I forewarn the reader that this piece will not be easy to read. I intend to address difficult and painful possibilities in a realistic way. Rational Emotive Behavior Therapy (REBT) is a practical approach to problems of daily living.
With the philosophical attitudes of REBT, you can transcend great adversity such as illness, death to you or a loved one, loss of employment, significant financial loss, or social isolation. REBT has something to offer in the face of life’s most significant hardships.
These are exceptionally challenging times. Every person on the planet is facing a great deal of uncertainty. Serious illness, financial loss, unemployment, social isolation, boredom, and perhaps even death to self or our loved ones are real possibilities. In times like these Rational Emotive Behavior Therapy is the cognitive behavior therapy that is particularly useful when your worst nightmare has or may well come to pass. I have used that last sentence as a tag line on my emails for some time now because I have long been aware of the unique power of REBT philosophy.
In other forms of cognitive behavior therapy, the first line of attack would be to assume distortions in one’s thinking. This approach has its limitations when the reality is grim. From the outset of any crisis REBT encourages you to pivot and look the worst-case scenario squarely in the eye. This pivot is not natural, but in my view, it is a necessary pivot to take when the going gets tough if you wish to transcend it. REBT is capable of helping you to have a healthy emotional reaction to the current state of affairs. It helps you to respond to Covid-19 and its related threats in an emotionally constructive way. REBT will not fail you if you go down its prescribed rational, self-helping, philosophical path. Be forewarned the road is not an easy one to take, but it is a path that leads to resiliency in the face of extreme hardship.
Core Concepts of REBT
Let me review a few essential concepts of REBT theory and philosophy. First, REBT reminds you that rigid attitudes, or what we also call demandingness, lie at the core of emotional disturbance. Often these rigid attitudes will generate extreme secondary attitudes, which also lead to self-impairing emotional and behavioral consequences.
Self-Impairing vs. Self-Helping Negative Emotions During a Crisis
REBT teaches that we can choose between two qualitatively distinct negative emotions. REBT takes the position that emotions are choices. Circumstances do not solely determine our feelings. We construct a good deal of what we feel. During this challenging time, it is not adaptive to feel neutral, and it is not possible to feel joyful about the threats that are looming or the losses that have occurred. Often the unhealthy negative emotions we unwittingly “choose” to feel are anxiety, worry, panic, depression, and despair. These self-impairing negative emotions are choices fallible humans quickly and easily tend to default to in dire circumstances. These unhealthy negative emotions will do you little good. They are self-defeating. They will lead to all sorts of counterproductive behavior in the face of the current public health threat.
You have an alternative. With the healthy philosophical attitudes that REBT teaches, you could strive to adopt and go on to choose self-helping negative feelings of genuine concern, deep sorrow, or disappointment. The great concern you could choose to feel is a particularly useful negative emotion because it acknowledges the threat that looms but facilitates self-helping actions. Your concern will enable you to do what you can to do to keep healthy. It will help you to have the discipline to engage in social distancing and maintain hand hygiene even when there is no immediate reinforcement for doing these things.
For those of you who have already suffered tangible losses and great misfortune, sorrow in proportion to the nature of your loss is an appropriate and healthy negative emotion. Great sorrow acknowledges the significant losses which have occurred. However, concern and sorrow, no matter how deep, also allow you to continue to function to salvage what remains to be rescued and to continue to take whatever steps are possible to prevent further pain and hardship. Strong feelings of concern, intense disappointment, and great sorrow are emotions that allow us to transcend the gravest of misfortunes.
Preparing for Hardship – Premeditatio Malorum
REBT derives from classical philosophy. For over two thousand years, those who have transcended the greatest of hardships have taken a different path. Ancient philosophers like the Stoics and the Buddhists encouraged that we appreciate, daily, the fragility of our lives and to understand that this precious gift could end at any time. The Stoics called the practice of reflecting in advance of the occurrence of misfortune, premeditatio malorum. It was a prescribed philosophical practice. They advocated that we prepare ourselves for hardship long before it occurred by regularly meditating on its eventual occurrence. I consider this ancient practice emotional fitness training for the great difficulties of life. Like physical fitness, this emotional fitness will allow us to be ready for great misfortune when it occurs. The question is – will you be ready?
Focus on What Is Under Your Control
REBT encourages you to focus on what is under your control and direct your efforts to that which you are able to influence. Our attitudes and reactions to adversity always remain within our direct control. Furthermore, REBT encourages you to leverage the benefits of acceptance. In REBT, acceptance is defined by leading practitioners Dr. Windy Dryden and Wayne Foggette in the following way:
To accept something is to (1) acknowledge that it exists, (2) acknowledge that all the conditions are in place for it to exist (3) believe that while it is preferable for this reality not to exist, it does not follow that it must not exist, and (4) resolve to change the existing conditions if they can be changed and adjust constructively and move on if they can’t be changed.
REBT teaches that acceptance is instrumental in creating healthy emotional reactions and adaptation to a painful reality. It is a choice that is more likely to occur when we hold flexible and non-extreme attitudes towards adversity. In times like these, acceptance is a powerful weapon to bring to bear in facing this pandemic. Unfortunately, today, this kind of emotional acknowledgment and adaption which is a foundation of REBT is rarely formally taught to children and adults.
Let us now examine how REBT offers you emotional leverage in these uncertain times. I will list several irrational attitudes which people may easily default to during this pandemic. After each self-impairing attitude, I will present the rational counter attitude that stems from REBT theory and philosophy. It is worth emphasizing that the path REBT encourages is not an easy one to take. However, you can adopt these attitudes with work and practice. If you do adopt these attitudes, you will gain leverage over the hand of fate regardless of what it has in store for you.
Attitudes Related to Possible Illness of a Loved One
Self-defeating rigid attitude: I need to know my loved ones will remain healthy.
Self-Helping flexible attitude: I very much want to know my loved ones will remain healthy, but sadly I cannot know this. I do not have to know if they will remain healthy throughout this pandemic. Such knowledge is impossible to have right now. It would be easier if I knew what fate they will face. However, it is worth acknowledging that knowing this could also be quite burdensome. Either way I will accept I cannot know what the future holds and live well with the uncertainty which exists.
I will have healthy concern that they could contract the virus. I will also encourage and help them to control what they can control to better their odds of remaining healthy. I will comfort them if they are making themselves anxious over the threats that currently exist. Making myself anxious about what could happen will not help me or them in these uncertain times.
Self-defeating extreme attitude: It would be awful if my loved one contracted the Covid-19 virus.
Self-helping non-extreme attitude: It would be very, very bad if my love one contracted the Covid-19 virus, but not awful or the end of the world. Depending on the course and outcome of the illness, it would be bad, very bad, exceptionally bad but not more than 100% bad. Bad events can only lie on a scale from 0% bad to wholly bad, 100% bad. Even their death would not necessarily be 100% bad. As hard as it is to think of this if death ended suffering then it would have an element of good to it. Death adds meaning, context, and urgency to life that would not exist without this hard stop to life.
Keeping the degree of badness in perspective will help me fully appreciate them and to stay calm and concerned about the health of my loved ones. By remaining calm I will more easily call to mind that contracting the disease is not necessarily a death sentence. Many people can fend off the disease. Making myself anxious over the possibility of my loved ones contracting the disease will not help me or them in any way. Extreme thinking, or what REBT refers to as “awfulizing”, is easy to do but very self-defeating. It leads to considerable anxiety in the face of uncertainty in this important matter. Stay concerned, you can make this choice!
Self-defeating extreme attitude: It would be unbearable to have to watch a loved one struggle with the illness.
Self-helping non-extreme attitude: It would be exceedingly difficult to witness a loved one struggle with this illness but not necessarily unbearable. I could stand to support them in their battle until either they prevailed or perished from it. It probably could be the most onerous burden I have had to bear in my life, but I could take it. Many people prevail and survive the illness, and I will encourage my loved one to fight to resist death as vigorously as possible.
This attitude is worth adopting if they became ill. There would not be much of a choice other than to bear witness to their struggle. Would I bear witness calmly and remain a source of strength to my loved one, or would I be an emotional burden to them as this dreadful scenario unfolded? That is the question. My goal would be to remain strong for my loved one, and this attitude would enable me to do just that.
Self-defeating extreme attitude: Life would be completely bad if a loved one contracted the Covid-19 virus.
Self-helping non-extreme attitude: Life would be so very bad if a loved one contracted the Covid-19 virus but not completely bad. Concluding it would be completely bad will lead to paralyzing anxiety now and despair then. If they became ill, I still would have as part of the context all the good times I had with them before their falling sick, and this would be part of the evaluation of life. All those good times I enjoyed with them have been many, and that is undeniable.
I also continue to have other blessings despite this hardship. Life will be very, very, very bad but not wholly bad if they contract the Covid-19 illness. It is important to remind myself that despite it being bad that my loved one contracted the virus it does not necessarily mean they will die. Since my goal is to support my loved one this attitude will help me accomplish my goal.
Attitudes Towards Death of Self
Self-defeating rigid attitude: I must not lose my life to this illness.
Self-Helping flexible attitude: No one, especially me, wants to die and lose their life to this illness, but it does not mean I must not lose my life to this illness. If I lose my life to this illness, it means that all the conditions were in place for my life to end. Sadly, no degree of demanding that these conditions not unfold would change those conditions. I sincerely hope that this perfect storm of circumstances does not come to pass, and I will do everything I can do to prevent these conditions from materializing in order to remain alive and prevail over this illness.
Upsetting myself by demanding I not lose my life will only cause me to feel panicked or depressed. It won’t help me in this struggle. Panic, anxiety or despair will make my existence more unpleasant for me and only facilitate my death. Life is precious until the moment it ends. I do not want to live poorly now through the end if the end occurs due to this illness. I commit to accepting my fate, whatever that may be.
Self-defeating extreme attitude: It would be awful if I lost my life to this illness.
Self-helping non-extreme attitude: It would be very, very, very bad but not awful if I lost my life to this illness. In this case, holding the attitude that it would be awful if I lost my life to this illness implies that my death should not occur which, if I were to die, would be false. My death will be very bad to me and to a few other people who love me, but surely the world will keep spinning. Awfulizing about my death will not allow me to be fully engaged in living and relating to loved ones and other humans until the end. This mindset will serve no useful purpose. It will only reduce my resources to struggle against this illness.
When I die, I will take nothing with me but my state of mind. Awfulizing during the final days of my life will probably not contribute to a peaceful passing. I will strive to accept what I cannot change and enjoy existence until the end in a calm state of mind. Keep fighting and commit to remaining in a healthy state of mind.
Self-defeating extreme attitude: I could not bear the process of losing my life to this illness.
Self-helping non-extreme attitude: It would be tough to bear the process of losing my life to this illness, but it would not be something I could not take. I could endure the process of losing my life to the disease for the length of time I was in the process of living out my final days. It would be worth seeing this time as tolerable if only because it will enable me to have some degree of emotional control while I am dying. This mindset will better enable me to bear the process. It would be worth doing because there is life until the moment of death. Life is so precious that living those final moments of my life well will be especially important to do. I commit to living well until the end.
Self-defeating extreme attitude: Life would be totally bad if I died due to this illness.
Self-helping non-extreme attitude: Life would not be totally bad if I died due to this illness. Life would remain a mix of good, neutral, and bad even if I died due to this illness. My death does not change the nature of life. Despite my death to this illness, there have been many good times that preceded it. They are part of the picture that accounts for a fair and balanced view of life. It is also good to remember life goes on with or without me.
Attitude towards Unemployment or Financial Loss
Self-defeating rigid attitude: I must not lose my job or experience significant financial loss as a result of the Covid-19 pandemic.
Self-Helping flexible attitude: I hope not to lose my job or experience significant financial loss as a result of the Covid-19 pandemic, but sadly it could happen. There is no universal law that protects me from losing my job or suffering significant financial loss. I wish I were exempt from this possibility, but I am not a special person that “should” be excluded from this hardship. I do not want this to happen, but millions of other people will likely lose their jobs and experience serious financial hardship.
If this is to occur, it will occur, and I will do better to accept it. I will do everything I can to prevent it from happening or to recover from it once it occurs. Acceptance that unemployment and significant financial loss can happen will help me feel concerned before it and enable me to endure and transcend it after its occurrence. If I hold a rigid attitude towards job loss or financial loss, I will not cope very well with these challenging scenarios.
Self-defeating extreme attitude: It would be the end of the world if I lost my job or experienced significant financial loss as a result of the Covid-19 pandemic.
Self-helping non-extreme attitude: It would be a great misfortune if I lost my job or suffered a significant financial loss. These would not be awful or the end of the world. I can see that beyond job loss or substantial financial loss, there are even worse things that could transpire like losing love ones or losing my own life.
Putting job and economic loss into proper context will help me face this possibility without suffering. I would endure this challenging set of circumstances if they were to occur to me. I will take whatever steps I can to prepare for and prevent these things from happening. However, I will acknowledge they still could happen, and I can accept the existence of this possibility and also accept these things if they were to occur.
Self-defeating extreme attitude: It would be intolerable to lose my job or suffer significant financial loss as a result of the Covid-19 pandemic.
Self-helping non-extreme attitude: It will be tough for me to lose my job or suffer significant financial loss but not unendurable. I hope these challenges do not occur, but if these challenging things were to happen, I would not have a choice but to endure them, and I would be able to withstand these things. This attitude is hard to adopt and maintain, but it will strengthen me for extreme hardship, and so it will empower me. It is worth it to me to choose this stance because I would not want job loss or substantial financial loss to defeat my family and me if they were to occur. I want to provide for my family regardless of how difficult life gets, and I will fight each day until I get back on my feet. I commit to transcending both job loss and substantial financial loss.
Self-defeating extreme attitude: Life would be totally bad if I lost my job or suffered enormous financial loss as a result of the Covid-19 pandemic.
Self-helping non-extreme attitude: Life would be exceptionally bad, but not wholly bad if I lost my job or suffered great financial loss. Losing a valued job or suffering significant financial loss will certainly color much of life but not all of life. It would be good for me to count the remaining blessings in my life if these very bad things were to occur. Having a more balanced attitude will help me before the occurrence of these painful challenges and during their existence, if they materialize. A balanced attitude towards life under these circumstances would be tough to adopt. Still, with careful study and deliberate choice, I could see it as both a valid attitude and an instrumental one for handing such crises.
Attitudes Towards Death of a Loved One
Self-defeating rigid attitude: Covid-19 must not take the life of my loved one.
Self-Helping flexible attitude: I very much hope that Covid-19 will not take the life of my loved one. Still, sadly this could happen, and it is an unfortunate possibility I can come to terms with even though this is hard to accept. Unfortunately, no law of the universe exists to protect the life of my loved one from this disease. Regardless of how badly I want something not to occur, it does not mean it must not happen. This loss may be very hard for me to accept, but the difficulty in accepting this loss does not mean it must not occur. The universe is not cruel, just indifferent to me.
Self-defeating extreme attitude: It would be awful, terrible, and the end of the world if my loved one died due to this illness.
Self-helping non-extreme attitude: It may well be the worst thing that has happened in my life until this time, but it would not be the awful, terrible, or the end of the world if a loved one died due to this illness. It may seem as if it is the end of the world if I lost my loved one, but it would not be so. As difficult as it might be for me to appreciate that it would not be awful, terrible, or the end of the world it just would not be true that it would be the worst thing that could happen. Far worse things could happen.
For example, my loved one could have died younger than they did, or I could have never had this loved one in my life for any length of time. If they died regardless of how much they suffered, they could have suffered more. If I lost a loved one, I would still be alive.
Therefore, I would presumably want to suffer as little as possible as I continued living without this person in my life. Striving to see this significant loss as tremendously bad, not awful, and to accept it will help me to survive it. I will hope I do not need to do this, but if so, this attitude will enable me to endure the great pain that would come from this loss.
Self-defeating extreme attitude: Losing a loved one to Covid-19 would be unendurable.
Self-helping non-extreme attitude: It would be a tremendous burden, one perhaps heavier than I ever have had to bear if my loved one died, but it would not be unendurable. I would be able to endure this tremendous burden. Moving forward with this heavy burden would be worth doing because it would be my burden, and I would have no choice but to bear it. I commit to transcending it even though it is incredibly hard to imagine how I would have the strength to do it. Somehow, someway I would bear it.
Self-defeating extreme attitude: Losing a loved one to Covid-19 would make life totally bad and worthless.
Self-helping non-extreme attitude: Losing a loved one to Covid-19 would make life tremendously bad, not wholly bad, and worthless. This attitude is true because life is too complex to weigh in total. Factoring in all the years and wonderful experiences I have had with my loved one would be impossible to do. I could still see life as a mix of good, very good, neutral, all the way through to tremendously unfortunate events, which makes life itself unmeasurable. The pain I feel would be very deep because there once was great love and joy, but life itself would not be worthless.
As you can see, REBT can address the most difficult existential challenges of life, namely illness, death of self, or the death of a loved one. After the examination of disease and death, it will likely be easier for you to apply REBT to the deprivation of pleasure resulting from social isolation and the associated boredom. Covid-19 will continue to substantially inconvenience people around the world. The fortunate ones are those merely inconvenienced by Covid-19, while others will experience tremendous loss. Keep it all in perspective throughout this ordeal.
I wish to close by underscoring that REBT philosophy is not a cold, compassionless philosophy. In my view, it is just the opposite. REBT is a philosophy of compassion because it shows you how to transcend the most substantial existential burden life can give to you.
For over 2,000 years, people have used Stoicism, the philosophy REBT derives from, to control what they can control and accept what they cannot. Many people who have gone before you have chosen to adopt this philosophical path to cope with their burdens. Do not assume you, too, cannot move towards and then utilize these flexible, non-extreme philosophical attitudes in the face of your particular hardship.
Bottom line: Assume that you can and then discipline your mind to bear anything life may throw your way, and you will do so.
Dr. Walter J. Matweychuk is a clinical psychologist and practitioner of Rational Emotive Behavior Therapy (REBT). He both practices and trains psychologists in REBT at the University of Pennsylvania Perelman School of Medicine and teaches Cognitive Behavior Therapy (CBT) at New York University. He has been an expert consultant on a project with the US Navy aimed at teaching CBT related coping skills in a classroom setting to sailors. He is co-author on Rational Emotive Behavior Therapy: A Newcomer’s Guide. He disseminates information on REBT through his website, REBTDoctor.com.
Thank you so much for this article at this time. I would love to be trained in this method.
I will be happy to discuss the possibility of training you. Please feel free to contact me at REBTDoctor@gmail.com
I congratulate Dr. Matweychuk on a brave and bracing exposition of REBT and its prominent roots in Stoic philosophy. For those of us already steeped in REBT and Stoic teachings, the arguments presented here will be quite convincing. And yet, as a psychiatrist, I have some misgivings about translating these teachings into clinically useful interventions. I suspect, for example, that many patients racked by anxiety and (perhaps unrealistic) fears of death from Covid-19 will not be easily persuaded that their own death would not be “awful”–but merely “very, very, very bad .” (Let’s leave aside the semantic question of why something that is “very, very, very bad” is not perforce “awful.”). I suspect that Dr. Matweychuk is implicitly acknowledging this when he writes, “It is worth emphasizing that the path REBT encourages is not an easy one to take.” Indeed, it is not!
Furthermore, without using certain “buffering strategies,” I suspect that the therapist who approaches the frightened patient with the austere teachings of the Stoics may find–with at least some very vulnerable patients–that this approach backfires, and even alienates the patient. This is in no way an indictment of the validity of either REBT or of Stoic teachings; rather, it is an empirical observation based on my own work with certain patients whose ego defenses simply cannot tolerate the intensity of REBT and Stoic teachings, without a great deal of preparatory work.
By this, I mean the slow nurturing of the therapeutic alliance, such that the patient’s emotional connection to–and trust in–the therapist can “buffer” the stringency of the Stoic/REBT philosophy. I intend no criticism of the arguments presented by Dr. Matweychuk–after all, Albert Ellis was one of my “mentors from afar” (I never met him, but I did correspond with him in his last few years).
In short, I would welcome Dr. Matweychuk’s perspective on how to work therapeutically with the potentially frightened patient who is also, quite understandably, skeptical of and resistant to the REBT/Stoic perspective.
Best regards,
Ron
Ronald W. Pies, MD
Emeritus Professor of Psychiatry
One can run but not hide. With those who do not, as you say or imply, possess sufficient ego strength to face the elegant philosophical solution REBT encourages, I offer what is called inelegant solutions in the service of building a sufficiently strong therapeutic alliance. I might suggest short-run distractions to avoid thinking about the worst possible scenario, but this strategy has significant limitations, and I would gently point this out to the patient. I might also recommend seeking social support, but people are limited in what they can do for this person, even with their warmth and comfort. A psychotherapist can take what I sometimes call the statistical solution with some patients. The psychotherapist can offer some reassurance that the odds will work in the patient’s favor this time, and the patient will dodge a bullet. For example, not all people who get COVID-19 perish. Many survive COVID-19. Maybe your patient, if they contract COVID-19, will be one of the lucky ones and survive. However, sooner or later we have to face the music in life. Death eventually comes to all of us. So although with very fragile people, I may offer some statistical reassurance which they may want to hear, I sooner or later go back to emphasizing the necessity of accepting the worse possible outcome. As I said, we can distract ourselves, run psychologically from our fears, but sooner or later, these inelegant solutions breakdown. I accept that with some patients, I cannot reach them until they are ready to face the existential facts of life. I choose not to disturb myself about this and model acceptance. I accept them with their fears and their stubborn refusal to take accept as it is. I keep trying every which way to convince them that life never has to be as they want it to be. I keep showing them that they are capable of more inner strength than they may give themselves credit for, and REBT will show them the way if they are willing to work, practice, and discipline their mind. I reach many but accept that I cannot force people to adopt this sensible point of view, regardless of how much good it will do them.
Thank you very much for your considered reply, Walter. I agree with you that, sooner or later, we must all “face the music” and accept “the existential facts of life”, if we are to remain undisturbed, if not happy. And, yes–there are some patients we cannot reach. There are also what I call “pseudo-compliant” patients who nod appreciatively at our REBT and Stoic interventions, but who make little progress in therapy and may even worsen, all the while assenting to our very rational interventions. (I treated one such patient who had a history of self-injurious behavior and probably had a Borderline Personality Organization or Disorder). I suspect that many such patients eventually drop out of REBT-type therapies.
Indeed, we should not disturb ourselves over such resistant patients–but I believe that we, as therapists, sometimes need to adopt what in Buddhism is called, “skillful means” (in Sanskrit, upaya). This implies that there are subtle, non-confrontational ways of drawing the person toward us, circumventing resistance, and allowing progress to occur. The famous “parable of the burning house” is often cited in Buddhist teaching [see https://en.wikipedia.org/wiki/Upaya#Parable_of_the_burning_house%5D.
Finally, I agree with you that “building a sufficiently strong therapeutic alliance” is critical in working with resistant patients. Without that foundation, the most rational philosophy in the world will simply founder.
Best regards,
Ron
Thanks Walter,
A very helpful discourse with examples of using self-talk that cut right to the essence of the matter.
To my mind the vital few (rather than the trivial many) is that there are a myriad of things and events we have no control over and the best thing to do is to focus on what we do have control over i.e. what we think and our self-talk.
In my work I use Marty Seligman’s framework and client’s find it really easy to remember and apply e.g.
In adversity check your self-talk. The PGP formula will lead to depression while the TSE formula leads to empowerment.
PGP means the accidental use of thoughts that make the cause of the adversity Permanent, Global, and Personal.
TSE means the deliberate use of thoughts that make the cause of the adversity Temporary, Specific, and External.
Excellent article, Walter. Very comprehensive. Thank you.