Albert Ellis and Aaron Beck PDF

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REBT and CBT...

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Albert Ellis’s Rational Emotive Behavior Therapy ALBERT ELLIS (1913–2007) was born in Pittsburgh but escaped to the wilds of New York at the age of 4 and lived there (except for a year in New Jersey) for the rest of his life. He was hospitalized nine times as a child, mainly with nephritis, and developed renal glycosuria at the age of 19 and diabetes at the age of 40. Despite his many physical challenges, he lived an unusually robust, active, and energetic life until his death at age 93. As he put it, “I am busy spreading the gospel according to St. Albert.” Realizing that he could counsel people skillfully and that he greatly enjoyed doing so, Ellis decided to become a psychologist. Believing psychoanalysis to be the deepest form of psychotherapy, Ellis was analyzed and supervised by a training analyst. He then practiced psychoanalytically oriented psychotherapy, but eventually he became disillusioned with the slow progress of his clients. He observed that they improved more quickly once they changed their ways of thinking about themselves and their problems. Early in 1955 he developed an approach to psychotherapy he called rational therapy and later rational emotive therapy, and which is now known as rational emotive behavior therapy (REBT). Ellis has rightly been referred to as the grandfather of cognitive behavior therapy. To some extent Ellis developed his approach as a method of dealing with his own problems during his youth. At one point in his life, for example, he had exaggerated fears of speaking in public. During his adolescence he was extremely shy around young women. At age 19 he forced himself to talk to 100 different women in the Bronx Botanical Gardens over a period of one month. Although he never managed to get a date from these brief encounters, he does report that he desensitized himself to his fear of rejection by women. By applying rational and behavioral methods, he managed to conquer some of his strongest emotional blocks (Ellis, 1994, 1997). People who heard Ellis lecture often commented on his abrasive, humorous, and flamboyant style. In his workshops it seemed that he took delight in giving vent to his eccentric side, such as peppering his speech with four-letter words. He greatly enjoyed his work and teaching REBT, which was his passion and primary commitment in life. It seems that his work was his life, and he gave workshops wherever he went in his travels. Ellis proclaimed, “I wouldn’t go to the Taj Mahal unless they asked me to do a workshop there!” Ellis married Australian psychologist Debbie Joffe in November 2004, whom he has called “the greatest love of my life” (Ellis, 2008). They shared the same life goals and ideals, and they worked as a team presenting workshops. If you are interested in learning more about the life and work of Albert Ellis, I recommend two of his books: Rational Emotive Behavior Therapy: It Works for Me—It Can Work for You (Ellis, 2004a) and All Out! An Autobiography (Ellis, 2010).

Rational emotive behavior therapy (REBT) was the fi rst of the cognitive behavior therapies, and today it continues to be a major cognitive behavioral approach. REBT has a great deal in common with the therapies that are oriented toward cognition and behavior as it also stresses thinking, judging, deciding, analyzing, and doing. The basic assumption of REBT is that people contribute to their own psychological problems, as well as to specific symptoms, by the rigid and extreme beliefs they hold about events and situations. REBT is based on the assumption that cognitions, emotions, and behaviors interact signifi cantly and have a reciprocal cause-and-effect relationship. REBT has consistently emphasized all three of these modalities and their interactions, thus qualifying it as an integrative approach (Ellis, 2001a, 2001b, 2002, 2011; Ellis & Dryden, 2007; Wolfe, 2007). Although REBT is generally conceded to be the parent of today’s cognitive behavioral approaches, it was preceded by earlier schools of thought. Ellis gave credit to Alfred Adler as an infl uential precursor of REBT, and Karen Horney’s (1950) ideas on the “tyranny of

the shoulds” are apparent in the conceptual framework of REBT. Ellis also acknowledged his debt to the ancient Greeks, especially the Stoic philosopher Epictetus, who said around 2,000 years ago: “People are disturbed not by events, but by the views which they take of them” (as cited in Ellis, 2001a, p. 16). Ellis’s reformulation of Epictetus’s dictum can be stated as, “People disturb themselves by the rigid and extreme beliefs they hold about events.” REBT’s basic hypothesis is that our emotions stem mainly from our beliefs, which infl uence the evaluations and interpretations we make of the reactions we have to life situations. Through the therapeutic process, clients learn skills that give them the tools to identify and dispute irrational beliefs that have been acquired and self-constructed and are now maintained by self-indoctrination. They learn how to replace such ineffective ways of thinking with effective and rational cognitions, and as a result they change their emotional reactions to situations. The therapeutic process allows clients to apply REBT principles of change not only to a particular presenting problem but also to many other problems in life or future problems they might encounter. Several therapeutic implications fl ow from these assumptions: The focus is on working with thinking and acting rather than primarily with expressing feelings. Therapy is seen as an educational process. The therapist functions in many ways like a teacher, especially in collaborating with a client on homework assignments and in teaching strategies for straight thinking; and the client is a learner who practices these new skills in everyday life. REBT differs from many other therapeutic approaches in that it does not place much value on free association, working with dreams, focusing on the client’s past history, expressing and exploring feelings, or dealing with transference phenomena. Ellis (2011) maintains that transference is not encouraged, and when it does occur, the therapist is likely to confront it. Ellis believes the transference relationship is based on the irrational belief that the client must be liked and loved by the therapist, or parent fi gure. Although transference and countertransference may spontaneously occur in therapy, Ellis claims “they are quickly analyzed, the philosophies behind them are revealed, and they tend to evaporate in the process” (p. 221). Furthermore, when a client’s deep feelings emerge, “the client is not given too much chance to revel in these feelings or abreact strongly about them” (p. 221). Ellis believes that such cathartic work may result in clients feeling better, but it will rarely aid them in getting better. View of Human Nature Rational emotive behavior therapy is based on the assumption that human beings are born with a potential for both rational, or “straight,” thinking and irrational, or “crooked,” thinking. People have predispositions for self-preservation, happiness, thinking and verbalizing, loving, communion with others, and growth and selfactualization. They also have propensities for self-destruction, avoidance of thought, procrastination, endless repetition of mistakes, superstition, intolerance, perfectionism and self-blame, and avoidance of actualizing growth potentials. REBT encourages people accept themselves even though they will make mistakes. View of Emotional Disturbance REBT is based on the premise that we learn irrational beliefs from significant others during childhood and then re-create these irrational beliefs throughout our lifetime. We actively reinforce our selfdefeating beliefs through the processes of autosuggestion and self-repetition, and we then behave in ways that are consistent with these beliefs. Hence, it is largely our own repetition of early-indoctrinated irrational beliefs, rather than a parent’s repetition, that keeps dysfunctional attitudes alive and operative within us. Ellis contends that people do not need to be accepted and loved, even though this may be

highly desirable. The therapist teaches clients how to feel sad, but not depressed, even when they are unaccepted and unloved by signifi cant others. A major goal of the REBT therapist is to encourage clients to be less emotionally reactive, for example, by feeling sadness and disappointment about life’s adversities rather than by feeling anxiety, depression, and shame. Ellis insists that blame is at the core of most emotional disturbances. If we want to become psychologically healthy, we had better stop blaming ourselves and others and learn to fully and unconditionally accept ourselves despite our imperfections. Ellis (Ellis & Blau, 1998; Ellis & Harper, 1997) hypothesizes that we have strong tendencies to transform our desires and preferences into dogmatic “shoulds,” “musts,” “oughts,” demands, and commands. When we are disturbed, it is a good idea to look to our hidden dogmatic “musts” and absolutist “shoulds.” Such demands underpin disruptive feelings and dysfunctional behaviors (Ellis, 2001a, 2004a). Here are three basics musts (or irrational beliefs) that we internalize that inevitably lead to self-defeat (Ellis & Dryden, 2007): • “I must do well and win the approval of others for my performances or else I am no good.” • “Other people must treat me considerately, fairly, kindly, and in exactly the way I want them to treat me. If they don’t, they are no good and they deserve to be condemned and punished.” • “I must get what I want, when I want it; and I must not get what I don’t want. If I don’t get what I want, it’s terrible, I can’t stand it, and life is no good for depriving me of what I must have.” We have a strong tendency to make and keep ourselves emotionally disturbed by internalizing and perpetuating self-defeating beliefs such as these, which is why it is a real challenge to achieve and maintain good psychological health (Ellis, 2001a, 2001b). A-B-C Framework The A-B-C framework is central to REBT theory and practice. This model provides a useful tool for understanding the client’s feelings, thoughts, events, and behavior (Wolfe, 2007). A is the existence of a fact, or an activating event, or an inference about an event, of an individual. C is the emotional and behavioral consequence or reaction of the individual; the reaction can be either healthy or unhealthy. A (the activating event) does not cause C (the emotional consequence). Instead, B, which is the person’s belief about A, largely creates C, the emotional reaction

If a person experiences depression after a divorce, for example, it may not be the divorce itself that causes the depressive reaction nor his inference that he has failed, but the person’s beliefs about his divorce or about his failure. Ellis maintains that the beliefs about the rejection and failure (at point B) are what mainly cause the depression (at point C)—not the actual event of the divorce or the person’s inference of failure (at point A). Believing that human beings are largely responsible for creating their own emotional reactions and disturbances and showing people how they can change their irrational beliefs that directly “cause” their disturbed emotional consequences is at the heart of REBT (Ellis & Dryden, 2007; Ellis & Harper, 1997). How is an emotional disturbance fostered? It is fed by the selfdefeating sentences clients continually repeat to themselves, such as “I am totally to blame for the

divorce,” “I am a miserable failure, and everything I did was wrong,” “I am a worthless person.” Ellis repeatedly makes the point that “you mainly feel the way you think.” Disturbed emotional reactions such as depression and anxiety are initiated and perpetuated by clients’ self-defeating belief systems, which are based on irrational ideas clients have incorporated and invented. After A, B, and C comes D (disputing). Essentially, D is the application of methods to help clients challenge their irrational beliefs. There are three components of this disputing process: detecting, debating, and discriminating. First, clients learn how to detect their irrational beliefs, particularly their absolutist “shoulds” and “musts,” their “awfulizing,” and their “self-downing.” Then clients debate their dysfunctional beliefs by learning how to logically and empirically question them and to vigorously argue themselves out of and act against believing them. Finally, clients learn to discriminate irrational (self-defeating) beliefs from rational (selfhelping) beliefs (Ellis, 1994, 1996). Cognitive restructuring is a central technique of cognitive therapy that teaches people how to improve themselves by replacing irrational beliefs with rational beliefs (Ellis, 2008). Restructuring involves helping clients learn to monitor their self-talk, identify maladaptive selftalk, and substitute adaptive self-talk for their negative self-talk (Spiegler, 2008). Ellis (1996, 2001b) maintains that we have the capacity to signifi cantly change our cognitions, emotions, and behaviors. We can best accomplish this goal by avoiding preoccupying ourselves with A and by acknowledging the futility of dwelling endlessly on emotional consequences at C. Rather, we can choose to examine, challenge, modify, and uproot B—the irrational beliefs we hold about the activating events at A. Although REBT uses many other cognitive, emotive, and behavioral methods to help clients minimize their irrational beliefs, it stresses the process of disputing (D) such beliefs both during therapy sessions and in everyday life. Eventually clients arrive at E, an effective philosophy, which has a practical side. A new and effective belief system consists of replacing unhealthy thoughts with healthy ones. If we are successful in doing this, we also create F, a new set of feelings. Instead of feeling seriously anxious and depressed, we feel healthily sorry and disappointed in accord with a situation. In sum, philosophical restructuring to change our dysfunctional personality involves these steps: (1) fully acknowledging that we are largely responsible for creating our own emotional problems; (2) accepting the notion that we have the ability to change these disturbances signifi cantly; (3) recognizing that our emotional problems largely stem from irrational beliefs; (4) clearly perceiving these beliefs; (5) seeing the value of disputing such self-defeating beliefs; (6) accepting the fact that if we expect to change we had better work hard in emotive and behavioral ways to counteract our beliefs and the dysfunctional feelings and actions that follow; (7) understanding what the rational alternative to these irrational beliefs are; and (8) practicing REBT methods of uprooting or changing disturbed consequences and practicing their healthy alternatives for the rest of our life (Ellis, 1999, 2001b, 2002). The Practice of Rational Emotive Behavior Therapy Rational emotive behavior therapists are multimodal and integrative. REBT generally starts with clients’ disturbed feelings and intensely explores these feelings in connection with thoughts and behaviors. REBT practitioners tend to use a number of different modalities (cognitive, imagery, emotive, behavioral, and interpersonal) to dispel these self-defeating cognitions and to teach people how to acquire a rational approach to living. Therapists are encouraged to be fl exible and creative in their use of methods, making sure to tailor the techniques to the unique needs of each client (Dryden, 2007).

Aaron Beck’s Cognitive Therapy AARON TEMKIN BECK (b. 1921) was born in Providence, Rhode Island. His childhood, although happy, was interrupted by a lifethreatening illness when he was 8 years old. As a consequence, he experienced blood injury fears, fear of suffocation, and anxiety about his health. Beck used his personal problems as a basis for understanding others and for developing his cognitive theory. A graduate of Brown University and Yale School of Medicine, Beck initially was trained as a neurologist, but he switched to psychiatry during his residency. Beck attempted to validate Freud’s theory of depression, but his research resulted in his parting company with Freud’s motivational model and the explanation of depression as selfdirected anger. As a result of this decision, Beck endured isolation and rejection from many in the psychiatric community for many years. Through his research, Beck developed a cognitive theory of depression, which represents one of the most comprehensive conceptualizations. He found the cognitions of depressed individuals to be characterized by errors in interpretation that he called “cognitive distortions.” For Beck, negative thoughts reflect underlying dysfunctional beliefs and assumptions. When these beliefs are triggered by situational events, a depressive pattern is put in motion. Beck believes clients can assume an active role in modifying their dysfunctional thinking and thereby gain relief from a range of psychiatric conditions. His continuous research in the areas of psychopathology and the utility of cognitive therapy has earned him a place of prominence in the scientific community in the United States. Beck is the pioneering figure in cognitive therapy, one of the most influential and empirically validated approaches to psychotherapy. Beck joined the Department of Psychiatry of the University of Pennsylvania in 1954, where he currently holds the position of University Professor (Emeritus) of Psychiatry. Beck’s pioneering research established the efficacy of cognitive therapy for depression. He has successfully applied cognitive therapy to depression, generalized anxiety and panic disorders, suicide, alcoholism and drug abuse, eating disorders, marital and relationship problems, psychotic disorders, and personality disorders. He has developed assessment scales for depression, suicide risk, anxiety, self-concept, and personality. He is the founder of the Beck Institute, which is a research and training center directed by one of his four children, Dr. Judith Beck. He has eight grandchildren and two great-grandchildren and has been married for more than 60 years. To his credit, Aaron Beck has focused on developing the cognitive therapy skills of thousands of clinicians throughout the world. In turn, many of them have established their own cognitive therapy centers. Beck has a vision for the cognitive therapy community that is global, inclusive, collaborative, empowering, and benevolent. He continues to remain active in writing and research; he has published 21 books and more than 450 articles and book chapters. For more on the life of Aaron T. Beck, see Aaron T. Beck (Weishaar, 1993). Cognitive Therapy Aaron T. Beck developed an approach known as cognitive therapy (CT) as a result of his research on depression (Beck 1963, 1967). Beck developed cognitive therapy about the same time that Ellis was developing REBT, yet they appear to have created their approaches independently. Beck’s observations of depressed clients revealed that they had a negative bias in their interpretation of certain life events, which contributed to their cognitive distortions (Beck, 1967). Cognitive therapy has a number of similarities to both rational emotive behavior therapy and behavior therapy. All of these therapies are active, directive, time-limited, presentcentered, problem-oriented, collaborative, structured, and empirical. They make use of homework and require explicit identifi cation of problems and the situations

in which they occur (Beck & Weishaar, 2011). Cognitive therapy (CT) perceives psychological problems as stemming from commonplace processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information, and failing to distinguish between fantasy and reality. Like REBT, CT is an insight-focused therapy with a strong psychoeducational component that emphasizes recognizing and changing unrealistic negative thoughts and maladaptive beliefs. Cognitive therapy is highly collaborative and involves designing specifi c learning experiences to help clients monitor their automatic thoughts; examine the validity of their automatic thoughts; understand the relationship among cognition, feelings, and behavior; develop more accurate and ...