Rational Emotive Behaviour Therapy (REBT) for Alcoholism

When a person works to overcome their addiction to alcohol, the two foundational steps are to get help from specialists to safely detox and then to receive therapeutic treatment in a rehabilitation program. Rehabilitation programs provide a variety of forms of therapy, including 12-Step-based group work, Cognitive Behavioral Therapy, and Multidimensional Family Therapy. Offering multiple forms of talk therapy means that each individual has access to interventions to change their behaviors that work for them.

Behavioral therapies, according to the National Institute on Drug Abuse (NIDA), are intended to:

• Change behaviors and beliefs regarding alcohol or drug abuse
• Develop new, healthy life skills and coping mechanisms
• Maintain treatment with medications, if needed

These evidence-based approaches can be provided through a variety of forms of talk therapy, both from individual and group counselors. One subset of Cognitive Behavioral Therapy is Rational Emotive Behavioral Therapy (REBT). This short-term approach to behavioral treatment works directly on negative beliefs and behaviors, with a focus on changing them so the individual can stay healthy.

What is Rational Emotive Behaviour Therapy?

As a branch of Cognitive Behavioral Therapy, Rational Emotive Behavior Therapy applies many of the same approaches to examining the root causes of specific behaviors and beliefs. In this form of psychotherapy, an REBT therapist will help the client focus on the present time, examining current emotional distress or unhealthy behaviors. Then, the therapist will guide the client through an examination of emotions and beliefs, which may have led to these behaviors and had a negative impact on life. For example, a person with negative core beliefs about their work may suffer from depression or anxiety. Once these beliefs are identified, and it is understood how they turned into actions, the therapist and client work together to replace the negative behaviors with positive behaviors.

Psychologist Albert Ellis developed REBT in the 1950s, but continued to refine the practice, and there are many therapists who now specialize in this approach. For Ellis, the goal of developing a new, more specific approach to changing negative thoughts and behaviors was to give clients measurable steps to take to feel better about themselves, their loved ones, and their place in the world. Since the vast majority of humans, according to Ellis, want to be happy, learning to manage the negative impact of disappointments, rejections, and failures helps everyone stay focused on their overall wellbeing.

Core irrational beliefs include:

• Absolutism or demandingness: This involves inflexible or dogmatic beliefs.
• Demand for love or approval: As the foundation of one’s acceptance of oneself, the individual turns to outward praise and love for validation.
• Demand for success or achievement: When individuals find something important, achieving a high level of success in that goal becomes the measuring stick for their beliefs about themselves.
• Demand for comfort: This is defined as the inability to manage stress or discomfort.
• Awfulization: When one small thing goes wrong or not as expected, the individual catastrophizes the entire scenario, thinking everything is awful, has fallen apart, or is a disaster.
• Low frustration tolerance: The person frequent says they “cannot stand it” or that something is “too hard.”
• Global-rating: Using another individual as the basis of goodness or success, the person determines their own worth, which typically leads to self-deprecating remarks and poor self-esteem.

These core irrational beliefs can be understood in terms of Ellis’s basic musts. These three statements about the self highlight the negative personal impact of the irrational beliefs:

1. The person must perform well to win the approval of others; without approval, the person is no good.
2. Others must treat the person considerately, fairly, and kindly in exactly the right way; if they do not, they deserve to be condemned.
3. The person must get what they want, when they want it, and must not struggle with problems they do not want; if this does not happen, the person cannot stand the outcome.

The ABC Model of REBT

Ellis developed the ABC Model, which has since become the ABCDE Model, to approach changing these beliefs and associated behaviors. This acronym shows which steps the therapist can guide their client through to change behaviors to create a positive life.

• A, Activating Event: This is the incident that triggers negative beliefs and behaviors. This could be anything, from failing to receive a raise at work, to the loss of a romantic relationship, to the death of a close loved one
• B, Beliefs: These are the thoughts and feelings triggered by the activating event, which lead to negative self-talk, low self-esteem, anger or guilt toward one’s friends and family, and even depression or anxiety.
• C, Emotional and Behavioral Consequences: These are the consequences of the beliefs, including behavioral problems, such as lashing out at loved ones, self-harm, eating too much or too little, and abusing substances like alcohol.
• D, Disputing Irrational Beliefs: In REBT, this next step combats the ABCs, so instead of falling deeply into behavioral and emotional consequences or cycling through patterns of low self-esteem and negative behaviors, the person focuses on the underlying beliefs and disputes them with evidence to the contrary.
• E, Effective New Thinking and Behaviors: By disputing negative beliefs with evidence of positive outcomes and successful behaviors, the individual can measurably change the quality of their mood, relationships, work success, and satisfaction with life.

Three practices to change thinking, beliefs, and behaviors include the three forms of Unconditional Acceptance.

1. Unconditional Self-Acceptance: This involves acknowledging that one is a fallible human being, with good points and bad points; there is no specific reason that one has flaws, they are simply there; and despite both flaws and positive qualities, one is no more or less worthy than any other human being.
2. Unconditional Other-Acceptance: Sometimes, others will treat you unfairly; there is no reason they must treat you fairly all the time; those who conduct unfair treatment are humans, who are flawed and have good qualities, and they are still worthy.
3. Unconditional Life-Acceptance: Life does not always work out, regardless of effort; there is no reason why life must work out; life is not inherently pleasant or good, but it is not inherently unpleasant or bad.

Using REBT in Alcohol Rehab

REBT can be applied to many forms of substance abuse treatment, including alcohol dependence or alcohol use disorder. Depression and anxiety are both closely associated with alcohol abuse, often in people who abuse the intoxicating substance to self-medicate the symptoms – including thoughts, emotions, and behaviors – of their mood disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that, in 30 percent of the deaths due to suicide in the US, the individual’s blood alcohol content (BAC) was at the legal limit of 0.08 or higher; also among those who died due to suicide, 50 percent struggled with major depression. This suggests that alcohol abuse makes symptoms of depression worse.

When in rehabilitation, REBT approaches can be used to help the individual challenge their negative approach to stress. Rather than turning to alcohol to alleviate daily stresses like work or child-rearing, many therapists work with those overcoming alcohol abuse to understand that stress is a normal reaction, and the associated discomfort is normal. It will go away on its own, and it does not need to be suppressed, managed by others, or judged. This form of therapy may help one during detox, too, because the discomfort of some withdrawal symptoms can be acknowledged and accepted rather than worried about, leading to increased stress.

During or after rehabilitation, social support can be found via evidence-based, non-religious mutual support groups like Self-Management and Recovery Training (SMART) meetings. These groups are similar to 12-Steps meetings, but they often use REBT, cognitive-behavioral, and other non-religious or non-spiritual approaches.