9 January 2012

REBT versus CBT

"Not everything that can be counted counts, and not everything that counts can be counted." 
- Albert Einstein




I have a bit of a thing about CBT (Cognitive Behavioural Therapy). I expect it's to do with a longstanding aspect of my personality - the more popular something is and the more I am told what to like, the more likely I am to question it and challenge the status quo. The status quo of CBT in therapy today seems to be as a result of it's ease of measurement. This jars with my humanistic philosophy and approach; people are way more complex than empirical research allows - science has a long way to catch up with the sophistication of our organismic selves. I wrote a post about my struggles with CBT here.

That said, I do know a lot of people who say that CBT has helped them enormously and I would not argue with their experience of it. I would say, however, that it is not the panacea it is touted as, and just because it is a fashionable approach, does not deem it better than other approaches.

This post is not only about my dissatisfaction with the reductionist CBT but also to inform and educate on what I believe is an overlooked and yet decent alternative - REBT - Albert Ellis' Rational Emotive Behaviour Therapy - predating Aaron Beck's CBT by around a decade.

Albert Ellis had a "...crumbling faith in psychoanalysis" and has been attributed to saying "Freud was full of horseshit!". Strong words indeed, and Ellis has been criticised for being aggressive and foul-mouthed. Of his many infleunces he includes the early Stoic philosophers, most notably Epictetus:

"Man is not disturbed by things but by the views he takes of them"


Here follows a description of REBT (snagged from one of my diploma essays):

It is a comprehensive theory of human behaviour that proposes that a combination of biological, psychological and social factors are involved in the way human beings feel and behave (1). The principal thesis is that sustained emotional reactions are caused by internal sentences, in the form of dogmatics "musts", "shoulds" or "oughts" that people repeat to themselves. These reflect their unspoken assumptions, or irrational beliefs, about what is necessary to lead a meaningful life. It is what people believe about the situations they face, not the situations themselves, that determines how they feel and behave. Furthermore it is the presence of extreme philosophies that can make the difference between healthy negative emotions (such as sadness, regret or concern) and unhealthy negative emotions (such as depression, guilt or anxiety).


In REBT the goal is to modify the underlying core belief or philosophy of the client as opposed to modifying their behaviour, as is the case in CBT which approach Ellis refers to as "inelegant". According to Ellis, CBT does not tend to help the client to effect a philosophical shift at the most elegant level possible. (2)


The emphasis is placed on actively-directively teaching the client a system for self-help, known as the A-B-C model. A - the activating event is followed by C - an emotional consequence. However it is not correct to say that A causes C, which is how the client may perceive it. The therapist teaches the client to see that C occurs as a result of their belief system (B). In order to understand the emotional consequence at C, the therapist helps the client to focus on B, the irrational beliefs about A, and not A itself. D refers to the disputing of irrational beliefs and E to a new and effective rational outlook.


In common with CBT it places little emphasis on exploring the past, instead focusing on changing the client's current evaluations and philosophical thinking-emoting and behaving."



I have been scouring the internet for a synopsis of the differences between REBT and CBT and stumbled across a forum with a posting by Clinical Psychologist based in San Francisco  - Dr Michael R Edelstein, author of Three Minute Therapy. Here is what I found:


Question: What is the difference between Ellis REBT/Burns CBT? Which approach is easier to understand?



I favor REBT to CBT for many reasons, the most significant of which are:

1. REBT addresses the philosophic core of emotional disturbance as well as the distorted cognitions (the focus of CBT) which derive from this core. Consequently, it is more powerful than CBT in this way. As you change your basic philosophy, the cognitive distortions are eliminated as a byproduct.

2. REBT highlights the significance of secondary disturbance (SD) which is often the largest factor in life-long (endogenous) depression, severe anxiety, and panic attacks. As far as I can tell, CBT completely ignores SD.

3. REBT maintains that all anger is destructive and teaches individuals appropriate, yet unangry, effective assertiveness. CBT views some anger as healthy and, although it teaches assertiveness, fails to address uprooting the philosophic core of anger.

4. REBT presents an elegant solution to the self-esteem problem. It teaches unconditional self-acceptance (USA), rather than any kind of self-rating, "authentic" or otherwise. Most CBT therapists focus on bolstering their clients' self-esteem.

5. As a consequence of these powerful differences and others, REBT is easier to understand.

6. The average duration of my REBT therapy consists of 8 - 10 sessions, shorter than most CBT.

Dr Michael R Edelstein

(The above has been copied with the kind consent of Dr Edelstein. Click here for the link to the REBT-CBT forum.)

Secondary disturbance, or secondary emotional disturbance is when somebody has a negative emotional response to their emotional responses. For example, somebody who suffers from panic attacks may feel ashamed of their perceived weakness. So the secondary emotion here is shame. I often find with clients that the presenting issues are usually wrapped up in secondary emotional disturbance which makes the whole package bigger, more powerful and harder to manage. Get rid of that wrapper and then we can look at what's underneath.

In conclusion, although I, as a person-centred counsellor, would not normally utilise a technique such as CBT or REBT, there are elements of the philosophy behind REBT which correlate with my personal approach. Indirectly, secondary emotional disturbances are addressed through the therapeutic process, and through striving to acquire a truly empathic and non-judgmental connection with the client, questions are naturally asked which challenge underlying core beliefs which may no longer serve the client.

One last point, I like Albert Ellis and respect his challenging demeanour. Here's the man in action:



References:







9 comments:

Caterina (Counsellor) said...

I have to agree with this, I am sure that CBT works in some cases for some people but I fear it has turned the counselling process into a somewhat reductionist and formulaic process which it is not. It also seems to promote counselling in very short time frames which is not always productive for all client needs. The research on its success has been inconclusive. REBT makes more sense to me because our perception and emotional reponse to life events is paramount in how we deal with difficult situations.

Anonymous said...

Thanks. I agree with you!

Anonymous said...

Research on REBT is not inconclusive. You are clueless. There is a mountain of peer reviewed research to validate the approach.

Amanda Williamson said...

Thank you for your comment. I am disappointed that you feel the need to use an insulting and judgmental word ("clueless") and frustrated that you haven't expanded your argument. I really value feedback and comments so perhaps you would expand your argument further. I am very open to differing opinions.

Anonymous said...

I had REBT therapy. It changed my life. Other brief modalities were also used such One Eye Integration therapy, EFT,Timeline and such. I continue to use REBT. If you would ever want to talk to me as a case study through email interactions, I would be happy.

Anonymous said...

CBT therapies (under which umbrella REBT/CT/DBT all fall) are the most tested of all the counseling methods, but to suggest that empirical data on its (notice the lack of apostrophe, please and do likewise) efficacy is used by therapists to pigeon-hole their clients is a bit, well, wrongfully thought and in turn pigeon-holes multiple therapists. Any ethical therapist would use the evaluation aspect of CBT to determine if the process were working and make adjustments, including referrals to other specialists, if necessary. The empirical focus of CBT therapies ensures that you're getting treatment that has been proven effective, but it doesn't really preclude the incorporation of other techniques. And since one metaphorical construct does not fit all, there are many versions of CBT that have evolved to address those difficulties. Young comes to mind, for one. Anyone skeptical of this type of therapy it seems would be resistant and uncommitted to the therapy, and would possibly be better served by other another modality. One thing it certainly does is prevent your therapist from crawling into bed with you and generating false memories with sodium pentothol injections the way Dr. Cornelia Wilbur did with her most famous patient, commonly referred to as Sybil. We've come such a long way, it's high time we had some science-based accountability.

Amanda Williamson said...

Thank you 'Anonymous' for your reply. I don't think that anything you have said is contrary to my post, so I am unsure of your point. Your criticism of my correct usage of an apostrophe does puzzle me, as does your need to remain anonymous.

Thank you for stopping by!

Jo said...

Just found this, two years after you posted it seems. Really interesting read! I am receiving CBT at the moment but like to keep an open-mind to other possibilities.

I must say, the 3 'Gloria' sessions are absolutely fascinating (not least because of the amount of in-session smoking that goes on he he).

David Vick, MA said...

Thank you, Amanda, for sharing your thoughts. The topic is confusing for many of us and your dialogue is helpful. Thank you also for the model you've presented for handling criticism… I hope you will write often. Peace.

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