or getting me into trouble? ■ Where is the evidence to support my
irrational belief?º Is it really awful (as bad as it could be)?º Can I really not stand it?º Am I really a totally bad person?
■ Is it logical? Does it follow from mypreferences?
■ Use metaphorical disputation (e.g. metaphors, stories, humor)
Major Dysfunctional/Unhealthy Negative Emotion (Feeling):
Maladaptive/Unhelpful Behaviors (and/or Action Tendencies):
Briefl y Summarize the Situation as Objectively as Possible:
Critical A (What I Was Most Disturbed About):
A (Activating Events or Adversities) C (Consequences)
3BZNPOE�"��%JHJVTFQQF �,SJTUFOF�"��%PZMF �8JOEZ�%SZEFO �8PVUFS�#BDLY�"�1SBDUJUJPOFS�T�(VJEF�UP�3BUJPOBM�&NPUJWF�#FIBWJPS�5IFSBQZ��"QQFOEJY����$PQZSJHIU�ª������CZ�0YGPSE�6OJWFSTJUZ�1SFTT
0YGPSE�$MJOJDBM�1TZDIPMPHZ�]�0YGPSE�6OJWFSTJUZ�1SFTT
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Disputation
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T—S
“ ThetwowordsIusuallyrecommendare:“Toughshit!’Ifyoureallybelievethesewordsandthebasicphilosophyforwhichtheystand,youwillinstantlystarttoloseyourextremefeelingsofanxiety,depression,andshameandbecomeemotionallyunblocked.”
AlbertEllis.ExecutiveLeadership:ARationalApproach.Secaucus,NJ:CitadelPress,p.154–155
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Logical
• Whydoesithavetobeso,justbecauseyouwantit?• Howdoyougetfromwantingthemtorespectyoutothe
beliefthattheymustrespectyou?• Ifyouheardsomeoneelseclaimingitwastheworstthing
ever,wouldyoubeconvinced?• Youmightnotlikebeingdisrespected,butdoesitlogically
followthatyoucan’tstandit?• Howdoyoubecomeworthlessiftheydon’trespectyou?
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.165
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Empirical/Reality-Testing
• Whereistheevidencethattheymustrespectyou?• Whereisitwrittenthattheymustrespectyou?• Howwillyourworldbedestroyediftheydon’trespectyou?• You’vebeendisrespectedbeforeandsurvived.Where’sthe
proofthatyoucan’tstandit?• Assumetheydisrespectyou.Doesanyoneelseintheworld
valueyou?
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.167
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Pragmatic/Functional
• So,youthinkit’sterriblethattheydon’trespectyou.Howisthatthoughtworkingforyou?
• Whenyouthinkthatway,howdoyoufeel?Isthatfeelinghelpful?
• Whathappenstoyouwhenyouthinkthatthought?• Whydoyouholdontoabeliefthatcausesyousomuch
trouble?• Howhasthatbeliefhelpedyouaccomplishyourgoals?
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.167–168
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DisputingStyles
• Didactic• Socratic• Humorous• Metaphoric• Creative• Vicariousmodeling
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.170–178
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RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.352
REBT Self-help Form
Examples:- A can be internal or external, real or imagined- A can be an event in the past, present, or future
• Situation: “My wife and I disagreed about something”• Critical A: “She criticized me badly”
Bs (Beliefs): Irrational (Unhelpful/Dysfunctional) Beliefs
Ds (Disputation): Debate Your Irrational (Unhelpful/Dysfunctional) Beliefs
Es (Eff ective): Rational (Helpful/Functional) Beliefs
Fs (Functional): Major Functional/Healthy Emotion and Adaptive/Helpful Behaviors
(Goal): New Functional/Healthy Negative Emotion:
(Goals): New Adaptive/Helpful Behaviors:
Maladaptive Behaviors include:- Social avoidance- Not taking care of yourself GOALS(e.g. not exercising, not resting)- Being aggressive
Dysfunctional Negative Emotions include:- Anxiety/fear - Problematic jealousy- Shame/embarrassment - Problematic envy- Rage/anger - Hurt- Guilt- Depression (depressed mood)
To Th ink More Rationally, Strive For:1) Flexible Preferences
(e.g. I want to do well, but I don’t have to do so.)2) Anti-Awfulizing
(e.g. It may be bad or unfortunate, but it is not awful, and I can still enjoy some things.)
3) High Frustration Tolerance(e.g. I don’t like it, but I can stand it, and I can still enjoy many things.)
4) Self-Acceptance, Other-Acceptance, Life-Acceptance (e.g. I can accept myself as a fallible human being.)
Functional/Healthy Negative Emotions include:
x� Concernx� Disappointmentx� Healthy anger/annoyancex� Remorse/regretx� Sadnessx� Healthy concern for relationshipx� Healthy envyx� Sorrow
Adaptive/Helpful Behaviors include:x� Meeting friends or seeking supportx� Exercisingx� Assertive behaviors
To Identify Irrational Beliefs, Look For:
1) Demands (musts/absolute shoulds/oughts)2) Awfulizing/Catastrophizing
(It’s awful, terrible, horrible!)3) Frustration Intolerance
(I can’t stand it!)4) Self-Downing, Other-Downing, or Life-
Downing (I’m bad or worthless, He/she is bad or worthless, or Life is not worthwhile)
© Windy Dryden and Jane Walker, 1992. Revised by Albert Ellis, 1996. Revised by Windy Dryden and Daniel David, 2009.
To Change Irrational Beliefs, Ask Yourself:■ Where is holding this belief getting me?
Is it helpful or getting me into trouble? ■ Where is the evidence to support my
irrational belief?º Is it really awful (as bad as it could be)?º Can I really not stand it?º Am I really a totally bad person?
■ Is it logical? Does it follow from mypreferences?
■ Use metaphorical disputation (e.g. metaphors, stories, humor)
Major Dysfunctional/Unhealthy Negative Emotion (Feeling):
Maladaptive/Unhelpful Behaviors (and/or Action Tendencies):
Briefl y Summarize the Situation as Objectively as Possible:
Critical A (What I Was Most Disturbed About):
A (Activating Events or Adversities) C (Consequences)
3BZNPOE�"��%JHJVTFQQF �,SJTUFOF�"��%PZMF �8JOEZ�%SZEFO �8PVUFS�#BDLY�"�1SBDUJUJPOFS�T�(VJEF�UP�3BUJPOBM�&NPUJWF�#FIBWJPS�5IFSBQZ��"QQFOEJY����$PQZSJHIU�ª������CZ�0YGPSE�6OJWFSTJUZ�1SFTT
0YGPSE�$MJOJDBM�1TZDIPMPHZ�]�0YGPSE�6OJWFSTJUZ�1SFTT
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EffectiveRationalBeliefs
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EffectiveRationalBeliefs
• Flexiblepreferences– Iwanttodowell,butIdon’thaveto
• Anti-awfulizing– Itmaybebadorunfortunate,butit’snotawful,andIcanstillenjoysomethings
• Highfrustrationtolerance– Idon’tlikeitbutIcanstandit,andIcanstillenjoymanythings
• Acceptance– Icanacceptmyselfasafalliblehumanbeing
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.352
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BecomingTheirOwnTherapist
• Clientsneedtocontinuously,vigorouslypracticecopingstatements– TurniBs intoEs– Es transformCsintohealthy negativeemotionsandadaptive behaviors
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RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.352
REBT Self-help Form
Examples:- A can be internal or external, real or imagined- A can be an event in the past, present, or future
• Situation: “My wife and I disagreed about something”• Critical A: “She criticized me badly”
Bs (Beliefs): Irrational (Unhelpful/Dysfunctional) Beliefs
Ds (Disputation): Debate Your Irrational (Unhelpful/Dysfunctional) Beliefs
Es (Eff ective): Rational (Helpful/Functional) Beliefs
Fs (Functional): Major Functional/Healthy Emotion and Adaptive/Helpful Behaviors
(Goal): New Functional/Healthy Negative Emotion:
(Goals): New Adaptive/Helpful Behaviors:
Maladaptive Behaviors include:- Social avoidance- Not taking care of yourself GOALS(e.g. not exercising, not resting)- Being aggressive
Dysfunctional Negative Emotions include:- Anxiety/fear - Problematic jealousy- Shame/embarrassment - Problematic envy- Rage/anger - Hurt- Guilt- Depression (depressed mood)
To Th ink More Rationally, Strive For:1) Flexible Preferences
(e.g. I want to do well, but I don’t have to do so.)2) Anti-Awfulizing
(e.g. It may be bad or unfortunate, but it is not awful, and I can still enjoy some things.)
3) High Frustration Tolerance(e.g. I don’t like it, but I can stand it, and I can still enjoy many things.)
4) Self-Acceptance, Other-Acceptance, Life-Acceptance (e.g. I can accept myself as a fallible human being.)
Functional/Healthy Negative Emotions include:
x� Concernx� Disappointmentx� Healthy anger/annoyancex� Remorse/regretx� Sadnessx� Healthy concern for relationshipx� Healthy envyx� Sorrow
Adaptive/Helpful Behaviors include:x� Meeting friends or seeking supportx� Exercisingx� Assertive behaviors
To Identify Irrational Beliefs, Look For:
1) Demands (musts/absolute shoulds/oughts)2) Awfulizing/Catastrophizing
(It’s awful, terrible, horrible!)3) Frustration Intolerance
(I can’t stand it!)4) Self-Downing, Other-Downing, or Life-
Downing (I’m bad or worthless, He/she is bad or worthless, or Life is not worthwhile)
© Windy Dryden and Jane Walker, 1992. Revised by Albert Ellis, 1996. Revised by Windy Dryden and Daniel David, 2009.
To Change Irrational Beliefs, Ask Yourself:■ Where is holding this belief getting me?
Is it helpful or getting me into trouble? ■ Where is the evidence to support my
irrational belief?º Is it really awful (as bad as it could be)?º Can I really not stand it?º Am I really a totally bad person?
■ Is it logical? Does it follow from mypreferences?
■ Use metaphorical disputation (e.g. metaphors, stories, humor)
Major Dysfunctional/Unhealthy Negative Emotion (Feeling):
Maladaptive/Unhelpful Behaviors (and/or Action Tendencies):
Briefl y Summarize the Situation as Objectively as Possible:
Critical A (What I Was Most Disturbed About):
A (Activating Events or Adversities) C (Consequences)
3BZNPOE�"��%JHJVTFQQF �,SJTUFOF�"��%PZMF �8JOEZ�%SZEFO �8PVUFS�#BDLY�"�1SBDUJUJPOFS�T�(VJEF�UP�3BUJPOBM�&NPUJWF�#FIBWJPS�5IFSBQZ��"QQFOEJY����$PQZSJHIU�ª������CZ�0YGPSE�6OJWFSTJUZ�1SFTT
0YGPSE�$MJOJDBM�1TZDIPMPHZ�]�0YGPSE�6OJWFSTJUZ�1SFTT
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FunctionalEmotions&Behaviors
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HealthyNegativeEmotions
Unhealthy&Dysfunctional Healthy&Functional
Anxiety Concern
Depression Sadness
Clinicalanger Annoyance
Guilt Remorse
Shame Regret
Hurt Disappointment
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.113
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HealthyAdaptiveBehaviors
Maladaptive&Dysfunctional Adaptive&Functional
Socialavoidance Meeting friends,seekingsupport
Poor self-care Bathing,exercising
Aggression Assertive behaviors
Chemical coping Healthy copingbehaviors
RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.113
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RaymondA.DiGiuseppe,etal.APractitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014,p.352
REBT Self-help Form
Examples:- A can be internal or external, real or imagined- A can be an event in the past, present, or future
• Situation: “My wife and I disagreed about something”• Critical A: “She criticized me badly”
Bs (Beliefs): Irrational (Unhelpful/Dysfunctional) Beliefs
Ds (Disputation): Debate Your Irrational (Unhelpful/Dysfunctional) Beliefs
Es (Eff ective): Rational (Helpful/Functional) Beliefs
Fs (Functional): Major Functional/Healthy Emotion and Adaptive/Helpful Behaviors
(Goal): New Functional/Healthy Negative Emotion:
(Goals): New Adaptive/Helpful Behaviors:
Maladaptive Behaviors include:- Social avoidance- Not taking care of yourself GOALS(e.g. not exercising, not resting)- Being aggressive
Dysfunctional Negative Emotions include:- Anxiety/fear - Problematic jealousy- Shame/embarrassment - Problematic envy- Rage/anger - Hurt- Guilt- Depression (depressed mood)
To Th ink More Rationally, Strive For:1) Flexible Preferences
(e.g. I want to do well, but I don’t have to do so.)2) Anti-Awfulizing
(e.g. It may be bad or unfortunate, but it is not awful, and I can still enjoy some things.)
3) High Frustration Tolerance(e.g. I don’t like it, but I can stand it, and I can still enjoy many things.)
4) Self-Acceptance, Other-Acceptance, Life-Acceptance (e.g. I can accept myself as a fallible human being.)
Functional/Healthy Negative Emotions include:
x� Concernx� Disappointmentx� Healthy anger/annoyancex� Remorse/regretx� Sadnessx� Healthy concern for relationshipx� Healthy envyx� Sorrow
Adaptive/Helpful Behaviors include:x� Meeting friends or seeking supportx� Exercisingx� Assertive behaviors
To Identify Irrational Beliefs, Look For:
1) Demands (musts/absolute shoulds/oughts)2) Awfulizing/Catastrophizing
(It’s awful, terrible, horrible!)3) Frustration Intolerance
(I can’t stand it!)4) Self-Downing, Other-Downing, or Life-
Downing (I’m bad or worthless, He/she is bad or worthless, or Life is not worthwhile)
© Windy Dryden and Jane Walker, 1992. Revised by Albert Ellis, 1996. Revised by Windy Dryden and Daniel David, 2009.
To Change Irrational Beliefs, Ask Yourself:■ Where is holding this belief getting me?
Is it helpful or getting me into trouble? ■ Where is the evidence to support my
irrational belief?º Is it really awful (as bad as it could be)?º Can I really not stand it?º Am I really a totally bad person?
■ Is it logical? Does it follow from mypreferences?
■ Use metaphorical disputation (e.g. metaphors, stories, humor)
Major Dysfunctional/Unhealthy Negative Emotion (Feeling):
Maladaptive/Unhelpful Behaviors (and/or Action Tendencies):
Briefl y Summarize the Situation as Objectively as Possible:
Critical A (What I Was Most Disturbed About):
A (Activating Events or Adversities) C (Consequences)
3BZNPOE�"��%JHJVTFQQF �,SJTUFOF�"��%PZMF �8JOEZ�%SZEFO �8PVUFS�#BDLY�"�1SBDUJUJPOFS�T�(VJEF�UP�3BUJPOBM�&NPUJWF�#FIBWJPS�5IFSBQZ��"QQFOEJY����$PQZSJHIU�ª������CZ�0YGPSE�6OJWFSTJUZ�1SFTT
0YGPSE�$MJOJDBM�1TZDIPMPHZ�]�0YGPSE�6OJWFSTJUZ�1SFTT
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ClinicalExample
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Client
• Femalepatientsubjecttorandomurinetoxicologyperthechildprotectionsystem
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A&C
A ColorwheelC Anxiety abouthercolorcomingup
Anger andoutbursts whenhercolorcameup
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iBs
• Imust havetimetomyself.CPSshouldnot disruptmyday• Itwouldbeterrible ifmycolorcameupbecauseitwould
ruinmyday• Icouldn’tstandit ifmycolorcameup.Ican’thandle the
inconvenienceofrunningdowntoHCMC• MyCPSworkeristotallyevil
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D
• IsitlogicalthatjustbecauseIdon’twantmycolortocomeupthatitshouldn’t?
• Whereisitwrittenthatmycolorcan’tcomeup?Istherealawofphysicsthatsaysitcan’t?
• Wheredoesanxietyandangergetme?Dotheyhelpmereachmygoals?(lessemotionaldisturbance,gettingoffofCPS)
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E
• I’dreallylikemycolortonotcomeupbutthere’snoreasonwhyitshouldn’t
• Itwouldbeinconvenientifmycolorcameup,butitwouldn’tbeterribleorhorribleifitdid
• Idon’tlikeitwhenmycolorcomesup,butIcanhandleit• MyCPSworkerinconveniencesmebutthatdoesn’tmean
she’scompletelyrotten
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F
• Anxietybecameconcern• Angerbecameannoyance• Outburstsbecamecooperative,respectfulbehavior
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Resources
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StartHere
London:SAGEPublications,2011
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DeeperDive
• BishopFM.ManagingAddictions:Cognitive,Emotive,andBehavioralTechniques.Northvale,NJ:JasonAronson,2001
• EllisA.ReasonandEmotioninPsychotherapy.NewYork:LyleStuart,1962
• EllisA,etal.Rational-EmotiveTherapywithAlcoholicsandSubstanceAbusers.NewYork:Pergamon Press,1988
• DiGiuseppe RA,etal.Practitioner’sGuidetoRationalEmotiveBehaviorTherapy,3ded.NewYork:OxfordUniversityPress,2014
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