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Practical Applications of Rational Emotive Therapy
10 CEUs Practical Applications of Rational Emotive Therapy

Section 19
Rational-Emotive Behavior Therapy in the Treatment of Stress

CEU Question 19 | CEU Answer Booklet | Table of Contents | RET CEU Courses
Psychology CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs, Nurse CEUs

Introduction
When mental health professionals examine stress as an object of treatment, we are really talking about the distress, both physical and emotional, that ensues from a series of interpersonal and environmental irritants, or a particularly compelling one. The term `stress' is a broad or generic term applying to many different states and situations that act on the psyche and body to reduce homeostasis (Elliot & Einsdorfer, 1982). The lack of a consistent definition of stress makes any discussion of treatment difficult. After all, stress is not always bad. Yerkes & Dodson demonstrated this over a generation ago. Stress-related arousal frequently serves to enhance performance. In clinical work we typically use the term to apply to those pressures and strains of living that reduce the quality of life, and require changes in the individual to restore homeostasis. We shall also use the term to represent the result of several kinds of dysfunctional or irrational thinking.

REBT and the cognitive psychology of stress
Since REBT is a cognitive-behavioral therapy, let us clarify what we mean by `unconscious'. We do not refer to any dynamism (such as the id or the superego) taking direct action or direct control of behavior. Instead we refer to several cognitive processes that are rapid and require minimal capacity. This principle was set forth by Donald Broadbent more than 35 years ago. He described the mind as a processing system with a limited capacity. That is, we can perceive only a small portion of what we sense, and we can consciously apprehend less than that. Just as we cannot be aware of all the external stimuli to which we are continually exposed, we cannot be simultaneously aware of all of our internal information.

The vast array of experiments utilizing priming methods and implicit learning methods demonstrate that we are not always at one with our mental data base. Priming experiments reveal that our memorial stores can become activated without our awareness (Scarborough et al., 1979; Jacoby & Dallas, 1981; Jacobs & Nadel, 1985). Implicit learning and memory experiments have shown that humans can acquire complex information without any knowledge of having done so (Abrams & Reber, 1988; Reber, 1989). Other cognitive processes that are not always accessible to consciousness are attitudes, biases, schemata, and scripts that are quiescent and unconscious until activated. At that time they influence consciousness rapidly and indirectly, but they are not independent of will. With effort they can be ascertained and, if appropriate, disputed, and replaced with new attitudes, scripts and schemata.

Kahneman et al. (1982) demonstrated that most of us form judgments based on what may be faulty heuristics. They further warned that our acquisition of these heuristics may be involuntary. They and their co-workers have failed to show, however, that if a person is made aware that he or she is making judgments based on a faulty heuristic, and is given an alternative means of making a judgement, he or she will not do so. In most cases, he or she will.

We all possess these underlying prejudices but are only aware of them if they are addressed in some fashion. Most people do not think about how they feel about thin people or fat people until they come upon one of them. Their unconscious attitudes are not inaccessible but can act directly on behavior without directly entering verbal awareness. Other unconscious cognitive processes involve more specific judgments about individuals. We frequently make assessments about a person's nature, beauty or honesty after only a brief view of his or her face. These assessments, too, tend to be based on unconscious judgents (Lewicki, 1985, 1986). Another important phenomenon is based on the declarative-procedural-knowledge distinction. This model shows that we have the ability and knowledge necessary to perform many tasks without any conscious awareness of having it (Cohen & Squire, 1980; Cohen & Corkin, 1981; Jacoby & Witherspoon, 1982). In fact, there is research which indicates that many experts really do not know how they are able to do what they do so well (Nisbett & Wilson, 1977).

In general, then, what we call unconscious, the experimental psychologists tend to refer to as those stages of information processing that occur outside of awareness. In almost all cases these unconscious processes can be made conscious with effort. A similar process occurs in somatoform disorders which tend to occur with high frequency among stress sufferers (Lipowski, 1988; Frost et al., 1988). In these cases the stressed individual begins to exhibit physical symptoms that cannot be clearly pinned down. Of course, many people actually become ill, but are not accurately diagnosed. But those who feel ill without actually being so, do so because of their own beliefs. One of our clients exemplifies this.

The case of Gaetano
Gaetano was referred to the clinic of the Institute for Rational-Emotive Therapy in New York. He had been suffering from severe pains in his neck and jaw. He had consulted an otolaryngologist and a neurologist as well as his family physician. Exhaustive medical testing failed to discover any organic basis for his symptoms.

During therapy Gaetano revealed that he had come from Italy as an adolescent, and was raised in this country with conservative Italian values. He eventually did quite well as a construction manager, and married an American-born businesswoman. Over time the conflict between their two cultures began to greatly distress Gaetano. His wife, Gloria, was `too domineering and too independent'. She came and went as she pleased, and never accepted his authority as `the man' of the household. This led him to create an increasingly violent rage that he had great trouble acknowledging. After a few sessions, he said he had fantasies of killing her. When asked why he did not simply divorce her, he said he could not do so.

The house they lived in was where Gaetano had been raised, and the house his father had died in. To give it up would be both painful and humiliating. He said he could not stand the idea that Gloria could end up owning it: this would be a terrible indignity he could not bear. Thus Gaetano had locked himself into what Miller (1944) called an avoidance-avoidance conflict. He strongly `needed' to avoid his wife, but he also `needed' to avoid the hassles inherent in ending his hated marriage. He began picking up women in bars and sleeping with them in motels. By doing this he felt he was getting justice for the pain his wife was putting him through, but in turn he suffered great guilt. So, feeling trapped, he began to express himself through his neck and jaw pains.

The process by which his situation was converted to physical symptoms began with his irrational beliefs. Some of these were:

(1) `I cannot stand to be with Gloria one more moment.'
(2) `I must get rid of her, even if I have to kill her.'
(3) `Wanting to kill my wife makes me a terrible person.'
(4) `I must not lose my house, it would make me a fool.'
(5) `It would be terrible and dangerous if I let my rage show.'
(6) `I must punish her by sleeping with other women.'
(7) `I'm a terrible worthless man for cheating on my wife.

The irrational beliefs about Gaetano's marriage were like a series of cur-de-sacs. He was trapped, and his growing rage led to increased anxiety and physical tension. But two other factors led to the symptomology, the first being constitutional. Some people appear to possess the innate tendency to express emotions through physical symptoms (Templer & Lester, 1974; Suls & Rittenhouse, 1987). This notion is not new. Alexander (1950) proposed that people with these disorders have a biological predisposition to bring them on. Gaetano probably had this tendency: otherwise he would have probably expressed his distress in more traditional ways.

The second factor was Gaetano's beliefs and feelings about inescapable catastrophe. He saw this as too terrible to be real, so he literally denied its existence, and instead focused on a part of his body that was reacting in a typical way to his stress. The muscle tension in his jaw and head that commonly accompanies many stress reactions was interpreted as an illness. The focus on his illness distracted him from, even relieved him of, the pain of his apparently inescapable dilemma.
Thus when people perceive stressors as being so terrible as to fall outside the domain of any conceivable life event, they may tend to dissociate. In REBT terms, psychophysiological and somatoform disorders often result from extreme awfulising, combined with some additional irrational beliefs. These beliefs may be to the effect that `something bad absolutely will happen to me!' or `any physical symptom proves something terrible is happening to my body!'
Gaetano's therapy focused on three aspects of his difficulty. The first was the system of beliefs that he was in a terrible situation. He was helped to see that although his situation was bad, it was far from so bad as to make life unbearable. He was shown how to increase his frustration tolerance so that he could `stand' to be with his wife until a way out of his circumstances could be found.

His second set of irrational beliefs, that he absolutely must not be enraged and have fantasies of revenge, led to his self-downing. He was shown that although it would have been preferable for him to accept his wife's disagreeable ways without rage, he was not a bad person for feeling enraged. He was also shown that his wife was not the absolutely bad person he was making her out to be, simply because she differed from him and because he could no longer tolerate her.
The final aspect of Gaetano's therapy helped him to work on practical solutions. He was encouraged to tell his wife how he felt and to consult an attorney. After a couple of painful months of legal and domestic negotiations, she agreed to a divorce, and he was able to keep the house. His symptoms vanished.
- Abrams, Michael & Albert Ellis; Rational Emotive Behavior Therapy in the Treatment of Stress; British Journal of Guidance & Counseling; Feb 1994, Vol. 22, Issue 1.

Personal Reflection Exercise #5
The preceding section contained information about rational-emotive behavior therapy in the treatment of stress. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 19
How is stress related to rational-emotive behavior therapy? Record the letter of the correct answer the CEU Answer Booklet.

 
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Practical Applications of Rational Emotive Therapy

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