Rational Emotive Behavior Therapy (REBT) for Addiction Treatment
Rational Emotive Behavioral Therapy (REBT) is a therapeutic approach that is sometimes used in addiction treatment. It is based on the simple idea that it’s not external events that make individuals happy or unhappy but rather their internal thoughts about events or themselves.1
What is Rational Emotive Behavior Therapy (REBT)
REBT shares some similarities with cognitive-behavioral therapy (CBT), but the two therapies are not the same. One of the primary differences between REBT and CBT is that REBT places a strong emphasis on beliefs (including irrational beliefs) and how these influence an individual’s thoughts, feelings, actions, and reactions; whereas CBT focuses on challenging cognitive distortions to mitigate maladaptive behaviors. REBT also focuses on secondary beliefs, including anti-awfulizing, high frustration tolerance, and self or radical acceptance.2
However, similar to CBT, REBT’s cornerstone is the philosophy that beliefs surrounding an event influence your emotions or feelings, which, in turn, drives the way someone reacts and behaves.2
REBT for Substance Use Disorder Treatment
Behavioral therapies are the most commonly used substance use treatment modality. Behavioral therapy can be delivered in individual, group, or family therapy settings and helps the individual build healthy coping mechanisms, recognize maladaptive thinking and triggers, and maintain recovery.3
Treatment providers sometimes use REBT to help a variety of mental health conditions, including addiction.4 There are few empirical research studies that specifically address the efficacy of REBT within substance use disorder (SUD) treatment.5 However, studies have found that participants introduced to one form of REBT, known as rational emotive health therapy (REHT), during alcohol use disorder (AUD) treatment exhibited a significant reduction in their alcohol use frequency.4
These results were consistent with previous studies, which demonstrate that exposure to the REBT model of treatment resulted in a reduction of psychological and behavioral disruptions.4
REHT was developed to cater to the needs of people affected by alcohol and addiction. REHT was found to help people decrease their thoughts and feelings surrounding alcohol use. Within the study, there was evidence that REHT helped participants reduce their alcohol use.4
Effectiveness of REBT
More research is needed to determine the overall effectiveness of REBT for the treatment of addiction, but there is some evidence that REBT may be helpful for individuals with co-occurring mental health disorders like anxiety or depression.2,5
A meta-analysis found that REBT had moderate to strong outcomes for a variety of psychological conditions, including symptoms of anger, distress, anxiety, and depression, which may support REBT’s usefulness in treating a range of mental health conditions.5
One study examined the effectiveness of REBT changing the irrational beliefs to address comorbid depression and anxiety among post-9/11 Veterans with post-traumatic stress disorder (PTSD) and found that after 5 sessions of REBT, Veterans demonstrated a significant reduction at post treatment in depression and PTSD symptoms.6
And a meta-analysis of 111 studies measuring the impact of REBT on mental health issues, including anxiety and depression, found that two-thirds of the studies reported significant improvements on mental health from pre- to post-intervention.7
Benefits of Rational Emotive Behavior Therapy
REBT has undergone some empirical studies to evaluate its efficacy as a therapy model when used to treat different populations and mental health concerns.5 One meta-analysis suggests that REBT is equally effective as other psychological interventions or pharmacotherapy when used with clinical participants.8 A few benefits of REBT include:2,5,9
- Targeting behaviors and conditions motivated by irrational beliefs, including anger, guilt, and shame.
- Demonstrating positive effect on school performance in some patients.
- Enhancing and supporting mechanisms for change.
- Confronting secondary emotional disturbances.
- Serving as preparation for exposure therapies in some clients.
What Other Conditions is REBT Used to Treat?
The focus of REBT on irrational beliefs has been used in substance use treatment.4 In treatment of AUD, the focus of irrational beliefs around one’s drinking behavior is evaluated using REBT.9 More studies on the efficacy of REBT in substance use treatment are needed to determine the effectiveness of this therapy model on AUD, SUDs, and other mental health conditions, though as previously mentioned, there has been evidence to suggest that REBT is effective in the treatment of co-occurring disorders.
REBT is used to treat or aid in the treatment of mental health concerns associated with irrational beliefs, including.2,5,9
- Obsessive-compulsive behavior.
- Social and other phobias.
- Depression and depressive symptoms.
- Anxiety.
- Anger, guilt, and shame.
- Psychotic symptoms.
- Disruptive behavior.
The ABC Model of REBT
So how exactly does REBT work to treat addiction and other mental health conditions? The ABC framework is the core of REBT model, and it helps therapists assess and reframe irrational beliefs in clients. Reactions addressed in the ABC model might be either healthy or unhealthy.8
The key concepts of the ABC model in REBT include:2,8
A- Activating event. Adversity or an event is represented by the letter A. According to the ABC model, the activating event is not what causes someone to feel or react in a certain way. Instead, someone’s beliefs and inner dialogue cause them to feel, act, and react in either a healthy or unhealthy manner.
B- Beliefs. REBT focuses on reframing irrational beliefs. The letter B represents one’s beliefs around the situation (or A, the activating event). In this model, it’s assumed that someone prescribes meaning to events (A) through their belief systems and inner dialogue.
C- Consequence. The term “consequence” is used to explain a person’s emotional or behavioral reaction to (A) the activating event. Cs might include emotional responses, such as sadness, anxiety, or anger. Or, Cs might include behaviors such as doing something repeatedly or acting angrily.
Other Models of REBT
Returning to the traditional ABC model, psychologists determined that additional components should be added to the ABC framework in an attempt to explain the complexities that may occur with patients.8 These include:8
- D- Dispute. Following the I consequence, the person attempts to determine, differentiate, and dispute their irrational belief.
- E- Effects. The effect refers to the outcome of using a more rational thinking style.
- F- New feeling. There are several different meanings for (F), including force and functional consequence. The new feeling indicates that the participant will utilize their experience and new emotional and behavioral beliefs towards a new situation (A).
REBT Examples for Substance Use Disorder
As previously mentioned, the backbone of REBT is the ABC model.2 REBT therapists will likely use iterations of the ABC model to help treat irrational thoughts and beliefs in individuals, while making individualized adjustments when fit.8 Below is a substance use-focused example of the ABC model:
A- Activating event: You are working on your sobriety but walk past your familiar bar on the way home from work. You can hear your old friends chatting, and the smell of the bar lingers slowly out of the cracked door.
B- Beliefs: Irrational beliefs might be, “I’ll never maintain my sobriety,” “I’ll never not have a drink again,” or “I’m such a failure for wanting a drink.”
C- Consequence: Walking past the bar may be a triggering event for irrational thoughts, leading you to emotional behavior. Such behaviors might include going into the bar to have a drink or getting angry and yelling at your partner.
Continuing with the expanded model of ABC may include the following:
D- Dispute: You determine your irrational belief is “I’m a failure,” and you’re able to separate your feelings of failure from your choice to maintain your abstinence. You can dispute the irrational belief of “I’m a failure” by looking at the supporting facts: You have not broken your abstinence, recovery is a lifetime process, and it’s normal to grieve.
E- Effects: Recognizing that your irrational belief might drive a negative behavior, you instead call your sponsor and continue on your way home. Who knows? Maybe you’ll even have time to catch that 6 p.m. meeting.
F- New feeling: You feel proud of yourself and how you handled the situation. Now when walking by the bar, you feel empowered to continue along your way.
Finding Therapy That Works for You
If you or a loved one struggle with substance use and addiction, American Addiction Centers (AAC) can help. AAC operates treatment centers throughout the country; offers the complete continuum of care and evidence-based therapies, which may include components of REBT and other behavioral therapies; and provides co-occurring disorder treatment. Call to connect with a compassionate and knowledgeable admissions navigator, who can listen to your needs, answer your questions, explain your options, verify your insurance, and help you with the admissions process so you can begin your recovery journey.
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