By D. Robertson and T. Codd, originally published in The Behavior Therapist, vol. 42, no. 2, Feb 2019
Abstract: Stoicism provides the clearest example of a system of psychotherapy in ancient Greek or Roman philosophy. Albert Ellis acknowledged that some of the central principles of Rational Emotive Behaviour Therapy were “originally discovered and stated” by the Stoics and Beck that “the philosophical origins of cognitive therapy can be traced back to the Stoic philosophers.” However, the emphasis on mindfulness and living in accord with values in Stoicism was largely ignored by them and unknown to the third-wave psychotherapists who followed them. This article highlights Stoicism’s similarities to modern mindfulness and acceptance-based CBT and its potential as an approach to building emotional resilience.
Introduction
Socrates considered philosophy to be, among other things, a form of talking therapy, a sort of medicine for the mind. Within a few generations of his death, this idea of philosophy as psychotherapy had become commonplace among the various schools of Hellenistic philosophy. However, it was the Stoics who placed most emphasis on this therapeutic dimension of philosophy. For example, the Roman Stoic teacher Epictetus wrote “It is more necessary for the soul to be cured than the body, for it is better to die than to live badly” (Fragments, 32) and he states bluntly “the philosopher’s school is a doctor’s clinic” (Discourses, 3.23.30). Today, though, most people are unaware of the extent to which ancient Greeks and Romans conceived of philosophy as a type of psychological therapy.
Stoicism survived for five centuries but its therapeutic concepts and practices were largely neglected until the start of the 20th century when a rational approach to psychotherapy began emerging, which held that many emotional and psychosomatic problems were caused by negative self-talk or autosuggestions, which could be amenable to rational disputation. Its leading proponent, the Swiss psychiatrist Paul Dubois, employed Socratic questioning with his patients and taught them the basic principles of a Socratic and Stoic philosophy of life. Indeed, he declared:
If we eliminate from ancient writings a few allusions that gave them local colour, we shall find the ideas of Socrates, Epictetus, Seneca, and Marcus Aurelius absolutely modern and applicable to our times. (Dubois, 1909, pp. 108–109).
Dubois also noticed that, paradoxically, the Stoic words of advice he read in the letters of the philosopher Seneca “seem to be drawn from a modern treatise on psychotherapy,” although written in the first century AD.
Dubois placed more emphasis than subsequent psychotherapists on the fundamental distinction Stoics make between what is up to us and what is not. We should, the Stoics believed, learn to assume more responsibility for our own voluntary actions while also becoming more tolerant and accepting of things that merely happen to us. Or as Epictetus put it:
What, then, is to be done? To make the best of what is in our power, and take the rest as it naturally happens. (Discourses, 1.1.17)
This central teaching of Stoicism found perhaps its best-known expression in The Serenity Prayer, written by Reinhold Niebuhr in the 1930s, but made popular by Alcoholics Anonymous. “God, give me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference.” However, by the middle of the 20th century Stoicism and rational psychotherapy, based on these venerable philosophical principles, were temporarily eclipsed in popularity by an oddity that was to be rather short-lived by comparison: Freudian psychoanalysis.
Indeed, psychotherapists began to rediscover Stoicism from the 1950s onward through the writings of Albert Ellis, and what would become known as Rational Emotive Behavior Therapy (REBT). Despite the similarity of his approach to that of early rational psychotherapists such as Dubois, Ellis was initially unaware of their writings. However, as far back as his youth, before training as a psychotherapist, Ellis had “read the later Stoics, Epictetus, Seneca, and Marcus Aurelius” (Still & Dryden, 2012, pp. xii-xiii). Indeed, Ellis refers to the Stoics, particularly Epictetus, throughout his writings. Even when he doesn’t mention the Stoics by name, though, Ellis often describes concepts and techniques that seem to demonstrate their influence.
In Ellis’ first major publication on REBT, he famously explained the central premise of this emerging cognitive approach to psychotherapy: emotional disturbances, and associated symptoms, are not caused by external events, as people tend to assume, but mainly by our irrational beliefs about such events. However, he also explained that it was far from being a new idea:
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, Panaetius of Rhodes (who introduced Stoicism into Rome), Cicero [sic], 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.” (Ellis, 1962, p. 54)
(Footnote: Cicero was an Academic philosopher not a Stoic, although he was sympathetic to Stoicism and wrote extensively about it making him one of our main sources for information on the philosophy. Beck et al., under the influence of Ellis, reproduce this error in their own account.)
Elsewhere Ellis repeats his conviction that “Many of the principles incorporated in the theory of rational-emotive psychotherapy are not new; some of them, in fact, were originally stated several thousand years ago, especially by the Greek and Roman Stoic philosophers,” and he names Epictetus and Marcus Aurelius in particular as his influences in this regard (Ellis, 1962, p. 35). Indeed, Ellis taught the famous quote from Epictetus above to many of his clients during the initial socialization phase of treatment (Therapists today could better translate the same Greek passage: “People are not emotionally distressed by events but by their beliefs [dogmata] about them.”) Following Ellis, this saying also became extremely well known to subsequent generations of cognitive-behavioral therapists. Although, for some reason, surprisingly few of them chose to explore the writings of Epictetus or others Stoics for themselves.
Mainly through Ellis’ writings, Stoicism continued influence Aaron T. Beck, the founder of cognitive therapy and his colleagues. Beck opened his first book on cognitive therapy by describing how his new style of therapy was founded upon the emerging consensus among researchers that cognitions play a central role in determining our emotions. Then, like Ellis, he added:
Nevertheless, the philosophical underpinnings go back thousands of years, certainly to the time of the Stoics, who considered man’s conceptions (or misconceptions) of events rather than the events themselves as the key to his emotional upsets. (Beck A. T., 1976, p. 3)
Beck also illustrated the cognitive model of emotion with a quote from Marcus Aurelius:
If thou are pained by any external thing, it is not the thing that disturbs thee, but thine own judgment about it. And it is in thy power to wipe out this judgment now. (Marcus Aurelius, quoted in Beck, 1976, p. 263)
He’s talking about suspending irrational and unhealthy value-judgements, incidentally, rather than suppressing automatic thoughts.
Nearly two decades after Ellis had first brought it up, Beck et al. restated this claim that the doctrines of Stoicism constitute the “philosophical origins” of cognitive therapy in their groundbreaking treatment manual for clinical depression:
The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers, particularly Zeno of Citium (fourth century B.C.), Chrysippus, Cicero [sic], Seneca, Epictetus, and Marcus Aurelius. (Beck, Rush, Shaw, & Emery, 1979, p. 8).
Like Ellis, they quote the famous passage from Epictetus above, which they hailed as a forerunner of their own cognitive theory of emotion. Moreover, if the causes of emotional disturbance are mainly cognitive this implies the possibility of a cognitive cure. They realized, therefore, that this shared premise had led Stoics and cognitive therapists to the same conclusion: “Control of most intense feelings may be achieved by changing one’s ideas.”
Ellis was only exaggerating slightly when he later claimed: “I am happy to say that in the 1950’s I managed to bring Epictetus out of near-obscurity and make him famous all over again” (Ellis & MacLaren, 2005, p. 10). Indeed, in recent decades, partly as a consequence of CBT’s growing popularity, Stoicism has continued to undergo a wider resurgence in popularity. In the 1980s, Vice Admiral James Stockdale helped popularize Stoic philosophy in the US military. Stockdale documented his reliance on the Stoicism of Epictetus as a means of coping with torture and incarceration during the Vietnam War in Thoughts of a Philosophical Fighter Pilot (1995). The Tom Wolfe novel about the Stoicism of Epictetus, A Man in Full (1998) reignited popular interest in Stoicism as did director Ridley Scott’s movie Gladiator (2000), which featured Richard Harris as Roman emperor Marcus Aurelius. Since then an increasing number of self-help books influenced by Stoicism such as Ryan Holiday’s The Obstacle is the Way (2014) have appeared. Likewise, a growing number of blog articles and podcasts on the Internet testify to public interest in Stoicism as an approach to self-help and self-improvement. However, these Stoic ideas were ridiculed by Freud’s followers and they would never have resurfaced to this extent if CBT had not effectively replaced the psychodynamic tradition, paving the way for Stoic philosophy to be taken seriously once again.
However, as Stoicism was reaching a wider audience, through self-help literature and the Internet, the field of CBT was changing with the emergence of the third-wave. Third wave therapy introduced greater emphasis on themes like mindfulness, acceptance, and valued living, often turning to Buddhist literature and practices for inspiration. Ironically, though, these themes were already emphasized in the Stoic “philosophical origins” of cognitive therapy. Ellis and subsequently Beck had largely overlooked those aspects of Stoicism. So the next generation of therapists remained largely unaware of the extent to which mindfulness and acceptance were already practices native to ancient Stoicism. Practitioners and researchers began to lose interest in Western philosophy as they turned to Buddhism and eastern thought instead.
Yet many Western clients, and therapists, find Stoicism more congruent with their existing cultural concepts and values. When they learn about the Stoics, they often report a sense of déjà vu as they “join the dots” and realize how it connects countless philosophical themes already familiar to them. From Aesop’s Fables to Hamlet’s “There’s nothing good or bad but thinking makes it so” (also quoted by Ellis), to the Roman poet Horace’s carpe diem (made famous by Robin Williams in Dead Poets’ Society), or the memento mori tradition in the arts (e.g., Damien Hirst’s shark in formaldehyde), Stoic concepts permeate Western culture and literature to this day. It’s as though we’re living among the rubble of a once magnificent temple, without recognizing what it means. Then someone shows us a sketch of what it used to look like and suddenly the landscape is transformed before our eyes as we begin to understand how all the pieces were long ago organized into a whole.
Unfortunately, the popularity of Stoicism, the Greek philosophy, among therapists has also been hampered because of the tendency to confuse it with (lower-case) stoicism, the “stiff upper-lip” personality trait or coping style. The word “stoicism” is often taken to mean crudely suppressing feelings of distress — something potentially quite unhealthy. However, Stoic philosophy teaches a far more nuanced approach to emotional self-regulation, which is more consistent with the aims of psychotherapy. This article will address this and other misconceptions about Stoicism and make the case that it can contribute in important ways to the modern field of cognitive-behavioral therapy.
Who Were the Stoics?
The Stoic school was founded in 301 BC by a Phoenician merchant called Zeno of Citium who had been shipwrecked near Athens. Inspired by the example of Socrates, Zeno became a philosopher. He trained for ten years in the Cynic tradition and studied at the Platonic Academy and the Megarian school, founded by another of Socrates’ followers, before founding his own school combining these influences. He was succeeded as head (scholarch) of the school by Cleanthes of Assos, and then by Chrysippus of Soli, one of the most highly-regarded intellectuals of the ancient world. Between them, these three men defined the foundations of Stoicism.
Moreover, the Athenian school had an unbroken succession of teachers lasting over two hundred years, until Panaetius of Rhodes who died at the end of the second century BC. By that time the philosophy had already gained popularity among Romans and it continued as an important albeit more fragmented tradition right down to the time of the last famous Stoic, the Roman emperor Marcus Aurelius, who died in 180 AD. In other words, Stoicism survived as a living tradition, in ancient Greece and Rome, for over five hundred years.
At a rough estimate, less than one percent of the ancient Stoic writings survive today. We have about a book’s worth of fragments from early Greek Stoics but no complete texts of theirs. Most of our knowledge comes from commentators and from three famous Roman Stoics of the Imperial period: Seneca the Younger, Epictetus, and Marcus Aurelius.
Stoicism was eventually assimilated into Neoplatonism but left an impression on early Christianity. The Stoics are even featured in the New Testament, where St. Paul addresses an audience of Stoic and Epicurean philosophers at the Areopagus in Athens, quoting a line from the Stoic poet Aratus to them. Both traditions share similar ethical values so many modern followers of Stoicism describe it as providing them with a secular alternative to Christianity, based upon philosophical reasoning rather than religious faith.
Following the renaissance there was a revival of interest in Stoicism known as Neostoicism and the influence of the philosophy can particularly be seen in the writings of philosophers such as Justus Lipsius and Anthony Ashley-Cooper (Earl of Shaftesbury), and to some extent also in those of Descartes, Spinoza, Kant, and Montaigne. In addition to its direct influence on Ellis and others, Stoicism also indirectly influenced modern CBT through the writings of these and other influential Western thinkers. For instance, as well as citing the Stoics directly, Beck illustrated the cognitive theory of emotion by quoting Spinoza: “I saw that all the things I feared, and which feared me had nothing good or bad in them save insofar as the mind was affected by them.” (quoted in Beck, 1976:156).
What did the Stoics Believe?
Ancient schools of philosophy were typically distinguished from one another in terms of their definition of the goal of life. The Stoics rejected the popular notion that the goal of life was pleasure (hedonism), and the more philosophical Epicurean version that equated pleasure with freedom from pain and other unpleasant feelings (ataraxia). They also rejected the Platonic and Aristotelian view that the goal included a combination of virtue and external goods that lie partially outside of our control such as health, wealth and reputation. Instead the Stoics insisted on the hard line that the supreme goal of life is synonymous with arete, which is conventionally translated “virtue” although most scholars feel “excellence” (of character) is a better translation.
The Stoics adopt the fourfold model of virtue first mentioned by Socrates in the dialogues of Plato: Wisdom, Justice, Temperance, and Fortitude. However, these were broad conventional headings, which include dozens of other positive character traits. Following Socrates, the Stoics claim that all of these other virtues consist in forms of moral wisdom applied to different areas of life. Justice can be thought of as social virtue in general or what it means to deal wisely with others, both individually and collectively. Temperance and courage are the virtues of self-control: wisdom applied to our desires and fears respectively. So the goal of Stoicism can also be understood as a form of moral or practical wisdom, which is synonymous with living wisely or living rationally. They also equate this with sanity or mental health.
The central doctrine of Stoicism was therefore sometimes expressed as “virtue is the only true good” by which they mean that wisdom and excellence of character are to be valued for their own sake rather than as a means to some other end. Virtue is its own reward, in other words. For modern therapists, an important implication of Stoic psychology is their insistence on a worldview in which doing what is under our direct control to the best of our ability, or living wisely, is valued more highly than pleasure or the avoidance of unpleasant feelings, things not entirely under our control.
The Stoic Handbook of Epictetus provides a concise summary of practical guidance based on Stoic moral and psychological doctrines. It opens with the famous sentence: “Some things are up to us and other things are not.” Epictetus meant that the foundation of Stoic practice was the effort to maintain a clear distinction between what is voluntary and what is not, i.e., between our own actions and what merely happens to us. Modern Stoics call this the “dichotomy of control.” As we’ve seen, this Stoic doctrine was stressed by Dubois and other early rational psychotherapists but not by Ellis or subsequent cognitive-behavioural therapists, although it is still well-known having found popular expression in The Serenity Prayer.
Stoics class everything else as “indifferent” or unimportant with regard to the supreme goal of life — Epictetus tends to sum this up by speaking of things such as “health, wealth, and reputation” as indifferent. These things are also called “externals” by which Stoics mean not that they’re external to the body — the body itself is an indifferent — but external to our volition or sphere of control. A common misconception is that Stoics place no value on the “external” or “indifferent” things. However, one of the defining doctrines of Stoicism holds that wisdom consists precisely in our ability to distinguish between indifferent things rationally according to their relative value. However, this “value” (axia), used in practical decision-making, is completely incommensurate with the value of arete, as the supreme goal of life. Put crudely, for Stoics externals are not worth getting highly upset about, although as we’ll see it’s nevertheless still considered natural to experience some emotions toward them.
There’s much confusion about Stoicism’s view of emotion due partly to problems of translation and also to the tendency to conflate Stoicism, the ancient philosophy, with stoicism, the modern coping style. One of the easiest ways to dispel these misunderstandings is to highlight the distinction Stoic psychology made between good, bad, and indifferent emotions. (The Stoics used the term “passion” to refer to what we would call emotions but also to desires.)
Bad emotions are described as being unhealthy, excessive, and irrational. Crucially they’re under our direct control, at least potentially. It’s perhaps easiest to compare these to cognitive processes like worrying or ruminating or to voluntary (strategic) cognitions involving strong positive or negative value judgements, of an unhealthy and irrational nature.
Good emotions (eupatheiai) are healthy, moderate, and rational, and also under our voluntary control. They supervene upon a healthy rational worldview. Stoics classify all healthy emotions under three headings: rational joy, a healthy aversion to doing wrong, and goodwill toward oneself and others. (The English word “compassion” sits awkwardly with Stoics because it implies “sharing a passion,” an unhealthy emotion, but Stoics refer to something similar as the virtue of kindness.) The goal of ancient Stoic therapy wasn’t the suppression of unhealthy emotions but their transformation into healthy emotions by modification of the underlying beliefs from irrational to rational ones.
“Indifferent” emotion is how we might describe what the Stoics call the “proto-passions” (propatheiai), or initial involuntary stirrings of full-blown passions. The Stoics give examples such as being startled, blushing, turning pale, sweating, stammering, and the initial reactions preceding passions such as fear and anger in general. Seneca highlights their involuntary nature by comparing these emotional reactions to the eye-blink reflex. The Stoics emphasized that even a perfectly wise Stoic philosopher will experience these sort of involuntary emotional reactions in a stressful situation. However, because these primitive emotional reactions are involuntary, they’re neither good nor bad according to Stoic ethics but indifferent. Epictetus therefore said that they’re to be accepted as natural, and an inevitable part of life. We’re not to be afraid of them or consider them to be bad or harmful in themselves but rather to accept them with indifference. They resemble the emotional reactions of non-human animals, which naturally abate over time. However, we’re to be careful not to be “swept along” by them by indulging in worry or rumination, for example, in response to them and thereby amplifying or perpetuating them beyond their natural bounds.
What did the Stoics do?
Ancient Stoicism had a more extensive and sophisticated armamentarium of therapeutic strategies than any other school of philosophy. Most of these are well-known to modern students of Stoicism thanks largely to the scholarly work of a French historian of philosophy called Pierre Hadot who carefully identified a variety of “spiritual exercises” in ancient philosophy, particularly Stoicism. Robertson’s The Philosophy of Cognitive-Behavioural Therapy (2010) provides a detailed overview of these techniques, which draws extensive parallels between them and psychological strategies employed in modern cognitive-behavioural therapy. The following list is not exhaustive but includes some of the Stoic techniques of most interest to cognitive-behavioral therapists:
Socratic Questioning, which was used by Socrates to undermine irrational assumptions about virtue by exposing contradictions in the other person’s thinking, a process compared to the cross-examination (elenchus) of a witness in a trial, although we’re told it was done tactfully and with compassion.
The Dichotomy of Control, the foundation of Epictetus’ Handbook, which requires maintaining a clear distinction between what is up to us and what is not, i.e., taking more responsibility for our own actions while accepting what merely happens to us.
Separating Judgements from Events, which Shaftesbury called the “sovereign principle” of Stoicism, and Ellis introduced to the CBT field through the saying “It’s not things that upset us but our judgements about them” — comparable to the process called “cognitive distancing” in Beck’s approach.
Stoic Mindfulness, or prosoche (attention), through which Stoics maintain continual attention to their own voluntary thoughts and actions and particularly the distinction between these and external events or automatic thoughts, as in the two preceding techniques.
Stoic Acceptance and Indifference, or apatheia (not apathy but freedom from irrational passions), i.e., external events are viewed dispassionately without attaching strong values or emotions to them.
Contrasting Consequences, through which Stoics imagine beforehand steps required in and likely consequences of different courses of action, typically the contrast between actions guided by unhealthy passions and those in accord with wisdom and virtue — comparable to functional assessment or cost-benefit analysis in CBT.
Postponement of Responses, through which Stoics would wait until strong emotions such as anger or unhealthy desires had naturally abated before deciding what action to take in response to them — comparable to worry postponement or time-out in anger management.
Contemplation of the Sage, considering the virtues of real or imaginary role models or how they would behave in specific situations — comparable to modelling techniques in CBT.
Contemplation of Death, which takes a variety of forms but was considered to be of fundamental importance to the Stoics who sought to adopt a more philosophical attitude toward the existential problem of their own mortality.
The View from Above, which also takes various forms but typically involves picturing events from high overhead or in cosmological terms in order to place them within a broader context in terms both of space and time, something the Stoics and other philosophers found valuable as a way of moderating strong desires and emotions.
Contemplating Transience, this theme is encapsulated in the View from Above but the Stoics generally encouraged themselves to contemplate the temporary nature of all things, including their own lives and the lives of others, as a way of moderating strong emotions.
Contemplation of the Here and Now, a theme particularly emphasized throughout The Meditations of Marcus Aurelius, which involves grounding attention in the present moment, partly because this constitutes our locus of control.
Objective Representation, or phantasia kataleptike, the description or mental representation of events in objective terms without strong value judgements or emotive rhetoric — similar to decatastrophizing in CBT.
Premeditation of Adversity, praemeditatio malorum, another famous Stoic exercise, which involves regularly imagining a variety of feared situations as if they’re already befalling you, such as exile, poverty, sickness, dying, etc., in order to mentally rehearse a more philosophical attitude toward them (apatheia) through the use of some of the strategies mentioned above — this clearly resembles various imaginal exposure strategies used in CBT but perhaps a better analogy would be the covert rehearsal of cognitive and behavioural coping strategies in approaches such as Stress Inoculation Training (SIT).
Memorization of Sayings, of which there are many examples in the Stoic texts, which Stoics would learn until they were “ready to hand” in challenging situations — comparable to the use of coping statements in CBT.
Empathic Understanding, trying to understand the perspective, values, and assumptions of others in a rational and balanced manner rather than jumping to hasty conclusions about them because the Stoics were influenced by the famous Socratic paradox that “no man does evil willingly” (or knowingly) — Epictetus, e.g., taught his students to tell themselves “It seemed right to him” when offended by someone’s actions in order to moderate anger and cultivate a more philosophical attitude toward the perceived wrongdoing of others.
Contemplating Determinism, which Dubois had originally assimilated into rational psychotherapy, the Stoics frequently remind themselves to depersonalize upsetting events and view them as an inevitable part of life, e.g., there are people who behave honestly and dishonestly in the world, dishonest people do dishonest things, therefore the wise man is not surprised when he sometimes encounters these things in life.
Some of these general strategies are overlapping and not entirely conceptually distinct, e.g., The View From Above inevitably entails the contemplation of the finitude and transience of material things, and even one’s own mortality. Most of these strategie are also employed in the form of various different specific techniques, e.g., the Stoics often employ a shorthand version of contrasting consequences by reminding themselves of the maxim that irrational fear of something often does us more harm than the thing itself. (Also anger often does us more harm than the thing we’re angry about.) Indeed, there are a very wide variety of cognitive (both imaginal and verbal) and behavioral therapy techniques found in the Stoic literature, which go beyond this list. Many of these are found in other philosophical traditions, especially during the Hellenistic period, and also in the writings of poets such as Horace and Ovid who were influenced by philosophy. However, it’s the Stoics themselves who place most emphasis on these techniques.
We might also ask where and with whom the Stoics used these techniques. Conveniently, the three major surviving sources of Stoic literature provide some good examples:
The Discourses of Epictetus are transcripts of his discussions with groups of students at his philosophical school, where he can be seen answering questions and also employing Socratic questioning, in a way that could be compared to group therapy or a self-help workshop.
The Meditations of Marcus Aurelius are a private record of his own contemplative practices, like a Stoic self-help or therapy journal.
The letters of Seneca show him offering advice and support to others. Many are addressed to a novice Stoic (Lucilius). Here Seneca is acting in a manner comparable to an individual therapist or life coach.
About six of Seneca’s letters fall under the heading of a genre known as consolatio or philosophical consolation literature. Typically these are letters addressed to individuals who are struggling following bereavement or some other misfortune. They provide a particularly clear example of the way in which Stoic philosophy was administered as a form of psychotherapeutic advice. Moreover, Epictetus described a Stoic called Paconius Agrippinus having written similar consolation letters to himself, in which he describes the potential opportunities or positives to be found in seemingly catastrophic situations such as illness or exile. This might be compared to the practice of writing “decatastrophizing scripts,” advocated by Beck in the treatment of certain forms of anxiety.
However, there’s also some indication that novice Stoics had individual tutors who administered Stoic therapy in person. For example, Marcus Aurelius mentions that his Stoic tutor Junius Rusticus persuaded him to undergo therapeia to improve his character. The early Greek Stoics actually wrote several books on psychological therapy which are sadly lost, such as the Therapeutics of Chrysippus, the third head of the Stoic school. However, we do have a surviving book called On the Diagnosis and Cure of the Soul’s Passions by Galen, Marcus Aurelius’ court physician. Galen wasn’t a Stoic, he was something of an eclectic. However, he’d studied Stoicism and this book appears to be influenced by earlier Stoic writings on psychotherapy. Galen notes that we tend to have a blind spot for our own errors and so he recommends obtaining the help of a wiser and more experienced mentor who can question us about our character and actions, perhaps the role that Rusticus played for Marcus Aurelius.
REBT and Stoicism
The extent of REBT’s indebtedness to ancient Stoicism, both in terms of theory and practice, has been the focus of two recent books (Robertson, 2010; Still & Dryden, 2012). As REBT is the form of psychotherapy most closely related to Stoicism, it’s worth highlighting some of the similarities between them:
As we’ve seen, REBT practitioners often orient clients to their role in therapy by teaching them the quotation from Epictetus above (“Men are disturbed not by things…”); this was a frequently-cited strategy in ancient Stoicism, which involved gaining cognitive distance by reminding ourselves that our distressing emotions are due primarily to our own beliefs.
Both REBT and Stoicism therefore agree that our emotions are primarily determined by our beliefs or thinking (cognition) and that beliefs and emotions may be two aspects of a single process rather than, as Plato believed, two fundamentally separate psychological processes.
REBT trains clients to closely monitor the relationship between their thoughts, actions, and feelings, when becoming upset, which is similar to the Stoic emphasis on continual attention (prosoche) to one’s faculty of judgment.
REBT’s main technique is the rational or “Socratic” disputation of irrational demands, sometimes referred to as the client’s underlying “philosophy” of life; this is comparable to the philosophical disputation of our fundamental value-judgments in Stoicism.
REBT’s central claim that irrational and absolutistic demands (rigid “must” statements) lie at the root of emotional disturbance resembles the Stoic emphasis on the centrality of irrational value-judgments concerning what is unconditionally “good” or “bad” in life.
REBT encourages a threefold attitude of tolerance, and acceptance of imperfections, toward oneself, other people, and the world, comparable to the threefold emphasis on accepting our own body, other people, and external events as “indifferent” in Stoicism.
Ellis’ notion that there are rational and healthy emotions, which we should aspire to cultivate instead of our irrational ones, clearly resembles the Stoic notion of “healthy passions” (eupatheiai).
REBT’s concept of replacing absolutistic demands with flexible “desires” or “preferences” resembles the Stoic concept of the “reserve clause,” which attributes “selective value” to external events, for the purpose of making plans, while accepting that they may not turn out as we would like — the Stoics likewise distinguish between light “preferences”, which adapt to setbacks, and rigid desires that are irrational, excessive, and of a demanding nature.
REBT’s opposition to “awfulizing,” or judging events to be absolutely catastrophic, resembles the Stoic opposition to judging external events to be unconditionally “bad” or “evil” in an irrational and excessive manner.
The main imagery-technique employed in REBT, called “Rational Emotive Imagery” (REI), clearly resembles the Stoic practice of praemeditatio malorum; both involve repeatedly picturing future setbacks or loss, as if happening now, in order to reduce anxiety and build psychological resilience to potentially stressful events.
Indeed, overall, Ellis described REBT as a “philosophical” approach to therapy, and its fundamental goal as “rational living,” which we might compare to the Stoic goal of living “in accord with reason,” or prudently and wisely (Diogenes Laertius, Lives, 7.86). By “inducing the patient to internalize a rational philosophy of life,” in other words, REBT aims to directly uproot and counteract the core irrational beliefs developed from childhood (Ellis, 1962, p. 65).
By direct statement and implication, then, modern thinkers are tending to recognize the fact that logic and reason can, and in a sense must, play a most important role in overcoming human neurosis. Eventually, they may be able to catch up with Epictetus in this respect, who wrote — some nineteen centuries ago — that “the chief concern of a wise and good man is his own reason.” (Ellis, 1962, p. 109)
Some of these parallels between REBT and Stoicism are probably due to the direct influence of Stoic writings read by Ellis on his thinking, some are perhaps more indirect, and some are probably due to Ellis and the Stoics arriving at similar conclusions on the basis of their shared premise that it’s not things that upset us but our beliefs about them.
Stoicism also influenced Beck and his colleagues, as we’ve seen, although in this case the influence appears to be mainly indirect through their exposure to Ellis’ writings on REBT. However, the distinction Beck makes between strategic (voluntary) and automatic thought processes in his revised cognitive model of anxiety happens to parallel a distinction the Stoics also made. They distinguished between judgements or opinions that are up to us (dogmata) and automatic thoughts or impressions that are not (phantasiai). The former we should learn how to change, as they’re potentially under our control, whereas the latter we should learn to accept with a relatively neutral or indifferent attitude.
Third Wave CBT
In some ways third-wave CBT actually has even more in common with Stoicism than Beck and Ellis, although there’s basically no longer any explicit reference to Stoicism, so the connection has now been lost, ironically just as Stoicism is going through a resurgence. It’s unfortunate that third-wave therapists turned predominantly to Buddhism as an inspiration for introducing mindfulness to CBT when similar ideas were already there in Stoicism. These were the main aspects of Stoicism ignored by Ellis, Beck, and other early cognitive therapists. The third-wave practitioners could just have looked deeper into Stoicism and found an ancient Western mindfulness-based psychotherapy.
The focus on values clarification and living in accord with our core values that’s found in approaches such as Acceptance and Commitment Therapy (ACT) and Behavioral Activation (BA) has obvious parallels with ancient Stoicism. The Stoics made a fundamental distinction between the type of intrinsic value that belongs to our own character and voluntary actions, which they called virtue (arete), and the sort of extrinsic value that belongs to external events, including the outcomes of our actions, which they called selective “value” (axia).
The Stoics believed that we should accept that external outcomes are not entirely under our control and shift our focus more on to the intrinsic value of our own character traits, such as exercising greater kindness, friendship, and wisdom in life. They also construe this in terms of filling our various roles in life more admirably, insofar as this is within our sphere of control, such as being a good parent or teacher. The practice of questioning and clarifying our values is integral to the ancient Socratic method and Stoic philosophy as is the effort to live more consistently in accord with them, from moment to moment, throughout each day. The Stoics believed that this led to a greater sense of fulfilment in life, and personal flourishing, whereas over-attachment to external events and the outcome of our actions tended to lead to excessive desires and emotions, which damage our mental health.
With regard to mindfulness, the Stoics placed considerable emphasis on the practice of focusing attention on the present moment. The Stoics called this simply prosoche (“attention”), although modern Stoics tend to describe it as “Stoic mindfulness.” Whereas mindfulness practices derived from Buddhism sometimes entail greater attention to the body or breathing, though, Stoic mindfulness is focused specifically on the activity of our executive function ruling faculty (hegemonikon). For the Stoics, attention should be focused on the seat of our sphere of control: our voluntary cognitive activity in the present moment. The basic principle applied in Stoic mindfulness is then to distinguish clearly between our voluntary cognition (prohairesis) and automatic thoughts and impressions (phantasiai), taking more ownership for the former and adopting an attitude of greater detachment and indifference toward the latter. The Stoics also describe this process as the “separation” of our thoughts and beliefs from their objects as opposed to allowing them to blend or merge together — a strategy we might compare to “cognitive distancing” in Beck’s cognitive therapy or “cognitive defusion” ACT. For example, Epictetus taught his Stoic students that when a distressing thought pops into their mind they should speak to it (apostrophize) saying “You are just an impression and not at all the thing you claim to be.” Similar techniques involving talking to thoughts as if to another person are employed in ACT to aid defusion.
More detailed comparisons with third-wave approaches could be made. However, greater dialogue between Stoics and third-wave therapists is surely justified by the Stoic conceptions of value and mindfulness, and their emphasis on neutral acceptance of unpleasant feelings or events beyond our direct control. Over the past few decades a growing number of people have been drawn to Stoicism as a form of self-help as well as a philosophy of life capable of providing them with a sense of direction and purpose. People often report that they got into Stoicism because they see it as providing a Western alternative to Buddhism. It just happens that neither Ellis nor Beck presented it that way, so later generations of cognitive therapists looked elsewhere for inspiration when it came to mindfulness practices, and Stoicism was unjustly neglected.
Stoicism’s Benefits to CBT
Stoicism has things in common both with second and third wave approaches to CBT. Perhaps it can even help to unite practitioners of those approaches, expanding their common ground.
Moreover, some clients, and therapists, find Stoicism more congruent than Buddhism with their own cultural concepts and values. The classical nature of Stoic literature is also an important asset. For example, Seneca was one of the finest writers of antiquity. Many people therefore find these writings more meaningful, engaging, and memorable than modern self-help or therapeutic literature. People have quotes from Marcus Aurelius tattooed on their bodies — nobody has an Albert Ellis tattoo. These are very beautiful and profound writings, which contain teachings that people can identify with at a much deeper level, as a whole philosophy of life.
Although Stoicism was used as a therapy overall it has a more preventative orientation than CBT and in that respect it may hold promise as a form of training in emotional-resilience. CBT is a therapy; Stoicism is a philosophy of life. That does introduce limitations because some clients may disagree with the core concepts and values of Stoicism. That said, the values are not so far removed from some of the concepts relating to value taught in approaches such as ACT. Moreover, teaching clients about Stoicism is no more problematic in this regard than teaching them about Buddhism. However, there are clearly already many individuals who find Stoicism appealing as a philosophy, and broadly agree with its ethical values. The very fact that Stoicism is bigger and deeper than CBT in its aim to provide a philosophy of life perhaps gives us reason to believe that its benefits may be more lasting than those of existing CBT-based resilience training programs. People who study Stoicism embrace it as part of their life rather than viewing it merely as a set of coping techniques, which they might later forget if they don’t repeat their initial training. Stoicism offers people a permanent alternative to their existing worldview, which is aligned with CBT in many regards, and might provide a framework for changes that could endure long after initial exposure to them through books and courses. Our hope is that in the future research may be conducted on the potential applications of combined Stoicism and CBT based training courses as a form of long-term emotional resilience-building.
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Republished by kind permission of The Behavior Therapist from vol. 42, no. 2, available as PDF download from the website of ABCT.