Cognitive-Behavioral Therapy Health Article

Rational-emotive behavior therapy

Rational-emotive behavior therapy (REBT) is a popular variation of cognitive-behavioral therapy developed in 1955 by psychologist Albert Ellis. REBT is based on the belief that a person's past experiences shape their belief system and thinking patterns. People form illogical, irrational thinking patterns that become the cause of both their negative emotions and of further irrational ideas. REBT focuses on helping patients discover these irrational beliefs that guide their behavior and replace them with rational beliefs and thoughts in order to relieve their emotional distress.

There are 10 basic irrational assumptions that trigger maladaptive emotions and behaviors:

• It is a necessity for an adult to be loved and approved of by almost everyone for virtually everything.
• A person must be thoroughly competent, adequate, and successful in all respects.
• Certain people are bad, wicked, or villainous and should be punished for their sins.
• It is catastrophic when things are not going the way one would like.
• Human unhappiness is externally caused. People have little or no ability to control their sorrows or to rid themselves of negative feelings.
• It is right to be terribly preoccupied with and upset about something that may be dangerous or fearsome.
• It is easier to avoid facing many of life's difficulties and responsibilities than it is to undertake more rewarding forms of self-discipline.
• The past is all-important. Because something once strongly affected someone's life, it should continue to do so indefinitely.
• People and things should be different from the way they are. It is catastrophic if perfect solutions to the grim realities of life are not immediately found.
• Maximal human happiness can be achieved by inertia and inaction or by passively and without commitment.

Meichenbaum's self-instructional approach

Psychologist Donald Meichenbaum pioneered the self-instructional, or "self-talk," approach to cognitive-behavioral therapy in the 1970s. This approach focuses on changing what people say to themselves, both internally and out loud. It is based on the belief that an individual's actions follow directly from this self-talk. This type of therapy emphasizes teaching patients coping skills that they can use in a variety of situations to help themselves. The technique used to accomplish this is self-instructional inner dialogue, a method of talking through a problem or situation as it occurs.

Preparation

Patients may seek therapy independently, or be referred for treatment by a primary physician, psychologist, or psychiatrist. Because the patient and therapist work closely together to achieve specific therapeutic objectives, it is important that their working relationship is comfortable and their goals are compatible. Prior to beginning treatment, the patient and therapist should meet for a consultation session, or mutual interview. The consultation gives the therapist the opportunity to make an initial assessment of the patient and recommend a course of treatment and goals for therapy. It also gives the patient an opportunity to find out important details about the therapist's approach to treatment, professional credentials, and any other issues of interest.

In some managed-care clinical settings, an intake interview or evaluation is required before a patient begins therapy. The intake interview is used to evaluate the patient and assign him or her to a therapist. It may be conducted by a psychiatric nurse, counselor, or social worker.

Normal results

Many patients who undergo cognitive-behavioral therapy successfully learn how to replace their maladaptive thoughts and behaviors with positive ones that facilitate individual growth and happiness. Cognitive-behavioral therapy may be used in conjunction with pharmaceutical and other treatment interventions, so overall success rates are difficult to gauge. However, success rates of 65% or more have been reported with cognitive-behavioral therapy alone as a treatment for panic attacks and agoraphobia. Relapse has been reported in some patient populations, perhaps due to the brief nature of the therapy, but follow-up sessions can put patients back on track.

BOOKS

Greenberger, Dennis, and Christine Padesky. Mind over Mood: A Cognitive Therapy Treatment Manual for Clients. New York: Guilford Press, 1995.

PERIODICALS

Enright, Simon. "Cognitive Behaviour Therapy." British Medical Journal 314, no. 7097 (June 1997): 1811-16.

Goisman, R. M. "Cognitive-Behavioral Therapy Today." Harvard Mental Health Letter 13, no. 11 (May 1997): 4-7.

ORGANIZATIONS

Albert Ellis Institute. 45 East 65th St., New York, NY 10021. (800) 323-4738. <http://www.rebt.org>.

Beck Institute. GSB Building, City Line and Belmont Avenues, Suite 700, Bala Cynwyd, PA 19004-1610. (610) 664-3020. <http://www.beckinstitute.org>.

The National Association of Cognitive-Behavioral Therapists. P.O. Box 2195, Weirton, WV 26062. (800) 853-1135. <http://www.nacbt.org>.

Paula Anne Ford-Martin