What is Rational Emotive Behaviour Therapy?

Introduction

Rational emotive behaviour therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to resolve emotional and behavioural problems and disturbances and to help people to lead happier and more fulfilling lives.

REBT posits that people have erroneous beliefs about situations they are involved in, and that these beliefs cause disturbance, but can be disputed with and changed.

Brief History

Rational emotive behaviour therapy (REBT) was created and developed by the American psychotherapist and psychologist Albert Ellis, who was inspired by many of the teachings of Asian, Greek, Roman and modern philosophers. REBT is the first form of cognitive behavioural therapy (CBT) and was first expounded by Ellis in the mid-1950s; development continued until his death in 2007. Ellis became synonymous with the highly influential therapy. Psychology Today noted, “No individual—not even Freud himself—has had a greater impact on modern psychotherapy.”

REBT is both a psychotherapeutic system of theory and practices and a school of thought established by Ellis. He first presented his ideas at a conference of the American Psychological Association in 1956 then published a seminal article in 1957 entitled “Rational psychotherapy and individual psychology”, in which he set the foundation for what he was calling rational therapy (RT) and carefully responded to questions from Rudolf Dreikurs and others about the similarities and differences with Alfred Adler’s Individual psychology. This was around a decade before psychiatrist Aaron Beck first set forth his “cognitive therapy”, after Ellis had contacted him in the mid 1960s. Ellis’ own approach was renamed Rational Emotive Therapy in 1959, then the current term in 1992.

Precursors of certain fundamental aspects of rational emotive behaviour therapy have been identified in ancient philosophical traditions, particularly to Stoicists Marcus Aurelius, Epictetus, Zeno of Citium, Chrysippus, Panaetius of Rhodes, Cicero, and Seneca, and early Asian philosophers Confucius and Gautama Buddha. In his first major book on rational therapy, Ellis wrote that the central principle of his approach, that people are rarely emotionally affected by external events but rather by their thinking about such events, “was originally discovered and stated by the ancient Stoic philosophers”. Ellis illustrates this with a quote from the Enchiridion of Epictetus: “Men are disturbed not by things, but by the views which they take of them.” Ellis noted that Shakespeare expressed a similar thought in Hamlet: “There’s nothing good or bad but thinking makes it so.” Ellis also acknowledges early 20th century therapists, particularly Paul Charles Dubois, though he only read his work several years after developing his therapy.

Theoretical Assumptions

The REBT framework posits that humans have both innate rational (meaning self-helping, socially helping, and constructive) and irrational (meaning self-defeating, socially defeating, and unhelpful) tendencies and leanings. REBT claims that people to a large degree consciously and unconsciously construct emotional difficulties such as self-blame, self-pity, clinical anger, hurt, guilt, shame, depression and anxiety, and behaviours and behaviour tendencies like procrastination, compulsiveness, avoidance, addiction and withdrawal by the means of their irrational and self-defeating thinking, emoting and behaving.

REBT is then applied as an educational process in which the therapist often active-directively teaches the client how to identify irrational and self-defeating beliefs and philosophies which in nature are rigid, extreme, unrealistic, illogical and absolutist, and then to forcefully and actively question and dispute them and replace them with more rational and self-helping ones. By using different cognitive, emotive and behavioural methods and activities, the client, together with help from the therapist and in homework exercises, can gain a more rational, self-helping and constructive rational way of thinking, emoting and behaving.

One of the main objectives in REBT is to show the client that whenever unpleasant and unfortunate activating events occur in people’s lives, they have a choice between making themselves feel healthily or, self-helpingly, sorry, disappointed, frustrated, and annoyed or making themselves feel unhealthily and self-defeatingly horrified, terrified, panicked, depressed, self-hating and self-pitying. By attaining and ingraining a more rational and self-constructive philosophy of themselves, others and the world, people often are more likely to behave and emote in more life-serving and adaptive ways.

Beliefs about Circumstances, and Disputing the Beliefs

A fundamental premise of REBT is humans do not get emotionally disturbed by unfortunate circumstances, but by how they construct their views of these circumstances through their language, evaluative beliefs, meanings and philosophies about the world, themselves and others. This concept has been attributed as far back as the Roman philosopher Epictetus, who is often cited as utilising similar ideas in antiquity.

In REBT, clients usually learn and begin to apply this premise by learning the A-B-C-D-E-F model of psychological disturbance and change. The following letters represent the following meanings in this model:

  • A – The adversity.
  • B – The developed belief in the person of the Adversity.
  • C – The consequences of that person’s Beliefs i.e., B.
  • D – The person’s disputes of A, B, and C. In latter thought.
  • E – The effective new philosophy or belief that develops in that person through the occurrence of D in their minds of A and B.
  • F – The developed feelings of one’s self either at point and after point C or at point after point E.

The A-B-C model states that it is not an A, adversity (or activating event) that cause disturbed and dysfunctional emotional and behavioural Cs, consequences, but also what people B, irrationally believe about the A, adversity. A, adversity can be an external situation, or a thought, a feeling or other kind of internal event, and it can refer to an event in the past, present, or future.

The Bs, irrational beliefs that are most important in the A-B-C model are explicit and implicit philosophical meanings and assumptions about events, personal desires, and preferences. The Bs, beliefs that are most significant are highly evaluative and consist of interrelated and integrated cognitive, emotional and behavioural aspects and dimensions. According to REBT, if a person’s evaluative B, belief about the A, activating event is rigid, absolutistic, fictional and dysfunctional, the C, the emotional and behavioural consequence, is likely to be self-defeating and destructive. Alternatively, if a person’s belief is preferential, flexible and constructive, the C, the emotional and behavioural consequence is likely to be self-helping and constructive.

Through REBT, by understanding the role of their mediating, evaluative and philosophically based illogical, unrealistic and self-defeating meanings, interpretations and assumptions in disturbance, individuals can learn to identify them, then go to D, disputing and questioning the evidence for them. At E, effective new philosophy, they can recognise and reinforce the notion no evidence exists for any psychopathological must, ought or should and distinguish them from healthy constructs, and subscribe to more constructive and self-helping philosophies. This new reasonable perspective leads to F, new feelings and behaviours appropriate to the A they are addressing in the exercise.

Psychological Dysfunction

One of the main pillars of REBT is that irrational and dysfunctional ways and patterns of thinking, feeling, and behaving are contributing to human disturbance and emotional and behavioural self-defeatism and social defeatism. REBT generally teaches that when people turn flexible preferences, desires and wishes into grandiose, absolutistic and fatalistic dictates, this tends to contribute to disturbance and upset. These dysfunctional patterns are examples of cognitive distortions.

Core Beliefs that Disturb Humans

Albert Ellis has suggested three core beliefs or philosophies that humans tend to disturb themselves through:

“I absolutely MUST, under practically all conditions and at all times, perform well (or outstandingly well) and win the approval (or complete love) of significant others. If I fail in these important—and sacred—respects, that is awful and I am a bad, incompetent, unworthy person, who will probably always fail and deserves to suffer.”“Other people with whom I relate or associate, absolutely MUST, under practically all conditions and at all times, treat me nicely, considerately and fairly. Otherwise, it is terrible and they are rotten, bad, unworthy people who will always treat me badly and do not deserve a good life and should be severely punished for acting so abominably to me.”“The conditions under which I live absolutely MUST, at practically all times, be favorable, safe, hassle-free, and quickly and easily enjoyable, and if they are not that way it’s awful and horrible and I can’t bear it. I can’t ever enjoy myself at all. My life is impossible and hardly worth living.”
Holding this belief when faced with adversity tends to contribute to feelings of anxiety, panic, depression, despair, and worthlessness.Holding this belief when faced with adversity tends to contribute to feelings of anger, rage, fury, and vindictiveness.Holding this belief when faced with adversity tends to contribute to frustration and discomfort, intolerance, self-pity, anger, depression, and to behaviours such as procrastination, avoidance, addictive behaviours and inaction.

Rigid Demands that Humans Make

REBT commonly posits that at the core of irrational beliefs there often are explicit or implicit rigid demands and commands, and that extreme derivatives like awfulising, low frustration tolerance, people deprecation and over-generalisations are accompanied by these. According to REBT the core dysfunctional philosophies in a person’s evaluative emotional and behavioural belief system, are also very likely to contribute to unrealistic, arbitrary and crooked inferences and distortions in thinking. REBT therefore first teaches that when people in an insensible and devout way overuse absolutistic, dogmatic and rigid “shoulds”, “musts”, and “oughts”, they tend to disturb and upset themselves.

Over-Generalisation

Further, REBT generally posits that disturbed evaluations to a large degree occur through over-generalisation, wherein people exaggerate and globalise events or traits, usually unwanted events or traits or behaviour, out of context, while almost always ignoring the positive events or traits or behaviours. For example, awfulising is partly mental magnification of the importance of an unwanted situation to a catastrophe or horror, elevating the rating of something from bad to worse than it should be, to beyond totally bad, worse than bad to the intolerable and to a “holocaust”. The same exaggeration and overgeneralising occurs with human rating, wherein humans come to be arbitrarily and axiomatically defined by their perceived flaws or misdeeds. Frustration intolerance then occurs when a person perceives something to be too difficult, painful or tedious, and by doing so exaggerates these qualities beyond one’s ability to cope with them.

Secondary Disturbances

Essential to REBT theory is also the concept of secondary disturbances which people sometimes construct on top of their primary disturbance. As Ellis emphasizes:

“Because of their self-consciousness and their ability to think about their thinking, they can very easily disturb themselves about their disturbances and can also disturb themselves about their ineffective attempts to overcome their emotional disturbances.”

Origins of Dysfunction

Regarding cognitive-affective-behavioral processes in mental functioning and dysfunctioning, originator Albert Ellis explains:

“REBT assumes that human thinking, emotion, and action are not really separate or disparate processes, but that they all significantly overlap and are rarely experienced in a pure state. Much of what we call emotion is nothing more nor less than a certain kind—a biased, prejudiced, or strongly evaluative kind—of thought. But emotions and behaviors significantly influence and affect thinking, just as thinking influences emotions and behaviors. Evaluating is a fundamental characteristic of human organisms and seems to work in a kind of closed circuit with a feedback mechanism: First, perception biases response, and then response tends to bias subsequent perception. Also, prior perceptions appear to bias subsequent perceptions, and prior responses appear to bias subsequent responses. What we call feelings almost always have a pronounced evaluating or appraisal element.”

REBT then generally proposes that many of these self-defeating cognitive, emotive and behavioural tendencies are both innately biological and indoctrinated early in and during life, and further grow stronger as a person continually revisits, clings and acts on them. Ellis alludes to similarities between REBT and the general semantics when explaining the role of irrational beliefs in self-defeating tendencies, citing Alfred Korzybski as a significant modern influence on this thinking.

REBT differs from other clinical approaches like psychoanalysis in that it places little emphasis on exploring the past, but instead focuses on changing the current evaluations and philosophical thinking-emoting and behaving in relation to themselves, others and the conditions under which people live.

Irrational Beliefs

REBT proposes four core irrational beliefs;

  1. Demands: The tendency to demand success, fair treatment, and respect (e.g. I must be treated fairly).
  2. Awfulizing: The tendency to consider adverse events as awful or terrible (e.g. It is awful when I am disrespected).
  3. Low Frustration Tolerance (LFT): The belief that one could not stand or tolerate adversity (e.g. I cannot stand being treated unfairly).
  4. Depreciation: The belief that one event reflects the person as a whole (e.g. When I fail it shows that I am a complete failure).

Other Insights

Other insights of REBT (some referring to the ABCDEF model above) are:

  • Insight 1:
    • People seeing and accepting the reality that their emotional disturbances at point C are only partially caused by the activating events or adversities at point A that precede C.
    • Although A contributes to C, and although disturbed Cs (such as feelings of panic and depression) are much more likely to follow strong negative As (such as being assaulted or raped), than they are to follow weak.
    • As (such as being disliked by a stranger), the main or more direct cores of extreme and dysfunctional emotional disturbances (Cs) are people’s irrational beliefs – the “absolutistic” (inflexible) “musts” and their accompanying inferences and attributions that people strongly believe about the activating event.
  • Insight 2:
    • No matter how, when, and why people acquire self-defeating or irrational beliefs (i.e. beliefs that are the main cause of their dysfunctional emotional-behavioural consequences), if they are disturbed in the present, they tend to keep holding these irrational beliefs and continue upsetting themselves with these thoughts.
    • They do so not because they held them in the past, but because they still actively hold them in the present (often unconsciously), while continuing to reaffirm their beliefs and act as if they are still valid.
    • In their minds and hearts, the troubled people still follow the core “musturbatory” philosophies they adopted or invented long ago, or ones they recently accepted or constructed.
  • Insight 3:
    • No matter how well they have gained insights 1 and 2, insight alone rarely enables people to undo their emotional disturbances.
    • They may feel better when they know, or think they know, how they became disturbed, because insights can feel useful and curative.
    • But it is unlikely that people will actually get better and stay better unless they have and apply insight 3, which is that there is usually no way to get better and stay better except by continual work and practice in looking for and finding one’s core irrational beliefs; actively, energetically, and scientifically disputing them; replacing one’s absolute “musts” (rigid requirements about how things should be) with more flexible preferences; changing one’s unhealthy feelings to healthy, self-helping emotions; and firmly acting against one’s dysfunctional fears and compulsions.
    • Only by a combined cognitive, emotive, and behavioural, as well as a quite persistent and forceful attack on one’s serious emotional problems, is one likely to significantly ameliorate or remove them, and keep them removed.

Intervention

As explained, REBT is a therapeutic system of both theory and practice; generally one of the goals of REBT is to help clients see the ways in which they have learned how they often needlessly upset themselves, teach them how to “un-upset” themselves and then how to empower themselves to lead happier and more fulfilling lives. The emphasis in therapy is generally to establish a successful collaborative therapeutic working alliance based on the REBT educational model. Although REBT teaches that the therapist or counsellor is better served by demonstrating unconditional other-acceptance or unconditional positive regard, the therapist is not necessarily always encouraged to build a warm and caring relationship with the client. The tasks of the therapist or counsellor include understanding the client’s concerns from his point of reference and work as a facilitator, teacher and encourager.

In traditional REBT, the client together with the therapist, in a structured active-directive manner, often work through a set of target problems and establish a set of therapeutic goals. In these target problems, situational dysfunctional emotions, behaviours and beliefs are assessed in regards to the client’s values and goals. After working through these problems, the client learns to generalise insights to other relevant situations. In many cases after going through a client’s different target problems, the therapist is interested in examining possible core beliefs and more deep rooted philosophical evaluations and schemas that might account for a wider array of problematic emotions and behaviours. Although REBT much of the time is used as a brief therapy, in deeper and more complex problems, longer therapy is promoted.

In therapy, the first step often is that the client acknowledges the problems, accepts emotional responsibility for these and has willingness and determination to change. This normally requires a considerable amount of insight, but as originator Albert Ellis explains:

“Humans, unlike just about all the other animals on earth, create fairly sophisticated languages which not only enable them to think about their feeling, their actions, and the results they get from doing and not doing certain things, but they also are able to think about their thinking and even think about thinking about their thinking.”

Through the therapeutic process, REBT employs a wide array of forceful and active, meaning multimodal and disputing, methodologies. Central through these methods and techniques is the intent to help the client challenge, dispute and question their destructive and self-defeating cognitions, emotions and behaviours. The methods and techniques incorporate cognitive-philosophic, emotive-evocative-dramatic, and behavioural methods for disputation of the client’s irrational and self-defeating constructs and helps the client come up with more rational and self-constructive ones. REBT seeks to acknowledge that understanding and insight are not enough; in order for clients to significantly change, they need to pinpoint their irrational and self-defeating constructs and work forcefully and actively at changing them to more functional and self-helping ones.

REBT posits that the client must work hard to get better, and in therapy this normally includes a wide array of homework exercises in day-to-day life assigned by the therapist. The assignments may for example include desensitisation tasks, i.e. by having the client confront the very thing he or she is afraid of. By doing so, the client is actively acting against the belief that often is contributing significantly to the disturbance.

Another factor contributing to the brevity of REBT is that the therapist seeks to empower the client to help himself through future adversities. REBT only promotes temporary solutions if more fundamental solutions are not found. An ideal successful collaboration between the REBT therapist and a client results in changes to the client’s philosophical way of evaluating himself or herself, others, and his or her life, which will likely yield effective results. The client then moves toward unconditional self-acceptance, other-acceptance and life-acceptance while striving to live a more self-fulfilling and happier life.

Applications and Interfaces

Applications and interfaces of REBT are used with a broad range of clinical problems in traditional psychotherapeutic settings such as individual-, group- and family therapy. It is used as a general treatment for a vast number of different conditions and psychological problems normally associated with psychotherapy.

In addition, REBT is used with non-clinical problems and problems of living through counselling, consultation and coaching settings dealing with problems including relationships, social skills, career changes, stress management, assertiveness training, grief, problems with aging, money, weight control etc. More recently, the reported use of REBT in sport and exercise settings has grown, with the efficacy of REBT demonstrated across a range of sports.

REBT also has many interfaces and applications through self-help resources, phone and internet counselling, workshops & seminars, workplace and educational programmes, etc. This includes Rational Emotive Education (REE) where REBT is applied in education settings, Rational Effectiveness Training in business and work-settings and SMART Recovery (Self Management And Recovery Training) in supporting those in addiction recovery, in addition to a wide variety of specialised treatment strategies and applications.

Efficacy

REBT and CBT in general have a substantial and strong research base to verify and support both their psychotherapeutic efficiency and their theoretical underpinnings. Meta-analyses of outcome-based studies reveal REBT to be effective for treating various psychopathologies, conditions and problems. Recently, REBT randomised clinical trials have offered a positive view on the efficacy of REBT.

In general REBT is arguably one of the most investigated theories in the field of psychotherapy and a large amount of clinical experience and a substantial body of modern psychological research have validated and substantiated many of REBTs theoretical assumptions on personality and psychotherapy.

REBT may be effective in improving sports performance and mental health.

Limitations and Critique

The clinical research on REBT has been criticised both from within and by others. For instance, originator Albert Ellis has on occasions emphasized the difficulty and complexity of measuring psychotherapeutic effectiveness, because many studies only tend to measure whether clients merely feel better after therapy instead of them getting better and staying better. Ellis has also criticised studies for having limited focus primarily to cognitive restructuring aspects, as opposed to the combination of cognitive, emotive and behavioural aspects of REBT. As REBT has been subject to criticisms during its existence, especially in its early years, REBT theorists have a long history of publishing and addressing those concerns. It has also been argued by Ellis and by other clinicians that REBT theory on numerous occasions has been misunderstood and misconstrued both in research and in general.

Some have criticised REBT for being harsh, formulaic and failing to address deep underlying problems. REBT theorists have argued in reply that a careful study of REBT shows that it is both philosophically deep, humanistic and individualised collaboratively working on the basis of the client’s point of reference. They have further argued that REBT utilises an integrated and interrelated methodology of cognitive, emotive-experiential and behavioural interventions. Others have questioned REBTs view of rationality, both radical constructivists who have claimed that reason and logic are subjective properties and those who believe that reason can be objectively determined. REBT theorists have argued in reply that REBT raises objections to clients’ irrational choices and conclusions as a working hypothesis and through collaborative efforts demonstrate the irrationality on practical, functional and social consensual grounds. In 1998 when asked what the main criticism on REBT was, Albert Ellis replied that it was the claim that it was too rational and not dealing sufficiently enough with emotions. He repudiated the claim by saying that REBT on the contrary emphasizes that thinking, feeling, and behaving are interrelated and integrated, and that it includes a vast amount of both emotional and behavioural methods in addition to cognitive ones.

Ellis has himself in very direct terms criticised opposing approaches such as psychoanalysis, transpersonal psychology and abreactive psychotherapies in addition to on several occasions questioning some of the doctrines in certain religious systems, spiritualism and mysticism. Many, including REBT practitioners, have warned against dogmatising and sanctifying REBT as a supposedly perfect psychological panacea. Prominent REBTers have promoted the importance of high quality and programmatic research, including originator Ellis, a self-proclaimed “passionate sceptic”. He has on many occasions been open to challenges and acknowledged errors and inefficiencies in his approach and concurrently revised his theories and practices. In general, with regard to cognitive-behavioural psychotherapies’ interventions, others have pointed out that as about 30-40% of people are still unresponsive to interventions, that REBT could be a platform of reinvigorating empirical studies on the effectiveness of the cognitive-behavioural models of psychopathology and human functioning.

REBT has been developed, revised and augmented through the years as understanding and knowledge of psychology and psychotherapy have progressed. This includes its theoretical concepts, practices and methodology. The teaching of scientific thinking, reasonableness and un-dogmatism has been inherent in REBT as an approach, and these ways of thinking are an inextricable part of REBT’s empirical and sceptical nature.

I hope I am also not a devout REBTer, since I do not think it is an unmitigated cure for everyone and do accept its distinct limitations. (Albert Ellis).

Mental Wellness

As would be expected, REBT argues that mental wellness and mental health to a large degree results from an adequate amount of self-helping, flexible, logico-empirical ways of thinking, emoting and behaving. When a perceived undesired and stressful activating event occurs, and the individual is interpreting, evaluating and reacting to the situation rationally and self-helpingly, then the resulting consequence is, according to REBT, likely to be more healthy, constructive and functional. This does not by any means mean that a relatively un-disturbed person never experiences negative feelings, but REBT does hope to keep debilitating and un-healthy emotions and subsequent self-defeating behaviour to a minimum. To do this, REBT generally promotes a flexible, un-dogmatic, self-helping and efficient belief system and constructive life philosophy about adversities and human desires and preferences.

REBT clearly acknowledges that people, in addition to disturbing themselves, also are innately constructivists. Because they largely upset themselves with their beliefs, emotions and behaviours, they can be helped to, in a multimodal manner, dispute and question these and develop a more workable, more self-helping set of constructs.

REBT generally teaches and promotes:

  • That the concepts and philosophies of life of unconditional self-acceptance, other-acceptance, and life-acceptance are effective philosophies of life in achieving mental wellness and mental health.
  • That human beings are inherently fallible and imperfect and that they are better served by accepting their and other human beings’ totality and humanity, while at the same time they may not like some of their behaviours and characteristics.
    • That they are better off not measuring their entire self or their “being” and give up the narrow, grandiose and ultimately destructive notion to give themselves any global rating or report card.
    • This is partly because all humans are continually evolving and are far too complex to accurately rate; all humans do both self-defeating/socially defeating and self-helping / socially helping deeds, and have both beneficial and un-beneficial attributes and traits at certain times and in certain conditions.
    • REBT holds that ideas and feelings about self-worth are largely definitional and are not empirically confirmable or falsifiable.
  • That people had better accept life with its hassles and difficulties not always in accordance with their wants, while trying to change what they can change and live as elegantly as possible with what they cannot change.

Book: The Little CBT Workbook

Book Title:

The Little CBT Workbook: A Step-By-Step Guide to Gaining Control of your Life.

Author(s): Dr. Michael Sinclair and Dr. Belinda Hollingsworth.

Year: 2012.

Edition: First (1st), UK Edition.

Publisher: Crimson Publishing.

Type(s): Paperback and Kindle.

Synopsis:

Introducing essential Cognitive Behavioural Therapy (CBT) techniques, this practical workbook allows readers to explore the key principles behind CBT and discover how to apply them to improve their lives. With interactive exercises and checklists, this is suitable for self-teaching or for supplementing a CBT course.

On This Day … 24 February

People (Births)

  • 1900 – Irmgard Bartenieff, German-American dancer and physical therapist, leading pioneer of dance therapy (d. 1981).

Irmgard Bartenieff

Irmgard Bartenieff (1900 to 1981) was a dance theorist, dancer, choreographer, physical therapist, and a leading pioneer of dance therapy. A student of Rudolf Laban, she pursued cross-cultural dance analysis, and generated a new vision of possibilities for human movement and movement training. From her experiences applying Laban’s concepts of dynamism, three-dimensional movement and mobilization to the rehabilitation of people affected by polio in the 1940s, she went on to develop her own set of movement methods and exercises, known as Bartenieff Fundamentals.

Bartenieff incorporated Laban’s spatial concepts into the mechanical anatomical activity of physical therapy, in order to enhance maximal functioning. In physical therapy, that meant thinking in terms of movement in space, rather than by strengthening muscle groups alone. The introduction of spatial concepts required an awareness of intent on the part of the patient as well, that activated the patient’s will and thus connected the patient’s independent participation to his or her own recovery. “There is no such thing as pure “physical therapy” or pure “mental” therapy. They are continuously interrelated.”

Bartenieff’s presentation of herself was quiet and, according to herself, she did not feel comfortable marketing her skills and knowledge. Not until June 1981, a few months before she died, did her name appear in the institute’s title: Laban/Bartenieff Institute of Movement Studies (LIMS), a change initiated by the Board of Directors in her honour.

Dance Therapy

She held a position of dance therapy research assistant (1957-1967) to Dr. Israel Zwerling at the Day Hospital Unit of Albert Einstein College of Medicine. Zwerling, a psychiatrist […] was very receptive to further exploration of dance as a therapeutic tool for defusing aggression and anxiety. What particularly reinforced his interest in her was that she had a vocabulary and a notation for recording observations of movement. This became a vital factor in daily observations through the one-way screen, especially of family and therapeutic groups.

Dance therapy was then an emerging field of adjunctive therapy. Bartenieff’s special contribution was in bringing Laban’s work to a field very much in need of movement documentation: [It] provided a method of movement analysis and a system of notation which placed dance therapists on their own professional ground, giving them a language for describing patients’ movements, and eliminating the need to rely on less accurate jargon borrowed from other disciplines.

Book: Relaxation and Stress Reduction Workbook

Book Title:

Relaxation and Stress Reduction Workbook.

Author(s): Matthew McKay (PhD).

Year: 2019.

Edition: Seventh (7th).

Publisher: New Harbinger.

Type(s): Paperback and Kindle.

Synopsis:

The Relaxation and Stress Reduction Workbook broke new ground when it was first published in 1980, detailing easy, step-by-step techniques for calming the body and mind in an increasingly overstimulated world. Now in its seventh edition, this fully revised and updated workbook-highly regarded by therapists and their clients-offers the latest stress reduction techniques to combat the effects of stress and integrate healthy relaxation habits into every aspect of daily life.

This new edition also includes powerful self-compassion practices, fully updated chapters on the most effective tools for coping with anxiety, fear, and panic-such as worry delay and diffusion, two techniques grounded in acceptance and commitment therapy (ACT)-as well as a new section focused on body scan.

In the workbook, you will explore your own stress triggers and symptoms, and learn how to create a personal action plan for stress reduction. Each chapter features a different method for relaxation, explains why the method works, and provides on-the-spot exercises you can do when you feel stressed out. The result is a comprehensive yet accessible workbook that will help you to curb stress and cultivate a more peaceful life.

Book: Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment

Book Title:

Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment.

Author(s): Peggy O’Brien, Erika Crable, Catherine Fullerton, and Lauren Hughey.

Year: March 2019.

Edition: First (1st).

Publisher: US Department of Health and Human Services.

Type(s): eBook.

Synopsis:

In 2015, 20.8 million people aged 12 years or older (7.8% of the United States population) had a substance use disorder (SUD) in the previous year. Approximately 75% of this group, or 15.7 million Americans, had an alcohol use disorder,
2.0 million had a prescription opioid use disorder (OUD), and about 0.6 million had a heroin use disorder.

Since 1999, opioid-related overdose deaths in the United States have quadrupled, with more than 15,000 individuals experiencing prescription drug-related overdose deaths in 2015. Even though evidence-based SUD treatments are effective, rates of treatment receipt are quite low. In 2015, only 18% of the population with SUDs, or 3.7 million people, received SUD treatment – a number that has not increased significantly since 2002.

Only about 48% of patients who enter SUD treatment actually complete it.

You can access the book, for free, here.

Book: Approaches to Drug Abuse Counselling

Book Title:

Approaches to Drug Abuse Counselling.

Author(s): National Institute on Drug Abuse (NIDA).

Year: 2000.

Edition: First (1st).

Publisher: US Government Printing Office.

Type(s): eBook.

Synopsis:

Dual disorders recovery counselling (DDRC) is an integrated approach to treatment of patients with drug use disorders and comorbid psychiatric disorders.

The DDRC model, which integrates individual and group addiction counselling approaches with psychiatric interventions, attempts to balance the focus of treatment so that both the patient’s addiction and psychiatric issues are addressed.

The DDRC model is based on the assumption that there are several treatment phases that patients may go through.

You can access the book, for free, here.

Book: Integrating Behavioural Therapies with Medications in the Treatment of Drug Dependence

Book Title:

Integrating Behavioural Therapies With Medications in the Treatment of Drug Dependence (National Institute on Drug Abuse Research Monograph Series).

Author(s): Lisa Simon Onken (PhD), Jack D. Blaine (MD), and John J. Boren (PhD.

Year: 1995.

Edition: First (1st).

Publisher: US Government Printing Office.

Type(s): eBook.

Synopsis:

It is no revelation that drug dependence is a complex problem with behavioural, cognitive, psychosocial, and biological dimensions and may be treated with behavioural therapy (including behaviour therapy, psychotherapy, and counselling), and, where available, pharmacotherapy.

Drug use can be reduced behaviourally with appropriate manipulation of reinforcements within the environment (Higgins et al. 1993). Continued improvements over time in drug use can be initiated by cognitive behavioural psychotherapies to modify cognitions that perpetuate drug use (Carroll et al., submitted for publication), and a reduced likelihood of
relapse has been engendered by specialised training approaches (Rohsenow et al., in press).

Methadone, of course, has long been recognised as an effective pharmacotherapy to reduce opiate use, and its biological mechanism of action is well understood.

You can access the book, for free, here.

Book: Psychotherapy And Counselling In The Treatment Of Drug Abuse

Book Title:

Psychotherapy And Counselling In The Treatment Of Drug Abuse (National Institute on Drug Abuse Research Monograph Series).

Author(s): Lisa Simon Onken (PhD) and Jack D. Blaine (MD).

Year: 1990.

Edition: First (1st).

Publisher: US Government Printing Office.

Type(s): eBook.

Synopsis:

Drug abuse treatment occurs in a multitude of forms. It may be provided in outpatient or inpatient settings, be publicly or privately funded, and mayor may not involve the administration of medication. The differences among the philosophies of, and the services provided in, various drug abuse treatment programmes may be enormous. What is remarkable is that some form of drug abuse counselling or psychotherapy is almost invariably a part of every type of comprehensive drug abuse treatment. Individual therapy or counselling is available in about 99% of the drug-free, methadone-maintenance, and multiple-modality drug abuse treatment units in this country (National Drug and Alcoholism Treatment Unit Survey 1982). It is also available in approximately 97% of the detoxification units.

You can access the book, for free, here.

What is Exposure Therapy?

Introduction

Exposure therapy is a technique in behaviour therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalised anxiety disorder (GAD), social anxiety disorder, obsessive-compulsive disorder (OCD), post traumatic stress disorder (PTSD), and specific phobias.

Brief History

The use of exposure as a mode of therapy began in the 1950s, at a time when psychodynamic views dominated Western clinical practice and behavioural therapy was first emerging. South African psychologists and psychiatrists first used exposure as a way to reduce pathological fears, such as phobias and anxiety-related problems, and they brought their methods to England in the Maudsley Hospital training programme.

Joseph Wolpe (1915-1997) was one of the first psychiatrists to spark interest in treating psychiatric problems as behavioural issues. He sought consultation with other behavioural psychologists, among them James G. Taylor (1897-1973), who worked in the psychology department of the University of Cape Town in South Africa. Although most of his work went unpublished, Taylor was the first psychologist known to use exposure therapy treatment for anxiety, including methods of situational exposure with response prevention – a common exposure therapy technique still being used. Since the 1950s several sorts of exposure therapy have been developed, including systematic desensitisation, flooding, implosive therapy, prolonged exposure therapy, in vivo exposure therapy, and imaginal exposure therapy.

Medical Uses

Generalised Anxiety Disorder

There is empirical evidence that exposure therapy can be an effective treatment for people with generalised anxiety disorder, citing specifically in vivo exposure therapy, which has greater effectiveness than imaginal exposure in regards to generalized anxiety disorder. The aim of in vivo exposure treatment is to promote emotional regulation using systematic and controlled therapeutic exposure to traumatic stimuli.

Phobia

Exposure therapy is the most successful known treatment for phobias. Several published meta-analyses included studies of one-to-three hour single-session treatments of phobias, using imaginal exposure. At a post-treatment follow-up four years later 90% of people retained a considerable reduction in fear, avoidance, and overall level of impairment, while 65% no longer experienced any symptoms of a specific phobia.

Agoraphobia and social anxiety disorder are examples of phobias that have been successfully treated by exposure therapy.

Post Traumatic Stress Disorder

Virtual reality exposure (VRE) therapy is a modern but effective treatment of post-traumatic stress disorder (PTSD). This method was tested on several active duty Army soldiers, using an immersive computer simulation of military settings over six sessions. Self-reported PTSD symptoms of these soldiers were greatly diminished following the treatment. Exposure therapy has shown promise in the treatment of co-morbid PTSD and substance abuse.

Obsessive Compulsive Disorder

Exposure and response prevention (also known as exposure and ritual prevention; ERP or EX/RP) is a variant of exposure therapy that is recommended by the American Academy of Child and Adolescent Psychiatry (AACAP), the American Psychiatric Association (APA), and the Mayo Clinic as first-line treatment of obsessive compulsive disorder (OCD) citing that it has the richest empirical support for both youth and adolescent outcomes.

ERP is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears, but refrain from engaging in the escape response or ritual that delays or eliminates distress. In the case of individuals with OCD or an anxiety disorder, there is a thought or situation that causes distress. Individuals usually combat this distress through specific behaviours that include avoidance or rituals. However, ERP involves purposefully evoking fear, anxiety, and or distress in the individual by exposing him/her to the feared stimulus. The response prevention then involves having the individual refrain from the ritualistic or otherwise compulsive behaviour that functions to decrease distress. The patient is then taught to tolerate distress until it fades away on its own, thereby learning that rituals are not always necessary to decrease distress or anxiety. Over repeated practice of ERP, patients with OCD expect to find that they can have obsessive thoughts and images but not have the need to engage in compulsive rituals to decrease distress.

The AACAP’s practise parameters for OCD recommends cognitive behavioural therapy, and more specifically ERP, as first line treatment for youth with mild to moderate severity OCD and combination psychotherapy and pharmacotherapy for severe OCD. The Cochrane Review’s examinations of different randomised control trials echoes repeated findings of the superiority of ERP over waitlist control or pill-placebos, the superiority of combination ERP and pharmacotherapy, but similar effect sizes of efficacy between ERP or pharmacotherapy alone.

Techniques

Exposure therapy is based on the principle of respondent conditioning often termed Pavlovian extinction. The exposure therapist identifies the cognitions, emotions and physiological arousal that accompany a fear-inducing stimulus and then tries to break the pattern of escape that maintains the fear. This is done by exposing the patient to progressively stronger fear-inducing stimuli. Fear is minimised at each of a series of steadily escalating steps or challenges (a hierarchy), which can be explicit (“static”) or implicit (“dynamic” – refer to Method of Factors) until the fear is finally gone. The patient is able to terminate the procedure at any time.

There are three types of exposure procedures. The first is in vivo or “real life.” This type exposes the patient to actual fear-inducing situations. For example, if someone fears public speaking, the person may be asked to give a speech to a small group of people. The second type of exposure is imaginal, where patients are asked to imagine a situation that they are afraid of. This procedure is helpful for people who need to confront feared thoughts and memories. The third type of exposure is interoceptive, which may be used for more specific disorders such as panic or post-traumatic stress disorder. Patients confront feared bodily symptoms such as increased heart rate and shortness of breath. All types of exposure may be used together or separately.

While evidence clearly supports the effectiveness of exposure therapy, some clinicians are uncomfortable using imaginal exposure therapy, especially in cases of PTSD. They may not understand it, are not confident in their own ability to use it, or more commonly, they see significant contraindications for their client.

Flooding therapy also exposes the patient to feared stimuli, but it is quite distinct in that flooding starts at the most feared item in a fear hierarchy, while exposure starts at the least fear-inducing.

Exposure and Response Prevention

In the exposure and response prevention (ERP or EX/RP) variation of exposure therapy, the resolution to refrain from the escape response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, but they also practice a fear-incompatible behavioural response to the stimulus. The distinctive feature is that individuals confront their fears and discontinue their escape response. The American Psychiatric Association recommends ERP for the treatment of OCD, citing that ERP has the richest empirical support.

While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms. Generally, ERP incorporates a relapse prevention plan toward the end of the course of therapy.

Mindfulness

A 2015 review pointed out parallels between exposure therapy and mindfulness, stating that mindful meditation “resembles an exposure situation because [mindfulness] practitioners ‘turn towards their emotional experience’, bring acceptance to bodily and affective responses, and refrain from engaging in internal reactivity towards it.” Imaging studies have shown that the ventromedial prefrontal cortex, hippocampus, and the amygdala are all affected by exposure therapy; imaging studies have shown similar activity in these regions with mindfulness training.

Research

Exposure therapy can be investigated in the laboratory using Pavlovian extinction paradigms. Using rodents such as rats or mice to study extinction allows for the investigation of underlying neurobiological mechanisms involved, as well as testing of pharmacological adjuncts to improve extinction learning.

Book: Therapy with a Map: A Cognitive Analytic Approach to Helping Relationships

Book Title:

Therapy with a Map: A Cognitive Analytic Approach to Helping Relationships.

Author(s): Steve Potter.

Year: 2020.

Edition: First (1st).

Publisher: Luminate.

Type(s): Paperback and Kindle.

Synopsis:

A therapeutic relationship is a web of interactions, tasks and processes in space and time. It is not easy to stay aware of the relationship in the thick of talking and trying to help someone; but doing so boosts flexibility and enables deeper formulation. A therapist who can attend not only to a specific therapeutic model, but also to relational factors underlying all therapy, has a far greater chance of enabling change.

Therapy with a Map sets out a therapeutic process of talking accompanied by visual conversation maps set down in real time on paper. Like all maps, these help us to find our way, notice when we are lost, track our route and survey the wider landscape. The book uses mapping to introduce the tools and concepts of Cognitive Analytic Therapy (CAT), along with other relational, conversational and narrative approaches. By mapping patterns of thinking and relating, therapists can help clients to develop self-understanding, solve problems, and take away a freer, more self-aware relationship with themselves in the world.