Conquering Anxiety and Panic

Our clients and colleagues sometimes object that Rational Emotive Behavior Therapy bogs down in regard to anxiety. “You may rightly insist,” they say, “that most emotional problems stem from Irrational Beliefs that we feed ourselves and that we can overcome them by changing these Beliefs. But what about anxiety? How can we possibly control that by disputing our own assumptions? You’ll never change that life-saving trait, no matter how rational you are.”

Rot! You can often control anxiety by straight thinking. For it largely follows from Irrational Belief No. 6: The idea that if something is dangerous or fearsome, you must obsess about it and frantically try to escape from it.

We don’t claim that real or rational fears do not exist. They certainly do. When you prepare to cross a busy street, you’d better fear the possibility of getting hit by a car and feel quite concerned about your safety. Fear of this sort not only is a natural human tendency, but also a necessity for preserving your life. Without your having healthy fear or concern about your safety, your days on this earth would not be very long!

Nonetheless, fear and anxiety or panic are quite different. Anxiety, as we employ the term in this book, consists of overconcern of exaggerated or needless fear. And it often is not about physical injury or illness but about mental “injury” or “harm.” In fact, most of what we call anxiety is overconcern about what someone thinks of you. And this kind of anxiety, as well as exaggerated fear of bodily injury, is usually self-defeating on several counts:…

Acquiring Self-discipline

The easy way out is often just that—the “easy” way out of the most rewarding lifestyle. Yet you may have no trouble swearing by Irrational Belief No. 7: The idea that you can easily avoid facing many difficulties and self-responsibilities and still lead a highly fulfilling existence. This idea is misleading for several important reasons.

First of all, the notion that the easiest way out of difficulties is the best way often leads you to avoid action at the moment of decision—and to dis-ease during the hours, days, and years that follow. Augie M., for example, kept convincing himself that it would be terrible if Jenny, a woman he had known for several years, rejected his overtures. Every time he thought of putting his arm around her or holding her hand, he would feel overwhelmed by his terror of rejection and would take the “easy” way out by drawing away. At the exact moment of his withdrawal, he sighed with relief. But for the rest of the night, and often for many nights following, he loathed himself and suffered the torments of the damned for his moment of “ease.” For he realized that avoiding fearful tasks usually, in the long run, brought him far greater conflicts and annoyances.

By avoiding many difficulties, you tend to exaggerate their pain and discomfort. If Augie takes a chance, puts his arm around Jenny, and actually gets rejected by her, will this rejection hurt him as much as, in imagination, he thinks it will? If he keeps risking rejections, will he still feel just as hurt? If he does feel hurt, will his whole world fall apart? Most probably, if he keeps trying to win Jenny’s favor, he will find the answer to these questions a pretty solid no.

Rewriting Your Personal History

Perversely enough, one of the most important psychological discoveries of the past century, emphasized by both psychoanalytic and classical behaviorist schools, has been harmful to many individuals: the idea that people remain inflexibly influenced, in their present patterns of living, by their past experiences. People have used this partially helpful observation to create and bolster what we call Irrational Belief No. 8: The idea that your past remains all-important and that because something once strongly influenced your life, it has to keep determining your feelings and behavior today.

Often, in the course of one of my typical working days, I (A.E.) see about fifteen individual and another ten group therapy clients; and most of them, to one degree or another, believe that they have to behave in a certain disturbed way because of previous conditioning or early influences. A forty-year-old highly attractive divorcee, for example, tells me: “I couldn’t possibly be more active in meeting men, as you keep trying to induce me to do, when I’ve never done anything of the sort before in my life.” A young wife says that she would rather have her husband lose fifty thousand dollars in a business venture than get fired again—because she feels certain he would not find a good job when he has had so many poor jobs before. A remarkably good-looking, well-educated, and bright young man of twenty-two confesses that he can’t imagine himself getting a satisfactory woman partner again if his present one leaves him, because “I have been conditioned from childhood to see that I am too worthless to go out and get someone I really want. So how can I ever expect to do this?”

Accepting and Coping With the Grim Facts of Life

Let’s face it: Reality often stinks. People don’t act the way we would like them to act. This isn’t the best of all possible worlds. Even half-perfect solutions to many serious problems and difficulties just do not exist. Moreover, society often gets worse: seems more polluted, economically unfair, burdened with ethnic prejudices, politically oppressive, violence-filled, superstitious, wasteful of natural resources, sexist, and overly-conformist.

But you still don’t have to feel desperately unhappy. The grim facts of life don’t depress people. What does? Their unthinking addiction to Irrational Belief No. 9: The idea that people and things absolutely must be better than they are and that it is awful and horrible if you cannot change life’s grim facts to suit you. An idiotic idea—for several reasons.

1. There is no reason why people must be any better than they are, even when they act quite badly. Your grandiosity encourages you to tell yourself, “Because I don’t like people to behave the way they do, they absolutely shouldn’t.” Similarly, although it might be lovely if things and events did not exist the way they do, they frequently do. Again, there is no reason why Adversities should, ought, or must not happen, just because you (and others) desire them to be different.

Overcoming Inertia And Getting Creatively Absorbed

There seems no easy way out of life's difficulties and responsibilities. Yet millions of civilized people believe heartily in Irrational Belief No. 10: The idea that you can achieve maximum human happiness by inertia and inaction or by passively and uncommittedly “enjoying yourself.” This notion is irrational for several reasons:

1. People rarely feel particularly happy or alive when inactive except for short periods of time between their exertions. Although they may get tired and tense when continually on the go, they are easily bored and listless when they constantly rest. Passive “enjoyments,” such as reading, play-going, or watching sporting events, are often entertaining and relaxing. But a steady and exclusive diet of this kind of “activity” often leads to dullness and apathy.

2. Intelligent people tend to require vitally absorbing activity to stay most alive and happy. They rarely are enthusiastic for any length of time unless they have some rather complex, absorbing, and challenging occupations or interests.

The case of this client, as perhaps of most individuals who come for therapy, exemplifies the differences among what we call Insight No. 1, Insight No. 2, and Insight No. 3. Insight No. 1 is the fairly conventional kind of understanding postulated by Freud: knowledge that you have a problem and that certain events precede this problem. Thus, Allen, whose case we observed at the beginning of this chapter, knew that he had a problem with his career, but thought it stemmed from his dislike of certain subjects and not from his anxiety about social and vocational failure. Not knowing the beliefs behind his problem, he did not really have sufficient “insight.”

Naomi had more insight, because she not only recognized her failure at her chosen career, but also knew or suspected that (1) she lacked confidence and (2) she kept trying to punish herself for her previous sexual promiscuity. Knowing, therefore, some of her motives for her ineffective behavior, she had a considerable amount of “insight”—or what we call Insight No. 1. She only vaguely, however, had Insight No. 1, because she knew that she lacked confidence but didn’t clearly see that this lack of confidence consisted, more concretely, of her telling herself: “My older, very critical sister views me as inadequate. How absolutely terrible if she is correct about this! Perhaps she is. In fact, I feel sure she is and that I can never perform adequately!”

This young woman also knew that she felt guilty and self-punitive about her previous premarital affairs. But she did not specifically see that her guilt and self-punishment resulted from her internalized Beliefs: “Many people view promiscuity as wicked. I have behaved promiscuously. Therefore I am really a wicked person!” And: “People often agree that those who act badly deserve punishment for their sins. I have been promiscuous with males for whom I did not really care. Therefore, I must punish myself!”

Although, then, this client definitely had a good measure of Insight No. 1, she had it so vaguely that it was only partial. As for Insight No. 2, she had little. For Insight No. 2 consists of seeing clearly that the Irrational Beliefs that you create and acquire in your early life still continue, largely because you keep reindoctrinating yourself with them—you consciously and unconsciously work fairly hard to perpetuate them. Thus, Naomi kept telling herself, over and over again, “I absolutely should not have been promiscuous! In order to expunge my sins and lead a happy life today, I have to keep punishing myself and must continue to cleanse myself.” Without this kind of constant self-reinforcement, her early ideas (including those taken from her sister) would probably extinguish. So Insight No. 2—which Naomi only vaguely had at the start of therapy—would have consisted of her clearly seeing that she had not worked at extinguishing her traumatizing Beliefs and that she still actively hung on to them.

Insight No. 3 was far from Naomi’s horizon. This consists of the wholehearted belief, “Now that I have discovered Insights No. 1 and 2, and fully acknowledge my self-creation and continued reinforcement of my Irrational Beliefs, I had better reduce my disturbances by steadily, persistently, and vigorously working to change these Beliefs—and to act against them.”

More concretely, when Naomi acquired Insight No. 1 and No. 2, she could then go on to No. 3: “How fascinating that I have kept convincing myself that I absolutely should not have been promiscuous and that I have to keep punishing myself for my errors. As long as I keep believing this hogwash, how can I feel anything but self-downing and depression? Well, I’d better keep strongly disputing and challenging these nutty beliefs until I give them up!”

Naomi and I worked together to help her achieve these three important insights. By using them and following them with other hard therapeutic work during the next year, she finally solved her main problems. She not only got a teaching job and did quite well at it during this period but also kept having non-marital sex with a few suitable partners, enjoyed it considerably, and felt no guilt about it. We contend, in other words, that much neurotic (self-sabotaging) behavior results from basic ignorance or lack of insight. Although humans may behave neurotically because of certain biological conditions (such as severe hormonal imbalances or deficiencies in their neurotransmitters), they don’t often do so purely for biochemical reasons. Usually, they largely create their disturbances by their own ideas, which they consciously and/or unconsciously hold. Even when they suffer from severe traumas such as child abuse, incest, or rape, it is not only these extremely bad events that upset them and lead to post-traumatic stress disorders, but also their horrifying reactions—their awfulizing beliefs, about these traumas.

Thus, as in the cases of Allen and Naomi, people may know that they resist going to school because they fight against parental pressure. Or they may unconsciously resist going to school without clear awareness that they are balking against parental domination. Or they may realize that they punish themselves for sexual guilt. Or they may punish themselves without realizing they do so because of this kind of guilt.

We cannot justify our pronounced feelings of failure, Beliefs in our worthlessness, and unthinking acceptances of others’ damning tendencies. Not because they are absolutely wrong, or because they contradict the laws of the universe. But simply because, on good practical grounds, they almost always are self-defeating and needlessly prevent us from getting many of the things we healthily desire.

Moreover, self-downing beliefs and emotions usually stem from unrealistic overgeneralizations that we cannot scientifically uphold. They contain magical, demonizing philosophies that are definitional, unprovable, and unfalsifiable. If you say to yourself, for example, “I have failed at this task”—such as winning someone’s love or succeeding at a job—“and I find that unfortunate,” you make a statement that you can backup or disprove. For you (and others) can observe whether you really have failed and what disadvantages (in regard to certain of your personal goals) will probably follow from your failing. Once you desire to succeed, it is “bad” or “ineffective” to fail.

If you say to yourself, however, “Because I have failed at this task, it is awful and it makes me a rotten person,” you make a statement that you cannot prove or disprove. For awfulness, an essentially undefinable term, does not really mean very disadvantageous. It means one hundred percent disadvantageous, unfortunate, obnoxious, or inconvenient. Your finding it awful when you fail, moreover, means that you think you can’t stand failing and that you therefore must not fail. But, of course, you can stand failing; and the universe hardly insists that you should not or must not fail!

“Yes, it has an important tie-in with unconditional self-acceptance (USA). For self-acceptance means fully accepting yourself, your existence, and your right to live and to be as happy as you can be—no matter what traits you have or acts you do. It does not mean self-esteem, self-confidence, self-respect, or self-regard. For all these terms imply that you can accept yourself because you do something well or because other people like you. Unconditional self-acceptance means that you accept yourself because you are alive and have decided to accept yourself. Only a limited number of talented, intelligent, competent, and well-loved people can gain self-esteem or self-confidence. But anyone, merely because he or she chooses to have it, can gain self-acceptance.”

“Does self-acceptance mean that I consider myself worthy or deserving of living and enjoying no matter what I do?”

“Yes, though we don't like the words worthy or deserving, since they imply a rating of your you-ness. They suggest that you have to do (or refrain from doing) something in order to feel ‘worthy’ or ‘deserving.’ When you have what we call unconditional self-acceptance (USA), you make minimal assumptions about your (and other people’s) intrinsic worth or value.”

“What minimal assumptions?”

“Several: One, you exist. Two, you can probably, by continuing to exist, achieve more pleasure than pain, thus making it desirable for you to keep living. Three, you can help reduce your pain and increase your pleasure. Four, you decide—and this constitutes the essence of self-acceptance—that you will try to live and make your life as pleasurable and as unpainful as you can make it. Or, putting it another way, you choose as the main purpose of your existence short-range and long-range enjoyment. You may strive for achievement and approval not to prove your greatness as a person. Not to get into heaven. Just because you prefer to achieve and to be loved.”

“So instead of my asking myself, ‘What am I worth?’ ‘How do I keep proving myself?’ ‘How can I outstandingly impress others?’ or ‘What do I have to do to ennoble myself?’ I’d better, instead, ask, ‘How can I avoid needless pain and discover what I truly enjoy in life and do it?’ Right?”

“Right! You make the purpose of your existence having a present and future ball—in whatever personal and social ways you experimentally discover.”

“You mean that I may then look for my existence as more enjoyable. But I still will not really be more ‘worthwhile’—only more alive, happier?”

“Yes. And you will not, we hope, damn yourself or punish yourself whenever—as an imperfect human—you do something wrong or unwise. You will accept yourself with your foolish thoughts, feelings, and actions, and use your ‘bad’ experiences to help you enjoy yourself and behave better in the future. What greater acceptance of self can you then have?”

As Reinhold Niebuhr wisely said, you’d simply better accept unpleasant conditions that you can’t change. REBT holds that what exists, exists. If it includes misfortunes and frustrations, you can see that as bad. But you’d better not define it as catastrophic and awful! As long as you still live, you are the master of your emotional fate, the captain of your soul. Poor conditions may block and defeat your ends. Sometimes they can even kill you. But they cannot fully defeat you. Only you can defeat yourself—if you believe that what exists absolutely must not exist, or that because things oppress, you must seriously depress yourself.

Ceaselessly fight your own perfectionism. If, as an artist or a producer, you would like to try for a near-perfect work or product, fine. But you will never be perfect; nor will anyone else you know. Humans are quite fallible; life is essentially uncertain. The quest for certainty and perfection involves (a) the childish horror of living in a highly uncertain and imperfect world; and (b) the conscious or unconscious drive to surpass all others, to be King or Queen of the May, and thus to “prove” your absolute superiority over everyone else. You won’t live with minimal anxiety and hostility until you fully accept, as Hans Reichenbach shows, that you live in a world of probability and chance, and unless you accept yourself because you exist and not because you are better than anyone else.

Achievement-confidence or self-efficacy is closely related to activity. You know you can do something well because you have already proven, by your past behavior, that you have done so. A woman who never tried to walk would hardly acquire confidence in her ability to walk—or to swim, or ride, or do almost any other kind of muscular activity. Yes, our society does drill us with the dire need to succeed at important projects. It does. Much of our “pride” or “self-confidence,” therefore, actually consists of false pride and false confidence—born of this “need” to succeed.

As I (A.E.) note in Reason and Emotion in Psychotherapy, you obtain achievement-confidence and love-confidence by showing, in action, that you can achieve or can win love. You enjoy these feelings because you know you can do well at projects or at love, and you feel motivated to strive for future rewards in these areas. You’d better not confuse achievement-confidence and love-confidence, however, with self-confidence, which really exists definitionally and is an undesirable state.

For if you say, “I am confident that I can do well in school or in my job,” you make a statement that you can back up by demonstrating that, most of the time, you do perform well. But if you say, “I have great self-confidence,” you strongly imply that (1) you do practically everything well, (2) you therefore are a good person, and (3) you therefore have the right to live and enjoy yourself. These last two statements are true only because you believe they are.

You had better, then, by all means strive for work- or love-confidence but not for self-confidence or self-esteem. These are measures of your entire self or being—which are too complex and all-embracing to be given a single measure or rating.

A human is the kind of animal who had better accept certain challenges and at least try various tasks to gain confidence that he or she can perform them. And the philosophy of inertia and inaction, especially when motivated by fear of failure, blocks the development of achievement-confidence and love-confidence.

Well, they are right! The more we thought about it, the more we could see that calling yourself good because you are alive is somewhat meaningless. It is true by definition but can not be empirically confirmed or falsified. It works—but it is an inferior solution to the problem of human worth. Discussing the matter more thoroughly in a paper honoring the philosopher Robert S. Hartman, I (A.E.) concluded that the whole concept of human value is a sort of Kantian thing-in-itself. It can never be proven or disproven; and we can well dispense with it in psychology and philosophy. I said, in other words, that humans seem to have no “worth” or “value,” except by somewhat arbitrary definition; and they don’t have to rate, value, measure, or evaluate “themselves,” their “essence,” or their “totality” at all. When they do so they overgeneralize, and when they give up such evaluating, self-rating, or ego measurement, they reduce some of their most serious “emotional” problems.

REBT now teaches that if you insist on evaluating yourself totally, having a “self-image,” or rating your “worth” as a human, then you’d better use a “solution” such as the one we gave in the original edition of this book. Say, “I like myself (or, better, accept myself) simply because I exist, because I am alive.” That kind of solution still seems practical or pragmatic and will get you into virtually no emotional difficulties. Once again, it works!

Even better, however, you can refuse to rate “yourself,” your “humanity,” your “ego” at all! You can say: “I exist—that is empirically provable. I also can continue to exist, if I choose to do so. While remaining alive, I to some extent have the choice of reducing my pain and increasing my (short- and long-range) pleasure. OK: I therefore choose to remain alive and to enjoy myself. Now let me see how I can most effectively achieve these goals!”

With this sort of philosophy, you can avoid rating yourself, your totality, your human worth, at all. “You” isn’t globally rated as good, bad, or indifferent. “You” have no general image of yourself. But your organism—definitely exists; and this organism chooses to remain alive and to seek enjoyment rather than needless pain. Consequently, because you want (not need) to continue to exist joyfully, you evaluate many of your traits, deeds, acts, and performances. Any act, for example, that leads to your premature death or that causes you to live painfully, you evaluate as “bad.” And any act that leads to a long and pleasant life, you tend to evaluate as “good.” Ratings and measurements of your behaviors continue to be made and to be seen as important. But you eliminate “rating” and measurements of your self, your humanity, your totality, your ongoingness, your you-ness.

Will you find it difficult to stop evaluating your self? Indeed you probably will. For REBT assumes that your “normal” human condition involves not merely rating your acts, deeds, and traits but also perceiving a “self” or “ego” and rating it. So you’ll probably have great trouble refraining from rating your self. But try it! You definitely (though not perfectly) can do this. And accomplishing this difficult feat can be fun!

Unconditional Self-acceptance Revisited

The main emotional support that you can give yourself is what we have mentioned several times already in the book—achieving unconditional self-acceptance (USA). As therapists, we especially try to model this for just about all our clients. We show them that we accept them fully and unconditionally—just as Carl Rogers did when he gave all his clients what he called unconditional positive regard. We, like Rogers, show our clients that we deplore their self-defeating behavior, and especially their immoral treatment of others. But we still accept them, their personhood, whether or not they perform well and whether or not they are lovable or ethical. As ever, we use the Christian and REBT philosophy of accepting the sinner but not the sin.

As we noted before, however, many of our clients at first misread our intentions and wrongly accept themselves because we accept them. But this, of course, is conditional acceptance (or “self-esteem”), which REBT opposes. We therefore actively teach our clients how to achieve USA—to philosophically achieve it—as described in the previous chapter. So we give and teach unconditional acceptance.

The final answer, therefore, is that there is no final answer. REBT [Rational Emotive Behaviour Therapy]—like all other therapy methods—has none to give. As a human, you are a constructivist. You largely create your own goals and values—or creatively adapt them from those you choose to adopt from other people. You consciously and unconsciously construct “good” (or “rational”) solutions that help you achieve, and “bad” (or “irrational”) solutions that help you sabotage your goals and those of the society in which you choose to live. This book tries to show you how to aid your “rational” and minimize your “irrational” answers to your goals of living and enjoying. Like all human endeavors, it has its limitations and disadvantages. Don’t take it as gospel!

Various answers to “rational living” have been given over the centuries by philosophers, religious leaders, psychologists, and other thinkers. Many of them take the form of “positive thinking” or “positive visualization”—as shown in the writings of Emile Coué,—Norman Vincent Peale, and a host of their followers. These kinds of Effective New Philosophies (Es) are partly on the right track—because they acknowledge that you, as a human, can harm yourself with negative thinking and can, instead, constructively choose—yes, choose—to help yourself with more positive thoughts. Thus, you can take the negative thought, “I can’t control my feelings and desires and am thoroughly at their mercy” and you can change it to the positive thought, “To a large extent I can control my feelings and desires and can change them so that I lead a happier existence.” You can take the negative thought, “Life sucks and will always be miserable,” and can change it to the positive thought, “Life sometimes sucks but can also be very enjoyable and I can definitely make it much more enjoyable.”

Positive thinking, along with positive visualization, enables you to create rational coping self-statements and images that aid your goals and enhance your life. However, it is limited, and sometimes even dangerous, because you can easily use it unrealistically and pollyannaishly. Thus, you can positively tell yourself, “I can accomplish anything I want!” But, of course, you can’t. You can enthusiastically think, “Everything will happen for the best.” But, alas, it won’t.

Positive thinking, moreover, often covers up and doesn’t really remove your underlying negative thinking. For example, you can tell yourself, “If I keep taking this course and doing my homework, I can—yes, I can!—pass the course.” This will help you much more than the negative thought, “I’m unable to pass this course. No matter what I do, I’ll fail it!” So, again, positive thinking is often more “rational” than negative thinking, and often brings you better results.

However, most people who advocate positive thinking and positive visualization do not realize that it does not reveal or Dispute the important musts and shoulds that underlie your serious negative thinking. Thus, when you tell yourself, “I’m unable to pass this course. No matter what I do, I'll fail!” you first have a hidden demand, “I absolutely must pass this course and must show everyone what a great person I am. If I fail, it will be terrible and I will be worthless!”

Largely because of this hidden demand—this must—you may put yourself down and falsely conclude, “I’m unable to pass this course. No matter what I do, I’ll fail!” Unless you clearly see and unless you forcefully Dispute your underlying musts, your positive thinking won’t work. Because while you keep telling yourself, “If I keep taking this course and doing my homework I can—yes, I can pass the course,” you will also keep having very negative thoughts. Such as: “But suppose I still fail—as I absolutely must not! What a horror! I’d be a total idiot!”

So positive thinking often works well—but not well enough to get you to see your absolutistic musturbatory thinking and to give it up. Even when you do positive realistic thinking, you often still achieve light rather than profound rational thoughts, and they tend to bring you poor results. Thus, suppose you unrealistically believe, “If I fail at this job interview I’ll never be able to get a good job. I’ll always ruin my interviews and wind up as a dishwasher!” You can help yourself much more if you realistically tell yourself, “If I fail at this job interview, I can get a number of other interviews and still get a good job. In fact, if I learn from this failure, I can succeed better in future interviews and even get good at interviewing!”

This realistic rational coping self-statement is fine. But, once again, it may cover up your underlying Irrational Belief, “I absolutely must pass this interview to show what a good person I am! I have to get and keep a fine job to prove to everyone how competent I am! Otherwise I'm nothing!” If you do have these basic musturbatory Beliefs, not even realistic rational coping statements will help you very much. You will not convince yourself that they are accurate and will still tend to make yourself anxious and depressed.