Introducing The Philosophy of CBT (Karnac Blog)

Short blog article introducing the book The Philosophy of CBT (2010) by Donald Robertson, written for Karnac, the publisher.

The Philosophy of Cognitive-Behavioural Therapy

Stoic Philosophy as Rational & Cognitive Psychotherapy

The Philosophy of CBT CoverBlog article for Karnac.  Copyright © Donald Robertson, 2010.  All rights reserved.  This article includes adapted material from The Philosophy of Cognitive-Behavioural Therapy.

The Philosophy of Cognitive-Behavioural Therapy (CBT) is a new book about ancient philosophy and modern psychotherapy.  Professor Stephen Palmer, author of Brief Cognitive Behavior Therapy and several other books on CBT, has kindly contributed a foreword in which he observes that a thorough discussion of the historical roots of modern cognitive-behavioural therapy (CBT) has been lacking.  He adds,

This book takes us on a historical journey through millennia, and highlights the relevant philosophies and the ideas of the individual philosophers that can inform modern cognitive-behavioural therapies.  This book also contains some therapeutic techniques that seem to be modern, yet were developed and written about many years ago. (Ibid.)

This is the essence of The Philosophy of CBT.  It’s a book about the practical relevance of ancient philosophy to modern psychotherapy, most especially the relevance of Stoicism to modern CBT.  

Stoicism had more of a psychotherapeutic orientation than most modern psychotherapists are probably aware of – it was essentially a psychological and philosophical therapy in its own right.  CBT is also more indebted to it than is widely recognised.  Epictetus, one of the most important Stoic philosophers, went so far as to say that the philosopher’s school is a doctor’s (or therapist’s) clinic (Discourses, 3.23.30).  In 1979, Aaron T. Beck and his colleagues wrote in the first major CBT treatment manual, Cognitive Therapy of Depression, ‘The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers’ (Beck, Rush, Shaw, & Emery, 1979, p. 8).  These comments echo earlier remarks made by Albert Ellis, the founder of Rational-Emotive Behaviour Therapy (REBT).  Most CBT practitioners will be familiar with the famous maxim of Epictetus, from the Stoic Enchiridion (Handbook), that states,

It is not the things themselves that disturb people but their judgements about those things. (Enchiridion, 5)

This ancient philosophical precept is widely-quoted in introductory texts on CBT and in the writings of Beck, Ellis, and other leading authors in the field.  It serves to highlight the fundamental link between ancient Stoic therapeutics and modern cognitive therapies.  However, this link is never explored – at least not in much detail.

Moreover, there are many practical therapeutic strategies and techniques to be found in the literature of classical philosophy that have good “face validity”, appear consistent with CBT, and may well deserve empirical investigation in their own right.  Hence, some of the key points of The Philosophy of CBT might be summarised as follows,

  • The origins of modern cognitive-behavioural therapy can be traced, through early twentieth century rational psychotherapists, back to the ancient therapeutic practices of Socratic philosophy, especially Roman Stoicism.
  • The notion of Stoicism as a kind of “intellectualism” opposed to emotion is a popular misconception.  Stoicism has traditionally attempted to accommodate emotion, especially the primary philosophical emotion of rational love toward existence as a whole.
  • Ancient philosophy offers a clear analogy with modern CBT and provides many concepts, strategies, and techniques of practical value in self-help and psychotherapy.
  • The contemplation of universal determinism, of the transience or impermanence of things, including our own mortality, and the meditative vision of the world seen from above, or the cosmos conceived of as a whole, constitute specific meditative and visualisation practices within the field of ancient Hellenistic psychotherapy.
  • Contemplation of the good qualities (“virtues”) found in those we admire and in our ideal conception of philosophical enlightenment and moral strength (the “Sage”) provides us with a means of role-modelling excellence and deriving precepts or maxims to help guide our own actions.
  • The rehearsal, memorisation, and recall of short verbal formulae, precepts, dogmas, sayings, or maxims resembles the modern practice of autosuggestion, affirmation, or the use of coping statements in CBT.
  • The objective analysis of our experience into its value-free components, by suspending emotive judgements and rhetoric, constitutes a means of cognitive restructuring involving the disputation of faulty thinking, or cognitive distortion.  By sticking to the facts, we counter the emotional disturbance caused by our own “internal rhetoric.”
  • Mindfulness of our own faculty of judgement, and internal dialogue, in the “here and now”, can be seen as analogous to the use of mindfulness meditation imported into modern CBT from Buddhist meditation practices, but has the advantage of being native to Stoicism, the philosophical precursor of CBT, and to European culture and language.
  • The enormous literary value, the sheer beauty, of many of the classics with which we are concerned marks them out as being of special interest to many therapists and clients, just as it has marked them out for many thousands of previous readers throughout the intervening centuries.
  • Socratic philosophy has a broader scope than modern psychotherapy, it looks at the bigger picture, and allows us the opportunity to place such therapy within the context of an overall “art of living”, or philosophy of life.

Philosophers and psychotherapists have a great deal to talk about, and a better common ground is required on which the two traditions can meet each other and exchange ideas.  I hope that this study of the philosophical precursors of modern cognitive-behavioural therapy will help to clarify and strengthen the basis for further dialogue between philosophers and therapists in the future. 

The book is divided into two parts.  The first explores the historical and theoretical relationship between Stoicism and CBT.  However, the discussion extends to other schools of ancient philosophy, such as Pythagoreanism and Epicureanism, and other 20th century schools of psychotherapy, precursors of modern CBT, such as the rational persuasion school of Paul Dubois, etc.  The second part of the book focuses upon the practical strategies and techniques of Stoic therapeutics in relation to modern CBT.  For example, the role of specific mindfulness, visualisation, autosuggestion, and semantic techniques in ancient Stoicism are explored in some detail.  Appendices provide examples of a possible Stoic daily routine and a complete script for modern practitioners to employ in groups or with individuals, based on the Socratic meditation termed “The View from Above” by modern scholars.

Table of Contents

  • Foreword by Prof. Stephen Palmer
  • Introduction: Philosophy & Psychotherapy
  • Contented with Little

Part I: Philosophy & Cognitive-Behavioural Therapy (CBT)

  • The “Philosophical Origins” of CBT
  • The Beginning of Modern Cognitive Therapy
  • A Brief History of Philosophical Therapy
  • Stoic Philosophy & Psychology
  • Rational Emotion in Stoicism & CBT
  • Stoicism & Ellis’ Rational Therapy (REBT)

Part II: The Stoic Armamentarium

  • Contemplation of the Ideal Sage
  • Stoic Mindfulness of the “Here & Now”
  • Self-Analysis & Disputation
  • Autosuggestion, Premeditation, & Retrospection
  • Premeditatio Malorum & Mental Rehearsal
  • Stoic Fatalism, Determinism & Acceptance
  • The View from Above & Stoic Metaphysics
  • Conclusion: Fate Guides the Willing
  • Appendix: An Example Stoic Therapeutic Regime
  • Appendix: The View from Above Script

More information on the book can be found on the blog,

www.philosophy-of-cbt.com

Introducing The Philosophy of CBT

The Philosophy of Cognitive-Behavioural Therapy (CBT), Stoic Philosophy as Rational and Cognitive Psychotheray, by Donald Robertson, published by Karnac Books, 2010.

The Philosophy of CBT

Stoic Philosophy as Rational & Cognitive Psychotherapy

The Philosophy of CBT Cover“The philosopher’s school”, said Epictetus, “is a doctor’s clinic.”  The Philosophy of CBT is the first comprehensive review of the relationship between modern cognitive-behavioural therapies and classical philosophy.  The founders of cognitive therapy and REBT, Aaron Beck and Albert Ellis, both refer to Stoicism in particular as the main precursor of the modern cognitive approach.  This book elaborates in detail upon the historical relationship between different schools of ancient philosophy and modern psychotherapy.  It places particular emphasis on the specific therapeutic strategies and techniques employed in Stoicism and other Hellenistic philosophies and explores the potential for integrating them within modern psychological therapies. 

For example, the central principle of Stoicism was that emotional disturbance is linked to placing excessive value upon things outside of our direct control while neglecting things we can more easily change, especially our cognitions and behaviour.  Visualisation techniques such as “The View from Above” and Stoic mindfulness practices are explained as part of a “forgotten” armamentarium of therapeutic methods.  The author argues that certain aspects of these ancient schools of philosophical psychotherapy may well deserve to be rehabilitated within the modern psychotherapeutic framework.  This book opens up a new forum for dialogue between philosophers and psychotherapists, focusing on the practical dimension of Socratic philosophy and its relationship with the cognitive-behavioural tradition.

Foreword by Prof. Stephen Palmer

This is the foreword by Prof. Stephen Palmer to The Philosophy of Cognitive-Behavioural Therapy (2010) by Donald Robertson

Foreword by Prof. Stephen Palmer

The Philosophy of Cognitive-Behavioural Therapy (2010)

Cognitive behavioural therapies are at the cutting edge of modern psychological therapeutic interventions. They are evidence based and therefore are underpinned by much research. In The United Kingdom (UK) the National Institute for Health and Clinical Excellence has recommended cognitive behavioural therapy for depression and anxiety-related disorders such as panics, obsessive compulsive behaviour, body dysmorphic disorder and post traumatic stress disorder (e.g. NICE, 2004, 2005; 2006; 2009). It is no surprise that this interests stakeholders wishing to provide cost-effective psychological therapies to their customers, ie the public, in order to improve wellbeing and reduce financial expenditure. In the UK the Government has taken the next logical step and funded cognitive behavioural therapy training as part of the Improving Access to Psychological Therapies (IAPT) programme. Stressed, depressed and anxious citizens cost countries billions of pounds according to the research data, and understandably reducing absenteeism from work due to psychological illness is an attractive target to focus on. An effective IAPT programme can benefit both the country and the individual.

Cognitive behavioural therapy has become one of the main approaches for dealing effectively with a wide range of psychological disorders and this has led to a large increase in the training of health professionals in this approach especially within the UK. Key handbooks available to trainees based on Dr Aaron Temkin Beck’s Cognitive Therapy (Beck, 1976) or Dr Albert Ellis’ Rational Emotive Behaviour Therapy (REBT) (Ellis, 1958) only briefly, if at all, cover the historical roots of these therapies. Dr Albert Ellis in his publications is often more explicit about the early origins of REBT in comparison to the books on Cognitive and Cognitive-behavioural therapy. 

Yet, for many of us something is missing from most of the literature. What has been needed is a book that covers the underlying philosophy of the cognitive behavioural therapies in much greater depth. This book on the Philosophy of Cognitive-Behaviour Therapy by Donald Robertson provides us with the missing link between the theory and the philosophy. This book takes us on a historical journey through millennia and highlights the relevant philosophies and the ideas of the individual philosophers that can inform modern cognitive behavioural therapies. This book also includes some therapeutic techniques that seem to be modern yet were been developed and written about many years ago. It is a fascinating read. The Philosophy of Cognitive-Behaviour Therapy could be considered as either a prequel or a sequel to the standard textbook read by a trainee or experienced cognitive behavioural or rational emotive practitioner who wants to understand these approaches to therapy within an historical framework.

Professor Stephen Palmer PhD  FAREBT  FBACP

Director of the Centre for Stress Management, London, UK 

REFERENCES

Beck, A.T. (1976). Cognitive Therapy and The Emotional Disorders. New York: International Universities Press.

Ellis, A. (1958). Rational psychotherapy. The Journal of General Psychology, 59, 35-49.

NICE (2004) .Anxiety: Management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care (http://guidance.nice.org.uk/CG22/guidance/pdf/English).

NICE (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care (http://guidance.nice.org.uk/CG26/guidance/pdf/English).

NICE (2006). Obsessive-compulsive disorder: Core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder (http://guidance.nice.org.uk/CG31/guidance/pdf/English).

NICE (2009). Depression in adults (update): Depression: the treatment and management of depression in adults National Clinical Practice Guideline 90. (http://www.nice.org.uk/nicemedia/live/12329/45896/45896.pdf).

Excerpt: The Philosophy of Cognitive-Behavioural Therapy (CBT)

This article contains a brief excerpt from the introduction to the new book by Donald Robertson, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy (Karnac).

The Philosophy of Cognitive-Behavioural Therapy (CBT)

Stoic Philosophy as Rational and Cognitive Psychotherapy

Copyright (c) Donald Robertson, 2010. All rights reserved.

[F]or many of us something is missing from most of the [CBT] literature. What has been needed is a book that covers the underlying philosophy of the cognitive behavioural therapies in much greater depth. This book on the Philosophy of Cognitive-Behavioural Therapy by Donald Robertson provides us with the missing link between the theory and the philosophy. […] It is a fascinating read. The Philosophy of Cognitive-Behavioural Therapy could be considered as either a prequel or a sequel to the standard textbook read by a trainee or experienced cognitive behavioural or rational emotive practitioner who wants to understand these approaches to therapy within an historical framework.
— From the Foreword by Professor Stephen Palmer PhD FAREBT FBACP, Director of the Centre for Stress Management, London, UK


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.


Donald Robertson

Critics might say that it is actually a healthy sign that so little attention has been given to the historical and philosophical origins of CBT because it is inherently a forward-looking, scientific approach to psychotherapy. Just because ideas are very old, it doesn’t necessarily mean that they are particularly valid or useful today. However, there are number of legitimate reasons for exploring this matter in more detail. As [US naval pilot vice-admiral James] Stockdale [who used his knowledge of Stoic philosophy to survive incarceration in a Vietnamese torture camp] wrote,

Most of what Epictetus has to say to me is “right on” for modern times. Will Durant [an American philosopher] says that human nature changes, if at all, with “geological leisureliness.” According to me, not much has happened to it since the days of Homer. Epictetus lived a tough life: born a slave, crippled by a cruel master, went from boy to man in the murderous violence of the household of a totally indulgent Emperor Nero. And he read human nature across a spectrum like this, and by the standards of my spectrum it rings with authenticity. (Stockdale, 1995, p. 180)

Indeed, a handful of cognitive-behavioural therapists have already attempted to make some headway in the direction of increasing dialogue concerning the relationship between Hellenistic philosophy and REBT or CBT (Still & Dryden, 1999; McGlinchey, 2004; Herbert, 2004; Reiss, 2003; Montgomery, 1993; Brookshire, 2007; Robertson, 2005).

The Philosophy of CBT (Karnac)

Moreover, there are still therapeutic concepts and techniques to be found in classical literature that have good “face validity”, appear consistent with CBT, and may well deserve empirical investigation in their own right. Nevertheless, in his recent article, Herbert, while defending the notion that comparisons between ancient philosophy and modern psychotherapy are interesting and valuable in their own right, has called into question the extent to which correlation in their respective ideas can be taken as evidence of causation, i.e., of a historical influence (Herbert, 2004). While I agree that the question of influence is a complex one, and perhaps something of a diversion from the bigger issues, in the following chapters I will discuss the extent to which the founders of both REBT and cognitive therapy have explicitly stated, in some of their principal texts, that Stoicism and other ancient philosophical traditions were regarded by them as providing the “philosophical origins” of their approach, e.g., ‘The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers’ (Beck, Rush, Shaw, & Emery, 1979, p. 8).

Hence, some of the key points of the following text might be summarised as follows, for the benefit of readers requiring an overview of what may seem a complex and somewhat inter-disciplinary subject matter,

  • The origins of modern cognitive-behavioural therapy can be traced, through early twentieth century rational psychotherapists, back to the ancient therapeutic practices of Socratic philosophy, especially Roman Stoicism.
  • The notion of Stoicism as a kind of “intellectualism” opposed to emotion is a popular misconception. Stoicism has traditionally attempted to accommodate emotion, especially the primary philosophical emotion of rational love toward existence as a whole.
  • Ancient philosophy offers a clear analogy with modern CBT and provides many concepts, strategies, and techniques of practical value in self-help and psychotherapy.
  • The contemplation of universal determinism, of the transience or impermanence of things, including our own mortality, and the meditative vision of the world seen from above, or the cosmos conceived of as a whole, constitute specific meditative and visualisation practices within the field of ancient Hellenistic psychotherapy.
  • Contemplation of the good qualities (“virtues”) found in those we admire and in our ideal conception of philosophical enlightenment and moral strength (the “Sage”) provides us with a means of role-modelling excellence and deriving precepts or maxims to help guide our own actions.
  • The rehearsal, memorisation, and recall of short verbal formulae, precepts, dogmas, sayings, or maxims resembles the modern practice of autosuggestion, affirmation, or the use of coping statements in CBT.
  • The objective analysis of our experience into its value-free components, by suspending emotive judgements and rhetoric, constitutes a means of cognitive restructuring involving the disputation of faulty thinking, or cognitive distortion. By sticking to the facts, we counter the emotional disturbance caused by our own “internal rhetoric.”
  • Mindfulness of our own faculty of judgement, and internal dialogue, in the “here and now”, can be seen as analogous to the use of mindfulness meditation imported into modern CBT from Buddhist meditation practices, but has the advantage of being native to Stoicism, the philosophical precursor of CBT, and to European culture and language.
  • The enormous literary value, the sheer beauty, of many of the classics with which we are concerned marks them out as being of special interest to many therapists and clients, just as it has marked them out for many thousands of previous readers throughout the intervening centuries.
  • Socratic philosophy has a broader scope than modern psychotherapy, it looks at the bigger picture, and allows us the opportunity to place such therapy within the context of an overall “art of living”, or philosophy of life.

The modern industrialisation of psychotherapy, the division of the therapist’s labour, has compartmentalised it in a manner that is bound to cause certain contradictions. What was once a lifestyle and calling, a vocation in the true sense of the word, has now been degraded into a mere “job”. By nature, however, we do not merely study the cure of human suffering in order to alleviate it, but also to understand and transform ourselves and our relationship with life itself. Perhaps, as the ancients seemed to believe, the philosopher-therapist must first transform his own way of life, making it a living example of his views, in order to be able to help others. By contrast, if the goal of the “rational” or “philosophical” therapist is merely to do his job and leave it all behind him at the weekend, to treat what we call “psychotherapy” as just another profession then perhaps that’s not a very rational or philosophical goal.

Philosophers and psychotherapists have a great deal to talk about, and a better common ground is required on which the two traditions can meet each other and exchange ideas. I hope that this study of the philosophical precursors of modern cognitive-behavioural therapy will help to clarify and strengthen the basis for further dialogue between philosophers and therapists in the future.


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.