What Is Rational Emotive Behavior Therapy (REBT) for Substance Abuse?

What Are the Different Types of Therapy Available for Substance Abuse? » What Is Rational Emotive Behavior Therapy (REBT) for Substance Abuse?

Rational Emotive Behavior Therapy (REBT) was originally conceptualized and developed by the psychologist Dr. Albert Ellis. REBT is considered by many historians to be the first form of Cognitive Behavioral Therapy, even developed prior to the cognitive therapy of Aaron Beck.  

Dr. Ellis was a psychotherapist who was trained in the principles of psychoanalysis (Freudian approaches) and familiar with behavioral psychology. Like many of his contemporaries, especially in the United States, he was not satisfied with Freud’s assumptions of how behavior developed or with the mechanistic models of learning developed in behaviorism as a result of animal models of behavior. In addition, Ellis was looking for an approach that would not take years of therapy and several sessions a week in order to achieve results as was the case with psychoanalysis.  

Based on his own experiences with patients, he borrowed heavily from principles in cognitive psychology and added them to some of the more general dynamic principles of Freud. The use of techniques from the behavioral school of psychology helped to round out his overall approach. This approach became one of the most successful forms of psychotherapy in existence and has been used to treat numerous issues, including depression, anxiety disorders, personality disorders, and substance use disorders.

The Foundation of REBT

Dr. Ellis focused on cognition as his major source of intervention. Borrowing from an acronym in behavioral psychology, the ABC acronym, he altered the terms in the acronym and later added to it to describe his basic principles.

In behavioral psychology, the acronym that describes the relevant issues that occur in any behavior is:

A: The A in ABC represents the antecedents of behavior. The antecedents of any behavior are the conditions that occur prior to the behavior. These conditions can consist of environmental factors that help to “prime” actions.

B: The B in ABC represents the behavior itself. This is the phenomenon of interest, and it occurs as a result of the antecedents and consequences.

C: The C in ABC represents the consequences of the behavior. For many behaviorists, the consequences of the behavior represent the most important factor in determining whether or not the behavior would be likely to be repeated or built on. Famous behaviorists, such as B.F. Skinner, developed entire theories of learning and behavior based on reinforcement and punishment.

Dr. Ellis borrowed the ABC acronym from behavioral psychology and made it the cornerstone of his therapeutic paradigm. However, he changed the terms to accommodate for cognition, a factor that was not considered by strict behaviorists who were only interested in working with physically observable phenomena.

The Ellis acronym is outlined here: 

A: The A in the acronym stands for an activating event. In behaviorism, antecedents are external to the organism; most often, they are part of the physical environment. In REBT, an activating event can be either an external condition or an internal condition that helps to prime behaviors. Internal conditions can be expectations, emotional states, attitudes, etc. For Ellis, activating events did not need to be confirmable external stimuli as they must be in behaviorism.

B: The B in the acronym stands for beliefs about the activating event. Beliefs are evaluations or internally constructed viewpoints of the world that can either be malleable or very rigid. Individuals who have flexible belief systems have rational beliefs according to Ellis. Those who have inflexible or rigid belief systems often have irrational beliefs according to Ellis. Irrational belief systems take the form of “musts” or absolute “shoulds.”People who adhere to rigid beliefs will also tend to make irrational conclusions regarding the world. Irrational conclusions can take the following forms:

  • Low frustration tolerance  
  • Condemnation of oneself, of others, or of the world 
  • Dichotomous thinking, such as when an individual believes that he will always act a certain way or will never act a certain way with no room for middle ground

C: The C in the acronym remains the consequences of the particular beliefs about the activating event. Consequences can be internal or external. Consequences that follow from rigid and absolute beliefs are dysfunctional negative consequences. Consequences that follow from flexible rational beliefs tend to be nondisturbed.Dysfunctional negative consequences can lead to significant pain and discomfort, motivate an individual to engage in self-defeating behaviors, and prevent one from reaching goals. Flexible beliefs motivate an individual toward self-enhancement, motivate an individual to reach their goals, and do not result in significant discomfort or pain. 

In some of his later works, Ellis added to the ABC acronym, making the acronym ABCDE. The new letters were designed to account for the REBT intervention. 

D: The D in the extended acronym stands for disruption. When individuals have dysfunctional beliefs about activating events that are rigid, the therapist can disrupt these irrational beliefs and help clients to correct them.

E: The E in the extended acronym stands for effects. The effects of the intervention were to help individuals identify rigid irrational beliefs, disrupt the process, and reorganize the beliefs so new and realistic actions could be performed by the individual. 

Accordion Item

Many therapists, such as Dr. Ellis, spent significant amounts of time with individuals trying to understand how rigid irrational beliefs developed and also tried to understand the different types of irrational beliefs that can occur. As it turns out, the majority of cognitive-behavioral researchers and therapists have come to the same conclusion that Dr. Ellis came to regarding these types of beliefs. There simply were too many of them to list fully. However, all of the dysfunctional beliefs that individuals entertain tend to be centered on three certain themes. These themes, or internal working models of the world that individuals use to direct their behavior and thoughts, are often referred to as schemas by cognitive psychologists.Schemas represent very broad, implicit, internalized models of reality that individuals will generally adhere to under most conditions. Very often, different activating events prime different schemas.

The general types of schemas that cognitive-behavioral researchers identified as being inflexible and irrational, and that became targets for the types of interventions that Dr. Ellis used, are often labeled as the “three musts.”

  1. The first general theme observed in individuals who adhere to dysfunctional and rigid belief systems is that they often have very unrealistic demands of themselves. For instance, many individuals have an implicit notion that they must be accepted by others, liked by others, and cannot make mistakes. It is an unfortunate rule of living in the world that not everyone will like you, not everyone will accept you, and you are going to make mistakes. Individuals who adhere to very inflexible demands regarding themselves are very likely to experience substantial pain, disappointment, frustration, and resentment. Significant clinical issues can develop, such as anxiety, depression, or even psychosis, as a result of these types of unrealistic demands.
  2. The second general theme that occurs is that individuals often have inflexible and unrealistic expectations of how they believe others should treat them. Any time an individual adheres to absolute expectations about how others should react to them, they are going to suffer severe disappointment, resentment, confusion, etc.
  3. The third general theme consists of inflexible expectations of how the world should be. For example, individuals who think that life should always be “fair” are in for great frustration, disappointment, resentment, depression, etc., because fairness is a subjective interpretation of how the world should be, and reality does not operate on subjective expectations.

Ellis and other cognitive-behavioral theorists recognize that in the majority of cases, the types of expectations and belief systems that individuals have are flexible and functional. When individuals adhere to dysfunctional and rigid beliefs and expectations, they open themselves up to experience major issues with disappointment, pain, emotional distress, etc. Not everyone who has this experience will need to become involved in therapy; however, some individuals have developed extremely inflexible and rigid belief systems as a result of early experience and upbringing. Often, these individuals need professional help.

<a>The Process of Applying REBT to Substance Use Disorder Treatment</a><a>The Complexity of Therapy</a>

According to the Rational Emotive Behavior Therapy model, substance abuse is often driven by irrational beliefs about the world. Individuals who have irrational beliefs may directly use alcohol and other drugs to deal with the frustration they experience as a result of these beliefs. Later, substance abuse becomes a means to an end itself. Individuals begin to enjoy the sensation that results from using drugs or alcohol, develop the irrational belief that their use of drugs or alcohol gives them control over their circumstances, and begin to believe that their use of drugs or alcohol is necessary for them to function “normally” or to be happy.
The approach used by REBT therapists concentrates on several different objectives.

  • One of the most important objectives is to develop a strong therapeutic alliance between the client and therapist. The therapeutic alliance is crucial to the success of any form of therapy. This consists of the working bond between the client and therapist, and includes feelings of trust, mutual respect, and competency.
  • By listening to the client, the therapist slowly begins to identify how the client expresses their own irrational beliefs and how these irrational beliefs fit in with the three musts.
  • The therapist must learn how the client’s behavior is related to their expectations and belief systems.
  • The therapist helps the client to identify their irrational beliefs and determine how these irrational beliefs affect their behavior. The therapist also challenges the client to test these irrational beliefs in the real world. Most often, clients realize through their interaction with the therapist that their beliefs are dysfunctional. Then, the therapist and client work together to develop more realistic expectations.
  • As the individual develops more realistic beliefs and expectations, they also begin to alter their behavior in a manner consistent with these. The therapist helps them to do this by applying behavioral techniques.
  • As the therapist and client work together, they aim to help the client develop an overall approach to flexible and rational thinking.

The particular issues that are addressed in therapy depend on the particular situation and the needs of the individual client. Rational Emotive Behavior Therapy is a flexible approach to therapy, such that there is no singular approach that works for everyone.

The major mechanism of change in REBT is the working bond between the therapist and client. Without a good solid working bond, the therapy cannot progress. In addition, a strong therapeutic alliance allows the therapist to challenge the client in a way that is nonconfrontational and does not result in resentment. Therapists continue to emphasize that clients are responsible for their behavior and help clients to develop a sense of autonomy and responsibility that helps them to drive more flexible patterns of thinking.

REBT is typically time-limited in its approach, such that the therapist and client work on specific issues together, judge their progress toward the goals of the therapy, and once the issues of been addressed and the necessary changes been made, the therapeutic situation is terminated. Clients have the option to visit the therapist for booster sessions in the future or to seek additional help for other issues; however, unlike many other types of therapy, REBT attempts to address the specific issues that brought the client to therapy and release them as opposed to keeping them in therapy for years.

Whenever someone reads a summary of a particular therapeutic paradigm, it is quite easy to conclude that performing psychotherapy, such as REBT, is straightforward and not complicated. Nothing could be further from the truth. Clients in therapy will often demonstrate significant resistance to change, even though they came to the therapeutic environment to change their situation.

Simple summaries of how a particular type of therapy works and the general principles of the therapy can never do justice to all the intricacies that are involved in therapy and the type of specialized training, education, and experience competent therapists must complete. Identifying dysfunctional schemas and implementing cognitive restructuring techniques is not as easy as it may sound. Licensed therapists who practice these types of techniques are often required to have some form of graduate education, participate in some form of internship training, and pass a formal licensing exam before they can begin to practice.

Does REBT Work?

The simple answer to the above question is “yes.” However, there are some instances that can decrease the effectiveness of these approaches. Rational Emotive Behavior Therapy and other forms of Cognitive Behavioral Therapy are action-oriented therapies that attempt to get the client actively involved in the process of change. Being involved in any form of Cognitive Behavioral Therapy is not a passive process, and clients must be willing to do the work both in therapy sessions and outside sessions as homework in order to achieve maximum results. The stereotype of a therapist listening to a client who lies on the couch is not applicable to therapies like REBT.

The effectiveness of REBT has resulted in many professional sources, including psychiatric texts, reporting that cognitive-behavioral therapies such as REBT are the frontline treatment approaches to many types of issues, including anxiety, trauma- and stressor-related disorders, and even substance use disorders. While medications can treat some of the symptoms associated with these disorders, they cannot address the entire syndrome and result in significant change. In addition, REBT therapists remain flexible in their approach, and they will often incorporate techniques and principles from other paradigms.

One of the most recent paradigms to affect most forms of Cognitive Behavioral Therapy comes from the technique of Motivational Interviewing (MI). MI is a cognitive-behavioral-based paradigm that utilizes a method to determine where an individual’s awareness of their need to change is before outlining a therapeutic approach. Individuals with substance use disorders who do not see a valid reason for them to change their behavior require a different approach than individuals who view their behavior as problematic. Thus, like its approach to developing more flexible and rational belief systems in its clients, REBT remains flexible and open to growth and change.

While the overall approach used in REBT still follows many of the tenants developed by Dr. Albert Ellis, the technique continues to evolve in order to fit the needs of clients and to be consistent with the latest empirical evidence regarding positive change.

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