The ABC Exercise is from Rational Emotive Therapy (REBT). The ABC Exercise is a simple and effective tool that can be used by anybody, and most importantly – it works. This exercise helps an individual examine irrational thought processes, and stop being victimized by their irrational thinking. Often when we feel an emotion, or a thought comes into our awareness, we think that it just happens: In fact, these thoughts and emotions are a result of our observations and our beliefs regarding those observations. We choose our reactions, and our emotions: they are not forced upon us. Though, we are often unaware of the underlying beliefs that cause our reactions. Taking the time to slow this habitual thought process using the ABC Exercise allows us to examine why we think or feel a certain way, and create new healthier thoughts and emotions in reaction to the world around us.

A common example used in the ABC Exercise is that someone else’s behavior is “making us angry.”  This is a very common expression and we hear it often. In fact, rationally, this is a distortion of the situation it attempts to describe. A more accurate description of “someone making me angry” is to say “I feel angry about someone’s behavior.” They are not making me anything – they are simply behaving in a way that I am getting angry about. I notice their behavior and then I become angry. The responsibility for feeling anger is mine, not theirs. This may sound strange at first, but dealing with anger and frustration this way works to have a healthier and more realistic view of the world. The REBT theory says that it is generally irrational and self-defeating to get all worked up about someone else’s behavior.

Think about anger for a moment.  Someone does something you do not like.  You do have a “right” not to like it.  You even have a “right” to share your dislike with them.  But where does it follow that because you do not like it, they therefore SHOULD not do it?  Do you own them, control them, are they your possession? You may have a very rational preference that they change their behavior. However, when you then take this preference and escalate it to a DEMAND, as if you were granted supreme power, it becomes irrational. In addition, their behavior is governed by how they think and feel at that time and is consistent with their thoughts.  In fact, their behavior at that moment cannot be anything different than it is (this is reality based thinking).  You don’t like it, and you wish it were different, but their behavior is consistent with their thinking.  You may still be left with a practical problem, “how do I get them to change their behavior?”  But then you become focused on problem solving instead of simply focusing on the problem.

The result of this change in thought process means you may still feel annoyed or irritated about their behavior, but not angry or enraged.  You changed your very irrational DEMAND to a very rational Preference.  Once you downgrade the DEMAND to a PREFERENCE, the heat is turned down and you can function again. The less intense emotion will allow you to become much more creative in trying to convey your feelings to the other person with an attempt to get them to change.

REBT has a simple exercise to help us make the adjustment from reactionary habitual thinking to more useful rational thoughts: it is the ABC Exercise.   It is used to analyze our thoughts, emotions, and beliefs about a situation. We can then change what happens within us so that we can feel better about the situation. That isn’t to say that we shouldn’t try to change the external reality: sometimes changing the reality is appropriate. By taking the time to rationally examining a situation and how we think and feel about it, instead of simply reacting, we are able to choose an appropriate and effective response.

To use the ABC Exercise for yourself, pick any situation where you were angry about someone’s behavior and examine what it is you are thinking: Is it DEMAND-ing and irrational? Try to change those thoughts into something more rational – a PREFERENCE.

Here is an example using drunken people making a lot of noise late at night as they pass by outside where I live.

• A. (Activating event)
  Drunk people outside, making some noise.

• B. (irrational Belief (iB) I have about A)
  They MUST NOT make any noise.

• C. (Consequences of having those beliefs about A)
  When noisy drunk people pass by in the street outside late at night and wake me up, I feel angry. It feels bad. I lie awake feeling angry and upset and don’t get back to sleep for a long time.

• D. (Dispute the irrational Beliefs (iB’s) in B
  by turning them into questions and answers)
  WHY shouldn’t they make any noise? Where is that commandment written in stone? Where is the evidence?  Again, who made you Supreme Ruler of the Universe dictating how people Should or Must act?

• E. (Effective new thinking- substitute something rational instead of B)
  Drunk people are often noisy, but really it’s no BIG deal. I don’t like it, but I am able to deal with what I don’t like.  Maybe I will touch base with them in the morning (when they are sober).  I will CHOOSE to not upset myself about this, and I may even stop even noticing it because I am no longer demanding it be different than it obviously is (Reality Based).
  When this happens I will say “Ah, the drunk people who pass in the night” and maybe go back to sleep.

You can make an ABC exercise really short:

• A. (Activating situation)
  Drunks walking past outside, making some noise.

• B. (irrational Belief (or IB)I have about A)
  They SHOULDN’T make any noise.

• C. (Consequences of having those beliefs about A)
  I feel angry, etc.

• D. (Dispute the irrational Belief/s in B)
  WHY shouldn’t they make any noise?

• E. (Effective new thinking)
  Drunk people do make noise, it’s what they do.  It’s like a natural talent for them. I will CHOOSE to not upset myself about this.

That’s it. That is how to do an ABC Exercise. Try this technique with something that is bothering you. Try to keep it as simple as you can while you get used to the ideas involved.

Please note; this is a tool not just a theory: success with this (and other) cognitive techniques is dependent on you writing out your own examples and making it part of the way you think. Try to find some Activating situations, iB’s and Consequences of your own and do this exercise with them. Use this MS Word Document (ABC Worksheet) to write down the exercise.

Whenever you feel upset it can be a useful exercise to see if an ABC can be done on the situation and your thinking about it. You never know, you might just feel better. Get into the habit of doing this regularly and you might feel a lot better overall.

More In-depth Explanation of the ABC Exercise Steps:

NOTE: It is often is easier to start with the Consequences you are unhappy with, then work back to the A and B understand what they were.

• What is an “A”?
  (Activating Event)
  Something has disturbed you. This disturbance could be from the past, present, or thoughts about the future. These disturbances could be internal or external, real or imagined. It is important to know what actually happened to you, and what you truly observed.

• What is a “B”?
  (Your beliefs about “A”)
  Our beliefs can be helpful or unhelpful, self-enhancing or self-defeating, rational or irrational. This part of the exercise asks you to look closely at your beliefs, and carefully judge them as rational or irrational, helpful or unhelpful. This can be done by understanding some of the common distortions or irrational beliefs many of us have when we’re upset. Here are some irrational “core beliefs” with examples:
  • Awfulizing: “This is as bad as it can be!” Or having the belief that the worst has happened, or that one event will “automatically” lead to total despair.
  • Frustration Intolerance: “I just can’t stand this!” Easily frustrated by common disturbances, when we know that it really won’t kill us.
  • Demandingness: “All of this must go my way!” Having an expectation of absolute control.
  • Person Rating: “You’re no good, I’m better than you!” Judging others without cause; judging the entire person based on one action.
  • Entitlement: “I deserve this, the world owes me!” Expecting or demanding special treatment.
  • There are other common distortions that can disturb our ability to reason things out, but these are the five core irrational beliefs that stand in the way of our ability to make sense of our problems.

• What is a “C”?
  (Consequences of “B”)
  Some consequences of our irrational beliefs can appear as rage, anxiety, depression, or some other strong negative emotion. Consequences can also appear as inappropriate behavior such as drug and alcohol misuse; gambling, sexual, or food addictions; or physical and emotional violence. These emotions and behaviors are the consequences of holding on to our irrational beliefs and acting upon them.

• What is a “D”?
  (Disputing the irrational beliefs, and adopting more helpful “B’s”)
  Here are some important questions to ask yourself when examining your irrational beliefs:
  • “What is the evidence that my belief is true?”
  • “Could there be other explanations for what occurred?”
  • “In what ways are my beliefs helpful or unhelpful?”
  • “What harm could come from examining other ideas and options?”
  • “If someone close to me were experiencing this event, what would I tell them to do?”

• What is an “E”?
  (A new effect, or effective behavior based on your rational beliefs)
  Calmly make the effort to change your irrational beliefs about any disturbing events so that you can develop a more rational response to them. If you are successful at examining how you respond to the events that occur in your life, you can reduce the stress and anxiety that results from reacting to events with negative responses and enjoy a more positive relationship with yourself and others.

Many newcomers to Self Management and Recovery Training (SMART) meetings have previous experience with Alcoholics Anonymous (AA). Although they have decided to investigate SMART because of dissatisfaction with AA, frequently with its “spiritual” component, they are still unclear about both what they themselves are looking for (aside from either not drinking or cutting back), and what SMART specifically stands for and how it differs from AA. One member of the Washington, DC Area SMART groups offers some thoughts on the subject (which may differ from other members of the groups):

1. SMART Recovery is not an ideology, that is, a fixed set of beliefs. The emphasis is not on belief, but on rational analysis and action. Unlike AA, SMART works to provide an analytical framework which allows each participant to chart his or her own path to freedom from addiction. The mainstay of this framework is Albert Ellis’ Rational-Emotive Behavior Therapy (REBT), but this is not the only approach used in our meetings. SMART’s view, unlike AA’s, is that we should “utilize and analyze.”
2. It follows from this that SMART does not consider that all addicts are alike. Thus, no one “solution” fits all. Objective scientific studies have shown that everything from drinking patterns (for example, daily use to binge drinking) to degree of dependency, age at the outset of addiction, sex, family patterns, psychological reasons to use (i.e., to get “high” or to avoid feelings of inadequacy or discomfort) etc., produce strikingly different types of addicts.
3. Therefore, SMART does not claim that it is the best program for everyone with addiction problems. SMART emphasizes the goal of abstinence, as does AA. SMART might be best for some, AA for others, Moderation Management for others, religious denomination-based programs for others, or even personal determination to quit. The only way for a person with an addiction habit he or she wishes to end is to experience SMART Recovery or AA or some other program and see if it works; if it doesn’t something else should be tried.
4. Thus, we see that, SMART emphasizes personal choice and responsibility for one’s actions. It is up to each addict to determine what is best for him or her, not have the choice forced upon him or her. This point is in particularly strong contrast with AA’s emphasis on “powerless.” Rather, SMART believe strongly in rational analysis leading to freedom for the individual and his or her empowerment through self-knowledge leading to control over one’s decisions.
5. While SMART fully respects diverse religious views, and indeed some of its participants hold personal religious and spiritual beliefs, they do not view religious and spiritual beliefs as essential in solving our problems of addiction. SMART does not consider that a malevolent or benevolent “Higher Power” is either responsible for our addiction problems nor will it intervene to aid us in our individual efforts to overcome them.
6. SMART also does not consider “alcoholism” a life-long preoccupation. They prefer the term “addiction,” which refers to the physical addiction experienced while using (and for some time thereafter during withdrawal). After this physical addiction is over, the real problem is psychological—and solvable by the individual. Following this—or occurring simultaneously with it—the individual can move on to work on his or her other goals in life.
7. Simple observation as well as scientific studies show that there is no single “alcoholic personality” type or profile which can usefully describe an individual and his or her addictive actions. SMART instead observes that conflicting desires exist within each individual, some strong to use, but others equally earnestly desiring to end the addiction. We do not dwell on the historical sources of these desires, as is often done in traditional psychoanalysis, but instead on identifying and analyzing the underlying rational and irrational beliefs causing these desires in the here and now.
8. SMART meetings are self-help groups, not support groups. While attendees sympathize with, and try to assist others in the group, the primary goal of participants in our meetings is to support and strengthen their own efforts to be free of addiction. Unlike AA, probing discussion through cross-talk and feedback is encouraged. Like AA, however, these groups are confidential and administered by their own participants. Also like AA, SMART meetings are free, with minimal contributions encouraged but not required.
9. SMART has no definitive and incontrovertible text, such as AA’s Big Book. They have developed and continue to develop our own suggested reading material, which is available at meetings, but also draw on other sources in our discussions.

For more information on Self Management and Recovery Training and their meetings, please visit SMARTRecovery.org.

Differences Between SMART an AA

By Shari Roan
Originally published by The Los Angeles Times, January 6, 2010

Only people with severe depression benefit from antidepressants, says research published in the Journal of the American Medical Assn. Others do better with non-medical approaches.

Antidepressant medications probably provide little or no benefit to people with mild or moderate depression, a new study has found. Rather, the mere act of seeing a doctor, discussing symptoms and learning about depression probably triggers the improvements many patients experience while on medication.

Only people with very severe depression receive additional benefits from drugs, said the senior author of the study, Robert J. DeRubeis, a University of Pennsylvania psychology professor. The research was released online Tuesday and will be published today in the Journal of the American Medical Assn.

Hundreds of studies have attested to the benefits of antidepressants over placebos, DeRubeis said. But many studies involve only participants with severe depression. Confusion arises, he said, “because there is a tendency to generalize the findings to mean that all depressed people benefit from medications.”

The current analysis attempted to quantify how much of antidepressants’ benefit is attributable to chemical effects on the brain and how much can be explained by other factors, such as visiting a doctor, taking action to feel better or merely the passage of time.

Researchers reviewed six randomized, placebo-controlled studies with a total of 718 patients who took either an antidepressant or placebo. The patients were adults with levels of depression ranging from mild to very severe based on the Hamilton Depression Rating Scale, a questionnaire widely used in depression research. The studies did not exclude patients who were likely to have a strong response to a placebo. Researchers then compared the patients’ depression scores at the beginning of treatment with those after at least six weeks of treatment.

The study found that the magnitude of the drugs’ benefit increased with the baseline level of depression. The effect of treatment was similar in people with mild, moderate and severe symptoms, regardless of whether they took an antidepressant or placebo. Only the people who rated very severe on the depression scale at the start of the study showed measurable improvements on antidepressants.

“There is no doubt that there are tremendous benefits from antidepressants, as our study showed,” DeRubeis said. “But this study helps us resolve, to some degree, the question of how much benefit people can expect from the medicines themselves when symptoms are not severe.”

Other research has also found that antidepressants are most effective for severe symptoms, said Dr. Philip Wang, deputy director of the National Institute of Mental Health. Though it could be that antidepressants don’t work well for mild to moderate depression, it’s also possible that people enrolled in antidepressant studies have robust placebo responses that mask some of the impact of the medication.

A severely depressed person who would probably benefit from antidepressants might have symptoms such as frequent weeping, feelings of guilt and sadness, thoughts that life is not worth living, problems sleeping, fatigue and withdrawal from normal activities, DeRubeis said.

Better antidepressants are needed for people with mild to moderate depression, Wang said, as is research on how to diagnose depression with tools, such as biomarkers, that could help personalize treatment.

Of the six studies in the current analysis, three involved selective serotonin reuptake inhibitors, or SSRIs, the most commonly used antidepressants, and three involved an older class of medications called tricyclics. Both classes are thought to be equally effective, although SSRIs are associated with fewer side effects.

One exception to the study findings, DeRubeis said, was people with dysthymia, or chronic, low-level depression. The analysis assessed severity of symptoms, not chronically, he said. Other studies have established that people with chronic depression, no matter how severe, tend to respond well to antidepressants while other treatment may be ineffective.

Study Finds Medication of Little Help to Patients with Mild to Moderate Depression