Stress Counselling

A Rational Emotive Behaviour Approach

Albert Ellis, Jack Gordon, Michael Neenan, Stephen Palmer

• Publisher: SAGE Publications Ltd
• Year: 2001
• ISBN:
  9781446237137
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

`The text is clear and easy to follow with vivid sessional excerpts that illustrate the theoretical dialogue? - International Review of Psychiatry

`The publication proves to contain much instructive and practice-oriented material? - Nursing Standard

Stress Counselling is a comprehensive study of the theory and practice of the Rational Emotive Behaviour approach applied to stress counselling and psychotherapy. Albert Ellis pioneered Rational Emotive Behaviour Therapy (REBT), which has since been adopted internationally. This approach enables the clients to embark on a course of effective counselling which has a clear beginning and end.

This book discusses techniques and solutions to common problems and also provides guidance on conducting group work. Its comprehensive coverage includes additional material on techniques such as skills training, relaxation methods, hypnosis and biofeedback.

CHAPTER 1

Stress: A Rational Emotive Behaviour Perspective

The last decade has been notable for a growing interest and emphasis on stress-related topics in both the public and academic media. In academic journals there has been a proliferation of published research on stress and related topics, and at the same time, the public media have been drawing attention to the effects of stress on personal health and well-being in general. Stress management training programmes have been introduced to business organizations concerned about absenteeism in the workforce and in helping employees to cope more effectively with the daily pressures and demands of their job. However, despite the continuing output of published research on stress and anti-stress therapies, stress counselling, as Wagenaar and La Forge observed, remains vague and imprecise.¹ Part of the difficulty in discussing effective treatment of stress stems from the lack of a consistent definition of stress. Stress is not always bad; in fact, some individuals - especially those in competitive sports - have found that a degree of stress-related arousal can enhance their performance, while a lack of it has the opposite effect.²

It seems, therefore, that in a stress counselling context we are really talking about the emotional and physiological distress experienced by a person exposed (1) to a series of interpersonal and environmental stressors perceived as demands that exceed the person’s capabilities of coping with them, or (2) to an ongoing situation perceived as sufficiently threatening to overwhelm the person’s resources for handling it. Since an accurate conceptual model of a problem is a prerequisite for the development of effective solutions, let us begin by clarifying what we mean by ‘stress’.

Conceptualizing stress problems from a rational emotive behaviour perspective

What is stress? The answer, according to REBT, is to be found mainly in the way a person perceives, interprets and evaluates environmental and other kinds of stressors. In other words, stressful conditions rarely exist in their own right, but certain life situations or conditions may be experienced as stressful depending upon the perceptions and cognitions of those who are reacting to these conditions.³

This is not to say that there can never exist circumstances that are intrinsically ‘stressful’. If, for example, a group of randomly selected individuals are hijacked by armed political thugs - so-called terrorists - and are deprived of sleep, food or water for an extended period of time, and subjected to various kinds of torture, such as beatings and non-stop interrogation, it is likely that just about all of them will experience a level of stress that exceeds their capacity to withstand it, and will at least partially crack under the strain. For some, the experience may even be fatal; others who manage to survive will live with disturbances such as anxiety, depression and suicidalness, often accompanied by various kinds of PTSD (post-traumatic stress disorder), such as cognitive intrusion and sleeplessness. In addition lowered levels of immune system regulation and increased levels of catecholamines following prolonged exposure to severe stressors can persist long after the chronic stressors have actually ended.⁴

Of course, strictly speaking, the Stimulus does not cause the Response directly but acts via the Organism to produce the Response. It is the particular biosocial makeup of humans that determines the (human) response. Other living creatures with different biologies would respond differently to the same set of life-threatening stressors than would a human.⁵ Thus, strictly speaking, stress per se, unlike gravitation or molecules of carbon dioxide, has no independent existence of its own. As Klarreich notes, ‘Events in the environment are not significant unless the person attributes significance to them and perceives them to be stressful’.⁶

Clinically, stress appears to exist only in the nervous systems of humans as a synthesis of certain physiological symptoms and disturbed negative cognitive, emotional and behavioural responses to events or situations which are perceived and evaluated as a threat to one’s life or well-being to a degree that exceeds one’s capacity to manage them effectively, either temporarily or permanently. Thus the three key elements in stress are perception, belief and ineffective management or behaviour.

In discussing how stress is conceptualized we wish to emphasize two points. First, as we previously pointed out, we are really talking about distress, since not all stress is distress. Some ‘stressors’ are actually viewed as ‘exciting’ and ‘pleasurable’. Second, stress can take several forms; it is used to denote anxiety, panic, depression, anger and other disturbed emotional states together with maladaptive behaviours and various accompanying physiological reactions that may in turn become the focus of secondary disturbances (for example, anxiety about hypertension).

What triggers the experience of stress?

Stressors described as extremely life-threatening situations, such as those mentioned above, rarely occur in most people’s experience. The most commonly occurring stressors are negative life events. In REBT a negative event may be defined as one that has the potential or actual ability to trigger a chain of cognitive and emotional reactions leading to adverse outcomes for the individual in terms of his or her physical and psychological health. Examples of both acute and chronic stressors include natural and technological disasters, violent crimes, bereavement, relationship breakups, various job stressors such as job loss and work-related pressures and failures, chronically bad housing and serious injury or illness. In addition to these, Ellis listed early traumas (beatings), rape, major life changes, a series of apparently never-ending troubles or noxious events, lack of leisure, general fatigue syndrome (GFS), a boring existence, and hypervigilance as stressors that people typically face during the course of their lives.⁷ Biological stressors include hormonal or neurotransmitter dysfunction, physiological overload, chronic lack of sleep and various kinds of debilitating injuries. All of these are examples of negative life events or stressors.

Recognizing stress symptoms

Stress consists of disturbed psychological reactions usually accompanied by certain physiological components.

1. Physiological reactions of individuals to internal or external stressors tend to vary according to the individual’s constitution.⁸ These may vary from mild and relatively transient gastrointestinal sensations such as ‘butterflies in the stomach’ to more serious disorders. Typical disorders that develop or worsen as a direct result of relatively prolonged exposure to various stressors include hypertension, migraine and tension headaches, digestive system disorders and a number of other more serious complaints. The longer an individual suffers from stress, the worse the physiological disorders tend to become.

Chronic stress acts to maintain arousal of the autonomic nervous system (ANS), and the biochemical effects of continued arousal of the sympathetic component of the ANS cause a gradual breakdown of the weakest systems in the body. The physiological consequences of one particular chronic stressor, caregiving for family members with Alzheimer’s disease, showed that chronic stress could have potentially irreversible damaging consequences on the general mental and physical health of older adults in the longer term.⁹ Hypertension, diabetes, ulcers and a lowered efficiency of the immune system may follow as a consequence of prolonged and unrelieved exposure to stressors which overcome the individual’s coping resources, and therefore are experienced as some form of stress. Thus, counselling and stress management can involve helping the person to deal with the stressors in life as well as the physiological consequences of exposure to chronic stressors.¹⁰

2. Psychological aspects of stress include feelings such as anxiety, depression, anger, guilt, hurt, morbid jealousy, shame, embarrassment and envy. These may be linked with various other responses that can include sensations, imagery, behaviours, cognitions and physical symptoms.¹¹ As we noted above, as well as being part of the stress syndrome, both the physiological and the initial psychological reactions to stress may react upon one another and therefore complicate the overall picture. These ‘second order’ disturbances will be considered in more detail later. For the moment it is important to remember that a person suffering from any one of the different kinds of psychological stress listed above may develop a stress-related physical illness. This in turn becomes yet another stressor for the person to cope with. The consequence is that the person feels even more stressed and debilitated and may simply give up trying to cope with the problem.

It is important to recognize and deal with second order disturbances, for, as Martin found in his review of stress in psychomatic medicine, a much better predictor of health and illness than life events or stressors per se is whether someone goes through a period of ‘giving up’. Anxiety and depression about one’s poor health will almost always have a negative effect by making both the physical and psychological conditions more difficult to treat. For the client, fear, anxiety, helplessness and panic simply make physical illness worse or more difficult to cope with. The inter-relationship between physical illness and emotional disturbance is important to bear in mind when dealing with stress as it has obvious implications for deciding the most appropriate kind of psychological approach to be used in the treatment of stress. ¹²

The rational emotive behaviour approach to stress counselling

Rational emotive behaviour therapy (REBT), formerly known as rational emotive therapy (RET), is a theory of personality and a comprehensive approach to psychological treatment that was developed by Albert Ellis, a clinical psychologist, in the 1950s. A key element of rational emotive behaviour therapy is the emphasis it places upon the cognitive element in self-defeating behaviour. At the same time, rational emotive behaviour theory maintains that cognition, feeling and behaviour are interrelated and interacting processes, and that all of these must be taken into account if treatment methods are to be effective.¹³

REBT states that our perceptions and evaluations of events in our environment largely determine how we respond emotionally and behaviourly to these events.¹⁴ The core assumption of REBT is that what we label ‘stress’ or ‘distress’ is determined not by the unpleasant events or ‘stressors’ that people experience in their lives, but mainly by their Irrational Beliefs about what they perceive is happening to them. Thus, when subjected to various environmental or interpersonal stressors or irritants, one set of individuals will see themselves pressured but will not feel stressed. Such people see themselves capable of coping adequately with difficult circumstances or adversities in their lives. By contrast, other individuals confronted with similar kinds of stressors feel highly aroused emotionally and physiologically, and cope poorly and inadequately with their situation.

The key issue, then, as Abrams and Ellis note, is: how does the environmental or interpersonal stressor become oppressive?¹⁵ What causes the dysfunctional emotional and physical states symptomatic of stress? And what can be done to help people to reduce their levels of stress and to function in a healthier and more effective manner? Biological stressors, such as those listed above, can obviously contribute to the experience of stress, and even predispose certain individuals to experience severe degrees of stress, as can virtually any of the other kinds of stressor. Since only on rare occasions is it possible or realistic to help a distressed client by eliminating the particular environmental stressor(s) supposedly causing the client’s problem, we are left with one main possibility: the psychophysical condition of the distressed client had better become the focus of our attention.

One of the primary goals of rational emotive behaviour therapy is to show distressed clients (1) that the unfortunate events they experience in their lives do not by themselves cause their distress, although they may contribute to it; (2) that their distressed feelings and self-defeating behaviours arise from and are maintained by the distorted inferences and Irrational Beliefs they hold about the unfortunate activating events in their lives; and (3) that surrendering their irrational cognitions and replacing them with more rational philosophies will help them to reduce or overcome their disturbed psychological and physiological states we call stress and to emote and behave in healthier, and more constructive, or self-helping ways.

In their discussion of the nature of the personality and behavioural variables that mediate individuals’ ability to cope with stress, references were made to the results of work carried out by various researchers which seemed to suggest that a disposition to optimism, an ‘easygoing’ attitude to life, and relatively robust coping strategies can play a part in determining how well an individual reacts to the stressors encountered in daily life.¹⁶ While we would not disagree that specific personality characteristics can influence individuals’ ability to cope with stress, nevertheless we believe that these characteristics encourage people to create various kinds of irrational cognitions about the negative life events or stressors in their lives. Following Abrams an...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Foreword
• Preface
• 1 Stress: A Rational Emotive Behaviour Perspective
• 2 Assessment in Rational Emotive Behaviour Therapy
• 3 The Beginning Stage of Stress Counselling
• 4 The Middle Stage of Stress Counselling
• 5 The Ending Stage of Stress Counselling: Working Towards Termination of Stress Counselling
• 6 Additional Techniques for Stress Counselling with REBT
• 7 Brief Psychotherapy with Crisis Intervention in Rational Emotive Behaviour Therapy
• 8 How to Deal With Difficult Clients
• 9 Occupational Stress and Group Work
• Afterword: Training in Rational Emotive Behaviour Therapy
• References
• Appendix 1: REBT Self-Help Form
• Appendix 2: Assignment Task Sheet
• Appendix 3: Techniques for Disputing Irrational Beliefs (DIBS)
• Appendix 4: How to Maintain and Enhance Your Rational Emotive Behaviour Therapy Gains
• Appendix 5: An ABCDE Form
• Appendix 6: An Introduction to Rational Emotive Behaviour Therapy
• Appendix 7: Stress Mapping
• Appendix 8: Big I/Little i Diagram
• Appendix 9: Irrational Belief: Cost-benefit Form
• Appendix 10: Rational Belief: Cost-benefit Form
• Index