Cognitive Behavioral Therapy vs. Rational Emotive Behavior Therapy

​Psychiatrists use various approaches to help patients navigate negative emotions, behaviors, or attitudes. Cognitive-behavioral therapy (CBT) is the most popular avenue. One psychiatrist may prefer CBT over REBT or vice versa for various reasons.

Albert Ellis introduced REBT in the 1950s. CBT emerged in the 1960s as one of several REBT offshoots. It focuses on altering patients’ irrational or unhealthy thoughts or behavior attitudes to achieve a healthy outlook on themselves and their surroundings. It theorizes that individuals’ perception of events impacts their wellbeing - not the events themselves. Therefore, REBT seeks to inspire behavioral change by helping people alter their thinking.

CBT, like REBT, seeks to change harmful thinking patterns. It attributes social, emotional, and cognitive problems to a single cause and seeks to uncover how the individual uses that trigger to reinforce negative thoughts or behaviors.

The difference between the two approaches goes beyond the conceptualization of human problems. REBT and CBT also differ in how they approach solve the problems. REBT seeks to uncover the philosophic basis of harmful or distorted thought processes. CBT ignores the philosophic underpinnings or assumptive worldviews of the patient.

For example, a man intending to ask a woman for a second date may feel anxious - a feeling he perhaps attributes to the woman’s nonchalance on the first date. CBT considers this "mind reading," dismissing it as mere cognitive distortion. Conversely, REBT seeks to uncover why the man jumped to that conclusion. One of the many reasons could be a deep desire for the woman’s approval. Giving up the need for approval may help the man overcome anxiety and improve his interpersonal relationships.

A secondary disturbance is worrying about worrying. In the dating example above, a secondary disturbance would be feeling guilty or anxious about appearing anxious when requesting a second date. REBT recognizes the role of secondary disturbance. CBT downplays it, focusing solely on the root disturbance.

REBT teaches patients unconditional self-acceptance and embracing shortcomings instead of looking for positive attributes to cope with negative ones - the focus of CBT. The REBT solution to the self-esteem problem is more sustainable since it encourages enjoying life rather than coping.

Conversely, in CBT, individuals identify positive characteristics, attitudes, or emotions and focus on them to cancel the negative ones. CBT can be counterproductive, causing an unhealthy focus on accomplishments and a preoccupation with proving oneself.

Another difference between CBT and REBT is in viewing negative emotions. In CBT, individuals believe that some anger is positive and they can use it constructively. If the man in the dating example struggles to assert himself or feels the woman is taking advantage of his niceness, becoming angry might help him reassert himself. REBT deems any form of anger unacceptable, and harnessing a negative behavior may worsen the situation.

CBT seeks to single out the causes of social, cognitive, and emotional problems. REBT looks beyond a single cause and examines the interplay between predisposing factors, such as the individual’s worldview.

Despite the divergent views on human problems and their solutions, CBT and REBT are solution-focused. While they do not discount symptoms, they focus not on the sources of unhealthy thoughts and behaviors but on how and why patients maintain them.

Sandeep Mellacheruvu

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