Rational Emotive Behaviour Therapy (REBT) in Addiction Treatment

Even as little as 50 years ago, many people would find it hard to believe that so many therapies for addiction would exist by 2023.

While Substance Use Disorders have been met with stigma historically, the drive to create new treatments has been in motion since the 1950s.

Many of these involve sitting down with a therapist and tackling the emotional issues that so often underpin an addiction, and REBT is no exception.

In 1955, Dr Albert Ellis pioneered a radical new therapy that differed in its approach from popular methods at the time.

He called it Rational Emotive Behavior Therapy [1] and explained it would help patients identify and replace unhealthy thoughts or beliefs getting in the way of achieving their goals.

These goals might be overcoming a mental illness, recovering from trauma, or tackling self-sabotaging behaviours like substance abuse.

Despite being a foundational component of Cognitive Behavioural Therapy (CBT), it’s often assumed that REBT emerged later. However, placing REBT under the CBT umbrella would be doing its complexities a disservice, as these two therapies have some key differences.

While Dr Aaron Beck developed CBT to tackle cognitive distortions (concrete thought patterns), REBT takes a more philosophical approach. While also focusing on distorted thinking, REBT also hones in on emotional disturbances, e.g. how our feelings and belief systems get in the way of addiction recovery [2].

So, Dr Ellis believed that humans tend to hold negative beliefs about events and that it’s these thoughts and beliefs that contribute to mental illness.

While we can blame our psychological distress on the event itself, it’s the way we think about the event that compromises our mental health.

Let’s take an example of a common cognitive distortion: catastrophising or blowing things out of proportion. Someone goes on a date with someone they’ve met online, but the interaction is awkward, and they just don’t click.

After the event, they’ll start catastrophising and filling this minor setback with low self-worth, thinking to themselves, “I’ll never find love; I’m intrinsically unloveable”, or “All future dates will be like this; I’m doomed to end up alone”.

In REBT sessions, therapists teach the emotionally healthy response to such negative beliefs. In this context, your therapist will help you learn to view setbacks as an opportunity for healthy growth and that while something may not go our way, it doesn’t mean we’re unloveable or bad people.

The Key Concepts

Whether used to help people overcome addictive behaviours, mental disorders, or both, REBT [3] has a few integral concepts that are key to its methodology.

These three fundamental beliefs are as follows:

• Realising that negativity is a part of life and that just because setbacks occur, this doesn’t mean that things are happening in an atypical way. We can’t expect things to go our way all of the time; these ebbs and flows of positivity are a normal part of the human experience. Trying to achieve a state of constant positivity will make us unhappy in the end.
• Fostering positive beliefs, such as self-acceptance, helps maintain a higher quality of life. REBT philosophy helps individuals escape cycles of shame and guilt by understanding that they are worthy of self-acceptance even if things aren’t going their way.
• Other people in our lives are worthy of acceptance, too, whether they are family, friends, partners, or acquaintances. REBT teaches that even if someone’s actions don’t align with our personal beliefs, we should remain as non-judgemental as possible and practice empathy instead of reacting negatively.

During sessions, REBT therapists refer to these three principles and use them to build activities. Each core tenet contributes to the overarching goal of REBT: to help patients respond rationally to stress, depressive episodes, or other negative emotions.

Over time, it’s hoped that irrational, negative beliefs can be replaced with positive beliefs and healthy emotional responses.

How Can REBT Treat Substance Addiction?

When building a treatment plan for addiction [4], mental health professionals consider which form of behavioural therapy will benefit the patient and their unique set of difficulties.

Because REBT was designed to help a variety of mental health conditions, it’s also effective in treating addiction.

Oftentimes, SUD and psychiatric conditions like depression and anxiety come hand in hand: trapping sufferers in a cycle of negativity. To escape their psychological symptoms, many people use drugs or drink alcohol: finding that it numbs the pain temporarily and provides fleeting relief.

With this in mind, REBT not only helps people manage their thoughts and feelings surrounding substance use, but it helps them get to the root cause of their disorder.

By understanding more about themselves and the beliefs that they’ve harboured for years, SUD victims can develop bespoke coping mechanisms to prevent relapse.

At the same time as REBT, patients in rehab will work through various other treatment approaches [5]. After all, studies show that behavioural therapies are most effective when carried out alongside medical and holistic methods.

For example, many people undertake medication-assisted therapy to overcome physical withdrawal symptoms, which means they’re in a better head-space for tackling emotional issues.

Because REBT for addiction is so flexible, its duration can be easily modified depending on each person’s needs.

While some people have deep-seated co-occurring disorders that take many weeks to treat, others benefit more from just a few sessions to identify irrational beliefs.

Regardless of whether they opt for short or long-term therapy, the overarching goal of REBT [6] is the same: to identify relapse triggers and teach patients how to cope with them.

Although group REBT sessions can be beneficial, it’s mainly an individual-centred style of therapy and is conducted on a one-to-one basis.

This structure allows REBT therapists to get to grips with their patient’s addictive behaviours and identify which irrational belief systems might be working against their recovery.

Once they’ve identified these negative thought patterns, they’ll work with the patient to replace the negative emotions that often accompany these thoughts.

Myriad therapeutic techniques can be used to help addiction sufferers, such as problem-solving, cognitive restructuring, and coping mechanisms.

However, to target addiction specifically, REBT therapists use a method known as Disputation. As the term suggests, this is a process wherein someone disputes their beliefs and thoughts: essentially challenging the way they think.

To help patients dispute their thoughts, therapists will choose either cognitive disputation or imaginal disputation.

The option that they pick boils down to how best their patient can challenge their irrational thinking: whether this is through verbal communication or imagining how a situation might play out visually.

In imaginal disputation, your therapist will ask you to imagine different aspects of a distressing situation through visual imagery.

However, rather than simply replaying a situation that would normally trigger a relapse [7], patients work through ways of reimagining the scenario. For each scenario, there’s a different, healthier way of coping with any negative feelings.

While similar, cognitive disputation places less emphasis on using visual imagery to reimagine relapse-inducing scenarios. Instead, your therapist will ask you questions that challenge the logic of negative thinking patterns, encouraging you to face up to uncomfortable situations.

By confronting your fears this way, REBT helps break the link between discomfort and substance use [8].

The ABC Model

The research and psychoanalysis surrounding REBT for addiction is pretty complex, but how it’s carried out seems basic. To help those suffering from addiction, REBT specialists carry out what’s known in the therapy world as the ABC Model.

This is a specific philosophy that patients are guided through at a pace that suits their addiction recovery journey.

The first part of this acronym stands for Action or Activating event. This refers to a particular incident that led someone to develop negative feelings [9], thoughts, and views of themselves or the world.

Ultimately, the activating event is what carries them down the path of substance abuse or triggers future relapse.

Common examples include trauma, abuse, panic attacks, or an event which caused someone to feel out of control.

Second, is the letter B, which represents someone’s Beliefs about the situation or activating event. It’s these beliefs that therapy tries to reframe, as they’re standing in the way of sustainable sobriety and quality of life.

According to the REBT model, people will prescribe their meaning to an activating event by using their inner dialogue and unhelpful belief system.

The third letter (C) stands for Consequence and is used to explain someone’s reaction to the activating event, influenced by their interpretation of it.

Consequences may include emotional outbursts that present as anxiety [10] or anger, but in this context, C’s are the behavioural response: namely drinking or using drugs.

This is the traditional three-part model used in REBT methodology, but nowadays, therapists can choose to extend “ABC” to “ABCDE”. This makes the traditional acronym more comprehensive and describes the thought adaptation process.

“D” pinpoints the phase of Disputing irrational beliefs and undermining the power they hold over someone.

Once you’ve developed awareness of your distorted beliefs and how they exacerbate your addiction, the next stage is to dispute them. Your therapist will aid you in replacing negative cognitions with healthy and positive beliefs.

The final part of the acronym is “E” for new Effect and is the last stage of REBT for addiction. Having identified your dysfunctional beliefs, developed an understanding of how they might trigger a relapse, and disputed them, you’ll have developed a healthier philosophy.

Oftentimes, patients emerge from REBT with a more positive outlook, armed with various coping mechanisms to prevent substance cravings.

Rational Behavioural Therapy in Action

Now that we’ve looked at the ABC model, it’s important to view how this REBT philosophy would operate in an addiction treatment program.

The following example uses a common irrational belief among those with SUD and uncovers how the ABCDE model will tackle it:

The (A) motivating event in this case is the loss of a romantic relationship. This is the individual’s first healthy relationship since becoming sober and getting their life back on track, so the fact that it hasn’t worked out seems especially significant.

As can be imagined, the relationship ending has triggered various negative behaviours and emotions: including relapse.

But why has their relationship ending caused them to experience substance cravings? This is because a destructive (B) belief has formed, manifesting as negative self-talk [11] and low self-esteem.

The individual tells themselves that, because the relationship ended, this must mean that they’re intrinsically unloveable. They might also convince themselves that any future attempts at romance are doomed to fail.

(C)Consequently, the person experiences behavioural problems that hinder their recovery, even suffering a full relapse and abusing substances. This is because they can’t see another feasible way of coping with the feelings of sadness and worthlessness that have manifested.

With the help of their therapist, they’ll work through the following REBT steps and overcome these negative feelings. Firstly, they’ll uncover why their beliefs are irrational and how they’re harming their addiction recovery. Then, they’ll start (D) disputing their cognitive distortion by providing contrary evidence.

For example, if their negative self-talk states that “because this relationship ended, there must be something wrong with me”, they’ll develop a healthier response to this, such as “relationships come and go and just because one ended, it doesn’t make either party a bad person”.

They’ll learn that their negative self-talk and awfulising is just transient thought and isn’t based on truth.

After multiple REBT sessions, the patient will notice that a new (E) effect has formed that changes their negative approach to stress.

Rather than abusing substances as a way of coping with setbacks and negative life events, they’ll be able to employ positive self-talk and other coping skills. They’ll also understand that stress is a normal reaction and that the discomfort will pass with time.

What are Some Benefits of REBT?

Rational emotive behaviour therapy can be applied to various forms of substance abuse treatment and comes with a vast range of benefits.

Research has shown that REBT is just as effective as more traditional therapeutic methods such as 12-step programmes, CBT [12], and contingency management.

Here are a few key benefits of REBT for addiction when utilised in a comprehensive treatment plan.

1. It Helps People Combat Withdrawal

REBT can help people during detox: the important yet uncomfortable first stage of addiction recovery. Despite receiving medication and various treatments, many people find that the process of removing substances produces withdrawal symptoms.

By helping patients acknowledge and accept their discomfort, REBT can make the withdrawal process far less stressful. By sitting with anxiety or physical discomfort and accepting its transience, people going through detox can change the way they view withdrawal.

Rather than worrying about their symptoms and the recovery process as a whole, they can find comfort in knowing it will pass.

2. REBT Increases Positivity

Although deciding to enter treatment for SUD [13] is a positive event, many people are used to harbouring the negativity that comes with active addiction.

If left unchecked, irrational beliefs and negative belief systems can cause your mental health to decline, rendering treatments less effective.

REBT is one of the few treatment options that place such clear emphasis on remaining positive, regardless of what life throws our way.

This makes REBT sessions an invaluable tool for helping patients increase positivity during treatment, even when the going gets tough. In turn, increasing positivity will help boost their motivation to stay sober and continue working through other treatments.

Patients Can Build a Trusting Relationship With their REBT Therapist

Unlike group methods such as family therapy or 12-step programmes, REBT favours a one-to-one approach. Because patients interact with the same therapist each session and without their peers present, they can build a rapport and a stronger sense of trust.

During sessions, your REBT therapist will work solely with you and develop an intricate understanding of your unique addiction and comorbidities [14].

Due to the topics being covered and the emotions being tackled, REBT is a form of psychotherapy that requires both the therapist and the patient to be fully present.

Commitment to the therapeutic process in this way, rather than skipping sessions or not being fully present, creates a more honest relationship and makes REBT more effective.

It Enhances Productivity

Focusing on overcoming hardships in SUD recovery and life in general, REBT often makes people feel more productive.

Working towards self-improvement and achieving your life goals in therapy will do wonders for your productivity, whether this is at home, at work, or in a rehab routine [15].

For example, someone who holds negative beliefs about work and uses alcohol to cope with stress can tackle these issues during REBT.

Over time, they’ll learn to change their patterns of irrational thinking and become more productive in both their work life and personal life (without the help of alcohol).

Another productivity-boosting feature of REBT is the homework assigned by therapists. These activities, often given in the form of journals or worksheets, encourage patients to try out new problem-solving techniques and cognitive disputation methods [16].

As you can imagine, these evidence-based approaches boost productivity outside of sessions and optimise self-confidence.

Access Effective Treatment and Start Your Recovery Journey

Treating Substance Use Disorder is a rewarding yet complex process, and it’s not one that you have to go through alone. Deciding that it’s time to access therapy and get the help you need is a vital step towards living the life that you want, free from drug or alcohol abuse.

To get an idea of your treatment options, seek support for a loved one, or find an REBT therapist in your area, you can reach out to Rehab 4 Alcoholism [17] free of charge.

We’re qualified to provide expert advice on how to find a certified therapist, types of addiction treatment, entering a rehab clinic, and much more.

Our team of addiction specialists believe that a one-size-fits-all approach rarely works, and we’ll work towards finding you bespoke treatment.

You can call 0800 326 5559 at any time of day and speak to a member of the team directly. Or, complete our hassle-free contact form and hear back from a team member in a matter of hours.

References

[1] The Practice of Rational Emotive Behavior Therapy The Practice of Rational Emotive Behavior Therapy – Google Books

[2] Rehab 4 Alcoholism: Alcohol Addiction Counseling Alcohol Addiction Counselling | Rehab 4 Alcoholism

[3] Advances in REBT, Theory, Practice, Research, Measurement, Prevention and Promotion Advances in REBT – Google Books

[4] Substance Use Disorders, A Biopsychosocial Perspective Substance Use Disorders – Google Books

[5] Fundamentals of Motivational Interviewing, Tips and Strategies for Addressing Common Clinical Challenges Fundamentals of Motivational Interviewing – Google Books

[6] Overcoming Destructive Beliefs, Feelings, and Behaviors, New Directions for Rational Emotive Behavior Therapy Overcoming Destructive Beliefs, Feelings, and Behaviors – Google Books

[7] The Addiction Solution: Unravelling the Mysteries of Addiction Through Cutting-Edge Brain Science https://books.google.co.th/books?id=_HlQfxWyJogC&printsec=frontcover&dq=valium+addiction&hl=en&sa=X&redir_esc=y#v=onepage&q=valium%20addiction&f=false

[8] Innovations in the Treatment of Substance Addiction https://www.google.co.th/books/editionHuman_connection_as_a_treatment_for_addi/B1CqEAAAQBAJ?hl=en&gbpv=0

[9] How to Change Your Thinking About Shame, Hazelden Quick Guides How to Change Your Thinking About Shame – Google Books

[10] Anxiety Symptoms: the Different Types of Cognitive Distortions That Result in Bad Coping Mechanisms Anxiety Symptoms: the Different Types of Cognitive Distortions That Result … – Google Books

[11] Stress Counselling, A Rational Emotive Behaviour Approach Stress Counselling – Google Books

[12] Rehab 4 Alcoholism: Cognitive Behavioral Therapy for Alcoholism Cognitive Behavioural Therapy for Alcoholism – Rehab 4 Alcoholism

[13] The Relevance of Rational Emotive Behaviour Therapy for Modern CBT and Psychotherapy The Relevance of Rational Emotive Behaviour Therapy for Modern CBT and Psyc… – Google Books

[14] Dual Disorders, Essentials for Assessment and Treatment Dual Disorders – Google Books

[15] Recovery Allies, How to Support Addiction Recovery and Build Recovery-Friendly Communities Recovery Allies – Google Books

[16] Cognitive and Behavioral Theories in Clinical Practice Cognitive and Behavioral Theories in Clinical Practice – Google Books

[17] Rehab 4 Alcoholism: Contact Us Contact Us | Rehab 4 Alcoholism

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