Theory Analysis: Rational Emotive Behavior Therapy (REBT) and Cognitive Therapy (CT)
Primary Figures in the Development and Expansion of the Theories
Rational Emotive Behavior Therapy (REBT) was developed by an American psychotherapist and psychologist Albert Ellis. Ellis expounded on the theory from the mid-1950s to 2007. Ellis received inspiration from teaching of Asian, Greek, and Roman philosophers on which they founded the philosophical basis of the theory: that an individual is rarely affected by outside factors, but rather by their own perceptions, attitudes, or internalized sentences about such phenomena (Ellis, 1994). Simply put, people are affected not by things, but by views, they have of these things.
On the other hand, Cognitive therapy theory was developed and expounded by an American psychologist, Aaron Beck. Beck expounded the theory in the 1960 by basing its philosophical foundation on cognition, a process they believed was critical in perception, interpretation, attribution of meaning by individuals in their daily lives (Beck, 2008). The philosophical basis is encapsulated in the cognition model, which postulates about the interconnection between thoughts, feelings, and behavior, and that individuals can overcome challenges and meet their goals through identification and changing of unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses.
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Basic Assumptions of the Theories
The premise of REBT on humans being emotionally perturbed not by phenomena, but by associated views assumes a number of factors about the human mind. First, the framework assumes that individuals both innate rational and irrational tendencies and leanings. The theory claims that individuals largely, consciously, or unconsciously, construct emotional difficulties with the aid of their irrational defeatist thinking, emoting, and behaving. Secondly, REBT assumes that an individual’s thoughts, emotion, and action are inseparable or disparate processes, but all overlap to a certain level and are never experienced in pure state. A counselor’s objective is to enhance acceptance of these assumptions, which are believed to be instrumental in inspiring change in the client if they express willingness to work together with the psychotherapist.
According to Shean (2001), the contestations on applicability and effectiveness of CT stem from lack of consistency between neurological evidence and the assumptions that cognition is a necessity for emotions. The debate originates from CT assumptions that abnormality is an outcome of faulty cognitions about people and phenomena; that such cognitions cause distortions in an individual’s perception of things; and that people interact with the world through their mental representation of it, which if inadequate, results to disordered behavior. This leads to another assumption that clients can change such perceptions to their emotional advantage, and psychotherapists are central to the process of aiding such change through collaboration with the client.
Goals of Each Treatment Approach
According to Ellis (1994), REBT is a comprehensive and active-directive psychotherapy with philosophical and empirical basis whose objective is to resolve emotional and behavioral disturbances thus allowing people to lead happier and fulfilling lives. Therefore, the goal is to enable people to recognize and accept the reality that their emotional disturbances are partially outcomes of adversities or activating events, but largely due to their views of such events. Therefore, REBT framework focus is on changing prevailing evaluations and philosophical thinking, emoting, and behaving of individuals in relation to themselves, others, and circumstances under which they live.
Alternatively, CT emphasizes on enabling individuals to promote self-awareness and emotional intelligence by teaching them to read individual emotions and differentiate healthy from unhealthy, hence critical towards the development of self-control. Clients are able to appreciate the role of distorted perceptions and thoughts in the development of painful feelings. The emphasis on prevailing circumstances is important in prevention of symptoms. The process is important in curtailing future incidences of emotional disturbances through personal growth and change of core beliefs causing them suffering (The Washington Center for Cognitive Therapy, 2014).
Techniques Associated with Each Approach
It is important to understand that REBT and CT approaches fall under the umbrella of cognitive behavioral therapies (CBT), whose main objective is the modification of individual’s thoughts, beliefs, and perceptions to change their usual pattern of behaving. The techniques used by psychotherapists in each approach may differ depending on the symptoms to be treated, but given the difficulty in diagnosis and categorization of psychological problems; the techniques cut across the board and include:
Drawing from evidence-based practice where the approaches have been empirically shown to be effective against ranges of clinical problems
Goal oriented, involving working with the therapist to set treatment goals and monitor progress to determine if desired changes have been achieved
Problem focused by tailoring the treatment to individual problems and reduction of specific symptoms
Collaborative through the client and therapist working together to identify and understand the former’s problems and changes needed to overcome them
Active through education about potential problems to facilitate understanding of potential underlying causes and possible solutions
Homework is often assigned to facilitate the treatment process with emphasis on practicing techniques learnt in previous sessions
Issues in Multicultural Contexts
The need for a balanced range of effective therapies that are culturally appropriate and effective cannot be understated (Rathod & Kingdon, 2009). Despite CBT being widely accepted and used in the treatment of most mental disorders, concerns have been raised about its philosophical foundations on Western concepts and illness models. As a result, most psychotherapists adopt generalization approach when dealing with clients from different cultural backgrounds. However, counselors may encounter challenges due to individuals from different cultures having different worldviews that influence their emoting, thinking, and behaving. Some cultures also do not recognize the existence of mental problems and may be reluctant to undertake mental tests, making the whole process difficult. The implication for stakeholders is the need for culture specific evidence-based practice.
Personal Preference
The similarities between CT and REBT in relation to the goals of treatment are significant, but personal preference for the latter is based on:
Its simplistic philosophical approach that makes it easy to understand and accept because it emphasizes on worldview of phenomena rather that things themselves as the cause of emotional problems
REBT theory places emphasis on the role of secondary disturbance, which refers to disturbing oneself about the existing disturbance, a situation often associated with life-long depression, anxiety, and panic attacks
The theory is important in differentiating between self-destructive, inappropriate negative emotions (anxiety, depression, and anger) versus helpful, appropriate negative ones (intense sadness, deep sorrow, great concern, and regret).
Application of Treatment Approaches to the Case Study
Targeted Problem for Treatment
Jane suffers from anxiety disorder, eating disorder, and sleep disorder as evidenced by their confession that they take a sleeping pill because they experience interrupted sleep and lacks appetite. Jane’s high levels of distress can be argued to be a symptom of these disorders due to uncertainty about their husband’s health and possible implications on the family.
Theoretical Conceptualization on the Causes of the Problem
Application of Ellis’ REBT theory leads to the conclusion that Jane holds a unique set of assumptions about themselves and their world that guides them through life and determines their reactions to the current situation they have encountered, their husband being diagnose with cancer. Jane’s reactions can best be described as irrational because they drive them to act in a manner that denies Jane happiness and success. On the other hand, the application of Beck’s CT theory leads to the conclusion that the interaction between Jane’s feelings, emotions, and behavior results to negative outcomes in the form of unrealistic thoughts that cause distress, this resulting in problems. Jane’s high levels of distress imply that their interpretation of the situation is skewed.
Behavioral Definitions of Presenting Problems
Jane expresses symptoms of interrupted sleep and lack of appetite. The client also demonstrates exceptionally high level of distress and anxiety. Restlessness is also manifested by the inability to concentrate when working. Moreover, Jane suffers from a host of physical conditions including back pain, overweight, and blood pressure that may be contributing towards the problems they are experiencing.
Cognitive Distortions from the Case
The cognitive distortions that apply to Jane’s case are:
All-or nothing, which is evident by the obsession with therapy as the only solution to their problems because it allows them to share emotions
Mental filter and abstraction as depicted by Jane’s personalization of the problem
Disqualification of the positive evidence by negative expectations about the outcome of the husband’s imminent surgery
Jumping to conclusions through strong belief in the outcome of the medical condition of the husband and that sharing emotions can help
Tunnel vision through magnification of the problem despite evidence suggesting the opposite – they are capable of handling themselves regardless of the outcome of the medical condition
Emotional reasoning observed through narration of childhood experiences of family disruptions and tough upbringing
Goals of Treatment
The goal of REBT in the treatment of the diagnosed disorders involves changing Jane’s perceptions and attitudes by teaching them how to be rational in their thinking, which the theory postulates influences emotions and behavior. On the other hand, CT seeks to inculcate positive behavior that is inquisitive to be able to able to recognize negative thoughts and errors in logic, their interpretations, and available alternatives.
Interventions
Using REBT framework, the therapist should employ diversion technique to reduce Jane’s negative thinking and emotionality. They can also employ task scheduling for developing positive emption and mastery, and homework with incremental difficulty in reaching treatment goals, and role-play and rehearsal. Self-monitoring and stimulus control techniques are also important in addition to exposure with response prevention method. Intervention techniques for CT include learning identification of negative and automatic thoughts, identification and changing elements of the belief system and cognitive distortions, and considering alternative explanations of the cause of events.
Effectiveness of Treatment Approaches
Empirical evidence exists on the effectiveness of CBT approaches in the management of cases such as Janes. The methods focus on symptom relief and behavior change, and may be crucial in targeting Jane’s anxiety, which may be the cause of other problems such disturbed sleep and lack of appetite. However, it is important to understand that Jane has a number of underlying issues that may cause them stress and unhappiness even after undergoing therapy. Therefore, going beyond behavioral change and symptom control is a necessity for the methods to be effective.
Applicability of the Cognitive Approach to the Case and Suitability in Other Scenarios
The cognitive approach is applicable to Jane’s case because it takes to account two of the elements of the cognitive triad in the form of negative view of the world and negative view of the future, all of which outcomes of cognition of the dilapidating condition of their husband. Cognitive therapy is best suited to individuals with negative schemas, a condition Jane manifests to a small extent because they were victims of parental rejection during childhood, which may elicit fears of rejection. This theory may not benefit all types of problems due to cultural barriers as some clients may fail to relate to the language of psychology or develop negativity towards its methods and techniques. It is important to design treatment that fits into cultural practices of the client for better results.
References
Beck, J. S. (2008). Questions and answers about cognitive therapy. Diakses Tanggal , 5 .
Ellis, A. (1994) Reason and Emotion in Psychotherapy: Comprehensive Method of Treating Human Disturbances: Revised and Updated. New York, NY: Citadel Press
Rathod, S., & Kingdon, D. (2009). Cognitive behavior therapy across cultures. Psychiatry , 8 (9), 370-371.
Seligman, L., & Reinchenberg, L. W. (2014). My counselling lab for counselling theories . (eTexted). Upper Saddle River, NJ: Pearson.
Shean, G. (2001). A critical look at the assumptions of cognitive therapy. Psychiatry , 64 (2), 158-164.
The Washington Center for Cognitive Therapy – CCT. (2014). Goals of Cognitive Therapy. Retrieved March 14, 2018 from: http://www.washingtoncenterforcognitivetherapy.com/philosophy-of-treatment/cognitive-therapy/goals-of-cognitive-therapy/.
