Cognitive Therapy and Rational Emotive Behavior Therapy: Similarities and Differences Helga El Mokdad CBT/REBT Diploma Cognitive Therapy and Rational Emotive Behavior Therapy: Similarities and Differences Cognitive Behavioral Therapy (CBT) is a broad term that encompasses several types of psychotherapies including Cognitive Therapy and Rational Emotive Behavior Therapy. Although both of these psychotherapies are considered talking therapies and are under the same school of thought, cognitive behavioral therapy, there are many similarities and differences between them. Cognitive Therapy was developed by Aaron Beck whereas Rational Emotive Behavior Therapy was developed by another prominent pioneer of CBT, Albert Ellis. The following paper will compare these two types of psychotherapies in an attempt to better understand the similarities and differences theoretically and practically. Rational Emotive Behavior Therapy (REBT) is considered to be one of the first cognitive behavioral approaches that was developed by Albert Ellis in 1955. The basic principle of REBT is that of emotional responsibility. This principle of emotional responsibility states that individuals are held responsible for their emotions because it is the way they interpret events and situations that creates their psychological problems. Moreover, according to REBT, cognitions, behaviors and emotions interact in a complex manner and have a reciprocal cause-and-effect relationship. Thus, while one would think that interpretations of events may lead to thoughts which eventually lead to emotions and behaviors, the interaction is not as simple as that. REBT is based on a simple model which is called the ABC model. In this model, A is the activating event, B is the belief about the event, and C is the consequence. Basically, the model states that it is not the activating event that causes the emotions, thoughts, behaviors, action tendencies, and physical symptoms at C, but rather it is the belief about the event that results in the consequence. Therefore, REBT emphasizes the concept of beliefs, which are the interpretations and evaluations we give to certain life situations. These beliefs can be either rational or irrational. Rational beliefs are those that are flexible, realistic, logical and practical in that they help individuals move towards their goals. On the other hand, irrational beliefs are considered to be rigid, illogical and unrealistic and they impair individuals and impede them from moving towards their goals. REBT therefore teaches clients about the differences between rational and irrational beliefs and helps them identify and dispute the irrational beliefs that have been selfindoctrinated and acquired over time in order to replace them with the more rational beliefs. However, these rational and irrational beliefs do not exist by themselves, as there are derivatives from these beliefs as well. For instance, the irrational belief, which is usually based on a rigid “must”, “should” or “ought to”, has three derivatives including awfulizing, low-frustration tolerance, and self, other or world-damning. Rational beliefs on the other hand are represented by preferences and have three derivative as well which include anti-awfulizing, high-frustration tolerance, and self or other acceptance. Thus, by helping clients identify and dispute the irrational beliefs and replace them with the more flexible rational ones, clients can change their emotional reactions to situations and therefore develop healthy negative emotions, rather than unhealthy negative emotions from irrational beliefs. The difference between healthy negative emotions and unhealthy negative emotions is also emphasized in REBT, as an irrational belief leads to an unhealthy negative emotion whereas a rational belief leads to a healthy negative emotion. The goal therefore is to replace the irrational belief with the rational one in order to replace the unhealthy negative emotion with a healthy negative emotion. Thus, therapy in REBT is seen as an educational process in which the therapist teaches the client how to identify and dispute irrational beliefs, and the focus in therapy is on thinking and acting rather than expressing emotions. The therapist also collaborates with the client on assigning homework in between the therapy sessions and teaches the client certain strategies for rational thinking which the client can learn to use and practice in everyday life. While Albert Ellis was developing Rational Emotive Behavior Therapy, Aaron Beck was also developing his approach known as Cognitive Therapy at about the same time, but both were developing their approaches separately and independently. Cognitive therapy holds the premise that psychological problems stem from several common processes which include a faulty way of thinking, making incorrect inferences, and failing to differentiate between what is real and what is not. In cognitive therapy, Beck uses the term cognitive distortions to refer to the faulty thinking patterns individuals engage in. Thus, the feelings and behaviors of individuals are determined by how they perceive and structure their experiences. In other words, cognitive therapy emphasizes the importance of focusing on the cognitive content during an individual’s reaction to a certain negative life event or to a certain line of thoughts that the individual is experiencing. By focusing on the thoughts and behaviors and changing them, an individual can change his or her emotions. Cognitive Therapy is based on a cognitive model which includes three levels: the core belief, the intermediate thought and the automatic thoughts. Core beliefs are the ultimate underlying beliefs that individuals hold and that have been indoctrinated and deeply held. These core beliefs lead to intermediate thoughts, which in turn when an individual experiences a certain life event, they generate what we call automatic thoughts. Automatic thoughts are thoughts or personalized notions that an individual has immediately when experiencing a certain situation or event and which lead to an emotional reaction. Cognitive therapists use Socratic questioning to get to the intermediate thoughts and ultimately to the core beliefs of the individual. When reached, cognitive restructuring or schema restructuring is used by encouraging clients to find evidence for and against their core beliefs, and this is done in an effort to help individuals restructure and change their core schemas to develop a way of thinking that is more functional. In brief, the theoretical assumptions on which cognitive therapy is based on include the following: the therapist is able to access the internal communication and cognitive content of an individual’s experience, a client’s belief has highly personal meanings, and these personalized notions and meanings can be identifies and discovered by the client rather than taught or interpreted by the therapist. And finally, according to Aaron Beck, when people experience difficulties, they tend to commit logical errors which are the cognitive distortions that have been previously described, that do not represent the objective reality. These cognitive distortions are disputed in therapy as well by finding evidence for and against them, in order for the client to understand that his or her way of thinking is distorted and does not represent the objective reality of his or her surroundings. After describing the basic premises of both Rational Emotive Behavior Therapy and Cognitive Therapy, it is important to distinguish between these two forms of psychotherapies by delineating the similarities and differences that exist between them. First, a discussion of the similarities will show how these two therapies are alike and how they both share certain assumptions. Both of these therapies share an important view that entails that psychological difficulties and disturbances are the result of faulty thinking, and changing this faulty thinking and adopting corrective actions is the remedy for such psychological difficulties. Moreover, both Rational Emotive Behavior Therapy and Cognitive therapy focus on the present moment. In other words, therapists focus on the client’s problems and thinking that are part of the present, and no attention is given to the past as in earlier forms of Freudian therapies. These therapies are also active and directive, which means that the therapist and the client have active roles to play during the therapy, and the therapist directs the client and guides him or her on what to do during the therapy sessions. Being time-limited is also a very essential component of these therapies, as both usually required a limited number of sessions. In addition, both are structured and empirical, as they are based on evidence from research, and both implement the use of homework assignments as a way of helping clients practice in between the therapy sessions what they have learned during the therapy sessions. Since both therapies also focus on faulty thinking, they also require an explicit identification of the situations in which problems occur and the associated interpretations and perceptions of those situations that lead to the psychological disturbances and difficulties. This brings us to the importance of the behavioral principle in both of these therapies, as it is emphasized that altering an individual’s behavior will help alter his or her emotions and thoughts. After discussing both Cognitive Therapy and Rational Emotive Behavior Therapy separately, and after pointing out the similarities between these two types of therapy, it is important to follow the aforementioned discussions with a discussion of the differences between both therapies. First, REBT is based on the ABC model whereby it is the beliefs about an event that result in the thoughts, emotions, and behaviors experienced by an individual. Cognitive Therapy is based on the cognitive model which focuses on the three levels of cognition: automatic thoughts, intermediate thoughts, and core beliefs. Second, REBT is highly persuasive and confrontational, whereby the therapist acts as a teacher and models a rational way of thinking by helping clients identify and dispute their irrational beliefs. Cognitive Therapy uses Socratic questioning by asking open-ended questions in an effort to help clients reflect on their thoughts and get to conclusions. Thus, in Cognitive therapy, more emphasis is placed on helping clients themselves reach conclusions about their misconceptions, instead of teaching them as in REBT. Collaborative empiricism is used in Cognitive therapy, as the therapist works collaboratively with clients in an attempt to find evidence for and against their cognitions. Third, there is a difference in the way both therapies attempt to explain faulty thinking. REBT views beliefs as being irrational and nonfunctional. Cognitive therapy, on the other hand, does not explain beliefs as being irrational, but instead views dysfunctional beliefs as being problematic because of their impeding of normal cognitive processing. Thus, instead of viewing beliefs as irrational, they are viewed as distorted, by being either too extreme, absolute or broad. Fourth, REBT deals with both symptom treatment and advocating for a philosophy of healthy living. Cognitive therapy simply focuses on symptom treatment. Fifth, REBT implements the use of worse case scenarios to help clients face and confront the worse that can happen, whereas Cognitive Therapy does not advocate for a discussion of worse case scenarios between the therapist and the client. Sixth, the techniques used in REBT are cognitive, behavioral and emotive in nature. While Cognitive Therapy does use cognitive and behavioral techniques, emotive techniques are not used in Cognitive Therapy. Examples of emotive techniques used in REBT are rational emotive imagery whereby worse case scenarios are imagined, using humor, role playing, shame-attacking exercises, and use of force and vigor. And finally, an important difference between REBT and cognitive therapy lies in the research efforts that have been put into testing both therapies. Because of the therapeutic flexibility and the fact that most research can only examine and test how people feel better, but not how they have made a philosophical behavioral change, controlled research is difficult to attain for REBT. Thus, more research efforts were put into Cognitive therapy. To sum up, REBT and Cognitive Therapy have their differences in the terminologies used, the techniques employed, their views of faulty thinking, the models they are based on, and in the roles the therapist acquires in each, but this does not make them very different in their ultimate goals. Both therapies advocate for clients to be relieved from psychological disturbances and to attain a healthier living experience, but REBT adds to that the goal of having a healthy philosophy of living rather than just finding a remedy to psychological disturbances.