Letting a little nonverbal air into the room: Insights from acceptance and commitment therapy Part 1: Philosophical and theoretical underpinnings

In recent years, a new “wave” of mindfulness based Cognitive Behavior Therapies (CBT) has become popular. Such approaches include Acceptance and Commitment Therapy (ACT; Acceptance and commitment therapy: An experiential approach to behaviour change. New York: Guilford Press, 1999), Mindfulness-based Cognitive Therapy for Depression (Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press, 2002), and Mindfulness-based Stress Management (Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing, 1990). In contrast to traditional CBT, these approaches often minimize attempts to change the form and frequency of dysfunctional thoughts. Is there any way to integrate traditional CBT with mindfulness based CBT? To answer this question, we discuss the philosophical and theoretical underpinnings of one form of traditional CBT (Rational-Emotive and Cognitive Behavioral Therapy) and one form of mindfulness based CBT (ACT). We argue that some aspects of each therapy can be integrated. However, in order to prevent techniques from being used haphazardly or inconsistently, we suggest that the different forms of CBT need to be driven by a common philosophical orientation (e.g., functional contextualism) and theoretical orientation (e.g., Relational Frame Theory).     

SOME FINAL,GULP, “WORDS” ON REBT,ACT &; RFT

After reviewing the target articles of this issue, Hayes and Ellis respectively see less and more possibilities for integration. This concluding article attempts to better elucidate possibilities for integration between second and third wave CBT’s, as exemplified by Rational-Emotive & Cognitive-Behavior Therapy (REBT) and Acceptance and Commitment Therapy (ACT). We suggest that if ACT is going to err, it will be in the direction of being too afraid of talk. If REBT is going to err, it will be in the direction of not being afraid enough. Address correspondence to Hank Robb, 4550 SW Kruse Way, Suite 225 Lake Oswego, OR 97035, USA.     

CAN RATIONAL-EMOTIVE BEHAVIOR THERAPY (REBT) AND ACCEPTANCE AND COMMITMENT THERAPY (ACT) RESOLVE THEIR DIFFERENCES AND BE INTEGRATED?

Rational-Emotive Behavior Therapy (REBT) is a pioneering form of Cognitive Behavior Therapy (CBT). Acceptance and Commitment Therapy (ACT) is part of the new wave of CBTs. In this article, I discuss the papers of Ciarrochi, Robb, and Godsell, and of Ciarrochi and Robb, who propose that REBT and ACT can be quite suitably integrated, and the paper of Steven Hayes, the originator of ACT and of Relational Frame Theory, who is skeptical about the feasibility of Ciarrochi, Robb, and Godsell’s proposals. My own view is that ACT and REBT significantly overlap in their theory and practice and that they can be successfully integrated if both therapies make some changes.     

接纳承诺疗法的作用机制——基于元分析结构方程模型

接纳承诺疗法(Acceptance and Commitment Therapy, ACT)被认为是行为治疗“第三浪潮”的重要代表。本研究使用元分析结构方程模型, 考察ACT的作用机制。通过数据库检索与筛选, 最终纳入文献50篇。结果发现: ACT所假设的心理灵活性、接纳、此时此刻、价值的中介作用都达到统计显著, 认知解离这一中介变量并不显著; 中介机制在网络化干预中仍然得到检验; 相较之传统CBT, ACT在所假设的机制上有其区别于CBT的优势。后续临床研究应更全面地测量6大核心机制, 关注对美好生活提升的影响, 采用多点瞬时评价法, 并尽可能使用更高级、更先进的统计方法检验其作用机制。     

Logotherapy-Enhanced REBT: An Integration of Discovery and Reason

Viktor Frankls Logotherapy and Albert Elliss Rational Emotive Behavior Therapy (REBT) are at seemingly opposite ends of the psychotherapeutic spectrum. However, a close review of the assumptions and philosophy of each school of therapy reveals that these two systems are compatible. We propose that a Logotherapy-enhanced REBT can increase human achievement and happiness by balancing the individual discovery of meaning with the pursuit of reason. This integrated and enhanced therapy will help human beings participate in positive life experiences and take greater responsibility for change. Fruitful and beneficial aspects of a Logotherapy enhanced-REBT are explored with respect to cognitions, emotions, and the reduction of rumination. Conclusions are drawn, limitations are discussed, and future recommendations are outlined.     

Can the REBT theory explain loneliness? Theoretical and clinical applications

Loneliness is a common psychological experience affecting a significant minority of the general population. Loneliness may in part be related to the existence of dysfunctional cognitive evaluations. To date, however, loneliness has yet to be explicitly assessed within a cognitive-behavioural theoretical framework. The current study sought to determine the association between negative cognitions, within the context of Rational Emotive Behaviour Therapy (REBT), and the experience of loneliness. A multinational sample of university students (n = 397) completed self-report assessments of rational and irrational beliefs, and loneliness. Structural equation modelling results found that the REBT model of psychopathology, and the REBT model of psychological health, provided satisfactory representations of loneliness, explaining 36% and 23% of variance in loneliness, respectively. Several dysfunctional (“Demandingness”, “Catastrophising” and “Self-Downing” beliefs) and functional (“Preferences” and “Self-Acceptance” beliefs) cognitions were directly and indirectly associated with loneliness. These results highlight that cognitions and loneliness are meaningfully related, and indicate that cognitive-behavioural models may be useful in understanding loneliness. More specifically, current results suggest that REBT may offer a viable psychotherapeutic approach to treating loneliness.     

Acceptance and Commitment Therapy as a Spiritually Integrated Psychotherapy

This article presents acceptance and commitment therapy (ACT) as a spiritually integrated therapeutic modality. ACT is a value‐driven therapy that involves facilitating transcendence of physical, mental, and emotional experience to alleviate human suffering; as such, ACT shares common ground with the domain of spirituality. Approached as a spiritually integrated therapy, ACT can help clients to access spiritual resources and create life meaning as well as aid in the resolution or transformation of spiritual struggles. Given that spiritual struggles, in particular, can have a significant impact on mental health and well‐being, this article provides guidance in how ACT can address such struggles.     

When Laddering and the Downward Arrow Can Be Used as Adjuncts to Inference Chaining in REBT Assessment

This paper looks at the ways in which laddering in Personal Construct Therapy and the downward arrow in Cognitive Therapy can be used as adjunctive techniques to inference chaining in locating a client's critical A or emotional core. We describe their use through a number of case examples and annotations. We conclude that these two methods require skilled use if they are to be successfully integrated into inference chaining and are offered as part of REBT's interest in theoretically consistent eclecticism. The use of inference chaining in Rational Emotive Behaviour Therapy (REBT), the downward arrow in Cognitive Therapy (CT) and laddering in Personal Construct Therapy (PCT) are techniques which aim to help therapists and clients gain rapid insight into the latters' core beliefs and values about themselves, others and the world. This article will show how each technique reveals underlying beliefs and then, from the REBT viewpoint, in what circumstances laddering or the downward arrow might be used as an adjunct to inference chaining in the assessment stage of therapy.     

Acceptance in Cognitive Behavioral Psychotherapies: Different or the Same?

Acceptance is a key construct in both rational emotive behavior therapy (REBT) and acceptance and commitment therapy (ACT). The objectives of this study were to assess and compare the properties of ACT acceptance with those of REBT acceptance in predicting emotions. A sample of 112 subjects, comprising different educational and occupational status, completed three measures of acceptance (REBT and ACT), two of mindfulness, as well as completing depression and anxiety scales. Both ACT acceptance as process and REBT acceptance could predict significant ACT acceptance as outcome. Mindfulness as a trait also predicted the level of ACT outcome acceptance as well as the level of REBT acceptance, but mindfulness as process predicted only ACT outcome acceptance. The results show that REBT acceptance, ACT acceptance and mindfulness can explain anxiety and depression in different ways. The results show that the difference between ACT acceptance and REBT acceptance primary concern the process of acceptance, most likely due to the underlying cognitive processing. The outcome acceptance and emotional level are similar in the two conditions. Future research should employ multiple cognitive measurements.     

Freud, Rogers, and Ellis: A Comparative Theoretical Analysis

Albert Ellis, Sigmund Freud, and Carl Rogers are widely recognized as the three most influential psychotherapists of the twentieth century. In the present article, it is argued that the striking differences in their therapeutic systems, Rational Emotive Behavior Therapy (REBT), psychoanalysis, and person-centered therapy, respectively, are rooted in more fundamental theoretical differences concerning the essential nature of client personality. The positions of Freud, Rogers, and Ellis on three critical issues in personality theory especially relevant for the practice of psychotherapy are examined and comparatively analyzed. The critical issues are: (1) nature vs. nurture as the foundations of personality; (2) the potency of reason in human behavior; and (3) the possibility of fundamental personality change. For each critical issue the treatment implications are also briefly explored with a view toward illustrating how the theorists' positions directly translate into therapeutic practice. The basic intent of this comparative analysis is to strengthen and further clarify the personality theory underlying REBT.     

Rational Emotive Behavior Therapy and Cognitive Behavior Therapy for Elderly People

Several therapies have been adapted for use with elderly people, including Rational Emotive Behavior Therapy (REBT) and Cognitive Behavior Therapy (CBT). These two therapies emphasize the importance of irrational or dysfunctional beliefs in the creation of emotional disturbance, and tend to use a number of cognitive, emotive, and behavioral methods of disputing and changing these beliefs for more functional ones. Some of the main therapeutic techniques used in REBT and CBT are presented in this paper.     

Frustration Intolerance: Therapy Issues and Strategies

This article aims to provide an overview of the Rational Emotive Behavior Therapy (REBT) concept of frustration intolerance. Therapeutic issues regarding these beliefs are discussed, including engagement, the use of disputation, and behavioral techniques.     

Frustration and Discomfort Intolerance: Introduction to the Special Issue

This article aims to provide an overview of the Rational Emotive Behavior Therapy (REBT) concept of frustration intolerance. Therapeutic issues regarding these beliefs are discussed, including engagement, the use of disputation, and behavioral techniques.     

A Study of Volunteer Clients Who Experienced Live Sessions of Rational Emotive Behavior Therapy in Front of a Public Audience

This is a study of the responses of 100 selected subjects who gave their reactions to experiencing a live session of Rational Emotive Behavior Therapy (REBT) with Albert Ellis in front of a public audience. Ninety-seven of the respondents found their session helpful; only 13 felt uncomfortable discussing their problems in public; 99 of them felt that Dr. Ellis focused on their main problem; 94 of them reported that they somewhat or very much used Dr. Ellis's suggestions; 90 of them felt that the members of the audience suggestions were helpful; and 93 of them said that they would like to work with Dr. Ellis again at a public therapy session. Limitations of this study are discussed.     

Dr. Albert Ellis—In His Own Words—On Success

Albert Ellis, Ph.D. gives his formula for success, along with his unique and extremely candid take on some of the obstacles he encountered along the way in his amazing quest to take Rational Emotive Behavior Therapy (REBT)—the original cognitive behavioral approach—from its initial status as renegade to its current mainstream status.     

Can Multimodal and Rational Emotive Behavior Therapy be Reconciled?

The purpose of this article is to determine whether two distinct modes of cognitive-behaviour therapy—Rational Emotive Behaviour Therapy (REBT) and Multimodal Therapy (MMT)—can be reconciled. This quest in the spirit of integrationism is pursued along three lines of inquiry: Do we talk about schools, approaches, or techniques? A reconciliation between MMT and REBT as systems seems not to be feasible, just because of the simple fact that MMT is not a new school with an idiosyncratic theory, whereas REBT is. However, REBT is also a congenial approach consisting of various eclectic techniques, as is MMT. It is explained how the A-B-C format and firing orders of the BASICI.D. modalities stem from an S-O-R model. Furthermore, the circular character of the various modalities (thinking, feeling, and behaving) is recognised both in MMT and in REBT. The techniques used in REBT and MMT overlap for 65–80%, according to a comparative perusal of Ellis's and Lazarus's presentations of preferred techniques. This means that MMT and REBT, as an approach with distinct techniques, “must” be very similar in practice. The conclusion is that philosophically Ellis and Lazarus see eye-to-eye and that MMT and REBT overlap a great deal. But a fusion is not yet at hand. At best the two can be described as two sides of one coin. “When you wake up in the morning, Pooh,” said Piglet at last, “what's the first thing you say to yourself?” “What's for breakfast?” said Pooh. “What do you say, Piglet?” “I say, I wonder what's going to happen exciting today?” said Piglet. Pooh nodded thoughtfully. “It's the same thing,” he said. “What's that?” the Unbeliever asked. “Wisdom from a Western Taoist,” I said. “It sounds like something from Winnie-the Pooh,” he said. “It is,” I said. From The Tao of Pooh Benjamin Hoff (1982)     

A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses

Background: Levels of stress and burnout increase during nursing education. This development has consequences for nursing students' health, learning, competence, and interest in quality issues in health care. Design: In a randomized controlled pilot trial with a sample of 113 nursing students the effect of an intervention using techniques from acceptance and commitment training (ACT) to prevent the development of stress and burnout was evaluated. Method: The 6 × 2-hour program was compared to standard treatment (reflection seminars) post-intervention and at a three-month follow-up using longitudinal analysis of mean response profiles. Mechanisms of change were investigated using a baseline-post intervention two-mediator model. Results: The intervention resulted in increased mindful awareness and decreased experiential avoidance, as well as decreased perceived stress and burnout. Levels of mindful awareness and perceived stress were sustained at follow-up. The proposed mechanisms of change were partly supported by the data. Conclusion: This study shows that techniques from ACT might have the potential to contribute to preventing the development of stress and burnout during nursing education. However, additional studies are needed to validate these results.     

Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results

Cognitive behavior therapy (CBT) has been demonstrated in a number of randomized controlled trials to be efficacious as an adjunctive treatment for psychotic disorders. Emerging evidence suggests the usefulness of CBT interventions that incorporate acceptance/mindfulness-based approaches for this population. The current study extended previous research by Bach and Hayes (2002. The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139) using Acceptance and Commitment Therapy (ACT) in the treatment of psychosis. Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual (ETAU) or ETAU plus individual sessions of ACT. At discharge from the hospital, results suggested short-term advantages in the ACT group in affective symptoms, overall improvement, social impairment, and distress associated with hallucinations. In addition, more participants in the ACT condition reached clinically significant symptom improvement at discharge. Although 4-month rehospitalization rates were lower in the ACT group, these differences did not reach statistical significance. Decreases in the believability of hallucinations during treatment were observed only in the ACT condition, and change in believability was strongly associated with change in distress after controlling for change in the frequency of hallucinations. Results are interpreted as largely consistent with the findings of Bach and Hayes and warrant further investigations with larger samples.     

The Relationship of Rational Emotive Behavior Therapy (REBT) to Social Psychology

Rational Emotive Behavior Therapy (REBT) includes several main theories and practices, especially the hypotheses that people are both constructivists and destructivists. It holds that they have powerful innate and socially acquired tendencies to often be self-helping and rational but also self-defeating and irrational. REBT largely derives its method of therapy from many clients seen by the author, from hundreds of therapy studies, and from the social psychology literature. This article shows how REBT formulations overlap with some of the findings of social psychology, how these findings can appreciably be used to improve REBT practice, how some of the unique theories and methods of REBT may contribute to the field of social psychology, and how social psychologists can help to research some of the main REBT principles.     

How REBT Can Be Less Disturbing and Remarkably More Influential in Britain: A Review of Views of Practitioners and Researchers

We asked British cognitive behaviour therapists and researchers for their views on the current status of Rational Emotive Behaviour Therapy in Britain. All agreed that REBT had lost influence in comparison with Cognitive Therapy since the cognitive revolution 20 years ago. The main reasons given were that REBT, particularly in comparison with CT, was under-researched, was too rationalist in its approach and too active/directive in its style. One responder thought REBT was remarkably atheoretical. Overall there was a surprising degree of ignorance and misinformation. On the positive side, REBT was felt to be focused on the person rather than the symptom, and oriented more to the client than the professional or academic in its publication output than CT. We consider each issue and make recommendations for change.