The Philosophy of Cognitive-Behavioural Therapy (CBT)
Stoic Philosophy as Rational and Cognitive Psychotherapy
Copyright (c) Donald Robertson, 2010. All rights reserved.
This is a brief excerpt from my new book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, published by Karnac and available for order online now. You can also now order The Philosophy of Cognitive-Behavioural Therapy from Amazon, where you may preview a sample of the contents online free of charge.
Social Anxiety, Value Judgements, and Rigid Demands
[Albert Ellis was the founder of Rational-Emotive Behaviour Therapy, REBT, a precursor of modern CBT.] Ellis’ approach differs from other modes of cognitive-behavioural therapy in that he places most emphasis upon the role of irrational or “absolute” demands placed by the subject upon himself, other people, or his environment. According to Ellis, REBT is based on the assumption that the tendency to make “devout, absolutistic evaluations” of events in life is at the core of emotional disturbance and that these value judgements are typically framed in terms of dogmatic “must”, “should”, “have to”, “got to”, “ought to” statements, i.e., unconditional imperatives (Dryden & Ellis, 2001, p. 301). These are called “irrational beliefs” because they are viewed as cognitions, spoken or unspoken, which embody rigid and unrealistic demands and conflict with the goals of enlightened self-interest. By being “rational”, in other words, Ellis often appears to mean something akin to being pragmatic in our pursuit of long-term happiness.
Other types of irrational thought, such as over-generalisations, or unfounded assumptions, are emphasised throughout other schools of CBT, most notably Beck’s cognitive therapy. Ellis concedes that these can contribute to human suffering, and that it can be useful to target them in therapy. However, he insists that fundamentally rigid demands are the pre-eminent underlying cause of emotional disturbance, and even that they are a necessary condition of it. Even if I falsely concluded that everyone hated me, an irrational over-generalisation, in principle, I could still say “So what?” to myself and dismiss it without becoming upset. The unconditional demand that people must like me when combined with the belief that they do not, according to REBT, inevitably generates emotional distress. However, other people’s attitudes and behaviour, like other external events, are not under my direct control. Ellis makes this point, again by reference to Stoicism, when he advises those using REBT for self-help as follows,
As Epictetus pointed out two thousand years ago, although you do have considerable power to change and control yourself, you rarely can control the behavior of others. No matter how wisely you may counsel people, they are independent persons and may – and, indeed, have the right to – ignore you completely. If, therefore, you unduly arouse yourself over the way others act, instead of taking responsibility for how you respond to them, you often will upset yourself over an uncontrollable event. (Ellis & Harper, 1997, p. 198)
The irrationally rigid demands which REBT warns against, which are similar to the “rules” and “assumptions” in Beck’s cognitive therapy, also bear a striking resemblance to the unconditional value judgements which Stoics believe are at the root of emotional distress. For the Stoic, it is the tendency to judge things as being inherently or absolutely good or bad which leads to irrational craving (epithumia) or fear (phobos) respectively. In Stoic psychology, irrational desire, or craving, which places too much value on external things and other people’s opinions, is the root cause of anxiety. Believing that “I have to” have (or avoid) something, or that other people “must” behave (or not behave) in a certain way, as REBT would put it, is tantamount to saying that these things are of overriding importance in themselves, or absolute external values, as Stoicism would put it.
As is often the case, the Stoics give clear examples which would not seem out of place in a modern psychotherapy text, e.g., in this striking passage Epictetus describes the relationship between desire and social anxiety, or stage fright, as follows.
When I see somebody in a state of anxiety, I say, ‘What can this man want?’ Unless he wanted something or other which is not in his own power, how could he still be anxious? That is why a person who sings to the lyre feels no anxiety while he is singing by himself, but is anxious when he enters the theatre, even if he has a very fine voice and plays his instrument beautifully. For he wants not only to sing well, but to gain applause, and that lies beyond his control. […]
He does not understand what a crowd is, or the applause of a crowd. He has learned, indeed, how to strike the lowest and highest strings; but what the applause of the multitude is, and what force it has in life, he neither understands, nor has studied. Hence he must necessarily tremble and turn pale. […]
He does not know that he is wishing to have what is not allowed him, and wishing to avoid what he cannot escape; and he does not know what is his own and what is not his own [i.e., his value-judgements]; for if he did know, he would never feel hindered, never feel restrained, never feel anxious. […]
If, then, things outside the sphere of choice are neither good nor bad, and all things within the sphere of choice are in our power, and can neither be taken away from us, nor given to us, unless we please, what room is there left for anxiety? But we are anxious about this paltry body or estate of ours, or about what Caesar will think [i.e., about health, wealth, or reputation] and not at all about what is within us. Are we ever anxious not to take up a false opinion? No, for this is in our own power. Or about following an impulse, contrary to nature? No, nor this either. When, therefore, you see any one pale with anxiety, just as the physician pronounces from a person’s complexion that this patient is affected in his spleen, and that in his liver, so you likewise should say: this man is affected in his desires and aversions, he is out of sorts, he is feverish. For nothing else changes the complexion or makes a man tremble or sets his teeth a-chattering, or ‘Shift from leg to leg and squat on one foot then the other.’ (Discourses, 2.13.1-13)
Instead of attaching too much value to other people’s opinions, absolutely demanding their approval and fearing their rebuke, the musician should patiently train himself, over time, to put value primarily upon his own intentions and judgements and to take the audience’s praise or leave it with similar equanimity. For the Stoics, to value something positively or negatively is to try to control it, and we have more control over our own judgments and intentions than over external events or other people, so we should shift the focus of our value judgements inwards, within the here and now, and focus on the importance of our own mental activity and responses more than other people’s opinions. The example of stage fright is extended by Epictetus to oratory and any similar social anxiety. Anyone who anxiously demands, rather than merely preferring, that others praise him is being unphilosohical, and has failed to understand the nature of things in relation to his sphere of control. He blames his nerves on the situation, neglecting the importance of his own misplaced value judgements in determining his emotional disturbance.
Nor does he even know what anxiety itself is, whether it be our own responsibility or outside it, or whether it be possible to suppress it or not. Because of this, if he is praised, he leaves the stage puffed up with pride: but if he is laughed at, his poor bubble is pricked and collapses.
We too experience something of this kind. What do we admire? Externals. What do we strive for? Externals. Are we then at a loss to know how fear and anxiety overcome us? Why what else is possible when we regard impending events as evils? We cannot help being fearful we cannot help being anxious. (Discourses, 2.16.10)
This is a brief excerpt from my new book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, published by Karnac and available to order online now. You can also now order The Philosophy of Cognitive-Behavioural Therapy from Amazon, where you may preview a sample of the contents online free of charge.