Veterans risk their physical safety, and that is only the beginning. Many veterans exposed to combat suffer with behavioral health issues as a result of their service. The suffering can be intense. Posttraumatic Stress Disorder (PTSD) may impact as many as 20% of Iraqi war veterans. While it may not seem possible, there is help. PTSD is one of the most intense and debilitating issues one can have, but there is very effective treatment that works very quickly and the results last.
I am Ryan Fuller. I am a clinical psychologist. I have done anger research and I treat a lot of angry clients in New York City. I’ll talk to you a little bit about the top causes of anger. So oftentimes when we’re talking about the causes of anger, we refer to them as anger triggers. And frequently, triggers are the external events, usually other people that, in fact, precede an anger episode.
Frequently, when we talk about anger, we’re really talking about the emotional experience of an anger phenomenon. But with that, there are also certain action tendencies and behaviors that go along with it.
So there are a number of different anger theorists who have talked about different kinds of anger styles. But the one I’ll mention breaks anger styles into three forms of expression. So there is “anger out”; and “anger out” typically looks like the kinds of behavior we see with someone that we consider to have a temper. So they become very angry and then they are going to be doing things like yelling, they may be using profanity, they may smash cell phones or pound their fist on a desk, or something along those lines, destroy property.
What is anger?
Anger is a negative feeling and when it comes in frequencies and intensities and durations that are in the normal range, it can be quite healthy. Unfortunately, when it becomes really intense or really frequent and it is paired with behaviors that are problematic that are aggressive or uncooperative, it can cause big problems and people can run into anger management issues.
Cognitive Behavior Therapy: REBT, The Elegant Solution
Cognitive Behavioral Therapy (CBT) is a term bandied around a lot in news stories or any conversation about therapy. There is a lot of scientific support for its efficacy in treating issues such as Obsessive Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), unipolar depression, anger, and bulimia. But there is still not perfect consensus among researchers, theorists, and clinicians about what exactly CBT is and what it isn’t. While some disagreements are about whether or not cognitive changes or learning principles (behavioral) are responsible for someone with depression feeling less depressed, some of the confusion is simply due to the variety of cognitive behavioral treatments.
Anger and Aggression in the Harsh Winter
Anger management is important year round. I haven’t seen evidence that there has been more aggression or anger outbursts this year because of a harsh winter. But there are good reasons to suspect that could be the case as our nerves become frayed.
Hot temperatures are frequently thought of as putting us at risk for violence. But there is a great deal of scientific evidence that any environmental factor that makes us uncomfortable can lead to aggression. Certainly bitter cold temperatures can do just that.
Anger is often thought to precede aggression, and many times it does. But most of us do not realize that other emotions put us at risk for aggression too. There is ample scientific evidence that any negative emotion, e.g., anxiety, guilt, loneliness, etc. make the likelihood of aggression more likely. So a difficult winter that may lead to less social contact or make us more nervous because of driving conditions could certainly put us at risk for becoming aggressive.
Another predictor of aggression is frustration. In the social science literature frustration occurs when a goal is being blocked or a desired outcome is prevented from occurring. Big snowfalls can lead to just that. People are stuck in their homes or can’t get their cars out their driveways and are prevented from completing all kinds of goals. And it is easy to see how those situations can also lead to more and more negative emotions, putting us at greater risk of becoming aggressive.
Rational-Emotive Behavior Therapy (REBT) was developed by Albert Ellis. Dr. Ellis who was originally trained in psychoanalysis. After completing his doctoral work he began treating patients in New York City. He became frustrated by the limited progress his psychotherapy patients were making in psychoanalysis.
He then decided to turn to one of his earliest interests, philosophy. He went back and read Stoic philosophy as well as eastern philosophy. He based a new system of psychotherapy on much of this work. The hypothesis that made the most sense to him was that our emotional pain is not the product exclusively of the situation, but also our thinking about the situation, ourselves, life, and the future.
From this view of human emotion, he developed the ABC model, which is used by many Cognitive Behavior Therapists (CBT) today. In REBT, “A” stands for activating events. These are the situations, real or imagined, that trigger, or activate, our beliefs. “Bs” are these beliefs, which can be rational (or helpful) or irrational (unhelpful). Over the years the kinds and number of irrational beliefs he identified changed. The most refined version of REBT beliefs includes four core irrational beliefs and four alternative rational beliefs.
Low frustration Tolerance (LFT)
Global Evaluations (Self-downing; SD)
High Frustration Tolerance (HFT)
Unconditional Self-acceptance (USA) or Unconditional Other/Life Acceptance
REBT posits that the combination of activating events (As) and beliefs (Bs) produce consequences or the “Cs.” The situation (A) is interpreted and evaluated (B), which results in an emotional consequence (C). For example, if a student receives a failing grade on her exam (A), and she believes this proves it, “I’m a failure (B).” She might then feel depressed (or depressed and anxious) (C). That particular consequence is an emotional consequence (Ce). When feeling that way, certain behaviors become more likely than others. When we are depressed, staying in bed may become more likely than going to the gym. These are behavioral consequences (Cb).
REBT therapists target behavior change largely by identifying the events, irrational beliefs, and then emotions that precede the behavior they want to change. The most common intervention is to dispute (D) the irrational beliefs, i.e., asking challenging questions to reduce the strength of the irrational belief. Then once the client no longer believes the irrational beliefs as strongly, an alternative rational belief can be selected to rehearse (E; effective new philosophy).
In this case, an REBT therapist may help the client, through disputation, to recognize that even though she may have failed one exam, it does not logically follow that she becomes a failure. It may take a great deal of effort on the part of the therapist and even more on the part of the client to get there. The hope is, she will eventually let go of the belief that she is a failure, and can rehearse and practice behaviors to support the rational alternative. The rational alternative to the global evaluation/self-downing (“I”m a failure”) belief would be unconditional self-acceptance (USA). If she can accept herself unconditionally, regardless of what grades she receives, she can be more emotionally stable. Without the thinking that “I’m a failure” could be looming, the client can become less anxious she will become depressed again. Now if she fails at something, she can practice unconditional self-acceptance, and tell herself, “even though I fail at things, I do not become a failure– I do not become what I do.” This new attitude can inoculate her against self-defeating thoughts that “dog” her. And this new accepting attitude can reduce or prevent feelings of depression or anxiety that she may become depressed again. Without the anxiety she may be able to concentrate more when studying, hopefully decreasing the possibility of failing future exams.
REBT therefore aims to change beliefs in order to reduce not only future negative emotions, thereby making adaptive behaviors, e.g., effective studying, more likely, but also intends to reduce failures. Since intense negative emotions often lead to poor judgement, impulsive actions, or unhealthy coping, e.g., procrastination, drinking, overeating, etc… REBT aims to improve behaviors and life circumstances over time, by first changing thinking and feelings. So while it is a cognitive model of psychotherapy, it by no means ignores improving behaviors and life circumstances. REBT simply believes the closest target to emotion is cognition, and changing that link alters for the better the entire chain reaction, resulting in better behaviors and eventually improved life circumstances.
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A synopsis of rational-emotive behavior therapy (REBT); Fundamental and applied research. David, Daniel; Szentagotai, Aurora; Eva, Kallay; Macavei, Bianca
Journal of Rational-Emotive & Cognitive-Behavior Therapy, Vol 23(3), 2005, 175-221.
Science of Sex
Casual sex has been on the rise for decades. This has been concerning for many reasons.
But, did you know that 75% of casual sexual encounters may lead to a relationship?
Did you know that 45% of men hoped their last casual sex partner had turned into a steady relationship?
Or what about for those suffering from depression, casual sex may improve their mood (although for those with a healthy social life, they may feel worse)?
Ok- these are the positives, and there are clearly some negatives. Regret and shame are two emotional possibilities, and unwanted pregnancies, and sexually transmitted diseases are also serious risks.
But, this article by Pere Estupinyà sheds light on a side of casual sex that may have been overlooked. This is by no means an endorsement, only an example of how science can uncover aspects of a behavior we may not have previously understood.
In this case, more casual sex may not be a good thing. But it does seem evident the studies (and interview) he references indicate a few things in need of further investigation.
To start, it does sound as though many people are looking for steady relationships, even though they may engage in a “casual” encounter without that in mind.
Is this the healthiest and most effective strategy for initiating a long-term relationship? I believe most of us would assume the answer is no, but it is an empirical question. Perhaps it saves time.
Or perhaps there is a breakdown in our current socialization for us to understand what we really desire, e.g., a long-term relationship, and/or we don’t know how to communicate about that, so instead we end up in casual encounters. Perhaps developing greater self-awareness and effective communication skills could reduce casual encounters, while increasing the number of healthy long-term relationships if that is the goal.
In any event, we have a lot to learn (and I hope we do it quickly) about how changes in the media are impacting our sexual and relationship behaviors.
REBT (Rational Emotive Behavior Therapy) Interview can be heard on the link above.
Rational Emotive Behavior Therapy (REBT) and Acceptance and Commitment Therapy (ACT) are compared in terms of how psychotherapy would be conducted. Cognitive Behavior Therapy (CBT) and Behavior Therapy are similar, but are based on different theoretical models. REBT is rooted in a cognitive (CBT) theoretical model, while ACT advocates emphasize models of learning without reliance on cognitive restructuring.
Acceptance and Commitment Therapy (ACT) and Rational Emotive Behavior Therapy (REBT) Transcript
J. Ryan Fuller: Ok, I am Ryan Fuller and I am very pleased to be with Dr. Windy Dryden, the author of well over a 180, soon 200, books on Rational-Emotive Behavior Therapy and many other topics on counseling and psychotherapy. He is currently a professor at Goldsmith College and has a successful private practice and I am pleased to have you in the office tonight.
Windy Dryden: I am pleased to be here.
J. Ryan Fuller: So, we’ll probably cover a variety of topics, but I wanted, in particular, to make sure that we touch on a couple of elements. One, the future of Rational-Emotive Behavior Therapy and perhaps even some reflection on historical changes in the, sort of, evolution of the therapy over time. Also, maybe some comparison between REBT and ACT, which has currently received a lot of scientific attention and clinical attention. So if you would, first, maybe start with the historical and kind of move through in a temporal fashion and obviously through the development of REBT Albert Ellis even changed the name at different times and might have emphasized different things. I was wondering what particular kind of changes that you saw as, sort of, the most important or idiosyncratic that, sort of, differentiate REBT from other therapies.
Windy Dryden: From when were you thinking? J. Ryan Fuller: Really, the beginning, in the mid-50’s when he started off with a much larger number of irrational beliefs and then changing over time, incorporating more of an emphasis on behavior and things like that. Windy Dryden: I think that, the kind of, the major distinctive feature, if you like I think, stayed fairly constant, although I think the way that this particular concept has been put forward and, sort of, modified a little, is the emphasis on a concept known as beliefs. Now, in beliefs, which I think is a very distinctive feature, now, the way I tend to look at it is like this: human beings have a built-in mechanism to either prefer certain things to happen and for other things not to happen. It is, that is a built-in mechanism, which no amount of modification is going to change. Now, when people keep their desires flexible, they end up with an idea that I want something to happen but it doesn’t have to do so vs. they are transforming their want into something, which is rigid, I want something to happen and therefore it does have to do so. It is, I think, one of the defining features and distinctive features of REBT that Albert Ellis really emphasized. In his list, his original list, of irrational beliefs in which, I think, he kind of emphasized more the concept of rigidity, absolutism, and the like later on. In fact, if you look at his original list of irrational beliefs, well, I think he called them irrational ideas in those days, some of them wouldn’t pass muster as irrational beliefs now, more like, sort of, distorted influences. So I think that that particular concept is fairly distinctive and defining to the rational-emotive approach to cognitive-behavioral therapy. And I think one of the things that Ellis had been very good at over the years is that he is showing how his therapy is relevant to the changes of the zeitgeist, in terms of for example, the late 60’s he showed how his ideas could be applied to rational, ….. rather, and he developed rational ideas to how it could be applied to marriage and family counseling. He showed how it could be applied to pastoral counseling and so he’s been very good at showing the application of his ideas. In terms of the development of those ideas, I think that the real, sort of, emphasis towards the end of his days, really, was to show how people could really develop constructivistic ideas, so he really, kind of, tied down his theory out of constructivism. And he had no doubt, if he was alive today, I think he probably did just before he died, show how rationality and the rest of the behavioral approach could be applied to the concept of acceptance. In fact, I think that he and Hank Robb wrote a contribution to Steven Hayes’ edited book on acceptance and change in the 1980’s, I think, or the 1990’s.
J. Ryan Fuller: But before you…let me interrupt for one moment. I definitely want you to flush out the contributions to self-acceptance but you mentioned constructivism and the contributions it can bring. Can you just maybe expand on that a little bit for those listeners who may not be familiar with the idea?
Windy Dryden: Well, the idea is really that we as human beings, we construct various ideas instead of being, sort of, that we are not passive recipients of those ideas, although, I think you can listen to clients, kind of, talk as if they were rather passive in those ideas. Now, Ellis would argue that, although we are born with a tendency, you know, towards constructivism, in his ideas there is a definite emphasis on the idea that we actively develop and construct our, kind of, rigid ideas from the basic, kind of, idea that we want certain things to happen and don’t want certain things to happen. And then we can certainly construct rational ideas, so I don’t really think that necessarily that this was absent in REBT’s, sort of, theory prior to constructivism. But I think he saw that there was a contribution to be made. And he made it and he’s actually written some ideas, some articles on constructivism. So, I think what Ellis was very good at was in terms of propagating his ideas and showing how they could be applied to whatever was hot in terms of the day.
J. Ryan Fuller: So he was rather flexible at least in taking maybe strong beliefs he had about his theory but really, sort of, making them pertinent to what the zeitgeist of the time was.
Windy Dryden: Oh yes, absolutely.
J. Ryan Fuller: Probably made him quite adaptive and successful in the therapy office but maybe also in the larger psychotherapeutic community.
Windy Dryden: Yes, and he would write articles on the application of REBT in terms of whoever was actually kind of popular in the day.
J. Ryan Fuller: Ok. Um, if we could… I cut you off and kind of sidetracked you when you were speaking about acceptance and how he’d contributed with Hank Robb, I think, to an edited book by Steven Hayes in the 80’s.
Windy Dryden: Right. I think that certainly the thinking within the REBT community has moved on and certainly I think that the acceptance is not only applied to oneself and when it’s done that, it’s based on a certain view of human beings, which are factual. The fact, which I don’t think anybody could really deny, is (1), that we as human beings are fallible, and you can’t really dispute that. (2), that we are too complicated, too complex to be given a single rating that completely defines us. Can’t argue with that. (3), that we are in flux and we constantly change. You can’t deny that.
J. Ryan Fuller: You can’t deny that, is that what you said? Windy Dryden: You can’t deny that. I mean, I, you know, in somebody who is, you know, sort of, just kind of artificially alive is probably going to change in some, losing a few, kind of, you know, aspects of skin, their cells are changing. You know, we are constantly in flux. Finally, the idea that we are unique. Even if, you know, you were cloned, your clone would be different from you because even if you carried your clone around with you on your left hand-side, your clone would still see the world from a slightly different angle than you. That would have some sort of impact on your clothes. And so that’s a completely interesting idea to Ryan Fuller. So those, now, that idea that we can accept ourselves as that, is a difficult idea for quite a lot of clients to … ,really to, what is the easy word, accept and kind of digest. Because we, in a sense, it’s basically saying, “do not give yourself a rating to completely and utterly account for you”. Certainly rate aspects of yourself, evaluate what happens to you, but don’t, kind of, jump to an evaluation, a total evaluation of yourself. Do not do that towards others, and do not do that in terms of the world or life conditions in general. Now, I see that these are concepts like self-actualization, that nobody is going to be able to do that perfectly but it is just something to strive towards. And it’s mainly, kind of, a strive towards because not only is that a factual statement and probably a logical conclusion based on experiences, but also that it will have a particular impact on our psychological, emotional health. So, acceptance can be applied as an attitude, as a stance, as a position. J. Ryan Fuller: In a way, it’s a process, you’re saying, without end.
Windy Dryden: Without end. J. Ryan Fuller: So it’s not achieved… Windy Dryden: No, it’s not achieved once and for all. In a sense you can never say you’ve cleaned your teeth once and for all and now you are perfectly clean and do not have to be cleaned. They involve some maintenance.
J. Ryan Fuller: Right. You don’t achieve hygiene, rather, it’s something you do on a regular basis. Windy Dryden: That’s right. You can’t achieve it once and for all. You can achieve a certain level of hygiene, but you have to maintain it. And I think that that is the same as what is the concept of acceptance, if you like, as a philosophy towards the self, other people and the world. Now, what I am particularly interested in is the kind of relationship between ACT, Acceptance and Commitment Therapy, which is, kind of, you know, stems from a radical behavioral view. I think, to kind of cut to the chase here, its view is, you know, there is no real value to be gained in challenging and examining cognitions. J. Ryan Fuller: The content, to change the frequency necessarily or the duration…
Windy Dryden: That’s right. Don’t change the content. So you acknowledge that this particular thought is happening, then you actually commit yourself to whatever it is that is important to you. J. Ryan Fuller: I am going to engage in some kind of behavior to some degree independent of the content of the thought or thoughts that I might be experiencing and hopefully that behavior is in line with what is important to me, that I value. Windy Dryden: Exactly. Now I think that that is a good approach under certain conditions within the Rational Emotive Behavior Therapy process. And I particularly think that this is a good way of approaching things according to the following idea. If we go back to the ABCs of REBT where A stands for, let’s say, adversity (I think this is what we call it these days), an activating event, some negative event, some adversity. B stands for the belief system. And C, the consequences of holding this belief system of the adversity. Now, there are three main consequences, which are interrelated. The emotion consequence, we experience a feeling, when we have a tendency to fail or when we encounter an adversity and we hold either a rational or an irrational belief of that adversity. We also experience a behavioral consequence, or a tendency to act in a certain way. I am using act in the behavioral sense, not ACT as in Acceptance and Commitment Therapy sense. So when we hold again either a rational or irrational belief of an adversity, we behave in a certain way or we tend to behave in a certain way, which we can suppress. That’s one of the beauty of things of human beings, we can, actually, convert out urges to act to actions or, kind of, not act on them or we can suppress them. J. Ryan Fuller: Can you just flush that last piece out? We can convert our urges to actions, meaning I can behave while I am experiencing the urge and then the urge dissipates? When you say conversion….
Windy Dryden: No, I can act on the urge. If I have the urge to punch you in the face, which I don’t because we’re good friends, but that’s idea – we can either choose to act on the urge and actually punch you in the face, or I can choose not to act on that urge.
J. Ryan Fuller: So an urge, if we take a behavioral standpoint, is a stimulus, right? So there is this discriminative stimulus and I might with free will, or depending on our philosophical take, behave in one or another way.
Windy Dryden: Yeah. But the beliefs about the adversity will actually pull me in a certain behavioral way. One of the things that I’ve tried to do is to bring this… Before I go there let me finish the, kind of, final piece of the jigsaw. The final piece of the jigsaw is that when we experience a belief, either rational or irrational, about the adversity, that affects how we subsequently think.
J. Ryan Fuller: So the thoughts that might follow after the A and the B and temporarily there is a consequence that’s that thought, and maybe it’s more metaphorical in terms of the order but there are thoughts that come about the consequence.
Windy Dryden: Yes, and these thoughts, because they have been processed by our beliefs, they are kind of like you often call it “under the influence” of a certain belief. Let’s suppose that you, under the influence of an irrational belief, tend to think irrationally about a certain adversity. And that, you subsequent thinking will tend to be highly distorted, skewed to the negative.
J. Ryan Fuller: So there is selective abstraction taking place, we’re sort of filtering and priming.
Windy Dryden: That’s right. And I see that’s the REBT view, which Albert Ellis and I wrote to make that point in our book the Practice of Rational Emotive Behavior Therapy in the late 1980’s as a matter of fact. I couldn’t see it at that time, he saw it, the importance of what we were saying. And that is, you know, the cognitive distortions that Aaron Beck and David Burns talked about in the beginning, are really, a lot of them are cognitive consequences of irrational beliefs. So it actually kind of helps therapists to some degree with some clients who can use this framework, this somewhat complex framework to understand how their mind works.
J. Ryan Fuller: If we could, maybe, it might help some of us to understand if we, in fact, plugged in some content in an A, a B, an emotional consequence, a behavioral consequence, and then the thoughts, the cognitive consequences.
Windy Dryden: A common example, for example, is somebody who has public speaking anxiety and they become anxious about a certain threat. And the threat might be that “my mind might go blank”. It is a common fear that people have when they are in public speaking or, you know, about to speak. Now, that would be regarded as the A, that they would predict that their mind is going to go blank. Then they would evaluate that or bring their beliefs to that and their beliefs are either “my mind must not go blank”, “it would be terrible if my mind went blank”, or “look, I really don’t want my mind to go blank but if it does, I am not immune from it and I don’t have to be immune, and it would be pretty uncomfortable but it would not be the end of the world”. So if you have an irrational belief and you think that your mind will go blank, and that sort of threat becomes active, therefore your beliefs become active, you will then tend to think various things like, “If my mind goes blank, everybody will notice, I will develop a bad reputation, it will affect my job, I might lose my job, and I might not get another one”. Ok? You can see how that is much more distorted in character than the prior inference “my mind might go blank”, which is a possibility but the person who actually probably sees it as a high probability. Now, the REBT therapist would, kind of, do it differently than a cognitive therapist. Initially, you would say, “well, let’s assume it does”, so you can gain access to their beliefs, and do work on their beliefs.
J. Ryan Fuller: So rather than challenging the inference, for example, an REBT therapist might emphasize, “let’s assume the worst case scenario”…
Windy Dryden: “Let’s assume your mind is going to go blank, what can you do, you know, to minimize that, etc. etc.” We would tend not to do that initially.
J. Ryan Fuller: Let me just make sure we make that clear. So, and by doing that with the A, by sort of saying, “let’s imagine my mind does go blank”, the emphasis is going to be placed on the B, the belief about that possibility.
Windy Dryden: If you have…it’s theory consistency…if you have an idea in your theory, a main concept, that people’s emotional, behavioral, cognitive response to adversity is mediated largely by these beliefs, and your disturbance is mediated by irrational beliefs, it’s important to get at those beliefs.
J. Ryan Fuller: So the focus is going to be placed on the belief, not necessarily trying to convince someone that their expectations might be unrealistic to reduce the probability, the likelihood that I think some activating event is going to occur even when the probability I might be using might be overinflated. And by targeting the B, there is going to be a greater…we’re going to be able to generalize it across different activating events and therefore a more elegant solution is Ellis’.
Windy Dryden: Yes, although, you know, that will come later because people like to generalize in it too quickly, before they actually kind of worked through, you know, whatever is that they are disturbing themselves about but a particular situation. Now, if you take these consequences, that we are talking about, you know, these very very negative consequences, and this is the bit I want to emphasize in terms of how REBT can use the ACT idea, when you helped somebody to challenge their ideas, their beliefs rather, irrational beliefs about their mind going blank, particularly when they are approaching the situation, then there it’s a bit like going to the gym. You know, you don’t expect to go to the gym, have a workout, and be thoroughly fit. You go to the gym to, kind of, put in investment, if you like, toward your physical fitness. So, when you encourage the client to challenge their irrational beliefs, it’s the same thing. You don’t hopefully as the therapist think that therefore they are going to believe that and all these consequences are going to change. So, I see what happens is, I think that when a client is rehearsing a rational belief, which still needs to be acquired more, and they are in a situation, which, you know, that they find threatening, they are still going to have these distorted cognitive consequences at sea. They are still going to…part of them, part of their mind is still going think, “you know, even though I am practicing saying to myself, it’s not terrible to have my mind go blank, I am still having these thoughts, you know, that if other people notice, it will ruin my career”. Now, if you help people understand the status of these thoughts, that they are, in a sense understandable, somewhat habitual, because you have been practicing that way; thoughts which are still the, kind of, still stem from irrational beliefs which they have been rehearsing for the rest of eternity, they are still going to be somewhat activated. You can learn to not engage with those thoughts, you can learn, in a sense, to accept them. You can learn, because they are these consequences of these irrational beliefs, you can learn to accept them and this is where the bit that I say it’s important that you don’t suppress them, that you don’t distract yourself from them, nor do you engage with them.
J. Ryan Fuller: Meaning, to try to dispute a cognitive distortion that at this point is in the consequence column.
Windy Dryden: You may, kind of, want to challenge it once, but don’t expect it to, kind of, disappear. It’s still going to be active.
J. Ryan Fuller: So if I continue to dispute with it, in your term engage with it, that, in fact, might be dysfunctional to pursue.
Windy Dryden: Right, it’s like an itch. You know, one of the things is, if you tried to ignore it, you are not going to be able to. If you scratch the itch, you are going to make it worse. So, it’s like an itch. You, kind of, recognize the itch is there, and you kind of say, “ok, the itch is there, I know what this itch means, and I know what I need to do. I am tempted to, kind of, get rid of it, tempted to scratch it but I know what it is, so I am going to get on with whatever is I would be getting on if this itch wasn’t there. So I think that dealing with cognitive consequences, after perhaps an initial challenge, of both the irrational belief and the cognitive consequence itself, it would be a mistake to try to re-engage with it, because you re-engage with it, you are more likely to, kind of, re-activate the irrational belief. So, you accept in and in doing that you’ve actually moved forward.
J. Ryan Fuller: If I can, let me just, kind of, repeat that back to you to make sure I have a grasp of this. So, the concept is, from a primarily REBT standpoint, we have this activating event – “perhaps my mind will be going blank”, this expectancy, we’re not going to challenge that, rather we are going to see the belief that follows that, which may be something like a demand, like, “my mind shouldn’t go blank” with some derivative like, “and it would be awful it that were to occur”. The emotional consequence might be anxiety, my behavior may be procrastination and preparing or avoidance altogether…
Windy Dryden: Or over-preparing.
J. Ryan Fuller: Right. And the cognitive consequence might be some kind of cognitive distortion about, “and then I would lose my job and wouldn’t be able to have friends and colleagues, etc. etc.” So, that’s the way it’s laid out and then what you suggested, which is a bit of a change to some degree from the way REBT has been practiced by many people, is with that cognitive consequence I will dispute it once, but after that, regardless of what happens to my conviction about that one particular thought being true, I will then instead not distract myself, not engage it further, but rather accept it. As if it’s a secondary disturbance, that it becomes another…
Windy Dryden: Yeah. Now, I think there is a difference in that, because in a sense what I am trying to do actually with my clients and most of my trainees, is to help them, in a way, not take an accepting attitude towards ‘awfuls’. It’s learning which thoughts to engage with when and which thoughts not to engage with.
J. Ryan Fuller: So from my standpoint that’s, kind of, always the crucial aspect here, which is the serenity prayer, to have the wisdom to know what can be changed and what can’t and to discriminate. And so there may be some beliefs or thoughts with a level of conviction that is always going to show up in some form. The irrational belief, even if there is a high degree of conviction about a rational alternative, has never been erased or terminally suppressed; but rather it may not be the dominant response anymore.
Windy Dryden: Right. Exactly. So, what I am trying to do is, kind of, really, show that yes, I still want people to challenge their beliefs. I think you can overchallenge beliefs and I think people who are particularly obsessive-compulsive in mind overchallenge beliefs, and I think the risk there is you actually increase people’s tendency to ruminate. They ought to think that because they still have this belief, and some of the consequences that are going to happen if it’s still activated, they haven’t challenged it enough, that they have to smash it to smitherings, it has no effect on them whatsoever. And I think that people who do that actually keep their beliefs alive because they feel like they are helping them to…
J. Ryan Fuller: Reactivating them?
Windy Dryden: For example, I saw a client once and she had seen a cognitive therapist. And I did explain that I may be approaching things a little differently and that was fine by her. And she said, “Would you like to see the work that I have done with my cognitive therapist?” I said, “Yeah, that’s always good to see”. And then she turns up in my office with about, you know, two feet of self-help forms, daily records of dysfunctional thought forms. She didn’t like application but it was based on that idea that I have got to get rid of these thoughts and these beliefs.
J. Ryan Fuller: So, the conviction needs to come down or there needs to be a more general response, or perhaps even that my behavior improves…
Windy Dryden: Right. Because, you know, I think that we would all, you know, kind of, however important we are in terms of seeing the impact of cognition is that without behavioral change, as I put in many years ago, we have cognition without ignition. It’s the ignition of the behavior, which really makes the change process, you know, go hand in hand. So, the idea is that you, kind of, help people to act in ways consistent with their rational beliefs, but while kind of accepting the existence of these cognitive consequences in their mind until they go, until they fade away. And if you…
J. Ryan Fuller: And even if they don’t fade away…
Windy Dryden: And if they don’t fade away, you still, kind of, you know…
J. Ryan Fuller: I mean, I think that’s something that (1) bridges the gap between REBT and ACT, but to me it seems more the matter of, sort of, style or clinical judgment, and I think people can practice REBT and really determine which irrational beliefs are worthwhile to dispute, regardless of whether you think cognitive restructuring is taking place or not, the notion is, if it isn’t tied to a behavioral target, there may not be any reason in the first place to go after it.
Windy Dryden: That’s right. So, that’s really how I have attempted to, sort of, marry some of the continuity developments in terms of ACT with REBT.
J. Ryan Fuller: Well, that sounds quite similar. And if I can just, you know, we sort of recapped before, putting it in the REBT framework, in the ABC with the cognitive consequence coming. And then you could see how that, to some degree, is a form of secondary disturbance from an REBT perspective, where the consequence of the first chain becomes the activating event of the second. And I mean, what you described, to some degree, is the acceptance of this consequence. That, of course, sounds very very similar to the ACT concept of defusion, where we, sort of, one would allow the thought to be there. And as someone from the Zen school might examine it with openness and maybe a curiosity about judgment and evaluation and not continue to re-engage it, nor try to suppress or distract from it.
Windy Dryden: Right.
J. Ryan Fuller: Is there an upside to challenging that first time? You sort of mentioned engaging it one time.
Windy Dryden: Yes, because in a sense, we still want people to, sort of, see that, for example, like, ok, how do I know that this is going to…, you know, what the chances are that this is going to affect, you know, my whole career. You even might actually help them to see, you know, the label the kind of cognitive distortion as some of the cognitive therapists do. This is clearly what they might call catastrophizing, I don’t know, or …I don’t know. What is that particular cognitive distortion, where you kind of…?
J. Ryan Fuller: Magnifying?
Windy Dryden: Magnifying, right. So might say, “I am clearly magnifying, the chances are that I won’t do it.” Now, of course, people who have irrational beliefs about uncertainty, this is not going to be good enough, because they will say, “Not good enough. I have got to make this sure” and back they go, you see. So, with those people in particular you might just want to say, “You know, just bear in mind, though, what you’re trying to do”. This is what I say, “Let my help you see how your mind works from a rational-emotive behavior therapy point of view”. It is still, I think, worthwhile encouraging people to actually get in that practice, that once a day or once in a while practice because you’re trying to nurture a skill. And the skill is helping people to see that, you know, this is a highly distorted conclusion.
J. Ryan Fuller: I don’t have to take this piece of data as true, I can first check it out. That doesn’t necessarily mean it’s going to go away…
Windy Dryden: Right. What I want to avoid is people getting caught up with that so that they actually re-engage with the irrational belief that underpins it.
J. Ryan Fuller: So, I am assuming by doing that, from your standpoint, (1) they might be re-activating and, sort of, deepening the groove in the irrational belief, and (2) they are spending time and energy engaging with this thought as opposed to engaging in, sort of, a behavior that’s helping them.
Windy Dryden: Yeah. I think that, really, one of the things that has affected my thinking is all the research done on different types of rumination, depressive rumination, angry rumination, anxious rumination, worry. So, in a sense, the real danger is, you know, like in the Steven Hayes book, ‘Get Out of Your Head and Into Your Life’.
J. Ryan Fuller: Get Out of Your Mind and Into Your Life. Windy Dryden: Yeah, I like that idea. But there are times, of course, in your life when you want to get into your mind, so…
J. Ryan Fuller: The mind, obviously, is going to have benefits in planning and things but there may be times when it is …
Windy Dryden: Yeah, so what I am trying to do is to create an REBT based on the old idea of golden pole, which is under which conditions, which techniques are effective with which kind of patients. You know, under which conditions do you encourage people to challenge their beliefs and under which conditions do you, kind of, let them defuse from their beliefs, if you like, or accept them. And to what extent, you know, do you encourage them to, kind of, act behaviorally along the line. So, it’s, in a way, I am trying to, kind of, draw upon different developments in the, kind of, so-called ‘third wave’ approaches to cognitive psychotherapy. But, still very much maintain and preserve Albert Ellis’ basic message. I don’t think anything I said today, you know, contradicts that. It may make it a little bit more sophisticated but it doesn’t go against Albert’s basic message. And you know, strange as it may seem, I am probably more Albert Ellis in that than Albert Ellis, in my focus on really if we take, kind of, the rational belief alternative to a demand or a must and it’s so important that the client gets clear that it’s not only desire that they have but it’s important to negate that must. So, “I want to do well at this task but I don’t have to do so”. It’s the ‘but I don’t have to do so’, which really is, I think, what I emphasize. I think I have emphasized it more than Ellis in his right. If you look at his new book with his wife, Debbie Joffe Ellis, which I think is a good book, but he is not, or they are not, when they, kind of, go over their ‘musts’ or their alternatives to the ‘musts’, they are not good at actually specifying, spelling out the…
J. Ryan Fuller: The negation of the demand.
Windy Dryden: The negation of the demand. You see, so, in a way, I just want to make the point, I am still very much a core REBT-er in my theorizing and recognizing that, you know, the importance of the ‘musts’. But it is… ,I think you need to be a bit more sophisticated at times.
J. Ryan Fuller: At least it seems like discriminating the inflexible, keeping in mind what the overall goal of the process is.
Windy Dryden: Yes, exactly. In other words, we don’t want to create the idea that …
J. Ryan Fuller: That I must get rid of every single ‘must’. Windy Dryden: Totally, that’s an irrational belief in and of itself.
J. Ryan Fuller: Ok, well I have to say that, (1) we touched on a number of things that I’d like to possibly pick up with you in another conversation regarding some other differences, I think, between ACT and REBT having to do with, sort of, the mechanisms involved and how these changes take place, but I don’t think we have time now. But just to recap, it sounds like as though you are saying, there are quite a few similarities. And when I heard you earlier speaking about how this is a process, that sounded very much along the lines of what Steven Hayes and other ACT authors have talked about in terms of values, that sort of, something that provides direction that is important to me but something that doesn’t have, sort of, a fixed endpoint. And along that process there are going to be behaviors or goals that we are moving towards. And that some of the differences may be about the emphasis on the, sort of, sophisticated switch your are making in terms of the cognitive consequence being something that perhaps we can acknowledge and accept without trying to get rid of it. But that there are these, sort of, overlapping congruent pieces between the two theories.
Windy Dryden: Exactly, yeah. J. Ryan Fuller: Well, thank you very much, Windy Dryden. We appreciate you coming in and sharing your ideas. I wanted to just follow up with one quick mention. I think you had mentioned that there was a new book you have coming out and I didn’t know if you were actually able to mention this shift and how you’re tackling the cognitive consequence or if it’s that something we can look forward to in a future book.
Windy Dryden: Well, I’ve got, I mean, I always have a book coming out, that’s my addiction, you know. But I think that one place that people can actually get a hold of these particular ideas, in terms of how I have talked about them in practice, is I’ve got coming out in September two linked books. One is called ‘Dealing with Emotional Problems’ in what I call Rational-Emotive Cognitive Therapy, a clients’ guide and there’s a linked practitioners’ guide. And I certainly show how you can actually, kind of, deal with that particularly in certain emotional disorders. J. Ryan Fuller: So, clinicians can learn and clients alike how possible to deal with the cognitive consequences a little differently.
Windy Dryden: Yes, with just a little bit of how I have done this. I have written a clients’ guide and in the practitioners’ guide the clients’ guide is reproduced but in a different typeface, a heavier typeface. I show clinicians how you can apply these with clients and then, kind of, the main obstacles that can crop up at different junctures. So, that’s a sort of, kind of, fairly, like if you look at ‘Mind over Mood’, which is a very very popular and well-written and well-received book, and there is a clinicians’ guide. They approach it very differently. What I am trying to do here is, kind of, the practitioners’ is on the same page as the client but they’ve got some extra, sort of, guidelines to help them to deal with that. And one of the guidelines is how you can deal with these cognitive consequences in different emotional disorders so that the client doesn’t get re-activated, caught up in them.
J. Ryan Fuller: Great. Well, I think listeners will really benefit from getting that kind of guidance because I think as you have mentioned one of the things that really distinguishes how effective a therapy session can be, is sort of the art and sophistication of when and how to intervene with what tool with any particular client. And I think it’s something that many books can’t quite communicate.
Windy Dryden: And also, I think, the more that we can, if you like, help people to understand how their mind works, as I like to call it, what’s now called mentalization, partly, as well as how other people’s minds work, that they can actually learn to become their own therapist. And themselves know when to, kind of, challenge which thought and when not to challenge thoughts.
J. Ryan Fuller: So helping them become their own sophisticated therapist so they can be independent and autonomous.
Windy Dryden: Yes.
J. Ryan Fuller: Great. Thank you very much for coming in.
Windy Dryden: My pleasure.
Positive thinking is typical in our New Year’s Resolutions. Resolutions aren’t the only reason to change habits, but if they motivate you, great. The Scientific American magazine article (link below) is a short four paragraph summary of a study published a few years ago that might be relevant. The Northwestern University study demonstrated that a certain kind of belief (cognition), restraint bias, may put those with bad habits or addiction at risk.
The study may also have raised the possibility that it is fairly easy to influence this belief in research participants.
Smokers were randomly assigned to two groups, both of which took a self-control test. But one half was randomly told they had low self-control and the other half was told they had high self-control. Therefore, some of these individuals would have unrealistic positive thinking, i.e., his/her self-control is really low, but he/she was told it was high.
Then they watched a movie that included smoking. They were offered a choice to be paid to resist smoking during the film by keeping an unlit cigarette in their mouths, their hands, or on a desk in another room. The cash rewards were higher for the greater level of temptation.
Those smokers told they had high self-control were much more likely to take higher levels of temptation. But they ended up being more likely to light up and smoke during the film.
It appears that overestimating one’s level of self-control could lead to putting oneself at greater risk of temptation only to end up giving in to a habit one may be trying to resist. Having accurate beliefs about our capacities can be really important in behavior change. In this case, even positive thoughts, which are inaccurate or irrational, can be harmful. So telling ourselves positive things is not always good advice.
#habits #positivethinking #smoking