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The Theory and Method of Psychotherapists and NJ Psychologists Dr. Abrams' Psychotherapeutic Approach  


Below are publications by Dr. Abrams and Dr. Albert Ellis generally considered to be the  founder of all modern therapies and before that was the first full time sex therapist..  Dr. Mike Abrams  studied and collaborated with Dr. Ellis for 17 years.  Dr. Ellis developed Rational Emotive Behavior Therapy which was the first of the cognitive or cognitive behavior therapies. The linchpin of this approach is avoidance of moral judgments and the striving to understand all problems from the client's point of view. CBT has been researched to be effective irrespective of the history of the person seeking help.. REBT and CBT rejects the unsupported conjecture of unconscious transference and, therefore, accepts all client actions, emotions, and communications as real and legitimate. Its humanistic perspective holds that each individual has developed his or her own unique construction of the world, that must be understood and appreciated before any psychotherapeutic intervention can be developed. Importantly, when a person is anxious,despondent, or otherwise feeling or behaving in a non-optimal way it is because the person's construction of the world is not allowing the individual function optimally. Thus, REBT and CBT will help you find those aspects of your world-view, your personal philosophy, or your beliefs that have become the source of your distress, fear, or despair. Working together with you he will help change those constructions that are keeping you from reaching your personal best


Article on  Stress by NYC psychologists Dr. Mike Abrams and Dr. Albert Ellis


Couples Counseling and Intimacy by  Dr. Mike Abrams a


PDF's for your Download
Is Psychoanalysis Harmful? by Dr. Albert Ellis (click for PDF)



Help for Couples by Dr. Mike Abrams (click for PDF)



Cognitive Behavior Therapy for Stress by Dr. Mike Abrams & Dr. Albert Ellis (click for PDF)



Dr. Mike Abrams' approaches life problems by continually listening for client beliefs that lead to emotional distress.  This humanistic technique is applicable to social, interpersonal, family, and sexual problems. He is among the few psychologists in New York City  Board who is Certified in these methods.  Below are some of the core beliefs that cause emotional disturbance.


The Core Irrational Beliefs of REBT

12 Self-defeating Beliefs  

12 Rational Beliefs

1.  I need love and approval from those    significant to me - and I must avoid disapproval from any source.

1. Love and approval are good things to have, and I'll seek them when I can. But they are not necessities - I can survive (even though uncomfortably)  without them.

2.  To be worthwhile as a person I must achieve, succeed at what ever I do, and  make no mistakes.

2.   I'll always seek to achieve as much as I  can - but unfailing success and  competence is unrealistic. Better I just accept myself as a person, separate to my   performance.

3.  People should always do the right thing. 
When they behave obnoxiously, unfairly or selfishly, they must be blamed and  

3.   It's unfortunate that people sometimes do 
 bad things. But humans are not yet   perfect - and upsetting myself won't  change that reality.

4.  Things must be the way I want them to  be - otherwise life will be intolerable.

4.  There is no law which says that things   have to be the way I want. It's disappointing, but I can stand it -   especially if I avoid catastrophising.

5.  My unhappiness is caused by things  outside my control - so there is little I can   do to feel any better. 

5.  Many external factors are outside my  control. But it is my thoughts (not the  externals) which cause my feelings. And I   can learn to control my thoughts.

6.  I must worry about things that could be dangerous, unpleasant or frightening - otherwise they might happen.

6.  Worrying about things that might go  wrong won't stop them happening. It will,  though, ensure I get upset and disturbed   right now!

7.    I can be happier by avoiding life's difficulties, unpleasantness, and  responsibilities.

7.  Avoiding problems is only easier in the short term - putting things off can mak  them worse later on. It also gives me more  time to worry about them!

8.   Everyone needs to depend on someone stronger than themselves.

8.  Relying on someone else can lead to dependent behavior. It is OK to seek help - as long as I learn to trust myself and my own judgment.

9.  Events in my past are the cause of my problems - and they continue to influence  my feelings and behaviors now.

9.  The past can't influence me now. My  current beliefs cause my reactions. I may  have learned these beliefs in the past,     but can choose to analyze and change   them in the present.

10. I should become upset when other people  have problems and feel unhappy when they're sad.

10. I can't change other people's problems and bad feelings by getting myself upset.

11. I should not have to feel discomfort and  pain - I can't stand them and must avoid   them at all costs.

11.  Why should I in particular not feel  discomfort and pain? I don't like them,  but I can stand it. Also, my life would be  very restricted if I always avoided  

12. Every problem should have an ideal solution, and it is intolerable when one  can't be found.

12. Problems usually have many possible  solutions. It is better to stop waiting for the perfect one and get on with the best available. I can live with less than the   ideal.



The Philosophy of Rational Emotive Behavior therapy and Cognitive behavior therapy.  Dr. Mike Abrams and Dr. Lidia assiduously apply this philosophy with all of their clients.

  Rational Emotive Behavior Therapy is a comprehensive approach to psychological
treatment that deals not only with the emotional and behavioral aspects of human
disturbance, but places a great deal of stress on its thinking component. Human beings are
exceptionally complex, and there neither seems to be any simple way in which they
become “emotionally disturbed,” nor is there a single way in which they can be helped to
be less-defeating. Their 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.
REBT is based on the assumption that what we label our “emotional” reactions are
largely caused by our conscious and unconscious evaluations, interpretations, and
philosophies. Thus, we feel anxious or depressed because we strongly convince ourselves
that it is terrible when we fail at something or that we can’t stand the pain of being
rejected. We feel hostile because we vigorously believe that people who behave unfairly
to us absolutely should not act the way they indubitably do, and that it is utterly
insufferable when they frustrate us.
Like stoicism, a school of philosophy that existed some two thousand years ago,
rational emotive behavior therapy holds that there are virtually no good reasons why
human beings have to make themselves very neurotic, no matter what kind of negative
stimuli impinge on them. It gives them full leeway to feel strong negative emotions, such
as sorrow, regret, displeasure, annoyance, rebellion, and determination to change social
conditions. It believes, however, that when they experience certain self-defeating and
unhealthy emotions (such as panic, depression, worthlessness, or rage), they are usually
adding an unrealistic and illogical hypothesis to their empirically-based view that their
own acts or those of others are reprehensible or inefficient and that something would
better be done about changing them.
Rational emotive behavior therapists — often within the first session or two of
seeing a client — can almost always put their finger on a few central irrational
philosophies of life which this client vehemently believes. They can show clients how
these ideas inevitably lead to emotional problems and hence to presenting clinical
symptoms, can demonstrate ex actly how they forthrightly question and challenge these
ideas, and can often induce them to work to uproot them and to replace them with
scientifically testable hypotheses about themselves and the world which are not likely to
get them into future neurotic difficulties.
Rational therapy holds that certain core irrational ideas, which have been clinically
observed, are at the root of most neurotic disturbance. They are:
(1) The idea that it is a dire necessity for adults to be loved by significant others for
almost everything they do — instead of their concentrating on their own self-respect, on
winning approval for practical purposes, and on loving rather than on being loved.
(2) The idea that certain acts are awful or wicked, and that people who perform such acts
should be severely damned — instead of the idea that certain acts are self-defeating or
antisocial, and that people who perform such acts are behaving stupidly, ignorantly, or
neurotically, and would be better helped to change. People’s poor behaviors do not make
them rotten individuals.

(3) The idea that it is horrible when things are not the way we like them to be — instead
of the idea that it is too bad, that we would better try to change or control bad conditions
so that they become more satisfactory, and, if that is not possible, we had better
temporarily accept and gracefully lump their ex istence.

(4) The idea that human misery is invariably externally caused and is forced on us by
outside people and events — instead of the idea that neurosis is largely caused by the
view that we take of unfortunate conditions.
(5) The idea that if something is or may be dangerous or fearsome we should be terribly
upset and endlessly obsess about it — instead of the idea that one would better frankly
face it and render it non-dangerous and, when that is not possible, accept the inevitable.
(6) The idea that it is easier to avoid than to face life difficulties and self-responsibilities
— instead of the idea that the so-called easy way is usually much harder in the long run.
(7) The idea that we absolutely need something other or stronger or greater than
ourselves on which to rely — instead of the idea that it is better to take the risks of
thinking and acting less dependently.

(8) The idea that we should be thoroughly competent, intelligent, and achieving in all
possible respects — instead of the idea that we would better do rather than always need to
do well and accept ourselves as a quite imperfect creature, who has general human
limitations and specific fallibilities.
(9) The idea that because something once strongly affected our life, it should indefinitely
affect it — instead of the idea that we can learn from our past experiences but not be
overly-attached to or prejudiced by them.
(10) The idea that we must have certain and perfect control over things — instead of the
idea that the world is full of probability and chance and that we can still enjoy life despite

(11) The idea that human happiness can be achieved by inertia and inaction — instead of
the idea that we tend to be happiest when we are vitally absorbed in creative pursuits, or
when we are devoting ourselves to people or projects outside ourselves.
(12) The idea that we have virtually no control over our emotions and that we cannot
help feeling disturbed about things — instead of the idea that we have real control over
our destructive emotions if we choose to work at changing the musturbatory hypotheses
which we often employ to create them.
1.  De-emphasis of early childhood. While REBT accepts the fact that neurotic states
are sometimes originally learned or aggravated by early teaching or irrational beliefs by
one’s family and by society, it holds that these early-acquired irrationalities are not
automatically sustained over the years by themselves.
  Instead, they are very actively and creatively re-instilled by the individuals
themselves. In many cases the therapist spends very little time on the clients’ parents or
family upbringing; and yet helps them to bring about significant changes in their
disturbed patterns of living. The therapist demonstrates that no matter what the clients’
basic irrational philosophy of life, nor when and how they acquired it, they are presently
disturbed because they still believe this self-defeating world- and self-view. If they will
observe exactly what they are irrationally thinking in the present, and will challenge and
question these self-statements they will usually improve significantly.
2.  Emphasis on deep philosophical change and scientific thinking. Because of its
belief that human neurotic disturbance is largely ideologically or philosophically based,
REBT strives for a thorough-going philosophic reorientation of a people’s outlook on
life, rather than for a mere removal of any of their mental or psychosomatic symptoms. It
teaches the clients, for ex ample, that human adults do not need to be accepted or loved,
even though it is highly desirable that they be. REBT encourages individuals to be
healthily sad or regretful when they are rejected, frustrated, or deprived. But it tries to
teach them how to overcome feelings of intense hurt, self-deprecation, and depression. As
in science, clients are shown how to question the dubious hypotheses that they construct
about themselves and others. If they believe (as alas, millions of us do), that they are
worthless because they perform certain acts badly, they are not merely taught to ask,
“What is really bad about my acts?” and “Where is the evidence that they are wrong or
unethical?” More importantly, they are shown how to ask themselves, “Granted that my
acts may be mistaken, why am I a totally bad person for performing them? Where is the
evidence that I must always be right in order to consider my-self worthy? Assuming that
it is preferable for me to act well rather than badly, why do I have to do what is

  Similarly, when people perceive (let us suppose, correctly) the erroneous and unjust
acts of others, and become enraged at these others, they are shown how to stop and ask
themselves, “Why is my hypothesis that the people who committed these errors and
injustices are no damned good a true hypothesis? Granted that it would be better if they
acted more competently or fairly, why should they have to do what would be better?”
REBT teaches that to be human is to be fallible, and that if we are to get on in life with
minimal upset and discomfort, we would better accept this reality — and then
unanxiously work hard to become a little less fallible.

3.  Use of psychological homework. REBT agrees with most Freudian, neo-Freudian,
Adlerian, and Jungian schools that acquiring insight, especially so-called emotional
insight, into the source of their neurosis is a most important part of people’s corrective
teaching. It distinguishes sharply, however, between so-called intellectual and emotional
insight, and operationally defines emotional insight as individuals’ knowing or seeing the
cause of their problems and working, in a determined and energetic manner, to apply this
knowledge to the solution of these problems. The rational emotive behavior therapist
helps clients to acknowledge that there is usually no other way for him to get better but by
their continually observing, questioning, and challenging their own belief-systems, and by
their working and practicing to change their own irrational beliefs by verbal and
behavioral counter-propagandizing activity. In REBT, actual homework assignments are
frequently agreed upon in individual and group therapy. Assignments may include dating
a person whom the client is afraid to ask for a date; looking for a new job; experimentally
returning to live with a husband with whom one has previously continually quarrelled;
etc. The therapist quite actively tries to encourage clients to undertake such assignments
as an integral part of the therapeutic process.

The REBT practitioner is able to give clients unconditional rather than conditional
positive regard because the REBT philosophy holds that no humans are to be damned for
anything, no matter how execrable their acts may be. Because of the therapist’s
unconditional acceptance of them as a human, and actively teaching clients how to fully
accept themselves, clients are able to express their feelings more openly and to stop rating
themselves even when they acknowledge the inefficiency or immorality of some of their
  In many highly important ways, then, rational emotive behavior therapy utilizes
expressive-experimental methods and behavioral techniques. It is not, however, primarily
interested in helping people ventilate emotion and feel better, but in showing them how
they can truly get better, and lead to happier, non-self-defeating, self-actualized lives.

Dr. Mike Abrams and Dr. Albert Ellis

British Journal of Guidance & Counselling; Feb94, Vol. 22 Issue


ABSTRACT Rational emotive behavior therapists view stress-related
disorders as originating in irrational beliefs (iB's), philosophies and
attitudes, as opposed to the stressor. People who suffer from stress
differ from people who suffer from emotional or neurotic problems mainly
in that the stressed people have iB's about specific, short-term or more
readily identifiable events, as opposed to the more mundane and diffuse
difficulties suffered by the neurotic individual. Both the conscious and
unconscious antecedents to stress difficulties and how they relate to
distorted thinking and psychophysiological disorders are discussed from
an information-processing perspective. Rational emotive behaviour
treatments for stress-related disorders are detailed and explained.


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

Does `stress' exist?

The key issue for the rational emotive behaviour therapist is: how does
the environmental irritation become oppressive? The answer is largely
found within the stressed individual, not in the events. It is quite
clear that the very same event will produce physiological or emotional
arousal in one set of individuals and virtually no reaction in others.
How then do the dysfunctional emotional and physical states that we call
stress come about?

The answer is simple: stress does not exist. There is no iconoclasm
intended here. We mean it quite literally: stress does not exist in
itself. Stress is like good or evil: it exists only in its perceptions
and reactions of the beholder (or the stressee). To quote Shakespeare:

Hamlet: Why, then 'tis none to you; for there is nothing either good or
bad but thinking makes it so....

The evidence proves the same for stress. There is nothing intrinsically
stressful or assuaging but thinking makes it so (Ellis & Abrahms, 1978).
This is the foundation of the rational emotive behaviour treatment for
stress-related and most emotional disorders (Ellis, 1962). Specifically,
the rational emotive behaviour therapist works to bring the individual
who is quite distressed by events in his or her environment to a state
of mind similar to that of one who does not respond excessively to the
same putative stressors. Only on rare occasions can a therapist help his
or her client by eliminating their problem for them. The therapist is
most effective in changing the client's reaction to the problem, which
will tend to persist despite the best efforts of most clients and
therapists. Specifically, the REBT therapist will seek first and
pre-eminently to change the client's philosophies, attitudes and beliefs
which lead to disturbance.

Stress v. other disturbances

Those who react to activating events (A's) with severe stress differ
from those who have other disturbances in several key ways. First,
stress tends to be more associated with physical illnesses or symptoms
than do other psychological reactions. Second, stress reactions tend to
be based on a single `catastrophic' event or a group of noxious events
that linger over time. This is in contrast to someone who suffers from,
for example, chronic anxiety in which there tend to be a large array of
activating events that ultimately lead to anxiety. In REBT terms, in
stress reactions the A's are often more salient in the formula than the
B's (the person's beliefs). This is particularly true of a particular
kind of stress, post-traumatic stress disorder (PTSD), where the A's are
so stark, unpredictable and harmful (such as rape, incest, or torture)
that a large percentage of `normal' people, who would take less noxious
events in good stride, tend to upset themselves severely and bring on
terrifying flashbacks and nightmares for a period of years (Warren et
al., 1989, 1990; Ellis, 1993).

Thus people with generalised anxiety require very little in the way of
activating events (A's) to perpetuate their anxiety: their own
compelling belief system about possible A's is usually sufficient. In
contrast, the person suffering from a stress reaction can usually point
to some objectively bad events that are the impetus of his or her
malaise. This has the disadvantage of reinforcing the apparent
connection between the A and the C. The stressed individual will
conclude that `my job is giving me an ulcer', or `my husband's temper is
giving me these migraines', and so on. As we will show later on, one
prime goal of rational emotive behaviour therapy is to demonstrate to
the client that the activating event does not by itself cause his or her
psychological or psychophysiological consequence: his or her beliefs
about the event do!

Physiological and psychological reactions

Irrational beliefs and self-defeating styles are the essential origin of
stress (Decker et al., 1982; Vestre & Burnis, 1987; Forman et al.,
1987). However, the individual's particular reaction to stress tends to
be constitutional. Let us examine for a moment the psychophysiological
disorders that develop or worsen as a direct result of stress. These
include digestive system ulcers, hypertension, migraine and tension
headaches, lower back pain, temporo-mandibular joint syndrome, sciatica,
lupus, multiple sclerosis, and others. We do not suggest that there is a
linear correspondence between these stress-related illnesses and
irrational beliefs. Rather, we have found that irrational beliefs are
the foundation of the prolonged arousal and the emotional anguish that
has been shown to be the prime cause of most ills associated with stress
(Larbig, 1978; Woods & Lyons, 1990; Hart et al., 1991).

The process by which irrational beliefs lead to psychophysiological
disorders closely follows Selye's general adaption syndrome. The process
begins with some activating event in the person's environment. The
person then either consciously or unconsciously evaluates this event as
good, bad, dangerous, or unjust, based on his or her belief systems. At
this point there follows arousal of the autonomic nervous system. With
continued arousal, the weakest systems in the body begin to break down.
The unconscious aspects of this process also makes stress disorders more
difficult to treat than those disorders in which there is a reaction to
an overt problem.

REBT and the cognitive psychology of stress

Since REBT is a cognitive-behavioural 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 behaviour.
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 utilising 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

Kahneman et al. (1982) demonstrated that most of us form judgements
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 judgements 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 behaviour without directly entering verbal awareness. Other
unconscious cognitive processes involve more specific judgements 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 judgements (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

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.

Irrational beliefs and stress

Rational emotive behaviour therapy (REBT) predicates its treatment of
most neurotic problems on the hypothesis that humans, to varying
degrees, endorse and act on convictions that are self- and
socially-defeating. These partially learned and partly constructed
irrational beliefs lead to a significant portion of psychological
difficulties. There are other factors involved in mental disorders, but
these can only be partially addressed with psychotherapy. The other
causes are genetic, biochemical, and structural. Psychotherapy
indirectly treats these other ailments in the same way that it helps
with other problems of life that are unyielding--by helping people
change what they can change, and accept and endure what they cannot

REBT uses a simple model in its system of therapy: the ABCDE model. The
A refers to an unfortunate activating event in people's lives that
results in a dysfunctional behavioural or emotional reaction. B is the
belief system that largely determines or regulates their response to the
A. C is their disturbed consequence to the A and B. D refers to the
disputing that challenges their irrational disturbance-creating beliefs.
Finally, E is their effective new philosophy that they are encouraged to

In most discussions of REBT, the C (consequences) refers to emotional
reactions. However, in the case of stress the C is often organic or
physical symptoms. This is very similar to the model of stress adopted
by the National Academy of Sciences (Dollahite, 1991) which expressed
stress reactions in terms of an xyz model. In their version they refer
to the x as the potential activator, the y as the individual's reactions
to the potential activator, and the z as the consequence of the x's and
y's. The authors also label interactions between the x's and y's as
mediators. These researchers came to the same conclusion that I (AK)
came to in 1955. External events do not by themselves result in
disturbance-whether stress or any other kind. The range of reactions to
unpropitious events is so wide that people's perceptions and evaluations
of these events are the prime mediators of their reaction (Ellis, 1962,
1978, 1985a, 1988, 1991; Ellis & Dryden, 1987).

The cognitive process that facilitates the creation of stress almost
always involves irrational beliefs (Woods, 1987; Vestre & Burnis, 1987;
Forman, 1990; Henry et al., 1991). These have been detailed extensively
in previous articles and books, but briefly they include rigid,
inflexible, and usually unexamined beliefs, personal philosophies and
attitudes that we all possess to varying degrees. These can take the
form of unconditional demands, such as: `I have to be successful!'; `All
people who have hurt me must be severely punished!'; `I absolutely must
be physically competent and healthy or life is terrible!'

Negatively distorted judgements (awfulising) are also efficient stress
producers. Some typical ones are: `It would be awful if I were to lose
this case!'; `I couldn't stand to be fired'; `I am totally worthless if
I lose my business!'

Beliefs based on absolute social needs commonly produce stress
reactions. People create traps for themselves with musts that often
cannot be satisfied: `I must get the respect of or love from all
significant people!'; `Other people must respect my needs!'

Stress reactions to irrational thinking differ in one important way from
other disturbed consequences (C) in that the stressed individual tends
to link a number of irrational conclusions together into an overwhelming
whole. The woman who is vying for a promotion and is asked to produce a
key business report on a near-impossible deadline, all the while seeking
to get home early enough to get her child out of day care, will tend to
experience stress. But let us examine the underlying beliefs and demands
that transform these social pressures into her experience of stress. The
stress process begins with her compelling desire to get the promotion,
which becomes the demand: `I must get a promotion and I will be a total
failure if I blow it!' or `I must get the promotion or I'll never get
anywhere!' Next, she becomes aware of the deadline, and further elevates
her arousal with a belief like: `If I don't get the report in by
tonight, they'll know I'm not competent, and that would be awful!', or
`I'll never get it done right in the time they have given me, and
they'll see what an incompetent person I am!'

Research has provided compelling evidence that complex cognitive
processes, like speech, becomes automatic and extremely rapid with
repetition (Posner & Snyder, 1974). Thus habitual statements, like the
preceding, will at times be subtle and rapid. So it requires effort to
first bring them into awareness and then to practice disputing them once
we clearly see them. Without the effort to understand these irrational
cognitions, we are at their mercy. As noted above, experimental
psychology has demonstrated that many judgments occur rapidly, and
sometimes outside of awareness, and that they often result in emotional
changes (Foster & Grovier, 1978; Kunst-Wilson & Zajonc, 1980; Zajonc,
1984). It is difficult, if not impossible, to physically control these
reactions. But a change in personal philosophy ultimately leads to the
cognitive changes that can bring them under control.


Rational emotive behaviour therapy uses a large number of cognitive,
emotive and behavioural techniques to help people who over-react to
stressors and who add to their appropriate feelings of concern,
displeasure, and frustration about these stressors, inappropriate,
self-defeating feelings of severe stress, anxiety, and panic. Thus,
rational emotive behaviour practitioners often use biofeedback and
relaxation techniques (Fried & Golden, 1989; Fried, 1990), hypnosis
(Ellis, 1985b; Stanton, 1989), self-instructional training (Meichenbaum,
1977), meditation and yoga (Benson, 1975; Ellis, 1984; Goleman, 1993),
behavioural exercises (Ellis & Abrahms, 1978) and other methods that
other therapists use.

In addition to these traditional methods, REBT usually includes a number
of special cognitive techniques, especially active-directive disputing
(D) of clients' dysfunctional and irrational beliefs (B). Thus, when a
rational emotive behaviour therapist works with someone suffering from
stress-related disorders, the first step usually involves finding the
events that the client is making stressful. The next critical step
involves finding the beliefs, attitudes and personal philosophies by
which clients convert the perceptions to dysphoria. It is this aspect of
REBT that most tests the skill of the therapist.

Many clients seeking help for stress-related disorders feel trapped by
the events that are distressing them. They typically have strong
convictions in the absolute badness of these happenings. Therapists
therefore need to be sensitive and cautious in challenging these
beliefs. Clients suffering from severe stressors are convinced, either
overtly or implicitly, that these `terrible' things are the direct and
only cause of their problems. Helping them come to see that the things
are indeed bad but that their `terribleness' is largely their own
creation will be resisted unless therapists first establish that they
empathetically accept the clients' suffering as real. Perhaps the worst
thing any therapist can do is to dismiss a particular stressor as
`insignificant' or `minor'. If the client perceives it as monumental,
the therapist had better accept this as the starting point.

The next step is to find the specific beliefs, philosophies, and
attitudes that create stress. This can be accomplished by interviewing
clients about their feelings when they encounter stressors. Once their
disturbed emotions are clarified, the therapist in collaboration with
the client probes for the irrational beliefs and dogmas that create
stress reactions, and shows clients how to actively and forcefully
dispute (D) these beliefs (B).

More specifically, REBT teaches clients how to do the following

*    Disputing absolute musts: `Why must I always succeed and
experience no unfortunate hassles'? Answer: `I never have to succeed,
though I would very much prefer to do so. I really have to experience
many unfortunate hassles because that is the nature of normal living.
It's too damned bad-but hardly awful or terrible.'
*    Disputing I-can't-stand-it-itis: `Where is the evidence that I
can't stand these stressors that are now occurring?' Answer: `Only in my
nutty head! I won't die of them and can be happy in spite of them.
They're not horrible but only bearably painful!'
*    Disputing feeling of worthlessness: `Is it true that I am an
inadequate, worthless person if I do not handle stressful conditions
well and even make them worse?' Answer: `No, I am a person who may well
be acting inadequately at this time in this respect but I am never a
totally worthless (or good) person, just a fallible human who is doing
my best to cope with difficult conditions.'

As REBT shows people how to look for their absolutist shoulds, oughts,
and musts, and for their awfulising, can't-stand-it-itis, and
self-downing about the stressors that they experience, it also employs a
number of other cognitive methods that it has invented or adopted to
help people change their dysfunctional thinking for more effective and
less disturbing thinking. Thus it uses reframing, and shows clients how
to find good things in some of the bad things that happen to them and
how to accept the challenge of not upsetting themselves when they are
under unusual stress. It helps them, when they procrastinate or are
addicted to harmful feelings and behaviours, to referent a number of
disadvantages of what they are doing and to forcefully go over them
several times a day, so as to plant them into their consciousness. It
`works out' with clients' coping rational self-statements, particularly
philosophical ones, that they keep using to face some of the worst
stressors and to refuse to upset themselves about. Such as: `Yes, I am
really under great strain right now and there is nothing that I can do
about relieving some of it, but I don't have to eliminate it and I can
lead a reasonable happy life even if these difficulties continue.'

Rational emotive behaviour therapy encourages clients to do cognitive
homework, including the steady filling out of the REBT Self-Help Form
(Sichel & Ellis, 1984). This helps them to find and dispute their
irrational beliefs. It provides them with psychoeducational materials,
such as pamphlets, books, and audiovisual cassettes, that show them how
to use rational-emotive anti-disturbing and problem-solving methods
(Ellis, 1978, 1988; Ellis & Harper, 1975). It encourages them to record
their therapy sessions and to listen to these several times. It pushes
them to learn REBT methods and to teach them to others, so as to implant
them into their own hearts and heads. It shows them how to model
themselves after other individuals who have coped well with stressors.

Rational emotive behaviour therapy always uses a number of
emotive-evocative, dramatic methods to help individuals cope with stress
situations. Thus it teaches them how to use rational-emotive imagery
(Maultsby, 1971), in the course of which they work on their disturbed
feelings when they imagine a very stressful event happening, and change
these to appropriate feelings of sorrow, regret, and frustration. It
encourages them to do its famous shame-attacking exercises (Ellis, 1973,
1988) and learn to deliberately do foolish and ridiculous acts in public
and not to upset themselves or put themselves down when others
disapprove of them for doing these acts. It show them how to create and
use very forceful and dramatic coping statements to change some of their
disturbance-creating thoughts and feelings. It encourages them to
tape-record some of their worst irrational beliefs and to strongly
dispute them on tape, and then let their therapists and other people
listen to their disputations to see how forceful they really are. It
provides them with rational humorous songs and other humorous ways of
interfering with their taking stressors too seriously (Ellis, 1987).

Behaviourally, REBT employs a number of action methods to help people
overcome their overly stressful reactions to the difficulties of their
lives. Thus, it encourages them to use in vivo desensitisation and
exposure methods to overcome some of their irrational fears. It shows
them how they can deliberately stay in poor situations (e.g. remain in a
job where their supervisor is hostile and negative) until they give up
their own feelings of horror and terror-and then decide whether to leave
these situations. It shows them how they can reinforce themselves when
they do REBT homework that they agree to do and penalise themselves when
they fail to do it. It gives them skill training in important areas
where they feel very stressed, so that they will function better and
enjoy themselves more in these areas. Thus it often provides clients
with assertion, communication, relationship, and social skills training.

As usual, then, rational emotive behaviour therapy uses a good number of
cognitive, emotive, and behavioural methods, some of which are special
to REBT, to help people make their lives less stressful and to cope with
stressors that they cannot change. It especially tries to help them push
themselves to improve unpleasant social and environmental situations;
but to unconditionally accept themselves, other people, and the world,
even when unusually stressful conditions persist. As Hauck (1977) points
out, when people are faced with unpleasant situations, they have three
main choices: to change, stay with, or leave them. Whichever of these
choices them make, REBT endeavors to help them accomplish it with a
minimum of stress or emotional disturbance. Severe stressors are often
inevitable; undue stress about them is not.


ABRAMS, M. & REBER, A.S. (1988) Implicit learning: robustness in the
face of psychiatric disorders, Journal of Psycholinguistic Research, 17,
pp. 425-439.

ALEXANDER, F. (1950) Psychosomatic Medicine: its Principles and
Applications (New York, Norton).

BENSON, H. (1975) The Relocation Response (New York, Morrow).

COHEN, J.J. & CORKIN, S. (1981) The amnesic patient, H.M.: learning and
retention of a cognitive skill, Society for Neuroscience Abstracts, 7,
p. 235.

COHEN, K.M. & SQUIRE, L.R. (1980) Preserved learning and retention of
pattern-analyzing skill in amnesia: dissociation of knowing how and
knowing that, Science, 210, pp. 207-210.

DECKER, T.W., WIILIAMS, J.M. & HALL, D. (1982) Preventive training in
management of stress for reduction of physiological symptoms through
increased cognitive and behavioral controls, Psychological Reports, 50,
pp. 1327-1334.

DOLLAHITE, D.C. (1991) Family resource management and family stress
theories: toward a conceptual integration, Lifestyles, 12, pp. 361-377.

ELLIOT, G.R. & EINSDORFER, C. (1982) Stress and Human Health: Analysis
and Implications of Research (New York, Springer).

ELLIS, A. (1962) Reason and Emotion in Psychotherapy (Secaucus, NJ,

ELLIS, A. (1975) How to Live With an Neurotic: at Home and at Work
(Hollywood, CA, Wilshire Books).

ELLIS, A. (1973) How to stubbornly refuse to be ashamed of anything
(cassette recording), Institute for Rational-Emotive Therapy, New York.

ELLIS, A. (1978) What people can do for themselves to cope with stress,
in: C. L. COOPER & R. PAYNE (Eds) Stress at Work, pp. 209-222 (New York,

ELLIS, A. (1984) The place of meditation in cognitive-behavior therapy
and rational-emotive therapy, in: D. H. SHAPIRO & R. WALSH (Eds)
Meditation, pp. 671-673 (New York, Aldine).

ELLIS, A. (1985a) Overcoming Resistance: Rational-Emotive Therapy with
Difficult Clients (New York, Springer).

ELLIS, A. (1985b) Anxiety about anxiety: the use of hypnosis with
rational-emotive therapy, in: E. T. DOWD & J. M. MEALY (Eds) Case
Studies in Hypnotherapy, pp. 1-11 (New York, Guilford Press).

ELLIS, A. (1987) The use of rational humorous songs in psychotherapy,
in: W. F. FRY, JR. & W. A. SALAMEH (Eds) Handbook of Humor and
Psychotherapy, pp. 265-287 (Sarasota, FL, Professional Resource

ELLIS, A. (1988) How to Stubbornly Refuse to Make Yourself Miserable
About Anything Yes, Anything (Secaucus, NJ, Lyle Stuart).

ELLIS, A. (1991) The revised ABC's of rational-emotive therapy (RET),
Journal of Rational-Emotive and Cognitive Behavior Therapy, 9, pp.

ELLIS, A. (1993) Post-traumatic stress disorder, Journal of
Rational-Emotive and Cognitive Behavior Therapy (in press).

ELLIS, A. & ABRAHMS, E. (1978) Brief Psychotherapy in Medical and Health
Practice (New York, Springer).

ELLIS, A. & DRYDEN, W. (1987) The Practice of Rational-Emotive Therapy
(New York, Springer).

ELLIS, A. & HARPER, R.A. (1975) A New Guide to Rational Living (North
Hollywood, CA, Wilshire Books).

FORMAN, S.G. (1990) Rational-emotive therapy: contributions to teacher
stress management, School Psychology Review, 19, pp. 315-321.

FORMAN, M.A., Tosl, D.J. & RUDY, D.R. (1987) Common irrational beliefs
associated with the psychophysiological conditions of low back pain,
peptic ulcers and migraine headache: a multivariate study, Journal of
Rational-Emotive Therapy, 5, pp. 255-265.

FOSTER, J.A. & GROVIER, E. (1978) Discrimination without awareness?,
Quarterly Journal of Experimental Psychology, 30, pp. 282-295.

FRIED, R. (1990) Integrating music in breathing training and relaxation:
ii. applications, Biofeedback and Self Regulation, 15, pp. 171-177.

FRIED, R. & GOLDEN, W.L. (1989) The role of psychophysiological
hyperventilation assessment in cognitive behavior therapy, Journal of
Cognitive Psychotherapy: an International Quarterly, 3, pp. 5-14.

Somatic response to stress, physical symptoms and health service use:
the role of current stress, Behaviour Research and Therapy, 26, pp.

GOLEMAN, D. (1993) A slow medical calming of the mind, The New York
Times Magazine, March 21.

HART, K.E., TURNER, S.H., HITTNER, J.B. & CARDOZO, S.R. (1991) Life
stress and anger: moderating effects of type a irrational beliefs,
Personality and Individual Differences, 12, pp. 557-560.

HAUCK, P.A. (1977) Marriage is a Loving Business (Philadelphia,

(1991) El indice de reactividad al estres en pacientes asmaticos
cronicos (The stress reactivity index in chronic asthmatic patients),
Psiquis: Revista de Psiquiatria, Psicologia y Psicosomatica, 12, pp.

JACOBS, W.J. & NADEL, L. (1985) Stress induced recovery of fears and
phobias, Psychological Review, 92, pp. 512-531.

JACOBY, L.L. & DALLAS, M. (1981) On the relationship between
autobiographical memory and perceptual learning, Journal of Experimental
Psychology: General, 110, pp. 306 340.

JACOBY, L.L. & WITHERSPOON, D. (1982) Remembering without awareness,
Canadian fournal of Psychology, 32, pp. 300-324.

KAHNEMAN, D., SLOVIC, P. & TVERSKY, A. (1982) Judgement Under
Uncertainty: Heuristics and Biases (New York, Cambridge University

KUNST-WILSON, W.R. & ZAJONC, R.B. (1980) Affective discrimination of
stimuli that cannot be recognized, Science, 207, pp. 557-558.

LARBIG, W. (1978) Psychophysiological approach to etiology and the
therapy of psychosomatic disorders, Zeitschrift fur Psychosomatische
Medizin und Psychoanalyse, 24, pp. 355-367.

LEWICKI, P. (1985) Nonconscious biasing effects of single instances on
subsequent judgements, Journal of Personality and Social Psychology, 48,
pp. 563-574.

LEWICKI, P. (1986) Nonconscious Social Information Processing (Orlando,
FL, Academic Press).

LIPOWSKI, Z.J. (1988) Somatization: the concept and its clinical
application, American Journal of Psychiatry, 145, pp. 1358-1368.

MAULTSBY, M.C., JR. (1971) Rational emotive imagery, Rational Living, 6,
pp. 24-27.

MEICHENBAUM, D. (1977) Cognitive-Behavior Modification (New York, Plenum

MILLER, N.E. (1944) Experimental studies of conflict, in: J. McV. HUNT
(Ed.) Personality and Behavior Disorders (New York, Ronald Press).

NISBETT, R.E. & WILSON, T.D. (1977) Telling more than we can know:
verbal reports on mental processes, Psychological Review, 84, pp.

POSNER, M.I. & SNYDER, C.R.R. (1974) Attention and cognitive control,
in: P. M. A. RABBIT & S. DORNIC (Eds) Information Processing and
Cognition: the Loyola Symposium (Hillsdale, NJ, Erlbaum).

REBER, A.S. (1989) Implicit learning and tacit knowledge, Journal of
Experimental Psychology: General, 118, pp. 219-235.

SCARBOROUGH, D.L., GERARD, L. & CORTESE, C. (1979) Accessing lexical
memory: the transfer of word repetition effects across task and
modality, Memory and Cognition, 7, pp. 3-12.

SICHEL, J. & ELLIS, A. (1984) RET Self-Help Form (New York, Institute
for Rational-Emotive Therapy).

STANTON, H.E. (1989) Stressreduktion durch rational-emotive therapie und
hypnoseinduktion (Stress relief through rational-emotive therapy and
hypnotic induction), Expenmentelle und Klinische Hypnose, 5, pp. 83-90.

SULS, J. & RITTENHOUSE, J.D. (1987) Personality and physical health: an
introduction (in special issue: personality and physical health),
Journal of Personality, 55, pp. 155-167.

TEMPLER, D.I. & LESTER, D. (1974) Conversion disorders: a review of
research findings, Comprehensive Psychiatry, 15, pp. 285-294.

VESTRE, N.D. & BURNIS, J.J. (1987) Irrational beliefs and the impact of
stressful life events, Journal of Rational-Emotive Therapy, 5, pp.

WARREN, R., ZGOURIDES, G. & JONES, A. (1989) Cognitive bias and
irrational belief as predictors of avoidance, Behaviour Research and
Therapy, 27, pp. 181-188.

WARREN, R., ZGOURIDES, G. & ENGLERT, M. (1990) Relationships between
catastrophic cognitions and body sensations in anxiety disordered, mixed
diagnosis, and normal subjects, Behaviour Research and Therapy, 28, pp.

WOODS, P.J. (1987) Reductions in type a behavior, anxiety, anger, and
physical illness as related to changes in irrational beliefs: results of
a demonstration project in industry, Journal of Rational-Emotive
Therapy, 5, pp. 213-237.

WOODS, P.J. & LYONS, L.C. (1990) Irrational beliefs and psychosomatic
disorders (in special issue: cognitive-behavior therapy with physically
ill people: i), Journal of Rational-Emotive Cognitive Behavior Therapy,
8, pp. 3-20.

ZAJONC, R.B. (1984) On the primacy of affect, American Psychologist, 39,
pp. 117-123.












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