Rational Emotive Behavior Therapy

REBT uses a model known as the ABC model, or sometimes the ABCDEF model.

• A: Activating event. This is the external event that activates a thought or feeling.
• B: Belief. These are our automatic beliefs about the activating event, others, or ourselves. 
• C: Consequence. The consequence is our behavioral or emotional response to the activating event.
• D: Dispute. This is what happens when you question automatic, irrational beliefs. 
• E: New effects. An effective new belief replaces irrational beliefs, and the mental process that results from this change may lead to more effective behavior.
• F: Functional feelings. A person may experience more functional feelings as a result of this process.

In practice, the ABCDEF model generally follows a common procedure. The therapist³ typically creates rapport with the patient to establish a therapeutic alliance and structure future sessions. They often work together to identify the sources of stress that cause negative reactions and set goals for treatment. Then, the therapist typically guides the patient by asking thoughtful questions to determine their irrational thoughts or inaccurate beliefs. 

Throughout subsequent REBT sessions, the therapist typically helps the patient identify negative emotions associated with irrational beliefs. The therapist often helps the patient dispute their inaccurate beliefs and presents alternative perspectives. Then, the therapist typically exposes the patient to more adaptive techniques. Finally, the therapist may teach self-monitoring skills with the use of guided imagery. REBT sessions may last 10 to 16 weeks, with one or two weekly sessions.

During treatment, REBT therapists typically work with people to identify the thought patterns and beliefs that may contribute to psychological distress, hold them back from achieving a goal, or cause disruptions in everyday life. Using a variety of mental exercises, the therapist typically helps the person understand how those unhelpful thought patterns create emotional and behavioral difficulties. Then, they usually aim to help the person reduce and reframe those patterns and develop healthier coping strategies and behaviors to better handle future challenges.

Some of the techniques therapists might use include:

• Role-playing
• Visualization exercises
• Mindfulness⁴ exercises
• Rational emotive imaging
• Behavior activation
• Cognitive restructuring
• Thought stopping

Specifically, the therapist may ask if the person has any evidence for their beliefs (called Socratic questioning), whether they are consistent with reality or logic, and whether their beliefs are helpful or harmful. Once an inaccurate belief is disputed, the therapist and the patient typically work to create an alternative belief.

REBT therapists often give patients homework assignments like journaling to reinforce techniques and learning between sessions.

REBT can be used in a wide variety of treatment scenarios and can be appropriate for anyone experiencing cognitive distortions that lead to distressing emotions and self-defeating thoughts and behaviors. People with cognitive distortions may engage in:

• Catastrophizing: Assuming the worst possible outcome to a situation. For example, your partner is late coming home from work, so you automatically assume they’ve been in a car accident rather than thinking they may be stuck in traffic.
• Negative filtering: Disregarding the positive aspects of a situation while focusing only on the negative. For example, an individual concentrates disproportionately on one suggestion for improvement in a workplace performance review containing overwhelmingly positive feedback.
• Polarization: Also called “all or nothing” thinking. For example, you got along really well with your coworker until you found out they voted for a political candidate you don’t support, and now you dislike them intensely. 
• Jumping to conclusions (or mind-reading): Interpreting something negatively without evidence. For example, “The boss seems irritated; they’re probably unhappy about how I handled the project.” 
• Overgeneralization: Interpreting an isolated adverse event as a pattern spanning to other areas. For example, “That person isn’t interested in me. I’ll never find a partner.”
• Personalization: Believing one is responsible for situations or events they have no control over. An example might be blaming yourself when your child falls off the swing set because you were the one who took them to the park. 
• Labeling: Assigning a label to something or someone based on an isolated event. For example, someone may label themselves as a failure based on a single negative event. 

REBT may help people experiencing a variety of mental health challenges, including: 

• Obsessive-compulsive disorder
• Social phobia
• Anxiety
• Depression
• Parental distress
• Disruptive behavior
• Binge eating disorders
• Job burnout
• Posttraumatic stress disorder
• Distress in patients with cancer and their caregivers

Finally, some recent research suggests that REBT has some similarities with mindfulness and that integrating the two may help people in high-performance settings stay more task-focused, which may enhance performance outcomes. For example, this type of therapy may help the performance and mental health of athletes.

REBT typically aims to identify and challenge self-defeating thoughts and replace them with more productive beliefs, helping the person maintain behavioral and emotional functionality in daily life, which may help people with long-term goal attainment. REBT may also help people develop healthier lifestyle habits and establish healthier relationships.

REBT is based on the idea that people’s thoughts about a situation cause them the most distress. In REBT, people often learn how to notice and challenge unrealistic or unhelpful thought patterns and explore how they lead to unfavorable behaviors or emotions. This can help empower people to reframe their core beliefs into more realistic ones that support better mental health and wellness. 

Therapists often help people in REBT focus more on the present so that they can identify any inaccurate thoughts in real time and challenge them on the spot. Also, REBT doesn’t just have to be about solving a problem; it can serve as a preventative approach to improving mental health. Overall, REBT may help people take ownership of their emotions, thoughts, and behaviors to change their beliefs and approach to living.

A recent study published in The American Journal of Psychotherapy aimed to explore the efficacy of REBT in a clinical setting. This study examined the effectiveness of REBT provided at the Albert Ellis Institute over 10 years. The main finding was that patients reported significant improvements in functioning. Most study participants attended more than three sessions. A quarter attended 20 sessions, and about 22% participated in all prescribed sessions. Medium effect sizes were seen after only three sessions, and session-by-session comparisons show that improvements were evident starting after the first session. 

Significant reductions in clinical symptoms were also documented by the end of the study. At the beginning, 75% of participants had clinical symptoms; by the end, half had become non-clinical. This analysis suggests that the number of sessions attended directly correlated with symptom severity by the end of treatment. 

Overall findings indicate that REBT is effective in controlled studies and can be used to treat a wide range of problems in clinical settings. Further studies, such as a systematic review or longitudinal study, may reveal more about the effectiveness of REBT in various contexts.