Although we all encounter adverse situations, we also react to them differently. While one person might be patiently waiting and listening to music while facing a traffic jam, another will be angrily honking their horn and feeling anxiety building up. Why is this the case?

During negative experiences, the first thing we naturally do is subconsciously explain to ourselves why the situation happened. Our beliefs about the causes of adversity determine our reaction.¹ Holding negative beliefs about why something might have happened can make us more likely to experience negative emotional responses.

The ABC model is a technique used in cognitive behavioral therapy (CBT), a form of psychotherapy that helps individuals reshape their negative thoughts and feelings in a positive way. The idea of the ABC model is that it’s not external events that drive our emotions but our beliefs about these events.1 As such, understanding how we evaluate external events is key in changing how we react to them. CBT trains individuals to be more aware of how their thoughts and feelings affect their behavior, and the ABC model is used in this restructuring to help patients develop healthier responses.

Antecedent: Any event that occurs before a behavior and triggers that behavior. This could include something happening in the environment, interactions with other people, topics of conversation, or even locations or times of day. In the ABC model, antecedents serve as activating events that trigger a certain thought or belief.

Emotional Responses: How people react emotionally to a situation or activating event. These responses can be positive or negative but vary based on one’s beliefs about the event.⁶ For example, someone is more likely to feel bad about making a mistake at work if they believe the mistake is an indication of personal weakness.

Cognitive Distortions:  Irrational beliefs or unhelpful thinking styles that can negatively affect our emotional responses in the ABC model. These include tendencies to overgeneralize, catastrophize, take information out of context, or personalize external events to ourselves.¹⁰

Disputation: A method of challenging and restructuring automatic thought processes to reduce cognitive distortions. The traditional method of disputation involves considering evidence both for and against the belief and then evaluating all of this evidence to determine if the belief is likely true or false.¹⁰

Cognitive Behavioral Therapy (CBT): A type of therapy commonly used to challenge unhelpful ways of thinking and reduce symptoms of psychological problems such as depression, anxiety, and addiction.¹¹ CBT is based on the idea that thoughts, feelings, and behaviors are connected. In short, addressing thinking patterns is important for changing behavior patterns.

Rational Emotive Behavior Therapy (REBT): An early type of cognitive therapy widely seen as the original form of—and precursor to—modern CBT.⁶ Like CBT, REBT focuses on helping people challenge the irrational thought patterns that lead to negative emotions and unwanted behaviors.

Psychologist Albert Ellis developed rational emotive behavior therapy (REBT) in the mid-1950s. This form of therapy was designed to be an active-directive psychotherapy with the goal of resolving emotional and behavioral problems and helping people build more fulfilling lives.² 

Around the same time, Aaron Beck was using free association in his psychoanalytic practices, an idea put forth by Sigmund Freud to help patients express their unconscious thoughts.³ Free association refers to uncensored communications - either written or verbal - of anything and everything that comes to mind. There is no linear structure to free association: practitioners will explore ideas as they appear. However, Beck noticed that thoughts weren’t as “unconscious” as Freud originally believed, and that certain types of thinking might be antecedents for emotional distress. Beck developed cognitive therapy in the 1960s, proposing that thoughts, feelings, and behaviors were all connected.

Ellis’s REBT and Beck’s cognitive therapy are intertwined and considered the roots of modern CBT.  Both targeted beliefs as a fundamental course of treatment.³ As cognitive therapy combined with behavior therapy to become CBT as we know it today, REBT is considered the original form. The ABC model comes to play as a common method used in modern CBT.

In creating the ABC model, Ellis was influenced by several ancient philosophers and the stimulus-organism-response theory (S-O-R theory). S-O-R theory holds that the environment is a stimulus consisting of signs that cause someone to hold internal evaluation of beliefs, subsequently producing a response.¹ Ellis believed that people held common irrational assumptions that, if addressed, could alleviate their distressing responses to negative events. Some of these include:

• The idea that people should be completely competent at everything
• The idea that it’s a disaster when things aren’t exactly how we want them to be
• The idea that we have no control over our happiness
• The idea that we need someone stronger than ourselves to depend on
• The idea that our past holds a strong influence over our present life
• The idea that all problems have a perfect and findable solution

Ellis first formulated the ABC model in 1955, holding that activating events (A) contribute to people’s emotional and behavioral reactions (C) since they’re influenced by people’s beliefs about said activating events (B).¹ Ultimately, Ellis developed the ABC model to address people’s irrational beliefs and to build resilience to adversity. In 1991, Ellis expanded his model of activating events, beliefs, and consequences to the ABCDE model. Since the goal of the ABC model was to help people restructure their thoughts to dispute irrational beliefs, he added a (D), standing for disputation of beliefs. This disputation of beliefs would result in healthier beliefs, known as effects (E) in the model.

Using the ABC model, CBT has made incredible progress since the 1970s and is now one of the most popular forms of psychological treatment.¹ While still commonly called the ABC model in contemporary practice, the aspects of disputation and effect as per Ellis’ 1991 expansion are still present.⁶ Even without calling it the ABCDE model, the result of the ABC steps is disputing irrational beliefs, thus yielding a positive effect.

When it comes to applying the ABC model, a key element is helping clients see the connection between an activating event and how irrational evaluations or beliefs can cause harmful consequences, which often lead to increased distress.⁶ Practitioners work to help clients understand that it’s less about changing their environment, which they may not have much control over, and more about changing their reactions, over which they do have control.

Practitioners will first ask clients to describe the adverse situation and how they reacted to the event, to identify the target behavior to address.⁷ They will then ask the client to identify the belief behind their response: was the event caused by something in their control, or a situational factor? The client will be asked to challenge whether this belief is true, before exploring alternative explanations for the situation and healthier solutions. For example, while someone may believe that they were ignored on the street because the person they ran into doesn’t like them, a therapist may help them see alternative explanations such as the other person having headphones in and not hearing their name being called.

Importantly, the client will work toward identifying and debunking common irrational automatic attributions in an effort to independently reframe adverse situations as they happen in the future.

The criticisms toward Ellis' model can mostly be divided into two groups.⁸ First, there are those who agree with the overall idea, but feel that the model’s constructs have not been sufficiently operationalized. Second, there are those who wholly disagree with the model.

Those with deep behavioral psychology roots - relative to cognitive psychologists - have argued for the need for clear, conceptually discrete definitions of the ABC model’s constructs, to allow for reliable and valid measures of activating events, beliefs, and consequences.⁸ This criticism has mostly been extended to the construct of beliefs, since there is minimal consensus over what counts as a belief and how it should be assessed.

On the other hand, some believe that thoughts, feelings, and behaviors cannot possibly be separated, making the distinctions in the ABC model irrelevant.⁸ For the relationship between activating events and beliefs, critics believe that reality is constructive, such that it is based on the individual’s perceptions and cognitive processes. To this end, there is a lot of overlap between activating events and beliefs. As for the relationship between beliefs and consequences, critics hold that they are intertwined as one construct. If activating events, beliefs, and consequences are not separate constructs, then the model does not have a leg to stand on.

Adolescents’ mental health

In 2017, researchers Sælid and Nordahl felt that there was a lack of research on ways to empower adolescents in school settings, and help them face challenges in society and the workplace.⁹ They also saw a gap regarding how innovating research, such as implementation of the ABC model, could contribute to developing high quality education in high schools. The researchers examined the effects of educating students with subclinical levels of anxiety and depression about the ABC model. They predicted that this education would reduce students’ dysfunctional thoughts and symptoms of depression and anxiety, and increase their hope and self-esteem.

Three hundred and seven high school students from Norway were split into three groups:

1. A control group with no counselling;
2. An attentional placebo group, where students could vent and discuss their issues, but where they did not receive any advice; and
3. The ABC group, where students learned about the model and alternative responses to thinking and behavior, across three 45-minute sessions.⁹

Indeed, learning about the ABC model was effective for empowering adolescents’ mental health: it reduced symptoms of depression and anxiety, reduced dysfunctional thinking (in terms of irrational beliefs), and increased hope and self-esteem. These effects were much more pronounced than those in the attentional placebo group, where students could discuss their issues but could not receive interventional support.

Additionally, 90% of participants reported no prior knowledge of the links between thoughts, feelings, and behaviors. This finding suggests that just an awareness of the relationships supporting the ABC model can be a powerful tool: if people are not aware of the relationship, they cannot be expected to work through it.

Cognitive Behavioral Grief Therapy

The ABC model has also been applied to grief and bereavement to understand how people process loss. In a 2010 paper, Tel Aviv University lecturer Ruth Malkinson uses the model to explore the differences between people who exhibit healthy reactions to loss and those who experience “prolonged dysfunctional grief.”¹³ Essentially, she applies the model to highlight the distinction between rational and irrational thought processes in response to a significant adverse event—in this case, death. Malkinson points out that humans tend to adopt irrational thoughts following death, such as “Life is worthless without him” or “The pain is intolerable.” In comparison, more functional or adaptive beliefs might look something like this: “My life will never be the same” or “Whenever I think of him it’s sad and painful.” While these more realistic beliefs still have negative emotional consequences, they are less upsetting than the former thought patterns.

In her paper, Malkinson proposes using the ABC model to offer cognitive, emotional, and behavioral strategies to promote healthier grieving. As an example of this in practice, she provides a case study of Suzie, a woman struggling over the loss of her husband who had died 10 months earlier. When Suzie started therapy, she was feeling angry with herself and guilty for not being able to function or pull it together for her children. Suzie’s therapist started her treatment by providing explanations of the ABC model and the emotional consequences of both irrational and rational thinking. The goal was to teach Suzie more rational ways of thinking about her loss and the pain she was enduring. 

Together with her therapist, Suzie identified some key irrational beliefs that kept popping up when she thought about her husband, including "I must pull myself together," "I must return to routine and must not cry," and "I must find the answer to why this happened to me." Over several therapy sessions, Suzie and her therapist worked on challenging her beliefs and replacing them with thoughts that allowed her to accept the pain as a normal and healthy response to her loss. When her therapy eventually terminated, Suzie felt that she was able to experience the pain without being completely overcome by it.

Other research has similarly found that CBT can be beneficial for restructuring thought patterns in grieving individuals, especially those experiencing debilitating grief reactions in response to the loss of a significant other.¹⁴ Overall, the goal of cognitive grief therapy is to enable healthy grief by helping the bereaved adapt to their new reality and the difficult emotions that come with it. This occurs through a process of changing irrational beliefs to minimize unhealthy, self-defeating feelings like despair and hopelessness.

Negativity bias

Negativity bias means that we’re more significantly impacted by negative events, relative to positive events, even at equal magnitudes. If we feel negative emotions more intensely, then using models like ABC under CBT are even more important. If we can reframe our negative responses, we might be able to curb negativity bias!

Cognitive Distortions

Cognitive distortions are inaccurate or irrational thought patterns that play an important role in our emotional reactions to adverse events. In this article, we explore the most common types of cognitive distortions and how they can impact our lives. We also dive a little deeper into Aaron Beck’s development of cognitive distortion theory and the beginnings of CBT.

1. Ellis, A. (1991). The revised ABC’s of rational-emotive therapy (RET). Journal of Rational-Emotive & Cognitive-Behavior Therapy, 9(3), 139-172.
2. Ellis, A. (1995). Changing rational-emotive therapy (RET) to rational emotive behavior therapy (REBT). Journal of Rational-Emotive & Cognitive-Behavior Therapy, 13(2), 85-89.
3. Oatley, K. (2004). Emotions: A brief history. Blackwell Publishing.
4. The Albert Ellis Institute. (n.d.). About Albert Ellis, Ph.D. https://albertellis.org/about-albert-ellis-phd/
5. Smith, D. (1982). Trends in counselling and psychotherapy. American Psychologist, 37(7), 802-809.
6. Selva, J. (2021, February 17). Albert Ellis’ ABC Model in the Cognitive Behavioral Therapy Spotlight. Positive Psychology. https://positivepsychology.com/albert-ellis-abc-model-rebt-cbt/
7. McLeod, S. (2019, January 11). Cognitive Behavioral Therapy. Simply Psychology. https://www.simplypsychology.org/cognitive-therapy.html
8. Muran, J. C. (1991). A reformulation of the ABC model in cognitive psychotherapies: Implications for assessment and treatment. Clinical Psychology Review, 11(4), 390-418.
9. Sælid, G. A., & Nordahl, H. M. (2017). Rational emotive behaviour therapy in high schools to educate in mental health and empower youth health. A randomized controlled study of a brief intervention. Cognitive Behaviour Therapy, 46(3), 196-210.
10. Whalley, M. (2019, March 18). Cognitive distortions: Unhelpful thinking habits. Psychology Tools. https://www.psychologytools.com/articles/unhelpful-thinking-styles-cognitive-distortions-in-cbt 
11. American Psychological Association (2017). What is cognitive behavioral therapy? https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral 
12. Beck Institute. (n.d.). Dr. Aaron T. Beck. Beck Institute for Cognitive Behavior Therapy.  https://beckinstitute.org/about/dr-aaron-t-beck/ 
13. Malkinson, R. (2010). Cognitive-behavioral grief therapy: The ABC model of rational-emotion behavior therapy. Psihologijske teme, 19(2), 289-305.
14. Komischke-Konnerup, K. B., O'Connor, M., Hoijtink, H., & Boelen, P. A. (2023). Cognitive-Behavioral Therapy for Complicated Grief Reactions: Treatment Protocol and Preliminary Findings From a Naturalistic Setting. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2023.11.001