Behavior Therapy vs. Rational-Emotive Therapy: A Critical Comparison

Introduction

This paper considers the benefits and drawbacks of behavior therapy (BT) and rational-emotive therapy (RET) — two talking therapies with over half a century of application in clinical settings that are still used today, either in conjunction with or as alternatives to drug treatments for psychological disorders. The analysis concludes that both therapies remain useful, though each carries important limitations.

Behavior therapy and rational-emotive therapy were developed in the mid-twentieth century as alternative psychotherapies to Freudian psychoanalysis. A key foundational text for BT is Joseph Wolpe's (1958) Psychotherapy by Reciprocal Inhibition. Rational-emotive therapy — originally called simply "rational therapy" — was founded in 1955 by Albert Ellis (Ellis & Dryden, 1987, p. 1). Ellis' RET incorporates aspects of learning theory, which is central to BT, but goes beyond BT by utilizing the central concept of "cognition," which includes subjective beliefs, narratives, language, and the feelings these internal thoughts invoke. Rational-emotive therapy is thus regarded as an early form of cognitive-behavioral therapy (National Association of Cognitive-Behavioral Therapists [NACBT], 2010).

Wolpe's (1958) Psychotherapy by Reciprocal Inhibition grew out of findings from his laboratory experiments on cats. Wolpe demonstrated that he could inhibit the animals' fear responses by feeding them while gradually introducing and intensifying stimuli that would previously have frightened them. He extended this technique to humans, treating phobias and inhibitions through gradual desensitization — getting patients to physically relax while gradually increasing their exposure to anxiety-producing stimuli, within the safe, controlled context of a therapy session.

Behaviorist Foundations

Wolpe based his BT on the experimental psychology of the behaviorists. Behaviorism was pioneered in the early twentieth century by the Russian physiologist Ivan Petrovich Pavlov in his studies of the digestive system. Pavlov was interested in reflexive and involuntary reactions to anticipatory rewards. His experiments with dogs demonstrated the phenomenon of the "conditioned reflex" (also translated from Russian as "conditional reflex"). Pavlov showed that an involuntary, instinctual behavior — such as salivating — could be activated by an artificial environmental cue, such as the ringing of a dinner bell.

The idea of conditioning as a fundamental learning process was further developed in the United States by behaviorists, notably John B. Watson and B.F. Skinner, who argued that the investigation of overt, observable behavior constituted a more scientific basis for psychology than investigation into the subjective phenomena of mental states or feelings.

Skinner's studies of laboratory rats went beyond Pavlovian classical conditioning — eliciting an involuntary reflex by pairing the behavior with an environmental stimulus — by experimenting with operant conditioning, which involves increasing or decreasing voluntary behaviors through reward and punishment. Skinner (1953) distinguished four types of operant conditioning:

1. Positive reinforcement occurs when a behavior increases in frequency as it is rewarded by a desirable stimulus. For example, a child cleans her plate at dinner and her mother rewards her with dessert.

2. Negative reinforcement occurs when a behavior increases in frequency as it is rewarded by the removal of a negative stimulus. A child cleans her plate so her mother will stop nagging her.

3. Positive punishment occurs when a behavior decreases in response to an unpleasant stimulus. A child stops running around the house so her mother will not yell at her.

4. Negative punishment occurs when a behavior decreases as a result of a desired stimulus being removed. A child stops talking back so her toy will not be taken away.

The assumption of behavioral psychologists is that most — or possibly all — behavioral maladjustments must have been acquired through learning. People come to suffer later in life from being rewarded early on for self-defeating behaviors or punished for self-enhancing behaviors. Since negative behaviors were acquired by conditioning in the first place, they can be undone and replaced by better behaviors through a deliberate course of beneficial conditioning.

Albert Ellis, a contemporary of Wolpe, developed a competing model of psychopathology that incorporated some elements of BT but also aligned with the cognitive revolution. Over the course of his work in the 1940s as a clinical psychologist specializing in marital and sexual problems, Ellis grew dissatisfied with psychoanalysis as a means of problem solving (Ellis & Dryden, 1987, p. 1). The psychoanalytic model framed all relationship problems as the product of internal disturbances and conflicts within a person (Ellis, 1962, p. 3). Ellis based his alternative RET on ideas from Greek and Roman Stoic philosophers, such as Epictetus and Marcus Aurelius. Rather than internal psychodynamic conflicts, disturbances on this view were caused by irrational beliefs.

Mental constructs such as "beliefs" played no part in behaviorist psychology. The radical behaviorist view reduced all of human psychology to objectively observable behavior. Proponents of behaviorism saw their subject matter as more scientific than psychological theories that probed unobservable constructs such as the unconscious mind or the superego. This positivist goal of reducing all human experience to observable behavior came under challenge in the 1950s from advocates of cognitive science. Cognitive scientists — including linguists, psychologists, philosophers of mind, and computer programmers — proposed that the internal mental activities underlying action could be equally subject to scientific research, using introspection, as were overt behaviors.

Early investigations into cognition in experimental psychology predated the "cognitive revolution" of the 1950s, dating back to the work of William James and Wilhelm Wundt. These psychologists defined psychology as the science of mental life and examined their own subjective experience through introspection.

Influential theoretical critiques of behaviorism came from linguists such as Noam Chomsky (1959) and Lev Vygotsky (1962). These scholars argued that the syntax of human language is so subtle and complex that reward and punishment for correct usage by adult speakers is insufficient to account for language acquisition. Critics of behaviorism argued that language cannot be analyzed in behavioral terms alone, and that scientists should instead posit complex mental structures as the basis of analysis.

This critique marked the beginning of the cognitive revolution in psychology. Jean Piaget (1954) was a significant contributor to the field of cognitive psychology, studying the ways in which children build mental models of the world through observation and experimentation rather than simple reward and punishment. Albert Ellis (1962) and Aaron Beck (1967) were among the early clinicians who applied cognitive ideas to promote mental health.

Models of Psychopathology

A key assumption of BT is that maladaptive behaviors are acquired through learning and can be modified through additional learning — essentially unlearning what is causing distress and relearning new habits (Wolpe, 1958). Following the arguments of the radical behaviorists, the maladaptive behavior is itself the disorder that therapy addresses, not merely the symptom of some underlying mental problem. Effective BT therefore focuses on changing the behavior itself, rather than taking a detour to explain its underlying cause as a complex of developmental traumas. The basic premise of BT is: (a) emotional pathologies can be reduced to patterns of behavior, and (b) behaviors that have been learned can later be unlearned.

Cognitive therapists such as Ellis, by contrast, emphasize maladaptive thoughts as the underlying cause of psychopathology. Rather than focusing on changing overt behavior through reward and punishment, RET is designed to help patients reorganize the self-defeating habits of thought that manifest externally as maladaptive behaviors.

Behavior therapy focuses narrowly on changing behavior, using reward and punishment to reshape the patient's overt behavior in a desired direction. Cognitive therapy conceives of overt behavior as the external expression of patterns of thought, feelings, and beliefs. In order to produce positive change, the therapist helps the client restructure their thought processes.

Ellis (1962) claimed that irrational beliefs are pervasive in human life and are easy to acquire without much thought or effort. For example, it is easier for many people to fall into a pattern of self-defeating behavior — such as overeating — than to deliberately craft a self-enhancing behavior such as following a sensible diet. Ellis also took a critical view of religion as a source of dogmatic, inflexible strictures that block people from achieving their desires and generate negative, inhibiting feelings such as guilt, self-condemnation, and judgment of others. He regarded religiosity as a central feature of human emotional and behavioral disturbance, since religious belief systems tend to be absolutist and dogmatic, incorporating evaluative demands in the form of "ought," "must," and "have to."

In order to assess clients' psychological problems, Ellis developed an ABC framework, in which A stands for Activating event, B for a person's Belief about that event, and C for the Consequences that follow in light of that belief (Ellis, 1962).

RET does not advance an elaborate theory of how people come to acquire psychological disturbances. Ellis saw the tendency to arrive at irrational beliefs as part of human biological nature. Furthermore, simply knowing how a person developed an irrational belief does not suggest a therapeutic intervention, and RET is designed to provide practical solutions rather than elaborate explanations (Ellis & Dryden, 1987, p. 22).

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