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JOURNAL OF PSYCHOSOCIAL NURSING, VOL. 42, NO. 5 23

SUSAN BENDERSKY SACKS, MSN, RN, CS

Disputing Irrational Philosophies

ABSTRACT

This article provides an overview of theconcepts and techniques of rational emotivebehavior therapy to distinguish it from cognitive-behavioral therapy. Rational emotive behavior thera-py proposes that psychological disturbance is largelycreated and maintained through irrational philoso-phies consisting of internal absolutistic demands. Thistherapy strives to produce sustained and profoundcognitive, emotive, and behavioral change throughactive, vigorous disputation of underlying irrationalphilosophies.

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Faced with a plethora of psy-chotherapy techniques,mental health professionals

often unwittingly succumb tousing indiscriminately eclecticstrategies without a unifying the-ory. Rational emotive behaviortherapy (REBT) is one of manymodels of cognitive-behavioraltherapy (CBT). Both a philoso-phy and a psychotherapy, REBTis distinguished by its unifyingtheory. This therapy aims to cre-ate enduring personality andbehavioral change through pro-found philosophical modificationand reeducation. Rational emo-tive behavior therapy maintains a“here and now” orientation, anactive-directive and re-educativestyle, and integrates a variety ofcognitive, emotive, and behav-ioral techniques (Ellis & Blau,1998; Walen, DiGiuseppe, &Dryden, 1992).

The concepts of REBT can beused as a foundation for inpatientpractice, as well as a guiding the-oretical practice framework foroutpatient therapy. The followingcase example will be usedthroughout this article to demon-strate how REBT can help clientsin various settings.

CASE STUDYKim, a 37-year-old woman

diagnosed with borderline person-ality disorder, received 5 days ofinpatient psychiatric treatmentfor self mutilation. Kim’s addition-al problems included unstablerelationships, alcohol abuse,abandonment fears, and self-loathing. Her history includedchronic sexual abuse between theages of 3 and 10 by her father.Inpatient treatment includedthree REBT psychoeducationalgroups, followed by 20 outpatientREBT individual therapy sessions.End results included increasedself-acceptance, decreased fre-quency of self-cutting and alcoholbinges, and decreased episodes of

interpersonal outbursts andaggression.

BACKGROUND ANDSIGNIFICANCE OF REBT

Albert Ellis introduced thecognitive-behavioral revolutionin psychotherapy by foundingREBT in 1955. Rational emotivebehavior therapy became the firstmodern cognitive-behavioraltherapy (CBT) by merging cogni-tive therapy with behavior thera-py. It was later followed by otherCBT models, including those ofBeck, Meichenbaum, Glasser,Maultsby, Lazarus, Goldfried, andBandura (Ellis, 1994; Ellis &MacLaren, 1998). Rational emo-tive behavior therapy has beenpracticed with both children andadults and has been used for abroad range of mental disorders.It is designed to be an effectivetherapeutic method for individu-als, families, and groups, as well asfor group psychoeducation (Ellis& Blau, 1998).

Rational emotive behaviortherapy emphasizes the power ofunderlying beliefs and philoso-phies to create, maintain, pre-vent, and recover from emotionaldisturbance. The therapy main-tains that psychological distur-bances are influenced by biologi-cal tendencies and environmen-tal and social conditions, but arelargely created and sustained by aphilosophy of dogmatic, rigidcommands or demands and irra-tional conclusions. These com-mands or demands are expressedas “musts,” “shoulds,” “needs,”and “oughts.” Irrational conclu-sions are manifested as “awfuliz-ing,” “I can’t-standitis,” and“damnation of self and others.”(Ellis & Dryden, 1997; Ellis &MacLaren, 1998; Gandy, 1995;Walen et al., 1992).

Rational emotive behaviortherapy advocates significantphilosophical modification andreeducation to manage psycho-

logical disturbance and achievepsychological health (Ellen &MacLaren, 1998). In addition,REBT proposes that psychologi-cal health is contingent on sever-al factors, including the assump-tion of responsibility for emo-tions, scientific thinking, highfrustration tolerance, flexibility,responsible risk taking, creativepursuits, unconditional self-acceptance, responsible long-range hedonism, and rationalthinking. Rational thoughts aredefined as flexible, adaptive, pref-erential beliefs supported by real-ity and expressed as desires, likes,and dislikes (Ellis & Dryden,1997; Walen et al., 1992).

Irrational Demands andConclusions

Philosophical reconstruction isan active-directive process whichhelps clients detect, discriminate,dispute, and replace their dysfunc-tional or irrational philosophiesand beliefs. According to Ellis andMacLaren (1998, pp. 32-33),REBT considers the followingthree clusters of absolutisticdemands to be the essence ofhuman disturbance and the focusof philosophical modification:

• I absolutely must, under allconditions, do important taskswell and be approved by signifi-cant others, or else I am an inad-equate and unlovable person.

• Other people absolutelymust, under all conditions, treatme fairly and justly, or else theyare rotten, damnable people.

• Conditions under which Ilive absolutely must always be theway I want them to be and provideme with immediate gratification,without requiring me to work toohard to change or improve them;otherwise, it is awful, I can’t standthem, and it is impossible for meto be happy at all.

According to Ellis and Dryden(1997), Ellis and MacLaren(1998), Gandy (1995), and

No one loves me,and I am worthless.No one loves me,and I am worthless.No one loves me,and I am worthless.No one loves me,and I am worthless.No one loves me,and I am worthless.No one loves me,and I am worthless.No one loves me,and I am worthless.No one loves me,and I am worthless.

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Walen et al. (1992), REBTemphasizes the need to identifyand dispute three core irrationalconclusions, which stem fromthese absolutistic musts, com-mands, and demands:

• Awfulizing (e.g., “It is awfulto be abandoned.”).

• I-can’t-standitis (e.g., “Ican’t stand being alone.”).

• Damnation of oneself andothers (e.g., “He’s rotten for leav-ing me. I must be worthless.”).In REBT, absolutistic musts, com-mands, and demands also resultin cognitive or inferential distor-tions, which are uncovered andvigorously disputed. Cognitivedistortions include:

• Overgeneralizing (e.g.,“Since my father raped me, allmen will.”).

• Jumping to conclusions(e.g., “Since he abused me, I mustbe a despicable person.”).

• Personalizing (e.g., “It’s myfault my mother married a violentalcoholic.”).

• All-or-nothing thinking(e.g., “If you’re at all like myfather, then you’re completelylike him.”).

ASSESSMENT, EDUCATION,AND PHILOSOPHICALRECONSTRUCTION

Rational emotive behaviortherapy uses an educationalmodel and a didactic ABCDEformat to demonstrate the cause-and-effect links between beliefs,

adverse events, and emotionaland behavioral consequences, asdescribed by Ellis and Blau(1998):

A = Adverse or activatingevents.

B = Rational and irrational beliefs, ideas, thoughts, and cognitions about“A.”

C = Emotional and behavioralconsequences generatedby “A” and “B.”

D = Disputation of irrationalbeliefs.

E = End result or profoundand “effective newphilosophies.”

Therapists using REBTexplain that, despite the assump-tion that “A” directly produces“C,” this is usually false. Instead,“B” functions as an intermediarybetween “A” and “C” and candirectly produce “C” (Ellis &Blau, 1998; Ellis & Dryden,1997; Ellis & MacLaren, 1998).To achieve philosophical

change, clients’ uniqueABCDE sequence isrevealed, beginning with anassessment of emotionaland behavioral conse-quences (“C”). Forexample, therapistsask, “How do you feelabout that?,” “Howdo you physicallyfeel when that hap-pens?,” and “Whatdo you do [when

[REBT] maintains that psychological disturbancesare influenced by biological tendencies andenvironmental and social conditions, but arelargely created and sustained by a philosophy ofdogmatic, rigid commands or demands andirrational conclusions.

I can’t stand beingalone. I can’t standbeing alone. I can’tstand being alone.I can’t stand beingalone. I can’t standbeing alone. I can’tstand being alone.I can’t stand beingalone. I can’t standbeing alone. I can’tstand being alone.I can’t stand beingalone. I can’ts t a n db e i n galone.

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that happens]?” (Ellis &MacLaren, 1998, p. 50).

Activating events (“A”) aredetermined next by therapistsasking, “When do youfeel/behave that way?” and“Which situations usually resultin that consequence?” (Ellis &MacLaren, 1998, p. 51).Irrational beliefs (“B”) are thenuncovered with question such as,“What are you telling yourselfwhen you make yourself _____?”and “What’s going through yourhead while you’re feeling/behav-ing this way?” (Ellis & MacLaren,1998, p.52).

After a detailed ABC assess-ment, clients and therapists col-laborate to clarify, scrutinize, dis-pute, and replace absolutistic

demands and irrational con-clusions using cognitive,emotive, and behavioraltechniques. Desired endresults include “effectivenew philosophies,” healthyemotional responses, and

adaptive behaviors. These

desired outcomes involve a reduc-tion in dogmatic demands,awfulizing, human worth evalua-tions, and affect levels, as well asan increase in frustration toler-ance and self-acceptance. Desiredend results entail the assumptionof responsibility for emotions andthe management of challengesthrough action and responsiblerisk taking (Walen et al., 1992).

COGNITIVE, EMOTIVE, ANDBEHAVIORAL TECHNIQUES

Rational emotive behaviortherapy initially uses and empha-sizes cognitive techniques,including empirical, functional,and logical disputations, with aSocratic method of leading ques-tions. For example, a Socraticquestion would be, “As long asyou believe it would be horribleand awful to be alone, how willyou feel in any romantic relation-ship?” Rational self-statements,referencing, and cognitive home-work assignments are additionalcognitive techniques to reinforceeffective new philosophies.Emotive techniques are often dra-matic, evocative, and experientialmethods that reinforce or facili-tate positive gains from cognitivetechniques. Examples includerational-emotive imagery, reverserole playing, humor, and shame-attacking exercises. Behavioraltechniques are used selectivelyand are designed to encourageaction and direct clients to modi-

fy their behaviors to changeunderlying beliefs (Ellis, 1994).Behavioral methods include invivo desensitization, reinforce-ments and penalties, skill train-ing, and acting on rational beliefs.

Cognitive TechniquesEmpirical Disputations. Socratic

questions are frequently used tohelp clients evaluate whether their

Emotive techniques are often dramatic,evocative, and experiential methods that

reinforce or facilitate positive gains fromcognitive techniques. Examples include

rational-emotive imagery, reverse role playing,humor, and shame-attacking exercises.

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beliefs are accurate and conformto reality (Bernard & Wolfe, 2000;Walen et al., 1992). Examples ofsuch questions, derived from myprofessional experience, include:

• “If that’s true, and you arerejected, what’s the worst thatcould happen?”

• “How would that be cata-strophic and more than justinconvenient?”

• “Explain to me why youcouldn’t stand the emotional dis-comfort of it?”

• “Where is the evidencethat you’re totally worthlessbecause your father molestedyou?”

• “Where is it written thatyou must never be abandoned?”

Functional Disputations. Socraticquestions can also be used to helpclients examine the usefulness oftheir beliefs (DiGiuseppe, 2000;Ellis & Dryden, 1997). For exam-ple, using the above case study:

Sacks: “Don’t you think your“musts”—that you must not bealone, you need to feel physicalpain—are self-sabotaging?”

Kim: “No, how?”Sacks: “Well, look at the social

effects of your internal demandsand fears.”

Kim: “Oh yeah, you mean theeffect of stress on my relation-ships.”

Sacks: “Yes. And while you’reruminating about Tom abandon-ing you, couldn’t you be turninghim off by your insecure behaviorsand your self-mutilation?”

Kim: “I see your point. I takemy wants and turn them intoneeds and demands. I feel vulner-able, and then I get violent. Iguess that’s a real turn off, huh?”

Logical Disputations. Socraticquestions are also used to helpclients evaluate the logic of theirbeliefs (DiGiuseppe, 2000; Ellis& Dryden, 1997). Again, usingthe case study:

Sacks: “Explain to me thelogic in this, ‘Because your father

raped you, all men are evilrapists.’”

Kim: “But all the men I meetmight be.”

Sacks: “I know you believe allthe men you meet could be evilrapists, but isn’t this an illogicalleap from ‘My father evilly rapedme, and he’s a man,’ to ‘All menare evil rapists?’”

Kim: “Yeah. I know it’s irra-tional. It’s not very likely.”

Rational Self-Statements. Moti-vating rational expressions areformulated for clients to memo-rize, practice, and internalize(Ellis & Velten, 1992; Walen etal., 1992). Examples, derivedfrom my professional practice,include: “I failed, but I’m not afailure,” “I want love, but I don’tneed it,” “Emotional pain isinconvenient, not catastrophic,”“People may be messed up but arenot totally rotten,” and “I can andwill handle discomfort.”

Referencing. With REBT, a“cost-benefit analysis” ofunhealthy beliefs is undertaken.To bolster motivation, clients listthe advantages and disadvantagesof their unhealthy beliefs andbehaviors (Ellis & MacLaren,1998). For example, according toKim, her belief, “I must never beabandoned,” added someromance to her life, but the disad-vantages included increased anxi-ety and fears of desertion, whichled to self-cutting and toleranceof abusive men.

Cognitive Homework Assign-ments. Written assignments areused to help clients identify perti-nent irrational beliefs and correctmisunderstandings of REBT (Ellis& MacLaren, 1998; Walen et al.,1992). For example, according toEllis and Blau (1998, pp. 137-139),a homework assignment addressingdisputing irrational beliefs wouldinclude the following questions:

• What self-defeating irra-tional belief do I want to disputeand surrender?

• Can I rationally supportthis belief?

• What evidence exists of thefalseness of this belief?

• Does any evidence exist forthe truth of this belief?

• What are the worst thingsthat could actually happen to meif I don’t get what I think I musthave?

• What good things could Imake happen if I don’t get what Ithink I must?

Emotive TechniquesRational-Emotive Imagery. In

this emotive REBT technique,clients create a vivid mentalimage of a problematic situationthat produces an unhealthy nega-tive emotion. Clients transformthe unhealthy negative emotionto a healthy negative emotionthrough the use of rational beliefs(Ellis & MacLaren,1998; Walenet al., 1992). For example, in thecase study, Kim imagined beingrejected and feeling enraged, andthen transformed the feeling toirritation (e.g., “I want but don’tneed love. I can stay with thesefeelings, and I won’t explode.”).

Reverse Role Playing. For thistechnique, clients reverse roleswith their therapists and practicethe disputation of irrationalbeliefs voiced by the therapists.For example, referring to the casestudy:

Sacks: “I am totally defective.”Kim: “Where is the evidence

that you are completely defec-tive?”

Humor. Exaggeration is usedselectively to humorously chal-lenge “catastrophizing,” “awfuliz-ing,” and overly serious thinking,and may take the form of para-doxical intention techniques(Ellis & Dryden, 1997; Gandy,1995; Walen et al., 1992). Forexample, when clients say theycould not stand to be alone, ther-apists can reply, “I agree! It wouldbe so terrible to be alone. You

28 MAY 2004

couldn’t possibly ever livethrough it!” Rational, humoroussongs may also be assigned inbetween sessions. Ellis and Velten(1992, pp. 253-254) offer anexample to the tune of YankeeDoodle:

Drinking is the thing for me!With its stinking thinking.I can feel alive and freeWhen I’m really drinking!Drinking, drinking, keep it up!With the booze be handy!Keep pretending, yup, yup, yup,That I’m fine and dandy!

Shame-Attacking Exercises. Inthis technique, clients agree torepeatedly engage in a “shamefulactivity” in a public area toacquire discomfort tolerance andunconditional self-acceptance(Ellis & Dryden, 1997; Ellis &Velten, 1992; Gandy, 1995;Walen et al., 1992). For example,Kim from the case study agreed todance poorly on a busy sidewalk,read a magazine upside down inpublic, and ask a stranger if shecould borrow $20.

Behavioral TechniquesIn Vivo Desensitization. Using a

flooding paradigm, instead ofgradual exposure, clients quicklyand repeatedly expose themselvesto feared and avoided activities,while rehearsing the disputationof irrational beliefs (Ellis &Dryden, 1997). For example, Kimattended frequent AlcoholicsAnonymous meetings, whilerehearsing, “I can handle a wholeroom of strangers looking at me. Iwon’t die from it.”

Reinforcements and Penalties.Pleasurable activities are assignedto motivate clients toward con-structive behaviors and comple-tion of homework assignments.Unpleasant activities are assignedfor avoided homework assign-ments or unconstructive behaviors(Ellis & Velten, 1992). In the casestudy, Kim agreed to clean her toi-let after superficial hand cutting

and agreed to take long, luxuriousbaths after maintaining sobrietyduring a difficult situation.

Skill Training. When clientproblems are exacerbated byinsufficient skills, formal coursesare recommended, or briefinstruction is provided. For exam-ple, Kim learned assertivenessand relationship skills and con-sidered taking a computer course.

Acting on Rational Beliefs.Clients are encouraged to makeconstructive changes and behaveas if they only held rationalthoughts, instead of waiting tofeel better and more motivated(Ellis & MacLaren, 1998). InKim’s case, despite experiencingintermittent depression, shemade multiple job inquiries forwaitress positions.

REBT CONTRASTED WITHCBT

REBT and CBT significantlyoverlap, with similarities in struc-ture and perspective. In bothREBT and CBT, therapists helpclients explore their presentinterpretations of reality and theusefulness and effects of thoseinterpretations on their emotionsand behaviors. Both therapiesadvocate scientific thinking andthe use of cognitive, emotive, andbehavioral techniques to modifyclients’ interpretation process.Activity and collaboration arecommon to REBT and CBT, inthat both clients and therapistsactively target problems andnegotiate the selection of treat-ment strategies. In addition, gen-eralization is underscored in bothREBT and CBT, with consider-able attention placed on out-of-session functioning. Homeworkassignments are routinelyassigned to permit generalizationof in-session therapeutic gains(Vallis, Howes, & Miller, 1991).

However, REBT has severalfeatures that distinguish it fromCBT. First and foremost, REBT,

unlike CBT, provides a unifyingtheory, or a philosophy of rationalthinking and living, along withthe integration of a variety of cog-nitive, emotive, and behavioraltechniques. This approach is con-sidered “theoretically consistenteclecticism” (Ellis & Dryden,1997, p. 44), in which techniquesare selectively taken from othertherapeutic systems and usedaccording to REBT theory (Ellis,1994). In addition, REBT setstherapeutic goals beyond sympto-matic relief and strives instead forprofound and sustained philo-sophical, emotional, and behav-ioral changes.

Rational emotive behaviortherapy is based on an existential-humanistic perspective. As such,REBT views people as holisticand at the center of their uni-verse, with freedom of choiceover their emotional domains.Rational emotive behavior thera-py views people as human, neversubhuman or superhuman. Inaddition, REBT proposes that thecomplex essence or intrinsicworth of the “self” can never beevaluated, measured, or rated.Therefore, it proposes that self-rating be completely eliminated,along with positive self-rating,self-confidence, self-esteem, andother global ratings of self andothers.

Instead, REBT advocates theevaluation and rating of behav-iors and actions, with an empha-sis on unconditional self-accep-tance (Bernard & Joyce, 1984;Ellis, 1994; Ellis & Dryden,1997). Unconditional clientacceptance is recommended fortherapists using REBT, as long aswarmth and approval are kept toa minimum. Rational emotivebehavior therapy highlights thedifference between these andmaintains that warmth andapproval may foster dependenceand conditional self-acceptance.Conditional self-acceptance

People may bemessed up but arenot totally rotten.People may bemessed up but arenot totally rotten.People may bemessed up but arenot totally rotten.People may bemessed up but arenot totally rotten.People may bemessed up but arenot totally rotten.

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occurs when clients believe theyare good because they receiveapproval or love from their thera-pists (Ellis, 1994; Ellis & Dryden,1997; Gandy, 1995).

At the onset of therapy, REBTemphasizes the identification anddisputation of secondary symp-toms, which consist of clients’irrational musts and demandsabout their disturbance, whichreflect low frustration tolerance(e.g., “I must not have panicattacks.”) (Ellis, 1994). Low frus-tration tolerance is considered aform of human disturbance inREBT and is termed “discomfortdisturbance” (Ellis & Dryden,1997, p. 7). According to REBT,discomfort disturbance resultswhen people make demands forcomfort and comfortable life con-ditions and subsequently“awfulize” when these demandsare not met.

Rational emotive behaviortherapy highlights the distinctionbetween unhealthy and healthynegative emotions and addressescognitive distortions and dogmat-ic demands uniquely. It regards

emotions such as panic, rage, anddepression to be unhealthybecause of their potential to dis-turb, disrupt, and impede effec-tive coping and goal attainment.Conversely, REBT considersregret, concern, disappointment,and frustration to be healthy andrational negative emotionsbecause they may motivateclients and facilitate goal

achievement (Ellis & Blau,1998). Rational emotive behaviortherapy proposes that absolutisticdemands and irrational conclu-sions (e.g., “I must have love. It’sawful if I don’t.”) lead to cogni-tive or inferential distortions(e.g., “No one loves me, and I amworthless”) and ultimately tounhealthy negative emotions.This therapy avoids the initialdisputation of cognitive or infer-ential distortions. Rather, itaccepts these hypothetically, atfirst, and then proceeds to disputeirrational demands and conclu-sions (Ellis & Blau, 1998; Ellis &Dryden, 1997). For example, “Allright. Suppose every guy hasrejected your companionship.Prove to me that you can’t standrejection and that you mustnever be rejected.”

In REBT, techniquesthat challenge dogmaticmusts and demands areunderscored and referredto as “antimusturbatory”techniques (Ellis &Dryden, 1997, p. 69).Antimusturbatory tech-

niques are preferred toempirical techniques formodifying self-sabotagingphilosophies. Therapeutic effi-ciency is also featured in REBT,through the use of exposure andflooding techniques in lieu ofgradual desensitization. Rationalemotive behavior therapyhypothesizes that progressiveexposure unintentionally sup-

REBT considers regret, concern,disappointment, and frustration to be healthyand rational negative emotions becausethey may motivate clients and facilitate goal achievement.

30 MAY 2004

ports the irrational idea that dis-comfort is awful, perilous, andintolerable, and must never beexperienced. Similarly, there islimited use of distraction tech-niques in REBT. This therapyconsiders these techniques (e.g.,relaxation exercises) to be super-ficial and palliative, and main-tain that they are merely tempo-rary diversions from self-defeat-ing philosophies (Ellis, 1994).

In REBT, skill training andbehavioral reinforcement arehandled uniquely. The behavioraltechnique of skill training is used,but philosophical modification isinstituted first. This therapystrives to minimize irrationalphilosophies before skill trainingbegins because irrational philoso-phies are hypothesized to inhibitskill rehearsal due to irrationaldemands for guaranteed successand approval from others. Withregard to the behavioral tech-niques of penalties and reinforce-ments, REBT favors the use ofself-penalization over reinforce-ment. Rational emotive behaviortherapy considers self-penaliza-tion to be more motivating, espe-cially for clients with extremelylow frustration tolerance (Ellis,

1994). Finally, REBT proposesthat overly serious thinking maycontribute to psychological dis-turbances. Therefore, REBT useshumor to reinforce rationalphilosophies, counteract dogmat-ic demands, and help clients takethemselves and life less seriously(Ellis & Dryden, 1997).

ANALYSISThe major objections to REBT

involve its unconventional styleand position on negative emo-tions. Critics hold that the vigor-ous and forceful style of REBT ismanipulative and confrontation-al. However, the therapy consid-ers its style to be candid, persua-sive, and directive, in order tochallenge long-standing self-sab-otaging philosophies (Ellis &Blau, 1998). Critics have foundthe humorous use of obscenity inREBT to be objectionable. Theuse of obscenity is never consid-ered essential in REBT, and ifused, it is used sensitively to high-light critical principles (e.g.,“Prove to me that being rejectedmakes you a total ass!”). Rationalemotive behavior therapy holdsthat internal irrational beliefsoften take the form of obscenities

and that, if used selectively bytherapists, obscenities may serveto motivate clients and put themat ease (Walen et al., 1992).

Critics assert that REBT isrationalistic and, as such, aims toeliminate negative emotionsentirely. However, REBT holdsthat when adversity occurs, nega-tive rational emotions (e.g., irri-tation, disappointment) are actu-ally healthy and appropriatebecause of their potential tomotivate clients toward changeand problem resolution. Forexample, at times, Kim under-standably felt irritated whenunjustly insulted by a boyfriendand, therefore, was motivated tovoice her concerns, which gener-ated a reduction in insults. Whennegative emotions are exacerbat-ed to disturbing and disruptiveones (e.g., rage, depression), onlythen are they considered irra-tional and unhealthy (Ellis &Blau, 1998). Rational emotivebehavior therapy strives to mini-mize negative irrational emotionsby vigorously challenging irra-tional philosophies.

APPEAL OF REBT ANDPRACTICE IMPLICATIONS

The self-helping, didactic, andshort-term features of REBT maygenerate interest in prospectiveclients and nurse psychothera-pists. For nurse psychotherapists,the appeal may stem from thesimilarities between REBT andthe nursing paradigm, in particu-lar, its holistic perspective, self-care focus, and educational strate-gies. This therapy may be suitablefor nurse psychotherapists whosepractices are affected by managedcare stipulations, due to its short-term treatment course (averaging3 to 20 sessions), detailed proce-dures, and concrete expected out-comes.

Additional interest in REBTmay derive from the psychothera-peutic techniques it excludes.

1. Rational emotive behavior therapy (REBT) is a well established anddistinctive form of cognitive-behavior therapy that uses a unifyingtheory and an educational model, with an emphasis on philosophicalmodification.

2. REBT proposes that emotional distress is largely created andmaintained by a philosophy of dogmatic demands, catastrophizing,low frustration tolerance, and condemnation of oneself and others.

3. Cognitive, emotive, and behavioral methods of REBT are designed topromote unconditional self-acceptance, rational thinking, andfrustration tolerance, and include risk-taking assignments, experientialtechniques, and vigorous disputations of irrational beliefs.

K E Y P O I N T S

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JOURNAL OF PSYCHOSOCIAL NURSING, VOL. 42, NO. 5 31

Techniques that are excludedfrom or used minimally in REBTinclude protracted discoursesregarding activating events,exclusive focus on modifying acti-vating events, and simplistic andsuperficial positive thinking.Rational emotive behavior thera-py also avoids the use of catharsisand abreaction, methods withantiscientific ideologies, and psy-chotherapies that lack empiricalvalidation (Ellis & Dryden,1997).

Training and certification inREBT for nurse psychotherapistsare available at REBT Institutesthroughout the United States,and in Canada, Israel, France,Italy, Mexico, Australia,Germany, The Netherlands,Argentina, Yugoslavia, and Peru.Qualifications for certificate can-didacy is a master’s degree andparticipation in a 3-day REBTcourse. The course involves lec-ture, peer counseling, and smallgroup supervision, with no exam-ination (Ellis & Dryden, 1997).Considering the broad spectrumof practice settings, nurse psy-chotherapists with REBT certifi-cation are in a position to helpmany client through REBT psy-chotherapy and emotional educa-tion.

SUMMARYRational emotive behavior

therapy is a well-established formof CBT, which offers a philosoph-ical approach to psychologicalhealth. Within the domain ofCBT, REBT has several distin-guishing features. This therapy

advocates the vigorous disputa-tion of rigid irrational demands,which, if left unaddressed, canlead to irrational conclusions,cognitive distortions, unhealthynegative emotions, and dysfunc-tional behaviors. Rational emo-tive behavior therapy uses aneducational model and unifyingtheory, with an emphasis onaction, rational thinking, highfrustration tolerance, and uncon-ditional self-acceptance.

REFERENCESBernard, M.E., & Joyce, M.R. (1984).

Rational emotive therapy with childrenand adolescents. New York: Wiley andSons.

Bernard, M.E., & Wolfe, J.L. (2000).Rational emotive behavior therapy(REBT) today. In M.E. Bernard & J.L.Wolfe (Eds.), REBT resource book forpractitioners (2nd ed., pp. II4-II6). NewYork: Albert Ellis Institute.

DiGiuseppe, R. (2000). Disputing moreeffectively: Strategies and styles forchanging irrational beliefs. In M.E.Bernard & J.L. Wolfe (Eds.), REBTresource book for practitioners (2nd ed.,pp. I7-I12). New York: Albert EllisInstitute.

Ellis, A. (1994). Reason and emotion in psy-chotherapy. Secaucus, NJ: CarolPublishing Group.

Ellis, A., & Blau, S. (Eds.). (1998). AlbertEllis reader. A guide to well being usingrational emotive behavior therapy.Secaucus, NJ: Carol PublishingGroup.

Ellis, A., & Dryden, W. (1997). The prac-tice of rational emotive behavior therapy(2nd ed.). New York: Springer.

Ellis, A., & MacLaren, C. (1998). Rationalemotive behavior therapy: A therapist’sguide. Atascadero, CA: ImpactPublishers.

Ellis, A., & Velten, E. (1992). When AAdoesn’t work for you. Rational steps toquitting alcohol. New York: BarricadeBooks.

Gandy, G.L. (1995). Mental health rehabil-itation: Disputing irrational beliefs.Springfield, IL: Charles C. ThomasPublisher.

Vallis, M.T., Howes, J.L., & Miller, P.C.(1991). The challenge of cognitive thera-py: Applications to nontraditional popu-lations. New York: Plenum Press.

Walen, S., DiGiuseppe, R., & Dryden, W.(1992). A practitioners’ guide to rationalemotive therapy (2nd ed.). New York:Oxford University Press.

Ms. Sacks is a psychotherapist inprivate practice and a lecturer,University of Pennsylvania, Philadelphia,Pennsylvania.

Address correspondence to SusanBendersky Sacks, MSN, RN, CS, 650Malin Road, Newtown Square, PA19073; e-mail: sacksfamily@yahoo.com.

SELECTED INTERNET RESOURCES

Albert Ellis Institutehttp://www.rebt.org/

A Brief Introduction toRational Emotive Behavior Therapy

http://www.rational.org.nz/prof/docs/intro-rebt.htm

Online Journal of Multimodal and RationalEmotive Behavior Therapy

http://members.lycos.co.uk/onlinej/

REBT, Philosophy, & PhilosophicalCounseling

http://members.aol.com/PracticalPhilo/Volume3Articles/REBT.htm

REBT Therapyhttp://www.threeminutetherapy.com/

rebt.html

SMART Recovery: Self-Managementand Recovery Training

http://www.smartrecovery.org/nav/3min/