Dr. Michael R. Edelstein is a licensed clinical psychologist with over 25 years experience. He is in private practice in San Francisco and is the author of Three Minute Therapy: Change Your Thinking, Change Your Life, a self-help book for overcoming common emotional and behavioral problems.
In his practice, Dr. Edelstein specializes in the treatment of anxiety, depression, relationship problems, and addictions, and is one of the few practitioners of Rational Emotive Behavior Therapy (REBT) in the Bay Area. He is a SMART Recovery (SR) Professional Advisor and has served as a Rational Recovery (RR) Specialist. He is a Certified Sex Therapist and has served as a Consulting Psychologist for the National Save-A-Life League, Inc., the oldest suicide prevention center in the United States.
Dr. Edelstein is a Training Supervisor and Fellow of the Albert Ellis Institute. He holds a diplomate in Cognitive-Behavioral Therapy from, and is on the Board of Advisors of, the National Association of Cognitive-Behavioral Therapists. He is Past President of the Association for Behavioral and Cognitive Therapy. He also writes the popular advice column, “Ask Dr. Mike,” which appears in the San Francisco Intelligencer.
Dr. John Grohol: Dr. Edelstein, we’ve long heard about the ABCs of cognitive behavioral therapy, but in your book, you talk about Three-Minute Therapy using the ABCDEFs of REBT. What is REBT, and can you walk us through the ABCDEFs?
Dr. Michael Edelstein: Sure, John. And I just want to thank you for inviting me to take part in this interview.
REBT stands for Rational Emotive Behavior Therapy. It was devised by Albert Ellis in 1955, and since then, it’s spawned a variety of cognitive behavior therapies, most notably those devised by Aaron Beck and David Burns. And REBT says that it’s never situations themselves that upset us or disturb us or cause us to feel anxious, depressed, angry, or act in addictive ways, but rather it’s our thinking about those situations.
It’s our ideas that use notions, thoughts, views, opinions in our head, what we tell ourselves about those adverse situations that cause our problems, not the situations themselves. And that’s a very powerful idea because that means, if you’re feeling anxious, depressed, or angry, you are in control. You are creating that. You are making yourself feel that way. So you can uncreate those feelings. And that’s what cognitive behavior therapy and Rational Emotive Behavior Therapy is based on.
And Albert Ellis took that theory, or actually devised that theory, and took it down to a simple ABCDEF that you mentioned.
And let’s take a problem. Let’s suppose your mate criticizes you unfairly, in your view, and you get angry. So let’s see how we can apply the ABCDEF model to that. And I call that the three-minute exercise.
Dr. Grohol: OK.
Dr. Edelstein: So, A stands for activating event or adversity. So, A is “My mate criticized me unfairly.”
Then B is what you tell yourself about it. Now, B normally starts with a reasonable notion, such as “I prefer he or she not criticize me unfairly. I don’t like it. This is unpleasant, frustrating. I wish he wouldn’t.” And that preference leads to appropriate negative emotions, such as displeasure, frustration, concern, disappointment.
And those are appropriate negative emotions in that they’re not dysfunctional to feel that way; if you get criticized unfairly, it makes sense to have some negative reaction. It doesn’t make sense to feel numb or happy about it, so it makes sense to have a more measured or reasonable response to it.
But then, being imperfect humans, we take our strong preferences and convince ourselves they’re absolute musts, shoulds, have-tos, laws of the universe, things absolutely have to be that way. So I take my preference, “I’d prefer my mate not to criticize me,” and insanely convince myself, “Therefore she must not criticize me unfairly. She must be fair. And she’s no good, she’s rotten, because of her unfair treatment.”
And we call that B irrational belief. And that irrational belief in B leads to C, undesirable emotional consequence: anger, resentment, hostility, wife abuse, those kinds of things. So it’s B that causes C. My demand is she treat me fairly, rather than A, activating event, her unfair treatment.
Dr. Grohol: Got you.
Dr. Edelstein: So, if we look at B, “She must not treat me unfairly, ” my goal is reasonable, that I be treated fairly. That makes sense. It’s just the must about it that’s the toxic part that does me in and gets me angry.
So the question is, how can I keep my goal, to be treated fairly by my mate, but get rid of the demanding, the commanding, the musting about it? And the answer is we go on to D.
D stands for disputing or questioning the irrational belief. And to do that, it’s a simple process. We just take what we have at B, “She must not criticize me unfairly,” and just put “Why?” or “What is the evidence?” in front of it, and we get a good question: “Why must she not treat me unfairly? Where’s the evidence she must always be fair in her criticisms? Where is it written that my mate must be understanding, fair, kind, and considerate?” So that’s a good question.
And then we go on to E. E stands for effective new thinking, or the answer to the question. And if you think about it, and think about it and think about it, you’ll normally never find evidence for must. Since you don’t run the universe, as far as I know–I didn’t see in this morning’s paper that any of us were elected ruler of the universe–there’s no reason why anyone must or has to act the way we want them to.
So that’s what we could put in E: “No reason she absolutely must treat me fairly, although I’d prefer she treat me fairly.” And then the more you have in E, the more persuasive it tends to be, as long as what you write in E is meaningful and not pie-in-the-sky.
So you can add more things, like “It is disadvantageous to be treated unfairly, but not the end of the world.” “I don’t like being treated unfairly, but I definitely can stand it.” “I’ve survived unfair treatment in the past, and I’ll survive it in the future.” “It’s not my mate’s unfair treatment of me that makes me angry, but rather it’s my unrealistic thinking about it, and I can change my thinking.”
“In order to have the advantages of a good relationship with a mate, a partner, or a friend, or even a colleague, it’s necessary to have the disadvantages. That’s inevitable.” “I can still have a happy life, even though I’m treated unfairly at times, although I’d be happier if everyone in the world always treated me fairly.”
So you write out all the reasons why the must is false and self-destructive. And then, if you do that on a regular basis, even daily, once or twice or three times a day, you practice writing out those three-minute exercises and reinforce the effective new thinking, then, due to the learning process which says “Reinforcement is the royal road to learning, ” you slowly, or not so slowly, get to F, your new feeling: concern, disappointment, displeasure, frustration, or if it’s a big issue, great displeasure, great concern, great disappointment. But not anger, not resentment, not hostility, because you’ve banished the must.
Dr. Grohol: Yes, it makes a lot of sense when you break it down in that way.
And it kind of brings up the question in my mind that a lot of us–I guess maybe most of us–actually go through life, if we haven’t been exposed to cognitive behavioral therapy or some of these ideas, and we go through life thinking these kinds of thoughts, these must thoughts, these beliefs. Do you think we were taught them, in some way, as a child, or is it just something that, inherently, we automatically go to because we don’t have an alternative when we’re growing up?
Dr. Edelstein: Well, actually, John, I think it’s both. I think we’re both taught them or we don’t figure out an alternative for ourselves. And some people do. Some people naturally figure out that it’s their thinking that is their problem, or their emotional problem–not necessarily the practical problem, but their emotional problem–and then they work on changing their thinking. So there are people who realize that.
But that idea is reinforced that it’s situations that do it to us, not us. And then we have a genetic predisposition to think that way and part of it, I think, it just seems like if someone criticizes you unfairly and you immediately get angry, intuitively it seems reasonable that they made you angry. So it’s partly just the way we’re built.
But then Freud came along and set back the progress of psychotherapy 50 to 100 years by saying it’s your childhood and it’s your Oedipus complex and it’s your unconscious and how you were treated by your dysfunctional family. Those things, so again he was saying it’s A that causes C, your childhood causes your disturbance rather than what happens right now, but its still a situation.
So we have all these things going against us and that’s why I’m in business.
Dr. Grohol: Understood. Some critics of cognitive behavioral therapy techniques like this one argue that the therapists at times seem to be too intellectual and too simplistic in this thinking. We can just think away our problems and feelings. How do you respond to such critics?
Dr. Edelstein: Well I think that some therapists some of the time could fall into this being too intellectual and too simplistic. But a trained REBT therapist normally starts and ends with feelings, not intellect.
We talk about, in the first session, why the client is here and that has to do with feelings, “I’m depressed, I’m anxious, I’m having panic attacks, I feel guilty, I’m unassertive or I’m acting addictively.” So we do look at feelings.
And then the goal of REBT, this feeling exercise that we described, is to help people improve their feelings. All this is anchored in feelings, but since we see that it’s the intellect, especially the evaluative intelligent creates the feelings, we do focus on cognitions, intellectual, perception and thoughts, attitudes, beliefs. And we see that that’s the power in changing your feelings so it is important to focus on your thinking in order to change your feelings.
There are many more therapists, I think, who go to the other extreme, who are too feeling based and they focus on feelings, feelings, feelings. Get out your feelings, express your feelings, beat the pillow to get your anger out and those kinds of things. They’re barking up the wrong tree because, as I explained, that’s not how humans work.
As far as the simplistic argument, one of the highlights of REBT and the cognitive therapies is that it is simple. You have a few basic premises that it’s your thinking that causes your feelings. Its musty thinking that causes disturbed feelings and to overcome your disturbed feelings and behaviors you change your musty thinking.
Those are the few simple premises with profound implications. It is simple, but simplistic implies overly simple or glibly simple or superficial, and that’s not the case here because we go into your deep core beliefs that cause your problems. It’s not simplistic as far as I can tell, but rather simple, clear cut, and doable.
Dr. Grohol: You mentioned the emotion of anger, and in reading your book you don’t seem to think much about anger as an emotion that people should be able to express and that to combat it we should simply not allow ourselves to be angry in the first place.
It occurred to me that this seems to be going against the belief that there’s no such thing as a bad emotion and that if we try and repress our anger or to redirect it into something else we are suppressing a normal part of the human experience. What do you think about that? Can you talk more about your sense of anger?
Dr. Edelstein: Yes, and I agree with some of the things you say even if they’re criticisms. And that is, suppressing, or repressing anger is not our goal in REBT. It’s to get at the thinking behind it, again, we have some simple principles, it’s your thinking that causes your anger not situations. So if you change your thinking, if you don’t think in an angry, demanding, commanding way then you won’t get angry in the first place. So there’s nothing to suppress and repress in the second place.
Anger comes from a demand, “You must treat me kindly, considerably, lovingly, courteously, reciprocally, reasonably”, those kinds of things. And as long as you demand that, you get anger, and you are much less likely to get the results you want. And you are much less likely to get kind, loving behavior on your partner’s part or your colleague’s part. Because often when you get angry at someone they’ll say, “Who do you think you are telling me what to do, I’ll show you” and they’ll tend to get rebellious themselves. So anger certainly doesn’t work.
I don’t think that people should not necessarily be able to express anger. I think if people want to, and they feel that it’s in their best interest to express anger, that’s certainly their prerogative and I’m not going to try to stop them.
As a therapist, what I do is I ask people, what are your goals, what would you like out of therapy and if they say, “I’m angry but I don’t want to get un angry, I want to get over my cigarette addiction” then I’ll just help them with that.
They certainly have a right to get angry if they want. I’m just saying, in terms of most people’s goals most of the time it tends to sabotage, defeat, and interfere with your goals.
As far as, there’s no such thing as bad emotions, well there is no such thing as bad emotions in the abstract, emotions are all human, however in terms of people’s goals there are bad, self destructive, self defeating emotions. Not in a moralistic sense but in a practical sense that it tends to act against what you’d like to get out of life. In that case anger, anxiety, depression certainly doesn’t work, so I would say that they’re bad emotions.
Dr. Grohol: Good point. You also point out in the book a few problems with self-esteem and the idea of self-esteem. That it can delude us into believing that we are good at something, when in fact we are not. That we can see our self as sort of this unchanging essence and that things like self rating leads us to beat ourselves up unnecessarily when things go badly or compare ourselves unrealistically to others.
What kinds of things do you suggest instead of self esteem?
Dr. Edelstein: You are right that self-esteem is harmful. Its self rating. And in my book Three Minute Therapy, I have a chapter on self-esteem and I call it the “feel good about yourself chap.” Because self esteem, high self-esteem means you are rating yourself highly. You are thinking well of your entire self based on some of your good actions or people’s approval.
But then that’s going to lead to low self esteem if your actions don’t live up to your expectations or people disapprove of you. So you tend to be on that self rating roller coaster. “I’m good when I act well and I’m a bad person when I don’t act well.”
A solution to that is to give up all self rating. You are never a good or bad person no matter who loves you or who hates you, but rather you are always just an imperfect human who acts imperfectly. And if you accept yourself just as an imperfect human, not as a good or bad person who has to rate himself, then you get unconditional self acceptance.
You substitute self-esteem with unconditional self acceptance and then you get off the roller coaster. But you can still enjoy life immensely by setting up goals and working towards your goals and sometimes even achieving your goals. A byproduct of those things is enjoyment if you don’t sabotage it with “I must do well, I must get approval or else I’m no good’ then that leads to anxiety.
Self-esteem is not the solution. Unconditional self-acceptance, along with self discipline, working hard at achieving your goal, those are a better prescription for a happy life than going after proving yourself and high self-esteem.
Dr. Grohol: That certainly seems to make some sense. And I think that people often fall into that trap. So it was really enjoyable to read that chapter in your book and see how you recommend it, that there are alternatives to just self-esteem in that approach.
Dr. Edelstein: That’s right, John. And also, even sadder than that is therapists and teachers and educators and authors often fall into that trap, and most therapists that I’m familiar with and that I’ve read recommend improving your self-esteem. So they’re trapped, and then they teach this to their clients, who assume that this is the way to be and then go along with it, and then never really get over their anxiety or depression problems because they continually reinforce the self-esteem idea rather than abolishing it entirely.
Dr. Grohol: Yep, I agree.
Can you talk a little bit about what you mean by something you talked in your book called “low frustration tolerance,” and how that comes into play with the way we often think about things in our lives?
Dr. Edelstein: Yes. And as I just mentioned, John, along with unconditional self-acceptance, high frustration tolerance is a prescription for a happy life. And low frustration tolerance means you have goals in your life: long-term goals, middle-term goals, short-term goals, and then you try to figure out ways to achieve those goals.
Something as small, you would think, to many people, as getting out of bed in the morning. You have a goal to get out of bed at 6:00 AM and get to work on time. But then you get up in the morning, and it’s dark out, or it’s cold in the room, or your tired. So that’s frustrating to push yourself to get out of bed.
And low frustration tolerance comes from a demand: “It must not be so frustrating or so difficult to get out of bed. It should be easy. So I’ll press the snooze alarm and try again in five minutes when it’ll be easier.” And then, in five minutes, you have the same philosophy, normally, and you do it again, and ultimately you’re late out of bed and late to work, because you had difficulty, you created difficulty yourself in tolerating the frustration.
And this leads to procrastination. You put off doing things that are going to be frustrating because you convince yourself, “It should not be so hard. I can’t stand this frustration. I’ll do something fun now, like have a drink or have a smoke or surf the web, or anything but pay the bills or wash the dishes or do my homework, or ask the boss for a raise, because it’ll be uncomfortable.” And then that’s an easy way to a difficult life.
So the solution is to accept the fact that life consists of one frustration after another, one hassle after another, one dissatisfaction after another–of course, with satisfaction and joys in between, so it’s not all grim–and that’s the way it is.
And the more you accept that, again, unconditional self-acceptance, the more you accept the fact that there are going to be frustrations. And if you face them and get over them and not have them hanging over your head–if you do the homework right now, or just wash the dishes, or make the bed, or have the unpleasant discussion with someone that you’re better off having, and get it over with — and then you’ll have less frustration in the long run.
So people who have low frustration tolerance or low discomfort tolerance tend to go for a quick fix, immediate pleasure, short-range hedonism. But paradoxically that creates more frustration, discomfort, and hassles in the long term.
Dr. Grohol: A lot of the things you talked about in the book — and certainly, you give a lot of concrete examples and walk people through those examples to really show how this can be put into daily practice or what-not.
It kind of led me to wonder, though: how can a person move from hearing this, what you’re saying today, and thinking, “Wow, these are great ideas, and this is a great way of looking at my problems. I hadn’t thought of it this way,” into actually putting some of the techniques of Three-Minute Therapy into practice? How does a person do that?
Dr. Edelstein: Well, that’s the key question. And I answer that in my book, “Three-Minute Therapy.” And the answer is, first, is you’re saying we have a superficial recognition, once we understand some of these theories, that it’s our thinking that causes our problems, it’s our demanding, musty thinking, and that there are no musts, there are no shoulds, just preferences. So the first step, or the first stage, is the superficial recognition of that.
But then the question you’re asking is, how do you go from stage one, a superficial recognition, to stage two, a deep conviction, deeply feeling it and believing it, having an entirely new, demand-free philosophy? And the answer is that bridge from stage one to stage two comes from the same learning principle that we use to learn most things, and that says, “Reinforcement is the royal road to learning.” The more we reinforce, review, repeat, go over, practice something, again and again and again, whether it’s an idea or an action, the better we get at it.
So it’s the same with kicking at your demands and thinking in terms of preferences. The more you practice it, the more you etch new pathways in your brain and start to think a different way. So you’re more likely to go into a bar thinking like a non-addicted person, so you’ll be able not to take a drink, or have a hot discussion or a difficult discussion with your friend or colleague or partner without an angry philosophy, or perform without an anxiety-creating philosophy.
You have a new way of looking at things. You’ve developed stage-two learning and, through the practice, repetition, and reinforcement. And writing out the three-minute exercises is a key to that practice.
So I recommend to my clients that they religiously write out those three-minute exercises, daily–once a day, twice a day, three times a day. I once had a client who, after a week, brought in 41 three-minute exercises she had written out that week and was dramatically better as a result of that.
And in each chapter in my book, “Three-Minute Therapy, ” I discuss a different type of problem, like procrastination, panic attacks, social anxiety, anger, depression, relationship problems, addictions, and money worries, and show you how you can use these principles, apply it to that problem, with a three-minute exercise. So that’s very useful for the reinforcement process. That’s the key.
Dr. Grohol: It makes sense when you say it like that. And I guess it comes down to just a lot of practice, over and over again.
Dr. Edelstein: Exactly right. Practice, practice, practice.
Dr. Grohol: [laughs] Understood.
You mentioned the example of going into a bar. And certainly, in the book, you have a chapter devoted to the interesting background, an alternative look at Alcoholics Anonymous, one of the most famous and oldest self-help approaches around. What are some of your primary criticisms of the AA approach?
Dr. Edelstein: Well, the main problem, as I see it, with the 12 steps is that they encourage the idea of powerlessness. The first step of the 12 steps is something like, “We acknowledge that we’re powerless over alcohol.” And I think that’s a failed notion. I think it’s obvious that you have power over alcohol, because you’re the one who picks up the beer, pours it in your glass, and decides to swallow it. You exercised your power over the alcohol.
The alcohol didn’t knock you down and pour itself down your throat. If it did, I would admit that the first step is correct: you are powerless over the alcohol. But you did it. And unless you take responsibility for doing it, for your drinking, and stop saying you’re powerless or you have no control, then, to that extent, it’s going to be harder for you to get over your problem.
And I work with people who have gone or are in the 12 steps, and they say sometimes they use the first step as an excuse to drink: “Well, I’m powerless, so I’ll have another drink. I can’t help it. Don’t blame me; it’s not my fault.” So that really is a very harmful notion.
Also, another thing that I think that the 12 steps encourages is a kind of dependency–dependency on the meetings — as opposed to REBT, where we teach people to be their own therapist by giving them tools and strategies they can use.
And also, paradoxically enough, dependence on drugs at 12-step meetings. Often there’s a lot of coffee-drinking going on, and people might have substituted one addiction for another.
Also, dependence on other people. You’re encouraged to have a sponsor, and you speak to your sponsor, call your sponsor, whenever you have the urge to drink–which can be used constructively in some cases, but then there’s a tendency to get dependent on that and not depend on yourself.
Also, there’s the notion in the 12 steps: once an alcoholic, always an alcoholic, and if you’ve gone 99 years without drinking, you’re still an alcoholic. And I have a few problems with that. One is I don’t like the idea of an alcoholic. It sounds like self-rating to me. You’re evaluating the total person based on a pattern of behavior. And that’s not the total person; a person is a process, always changing. And so they could drink a lot for the first 10 years of their life and drink moderately for the next 10 years of their life.
So, to say that they’re an alcoholic is a gross over-generalization, and can, in some cases, lead to a self-fulfilling prophecy: “I’m an alcoholic, so I’m helpless. What can I do? An alcoholic has to drink.” But if I’m an imperfect human who over-drinks at times, then it’s clear that I can change, since it’s just my behavior, and I can change my behavior.
Also, another idea of alcoholics, or a related idea, is that you have this problem for life. And obviously you don’t because there are many people who have had drinking problems or other addiction problems for some of their life or much of their life and then they get over it, they give it up, they leave it behind, and they never over-drink or overuse drugs again. So it’s not a problem that someone has their entire life, just because they have it for part of their life.
And then, finally, in terms of critiques of Alcoholics Anonymous, is the abstinence idea, that only abstinence works; moderation is impossible. But we know from statistics, and from anecdotal evidence, that some people some of the time learn to drink moderately, or learn to use cocaine moderately or smoke moderately or eat moderately or gamble moderately, those kinds of things, and abstinence is not necessary for all people all the time.
Now, when I have clients who have an addiction problem, they say, “I don’t know whether to try moderation or try abstinence. What do you suggest?” And I normally say, “Well, whatever makes sense to you.”
But if neither makes more sense to you, usually abstinence is safer, because, for most people most of the time, it’s harder to slip back when you’re abstinent than when you’re moderate, because when you’re moderate, the line is somewhat less clear. Although you can make clear lines. You could say, “Only two drinks this week, and that’s it.” That’s a pretty clear line. But for humans, who tend to over generalize and blur things, it seems to be easier to go from two drinks to three drinks than go from zero drinks to one drink.
So I’d normally recommend abstinence. And it seems that more people, as a group, succeed when they use abstinence rather than moderation.
Dr. Grohol: Good point. A lot of what you just said there seems to make so much sense and yet you don’t hear it spoken very often out loud that a lot of the things that Alcoholics Anonymous seems to stand for, a lot of the 12 steps, is sort of a greater dependence on others and this belief that you have no responsibility or control over drinking.
Dr. Edelstein: That’s right. And one of the reasons that gets blurred is because they go from “You have no power over your drinking” to “Therefore you need a higher power to help you.” [laughs] So they sort of squirm out of it. Rather than saying, “Well, just go drink, because you have no power over your drinking…” They say, “This higher power will help you.” And so, again, that’s dependence of another sort on this idea of a higher power rather than on yourself as being squarely and firmly responsible for your drinking and someone who can change that on your own.
Dr. Grohol: If you could offer one piece of advice to people who have tried psychotherapy in the past and felt frustrated by their lack of progress or gains made in it, what might that be?
Dr. Edelstein: Well, that would be to consider that all therapy is not therapy, in the sense that there are different types of therapy. So, just as there are different types of cars and different types of food–if you try olives and you don’t like olives, you wouldn’t say, “Well, I’m not going to eat food because I don’t like food.” You’d say, “I don’t like olives. I’ll try broccoli,” or chicken, or something like that.
And it’s the same thing with therapy. There are dramatically different types of therapy–as I mentioned earlier, the Freudian brand where you talk about your childhood and your dysfunctional family, and then the cognitive behavior therapies where you talk about what’s going on now in your head and how you can change that.
So I would suggest to people that they look for a cognitive behavior therapist or a Rational Emotive Behavior therapist. And you can look on a website called rebtnetwork.com and there’s a referrals page there which lists REBT therapists around the country.
Also, I suggest that you look for a therapist who’s going to give you actual homework–things to do, cognitive and behavioral homework–at the end of each session, and then checks on that homework at the next session to see how it went and to help you modify it, because that’s the key.
As I tell my clients, it’s not my brains in the session that’s really going to help them that much; it’s what they practice and work on between sessions that’s going to make all the difference. And therapists, even cognitive behavior therapists, sadly, sometimes seem to be allergic to giving homework, checking homework, and making that a priority. So I think that’s very important in a therapist as well.
Now, I get emails from people around the world who have just read my book, “Three-Minute Therapy,” and have never gone to a therapist, and have been dramatically helped. So another option, especially for people who can’t afford the time or the money, or don’t want to afford it, is to read books. There’s my book, “Three-Minute Therapy.” And Albert Ellis has written over 80 books on Rational Emotive Behavior Therapy, which has many, many, many very useful, helpful, practical, and philosophical suggestions for getting over your various problems.
Dr. Grohol: Well, Michael, thank you very much for your time today. You’re the author of the book, Three-Minute Therapy, which I highly recommend to our readers and listeners. I appreciate your spending some time with us and answering our questions.
Dr. Edelstein: Well, it’s been a delight speaking with you, John. I’ve enjoyed your questions, and thank you for having me on this interview.