REBT for Pain

Approximately 25 million American adults suffer from daily chronic pain, many of whom will also live with other physical and emotional problems, including depression and anxiety, disturbed sleep, financial burdens, and social isolation. Pain can encompass every aspect of an individual’s life, and if you are reading this, it is likely that you understand the impact of pain all too well and are keen to find a solution. Rational Emotive Behavior Therapy (REBT) could be part of that solution.

What is REBT?

REBT is based on the premise that events themselves don’t impact our emotions, but rather our beliefs about these events, which can often be irrational and emotionally driven rather than logical and based on rational thinking. Here, the ABC model has been proposed to illustrate this chain of events.

Activating event: the event that occurs (e.g., pain)

Beliefs: the beliefs we have about the event (e.g., today is going to be awful)

Consequence: our emotional response to our beliefs (e.g., I may as well stay in bed)

Example: Dorothy suffers from arthritic pain. An activating event for her would be needing to take groceries from the car to her kitchen. She is unable to do so, so she thinks, “I am disabled and can’t do the things I used to, not even this simple task of carrying groceries.” This activates her belief that, “I’m useless.” According to the theory behind REBT, this belief is irrational. Experiencing pain or not being able to carry her groceries has nothing to do with Dorothy’s worth or usefulness. The irrational belief simply acts to put Dorothy in a psychologically vulnerable position, making her feel sad and frustrated (consequence).

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If you have read this far, you may be feeling as though your painful experience is being denied and that REBT is based on the assumption that your thoughts and feelings are mere exaggerations. That isn’t the case. Your pain is very real and that is exactly why it can lead to irrational and self-defeating thoughts. It is a natural reaction to living with a chronic and debilitating condition. However, there are other ways and means to respond.
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REBT is based on the notion that you can choose to either succumb to negative and often irrational beliefs or adopt a more logical, evidenced-based stance. Are you ready to make that step? If so, read on.

What does REBT involve?

REBT can help you understand the ABCs in your life and identify any irrational beliefs that are leading to negative feelings. Once this is established, you can move from ABC to D and E. This includes Disputing any harmful beliefs by questioning them, and then exploring the Effects of actively disputing your irrational or unhelpful beliefs.

For Dorothy, REBT would involve challenging her irrational belief that she is useless so that she can learn to distinguish this from more logical and rational beliefs. The unrealistic demands she is placing on herself can be examined and debated to work toward developing healthy self-talk that can replace the irrational belief. Through REBT, Dorothy would be encouraged to question her thinking by asking herself questions such as, “What is wrong with asking for help to get the groceries from the car?”

How can REBT help me?

Although changing thought patterns does not remove pain altogether, REBT can significantly improve how pain is coped with and managed. It can help you minimize any unhelpful beliefs and recognize when you might be creating new pain symptoms or behaviors or repeating previous ones.

Three insights to gain from REBT are:

1. irrational beliefs about feared events cause an emotional disturbance;
2. this disturbance continues because of recurrence of these beliefs; and
3. reducing and eliminating this disturbance requires consistent work.

Choosing to embark on REBT entails committing to practicing three forms of acceptance.

1. Unconditional self-acceptance: “I have some disability due to my pain, but that does not make me less worthy than anyone else.”

2. Unconditional other-acceptance. “Sometimes people don’t understand the impact of my pain, but that does not make them less worthy than anyone else.”

3. Unconditional life-acceptance. “Life isn’t always how I want it to be because of my chronic pain, but there are good times, too.”

Andrea Elkon, PhD, director of behavioral health for Alliance Spine and Pain Centers, says, “Most patients presenting for treatment of chronic pain are not psychologically minded. That is, they are VERY aware of the distress associated with pain, and they are also fairly good at stating what they can and cannot do because of pain. However, most patients have difficulty articulating the thought process in between feelings and behaviors. To that end, REBT, with its action-oriented focus, is potentially far more effective for an average chronic pain patient. Patients are able to focus on making small behavioral changes and see real results in a faster amount of time.”

Do I need an REBT therapist?

While working with an REBT therapist is recommended, you can try some techniques on your own if you find yourself thinking negatively or irrationally. These techniques fit into the ABCDE model.

1. Describe the activating event.
Ask yourself, “If there was a camera here right now, what would it see? Is it real or imagined? Is it felt or observed? Is it in the past, present, or future?”

2. Identify the beliefs you are having about this event.
Pick up any “musts” or “shoulds.” Are you using words like “awful” or “terrible”? Are you rating yourself negatively? Is the situation really as bad as it feels? Ask yourself, “What is the worst that could happen? Am I really close to the worst happening?”

3. What are the consequences of your beliefs? How are you feeling because of your beliefs?
Apart from working directly on your irrational beliefs, you can also work on the feelings and behaviors that stem from these beliefs with the help of imagery and behavioral techniques.

4. Dispute your beliefs.
Ask yourself, “What is the evidence to support my belief? Is my belief logical? Is there any evidence against my belief?” Use these strategies for disputing your beliefs.

• Functional disputes. Question whether your belief helps accomplish your goals.

• Empirical disputes. Question whether your “facts” are accurate.

• Logical disputes. Question the logic of your thinking process.

• Philosophical disputes. Question whether, despite some dissatisfaction, pleasure can be derived from life anyway.

• Double-standard dispute. In instances when you are holding a “must” or “should” statement for yourself, ask whether you would hold another person to the same standard. If your answer is “no,” then you are holding a double standard and could benefit from giving it up.

5. Experience the effects of the rational approach.
Re-evaluate the situation and come up with some alternative beliefs. For example, “The situation is bad, but it is not the end of the world” or “There are times when I really hurt, but I also have good days.” Other techniques include changing any “musts” and “shoulds” with preferences. Let’s consider how Dorothy’s “musts” and “shoulds” could be altered to help rather than harm her.

Belief: “I should be able to take the groceries from the car to the house.”
Rational alternative: “I wish I could take the groceries from the car to the house. Unfortunately, I can’t at the moment. Maybe I could take the lightest bag and ask my son to help with the others.”

Belief: “I must be useless.”
Rational alternative: “Sometimes I feel useless if I can’t do something I want to do, but one activity doesn’t define who I am.”

What does the research say?

Evidence supporting the effectiveness of REBT for treating chronic pain is scarce because it is a relatively new approach for this condition. However, the research that is available shows promising results, including:

– reduced symptoms in people with musculoskeletal pain receiving REBT in combination with medication;

– reduced pain among cancer patients;

– REBT together with behavioral interventions resulted in improved quality of life and decreased symptoms in one woman experiencing restless leg syndrome and its associated pain;

– people with chronic fatigue syndrome who took part in an REBT-based stress management group experienced improved quality of life; and

– paralympic athletes have improved their psychological health and boosted their athletic performance via REBT, showing the technique can be effective for improving both psychological and physiological health.

Overall, REBT can help enhance quality of life by reducing your negative perceptions of pain, enriching your engagement in daily life activities and social interactions and improving your coping. Why not give it a try?

Want to learn more about coping with chronic pain? Read “Your Self-Management Toolbox,” “Improving Quality of Life With Chronic Pain,” and “ACT for Chronic Pain.”

Nicola Davies, PhD, is a health psychologist.

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