**1. Introduction**

Cognitive-behavioral therapy (CBT) is considered to be the most well-founded in terms of scientific support. It has been widely disseminated worldwide, through numerous training programs, workshops, conferences, and also through a large number of monographs and practical manuals for practitioners in the field of clinical psychology and psychotherapy [1]. The goal of this therapeutic approach is to restore mental health and address a number of issues faced by individuals, by focusing on cognitive dysfunctional patterns that cause emotional distress and dysfunctional behaviors. In a synthetic definition formulated by Amy Wenzel, CBT is considered an active, semi-structured, and time-sensitive psychotherapeutic strategy [2]. Its active character results from the way in which the two actors of the therapeutic act are involved, the psychotherapist and their client; both prepare for counseling sessions, contribute to the analysis and assessment of the client's condition, and collaborate in the constructive approach to the problems they face. CBT is considered semi-structured, because the therapist, although flexibly positioned in relation to their client's problems, usually prepares for each session a kind of organized scheme to guide the stages of the session, which ensures that the therapeutic process is targeted and effective. Finally, this approach is anchored temporarily/in a time-sensitive manner, in the sense that the clients assume, consciously and with motivation, the proposed therapeutic approach, anticipating that the treatment followed will have an end, that what happens in each session produces a positive development, that this development is noticeable after each session, and that they can implement therapeutic strategies in their daily lives without the need for permanent assistance from the therapist.

Cognitive-behavioral therapy is founded upon three central assumptions, which are as follows:


The first of these assumptions is, in fact, a brief and up-to-date reformulation of the central thesis of the mediation model, proposed by Michael Mahoney. Since 1974, Mahoney has argued that changes in behavioral therapy necessarily require cognitive mediation. Today, there is an impressive body of empirical evidence indicating that cognitive assessments of life events affect our responses and that changes in the content of these assessments have an indisputable clinical value [3–6].

The second thesis tacitly incorporates the assumption that we can have access to cognitive activity and that our cognitions can be known and evaluated. Undoubtedly, there are enough reasons to believe that our access to our own cognitions is not perfect and that people often report their mental activity based on the likelihood of thoughts occurring rather than their actual occurrence [7]. A corollary of this second assumption is that the assessment of cognitive activity is only a prelude to the changes we can make at this level. In other words, accessing and evaluating one's own cognitions is necessary, but it does not automatically bring about the change we want.

Finally, the third assumption is a direct result of the adoption of the CBT in the model proposed by Mahoney. It explicitly states that the behavioral changes we seek to produce with our clients can only be achieved if we make cognitive changes. Specifically, although CBT theorists accept that a number of external, reinforcing contingencies can influence human behavior without direct cognitive intervention, this does not mean that they are independent and do not involve cognitive changes; moreover, the same changes, as well as others, can be produced by direct intervention on cognitions. To substantiate this assumption thoroughly, cognitive-behavioral researchers have collected a very large volume of experimental evidence.

### **2. The origins of cognitive-behavioral therapy (CBT)**

There were several favorable circumstances that created adequate premises for the development of cognitive-behavioral therapy. Thus, since the 1950s, Hans Eysenck

#### *Including Religion in Rational-Emotive Behavior Counseling DOI: http://dx.doi.org/10.5772/intechopen.104980*

has published several studies that vehemently criticized one of the prevalent therapeutic approaches of the time, namely, psychoanalytic psychotherapy, proposing behavioral therapy as a more viable alternative. In his challenging attempts, Eysenck argued that the resolution of neuroses does not require a focus on intrapsychic conflicts and that they can be treated completely by a direct approach to the symptoms that portray them [8, 9]. As a result of these warnings and encouragements, in the late 1950s and early 1960s practitioners turned their attention to behavioral therapeutic approaches; these were based on direct behavioral changes, founded upon the two paradigms of learning—classical conditioning, respectively, operant conditioning. However, as interest and involvement in this new commitment grew, it became increasingly clear that a strictly behavioral conceptualization was insufficient for explaining the full spectrum of clinical problems that therapists were facing in their practice. Moreover, there was already evidence that an exclusively behavioral intervention would leave a significant number of issues uncovered, such as the obsessions that are part of obsessive-compulsive disorder, or paranoid ideation [9–11].

A second favorable context was represented by the cognitive revolution, which started in the mid-1950s. Information processing models that began to attract the attention of contemporary psychologists in their attempts to explain psychic life and provide support to artificial intelligence specialists had made a significant contribution to the development of CBT. The new current, which had brought some fresh air to the field of psychology, through its emphasis on cognitive processes, greatly favored the inclusion of the cognitive component in traditional behavioral interventions. In the mid-1970s, a number of academics concerned with the development of therapeutic practice began to draw attention to the importance of the cognitive moment in our actions and propose a model of mediation in this regard. In this way, they explicitly advanced the idea that cognitive processes influence our emotions and behaviors and that cognitive intervention can lead to significant behavioral changes [2]. Once these premises had been accepted, the interest in cognitive-behavioral approaches increased considerably. As a result, a number of new psychotherapeutic approaches based on this new perspective have begun to develop. We mention here some of them: rational-emotive behavior therapy, cognitive therapy, schema-focused cognitive therapy, stress inoculation training, third wave therapies (acceptance and commitment therapy, dialectical behavior therapy, mindfulness therapy). Given the large and ever-increasing number of these new therapeutic guidelines, attempts have also been made to group them based on predefined criteria. Thus, toward the end of the 1980s, Mahoney and Arnkof proposed organizing them into three main categories: a. cognitive restructuring therapies; b. therapies focused on the development of coping strategies; c. problem-solving therapies. Cognitive restructuring therapies are based on the premise that emotional distress is the consequence of maladaptive thoughts. Therefore, clinical interventions aim at examining and replacing dysfunctional thought patterns with their adaptive variants. The second therapeutic category aims to develop a repertoire of skills designed to equip clients for coping with stressful life situations. Finally, the third group of therapies, those focused on problem solving, can be described as a combination of the first two. The latter emphasizes the importance of developing general strategies for the client to deal with a wide range of personal issues, emphasizing the importance of active collaboration between the therapist and their client in the planning of the corrective intervention program [1]. The first category is the most widely used in therapeutic practice, and the best-known paradigms of this family are—rational-emotive behavior therapy (REBT), respectively, cognitive therapy (CT). We will briefly describe each of the two therapeutic approaches, placing more emphasis on REBT, which is also the central object of this chapter.

### **3. Rational-emotive behavior therapy (REBT)**

Chronologically, rational-emotive behavior therapy (REBT) is considered to be the first of the cognitive-behavioral approaches in the category of those that focus, explicitly, on cognitive restructuring. Initially, it was called rational therapy, then rational-emotive therapy, and finally, starting in the 1990s, it became known as the rational-emotive behavior therapy (REBT). The fundamental theoretical and practical principles of REBT were formulated by Albert Ellis, considered the father of REBT and, respectively, the grandfather of cognitive-behavioral therapies. Originally trained in the psychoanalytic school of psychotherapy, after only a few years of therapeutic practice, Albert Ellis began to doubt the quality and effectiveness of this approach. Less and less motivated to continue in the spirit of this school, Ellis successively tested different treatment techniques, most of which involved an active and a directive approach, respectively. The first results of these experiments allowed him to formulate a personal theory on the genesis of emotional disorders, as well as to develop a set of treatment methods. Although ardent proponents of the psychoanalytic paradigm considered the methods proposed by Ellis to be heretical, the advent of behavioral therapy in the 1960s and, above all, the gradual recognition of the fundamental role of cognition in understanding human behavior, led to the acceptance of REBT(at the time called RET) as a viable and credible alternative to classical models of psychotherapy.

The central assumption of this approach is the belief that human cognition (our thoughts) plays a key role in the genesis, maintenance, or modification of the emotional and/or behavioral responses we produce. To make this perspective concrete, Albert Ellis developed the ABC Model of the genesis of emotional responses. The three components of the model are operationalized as follows: A represents the activating element—life events together with our inferences about these events; B refers to the system of personal beliefs (inferences and evaluations) that generate consequences, that is, those that lead to our reactions; C represents the answers that a person produces as a result of the presence of specific beliefs, which can be of a wide variety—emotional (e.g., anxiety), behavioral (e.g., motor agitation), and cognitive (e.g., thoughts of helplessness) [12].

The central objective of REBT therapy is vulnerabilization, namely the elimination of the personal system of irrational (unhealthy) beliefs characterized by exaggeration and rigidity, followed by the adoption of a flexible belief system that promotes/enhances psychological health. In this sense, REBT involves a multidimensional approach that incorporates cognitive, emotional, and behavioral techniques. Of all these, the principal strategy of therapeutic intervention is a logical-empirical method of questioning, challenging, and scientifically disputing the unhealthy thoughts that Albert Ellis called irrational cognitions [13]. Beyond this main healing method, REBT individualizes its intervention strategy using a wide variety of techniques, such as rational-emotive imagery, operant conditioning, modeling, role play, shame attach exercises, thought monitoring, library therapy, and development of various skills and so on [14].
