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Let me open this blog by introducing you to five patients I treated today. First up was 22-year-old Sarah.* A bipolar sufferer, she wanted help with her severe anxiety over the possibility of her premature death. When questioned, she me told that she thought it would be so unbearable to not exist, particularly at such a tender age, that it must not happen.
Later in the morning, Matthew asked for help with his long-standing anxieties about relating to women to whom he felt attracted. To my question, “What would be so horrible to you if you failed with them?” he answered, “It would prove I’m irrelevant and forgettable.”
A few hours later, Laurel told me how angry and bitter she was about the agonizingly slow death of her father who suffered from ALS. She explained that months before he had declined the opportunity to take his own life in a northwest state where euthanasia is legal, thereby putting her and other loved ones through this drawn-out, painful ordeal. Her belief: “He shouldn’t have been so selfish and put us all through this horror.”
Thirty-year-old Fred walked into my office mid-afternoon wearing a long face and carrying slumped shoulders. “Something sure is bothering you,” I said. With that opening, he blurted out that he became so angry after being scolded by his work supervisor earlier in the day that the security police had to be called to quiet him down. Detailed questioning revealed that, while his supervisor indeed criticized his customer service behavior, he interpreted her message to communicate that “I’m a worthless piece of s**t.”
My last patient today was Gloria. A talented graphic artist, she shared the hurt and anger she felt toward her husband after he fell asleep while she was sharing her dreams for her professional future. With probing, she came to see that what caused these feelings was the meaning she made of it, to whit: (1) “This shows that I don’t matter to him.” (2) “This proves that my value simply doesn’t exist.” (3) “He’s my enemy and I’ve got to protect myself from him.”
Can you recognize yourself reacting like any one of these people? I suspect so. I know I have on occasion. While the circumstances in all five of their lives are certainly different, there is a distinct similarity between each of them. It is that all responded to what he or she faced with a profoundly negative judgment either about themselves, someone else, or their particular life condition. Maybe you can recognize that at least at times you do think like one or several of them did.
My job as a practicing cognitive behavior therapist, specifically one who provides Rational Emotive Behavior Therapy (REBT), is twofold. One is to help each of my patients ferret out their negative judgments, analyze whether or not there is truth to them, and, if not, replace them with more valid ones that will both alleviate their suffering and open their door to experiencing happiness. A second is to teach them the five-step REBT process so that they are equipped to solve their emotional problems in the future without needing my help.
In this blog, I intend to share with you this five-step REBT process. Your job is to learn it so you too can use it in your personal life. In future blogs, I will show you how to successfully apply the process to the most common forms of human suffering. Read on.
Step One: Take Responsibility
In Rational Emotive Behavior Therapy, responsibility specifically means that one accepts, without self-blame, the role one plays in bringing about one’s own suffering. By taking responsibility, one then is positioned to fix what one is doing wrong and then get on with the business of living a healthy, happy life.
Let me be more specific. There are thousands of research studies and millions of case examples that show that it is not what happens that causes our emotional suffering. Rather, it is the judgments we make of them. In REBT, we illustrate this with the famous ABC model: A represents the activating event, the thing that happened about which we are upset; B stands for the belief we hold about the event, and C represents the emotional and/or behavioral consequences of holding that belief. Put in this model, it is not what happens at A that causes our reaction at C, but our judgmental beliefs about the event at B that causes how we react.
So that’s what taking responsibility means. Tongue in cheek, I often tell my patients that there is both good and bad news in this: the bad news is that they are responsible for causing their own personal problems; the good news is that they are responsible for causing their own personal problems. It is good news because, by taking responsibility for causing them, they can, if they choose, rid themselves of their disturbance-producing beliefs and thereby relieve themselves of their suffering, Nothing outside of themselves needs to change.
Imagine the power Sarah, Matthew, Laurel, Fred, and Gloria can claim for themselves if they accept, without self-blame, for causing their own personal problems. The question I have for you then, is this: Will you take responsibility for how you react to the events in your life? I hope so, for you will likewise be as empowered as can be these people. You will be primed to tackle the next step in the REBT process.
Step Two: Identify The Irrational Belief
Since it is the beliefs we hold (at B) that causes our emotional problems (the C), not the circumstances in our lives (the A), it is critical to finding happiness to identify and destroy our misery-making beliefs. This may sound daunting, but it’s not. Why? Because, first, they are right there to be observed if we only know what to listen for. And, second, we know that three major irrational beliefs are behind virtually every form of emotional disturbance. They are:
- Perfectionistic Demanding. Rather than appropriately wanting or desiring to do well, to be liked or loved, to be treated well by others, and/or to have life always be nice, just, and rewarding, one perfectionistically demands that it must, should, got to, has to, or needs to be so. In other words, to suffer misery at C, a person perverts a rational desire for some outcome—to do well and be liked, for another to treat you respectfully, to not face any difficult adversity—into a virtual necessity, a life-and-death matter.
- Catastrophizing. Rather than holding a personal failure, some obnoxious behavior from another, or some setback in life as dislikable, or unfortunate, or even out and out obnoxious, the person escalates in one’s mind the degree of badness of some onerous event to the level of a catastrophic tragedy. He or she thinks: This undesirable event is so awful, horrible, or terrible that it virtually ruins my life, that I, in fact, can’t bear it. By distorting something bad into an event equal to or worse than the Holocaust, one brings upon oneself untold amounts of anxiety, anger, and depression upon oneself.
- Self-judgment. Rather than limiting one’s judgment to what one does to a fault one has, one judges one’s total self, that of another, or the whole of life as all bad, rotten or worthless. This self-judgment belief at B sounds something like the following when applied to oneself: “Since I shouldn’t have made that mistake or have that failing, I am a totally worthless failure, not only now, but from birth till death.
We in REBT find that one or more of these beliefs, singularly or in some combination, lie at the root of virtually all-human misery. By ferreting them out, we are thereby primed to correct such faulty thinking with the truth.
Now, take a few minutes to reread the brief description of the patients I introduced at the beginning of this blog. Look first at Sarah. Notice that she demanded that her life must perfectly unfold the way she wants and, furthermore, that it would be unbearable for it to be otherwise. No wonder she experienced anxiety in thinking this way. What about the others? See if you can find each of these peoples’ perfectionistic demands, catastrophizing beliefs, and/or self-judgments.
Step Three: Seek the Truth
By the time a person enters into psychotherapy, he or she has most likely deeply endorsed and/or strongly habituated their irrational beliefs. Held for years as God’s gospel truth, they are automatically activated, unquestionably assumed to be true, and fervently defended.
In REBT we work hard to convince our patients to be skeptical, that is, to hold their beliefs up as a hypothesis to be critically examined for their validity. We tell them that the last thing they want to do is hold them as an absolute truth simply because they already believe them.
But, what is the truth? What determines truth? What do we need to do to distinguish truth from fiction?
These are not easy questions to answer. But they are questions that every thoughtful person would b wise to ponder. Why? Well, since irrational, false beliefs lie behind all psychological problems, finding and living by the truth is the royal road to happiness. And determining what beliefs are true and which aren’t lie at the heart of all elegant psychotherapeutic change. In REBT, we take the stand that truth is determined through the use of the logico-empirical method. That is, something is true or valid only if it passes the muster of logic, is supported by data, and serves to enhance a person’s life. Only then can we conclude a belief represents the truth. If it falls short on any one of these criteria, then we conclude it’s not true or valid.
In using the logico-empirical method with our patients, we encourage them to hold their beliefs up as hypotheses and then think their way through them using probing questions:
- Based on logic and data, is this belief true or valid? Why?
- Does this believe help or hurt me in leading a happy, healthy, fulfilled life? How so?
Future blogs will dig deep into the answers to these questions with regard to the beliefs that cause the major forms of emotional problems. For now, go back to the belief you identified in my patients and do your best to rigorously questions their validity using these two questions. Do they represent reality as determined by logic, empirical data, and practicality? If not, list as many reasons as you can to show why they don’t.
Step Four: Cognitive Re-education
The next part of the REBT change equation is to engrain new, more rational beliefs: anti-perfectionistic, anti-catastrophizing, and anti-self judgment ones, as per:
- Preferential beliefs: as in, I want, desire, or prefer beliefs, as opposed to perfectionistic, life and death, as per I must, should, got to, have to, or need to beliefs.
- Perspective beliefs: as in, rating something as merely bad, unfortunate, or undesirable, yet bearable, as opposed to deeming something as so awful, horrible, or terrible it’s beyond survivable.
- Self-accepting beliefs: as in making the distinction between failing at something versus being a total failure.
I will address these in great detail in the next several blogs when I show you how to rid the various forms of emotional turmoil. For now, go back to my patients and do your best to reformulate them along the line articulated above.
Step Five: Work, Work, Work
Albert Ellis, the founding genius who created the granddaddy of all cognitive behavior therapy, Rational Emotive Behavior Therapy (REBT), once said: “Emotional disturbance consists of an intelligent person thinking stupidly.” But, it’s more than that. It’s that emotional disturbance results from an intelligent person endorsing and habituating their irrational thought patterns, over a sustained period of time so that they are unquestionably believed.
As a consequence, it is rare for a person to give up his or her disturbance- producing beliefs after only one or even a handful of Step Three and Four run-throughs. What is most often required is for the person to commit to doing their therapy (i.e., this five-step process) every day, over an extended period of time. By identifying the irrational beliefs, disputing them, and replacing them on a daily basis, perhaps for one hundred days in a row, he or she will most likely “get” that they are irrational and truly believe the more rational alternative. This takes commitment, dedication, and
Going Forward
So there it is, the five-step REBT process to find the truth that shall set you free of your emotional turmoil. If you follow this process, not just today, but many days running, you can reap the same benefits that thousands upon thousands of people already have.
To get you started, I encourage you to now engage in the following therapeutic process, remembering that happiness is not a gift, but a byproduct of your effort and action. Each day, take an upset that you recently experienced and, using the ABC model, ferret out its component parts: What was the painful feeling you experienced at C that day? What was the event at A about which you felt this? Most importantly, what was your irrational belief?—Your perfectionistic demand? Your catastrophizing? Your self-judgment? Then, rigorously hold it up to the test of truth. If found untrue, come up with a more rational belief that makes logical and empirical sense.
With this grounding, I will devote the next several blogs to helping you apply REBT’s five-step truth-seeking process to the most common forms of emotional unhappiness. I will start with anxiety.
So, stay tuned. Until then, be well and live with passion.
*All names and identifying data have been changed to protect patient anonymity.