or discussion in an attempt to get patients to see the
irrationality of their beliefs. In addition to providing
patients with a rational analysis of their problems, the
therapist may attempt to teach them to“modify their
internal sentences.”That is, patients may be taught
that when they begin to feel upset in real situations,
they should pause and ask themselves what they are
telling themselves about those situations. In other
instances, the therapist may have patients in the ther-
apy room imagine particular problem situations. All
of this may be combined with behavior rehearsal, in
vivo assignments, modeling, and so on. Thus, ra-
tional restructuring is not a self-contained, theoreti-
cally derived procedure but an eclectic series of
techniques that can be tailored to suit the particular
demands of the patient’s situation.
A good example of rational restructuring is
Ellis’s (1962) rational-emotive therapy (RET). Ellis
was clearly a pioneer in what has become
cognitive-behavior therapy. RET aims to change
behavior by altering the way the patient thinks
about things. Conventional wisdom often suggests
that events cause (lead directly to) emotional and
behavioral problems. According to Ellis, however,
all behavior, whether maladjusted or otherwise, is
determined not by events but by the person’s inter-
pretation of those events. In the ABCs of RET,
Ellis argued that it isbeliefs(B) aboutactivatingevents
or situations (A) that determine the problematic
emotional or behavioralconsequences(C). He saw
psychoanalytic therapy, with its extreme reliance
on insight, as inefficient; the origins of irrational
thinking are not nearly as important as the messages
that people give to themselves.
In a sense, the basic goal of RET is to make
people confront their own illogical thinking. Ellis
tried to get the client to use common sense. The
therapist becomes an active and directive teacher.
Box 14-5 presents some of the more common irra-
tional ideas believed by Ellis to influence many peo-
ple. Reviews of the empirical literature suggest that
RET is an effective psychological intervention
(Smith et al., 1980). However, more detailed inves-
tigation of the components of RET that lead
to change in clinical status has been called for
(Haaga & Davison, 1993). As noted by Hollon
and Beck (2004), RET is among the least adequately
tested of the cognitive-behavioral treatments.
Although certain principles and strategies of RET
are incorporated into other forms of cognitive-
behavioral treatments, it seems that“pure”RET is
now much less frequently used than in the past.Stress Inoculation Training
Based on his own research, which indicated that
patients could use self-talk or self-instruction to
modify their behavior and that therapists could in
effect train patients to change their self-talk,
Meichenbaum (1977) developed stress inoculation
training(SIT). SIT aims to prevent problems from
developing by“inoculating”individuals to ongoing
and future stressors (Meichenbaum, 1996). It is
designed to help individuals develop new coping
skills and make full use of the coping strategies
that are already in place (Meichenbaum, 1996).
SIT for coping with stressors appears on the most
recent list of examples of empirically supported
treatments (Chambless et al., 1998; Chambless &
Ollendick, 2001). It proceeds in three overlapping
phases (Meichenbaum, 1996):- Conceptualization phase: First, the client is edu-
cated with regard to how certain thinking or
appraisal patterns lead to stress, other negative
emotions, and dysfunctional behavior. The
client is taught how to identify potential threats
or stressors and how to cope with them. - Skill acquisition and rehearsal phase: The client
practices coping skills (e.g., emotional self-
regulation, cognitive restructuring, using sup-
port systems) in the clinic and then gradually
out in the“real world”as he or she is con-
fronted with the stressors. - Application phase: Additional opportunities arise for
the client to apply a wide variety of coping skills
across a range of stressful conditions. To consoli-
date these skills, the client may be asked to help
others who are experiencing similar problems.
Further“inoculation”procedures, including
relapse prevention and booster sessions, are
incorporated during the follow-up period.
PSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 417