The ABCs of REBT: Perspectives on Suicide Conceptualization

Body of Abstract: The ABC has always represented the cornerstone of Rational Emotive Behavior Therapy (REBT) and has always assisted mental health professionals for decades to make sense of clients’ psychological problems (Dryden, 2013). The ABC within the REBT framework has always been used to conceptualize clients’ concerns to find solutions to these concerns. It is undeniable that the ABC application in some of the current models to understand suicide or Post Traumatic Stress Disorder (PTSD) has still maintained this original intent but over the decades has altered the ways to promote realistic alternatives to the clients’ suicidal crises. The ABC of REBT is defined by letters that stand A for Activating Events, B for Beliefs and C for Consequences (Di Giuseppe, at al., 2014). Some studies show that the presence of doubts about the ABCs applications could be traced mostly to the theoretical misperceptions of the REBT framework (Dryden et al., 2008). The REBT therapeutic misunderstanding could explain why over the decades the ABCs have been applied using different modalities than REBT as a framework in the clinical practice of understanding trauma and suicide and is possible that these subsequent applications have been misunderstood by both clients and professionals leading to different conceptualization of the ABC framework (Grieger, 1985). The basic cognitive therapy approach to understand suicidal crises had extended B to the presence of several aspects of the cognitions such as negative automatic thoughts, intermediate beliefs and core beliefs (Wenzel at al., 2009). Furthermore, Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT-SP) and Cognitive Processing Therapy (CPT) for trauma have identified C only in terms of emotional consequences omitting the behavioral component of C as in the original ABC model developed by Ellis in the 1950s as opposed to some of the statements that the ABC Worksheet was developed by Resick and colleagues for CPT in 2007 (Bryan & Rudd, 2018). The ABC in BCBT-SP and CPT are adaptations of the original ABC developed by Ellis but they do not represent any new development in the framework of the ABC for clinical purposes.

Consequently, in this presentation the focus will be on stressing the simplicity and the clinical value of the original ABC developed by Ellis by highlighting the several limitations of the current ABC model adaptations in terms of:
1. Critical A: The original version of the ABC model reserves A as a unique aspect of "critical A," which identifies a specific situation that disturbs the client. The uniqueness of the "Critical A" is to define the situation present in actuality and not an inferential A in nature. The new adaptations of the ABC focus on one situational A without identifying a critical A; the issue with this approach is that professionals could experience difficulties in more accurate identification of the A because the clients could make several different inferences under the A. The main limitation in this area is that inferential themes under A cannot fully determine whether the emotions felt by the clients are healthy or unhealthy.
2. Cognitive Beliefs: The original version of the ABC model under B is characterized by four main irrational beliefs underpinning the clients' psychological disturbance: demands (Must and Should), awfulizing beliefs, frustration intolerance, and self-, other-, and life depreciation beliefs. The new adaptations of the ABC under B have expanded the cognitive part to other aspects of B that could promote confusion and misunderstanding in the clients as well as the professionals, such as inferences, negative automatic thoughts, intermediate beliefs, and core beliefs.
3. Emotional C: REBT theory distinguishes between healthy negative emotions (HNEs), such as concern, and unhealthy negative emotions (UNEs), such as depression. The original C of the ABC, as developed by Ellis, has a qualitative rather than quantitative theory of emotions. The new adaptations of the ABCs have a quantitative approach to emotions and have only one continuum on the intensity of the emotions, such as depression, that can be measured from 0 to 10.
4. Behavioral C: The original ABC has a second set of consequences for beliefs that is behavioral and defines action tendencies. The new adaptations of the ABCs have focused their consequences on the emotional component and dropped the behavioral component to identify action tendencies even within a framework, leading to a better understanding of suicide or trauma.
5. Expanding ABCDEF Model: The original ABC model expanded as ABCDEF illustrates how clients can reduce their distress by using the D as "Disputation" for their dysfunctional beliefs, then the E as generating "Effective Alternative Beliefs" and finally the F as "Functional emotional and behavioral goals." The new adaptations of the ABCs have focused mostly on the ABC components, drastically reducing the importance of DEF.

Finally, the purpose of this presentation is to emphasize the crucial importance of reconsidering the ABC in suicidal crises, focusing on the original model developed by Ellis in REBT, rather than the most current versions. This approach aims to enhance professionals' understanding and generalizability, as well as to facilitate clients' socialization to the model, thereby promoting a more effective active-directive and problem-oriented approach to psychotherapy that focuses on understanding suicide.

Learning Objectives:

• Describe the original ABC model as originally developed by Ellis in his expanded version of ABCDEF.
• Discuss how the current ABC model to address suicidal crises have modified the original ABC as developed by Ellis.
• Demonstrate how the application of the original ABC model as developed by Ellis can improve the effectiveness of treatments focused on suicide prevention.
• Prepare the next generation of researchers to become more familiar with the original ABC model as developed by Ellis.