Rational Emotive Behavioral Therapy (REBT): How It Works & What to Expect

Central Concepts of Rational Emotive Behavioral Therapy

Like other forms of CBT, the central concept of REBT is that unwanted behaviors and feelings stem from flawed ways of thinking. Even though these thinking patterns come from the past, REBT spends a lot of time discussing how they affect the person’s present life.² Someone hoping to improve their health and well-being must adjust their thinking to relieve their symptoms and produce the wanted outcomes.

REBT identifies several categories of irrational thinking patterns that include:

• Demandingness: a rigid behavior that the people, the situations, or the world must be or should be a certain way, and if it is not, it is wrong.
• Awfulizing/ catastrophizing: overinflating something’s impact by believing that an unwanted event or situation is “the worst thing that could ever happen.”
• Discomfort and frustration intolerance: thinking that a present or future outcome will be so terrible that the person will never be able to manage it.
• People-rating or overgeneralizing: the process of exaggerating a person’s characteristics or behaviors and using it to judge the person or a group of people.¹

All therapeutic orientations offer a unique style and perspective that shape the way the therapist and client work together to identify and resolve the problematic issues. REBT offers a novel theory of causation and a theory of change to drive sessions forward.¹

Theory of Causation

The REBT theory of causation seeks to explain what makes people feel well and what makes them feel unwell. REBT is based on the idea that all emotions and behaviors emerge from the way people think. The thoughts, assumptions, and beliefs people hold about themselves, others around them, and the world dictate how they feel and function. Put another way, the way a person feels has less to do with what happens to them and more about how they view what happens.¹

As an example, two people could get $10– one person is excited because they expected nothing and the other is disappointed because they expected more. Regardless of the event, it was their belief that triggered the feeling.

REBT stresses the influence of psychological and social elements that create feelings, but it offers some limitations. A person’s biology and heredity can restrict how far a person can move from their starting point. REBT therapists and clients will work to identify the limitations of change and push up to that level.¹

Theory of Change

Along with the theory of causation, REBT provides a theory of change, which states that change happens at two distinct levels – a superficial change and fundamental change. Superficial changes are based on making small adjustments in the moment to feel better quickly.

Superficial changes can include:

• Changing your body by performing actions like using a medication, eating or drinking something, performing a relaxation technique, or exercising
• Changing the environment by leaving a situation or avoiding contact with a person
• Changing the thoughts about the situation by noticing the thinking patterns and adjusting them to produce wanted outcomes¹

Superficial changes can help a person feel better, but those who seek lasting improvement will require fundamental changes. Rather than addressing simple issues at the moment, these lasting changes involve the person permanently shifting their thoughts and beliefs. The process is challenging, but with practice, REBT can accomplish it.¹

What Can REBT Help Address?

Though other psychotherapies may be designed for a specific set of symptoms, REBT and other cognitive behavioral therapies are effective at treating a long list of mental health, physical health, and social health issues. REBT can help shrink the influence of a serious mental health issue, or it can help reduce the stressors, which are typically linked to everyday life. Whether the problem is life-altering or only mildly distressing, REBT can be useful.

Mental and Behavioral Disorders

Mental health conditions inflict various symptoms and effects on those with the diagnosis.

REBT can address many symptoms linked to psychological disorders like:

• Mood disorders including major depressive disorder and persistent depressive disorder
• Anxiety disorders including generalized anxiety disorder, panic disorders, agoraphobia, and other specific phobias
• Post-traumatic stress disorder
• Obsessive-compulsive disorder (OCD)
• Personality disorders like antisocial personality disorder
• Addictions and substance use disorders
• Eating disorders like anorexia and bulimia¹

In addition to these mental health conditions, REBT therapy can help address other aspects of mental health and well-being related to stress and anger. Working with an REBT therapist can help a person reduce the negative effects of stress and anger before they develop into fully-formed mental health disorders.

Other Issues Improved with REBT

REBT is a therapeutic orientation capable of minimizing issues existing outside of clinical mental health conditions.

Some additional applications of REBT include:

• Adjusting to a new chronic health problem or physical disability
• Managing chronic pain
• Unwanted behaviors of children that do not meet the criteria for a mental health disorder
• Problems with relationships, parenting, and family connections
• Self-improvement personal development skills to enhance wanted characteristics
• Exploring ways to improve performance as an employee or leader in the workplace¹

In these ways, REBT is not only about lessening the impact of a diagnosed mental health disorder, but it is about finding methods to become a better person or a better member of a team. Because of this, nearly everyone can benefit from the use of this treatment style.

Common REBT Techniques

Sound therapeutic styles, like REBT, use a foundation of techniques to help create the desired changes, and REBT offers many methods to encourage rational thinking patterns. Several techniques a therapist will employ include:¹

Rational Analysis

In REBT, irrational thinking leads to different types of disturbances like worrying, avoidance, procrastination, negativity, and complaining. Rational analysis helps uncover and challenge the problematic thoughts.

Role Playing

With these role plays, the REBT therapist will adopt and act out the client’s faulty beliefs to illustrate their flaws. At the same time, the client will debate the therapist by taking the opposing view and playing devil’s advocate.

Time Projection

The therapist asks the client to imagine the feared event coming true to see how they would react and manage the situation. Projection shows that time continues, and the client can adapt, even after the pain.

Exposure

This technique involves the client engaging in the stressful behavior to show how it is never as bad as they imagine. Going through with the scary behavior will challenge and shrink the distorted thought.

Acting Out of Character

Here, the therapist encourages the client to behave in an atypical way as an experiment to observe the results. If the client is normally shy and timid, they will be encouraged to act brave and confident.

The ABC Model

Perhaps the central technique of REBT is explaining and implementing the ABC model. This technique presents a new way of viewing a person’s experience with A being the activating event, B being the belief about the event, and C being the consequence or feeling. People often assume that the activating event causes the consequence, but REBT is based on the idea that the belief causes the consequence.¹ By shifting the focus to changing beliefs, rather than changing the activating event, the person can feel well.

In REBT, the ABC model is paramount, and many sessions will process the ways irrational thinking and flawed beliefs adversely impact the person’s life.

REBT Examples

REBT is useful for a range of mental health, physical health, and self-improvement issues, so REBT sessions may look different depending on the presenting problems and goals. As expected, the ABC model will always ground treatment.

Poor Work Performance

In this session, the client reflects on a situation where they received a poor evaluation at work— the A. They believe that this confirms how they are a complete failure— the B. The person then feels like a disappointment and wants to quit— the C.

Since no one can undo the poor evaluation, the REBT therapist will work to challenge the person’s extreme belief and put it in perspective. Together, the client and therapist will dispute the thinking pattern to create a new effect and more desirable feelings. In this case, motivation for improvement, rather than sadness, will be a preferred response.

Agoraphobia

Someone with agoraphobia has an irrational fear of places and situations like using public transportation, being in open or closed spaces, being in a crowd, or even leaving home.³ Their irrational thoughts will cut them off from trusted supports, work, school, and other healthy outlets as they think:

• The outside world is full of danger
• I will be harmed if I go outside
• I am powerless to prevent the pain

If someone with agoraphobia attends REBT therapy, the therapist will likely start with psychoeducation about the power of irrational thoughts, beliefs, and fears while asking the person to describe their thoughts when faced with the anxiety-provoking situation. The therapist will then present the ABC model to illustrate how the beliefs, not the situation, creates anxiety and panic.

Challenging the thoughts during the session is needed, but the therapist will encourage the client to confront their fears through exposure and observe how their irrational predictions did not come true.

Depressive Disorders

Someone with depression may present with varied irrational thinking styles like demandingness, rigidity, catastrophizing, all-or-nothing thinking, and emotional reasoning.⁴ These types of distorted thinking shape people’s experiences and their feelings towards sadness about themselves and the world around them.

The REBT therapist will help point out the irrationality of the thoughts and encourage the client to commit to doing the same. With a focus on detecting, disputing, and replacing the irrational thinking with positive statements, the consequences will shift towards happiness and self-acceptance.

How to Find an REBT Therapist

Finding therapists who specialize in REBT near you may be challenging. Although the approach is very effective, you may encounter more therapists who identify as a CBT therapist rather than an exclusively REBT therapist.

One helpful tool to locate those specializing in REBT is the “Find an REBT Therapist” tool provided by The Albert Ellis Institute. Named for the founder of REBT, this organization offers training and workshops for therapists interested in the approach.

Alternatively, someone can navigate to the “Help for Mental Illness” page provided by the National Institute on Mental Health. Many therapists use REBT techniques during an average session, so even if the therapist does not explicitly subscribe to REBT, they may still offer aspects of this treatment.

Who Provides REBT

Many types of mental health professionals provide REBT skills and techniques to their clients.

Psychotherapists using REBT may include:

• Psychologists
• Psychiatrists
• Social workers
• Professional counselors
• School counselors

REBT techniques work well alongside other therapeutic techniques, so a therapist may blend elements of REBT into other styles.¹ Some organizations, like The Albert Ellis Institute, offer additional REBT certifications for REBT therapists, but these are not required for treatment.

Cost of REBT

Since REBT is a well-studied and successful form of psychotherapy, insurance coverage will typically cover the associated costs, after out-of-pocket expenses like copays and deductibles. People using REBT for self-improvement may encounter issues, though, since insurances only tend to cover “medically necessary” treatments. Without a formal diagnosis, the company may not pay. Always be sure to have a frank conversation with the insurance company and the provider to learn about the costs before entering into treatment.

Key Questions to Ask an REBT Therapist

When consulting with a therapist, a person should spend some time asking questions like:

• What are your credentials and experience using REBT?
• What goals will treatment focus on, and how will they be achieved?
• How long is therapy expected to last?
• How does REBT differ from other therapy styles?
• Can REBT effectively manage my symptoms?
• What kind of working relationship do REBT therapists have with their clients?
• Is it appropriate to take medications while attending REBT therapy?
• Is REBT only for me, or can my family and friends attend sessions as well?^{2 5}

Therapists commonly differ based on their education, experience, and personal style, so finding a therapist that can improve symptoms is necessary. People should always spend time thinking about what they are looking for in a therapist and work to identify an appropriate candidate.

What to Expect at Your Initial Appointment

The initial REBT appointment will work to educate the client about the principles and techniques of the REBT process and demonstrate how REBT can improve their life.

A typical REBT first session will involve:

• Building a relationship: Without an appropriate therapeutic relationship built on trust and respect, therapy is usually ineffective.
• Inspecting the situation: The therapist will ask questions about the symptoms and the client’s perspective to gain an understanding of the problem. The therapist will also ask about potential physical health and substance use issues which could create the symptoms.
• Preparing for treatment: By discussing treatment goals, providing basic information about REBT, and planning future sessions, the therapist will help outline the proposed course of treatment.
• Implementing treatment: Within the first sessions, the therapist will help the client to identify irrational thinking and acknowledge problematic beliefs while recommending behavioral changes and offering complementary interventions like relaxation techniques and communication training to address symptoms.¹

Future REBT sessions will repeat many of these steps and begin evaluating the success of the meetings. When REBT treatment begins progressing, the therapist and client will address ways to measure treatment effectiveness and when termination is appropriate.

Is REBT Effective?

Various forms of CBT have been studied repeatedly to prove their effectiveness with a range of mental and physical health conditions. One comprehensive review published in 2017 sought to identify the benefit of REBT by investigating more than 1,900 published articles and analyzing the findings.

This meta-analysis showed that REBT had significantly positive effects in numerous areas including:

• Anger
• Anxiety
• Depression
• Distress levels
• Physical health
• Quality of life
• School performance
• Social skills⁶

In these areas, REBT was much more effective than no treatment and placebos, but it was also favorable when compared to the use of medications and other forms of therapy.⁶ REBT offers a strong chance of symptom improvement.

Risks of REBT

Another encouraging finding of this study is that REBT seemed to offer no risk. Out of the monitored outcomes like anger, anxiety, and depression, no symptoms worsened with the implementation of REBT.⁶ Anyone considering REBT should be encouraged to embark on this treatment due to very minimal risks.

Criticisms of REBT

Despite its successes, REBT is not immune to criticism.

Some people may complain that REBT:

• Encourages selfishness by having the person reflect on their thoughts. Reality: REBT discourages selfishness by teaching self-acceptance and the benefits of enjoying oneself.
• Is too confrontational. Reality: REBT therapists may seem blunt, but they are not confronting the client. The therapist is confronting and challenging the client’s irrational beliefs that stand in the way of happiness.
• Aims to eliminate emotions. Reality: REBT attempts to limit uncomfortable feelings, but more importantly, it tries to balance feelings and use the discomfort to motivate change.
• Ignores the past. Reality: REBT does place an emphasis on the client’s present experiences, but it recognizes that the past plays an important role in the development of core beliefs and thinking patterns.²

Of course, REBT is not the ideal for every person or every condition, but for many, REBT is an appropriate therapy style to quickly and effectively improve the health and well-being of many.

How Is REBT Different than Other Therapy Techniques?

With so many therapeutic approaches, REBT will appear to overlap with some and be completely unique from others.

REBT vs. CBT

Rather than being different or competing treatment options, REBT is just one of the therapy types that fall under the umbrella of CBT. REBT, developed in the mid and late 1950s, actually predates other forms of CBT. As the branch of therapy developed, CBT absorbed REBT and other similar treatments.¹

REBT therapists generally utilize helpful elements of CBT and other forms of psychotherapy.

REBT vs. DBT

A popular form of psychotherapy frequently used to address depression, suicidality, and personality disorders is called dialectical behavior therapy (DBT).

DBT uses CBT interventions and frameworks to address:

• Emotional regulation
• Mindfulness
• Interpersonal communication
• Distress tolerance⁷

Though DBT has solid roots in the traditions of CBT and REBT, DBT is a more rigid and structured treatment that combines individual and group therapy sessions.

REBT vs. ACT

Acceptance and commitment therapy (ACT) is a more recent form of therapy proven effective in the treatment of mental health conditions like depression and PTSD. ACT strives to have the client accept their state, choose a desirable path, and take action to live a happier life.⁸

Though this form of treatment uses different language, it is strongly associated with the principles of CBT and REBT. A primary difference with ACT is the decision to accept certain aspects of self and the world, rather than trying to change them.

History of Rational Emotive Behavioral Therapy

REBT begins with a psychologist trained in psychoanalysis named Albert Ellis. Ellis became frustrated with the limited improvements of his clients and searched for ways to speed up the process. It was 1957 when Ellis first introduced “rational therapy” as a way to produce better therapy results. Instead of focusing on the client’s unconscious thoughts and past experiences, Ellis shifted the sessions’ focus on the client’s beliefs.⁶

The world of psychotherapy was changing during this era as professionals were moving away from established therapy types like psychoanalysis associated with Freud and behaviorism. Several years later, a psychologist named Aaron Beck introduced a treatment called cognitive therapy, which shared similarities with Ellis’s “rational emotive therapy,” as it was then called.¹

Rational emotive therapy developed alongside cognitive therapy and others to become a significant part of the cognitive behavioral therapy category of psychotherapies. In the 1990s, the therapy formally adopted the rational emotive behavioral therapy (REBT) name to show the importance of changing behaviors.

Albert Ellis died in 2007, but the tradition of REBT continues long after its inception. REBT remains fluid and changes as new research and studies dictate.¹