The following story is based on a real conversation. Personal details have been changed or omitted to protect privacy.
There is something uniquely difficult about a medical waiting room. You sit under fluorescent lights. You stare at your phone. You check the clock. Then you check it again three minutes later. You have no new information, but your mind has been very busy.
Recently, someone connected with our practice was sitting in a waiting room while her husband underwent a routine medical procedure. She knew, rationally, that there was no reason to assume something was wrong.
Her nervous system had other plans.
She sent Dan a message:
“I am in the waiting room for my husband’s procedure, and I feel intense anxiety like I have never felt. Please help me. What do I do?”
– The first thing bothering her was uncertainty.
“I do not like not knowing what is going on.”
– Then came the urge for control.
“I hate waiting. I want to be with him to make sure they are taking the best care of him.”
– Then the loop started.
Is he done yet?
Why is this taking so long?
Is he done yet?
What if something is wrong?
And finally:
“What the hell is wrong with me?”
In the span of one waiting room, she had accidentally demonstrated one of the most useful ideas in Rational Emotive Behavior Therapy, better known as REBT.
Dan pointed it out. She had hit all three.
The Hidden “Should” Under Anxiety
REBT proposes that difficult situations do not automatically create our emotional responses. What matters is also what we tell ourselves about those situations.
Underneath the anxiety in this waiting room was a demand:
“I should not have to be going through this uncertainty with my husband.”
That sentence may sound reasonable. Most of us do not want uncertainty, fear, or helplessness.
But REBT makes an important distinction between a preference and a demand.
“I really wish I knew what was happening” is a preference.
“I need to know what is happening right now” is a demand.
“I desperately want my husband to be okay” is a preference.
“I cannot handle not knowing whether he is okay” is a demand.
That difference may look small on paper. Emotionally, it can be enormous.
According to REBT, our rigid demands often lead to three common ways of making an already difficult situation even harder.
1. Awfulizing: “What If the Worst Thing Happens?”
– The anxious mind is a talented screenwriter. Give it ten minutes without information, and it can produce an entire disaster movie.
In the waiting room, the mind jumped toward the frightening possibility of serious illness. Dan did not try to fight anxiety with empty reassurance. He did not simply say, “Stop thinking about it. Everything will definitely be fine.” Instead, Dan asked her to challenge the meaning of the feared outcome. This is where REBT can sound unusual at first.
The question becomes:
“If the thing I fear happened, would it truly be the absolute worst thing imaginable, or would it be deeply difficult, painful, and something I would still face?”
This is not positive thinking.
It is not pretending that illness, loss, or frightening news would be easy.
It is learning to replace:
“This would be absolutely unbearable and catastrophic.”
with:
“This would be very bad. I would strongly prefer that it not happen. But ‘very bad’ and ‘the worst possible thing’ are not always the same.”
Anxiety often wants certainty that the feared event will not happen. REBT asks a different question:
“What if I stopped requiring certainty before I allowed myself to cope?
2. Frustration Intolerance: “I Cannot Stand This”
Then came the repeated thought:
Is he done yet? Is he done yet? Is he done yet?
Dan recognized this immediately.
The deeper belief was not only, “I want this to be over.”
It was:
“I cannot tolerate this feeling.”
Dan has a way of explaining this that tends to make people laugh:
“If you truly cannot stand it, am I talking to a ghost?”
The humor makes a serious point.
When we say, “I cannot stand this,” we usually mean something closer to:
“I strongly dislike this, and I want it to stop now.”
Those are not the same thing.
She did not like the uncertainty. She did not want the anxiety. She wanted the procedure finished.
But she was standing it. Minute by minute, she was already doing the thing her anxious mind insisted she could not do.
A more rational belief might be:
“I hate waiting. I strongly wish I had more information. This is extremely uncomfortable, but I can tolerate discomfort while I wait.” The goal is not to enjoy uncertainty.
The goal is to stop adding “and I cannot bear it” to an experience that is already hard.
3. Global Evaluation: “What Is Wrong With Me?”
This may be the fastest trick of all.
First, we feel anxious. Then we judge ourselves for feeling anxious.
“What the hell is wrong with me?”
The situation is no longer the only problem. Now we are the problem.
In REBT, this is a form of global evaluation. We take one reaction, mistake, behavior, or difficult moment and use it to rate the whole person.
I am anxious, therefore something is wrong with me.
I handled this badly, therefore I am a failure.
They rejected me, therefore I am unworthy.
A human being is far too complicated to receive one final rating.
You can have an anxious reaction without being a defective person.
You can behave poorly without being a bad person.
You can struggle to cope without being incapable.
In this case, the more rational response was not:
“I should not be anxious.”
That would simply create another demand.
It was closer to:
“I am a person having an intense anxious reaction because someone I love is temporarily outside my control. I do not like this reaction, but I do not need to condemn myself for having it.”
She Was Not Just Anxious. She Was Doing All Three.
Within a few text messages, the pattern had become clear:
Awfulizing: What if something terrible is wrong?
Frustration intolerance: I cannot stand waiting and not knowing.
Global evaluation: What is wrong with me for reacting this way?
Underneath them all was the rigid demand:
“I should not have to be going through this uncertainty.”
Once she could see the pattern, something shifted.
Not because the procedure had ended yet
Not because anyone had given her certainty.
The situation was exactly the same.
But she understood what her mind was doing.
Sometimes insight does not make anxiety disappear. It gives us a little room around it.
And Then the Doctor Came Out… Everything was fine.
The feared catastrophe had not happened.
But that is not actually the most important part of the story.
If the only lesson were, “Do not worry because everything usually works out,” anxiety would simply return the next time we could not guarantee a good outcome.
The more useful lesson happened before the doctor came out.
She discovered that she could feel afraid without treating fear as proof of danger.
She could hate uncertainty without demanding certainty.
She could experience intense anxiety without turning that anxiety into a verdict about herself.
And, despite repeatedly thinking that she could not stand another minute of waiting…
She did.
A Question to Take With You
The next time anxiety begins to spiral, look underneath the surface thought and ask:
What am I demanding right now?
Then notice whether your mind is adding one or more of these:
1. Awfulizing: “This would be absolutely catastrophic.”
2. Frustration intolerance: “I cannot stand this.”
3. Global evaluation: “This means something is wrong with me, them, or the world.”
You do not have to convince yourself that everything will be fine.
Sometimes the more powerful work is learning:
I deeply want things to be okay. I do not have to demand certainty. I can tolerate more discomfort than my anxious mind tells me I can. And I do not have to judge my entire self for having a hard moment.
That is a very different kind of reassurance.
It comes from you.
