Rational behaviour therapy

1. Introduction

Version followed: the current form of Maultsby's rational behaviour therapy (RBT) and rational self-counselling, as described by his long-time collaborators in Wirga et al. (2020). It uses the ABCD model of emotions, the Five Rules for Healthy Thinking (2014 wording) and the two-column Rational Self-Analysis (left: A, B, C, D; right: HA, HB, HC, HD). Maultsby's older books (1975–1986) used an ABC1C2 model and earlier rule wordings; differences are noted where they matter. RBT is not Ellis's REBT, although Ellis was its largest influence. [source: Wirga et al. 2020; Wikipedia, Rational behavior therapy]

Sources and status (read first): The main source is Wirga et al. (2020), a detailed description of RBT by Maultsby's collaborators. Also drawn on: the Wikipedia pages on RBT and on Maultsby, Turknett's rational self-counselling training dialogue, the Albert Ellis Institute page on rational emotive imagery, and a Chicago juvenile-detention activity table. Tagged [source: …]: history; the ABCD model; the Five Rules and the three-rule criterion; learning stages and cognitive-emotive dissonance; RSA layout and checks; Camera Test; REI timing; the Instant Better Feeling Maneuver; healthy semantics; the group RSA procedure; Belief Work. Still [uncertain]: Maultsby's own books are not drawn on, so the older RSA headings, older rule wordings, session counts and detailed group protocols remain unconfirmed. All step-by-step breakdowns and example wording are [synthesis].

RBT is a short-term, homework-centred cognitive-behavioural therapy. It was developed by psychiatrist Maxie C. Maultsby Jr. (1932–2016), drawing on his years as a family physician, Luria's neuropsychology, Skinner's learning theory and, above all, Ellis's rational-emotive therapy. Maultsby worked at the University of Wisconsin (Madison) and from 1971 at the University of Kentucky. In 1973 he founded the Training and Treatment Center for RBT, which he directed until 1987, and from 1989 he chaired psychiatry at Howard University. RBT was the first cognitive-behavioural therapy designed specifically as a self-counselling technique ("rational self-counselling"). Unlike REBT, it leaves philosophical questions to the client. It has been used in individual and group therapy, classroom programmes, alcohol relapse prevention, prisons and juvenile detention, and cancer care. [source: Wirga et al. 2020; Wikipedia RBT and Maultsby pages; Heller et al. 2017, Table II]

How change happens (Maultsby's "psychosomatic learning theory"): people create, maintain and eliminate their own emotional feelings through their cognitions. A perception (A) is appraised by beliefs and attitudes (B) as a threat, a benefit or neutral. That appraisal produces negative, positive or neutral emotional feelings (C) and matching physical behaviour (D). Repeatedly pairing perceptions, thoughts, feelings and actions forms habits, and language-based beliefs turn into wordless attitudes that fire automatically. Old habits are replaced rather than erased, so the new habit needs more practice than the old one had. Change therefore runs through stages of emotional re-learning: intellectual insight, practice (written, imaginal and real-life), cognitive-emotive dissonance, emotional insight and a new habit. The therapist teaches; the client does the practice. [source: Wirga et al. 2020]

2. Framework

RBT is a teaching sequence, not a fixed-session manual. No standard session count is given in the sources. [uncertain] Wirga et al. (2020) give this teaching order. First the ABCD model: no new concept is introduced until the client understands it, accepts it and can apply it to their own life, which may take several sessions. Then the Five Rules, healthy semantics and the Rational Self-Analysis (RSA), with cognitive-emotive dissonance explained before the first RSA. Then rational emotive imagery (REI). Emotional and behavioural goals are reviewed regularly; if they are not met, therapist and client work out why and what can be done. [source: Wirga et al. 2020] Phase labels and session ranges in the table below are [synthesis].

Stages of emotional re-learning (Maultsby): learning a brand-new habit has four stages. Re-learning, which replaces an old habit, adds cognitive-emotive dissonance before emotional insight, giving the five below. An older training text gives three (intellectual insight, dissonance, emotional insight). [source: Wirga et al. 2020; Turknett]

1. Intellectual insight. The client understands that their own beliefs and attitudes, not the event, produce the feeling, and can show this in their own ABCDs.
2. Practice. Repeated mental practice (written RSAs, REI) and real-life practice of the healthy thoughts, feelings and actions.
3. Cognitive-emotive dissonance. The new thoughts feel "wrong", weird or unnatural because they clash with the habitual feelings. This is where most people quit, so warn clients in advance.
4. Emotional insight. The healthy thoughts begin to feel right, and the new feelings come more readily.
5. New habit formation. The new way of thinking, feeling and acting is automatic.

Typical clinical sequence and format. [synthesis, informed by the components Maultsby describes]

Formats: individual sessions. Group RBT, where members fill in the left column of an RSA before the session and the group helps complete the right column. Classroom emotional-competence programmes. Self-help groups: the Association for Rational Thinkers was formed in 1970 by former members of Maultsby's Madison groups and later became I'ACT. Self-help from Maultsby's books. Therapists often record a personalised REI script on the client's phone. [source: Wirga et al. 2020] Fuller group protocols (Maultsby 1981, in Gazda) are not drawn on. [uncertain]

3. Guiding principles

Sources for this section: Wirga et al. (2020) and the Wikipedia RBT page, as tagged. The practical meanings are [synthesis].

• Emotions come from cognitions about perceptions, not from events. Every intervention targets what the client believes about the A, not the A itself. [source: Wirga et al. 2020]
• Emotions and behaviours are learned habits, replaced by practice. Insight is not enough. The new habit needs more practice than the old one had, so assign frequent written, imaginal and real-life practice. [source: Wirga et al. 2020]
• Healthy (rational) means obeying at least three of the Five Rules for Healthy Thinking (see 4.2). Judge a thought by the rules, not by whether it feels true. [source: Wirga et al. 2020]
• Healthiness is personal and can change. What is healthy for the therapist need not be healthy for the client. Clients apply the rules themselves, so the therapist is not the judge of what is rational. [source: Wirga et al. 2020]
• Philosophical and religious neutrality. RBT leaves philosophical questions to the client, and rule 1 (facts) is not applied to religious or existential beliefs. Do not debate faith; test its effects on health, goals and feelings. [source: Wikipedia RBT; Wirga et al. 2020]
• Facts first (the Camera Test). Before working on beliefs, correct the description of the event. Inferences belong in B, not A. [source: Wirga et al. 2020]
• Self-help is the goal. RBT was built as a self-counselling method. Teach clients to do every step themselves, and act as reviewer and coach. [source: Wirga et al. 2020]
• Written homework is central. An RSA is written whenever a significant emotional upset occurs. [source: Wirga et al. 2020]
• Cognitive-emotive dissonance is normal. Warn the client before the first RSA that healthy thoughts will feel wrong at first, and that feeling wrong does not make them wrong. [source: Wirga et al. 2020]
• There are no "resistant patients". Maultsby called the label a misnomer: it reflects a failure to understand emotional re-learning. He saw the hardest clients as those who most need RBT. When change stalls, re-teach and adjust the practice rather than blaming the client. [source: Wirga et al. 2020]
• Change goals step by step. Emotive goals move from "less miserable" to "even less miserable" and then towards neutral. Set an HC that is one realistic step better, not ideal. [source: Wirga et al. 2020]
• Healthy does not mean unemotional. A real threat calls for a negative emotive choice. The aim is the feelings the client wants and that fit the facts, not the absence of feeling. [source on emotive choices: Wirga et al. 2020; practical meaning: synthesis]
• Brief, active, educational stance. Teach, demonstrate, correct and assign. Explore the past only as far as the current ABCD needs. [synthesis]
• Therapist non-attachment. Therapists are encouraged to apply non-attachment to their own work, which helps prevent burnout. Care about the outcome without making your wellbeing depend on it. [source: Wirga et al. 2020]

4. Intervention inventory

The techniques below are Maultsby's components as described in Wirga et al. (2020), which is the version followed. Where the older books may differ, this is noted. Maultsby's own books are not drawn on. [uncertain for older detail] The step-by-step breakdowns and all example wording are [synthesis] unless tagged otherwise. All therapist language is illustrative.

4.1 Teaching the ABCD model of emotions

• Purpose and when to use: the foundation for every other technique and the only content of the first session or sessions. Introduce no new concept until the client understands the ABCD model, accepts it and can apply it to their own life. Return to it whenever the client blames events for their feelings. [source: Wirga et al. 2020]
• The model: A = the activating event as perceived. B = beliefs and attitudes (self-talk) about it. C = emotional feelings. D = physical behaviour ("doing"). B appraises A as a threat, a benefit or neutral, which gives negative, positive or neutral feelings. Maultsby originally used ABC1C2 (C1 feelings, C2 actions); C2 was renamed D in the early 2000s. [source: Wirga et al. 2020]
• Steps: [synthesis]
  1. Ask for one recent, specific upsetting episode, with a time and place.
  2. Write four headings: A, B, C, D.
  3. Fill in C (name the feeling and rate the discomfort 1–10) and D (what the client did) first, then A, then draw out B by asking what was going through their mind.
  4. Show that a different B about the same A would give a different C and D; for example, several people at the same event react differently. Name the emotive choice the client's B made (threat, benefit or neutral).
  5. Check acceptance: have the client restate the link in their own words and apply it to a second episode of their own. Move on only when they can.
• Example language (illustrative): "Same rainstorm, two people. One is furious; the other is relieved because their garden needed it. The rain didn't decide how they felt. What they told themselves did. Let's find what you told yourself on Tuesday."
• Watch for: feelings written as B ("I thought I was angry"); inferences put into A, which belong in B; polite agreement without real acceptance. It is working when the client separates A, B, C and D in a fresh episode without prompting.

4.2 The Five Rules for Healthy Thinking

• Purpose and when to use: the yardstick that lets the client, not the therapist, judge any belief. Teach it once the ABCD model is accepted, and use it for every HB. [source: Wirga et al. 2020]
• The rules (current version, last changed by Maultsby in 2014; paraphrased): healthy thinking (1) is based on obvious facts; (2) best protects my life and health; (3) best helps me reach my short- and long-term goals; (4) best helps me prevent or handle my most unwanted conflicts with others; (5) best helps me feel the way I want to feel without abusing substances. A healthy belief obeys at least three of the five. Rule 1 is not applied to religious or existential beliefs. [source: Wirga et al. 2020]
• Versions: before 2014, rule 4 said "avoid or resolve" rather than "prevent or handle". [source: Wirga et al. 2020] An older training version lists: based on objective reality; protects life; goal-producing; prevents significant personal emotional conflict; prevents conflict with others or the environment. [source: Turknett] Say which version you teach. The 1984 book's wording was not checked. [uncertain]
• Steps: [synthesis]
  1. Give the rules as a card or handout in your own words.
  2. Take one B statement from the client's ABCD and test it against each rule aloud, answering yes or no.
  3. Count the yeses. Fewer than three means the belief is unhealthy for this client in this situation.
  4. Ask the client to build an alternative that passes at least three rules, then test it the same way.
  5. Point out that the client's own goals decide rules 3 and 5, so the test is personal.
• Example language (illustrative): "Let's run 'I can't stand him' through the five rules. Is it obvious fact? You did stand him, for two hours. Does it protect your health? Your blood pressure says no…"
• Watch for: using the rules to argue the client into the therapist's values, which breaks the client-goal principle; mechanical box-ticking without belief. It is working when the client applies the rules on their own and produces alternatives that pass.

4.2b Healthy semantics

• Purpose and when to use: helps clients spot words that make beliefs absolute or all-or-nothing. Teach it after the Five Rules and before the RSA, then use it to check the right column of every RSA. [source: Wirga et al. 2020]
• What is flagged: always, never, everything, nothing, everybody, nobody, I have to, I need to, I must, I should, I ought to, and "it's not fair". Maultsby did not ban these words. He asked people to notice their emotional effect and replace them when they cause disturbance. [source: Wirga et al. 2020] Turknett's training version adds "awful", "terrible" and "can't", plus a silent "think STOP" to interrupt the thought. [source: Turknett]
• Steps: [synthesis]
  1. Give the client a short list of the flagged words, written in your own words.
  2. Have them circle each flagged word in the B column of a recent RSA.
  3. For each one, ask what it does to the C rating.
  4. Rewrite it in precise, camera-compatible language ("on Monday and Wednesday", "I'd strongly prefer", "unfortunate rather than terrible").
  5. Check that the HB column has no flagged wording left.
• Example language (illustrative): "You wrote 'he never listens'. Never? The camera has 'he didn't answer my question on Monday or Wednesday.' Read both versions. Which one gets your anger to a 9?"
• Watch for: pedantic word-policing that feels like a grammar lesson. Not every "should" is disturbing; target only the words that drive the C. It is working when clients catch these words in their own speech and writing.

4.3 Camera Test (camera check)

• Purpose and when to use: checks how accurately the client perceived the activating event. Anything a video camera would not have recorded, such as inferences, belongs in B or C, not A. Use it before working on beliefs, especially when the A contains mind-reading, labels or exaggeration ("she humiliated me in front of everyone"). [source: Wirga et al. 2020; also used as "Camera Check" in Chicago juvenile-detention programming, Heller et al. 2017]
• Steps: [synthesis on the source principle]
  1. Ask the client to imagine a video camera had recorded the event.
  2. Go through the A sentence by sentence: "Would the camera have recorded exactly this?"
  3. Rewrite each sentence as only what the camera would show and hear: words said, actions, time and place.
  4. Move the removed evaluations into B as beliefs to be tested.
  5. In an RSA, write the result in the HA section (see 4.4).
• Example language (illustrative): "A camera wouldn't record 'humiliated'. It would record her saying 'that number is wrong' at the ten o'clock meeting, with six people there. 'Humiliated' is your B, so let's put it there."
• Watch for: clients who feel invalidated ("so I'm making it up?"). Make clear that the event was real and only its meaning is being sorted out. It is working when A sections shrink to plain facts and clients notice their own interpretations as they happen.

4.4 Rational Self-Analysis (RSA), the written core

• Purpose and when to use: Maultsby's main written homework. The client completes one whenever a significant emotional upset occurs. Explain cognitive-emotive dissonance before the first one. [source: Wirga et al. 2020]
• Format (current version): divide a page in half. The left column holds A (activating event), B (beliefs and self-talk), C (emotional feelings, with discomfort rated 1–10) and D (physical behaviour). The right column holds HA (Camera Test of A), HB (a healthy belief answering each B, obeying at least three rules), HC (healthy emotive goal) and HD (healthy behavioural goal). A standard RSA form is printed in the appendix of Wirga et al. (2020); make your own blank template rather than copying it. [source: Wirga et al. 2020] Older Maultsby books used different headings, often reported as Da (camera check), Db (rational debate) and E (new goals); these were not verified. [uncertain]
• Steps:
  1. A: describe the event briefly, as the client experienced it.
  2. B: list every thought as a statement, one per line and numbered, turning questions and images into statements. [numbering: synthesis]
  3. C: name the feelings and rate the discomfort 1–10.
  4. D: write what the client did.
  5. HA: Camera Test the A. Write "camera-accurate" or a corrected version, and move inferences to B.
  6. HB: for each B, write a healthy alternative. If a B is already healthy, keep it. Check that each HB obeys at least three rules.
  7. HC and HD: the feelings and actions the client wants next time a similar A happens, set one realistic step better (for example "irritated, about a 4" rather than "calm"). [stepwise goals: source]
  8. Final check: the right column has no unhealthy semantics, every HB passes at least three rules, and HC and HD follow logically from HA and HB. [source: Wirga et al. 2020]
  9. Bring the RSA to the next session, and memorise the right column for REI.
• Example language (illustrative): "For B, write every sentence your mind said, even the silly ones, one per line and numbered. Then in HB, answer each one, line for line, with something that passes at least three of the five rules."
• Watch for: Bs written as feelings; HBs that are positive but false ("everyone loves me"), which fail rule 1; HBs that only contradict without giving reasons; HC goals that are unrealistic ("feel nothing"). It is working when C ratings fall on similar later episodes and the RSAs need less correction.

4.5 In-session RSA review and correction

• Purpose and when to use: the main activity of most sessions after the first. The therapist reviews the client's written RSAs so that the client learns to write correct ones alone. Wirga et al. (2020) give the checks; the session procedure here is [synthesis].
• Steps:
  1. Start the session by reading the client's RSA or RSAs together.
  2. Check A against the camera (HA). Check B for missing or mislabelled thoughts, C for named and rated feelings, and D for actions.
  3. Test each HB against the five rules and the healthy-semantics list, and help the client rewrite weak HBs in their own words. Don't hand over the therapist's version.
  4. Check that HC and HD are realistic, one step better, and follow from HA and HB. [source: Wirga et al. 2020]
  5. Praise the correct parts specifically. Pick one or two teaching points rather than every error.
  6. Assign further RSAs and REI on the revised right column.
• Example language (illustrative): "B3, 'I'll never get a job', is a prediction, not a fact. Your HB says 'I'll definitely get one.' Does that pass rule 1 any better? What could you write that you'd honestly believe?"
• Watch for: the client relying on the therapist to rewrite; shame about "wrong" RSAs. It is working when the number of corrections per RSA falls from session to session.

4.5b Instant Better Feeling Maneuver

• Purpose and when to use: a quick relaxation that opens every REI session. It can also be used alone whenever arousal rises. [source: Wirga et al. 2020]
• Steps:
  1. Take a comfortable position: lying, sitting or standing. [source: Wirga et al. 2020]
  2. Breathe slowly and mindfully from the diaphragm. [source: Wirga et al. 2020]
  3. Let a soft smile form. [source: Wirga et al. 2020]
  4. Continue for a few breaths until the body settles, then start the REI or return to the task. [synthesis]
• Example language (illustrative): "Get comfortable. Slow breath into your belly, slow breath out. Let a small, soft smile come. A few more like that, then we'll start the imagery."
• Watch for: clients with panic who find attention to breathing alarming. Keep it brief and paced, and do not force deep breaths. [synthesis] It prepares the client for practice; it is not the change technique. It is working when the client can settle within a few breaths before REI.

4.6 Rational emotive imagery (Maultsby's REI)

• Purpose and when to use: mental practice of the right column of an RSA, to supply the repetition that real life rarely offers. Use it once a corrected RSA exists for the problem. Maultsby invented REI in 1971. In his version the client imagines the event and strongly thinks the healthy beliefs, so that milder feelings replace the disturbed ones. Ellis later developed a more "emotive-evocative" version for REBT, in which the adversity image stays unchanged and the client shifts an unhealthy negative feeling to a healthy negative one. This guide follows Maultsby's form. In 1974 Maultsby and Ellis co-published a technique booklet on REI. [source: Ellis Institute REI page; Wikipedia, Maultsby; Wirga et al. 2020]
• Steps: [source: Wirga et al. 2020, except where tagged]
  1. Memorise the right column (HA, HB, HC, HD) of a corrected RSA and keep it at hand.
  2. Schedule undisturbed practice of about 5–10 minutes, four or more times a day.
  3. Begin with the Instant Better Feeling Maneuver (4.5b).
  4. Imagine the HA situation vividly while thinking the HB thoughts, feeling the HC emotions and doing the HD actions.
  5. Hold each healthy thought for about half a minute (four to eight mindful breaths), keeping the breathing calm before moving to the next.
  6. Rehearse at most two unrelated RSAs in one ten-minute session. Practice can be extended to related situations.
  7. Add brief informal REIs during the day, for example while on hold or waiting in a queue.
  8. Rehearse once in session with the therapist guiding. Therapists often record a personalised script on the client's phone. [in-session rehearsal: synthesis]
• Example language (illustrative): "See the meeting room, the clock showing ten, her saying 'that number is wrong'. Now think your HB: 'She pointed out an error. Correcting it is my job, not a verdict on me.' Notice yourself breathing evenly and saying 'Thanks, I'll fix it.'"
• Watch for: the old self-talk taking over during the image; if so, stop, go back to the RSA and repeat. Imagery that brings severe distress, such as trauma memories, needs stabilisation first (see section 5). [synthesis] It is working when the client can hold the imagined scene while feeling the HC emotion, and real encounters begin to match the rehearsal.

4.7 Real-life practice of HC and HD goals

• Purpose and when to use: the practice stage of re-learning includes real-life practice as well as mental practice. Because life rarely offers enough real opportunities, REI fills the gap, and the new habit must be practised more than the old one was. [source: Wirga et al. 2020] Use it once REI for a situation goes reasonably smoothly. The graded structure below is [synthesis].
• Steps:
  1. Choose a real, upcoming situation that matches a practised RSA.
  2. Agree the specific HD action to try, scaled so that it is achievable.
  3. Rehearse with REI beforehand, then do it.
  4. Write an RSA afterwards if strong old feelings came up.
  5. Review it in session and step up to harder situations.
• Example language (illustrative): "This week, when your supervisor gives feedback, the plan is just to say 'Thanks, I'll look at that' and write it down. Do your imagery on Monday morning first. Whatever happens, it's material for an RSA."
• Watch for: avoidance disguised as "no opportunity came up", and practice in situations that carry real danger. Practice must be safe; it is not exposure to abusive situations. It is working when HD behaviours happen in real life, even while the feelings lag behind.

4.8 Preparing for and coaching through cognitive-emotive dissonance

• Purpose and when to use: prevents dropout at the stage where healthy thoughts feel wrong, which is where most people quit. Warn the client in advance, before the first RSA, and name the stage when the client says "it doesn't feel true". The core message is that feeling wrong does not make a thought wrong, and that change takes practice over time. [source: Wirga et al. 2020] The step sequence is [synthesis].
• Steps:
  1. Before practice starts, explain that new thinking habits feel strange at first, like writing with the other hand. [analogy: synthesis]
  2. When the client reports the "phoney" feeling, label it as the dissonance stage and as a sign that re-learning has started.
  3. Check that the HB really is healthy (at least three rules, including rule 1). If it is, encourage practice regardless of the feeling.
  4. Keep RSA and REI practice frequent through this stage.
  5. Track small falls in the C rating as evidence of change.
• Example language (illustrative): "That 'I'm just saying words' feeling is exactly what we expected. Your feelings are still running on the old habit. Keep practising: the feeling follows the thinking, usually some weeks behind."
• Watch for: an HB that feels false because it is false or unrealistic. Fix the statement rather than pushing more practice. It is working when clients get through the dissonance and later report that the thoughts are starting to "feel right".

4.9 Self-help reading and recorded REI scripts

• Purpose and when to use: RBT was designed for self-counselling. Maultsby wrote self-help books for clients, such as Help Yourself to Happiness, You and Your Emotions and Coping Better… Anytime, Anywhere. [source: Wikipedia, Maultsby] Therapists often record a personalised REI script on the client's phone. [source: Wirga et al. 2020] One training text advises rereading one's written material and rational responses several times a week over several months. [source: Turknett] Assign reading from session 1. Whether Maultsby had clients replay recordings of whole sessions was not verified. [uncertain]
• Steps: [synthesis]
  1. Assign short readings matched to the current skill, such as the ABCD model or the RSA format, using your own handouts where the books are unavailable.
  2. Record a two- to three-minute REI script from the client's corrected right column, in the client's own words.
  3. Ask the client to note one question and one idea to apply.
  4. Discuss briefly at the start of the next session.
  5. Encourage regular rereading of past RSAs.
• Example language (illustrative): "Let's record your imagery now, in your words, on your phone. Play it four times a day this week. Bring one question from the handout."
• Watch for: low reading levels; books that are hard to get (Maultsby's are largely out of print); recordings stored insecurely. It is working when the client brings questions, uses the vocabulary correctly and practises with the recording.

4.10 Rational self-counselling "in the moment"

• Purpose and when to use: a brief mental version of the RSA for use in real time. Wirga et al. (2020) encourage brief informal REIs during the day. Turknett's training dialogue teaches pausing with slow breathing or counting, catching absolute words with a silent "STOP", testing the thought against the five criteria, and, for a real unresolved problem, asking "What can I do about it?" before deciding and acting. [source: Wirga et al. 2020; Turknett] Use it once written RSAs are mostly correct. The combined sequence below is [synthesis].
• Steps:
  1. Notice the C or D signal: emotional or bodily arousal, or an urge to act.
  2. Pause: do the Instant Better Feeling Maneuver or a slow count.
  3. Silently Camera Test the A.
  4. Name the main B and spot any absolute words.
  5. Test it against the rules and think the practised HB.
  6. If a real problem remains, ask what can be done about it, and act.
  7. Write a full RSA later if the episode was significant.
• Example language (illustrative): "When your jaw tightens on the bus, that's your cue: breathe, camera, B, five rules, HB. Ten seconds. The written version comes in the evening."
• Watch for: quick checks used to skip written work before the skill is solid. It is working when the client reports catching and changing reactions as they happen.

4.11 Group rational self-counselling / rational behaviour training

• Purpose and when to use: teaching RBT and rational self-counselling in groups. Settings in the sources include group RBT (gRBT), classroom emotional-competence programmes, community self-help chapters (I'ACT), prisons, and a Chicago juvenile detention centre where youths wrote RSAs after incidents, used a Camera Check and reviewed them with staff. [source: Wirga et al. 2020; Heller et al. 2017, Table II] Maultsby's own group protocol (1981 chapter) is not drawn on. [uncertain]
• Steps:
  1. Give a structured teaching segment early on, in the source order: ABCD, then the Five Rules, healthy semantics, RSA and REI. [order: source]
  2. Members complete the left column (A, B, C, D) of an RSA before the session. [source: Wirga et al. 2020]
  3. Volunteers present their left column, and the group helps write the right column: Camera Test of A, HBs that pass at least three rules, then HC and HD. The leader models respectful correction. [group completion: source; leader role: synthesis]
  4. Lead a group REI rehearsal for a common situation. [synthesis]
  5. Set individual homework.
• Example language (illustrative): "Let's be the camera for Marcus's A. What would the video show? Now his B2: who wants to run it through the five rules?"
• Watch for: members ridiculing each other's self-talk; disclosure risks in correctional settings, where confidentiality is limited. Set ground rules and keep A details non-identifying. It is working when members correct their own and each other's RSAs accurately and kindly.

4.11b Belief Work (simplified RSA)

• Purpose and when to use: a shortened RSA for clients facing illness or existential and spiritual questions. In the Simonton-based cancer work Maultsby joined from 1985, Belief Work is a simplified RSA for patients. In nondenominational spiritual and existential counselling, it uses only the B and HB sections, in a nonjudgmental group where different views are discussed, and rule 1 is not applied to spiritual beliefs. [source: Wirga et al. 2020] Related concepts named in that source, which this guide does not detail, are "healthy hopefulness" and radical unconditional future acceptance (RUFA). [uncertain]
• Steps: [synthesis, built on the source description]
  1. The client writes their beliefs about the illness or existential question (B), one per line.
  2. For each, ask what it does to their feelings, health and goals.
  3. Write an HB that obeys at least three rules. For a faith belief, test it only against rules 2–5.
  4. Practise the HBs with the Instant Better Feeling Maneuver and REI.
• Example language (illustrative): "Whether there is a plan behind this is your question to answer, not mine. Let's look at what 'I'm being punished' does to your sleep, your treatment and the way you want to feel this week."
• Watch for: the therapist's own beliefs leaking in, and hope that drifts into abandoning medical care. Coordinate with the medical team. It is working when the client holds their beliefs with less distress and keeps engaging with treatment and the people around them.

5. Handling problems

The sources cover only part of this. They say to warn about dissonance in advance. They record Maultsby's view that "resistant patient" is a misnomer reflecting a misunderstanding of emotional re-learning, and that the hardest clients most need RBT. They call for step-by-step emotive goals, joint review of unmet goals to find out why and what can be done, and more practice of the new habit than the old one had. [source: Wirga et al. 2020] Everything else in this section is [synthesis] unless tagged otherwise.

Stuck client (RSAs done, no emotional change).

• Review the unmet goal together: why wasn't it reached, and what can be done? [source: Wirga et al. 2020]
• Check the Bs. The "hot" belief is often missing. Ask what the worst part was and what that would mean about the client, then add it as a new B.
• Check the HBs. They may be weak, false, full of absolute words, or written in therapist language the client doesn't believe. Rebuild them in the client's own words until they pass at least three rules, including rule 1.
• Check the amount of practice. One RSA a week rarely shifts a habit. The source standard for REI is 5–10 minutes, four or more times a day. [source: Wirga et al. 2020]
• Check that HC is one step better, not an ideal the client cannot reach. [source: Wirga et al. 2020]
• Check that the target is right. A secondary problem (anxiety about anxiety, shame about anger) may need its own RSA.
• If the client is in the dissonance stage, see 4.8.

Resistance to the model ("my feelings aren't caused by my thoughts"; "this is just positive thinking").

• Treat "resistance" as a sign that the client has not yet understood emotional re-learning, which was Maultsby's view. Re-teach the stages and the ABCD model rather than labelling the client. [source: Wirga et al. 2020]
• Don't argue. Run one of the client's own episodes through ABCD and ask what a different B would have produced.
• Stress that healthy is not the same as positive: rule 1 rules out unrealistic optimism.
• Stress that the client's goals set the standard (rules 3 and 5), so nobody is telling them what to want. The client, not the therapist, applies the rules. [source: Wirga et al. 2020]
• If the client faces real external problems (racism, poverty, abuse), say plainly that the A is real and may need practical or protective action. RBT works on reactions that make problem-solving harder; it does not deny the problem.

Non-adherence (no written homework).

• Find the barrier: literacy, time, privacy, shame or perfectionism.
• Shrink the task to an A-B-C only, or a five-line RSA. Allow voice notes or a simplified template where literacy is limited. This adaptation is [synthesis] and goes beyond the written form Maultsby required.
• Do the RSA together in session on the episode that happened, so the session still produces practice.
• Do an RSA on the non-completion itself (B: "It's pointless", "I'll do it wrong").

Overwhelm or high distress in session.

• Pause the RSA. Use grounding or slow breathing, then return to just the camera check, which is concrete and lowers arousal.
• Don't run REI on trauma memories or with clients prone to dissociation or flashbacks until they are stabilised. For PTSD, refer to or combine with a trauma-focused treatment rather than using REI as unstructured exposure. Get explicit consent before any imagery that recreates a distressing scene, and agree a stop signal.
• If the distress includes thoughts of suicide or self-harm, stop the cognitive work and do a standard risk assessment: current ideation, intent, plan, access to means, history and protective factors. Make a collaborative safety plan, including lethal-means counselling (safe storage or removal), and escalate according to local protocol. Never debate suicidal thinking as just an "irrational B" in place of assessment.

Ruptures (client feels judged or that their feelings are being dismissed as "irrational").

• Name it and take responsibility: "When I called that thought irrational, I think it came across as calling you irrational. That's not what I meant."
• Re-validate the C (the feeling makes sense given the B) and the A (the event was real).
• Switch from "irrational" to the client's preferred word, such as "unhelpful for your goals". Let the client do the five-rule test so the verdict is theirs.
• Rebalance the session so there is less correction and more collaborative review.

Modality-specific difficulties.

• Over-intellectualising: perfect RSAs but no change. Shift the weight to REI and real-life practice (4.6, 4.7).
• Using "healthy" to suppress emotion ("I shouldn't feel sad"): RBT allows negative emotive choices when a situation really is a threat or a loss, so HC can include fitting negative feelings such as grief. [source on emotive choices: Wirga et al. 2020] "Shouldn't feel" is itself a B to test.
• Rules used to justify harmful acts ("hitting him met my goal"): one rule is not enough, because a healthy belief must pass at least three. Rules 2 and 4 cover health and preventing or handling unwanted conflicts, including legal ones. In correctional and addiction work, add long-term consequences explicitly to the rule-3 discussion.
• Substance use: rule 5 sets the standard of feeling the way you want without abusing substances. [source: Wirga et al. 2020] Intoxication undermines practice. An alcohol relapse-prevention self-help method based on RBT exists (Gore & Maultsby 2008). [uncertain] Coordinate with substance-use treatment. RBT does not replace medical management of withdrawal.
• Severe mental illness (psychosis, mania, severe depression with poor concentration): written homework may not be feasible. Simplify, shorten and integrate with psychiatric care. Do not dispute delusional content as if it were an ordinary B.
• Religious and existential beliefs: do not apply rule 1. Test the belief's effects on health, goals and feelings, or use Belief Work (4.11b). [source: Wirga et al. 2020]
• Cultural fit: RBT leaves philosophical questions to the client, and healthiness is personal. [source: Wikipedia RBT; Wirga et al. 2020] Maultsby wrote on RBT with Black populations (1982 chapter). [uncertain] In practice, check that what counts as "obvious fact" and "unwanted conflict" is not being set by the therapist's cultural assumptions.
• Materials: Maultsby's books are largely out of print. A standard RSA form appears in Wirga et al. (2020). Make your own plain template with the A/B/C/D and HA/HB/HC/HD headings rather than copying forms.

Sources

Sources:

• Maultsby's Rational Behavior Therapy: Background, Description, Practical Applications, and Recent Developments (Wirga, DeBernardi, Wirga, Wirga, Banout & Fuller, 2020, J Rational-Emotive & Cognitive-Behavior Therapy 38, 399–423)
• The same article, University of Silesia repository PDF
• Rational behavior therapy (Wikipedia)
• Maxie Clarence Maultsby Jr. (Wikipedia)
• Dialogue for Learning RSC (Robert L. Turknett, Turknett practice)
• Rational Emotive Imagery (Albert Ellis, Albert Ellis Institute)
• Table II: Select JTDC activities (Heller et al. 2017, Quarterly Journal of Economics 132(1); author names from background knowledge)

Further reading (not drawn on): the Troy University CP 6649 class handouts and a Scribd RSA chart.

Books and papers cited (not drawn on). Titles and years follow the Wikipedia pages and Wirga et al.'s references where noted; anything else is [uncertain].

• Maultsby, M. C. (1971). Rational emotive imagery. Rational Living, 6(1). [uncertain]
• Maultsby, M. C. (1971). Systematic, written homework in psychotherapy. Psychotherapy: Theory, Research and Practice, 8(3). [uncertain]
• Maultsby, M. C., & Winkler (1972), cited by Wirga et al. 2020 for RBT as the first self-counselling CBT.
• Maultsby, M. C., & Ellis, A. (1974). Techniques for using rational-emotive imagery. Institute for Rational Living. [checked: Wikipedia, Maultsby]
• Maultsby, M. C., & Hendricks, A. (1974). You and your emotions. [checked: Wikipedia, Maultsby]
• Goodman, D. S., & Maultsby, M. C. Emotional well-being through rational behavior training (revised ed. 1977). [checked: Wikipedia, Maultsby]
• Maultsby, M. C. (1975/1976). Help yourself to happiness through rational self-counseling. (Wikipedia gives 1976.)
• Maultsby, M. C. (1979). A million dollars for your hangover; new version Stay sober and straight (2001). [checked: Wikipedia]
• Maultsby, M. C. (1981). Rational behavior therapy in groups. In G. Gazda (Ed.), Innovations to group psychotherapy. [checked: Wikipedia RBT]
• Maultsby, M. C. (1982). Rational behavior therapy. In S. M. Turner & R. T. Jones (Eds.), Behavior modification in Black populations. [checked: Wikipedia RBT]
• Maultsby, M. C. (1984). Rational behavior therapy. Prentice-Hall. [checked: Wikipedia]
• Maultsby, M. C. (1986). Coping better… anytime, anywhere: The handbook of rational self-counseling. Prentice-Hall. [checked: Wikipedia, Maultsby]
• Gore & Maultsby (2008), an RBT alcohol relapse-prevention self-help method, cited by Wirga et al. 2020.