by Kristen Tobias, M.A.
I would like to discuss the premise that some events are reasonably characterized as “awful” and propose one strategy for dealing with this reality. Those who practice REBT in its unadulterated form will not agree with this blog. In an attempt to help individuals to cope, Dr. Ellis would anti-awfulize all events. If you were talking or thinking about an event, it could be worse, and this reality nullified its awfulness. The rationale is that awfulizing, or thinking about an event as horrific and terrible engenders unhealthy negative emotions like anger, anxiety, and depression, which impede coping abilities. If you were in a car accident that resulted in monoplegia, you could have experienced enough damage to have paraplegia. If you were raped, you could have been murdered. If you were tortured for 24 hours, you could have been tortured for 7 days. If someone in your family died in a car accident, everyone in your family could have been in that car and died. An event was awful only if it were equivalent to being tortured to death slowly.
The theory of REBT emphasizes scientific thinking and non-dogmatism. Leaders in the field of REBT, trained directly by Dr. Ellis, apply these foundational principles to promote the ongoing refinement of REBT that is informed by research and clinical practice. Research has consistently identified the therapeutic alliance as a necessary, but not sufficient component of successful psychotherapy. Therapeutic alliance refers to the way in which clinician and client engage with one another, and is often defined to include an agreement on the goals and tasks of therapy. In A Practitioner’s Guide to Rational Emotive Behavior Therapy-Third Edition (2014), the authors oppose the practice of challenging the negative valence (i.e., awfulness) of traumatic events to help preserve the therapeutic alliance. Additionally, awfulizing can have a basis in reality and there exist a number of events that most people would reasonably define as awful (e.g., being diagnosed with a terminal illness, such as advanced cancer, as opposed to losing a job).
My training has included the relatively unique experience of practicing REBT at the Albert Ellis Institute and conducting supportive psychotherapy for patients with advanced cancer at Memorial Sloan Kettering Cancer Center (MSKCC). The two modalities (e.g., REBT and supportive psychotherapy) are distinct, and in some instances, at odds. As a supportive psychotherapist, one of my goals is to encourage the patient to emote and explore fears, avoiding any disputation or challenging of cognitions. In REBT, I am very active in helping the client to examine the evidence for a particular belief, as well as its functionality and rationality. The reconceptualization of awfulizing in the context of a traumatic event, such as being diagnosed with a terminal illness, provides an optimal blending of the two therapeutic modalities.
I have sat with many patients as they lamented the awfulness of their diagnosis and nodded my head in assent. I did not feel any ambivalence in reinforcing this belief; I agreed wholeheartedly with their assessment of the situation and it would not be genuine or authentic for me to ignore this reality. Most of us are not built to process extreme distress, shock, or suffering with pure reason. In the context of a traumatic event, modern REBT recommends challenging the dysfunctionality of awfulizing–“When you are thinking this way, how do you feel? What do you do? Does this thinking help you to spend your remaining time in the way that is consistent with your values? Does this thinking help you to engage in meaningful tasks?” Responses would likely indicate that when someone is thinking about how awful their illness is, they feel very low, engage in isolating behavior, and do not partake in meaningful activities. On one hand, this belief is not entirely helpful, but on the other hand, this belief is very real.
Both personal and professional experiences have provided me with anecdotal evidence that it can be important to process the awfulness of an experience. At the end of my second year of graduate school, my father was diagnosed with a rare and aggressive form of Stage III cancer. My father is the rock of my family and I can assure you that it would not have been helpful if someone were to question my valuation of the awfulness of this shocking event. I remember bouts of crying with my now fiancé, as well as periods of activity researching doctors and scheduling appointments. I cannot recall how I found a balance, but I believe that allowing myself to feel paralyzing horror and fear buttressed efforts to cope with the situation. As a therapist, I have witnessed patients cry about the state of their awful situation and end our hour together by saying that it felt good to unburden the emotional weight of their reality.
It might very well be adaptive to awfulize in extreme (i.e., traumatic) situations, but it is also clear that this thinking can become maladaptive if it is all-consuming. Scheduling or allowing awfulizing time (akin to worry time) is one approach to navigating this paradoxical reality. This might be accomplished alone, with a friend or family member, or with a therapist. During this time you will allow yourself to think about how bad the situation is and feel very low, but you will not stay here indeterminately. Schedule daily awfulizing time. Whether it is 15 minutes or one hour, spend time each day evaluating the situation as awful and terrible, and refrain from judging yourself. If this type of thinking comes up during non-awfulizing time, try to remind yourself that you can think this way during the next allotted time. To help to transition from awfulizing time, you might want to try deep breathing, going for a walk, or practicing the rehearsal of coping statements.
