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Home arrow Psychology arrow REBT in the Treatment of Anxiety Disorders in Children and Adults

What Is REBT?

Rational Emotive Behavior Therapy (REBT) is the first form of cognitive behavior therapy (CBT) and was created by Dr. Albert Ellis. According to the REBT model, people experience undesirable activating events, about which they have rational beliefs (RBs) and irrational beliefs (IBs). These beliefs then lead to emotional, behavioral, and cognitive consequences. Rational beliefs lead to functional consequences, while irrational beliefs lead to dysfunctional consequences. Clients who engage in REBT are encouraged to actively dispute their IBs and to assimilate more efficient, adaptive, and rational beliefs, with a positive impact on their emotional, cognitive, and behavioral responses (Ellis, 1962, 1994; Walen et al., 1992). Thus, REBT is a psychological theory and a treatment consisting of a combination of three different types of techniques (cognitive, behavioral, and emotive) you can use to help yourself feel better physically and emotionally, and to engage in healthier behaviors.

Managing Anxiety with Cognitive Techniques: The Power of Our Thoughts

• Although we may not always be aware of our thoughts, they nevertheless can have a strong effect on how we feel and behave in response to a particular situation or event.

(a) Re-learning our A-B-Cs:

• According to the cognitive theory, the effect that our thoughts can have on our physical, behavioral, and emotional responses to a particular situation can be illustrated using the following diagram:

A= Activating event or situation that we experience

B = Beliefs or thoughts regarding the situation

C = Consequence: How we feel or act based on these beliefs

(b) How to think in a more rational way—The alphabet approach (A-B-C-D-E-F):

Let's Start at the Very Beginning: A's (Activating Events)

• On the top of the form (the ABC monitoring form, see page 37), on the left hand side, you will see a box labeled “A (Activating Events).”

• In this box, we would like you to write about an upsetting event that happened to you today. We have provided some examples of upsetting events below the box, but you should fill in examples that are personal to you.

• We would like to particularly encourage you to focus on monitoring the times when you feel particularly sad or when you are anxious/worried.

• If there is a day where nothing particularly upsetting happens, we would like you to fill in this “A” box with either (a) an upsetting event that happened to you in the past, or (b) an upsetting event you've made up.

EXAMPLE: “I feel worried because of my insecure life, and wonder how I am going to get through the rest of the day”.

Before we move on to B's, let's first focus on C's. C's: Consequences Following the Events

• On the top of the form, on the right hand side, you will see a box labeled “C (Consequences).”

• In this box, we would like you to write the consequences of the event.

• There can be three types of consequences. You may experience one, two, or all three of them:

Unhealthy negative feelings. Below the box, we have included a few examples of unhealthy negative feelings (e.g., anxiety, fear, rage). However, we encourage you to write in whatever words best describe your experience.

Unhelpful behaviors. Below the box, we have included some examples of unhelpful behaviors. These are things you do that are unproductive or harmful in some way.

Negative Physical Consequences of Distress. When people experience an upsetting event, they may experience some physical symptoms. For example, if you argue with a friend, you may find yourself flushed, hot, or shaking. We have listed some examples of physical consequences below the box, but again, please write any physical reactions you experience.

The Keys to Change: B's (Negative or Unhelpful Beliefs)

• As we have shown above, even though it may seem like an upsetting event (A) leads you to feel upset (C), this is not 100 % true.

• In reality, it is not the event itself that upsets you, it is your negative or unhelpful beliefs (B's) about the event that upset you.

• So how do you identify your negative or unhelpful beliefs?

• See if your beliefs fall into any of the following categories:

Demands—Check to see if your thoughts contain the words “must,” “should,” or “ought.” For example, you might think, “I must be able to do all of my errands today!” or, you might think “Life should be fair.”

Awfulizing/Catastrophizing—Check to see if your thoughts involve words like “awful,” “horrible,” or “terrible.” For example, you might think, “I was too worried to leave the house, and that's AWFUL! I'm usually active all day long.”

Frustration Intolerance—Check to see if your thoughts include “I can't stand this!” or the word “unbearable.” For example, you might think, “I can't stand being worried like this!”

Self-Downing—Check to see if you're calling yourself names, being too critical of yourself, or beating up on yourself. Also, check to see if you're basing your self-worth on one or two minor things. For example, you might think, “I was too tense to make dinner for my kids today. I'm an insensitive mother and a terrible person.”

Other-Downing—Check to see if you're being too critical of or beating up on others, or basing your entire judgment of them on one or two minor things. For example, you might think, “My husband isn't very good at talking with me about my anxieties. He's totally insensitive and useless.”

Life-Downing—Check to see if you're judging all of your life as bad, just because it's not perfect. For example, you might think “Life is worthless because I feel so worn out.”

Remember, negative thoughts are those thoughts that make us feel and/or behave in a negative, hurtful, or unpleasant manner (e.g., feeling anxious, or angry and being short-tempered). Once you recognize the negative belief you have about the situation, please write it in the “B” box.

D's: Debating Your Negative Beliefs

• After you recognize your negative or unhelpful thoughts, the next step is to DEBATE or challenge them. There are lots of different ways you can do this.

• First, you can ask yourself, “Where is holding this belief getting me? Is it helpful, or is it getting me into trouble?”

– For example, if your belief leads you to feel upset (e.g., to cry, to feel anxious), to do things that are unhelpful or harmful to you (e.g., stop socializing with friends, not following through on treatment recommendations), or to physically feel worse (e.g., to feel more anxious), then you might decide that your belief is unhelpful.

• Second, you can ask yourself, “Where is the evidence to support my negative belief? Is it logical?”

– For example, I may think, “I CAN'T STAND feeling so tense.” But if I stop, and really consider this, I realize I can stand it. I'm still waking up every morning, I'm still taking care of my medical appointments, etc. So even though I may not like feeling so tense, I can stand it.

• Please write in box D what you said to yourself to debate and dispute your negative thoughts.

E's: Effective/Helpful Beliefs

• Once you have successfully debated against your negative beliefs, you are ready to replace them with new more effective or more helpful beliefs.

• Healthier beliefs may sound like one of the following:

Preferences—These are a healthier, more rational alternative to demands. Preferences are when you wish for something, or want it very badly, but do not demand that it must be so. For example, you might think, “I really wish I had the energy I used to have,” instead of saying, “I MUST feel exactly the way I did before I got anxiety.”

Anti-Awfulizing—This is a healthier, more rational alternative to awfulizing. This is when you can recognize that a situation is very bad, without thinking it is 100 % AWFUL. For example, you might think, “Being too worried to go to work 5 days a week is really bad, but at least I know this won't last forever, and staying at home does give me more time to catch up with my friends,” instead of thinking “Feeling this worried is AWFUL!”

High Frustration Tolerance—This is a healthier, more rational alternative to frustration intolerance. This is when you realize that even though you may find a situation very difficult, you can stand it. For

example, you might think, “I hate feeling so anxious, but I'll just keep finding new ways to cope with it, and I'll keep going!” instead of thinking “I can't stand feeling so anxious! It's unbearable!”

Anti-Self-Downing—This is a healthier, more rational alternative to self-downing. This is when you are able to accept yourself and approve of yourself, even when you're not perfect. So for example, you might think, “Ok, I'm not handling my worries as well as I would like. I'm usually such a strong person, and now I find myself often overwhelmed. But I recognize that I'm still a good, worthwhile person, even if I'm not as strong as I thought.” This thought is a more rational, positive alternative than calling yourself names like, “I'm a weak, terrible person.”

Anti-Other-Downing—This is a healthier, more rational alternative to other-downing. This is when you're able to accept others, regardless of mistakes they might have made, or things they might have done to upset you. For example, you might think, “I'm pretty upset at my husband for not listening to me. But I recognize he's still generally a great guy, who does lots of great things. He picks up the kids from day care, he takes them to the doctor, and he takes care of the house.” This is an alternative to thinking “He's not a good listener, and that makes him a horrible person.”

Anti-Life-Downing—This is a healthier, more rational alternative to life-downing. This is when you're able to be accepting of how your life is, even when it is not exactly as you would like it to be. For example, you might think, “This isn't how I planned for my life to be, but I recognize that life is a mixed bag, full of good as well as bad events,” instead of thinking “Life is meaningless and useless now that I have anxiety.”

F's: New More Functional Emotions and Behaviors

• Now you're ready to see the results of all your hard work!

• By changing your negative beliefs into more helpful ones, you should now:

– Feel better emotionally!

For example, you may feel more positive (happier, calmer, more relaxed), or less strongly negative (e.g., anxious vs. concerned, annoyed vs. furious).

– Behave in a more helpful way!

For example, you may exercise, or socialize with friends, or pursue a hobby.

– Feel better physically!

For example, you might feel more energetic or have less muscle tension.

Managing Anxiety with Behavioral Techniques

Behavioral Techniques

• Sometimes when we have to deal with a stressful or challenging life situation, or when we are having a particularly hectic day, we may not have enough time or energy to focus on using the cognitive techniques we have just reviewed (i.e., A-B-C-D-E-F model) in order to manage our negative thoughts.

• On those days, the simple and brief strategies outlined below are alternative techniques you can use to help you manage any feelings of distress, negative thinking, fatigue, or other symptoms.

(a) Activity Scheduling/Planning

• Some people may begin to feel overwhelmed by negative thoughts when undergoing their REBT treatment as they try to fit in all their usual dayto-day activities. Planning your daily and weekly schedules in advance will help you manage your daily activities, decrease your negative thoughts, control your level of fatigue, and overall, help you feel less more in control of your life.

(b) Distraction Techniques.

• Distraction techniques help take your mind off of your negative thoughts.

Some distraction techniques are as follows:

– Imagining a Pleasant Image/Scene.

– Listening to relaxing or enjoyable music tapes, CDs, videos.

– Take a short walk.

– Visualizing a “STOP” Sign.

Beyond REBT Treatment

• The REBT techniques that have been covered in this manual will help you to manage your anxiety symptoms. Moreover, these techniques can be applied to any situation in the future when you may feel overwhelmed and/or distressed.

• It is important to note that following the completion of your REBT treatment, you may occasionally experience days when you feel anxious or distressed. During such periods, we suggest that you review the contents of this manual and continue to use the REBT skills that you have learned.

• Over time and with practice, these REBT skills will become natural for you, like riding a bike or driving a car.

• We hope that you will find these techniques valuable, and we wish you every success in the future.

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