Stoicism & CBT
The Philosophical Roots of Cognitive-Behavioural Therapy
[These are my notes from a talk given at Conway Hall on 9th May 2012. You can find information on the talk and feedback from those who attended at the website of the London Philosophy Club. The content below is largely based on my book The Philosophy of Cognitive-Behavioural Therapy (2010). I departed significantly from the text below but it gives a flavour of the subjects covered.]
First of all, I should explain that ancient philosophy was very different from modern philosophy insofar as it involved a far greater practical orientation. Ancient philosophers often adopted a different lifestyle: they wore short grey cotton military-style cloaks, shaved or grew their hair and beards, slept on military camp beds, changed their diet, or observed vows of silence, in some cases, depending on the school they were aligned to. They changed their lifestyle and systematically rehearsed specific mental exercises, and meditation-like techniques, for explicitly therapeutic purposes. Whereas many ancient philosophers compared themselves to athletes, and trained in the open air of the gymnasia, modern philosophy became an increasingly bookish subject. Unfortunately, we all went from being warriors of the mind to something more like librarians of the mind. Among the ancient philosophies, Stoicism particularly sought to imitate the philosophical lifestyle of Socrates, the pre-eminent Greek sage, the ultimate role-model for later philosophers, and Stoicism was therefore the philosophical tradition that had the most explicit practical and therapeutic emphasis. So it’s been of special interest to modern psychotherapists for that reason and also because the founders of CBT made reference to it as a major inspiration for their overall approach. I’m going to proceed therefore by considering the questions: “What is Stoicism?”, “What is CBT?”, and “What’s the relationship between them?”, and concluding with some practical examples of Stoic psychological exercises.
What is Stoicism?
So who were the Stoics? In a nutshell, Stoicism is an ancient Graeco-Roman school of philosophy, founded in Athens at the start of the 3rd century BC by Zeno of Citium. The name “Stoic” comes from the stoa or covered street in the Athenian city centre where Zeno’s school met to do philosophy. So we might argue that, in a sense, “Stoicism” means urban philosophy or philosophy of the street. Its popularity continued for many centuries as leading Stoics introduced the philosophy to Rome, where it took root, was embraced, and developed an even greater therapeutic orientation. Historians record that the Stoics wrote hundreds, possibly thousands, of texts. However, we’ve lost most of the writings of Zeno and the other Greek founders of Stoicism. The three authors whose works we do have are Seneca, a wealthy Roman statesman, Epictetus a crippled slave, and Marcus Aurelius, one of the most-admired Roman Emperors. These three Stoics came from separate generations, which lived in Rome during the first two centuries AD.
So what did the Stoics actually believe? The famous Enchiridion or philosophical Handbook of Epictetus provides arguably the simplest outline of Stoic practices. It opens by stating the truism that some things are under our control and others are not. That’s arguably the core principle of Stoicism. Epictetus continues to say that, basically, our own actions are, by definition, under our control, whereas everything else that happens to us, is not under our control, at least not directly so. Of course, our actions may influence external events but we can’t absolutely guarantee the outcome, so we only have direct control over our own actions and everything else is, at least to some extent, in the hands of Fate. The Stoics believed that most human suffering is due to the basic error of confusing these two categories: taking too much responsibility for things outside our control and not enough responsibility for making our own actions accord with our own values or the virtues we aspire to possess. I’ve called this the “Stoic hypothesis” and it’s similar to certain concepts in modern therapy and also modern research on stress. The Stoic hypothesis is also pretty well captured by the famous Serenity Prayer used by Alcoholics Anonymous or “AA”, which is frequently-quoted by modern therapists:
Give me serenity to accept the things I cannot change;
Courage to change the things I can;
And wisdom to know the difference.
What is CBT?
So what is CBT? Cognitive-behavioural therapy or “CBT” is the most evidence-based form of modern psychological therapy. We should really say “therapies” in the plural because CBT is definitely not just one thing – it’s a broad movement consisting of dozens of different individual therapies. As the name implies, they mostly have in common the assumption that emotional suffering, and other problems, can be helped by learning to modify our cognitions and behaviour. By “cognitions” we just mean thoughts and beliefs. So CBT clients might typically be asked to keep a daily record of their distressing thoughts, to question the evidence for their underlying beliefs, and to engage in more fulfilling daily activities or to systematically face their fears without avoidance, etc.
What’s the relationship between ancient philosophy and modern CBT?
So what’s the relationship between CBT and Stoicism? The forerunner of CBT was Rational-Emotive Behaviour Therapy or “REBT”, founded in the 1950s and 1960s by Albert Ellis. Ellis was interested in philosophy and had read the Stoics in his youth before training as a psychoanalytic therapist. After becoming disillusioned with psychoanalysis, Ellis found himself returning to the Stoic principle that relatively “ordinary” irrational thoughts and beliefs cause emotional disturbance and this became the inspiration for the development of REBT, arguably the first major cognitive therapy. In the early 1960s, Ellis wrote:
This principle, which I have inducted from many psychotherapeutic sessions with scores of patients during the last several years, was originally discovered and stated by the ancient Stoic philosophers, especially Zeno of Citium (the founder of the school), Chrysippus [his most influential disciple], Panaetius of Rhodes (who introduced Stoicism into Rome), Cicero, Seneca, Epictetus, and Marcus Aurelius. The truths of Stoicism were perhaps best set forth by Epictetus, who in the first century A.D. wrote in the Enchiridion: “Men are disturbed not by things, but by the views which they take of them.” Shakespeare, many centuries later, rephrased this thought in Hamlet: “There’s nothing good or bad but thinking makes it so.” (Ellis, 1962, p. 54)
[By the way, there’s a small mistake in that passage. Cicero was a Platonist, not a Stoic but we’ll let Ellis off with that!] Anyway, Aaron T. Beck later developed “cognitive therapy”, which was at first heavily influenced by REBT and also cited Stoicism and particularly the quote from Epictetus as its inspiration and “philosophical origin”, as Beck put it. However, Beck’s treatment manual for depression was only published in 1979 and for anxiety in 1985. So cognitive therapy didn’t properly rise to prominence until the 1980s, by which time it was increasingly being combined with earlier approaches from behaviour therapy. Hence, Beck’s term “cognitive therapy” became gradually replaced by the more general term, which we all know and love, “Cognitive-Behavioural Therapy” or CBT. The story doesn’t stop there, though, because by the 1990s a number of “third wave” or “mindfulness and acceptance-based” approaches to CBT had already started to develop, which basically replaced Beck and Ellis’ emphasis on helping clients to directly question the evidence for their irrational beliefs with a greater emphasis on mindfulness and detachment from unhelpful thoughts. Recent “third wave” CBT puts more emphasis on gaining psychological distance from thoughts rather than disputing them, in other words.
So CBT has always been a broad church, composed of many different cognitive and behavioural theories and practices. Since the 1980s, Beck’s approach has been the most influential one, and following REBT it explicitly cites Stoicism as its philosophical origin. However, other forms of CBT may also have elements in common with Stoicism. For example, recently the emphasis in “third-wave” CBT has shifted on to the role of mindfulness and acting in accord with personal values. These are both key elements in Stoicism that were somewhat neglected by Beck and Ellis but which are emphasised in the new generation of CBT approaches, such as Acceptance and Commitment Therapy or “ACT”. I’ve argued in my book that mindfulness was one of the main aspects of Stoicism that Beck and Ellis failed to assimilate into their early cognitive-behavioural approaches. Mindfulness is all the rage now but it’s mainly associated with ideas from Buddhist meditation rather than Stoicism, even though Epictetus said, for instance, “Is there any activity that doesn’t benefit from being performed with true self-awareness?” Sleeping perhaps. But you might want to ponder how broad the beneficial applications of mindfulness and cultivating self-awareness might be in your own life? That’s a question perhaps to take away from this talk.
Example Philosophical Techniques
So we’ve talked about Stoicism, CBT, and the relationship between them. What about some practical examples of Stoic philosophical therapy?
- First of all, “Dogmata” or precepts of Stoicism attempt to sum up rules of living as brief phrases, such as “Follow nature” or “Know thyself”, a bit like affirmations or coping statements in modern therapy. Stoics like Marcus Aurelius used to practice writing down short passages or phrases over and over that tried to express important philosophical maxims in many different ways. We have a clear record of this in his personal journal, called The Meditations.
- Next, philosophical “katharsis”, not at all what Freud used the word to mean, but rather the knack of mindfulness, seeing thoughts as thoughts, distinct from external reality, as merely events in the mind and not confusing thoughts with the things they represent. This is very similar to the concept of psychological “distancing” we mentioned earlier as part of modern CBT.
- “Objective representation” (phantasia kataleptike) was an important Stoic practice that involved carefully describing events in purely objective terms, without any rhetoric or value judgements. Similar techniques are used in modern mindfulness-based meditation techniques in CBT.
- “Premeditatio malorum” involves imagining future catastrophes as if they’re happening right now and learning to cope with them better through mental rehearsal and Stoic acceptance. This is similar to a common CBT technique called “decatastrophising imagery”.
- “Contemplation of the Sage” involved verbally describing or imagining the ideal wise man, or ideal Stoic, and how he would cope with different problems of living. Again, this resembles a modern CBT technique called “covert modelling” or modelling in imagination.
- Finally, the technique scholars call “The View from Above”, which is found throughout classical literature. This involves picturing events from high above, as if from atop mount Olympus or looking down at the planet Earth from outer space. To the ancients this seemed like adopting the perspective of the gods on mortal events, trying to contemplate the place of the present moment within the vast totality of time and space. This technique creates a sense of psychological detachment that can be very useful but there aren’t many examples of the same type of visualisation being done in modern therapy.
So given the overlap, why would anyone, including modern therapists care about Stoicism? Well, the Stoics also provide a bigger philosophical system than modern therapy has to offer. They had their eye on the ideal way of life in general rather than just fire-fighting specific clinical problems such as anxiety or depression. The Stoics also had some strategies that modern therapy neglects or presents differently, including some of the ones mentioned a moment ago. However, an answer that’s very important to me, and to many other people, but not to everyone, is that the Stoics wrote some of the most beautiful and inspiring works in the history of European literature. Seneca, in particular, has always been revered as a great writer. Reading Seneca, or indeed Epictetus or Marcus Aurelius, is a very different experience from reading a modern clinical or self-help text on CBT. To some people it’s a much greater source of inspiration – the beauty of the writing and clarity of thinking often matters.
Philosophy is the love of wisdom. That’s what the word means and to the ancients that meant having the courage, integrity and persistence to live our lives wisely, even in the face of real adversity. As Plato famously wrote, philosophy is a battle of titanic proportions over the very nature of existence itself. It goes somewhat beyond what modern evidence-based psychological therapy can tell us. Philosophy demands that we ask even more penetrating questions. Quo vadis? Where are you going? What are we to do in life, more generally, with the specific pieces of knowledge that modern research on psychological wellbeing might give us?