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Rational Emotive Behavior Therapy: Philosophy and Application Mark S. DeBord, LCSW, LLC www.markdebord.com

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  • 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.

    2

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

    disturbed not by things, but by the views

    which they take of them.

    3

  • 4

  • 5

  • 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.

    6

  • 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)

    7

  • 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

    8

  • 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 ones self/ measure / rate Ellis was against rating ones self at all, but in favor of rating behaviors. A person is too complex to be given a global evaluation.

    9

  • 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 dont 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

    10

  • 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

    11

  • 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.

    12

  • 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)

    13

  • 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 ones 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.

    14

  • 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..

    15

  • 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

    16

  • Assumption

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

    17

  • 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.

    18

  • 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.

    19

  • 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.

    20

  • 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.

    21

  • 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?

    22

  • 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!

    23

  • 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.

    24

  • 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.

    (Mans Search for Meaning Viktor Frankl 1945)

    (Happiness Is. Shawn Christopher Shea - 2005)

    25

  • 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 ones self to be.

    26

  • REBT thoughtAlthough many attempt to deny responsibility,

    there is a general assumption that

    responsibility for ones 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.

    27

  • 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.

    28

  • 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 ones 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.

    29

  • 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.

    30

  • 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.

    31

  • 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

    32

  • 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.

    33

  • 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 ..

    34

  • 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.

    35

  • 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!

    36

  • 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

    37

  • Session Structure6. rational alternatives

    7. problem-solving and skill building

    8. review salient points of session

    9. assignment/ agreement on homework

    10.client feedback

    38

  • 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.

    39

  • ABC Model of REBT

    Activating Consequence

    Event

    Situations

    Emotionaland

    Behavioral reactions

    Irritation, disappointment vs. anger, depression,

    guilt, anxiety

    40

  • 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

    41

  • 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.

    42

  • 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!

    43

  • 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.

    44

  • REBT

    Our emotional and behavioral

    responses are largely caused/

    affected by our conscious and

    unconscious evaluations,

    interpretations and philosophies.

    45

  • Distinction between healthy and

    unhealthy negative emotions

    Concern vs. anxiety

    Sadness vs. depression

    Remorse vs. guilt/ shame

    Annoyance/ irritation vs. anger/ rage

    46

  • 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 cant 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 dont like it when I

    do, everyone makes mistakes.

    As bad as this may be and as

    much as I dont like it, I can

    stand it and God can handle it!

    1

    Emotional Pain:

    concern, remorse,

    irritated and sad.

    Effective Behaviors: problem-solving, ask

    for change, plan for similar events,

    connect with others, learn, make choices

    47

  • 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

    48

  • 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.

    49

  • 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.

    50

  • 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.

    51

  • 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.

    52

  • 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.

    53

  • 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.

    54

  • 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 clients 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.

    55

  • 56

  • Q&AMark S. DeBord, LCSW, LLC

    212 Cypress Street

    West Monroe, LA 71291

    318-381-9070

    www.markdebord.com

    57