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Journal of Rational-Emotive & Cognitive-Behavior Therapy, Vol. 23, No. 2, Summer 2005 ( 2005) DOI: 10.

1007/s10942-005-0008-8 Published Online: August 6, 2005

CAN RATIONAL-EMOTIVE BEHAVIOR THERAPY (REBT) AND ACCEPTANCE AND COMMITMENT THERAPY (ACT) RESOLVE THEIR DIFFERENCES AND BE INTEGRATED?
Albert Ellis
Albert Ellis Institute, New York

ABSTRACT: Rational-Emotive Behavior Therapy (REBT) is a pioneering form of Cognitive Behavior Therapy (CBT). Acceptance and Commitment Therapy (ACT) is part of the new wave of CBTs. In this article, I discuss the papers of Ciarrochi, Robb, and Godsell, and of Ciarrochi and Robb, who propose that REBT and ACT can be quite suitably integrated, and the paper of Steven Hayes, the originator of ACT and of Relational Frame Theory, who is skeptical about the feasibility of Ciarrochi, Robb, and Godsells proposals. My own view is that ACT and REBT signicantly overlap in their theory and practice and that they can be successfully integrated if both therapies make some changes. KEY WORDS: acceptance and commitment therapy; cognitive behavior therapy; psychotherapy; rational-emotive behavior therapy.

In two papers in this issue, Ciarrochi, Robb, and Goodsell and Ciarrochi and Robb have nicely shown how Rational-Emotive Behavior Therapy (REBT) and Acceptance and Commitment Therapy (ACT) have several distinct differences as well as similarities and how these two new cognitive behavior therapies (CBTs) might successfully be integrated. In a thoughtful paper discussing Ciarrochi, Robb, and Godsells suggestion, Steven Hayes (2005) summarizes the outcome studies of ACT and is concerned about the effects of REBT and CBTs focusing on the content of dysfunctional beliefs and the role of logicalempirical challenges to beliefs.
Author correspondence to Albert Ellis, Ph.D., Albert Ellis Institute, 45 East 65th Street, New York, NY 10021, USA; e-mail: aiellis@aol.com.

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Let me now comment on these three papers and give my views on integrating ACT with REBT and CBT. However, just as I was about to nish my comments, Guilford Press sent me the manuscript of a new book edited by Steven Hayes, Victoria Follette, and Marsha Linehan, Mindfulness, Acceptance, and Relationship: Expanding the Cognitive Behavioral Tradition (2005). I was asked to review this book and possibly endorse it and I shall favorably do so. The book contains 13 chapters by many outstanding cognitive behavior therapists who have also recently added to conventional CBT, just as Hayes and his associates have done, and have cited some innovative theories and techniques of their own. Some of the chapters are by the editors, Hayes, Linehan, and Follette; and other chapters are by well-known CBT practitioners, including Zindel Segal, John Teasdale, Robert Kohlenberg, T.D. Borkovec, G. Terence Wilson, and G. Alan Marlatt. These authors and their collaborators all largely favor Hayes ACT and his Relational Frame Theory (RFT), but they also add some original theoretical concepts and cognitive behavioral techniques. They all believe that their innovative methods can denitely be integrated with ACT and RFT without much difculty. I agree with themas does Steven Hayes. The interesting question is: Since most of the innovative therapies in his edited book, Mindfulness, Acceptance, and Relationship, include much less metacognition, which is at the basis of mindfulness, and distinctly less emphasis on acceptance than REBT has done for years, I wonder why Steve favors integrating the CBT therapies in this book with ACT but is much more unwilling to consider integrating it and REBT. Let us see! I shall rst make the important point that REBT has distinct differences with Becks (1976) cognitive therapy (CT) and with conventional CBT, and that Hayes often mentions REBT in the same breath with these other two forms of treatment. Formerly, all REBT was similar to Becks cognitive therapy and many other cognitive behavior treatments. Thus, they all mostly followed the ABCs of REBT. They all held that when Activating Events or Adversities (A) occur to people and they experience emotional-behavioral disturbances as Consequences (C), their Beliefs (B) lead to or cause C and therefore they would better change them to rational or preferential instead of irrational and absolutistic Beliefs (Ellis, 1957, 1962). When people believe (B), I wish I performed well, and they are not successful, they usually have the healthy or helpful feelings of sorrow,

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disappointment, and frustration and continue trying to succeed. When, however, they believe (B) I have to perform well and I am worthless when I dont, they often make themselves disturbedthat is, experience anxiety, depression, and worthlessness. REBT and CBT both say that people have the choice about disturbing themselves and they can change unhealthy Beliefs to healthy ones and undisturb themselves. In the original A, B, Cs of REBT, what happens to people at A (their environment) is important, since A B = C. So both A and B affect C (emotional-behavioral Consequences); and since peoples Beliefs (Bs) and their temperaments are biologically as well as environmentally learned and conditioned, they disturb themselves as a result of their heredity and their environment. So they can lessen their disturbances by changing either A or B. Because A (their environment) is often unchangeable, people can still lessen their disturbances and increase their happiness by engaging in Disputing (D) their Irrational Beliefs (IBs) and making them more preferential or exible and less absolutistic and rigid. Emotional and behavioral dysfunctioning, the original REBT theory said, were largelynot completelycorrelated with peoples absolutistic, rigid, inexible, unrealistic, perfectionistic, grandiose insistences instead of their exible preferences. This original ABC version of REBT has been largely incorporated into Aaron Becks (1976) CT and many of the other cognitive behavior therapies (CBTs). But it was soon added to in important ways in REBT. First, I began emphasizing that Beliefs (Bs) were not merely cognitive, but also included emotions and behaviors. Thus, the Belief I must perform well or else I am worthless! includes a forceful, strong emotional element (I am determined that I must perform well!) and also includes a powerful action tendency (Id better push myself to perform well, to ward off feelings of worthlessness!). Similarly, REBT holds that emotions are not merely feeling states but also include important cognitive and behavior aspects; and that behaviors are not merely actions but also include thinking and emotional factors (Ellis, 1962). According to this expanded theory of REBT, human disturbances do not merely follow from (or are caused by) Irrational Beliefs (IBs) but follow from a combination of dysfunctional thoughtsfeelingsbehaviors. Yes, all three working integrally together. If this is so, then REBT practitioners had better show their clients that they can thinkfeelact themselves into unhealthy Consequences (Cs) when unfortunate Adversities (A) occur in their lives or they can

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to a considerable degree constructively choose to thinkfeelact rationally or functionally and experience healthy negative feelings (e.g., sadness or regret) and healthy negative actions (e.g., sensible attempts to withdraw from Adversities). As a result of this theorizing, REBT has been a constructivist therapy for many years and includes in its practice a good many different kinds of thinking, feeling, and behavior methods, which integratively interact with one another and counter-attack peoples dysfunctioning. In this respect, it is rather different from Becks CT and from many of the other CBTs. Therefore, I have changed its name from the original RT and RET to REBT. As Ciarrochi, Robb, and Godsell (2005) have noted, REBT still active-directively and quite consciously Disputes (D) clients IBs realistically and logically, but it also heavily stresses functional Disputing: If you continue to believe the shoulds and musts that you now hold, where will this kind of thinkingfeelingaction get you? Will it lead to your achieving more of your goals and values-or less? Although REBT still is similar to Becks CT in several respects, it is radically different in that it is much more philosophic. As a recent discussion between me and Padesky and Beck (Ellis, 2004b; Padesky & Beck, 2004) shows, Beck emphasizes empirical formulations and information processing in CT, while I strongly emphasize profound and fundamental philosophical changewhich includes a philosophy of feeling and of behaving functionally (Ellis, 2001a, b, 2003, 2004a). In particular, REBT especially includes clients (and therapists) acceptance and commitment, and has been doing so years before ACT was formulated by Hayes and his collaborators (Hayes, Stroshal, &Wilson, 1999). In fact, Jacobson (1992), who used to be an almost exclusive behavior therapist, gives me credit for adding acceptance to the eld of therapy in my seminal book, Reason and Emotion in Psychotherapy (1962), and Marsha Linehan did a study of REBT with Marvin Goldfried in the 1970s and may have been inuenced by it when she formulated Dialectical Behavior Therapy for clients with borderline personality (Linehan, 1993). Many of the other recent innovators in CBT have also been inuenced by REBTs acceptance and commitment philosophy. Let me briey summarize the main REBT techniques of commitment that are taught at the Albert Ellis Institute and recommended to all therapists who want to practice modern-day REBT. I still theorize that people mainly (not exclusively) disturb themselves by taking their normal preferences for success and approval and destructively escalate them into absolutistic shoulds and musts.

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Why do they do so? Because that is their biosocial nature. As Alfred Korzybski (1933) brilliantly pointed out, people often sensibly generalize (I failed a few times and I may easily fail again) and they frequently exaggeratedly overgeneralize (Therefore I am a failure). Korzybski (1933) wisely noted that just about all the people on earth are both sane and unsane. He held, as does Steven Hayes (Hayes et al., 1999), that they are disturbed because they are language-creating animals, and their using language and symbols (as other animals do not do), helps them resort to both generalization and overgeneralization. So in Korzybskis form of psychotherapy, general semantics, they are specically shown how they create inaccurate overgeneralizations, mistake a map for a territory, and can be taught to prevent themselves from thinkingfeelingacting in that disturbing way. REBT, among other techniques, favors general semantics methods (Ellis, 1962, 2001b) and agrees that just about all people are often irrational and unsaneincluding therapists (Ellis, 1976)! Prophylactically and therapeutically, REBT strongly and cognitivelyemotionallybehaviorally promotes three major forms of acceptance. It hypothesizes that when people overtly or implicitly hold unrealistic and inexible demands, they frequently create three destructive forms of nonacceptance: (1) Since I have failed to perform well and be approved by signicant others as I absolutely must, it is not good and I am also no good, worthless. People put down their behaviors and their total selves; and they create, as Korzybski said, the is of identity, which leads to self-downing. (2) Since other people dont treat me kindly and fairly, as they absolutely must not, they are rotten people who deserve to be punished. Clients (and others) then make themselves hostile and antisocial. (3) Since the world and conditions in my community are frequently bad and frustrating, as they absolutely must not be, my life has unnecessary hassles and misfortunes, and that is awful and terrible, and almost totally bad. People, with this nonaccepting philosophy, create awfulizing and low frustration tolerance. Based on this theory of clients (and other peoples) self-chosen nonacceptance, REBT postulates that self-rating (I am good or bad), other-rating (You are good or bad) do not create all human disturbance, but very possibly create most of it. Contemporary (or latter day) REBT, unlike Becks CT and most of the other CBTs, uses every possibly means of helping clients to thinkinglyemotionallyactively solidly make three major acceptances: (1)

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unconditional self-acceptance (USA). This means that you fully accept yourself whether or not you succeed at important tasks and whether or not you are approved by signicant people. (2) Unconditional otheracceptance (UOA). This means that you fully accept (though not necessarily like) all other humanssimilar to Alfred Adlers (1964) social interestwhether or not they act fairly and competently. (3) You unconditionally accept life (ULA). This means that you fully accept life whether or not it is fortunate or unfortunate and do your best to discover and enjoy its personally selected satisfactions and pleasures (Ellis, 2001a, b, 2002, 2003, 2004a; Ellis and Harper, 1997). One more important aspect of REBT is today emphasized. I discovered soon after I created REBT that clients (and other people) not only destructively demand that they succeed in important tasks, be treated rightly by others, and live under what they consider as good conditions. To make matters worse, they also, when they upset themselves with their demandingness, berate themselves for making themselves anxious, depressed, and raging. They insist, I must not be anxious and depressed!and thereby make themselves more anxious and depressed. They also insist, Others must not be disturbed!and thereby make themselves more hostile to others. They also insist, I must not have low frustration tolerance (LFT)! and thereby have low frustration tolerance for their LFT. Not always, of course; but quite frequently. REBT therefore goes out of its way to show them these destructive secondary disturbances; and, of course, to fully accept themselves and others with their self-upsetting. They then achieve a thoroughgoing thinkingfeelingacting philosophy of acceptance (Ellis, 2001b, 2002, 2003, 2004a). REBT also stresses (but not demands) commitment to therapy if you desire lastingly change. I have been saying for many years, There are many insights that REBT can give you, but three are most notable: (1) You do not only get disturbed by people and events. You also frequently disturb yourself about them. So much of your disturbance results from your self-upsetting. (2) You usually began disturbing yourself in your early childhood. But you remain anxious, depressed, and raging today because you keep inventing your strong and persistent shoulds, oughts, and musts to which you habituated yourself in your earlier life. (3) Today, your destructive thinkingfeelingacting propensities and habits are usually so engrained that there is probably no way but continual work and practiceyes, steady work and practiceto minimize and to alleviate them. Tough! but you may well have to often put on your thinkingfeelingdoing

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caps for the rest of your life (Ellis, 1962, 2002). No rest for the weary! Then you look for many creative enjoyments! (Ellis, 1962, 1994). From what I have just said, it should be reasonably obvious that the critics of REBT, including Steve Hayes (2005) often wrongly perceive it as almost obsessed with irrational and illogical Beliefs. Some sloppy followers of REBT and some practitioners of forms of CBT may be in that camp. But hardly up-to-date REBTers. They frequently show clients how to nd and Dispute (D) their IBs and to arrive at Effective New Philosophies (E), otherwise known as Rational Coping Beliefs. Fine. That, as many empirical studies and an immense amount of clinical evidence have shown, is enormously effective in helping people (Lyons & Woods, 1991). REBT can frequently be effective in from 1 to 10 sessions. It also works with practically all kinds of severe personality disorders, and with people with psychotic disorders. Of course, REBT doesnt signicantly help all disturbed people; but it does remarkably well with most of themif their therapists induce them to commit themselves to working at it. It therefore requires a dedicated, committed therapist who uses good relating skillsjust as ACT does. However! competent REBT practitioners do much more than teach people how to nd and Dispute their destructive thinking. They also try to persuade their clients, in several cognitive, emotional, and behavioral ways, to consciously take and profoundly imbibe a philosophy of both acceptance and commitment. They strongly present these important therapeutic goals to their clients. To accomplish this, they frequently take on several roles and can serve as teachers, preachers, propagandists, persuaders, and encouragers. As far as I can see, ACT practitioners do something similar. For example, they often teach Mindfulness to clients; give them metaphors, analogies and fables, stories, puzzles, and other presentations just as REBT practitioners do; and even, though they deny using direct cognitive methods, use more active-directive teaching than many other therapistssuch as Rogerian, Reichian, and Gestalt therapists. REBT also stresses teaching clients to focus on their goals and valuesas pointed by several reviewers. And it uses evaluationwhich is a cognitive technique that involves languagenot only to assess whether a therapeutic method works; but it also explores clients evaluations of their goals and their demands about these goals. Thus, clients usually have the goal of succeeding in an important endeavor, and their rational evaluation is something like, I really wish to succeed and gain approval. That would be good. But their irrational

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evaluation of this goal may be, I must succeed or else it is terrible and Im worthless! Their irrational or musturbatory evaluations are radically different from their functional evaluations of their goals. So REBT practitioners point out this difference, and show clients how one kind of goal evaluation is helpful and another kind of goal evaluation is unrealistic and unhelpful. In this way, REBT is probably more focused on evaluation of goals than is ACT. Hayes (2005) cites several studies where, without addressing the content of dysfunctional thinking, ACT gets excellent therapeutic results. What he seems to mean is that ACT doesnt directly address the clients dysfunctional Beliefs, such as, Because I failed at this important project, that is awful and my failing makes me an incompetent person, a failure. But in several ways, it indirectly contradicts them. It shows, by stories, metaphors, coping statements, in vivo desensitization, and other cognitive behavioral techniques that your therapist accepts you with your failings; that your friends and loved ones do so, too; that many people dont consider you a total failure; that people who fail (like Lincoln for example) can nally succeed; that you can accept yourself no matter how many times you fail; that it isnt the end of the world to fail; that you can relax and not focus on your failures; that you can enjoy many other things, etc. In other words, ACT both explicitly and implicitly presents several philosophies of acceptance that help you to believe that failing doesnt make you a worm and is not catastrophic and awful. Now the interesting thing is that REBT uses a number of cognitive, emotive, and behavioral techniques that ACT also uses to help change your self-downing and awfulizing outlooks, but it consciously teaches them directly and indirectly with everyday language and with stories and metaphors. It analyzes the language of clients (as Korzybskis general semantics does) and does so quite openly and didactically; but it also uses realistic and logical Disputing of your IBs. Why does REBT logically and realistically Dispute your dysfunctional ideas, feelings, and actions? Because REBT (and some other CBTs) have found, in contradiction to ACT, that Disputing the content of what you think not only works, but works remarkably well in most (though hardly all) cases. It is effective, very often, in from 1 to 10 sessions. What is more, active Disputing of IBs is effective in selfhelp form, through books, handouts, cassettes, lectures, workshops, intensives, courses, etc. REBT direct teaching has helped millions of people prophylactically and therapeutically.

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Hayes (2005) states that ACT, theoretically and philosophically, is a contextual behavioral therapy which seeks rapid changes in the function of cognition and emotion, rather than what RFT suggests would be the more difcult and error-prone task of changing their content. That is quite different from traditional CBT, and the data so far seem to bear this out. Hayes may be largely right about the advantages of ACT over traditional CBT; but as I indicated at the beginning of this article, traditional CBT is far from being the same as REBT. So let me now show how his statement does not understand what REBT today is.
(1) In many ways REBT is a contextual behavior therapy. It clearly holds that peoples Beliefs about Adverse events often (not always) help create disturbed Consequences (thoughts, feelings, and actions) because they interact to do so. The REBT ABC theory clearly says that A B = C. So the environmental context is denitely taken into account. Thus, if you fail one test (at A) you may conclude (at B), Its only one failing and I probably will succeed the next time. You will probably therefore have the healthy emotional Consequence (C) of disappointment about your performance. But if you fail several tests in a row (A) you often (not always) will have the unhealthy behavioral Consequence (C) of anxiety and depression because you tell yourself (B), Ill never succeed and am a total failure. Both Rational and Irrational Beliefs occurof coursein some context, which inuences them. (2) ACT, notes Hayes (2005) seeks rapid changes in the functions of cognition and emotion, rather than what RFT suggests would be the more difcult and error prone task of changing their content. Fine. But REBT analyzes two different functions of cognitions: First, a helpful function, I dont like this failing. I wish that I usually succeed, but I can stand it if I dont and still be reasonably happy. Second, an unhelpful content, Because I hate failing, I absolutely must not fail and am a worthless person if I do! By showing clients how different are these two functions of cognitions, it helps them keep the rst and reduce the second.

The error-prone liability of REBTs analyzing the content of unhelpful cognitions sometimes arises when clients think, Since my therapist has shown me that my thoughts are irrational and unhelpful, I must not have them and its awful if I do! This, as Hayes has noted (Hayes et al., 1999), is an error that REBT disputing may encourage. Yes, it may, but it usually doesnt. Moreover, REBTers

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are keenly aware of this possible musturbatory error, usually quickly nd it, and help their clients Dispute their musts about their musts and surrender them to preferences. Hayes and I often tell clients the same parable in this respect: A king didnt want his daughter to marry a prince who had passed all the tests he had been given that made him eligible to marry her. So he said to his wise men, Find a test that the prince can not pass or off goes your heads! After much anxious planning, the kings wise men found a test that the prince could not passnamely, Dont think of a pink elephant for twenty minutes. Because, of course, in trying desperately to not think of a pink elephant, the prince had to think of one and therefore failed the test. I deliberately tell my clients this parable, to show them that if they were the prince and told themselves, I absolutely mustnt have any must! that Irrational Belief will paradoxically add to their must about thinking about an elephant. So absolutistic musts and musts about musts are, paradoxically, destructive. REBT therefore warns clients about them and thereby doubly Disputes the content of dysfunctional musts. (Incidentally, as I also show my clients, if the prince wants to pass the test and marry the princess, he could deliberately think of a white elephant and use other distraction techniques in order to pass it.) This parable, I think, really shows that clients can irrationally musturbate about any therapy technique, no matter how good it usually is. Thus, they can take the ACT and the REBT technique of acceptance, and tell themselves, I absolutely must follow the philosophy of acceptance, otherwise I am no damned good! They therefore reinforce their nonacceptance. Since ACT doesnt consciously look for, nd, and actively Dispute clients dysfunctional musts about their own therapeutic efforts, I would say that it omits one of the most useful therapeutic methods. REBT also points out that in using some distraction techniques that Hayes at times recommends, some clients do not see the error of their thinking and therefore change it. Thus, when they use mindfulness training, they dispassionately observe their thinking, think about it, see that it easily leads them into needless worry and obsession, and therefore decide that it is dysfunctional and decide to let go of it or change it to more functional thinking and doing. Just as they consciously and unconsciously plague themselves with musts, they now consciously and/or unconsciously let go of these musts. Acceptance includes implicit and explicit philosophic

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change, such as, I no longer have to give into and follow my worrisome thoughts. I am able to let go of them. Steven Hayes notes that ACT was more effective with hallucinated psychotic clients when compared to treatment as usual (TAU). I can well believe it was, because it used acceptance methods to help these clients accept themselves with their hallucinationsmeaning, accept themselves without blame. This is exactly what REBT does with clients with psychosis. It assumes that their hallucinations (and other bizarre behavior) are partly biologically caused and are not like the IBs of clients with neurosis. It therefore often does not try to change the hallucinationwhich may not stem from their making their preferential desires into demandsbut it stresses teaching hallucinating people USAunconditional selfacceptance. They may then retain or even increase their psychotic thoughts or perceptions, and still not damn themselves for having them. Good ACTbut also good REBT! The same thing goes for people with addictions, severe personality disorders, and practically all the difcult clients that seem to be successfully treated with ACT. It is not absence of Disputing of the content of their dysfunctional beliefs that ACT used with them. It is mainly ACTs helping them to fully accept themselves with their dysfunctional perceptions, emotions, and actions. This is precisely what happens in REBT practice in addition to sometimes Disputing the content of their IBs. Hayes lightly acknowledges REBTs very strong philosophy of unconditional acceptance. But then he implies that it is not a crucial REBT concept and practice. It damned well is! Hayes, in answering Ciarrochi and Robb, says, It is not clear to me why we must be attached to logicalempirical challenging. He forgets that REBT challenges IBs in cognitive, emotive, and behavioral ways, and that logicalempirical challenging is only one of these several ways. REBT also says that it is preferable to challenge IBsnot that we must. Hayes doubts that REBT would target the thought, life is wonderful along with the thought, life is awful. How wrong he is! Both thoughts, according to REBT (and to Alfred Korzybski) are irrational overgeneralizations, are unrealistic, and may easily be harmful to people. Hayes is unaware of studies showing that REBT in a few hours is effective. Actually, there are over 200 outcome studies of REBT, most

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of them 10 sessions or less, that show its effectiveness (DiGiuseppe, Terjasen, Rose, Doyle, & Vidalakis, 1998). Hayes (2005) admits that changing the content of client thought is not anathema to ACT or RFT. Indeed, ACT itself includes such efforts. Ah, indeed it does! ACT, as I noted above, consistently does Disputing and reframing. But where REBT does so both directly and indirectly, ACT obsessively-compulsively sticks to using only indirect and presumably nonverbal methods of challenging dysfunctional thoughts, feelings, and actions. As Hayes rightly says, since both REBT and ACT methods often work, we can do empirical studies to discover which work best and which have more disadvantages. ACT also employs a good many verbal language methods and then claims that it does not really do so. I also think that it indirectly employs the technique of Disputing IBs by helping clients to arrive at what REBT calls Effective New Philosophies (E). Thus, when clients believe, I must succeed at work or love, or else I am an incompetent, worthless person, REBT asks these Disputing (D) questions and actively-directively encourages these more functional answers of Effective New Philosophy (E):
(1) Realistic Disputing (D): Why must you succeed? Where is it written that you have to? Would a strong preference to succeed be better than your must? Answer or Effective New Philosophy (E): I clearly dont have to succeed, though it would be preferable. My need to succeed is only written in my nutty head. Of course, a strong preference to succeed would be more sensible than my demanding that I do so. (2) Logical Disputing (D): Does it logically follow that if I dont succeed, my failing will make me an incompetent, worthless person? Does my failing make me be or become a total failure? Answer or Effective New Philosophy (E): No, failing makes me a person who failed this time, not an incompetent or worthless person who will always fail. No, I (and anyone else) cant become a total failure because I would then have to fail at everything all the time. (3) Functional Disputing (D): Where will it get me if I think in this unrealistic and illogical way? Answer or Effective New Philosophy (E): It will get me nowhere, except anxious and self-downing. Disputing: Will it help me or make me happier? Answer or Effective New Philosophy (E): It damned well wont.

REBT employs this kind of Disputing to help clients see: (1) That they create their thinking errors. (2) That they can choose to think

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differently if they fail and get rejected by otherscan choose to feel sorry and disappointed instead of anxious and depressed. (3) That they can also similarly think dysfunctionally about many other failures, rejections, and adversities. (4) That their dysfunctional thinking-feeling-behaving practically always follows when they turn healthy preferences into dysfunctional demands. (5) That in the future they can continue to see their destructive cognitionsemotions behaviors and work hard at Disputing them until their common automatic thoughts habitually tend to be minimal and to be replaced by rational coping philosophies. So REBT hypothesizes that actively, determinedly, and persistently Disputing IBs is a hell of a good way to minimize them, therapeutically and prophylactically. It consciously aims, by this and many other cognitiveemotionalbehavioral techniques, to help clients Feel Better, Get Better, and Stay Betterwhich is the title of one of my best-selling books (Ellis, 1994, 2001a). And ACT? As far as I can see, its goals and purposes are quite similar to those of REBTto help clients clearly see that their usual ways of thinking, feeling, and acting frequently are dysfunctional and that therefore they had better fully acknowledge this and see precisely how they delude themselves and needlessly make themselves suffer. At the same time that they see how mistakenly and inefciently they behave, they had better not blame themselves for their selfdefeating behaviors but totally accept themselves with their dysfunctions and then actively seek alternate, more functional ways of living. To do this, they had better actively commit themselves to using ACTs potentially helpful methods. If these are some of ACTs main goals and purposes, I can only say that they are quite similar to REBTswhich has tried to implement them for many years before ACT was invented (Ellis, 1962). Let me nally give my general impressions of ACT and RFT. I largely favor what they say and dobut think that they have several important omissions. ACT is denitely a form of cognitive behavior therapy, with some unusual emphasis and techniques. It rightly emphasizes the role of human language in disturbance and notes that people most probably would not seriously disturb themselves if they had no language. This sounds accurate, except for psychotic and other biological-based disorders. Although regular and symbolic language has many great advantages, it also helps create emotional disturbances. Hayes (2005) says that ACT is the only behavior therapy

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with its own comprehensive research program into the nature of human language and cognition. I agree with his point and congratulate ACT devotees for doing this. They can teach REBT and all cognitivestressing therapists some important points. However, Hayes and his associates often imply that it is common language itself that people use to upset themselves and that by avoiding it and by using metaphorical language, therapists reach people better. I doubt this. Yes, the kind of language used in ACT denitely can workand Hayes has listed several studies where it quickly works. But language itself doesnt seem to cause disturbance while some kinds of internal languagewhich REBT specializes in investigating, much more than ACT doeshave been shown in hundreds of studies to be signicantly more prevalent in emotionally anguished than in nonanguished people. Before REBT was invented, personality inventories like the MMPI were shown to fairly accurately diagnose various kinds of psychological functioning, and they still do. Some of these scales, like the famous Beck Depression Inventory, are part of the regular CBT movement that Hayes thinks ACT is mightily different from. Other personality inventories, such as the MMPI, show that the content of peoples dysfunctional Beliefs are often highly correlated with their thinking, emotional, and behavioral disorders and can be usefully analyzed by therapists who use CBT and other forms of therapy. These personality inventories seem to have been used in several of the outcome studies of ACT and help make these studies more effective. Why Hayes is allergic to consciously nding and Disputing dysfunctional Beliefs in addition to his indirect ACT methods is still something of a mystery to me. Yes, language helps people improperly create disturbances. But language, in the form of consciously thinking about thinking and thinking about thinking about thinking (meta-thinking), may be one of the most effective antidotes to emotional and behavioral disturbances (Ellis, 2001b, 2002). I think that ACT indirectly uses powerful persuasive language similar to REBT. But instead of directly challenging clients to think differently by Disputing their IBs, it indirectly teaches them to adopt an Effective New Philosophy in a number of ways. Thus, it teaches clients to evaluate how effective is their thinking, emoting, and behaving. It highlights and explains why conventional thought is often dysfunctional. It provides clients with what REBT calls rational coping statements. It shows clients how to be more purposive. It encourages them to have a spiritual attitude meaning, to question their self-centeredness and

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have distinct social interest. It encourages exible thinking, emoting, and acting. Are these and other indirect methods of interrupting clients dysfunctional thinkingfeeling-and acting inefcient or bad? Not at all! Steven Hayes presents evidence that they work, and, as I say above, REBT also uses practically all of them, and has done so for a number of years (DiGiuseppe & Muran, 1992; Ellis, 1973, 1994). But REBT also uses considerable active-directive Disputing of destructive Beliefs, to which Steven Hayes is opposed. Because REBT does most of what ACT does and because it vigorously Disputes disturbing IBs, too, I naturally think that it is more effective than ACT. But that remains to be experimentally shown. Meanwhile, I denitely think, as Ciarrochi, Robb, and Godsell nicely say in their papers (2005), that REBT can productively be integrated with ACT. Lets try it and see! Hayes (2005) concludes his article with Effectiveness, not just logic, is the issue. Agreed! He recommends that if defusing and direct experience replace disputation and if believing in-context replaces belief, REBT and ACT may be integrated. Fine. REBT, unlike some other CBTs, has always included defusion, direct experiencing, and believing-in-context. But it also effectively includes empirical and logical disputation of dysfunctional beliefs. Therefore, I hypothesize, it is more likely to be both quickly and profoundly effective than ACT. Not only can it be integrated with ACT as it is practiced today, but I think that ACT would benet by adding some of the REBT forms of logical and empirical Disputing to its methods. Again, let us experiment and see. REFERENCES
Adler, A. (1964). Social interest: A challenge to mankind. New York: Capricorn. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York. Ciarrochi, J., Robb, H., & Godsell, C. (2005). Letting a little nonverbal air into the room. Insights for Acceptance and Commitment Therapy. Part 1: Philosophical and theoretical underpinnings. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 23. Ciarrochi, J., & Robb, H. (2005). Letting a little nonverbal air into the room. Insights from Acceptance and Commitment Therapy. Part 2: Applications. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 23. DiGiuseppe, R. A., & Muran, J. C. (1992). The use of metaphor in rationalemotive psychotherapy. Psychotherapy in Private Practice, 10, 151165. DiGiuseppe, R., Terjesen, M., Rose, R., Doyle, K., & Vidalakis, N. (1998). Selective abstraction errors in reviewing REBT outcome studies: A review of reviews. Poster presented at the 106th Annual Convention of the American Psychological Association, San Francisco, CA.

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Ellis, A. (1957). Outcome of employing three techniques of psychotherapy. Journal of Clinical Psychology, 13, 344350. Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Citadel. Ellis, A. (1973). Humanistic psychotherapy: The rational-emotive approach. New York: McGraw-Hill. Ellis, A. (1976). The biological basis of human irrationality. Journal of Individual Psychology, 32, 145168. Reprinted, New York: Albert Ellis Institute. Ellis, A. (1994). Reason and emotion in psychotherapy. New York: Kensington Publishers. Revised and updated. Ellis, A. (2001a). Feeling better, getting better, and staying better. Atascadero, CA: Impact Publishers. Ellis, A. (2001b). Overcoming destructive beliefs, feelings, and behaviors. Amherst, NY: Prometheus Books. Ellis, A. (2002). Overcoming resistance: A rational emotive behavior therapy integrative approach. New York: Springer. Ellis, A. (2003). Anger: Hot to live with and without it. New York: Citadel Press. (Rev). Ellis, A. (2004a). Rational emotive behavior therapy: It works for meIt can work for you. Amherst, NY: Prometheus Books. Ellis, A. (2004b). Similarities and differences between rational emotive behavior therapy and cognitive therapy. Journal of Cognitive Therapy, 17, 225240. Ellis, A., & Harper, R. A. (1997). A guide to rational living. North Hollywood, CA: Melvin Powers. Hayes, S. C. (2005). Stability and change in cognitive behavior therapy: Considering the implications of ACT and REBT. Journal of RationalEmotive and Cognitive-Behavior Therapy, 23. Hayes, S., Follette, V., & Linehan, M. (2005). Mindfulness, acceptance, and relationship. Expanding the cognitive behavior tradition. New York: Guilford Press. Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy. New York: Guilford. Jacobson, N. S. (1992). Behavioral couple therapy: A new beginning. Behavior Therapy, 23, 491506. Korzybski, A. (1933). Science and sanity: An introduction to non-Aristotelian systems and general semantics, Concord, CA: International Society For General Semantics. Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford. Lyons, L. C., & Woods, P. J. (1991). The efcacy of rational-emotive therapy: A quantitative review of the outcome research. Clinical Psychology Review, 11, 357369. Padesky, C. A., & Beck, A. T. (2004). Science and philosophy: Comparison of cognitive therapy and rational emotive behavior therapy. Journal of Cognitive Therapy, 17, 211224.