[Therapist:] Well, if we can help you to change your ideas and attitudes
about taking trains and about having a heart attack, that will really
help you and you won’t need medication. You see, you said you were a perfectionist. So you’re first making yourself anxious about doing things
perfectly well. “I must do well! I must do well!” Instead of telling yourself,
“I’d like to do well, but if I don’t, F … it! It’s not the end of the world.”
You see, you’re rarely saying that. You’re saying, “I’ve got to! I’ve got to!”
And that will make you anxious—about your work, about sex, about
having a heart attack, or about almost anything else. Then, once you
make yourself anxious, you often tell yourself, “I must not be anxious!
I must not be anxious!” That will make you more anxious—anxious about
your anxiety. Now, if I can help you to accept yourself with your anxiety,
first, and stop horrifying yourself about it; if we can help you, second, to
give up your perfectionism—your demandingness—then you would not
keep making yourself anxious. But you’re in the habit of demanding that
things have to go well and that, when they don’t, you must not be anxious
about them. “I must not be anxious! I must be sensible and sane!” That’s
exactly how people make themselves anxious—with rigid, forceful
shoulds, oughts, and musts.
[Client:] Like yesterday. Yesterday was my worst day in a long time.
[Therapist:] Yes, because?
[Client:] What I did is when I was going to the train, I said: “I need to put
something in my mind.”
[Therapist:] To distract yourself from your anxiety that you expected to have
when you got on the train?
[Client:] Yes. I said, “I am going to buy some sports things for the children.” So
I went to one of the stores and I bought some things, and as soon as I got on
the train I started deliberately reading. Ten minutes after I was on the train,
I still didn’t have any anxiety. I was okay. But then I remembered and I
said, “Jesus, I feel okay.” At that moment, I started feeling panicked again.
[Therapist:] That’s right. What you probably said to yourself was, “Jesus, I feel
okay. But maybe I’ll have another attack! Maybe I’ll get an attack!” You
will if you think that way! For you’re really thinking, again, “I must not
get another attack! What an idiot I am if I get another attack!” Right?
[Client:] Yes. (Ellis, 1992a, pp. 39–40)
Later in the first session, Ellis continues to dispute Ted’s irrational beliefs of
having an attack on the train. He also suggests self-statements that will be useful
when riding the train.
[Therapist:] So suppose you do have an attack on the train? What’s going to
happen to you then?
[Client:] Something will happen to me.
[Therapist:] What?
[Client:] Most of the time I’ve said to myself, “Okay, nothing will happen. Because
I know that whatever I have is not a heart problem—it’s a mental
problem, and I create it myself.” So I then relax. But what’s getting to me
is that I have to deal with the same thing every day. Every day I have to
deal with it.
[Therapist:] I know. Because you’re saying, “I must not be anxious! I must not
be anxious!” Instead of, “I don’t like being anxious, but if I am, I am!” You
see, you’re terrified of your own anxiety.