Thursday, August 13, 2009

Rational Emotive Behavior Therapy

I recently took the practice test that came in the ASWB Clinical Exam study guide and highlighted all of the terms/theories that I needed to brush up on. This led to me researching Rational Emotive Behavior Therapy. The title above links to a great website for the New Zealand Centre for Rational Emotive Behaviour Therapy. (I may be a bit partial to the Kiwis as I am married to one). The basics of REBT are as follows:

Developed by Dr. Albert Ellis in the 1950s, in REBT the focus is on the client's beliefs. REBT is one of many Cognitive Behavioral therapies. REBT proposes a "biopsychosocial" causation of human feelings and behavior. The premise is that almost all emotions and behaviors are a result of what we think, assume or believe (either about ourselves, others or the environment around us). REBT also accepts that a person's biology also plays a part and there are limitations to how much a human being can change. REBT is an "active-directive" therapy.
Ellis used an ABC model to illustrate the role of cognition:
A - the actual event or experience and the persons "inferences" or interpretation of it
B - the "evaluative" beliefs that follow
C - the emotions /behaviors that follow the evaluative beliefs
A - the waiter did not offer to show me the dessert menu (activating event)
A - the waiter must think I am fat and don't need dessert (inferences)
B - I am disgusting, worthless, I have no self control (evaluation)
C - Feeling depressed, go home and binge on oreos (emotional, behavioral reaction)
This can create a chain reaction where "C" becomes "A" triggering another episode. To achieve lasting change you must modify the underlying core beliefs.
Irrational thinking: a thought that blocks a person from achieving their goals, creates extreme emotions that immobilize and harm oneself and others. It distorts reality (misinterpretation not supported by available evidence). It contains illogical ways of self evaluation and evaluating others. REBT practitioners often refer to beliefs as "self defeating" to highlight that the main reason for replacing the belief is because it is negatively affecting their life.
Ego disturbance: an upset to the self image as a result of holding onto demands about one's self followed by negative self evaluations. (I must do _, When I fail I am worthless). Discomfort disturbance results from demands of others & the environment. This comes as Low frustration tolerance (LFT) demanding that frustration not happen and catastrophising when it does. Also Low discomfort tolerance (LDT) demands that one not experience emotional/physical discomfort and catasrophising when discomfort occurs. LFT & LDT leads to "discomfort anxiety", worrying, avoidance of potentially stressful events/circumstances, secondary disturbance (anxiety about having anxiety), short-range enjoyment (alcohol/food abuse, shopping -- instant gratification), procrastination, negativity and complaining.
People live by "core beliefs" that guide how they react to events. (i.e. I need love and approval from those around me -- I must avoid disapproval). There are three main levels of thinking 1) Inferences 2) evaluations 3) Core beliefs
Other key terms:
Awfulising: exaggerating the consequences of past/present/future events.
People-rating: overgeneralization where a person judges their (or someone else's) entire worth by a specific trait or behavior.
Some "selectively eclectic" Techniques:
Double-standard dispute: If the client has a "should" belief, ask if they would expect someone else (best friend, therapist) to believe the same. Help them to see the double standard.
Catastrophe scale: Have the client place stressful events on a scale amidst other events such as having to do a chore, find a new doctor, divorce, losing a loved one, major earthquake etc.
Devil's advocate/reverse role playing: therapist adopts the clients belief and argues for it.
The "blow-up" technique: ask the client to imagine a fear and then blow it out of proportion until it becomes almost amusing.
Exposure: Prescribing the client engage in a situation (after preparation) that they would usually avoid (speed dating) to test validity of fears, increase tolerance, develop confidence.
Shame attacking: confronting the fear of shame by asking the client to deliberately act in ways that they fear will attract disapproval.
Goals & Process of REBT:
  • Creating an awareness of the effect of beliefs/thinking on behavior.
  • Highlight relevant beliefs
  • Teach the client to dispute/change irrational beliefs -- often using the ABC format and extending it to D (Disputing) and E (new Effect)
  • Prescribing homework that actively practices disputing self defeating beliefs, inferences and evaluations.
Adapted from "A Brief Introduction To Rational Emotive Behaviour Therapy" by Wayne Froggatt

Erickson's 8 stages of Psychosocial Development

Main premise: a series of conflicts must be resolved throughout our development so we can attain a healthy personality.
  1. Infant (birth to 18mos) Trust vs. Mistrust: learns to trust self, environment
  2. Toddler (18mos to 3yrs) Autonomy vs. Shame and Doubt: learns to believe in him/herself
  3. Preschool (3 to 5) Initiative vs. Guilt: learns to take initiative in play rather than mimicking
  4. Latency State (6 to 12) Industry/Competence vs. Inferiority: learns that he/she is capable and able to accomplish
  5. Adolescence (12 to 18) Identity vs. Role Confusion: searches for individuality from environment
  6. Young Adult (19 to 40) Intimacy vs. Isolation: searches for meaningful relationships
  7. Middle Adult (40 to 65) Generativity/Productivity vs. Self Absorption or Stagnation: search for meaning through intergenerational communication
  8. Late Adulthood (65 to death) Ego Integrity vs. Despair: looking back with either feelings of accomplishment or despair