CENTER ON BEHAVIORAL MEDICINE
Traditional Approaches-Psychological: Related Paper
Using Rational Emotive Behavioral Theory to Influence the
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Using Rational Emotive Behavioral Theory to Influence the Human Disease State
When the body believes it is being threatened, it takes steps to protect itself (De Kloet, 2004; Givens, 2000). By automatically engaging the sympathetic nervous system, the body prepares to fight or flee the perceived danger. Often the fight or flight response involves a hastening of the heartbeat, increased levels of blood-sugar, and hormones being released from the adrenal gland. The pituitary gland produces the chemical cortisol, in order to induce inflammation after trauma or injury. Growth hormone is produced to repair injuries to bones and tissue. Anticoagulant is produced to prevent excessive bleeding. Each of these coordinated, involuntary responses is designed to assist an individual to survive assault or danger (De Kloet, 2004; Givens, 2000). Mother Nature, however, did not intend for this response to linger over long periods of time. Instead, the response was meant to be short lived and subside after the immediate threat was no longer a clear and present danger.
Psychological stress, also known as ‘modern stress,’ is a product of our modern culture and is dependent on an individual’s interpretation of the events that occur in h/er social environment (Johnston, 2006). Perception, therefore, can be responsible for the triggering both the fight or flight response, as well as the modern stress response. “It has been estimated that only about 10% or less of modern stress comes from actual physical threat to life. The other 90% comes from the perception of life events” (Johnston, 2006, ¶ 2, line 3).
Chronic modern stress can alter the body’s chemistry, threatening the physical wellbeing of the individual, causing the body to grow weaker as the immune system begins to fail from overuse. This sequence of events may result in the individual becoming prone to such illnesses as high blood pressure, ulcers, and heart disease (Selye, 2001; Kopolow, n.d.; Craigmile, 2006). Not withstanding the nefarious affects modern stress has on the human body, chronic depression, anxiety and generalized unease related to an individual’s perception of h/er social environment can lead, equally, to physical infirmity if continually exacerbated by emotional sickness (Huda, 2000; Timms, 2003; MacHale, 2002). It is crucial, therefore, that methods be developed to mediate and manage conditions of biopsychosocial etiology.
Conventional medicine may be effective when addressing acute, intense, or traumatic situations, but often does not view physical health as having psychological and social dimensions (Shackel, S., 1999). The biopsychosocial methodology of disease management, however, emphasizes the clinical value of personality dynamics, family and cultural dynamics, and health dynamics (Sperry, L. 2006). Surgery, pharmacotherapy and psychotherapy are considered the major physical and mental health treatment modalities. These schools are often attended to separately, creating a disconnect between the psychosocial and the biological domains (Gabbard, G. & Kay J., 2001). For example, people who are prescribed psychotropic medications (often for self-diagnosed depression) may not be directed by a physician to seek conjoint mental health counseling as a condition of taking the medication. Conversely, therapists who provide direct mental health services may not consider their patient’s physical health when addressing their emotional concerns. All things being equal, an argument can be made for either approach. An argument could be made just as easily against the two models. There are as many techniques or treatment protocols designed to address the issue of illness as there are patients. It is my opinion, however, that the human disease state can be influenced successfully by applying a multidimensional approach linking the biological, psychological and social dimensions. From a psychological perspective, I believe a focused, cognitive-behavioral psychotherapeutic intervention may be most appropriate. More specifically, rational emotive behavioral therapy (REBT) may influence the patient’s perception of h/er social environment, resulting in a reduction or complete extinction of the impetus for biopsychosocial illness.
“People are not disturbed by things, but by the view they take of them” (Epictetus 1st Century, AD) is the principle from which the theory of rational emotive behavioral theory (REBT) is built. REBT, one of a number of therapies that come under the heading ‘cognitive-behavioral,’ is an orientation in psychotherapy based on the principle that individuals can change their emotional state and, hence, their behavior by changing their interpretation of an event. Albert Ellis (1913- ), the founder and architect of the well-known ABC model, has spent much of his life teaching and practicing the principles of his alphabetical premise for emotional adjustment and psychological health. In his 2003 article entitled “Early Theories and Practices of Rational Emotive Behavior Therapy and How They Have Been Augmented and Revised During the Last Decade”, Ellis points out forty substantive points of analysis related to his theory of REBT, each point underscoring the philosophy that, “When people understand or have insight into how they needlessly disturb themselves and create unhealthy and dysfunctional feelings and behaviors, that insight often will help them change and make themselves less disturbed” (Ellis, 2003, p. 220).
Each of Ellis’ forty proclamations (2003) are a familiar dogma, recognizable in almost all literature related to the subject of cognitive-behavioral theory. Essentially, Ellis accepts as true that most emotions are individually determined, based on a person’s interpretation of an event. Maladaptive, disease-provoking emotions are those that are internally expressed by an individual as absolute, irrevocable beliefs. Ellis’ holds that humans defend these beliefs and translate them into truths that they tend to apply to all other persons they encounter. It is Ellis’ belief that people not only trust that what they believe is fact, but they cannot comprehend the notion that their belief is likely an assumption of how the world should, ought, must, and has to be in order for them to be happy (Boeree, G., 2006). Ellis recommends that humans had better stop connecting their emotions to events. Emotional fitness, he believes, can only be achieved “by a combined cognitive, emotive, and behavioral, as well as a quite persistent and forceful attack on one’s serious emotional problems” (Ellis, 2003, p. 241-242)
REBT is typically explained using the ABC paradigm. The A representing an Activating Event or an event; the B symbolizes the belief the individual holds about the A; the C is the emotional consequence or the emotion that results from the application of the B to the A. A simple illustration of an irrational thought leading, presumably, to social-environment-induced modern stress can be illustrated as follows: “I need to be respected. If I am not respected, then it is awful and the person who does not respect me be should be damned. People should respect me all the time and if they don’t I will not be able to stand it.” In this scenario, the therapist and the client would work together to discover the irrational non-sequiturs in the individual’s expression of the activating event or the A. In this case, the focus of therapy may be on the individual’s assumptions that s/he 1) needs to be respected; 2) if s/he is not respected that it is awful; 3) people who do not respect h/er are less than human, and, 4) receiving respect is essential to life. Following the discovery of the anxiety-producing self-talk, the therapist and the client engage in the D, or disputation of the B (the belief). The therapist helps the client adjust h/er belief to a more rational statement such as “I like to be respected by everyone, but sometimes I don’t get what I want. I am not getting what I want right now, and that is unfortunate. I can stand it when I am not respected, and this experience is no exception,” or “I am not being respected right now because this individual is exercising his free choice to act foolishly. It is unfortunate that he is making this choice, but I can certainly survive the experience.”
Ellis (2003) endorses the “self” promoted by actualization rather than one promoted by society (Boeree, 2000, n.p.). This approach is essential to successfully treating the client who is influenced by self-talk dictating conformity. REBT offers imagery, visualizations, symbolic thinking, in vivo experiences and exposure desensitization techniques to his inventory of therapeutic methods. Each of these techniques is designed to reduce or eliminate emotional consequences to events that can lead to psychogenic illness. In addition, the REBT therapist encourages the client to seek out other persons, places, and things that are thought to be impossible, or at the very least enormously unpleasant, to endure. While at the same time enduring the situation itself, the client and therapist can dispute the irrational conjecture related to the event, in real life, thus making a discussion of the client’s thoughts more immediate and, consequently, more accurate. “We have a whole host of behavioral techniques where we get people to do what they are afraid of, do public speaking, go for job interviews, approach members of the same or opposite sex” (McGinn, 1997, p. 311).
REBT can be effective for a wide range of biopsychosocial conditions (Froggatt, 1997). A person whose self-image may influence h/er diet and, as a result, caused medical problems such as obesity and diabetes, may improve h/er physical, psychological, and social wellbeing by therapeutically altering h/er self-image using the REBT ABC paradigm described above (Bibbo, K., 1999). Ellis (2003) declares, “ . . . unrealistic and over generalized inferences and attributions are not only acquired from early upbringing but are also part of the human biological tendency to think crookedly and self defeatingly . . .” (p. 233). Although he offers very little proof in the way of science to his declaration that there is a biological component to irrational thinking, it is, to say the least, one of the intriguing questions we might see explored by researchers, in order to determine an effective biopsychosocial intervention strategy.
Specialists who focus only on one aspect of the biopsychosocial components of an individual’s fundamental nature may overlook the tremendous impact each of these components can have on the healing process. It may be true that the body responds in incredible ways, when the mind believes that healing is both possible and imminent. REBT may prove to be one method for addressing multidimensional issues involving biological, psychological and social dimensions.
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