Introducing The Philosophy of CBT (Karnac Blog)

Stoic Philosophy as Rational & Cognitive Psychotherapy

Blog 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.

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 20^th 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

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The Philosophy of CBT, now in its second revised edition, is available from Routledge, and all good booksellers.