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STRESS COUNSELLING & STRESS MANAGEMENT: THE RATIONAL EMOTIVE BEHAVIOUR APPROACH
Dr Stephen Palmer interviews Dr Albert Ellis
Interview first published in The Rational Emotive Behaviour Therapist, 3, 2, 82-86, 1995. Republished with permission of the Editors. Copyright, 1999, Palmer and Ellis.
HOW DO YOU APPLY THE THEORY AND PRACTICE OF REBT TO THE FIELD OF STRESS COUNSELLING AND STRESS MANAGEMENT?
In REBT what is normally called stress - but is more accurately called distress - is the anxious feeling created by people when they live with stressors. Because they live in an environment that normally creates problems and difficulties for them that they cannot avoid. There are hassles and problems in any kind of environment. So people try to cope with stressors by trying to minimise them or temporarily get rid of them. But they can choose to react appropriately and helpfully to problems - not to upset themselves about the stressors that occur in the world.
When they feel distress - especially, feel anxious, depressed, enraged, horrified or terrified - they either do too much - act in an overly stressful and compulsive manner - or they run away from their problems, withdraw too much. In REBT we say that when they feel needless distress, they create this distress about stressors largely by thinking irrationally or self-defeatingly (at what we call their belief system). They have a dysfunctional philosophy. They largely create their own distress by over-reacting or under-reacting to the stressors.
If people look at what they are telling themselves, look at their thinking, at their irrational beliefs and self-defeating attitudes, they can change them to preferences instead of absolute musts. They can then experience `normal' stressful reactions. We can even call them `healthy' stressful reactions, because stress (which is a very misused word!) is not in itself self-defeating, though certain kinds of distress are. In other words, people can create healthy tension instead of unhealthy distress.
Humans cannot live without some kind of tension, otherwise they would do practically nothing. Healthy caution, vigilance, and tension help us to react well to the stressors of life, while unhealthy anxiety, despair, horror, and panic help us to become overly stressed and act in an unhealthy manner to these stressors. That is the REBT theory of stress - or of distress or unhealthy anxiety, as I prefer to think of it.
IN STRESS COUNSELLING AND STRESS MANAGEMENT, REBT SOMETIMES ADVOCATES THE USE OF PALLIATIVE TECHNIQUES SUCH AS MEDITATION AND RELAXATION EVEN THOUGH THIS IS NOT AN ELEGANT SOLUTION. WHY DOES IT DO THAT?
The two main ways in which people reduce their distress, anxiety, and over-concern (as opposed to their concern, caution, and vigilance) are:
First, by using various kinds of distraction. Instead of thinking about a stressful situation and then `awfulising' about it - i.e. horrifying and panicking themselves - they can think of something else instead. Instead of focusing on the stressor, they focus on a workable distraction, of which there are many kinds. One ancient, time-honoured kind of distraction is meditation. To use it, you think about your thoughts or monotonously say `um, um' or whatever to yourself. If you do this correctly, your mind is not able to worry at the same time. Another example is yoga, which is an exercise that you have to focus on doing. There are many other kinds of distraction. Jacobson's relaxation technique, biofeedback, etc. There are literally scores of things you can think about intently; and, if you do so, your mind is not at the same time able to overstress itself, to create worry, anxiety, or panic.
All of these techniques will temporarily calm you and your body. In Jacobson's relaxation technique, for example, you focus on relaxing your muscles. But you can also think of pleasant scenes - a running brook, the waves of the ocean or something pleasant in your life - and this relaxes your body and distracts you mentally from your overconcern about your problem. So if you want to stop panic quickly you can use any of these distraction methods and your panic will subside.
We recommend, however, that after you use distraction methods, you do not just stop there. Because whatever you think to create your panic you will tend to return to. When you bring on distress with anxiety- or stress-creating beliefs, your meditation or other kind of distraction will temporarily shunt them away. But it will not really change your irrational beliefs or your demands that the stressors of must not exist.
The second - and main - technique that REBT recommends is for distressed people to acknowledge their irrational beliefs - the horrorising and awfulising that really created the acute distress - and to dispute them and change them into healthy, self-helping beliefs. Horrorising beliefs, again, include demands and `musts'. `I must do well'. `I must cope with this situation adequately'. `people must treat me better than they are treating me ... must treat me fairly, kindly, considerately'. `Conditions, the stressors of my life, must not be too serious and must be relatively easy to cope with'. When feeling deeply distressed, people strongly, devoutly believe in these `musts'.
First they take the stressors, which are either normal or unusual or traumatic, and they make them into `haulocausts', which their body then reacts to. When they're really panicked their body usually overreacts to their belief system. And then when they notice that their body overreacts, especially in panic states, they have `musts', `shoulds', and `oughts', and commands about those bad body states. They say things to themselves like, `Oh my God I panicked! I must not be panicked! It's awful to be panicked! I can't stand panic!'. They thereby increase their distress. They bring up primary neurotic disturbance, usually by taking some stressor too seriously, exaggerating how bad it is. Their primary reaction creates what we call deep stress or anxiety. Then they frequently add, `I must not be plagued with my distress, my stress, my anxiety!'. Then they plague themselves more!
So, using REBT, we may employ distraction techniques - yoga, meditation, Jacobson's relaxation techniques, thinking of pleasant scenes, biofeedback. All of these may work, if used properly, to temporarily allay the dire feelings of distress and some of the physical sensations which tend to go with these feelings. However they don't get to the core philosophies and beliefs, attitudes, that move humans from health, caution and vigilance to unhealthy hypertension and anxiety.
Using REBT, we may first try to help people calm themselves down with these distraction/relaxation techniques, but then acknowledge and change their main contribution to the real feeling of distress - their irrational `musts', `oughts', `shoulds', commands, awfulising, `I can't stand it' damnation of themselves and other people. And their horror that because things have happened badly this time they'll always keep occurring and never stop. So we want them to get to these either with or without using relaxation techniques. Distressed people can directly dispute their self-disturbing musts - can do so after they use suitable relaxation techniques.
HOW ARE REBT STRESS THERAPY GROUPS OR STRESS MANAGEMENT GROUPS RUN?
It depends on the kind of groups. In regular group therapy at the Institute for Rational Emotive Therapy in New York, the members of the group are distressed in various ways, not in the same way. We usually have several different kinds of people in a group -and they bring up their feelings (`I felt upset, anxious, or depressed this week'). Then I and the other group members question each person about what they were telling themselves just before they felt serious distress or anxiety.We help them to see their irrational musts and demands and show them how to dispute and act against them. All the people in the group are taught the ABCs of rational-emotive behaviour therapy - shown how stressors contribute significantly to feelings of deep distress. They probably wouldn't feel deeply stressed if everything was nice in their lives. But the members are also shown that the main contribution or cause, the most direct cause of distress, is what they tell themselves, how they horrify themselves about the stressors with `I must do well', `people must treat me well' etc.
Using REBT, we show each individual how to dispute musturbatory beliefs, ask `Where is the evidence that I must do well?'; `How does it follow that if I do poorly I'll always fail, never succeed?'; `Prove that I'm a bad person for acting badly in this situation?'
We dispute logically and empirically and pragmatically the demands that people are making to create their real distress about stressors. We show them how to stop horrifying themselves about their stressor. We hope that we help distressed people to construct an effective new philosophy: `Yes, it is pretty bad, this stressful situation that is occurring, and I certainly don't like it and I hope I succeed in changing it for the better. But it's not awful and terrible and even if I can't change or improve it, I can still live with it and live a happy life, though less happy than without it'.
So we try to get distressed people to see what they're doing to upset themselves, distress themselves about stressors. But as we do this we go back to the stressor, the activating event, and try to see if they can really do something to change it, improve it, or get rid of it. This may consist of all kinds of practical solutions, like doing better at work, getting a new job, talking to one's co-workers. There are many ways of problem-solving about stressors. Usually in REBT, though not always, we try to help people feel less upset first, so that we can help them do better problem-solving.
When we're dealing with a small group, we go through the current distress of all of them and show them what they're doing to create it or exacerbate it, and what they can do to eliminate or minimise it, and then how they can go back to the stressors and sometimes quickly change them significantly. With a large group - because we can do stress management in a large group -we give them lectures and demonstrations, in which we show some of them how to reduce their distress. Then we give them a series of exercises, such as my famous shame-attacking exercise. To perform this, they deliberatly do something `shameful' and risky, that they ordinarily would distress themselves about if others laughed at them for doing it. Like singing out loud in public, for example, or discussing their sex life with a stranger. We show them how to do this presumably shameful thing, but to prepare themselves by having a sensible philosophy about it, so they don't put themselves down for being laughed at or for doing it badly.
We have a whole host of REBT exercises we can teach distressed people. However, the way we work to cope with the distress in group therapy clients, who are usually pretty severely anxious and disturbed about the stressful things that are happening to them, is not the same as how we would work with a group of business employees who may not be so disturbed but are interested in solving their practical business problems. The two groups would be similar in that we would try to help all the members to see their own irrational and self-defeating thoughts about stressors and change these demands to rational preferences. But depending on how large the group is, its goals, and the level of disturbance of the group members, we would handle distress in a somewhat different manner.
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