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[Therapist:] Well, if we can help you to change your ideas and attitudesabout taking trains and about having a heart attack, that will reallyhelp you and you won’t need medication. You see, you said you were a perfectionist. So you’re first making yourself anxious about doing thingsperfectly 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, abouthaving a heart attack, or about almost anything else. Then, once youmake yourself anxious, you often tell yourself, “I must not be anxious!I must not be anxious!” That will make you more anxious—anxious aboutyour 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, togive up your perfectionism—your demandingness—then you would notkeep making yourself anxious. But you’re in the habit of demanding thatthings have to go well and that, when they don’t, you must not be anxiousabout them. “I must not be anxious! I must be sensible and sane!” That’sexactly how people make themselves anxious—with rigid, forcefulshoulds, 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 putsomething in my mind.”[Therapist:] To distract yourself from your anxiety that you expected to havewhen you got on the train?[Client:] Yes. I said, “I am going to buy some sports things for the children.” SoI went to one of the stores and I bought some things, and as soon as I got onthe 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 Isaid, “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 feelokay. But maybe I’ll have another attack! Maybe I’ll get an attack!” Youwill if you think that way! For you’re really thinking, again, “I must notget 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 ofhaving an attack on the train. He also suggests self-statements that will be usefulwhen riding the train.[Therapist:] So suppose you do have an attack on the train? What’s going tohappen 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. BecauseI know that whatever I have is not a heart problem—it’s a mentalproblem, and I create it myself.” So I then relax. But what’s getting to meis that I have to deal with the same thing every day. Every day I have todeal with it.[Therapist:] I know. Because you’re saying, “I must not be anxious! I must notbe anxious!” Instead of, “I don’t like being anxious, but if I am, I am!” Yousee, you’re terrified of your own anxiety.
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