Download When practicing counseling one should use an approach

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REBT
Approach and Anxiety Disorders
by Galina Iolova - Buckhout
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Anxiety Disorders -Overview
Anxiety disorders are the most common of all mental
health disorders. Unfortunately nowadays with the fastpaced and stressful life we lead, the increase of these
types of mental disorders is very high.
According The Anxiety Disorders Association of America
(ADAA) an estimated 19 million adult Americans suffer from
anxiety disorders. Anxiety disorders are highly treatable,
yet only about one-third of those suffering from an anxiety
disorder receive treatment (“Brief Overview of Anxiety
Disorders”, © 2004 Anxiety Disorders Association of
America). One of the reasons is that until recently little
research has been done about how to treat these conditions
successfully especially in the field of counseling.
The reason I have chosen this topic is that today,
although Anxiety Disorders respond well to counseling and
psychotherapy, many people suffering from them are never
referred to a counselor/psychologist and are treated
instead only with prescription drugs (antidepressants and
benzodipines) like Xanax, Clonopin, Paxil, Prozac, Luvox
etc.. Many of these drugs come with a range of side effects
and some are highly addictive. Instead of merely
prescribing a medication, doctors should take some time in
assessing their patients and listening to their concerns,
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they should try to explore further the causes for the
conditions/disorders and take into consideration the whole
macro system the client is a part of. Techniques like
“meditation, relaxation therapy and cognitive-behavioral
therapy are very effective in managing the symptoms of
anxiety and putting the individual back in control” (“Brief
Overview of Anxiety Disorders”, 2004 Anxiety Disorders
Association of America) and can be used alone or together
with medicines.
The likelihood of developing anxiety involves a
combination of life experiences, psychological traits, and
genetic factors. There are many challenges in our lives
that may lead to anxiety, depression, and other mental
problems. Through counseling, the client can explore his or
her alternatives, build on his or her strengths, develop
new skills, improve communication, enhance relationships,
gain peace of mind, improve his or her self-esteem, obtain
more satisfaction out of life, acquire personal growth,
improve job performance etc. In my opinion, it is possible
to conclude that counseling in some cases is more
beneficiary to the client than the ordinary medication
which takes care of the symptoms but will not solve the
real problem and will not teach the client how to deal with
it.
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The causes for anxiety might be real ones (based on a
real situation) or might be triggered by “nothing”.
Common
external factors are stress at work, stress from school,
stress in a personal relationship such as marriage,
financial stress, stress from emotional trauma such as the
death of a loved one, stress from a serious medical
illness, side effect of medication. According DSM-IV
anxiety disorders are classified as follows: Anxiety dues
to a general medical condition, Substance –Induced anxiety
disorder, Generalized anxiety, Panic disorder, Acute stress
disorder, Posttraumatic stress disorder, Adjustment
disorder with anxious features, Social phobia, Obsessivecompulsive disorder, Specific phobias.
In counseling, one of the approaches / therapies that
has a very positive outcome in treating anxiety is REBT.
REBT-Major focus and assumptions
Rational Emotive Behavioral Psychotherapy (REBT),
created by Albert Ellis in 1955, is the oldest form of
cognitive-behavioral psychotherapy (CBT). According to
Ellis and MacLaren (1998), "rational emotive behavior
therapy is based on the assumption that cognition, emotion,
and behavior are not disparate human functions but are,
instead, intrinsically, integrated and holistic (p. 3)."
REBT is a highly didactic, cognitive, behavior-oriented
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approach
that proposes a ‘biopsychosocial’ explanation as
to how human beings come to feel and act as they do,
suggesting that a combination of biological, psychological,
and social factors are involved.
REBT explains how people’s psychological problems
“…arise from their misperceptions and
mistaken cognitions
about what they perceive; from their emotional
underreactions or overreactions to normal and unusual
stimuli; and from their habitually dysfunctional behavior
patterns, which enable them to keep repeating nonadjustive
responses even when they "know" that they are behaving
poorly.” (Ellis, A. The Essence of Rational Emotive
Behavior Therapy 1999. Retrieved 6/30/2004 from
http://www.fsu.edu/~gcp/).
Anxiety is often triggered by person’s irrational
beliefs and that is why by challenging and disputing these
beliefs
REBT
therapy is able to reduce the anxiety
triggered emotions/symptoms.
REBT assumes that
almost all human emotions and
behaviours are result of what people think, assume or
believe (about themselves, other people, and the world in
general). It is what people believe about situations they
face – not the situations themselves – that determines how
they feel and behave. That is way REBT is created as an
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approach based on the concept that if a person reorganizes
his/her self-statements, this will result in changing and
re-organizing of one’s behaviour.
Key Concepts of the approach
REBT is an insight oriented psychotherapy that stresses
one's need to recognize and change negative thoughts and
self-defeating beliefs. REBT believes people are
responsible for creating their own upsetting reactions to
stressors. This approach assumes people generally are able
to think rationally but at times become prey to their own
uncritical acceptance of irrational beliefs. Examples of
irrational beliefs are “it’s Awful, I can’t stand this, I
should have, I should not have, I am a rotten person etc.,
“ while examples of rational beliefs are “I’d prefer that
this did not happen to me, it is very unfortunate, it is
frustrating, what can I do to overcome this problem?”
(Ellis, A. 1975). A person in need of psychological help
has consistent patterns of irrational thinking. In order
for people to get better they must learn to dispute these
irrational beliefs. Disputation (D) of the irrational
beliefs is a must to help the person get the effect (E) of
understanding the irrational beliefs and turn into more
rational thinking.
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Ellis believes that people perceive, think, emote and
behave simultaneously. One’s emotional problems are the
result of a person's beliefs that need to be challenged
(Corey, 1996a, p. 320). The focus is on present
interpretations rather than past events themselves. REBT’s
A-B-C theory clearly outlines how this process might occur
and how it might be changed. The A-B-C is a model of
personality: A, being the actual event; B, being one's
belief system; and C, being the consequences of A and B.
According to Ellis it is not the activating event (A) that
causes the consequences, depression for instance (C), but
their beliefs (B) about the events that cause consequences
(Bishop, 1994, p. 28).
Thus, REBT has reinforced the
concept that the therapist needs to focus on the internal
processes rather than the situation itself in searching for
the roots to the client’s problems (Gilliland & James,
1998).
Of key importance is also the way Ellis delineated
specific types of irrational thinking, which provides for
better development of techniques to dispute cognitive
distortions. One example is musturbation. These are
important basic fundamentals that he believes lead to
irrational thinking. These are unconditional “musts,
shoulds, ougths” that people tell themselves about events.
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Musturbation is when people go from “preferences, desires,
and wishes about what is happening to absolutes and
necessities about what is happening” (Gilliland and James,
1998, p. 238). There are certain irrational beliefs to
which musturbatory thinking leads: awfulizing,
worthlessness, and I-can’t-stand-it-itis (Ellis, 1980).
REBT therapist does not believe a warm relationship
between counselor and a client is a condition for the
therapy to work as long as the client strongly believes in
the therapy itself. However, the therapist stresses on the
unconditional acceptance of and collaboration with the
client and at the same time encourages the client to
unconditionally accept him/herself despite their inevitable
fallibility. At the same time, the therapist is aware of
possible client’s dependency and that is why he/she uses
often hardheaded methods of convincing the client that
he/she is has better resort of self-discipline and selfdirection.
Another key concept is that REBT does not insist on
therapist being the keeper of knowledge, but instead
promotes that people can learn and change from a variety of
means, such as watching tapes, reading etc. Also, REBT is a
preventative technique in which the therapist teaches the
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client to use the REBT techniques outside of therapy
independently.
Techniques, goals and procedures
REBT is an eclectic approach using a lot of cognitive,
affective and behavioral techniques. REBT therapies use
role-playing, assertion training, desentization, humor,
operant conditioning, suggestion, support etc.
Some of the
most popular cognitive techniques include disputing
irrational beliefs, emotive techniques include rationalemotive imagery, behavioral include operant conditioning,
self-management strategies and others. REBT major goals are
to eliminate client’s self-defeating outlook on life,
replace irrational thoughts with rational ones and help
clients critically examined and reorganized (when needed)
present behavior and beliefs. Another major objective is
the way REBT helps people examine and change some of their
basic values- and mainly the ones that bring their anxiety
reactions. REBT is different from pure cognitive approaches
because it is more directive, highly persuasive and
confronting, while the cognitive therapy focuses more on
helping clients discover their misconceptions for
themselves.
Overview
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REBT is a therapy that has good success in treating
anxiety disorders. As a future counselor, I would use this
approach because it is action-oriented, didactic and at the
same time uses a large number of philosophical, emotional,
and behavioral methods that promote profound change. It
helps people integrate their cognitive and experiential
behaviors, enhance their growth and productivity, and free
themselves from unproductive and self-defeating habits
which are often the causes of anxiety disorders. Although
usually briefer than most other therapies, it includes more
depth and intensity than other approaches because it seeks
to reveal and change the basic core philosophies that
underlie much stress, anxiety, and other emotional
disorders.
In conclusion, I would like to stress again the
importance for counselors to understand that anxiety
disorders are caused by a combination of biological and
environmental factors, that their causes might lie in a
physical ailment or psychological one. Counselors should
explore all the factors, reasons and causes behind, be
aware that the origin behind the disorder should be
uprooted first before treatment is applied.
Finally, the
counselors should be open and flexible to different options
hence the client will benefit not only from medication but
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different approaches and techniques as counseling, which
(depending on the cause) might prove even more beneficiary!
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References:
1.“Assessment and diagnosis of DSM-IV anxiety disorders”,
by Fong, Margaret; Silien, K, published in Journal of
Counseling & Development: JCDv77n2 (Spring 1999).
2.” The effectiveness of counseling on anxiety and
depression by minimally trained counselors: A random
controlled trial”, by Ali, Badar Sabir; Rahbar, Mohammad H
Naeem, Shifa Gul, Ama Et al, published in American Journal
of Psychotherapy :57, mo3 (2003).
3.”Anxiety”, by Minas, Christopher J, MD: published 2004
in eMedicine.com,Inc.
4.”Anxiety Disorders”, by Yates, William MD: published 2004
in eMedicine.com,Inc
5. Corsini, R & Wedding, D.. Current Psychoterapies, 6th
edition.
6. Seligman, L