Stoicism and Therapy: Exeter University

Some thoughts and notes following a recent academic workshop on Stoic philosophy and modern therapy at the university of Exeter.

Stoicism & Therapy

Workshop at Exeter University

Marcus Aurelius
Marcus Aurelius

I’ve just come back from an academic workshop at the University of Exeter, organised by Christopher Gill, Professor of Ancient Thought.  Prof. Gill has a special interest in Galen and Stoicism, and their relevance for modern physical and mental wellbeing.

University of Exeter: Ancient Healthcare Blog

Update: The new blog below has been set up by Exeter University and contains detailed minutes from the workshop:

Stoicism and Its Modern Uses Blog

Along with Professor John Wilkins, Prof. Gill, leads the Healthcare and Wellbeing: Ancient Paradigms and Modern Debates  project in the Department  of Classics and Ancient History.  The project explores  the significance of ancient  medicine and psychology for modern debates  and practice in healthcare and  psychotherapy.

Our discussion involved a number of professional psychologists, psychotherapists and academic philosophers and classicists, with a specialist interest in Stoic philosophy, including Tim Lebon, author of Wise Therapy, Jules Evans, author of Philosophy for Life, and John Sellars, author of The Art of Living: The Stoics on the Nature and Function of Philosophy.  I talked briefly about the potential relevance of Stoicism for “third-wave” (mindfulness and acceptance-based) CBT, and vice versa.  Prof. Gill concluded with a discussion of his recent work on the thought and writings of Marcus Aurelius, the Stoic Emperor and philosopher.

My previous book on Stoicism, The Philosophy of Cognitive-Behavioural Therapy, goes into the practical analogies between Hellenistic philosophy and modern psychotherapy in some detail, from a moderately academic perspective.  By contrast, my subsequent self-help book Build your Resilience, in addition to many references to Marcus Aurelius, concludes with a chapter  on Stoicism and Psychological Resilience-Building, written as an introduction for the lay reader.  This is currently being expanded by me into a new book about Stoicism, which provides a much more comprehensive introduction to the use of Stoic concepts and techniques in daily living.

Reddit: Stoicism Q&A with Donald Robertson

Details of active Q&A online with Donald Robertson, author of The Philosophy of Cognitive-Behavioural Therapy, via the Stoicism Subreddit.

Reddit: Stoicism Q&A with Donald Robertson

Posted by Miyatarama on the Stoicism Subreddit (14th August 2012):

Hi everyone, a few months ago we had a very successful Q&A session with Dr John Sellars and now we have an opportunity to interview a modern author that approaches Stoicism from a psychology point of view. Donald Robertson, the author of The Philosophy of Cognitive-Behavioural Therapy has graciously agreed to answer our questions about CBT and Stoicism.

Here is how this will work. Please post your questions in this thread, then I will organize them after a few days and forward them to Donald. I will then post his answers and hopefully he will be available to answer any follow-up questions within a few days of the answers being posted.

Please be sure to check out his websites: The Philosophy of CBT website

London Cognitive

Books: The Philosophy of CBT

(Forthcoming) Resilience–How to Survive and Thrive in Any Situation

(Forthcoming) The Practice of Cognitive-Behavioural Hypnotherapy

Twitter: SolutionsCBT

Reddit: SolutionsCBT

Also, of particular interest to me is this excerpt from his book providing a Stoic Meditation script.

http://www.reddit.com/r/Stoicism/comments/y7ei9/rstoicism_interviews_donald_robertson_learn_more/

Reviews of The Philosophy of Cognitive-Behavioural Therapy (2010)

Links to available online reviews of The Philosophy of Cognitive-Behavioural Therapy (CBT) by Donald Robertson, as of July 2012.

The Philosophy of Cognitive-Behavioural Therapy

Stoic Philosophy as Rational and Cognitive Psychotherapy

Online Reviews as of July 2012

The Philosophy of CBT CoverThere are now seven reviews of The Philosophy of CBT on Amazon, all of them giving it five out of five stars:

Reviews on Amazon.co.uk

There are also six ratings and three text reviews on Goodreads, giving an average four out of five stars:

Reviews on Goodreads

There have also been two reviews, both very positive, in academic peer-reviewed journals:

Review in the European Journal of Psychotherapy

Review in the Journal of Value Inquiry

Numerous blogs have discussed or reviewed the book.  For example, Jules Evans has a bried review on The Browser blog:

Review on The Browser Blog

Stoic Philosophy in Build your Resilience (2012)

This excerpt from Donald Robertson’s book Build your Resilience (2012) explains the essence of Stoic philosophy and its relationship with moder resilience building.

Stoic Philosophy & Resilience-Building

Excerpts from Resilience: Teach Yourself How to Survive & Thrive in any Situation

Teach Yourself: Build your Resilience (2012)Copyright © Donald Robertson, 2012. All rights reserved.

ISBN: 1444168711

Details on Google Books

My previous book The Philosophy of Cognitive-Behavioural Therapy (CBT): Stoic Philosophy as Rational and Cognitive Psychotherapy (2010) discussed the relationship between Stoic philosophy and modern cognitive-behavioural therapy in some detail, from an academic perspective. My new book, Resilience: Teach Yourself How to Survive and Thrive in any Situation (2012), is a self-help guide to psychological resilience-building, based on modern CBT. However, it contains many references to Stoic philosophy. The outline below is based on modified excerpts from the text, which is available for pre-order now from Amazon and other online book stores.

Most of the chapters begin with a quotation from Marcus Aurelius, linking ancient Stoic practices to modern cognitive-behavioural approaches to psychological resilience-building. However, the final chapter, looks at perhaps the oldest Western system of resilience-building, the classical Graeco-Roman school of philosophy known as “Stoicism”, which is derived from the teachings of Socrates and influenced the development of modern CBT (Robertson, 2010). The Stoics are, in a sense, the ancient forebears of most modern resilience-building approaches. Indeed, Epictetus, the Stoic philosopher who has most influenced the field of psychotherapy, has been described as “the patron saint of the resilient” (Neenan, 2009, p. 21).

The Essence of Stoicism

So what practical advice do the Stoics give us about building resilience? Well, this is a philosophy that can be studied for a lifetime and more detailed accounts are available. An excellent modern guide to Stoicism already exists in the book A Guide to the Good Life: The Ancient Art of Stoic Joy by Prof. William Irvine, an academic philosopher in the USA (Irvine, 2009). My own writings, especially my book The Philosophy of Cognitive-Behavioural Therapy, have focused on describing the relationship between Stoicism and modern psychotherapy (Robertson, 2010; Robertson, 2005).

However, although, Stoicism is a vast subject, it was based upon a handful of simple principles. Epictetus summed up the essence of Stoicism as “following Nature” through the “correct use of impressions”. By “following Nature”, the Stoics meant something twofold: accepting external events as decreed by the Nature of the universe, while acting fully in accord with your own nature as a rational human being, living in accord with your core values. (Scholars capitalise “Nature” when referring to the nature of the universe as a whole, whereas lower-case “nature” means your internal human nature as an individual.)

Don’t treat anything as important except doing what your nature demands, and accepting what Nature sends you. (Meditations, 12:32)

Reverence: so you’ll accept what you’re allotted. Nature intended it for you, and you for it.

Justice: so that you’ll speak the truth, frankly and without evasions, and act as you should – and as other people deserve. (Meditations, 12: 1)

However, the basic twofold principle “follow Nature” leads on to an elaborate system of applied philosophy, which this chapter will explore in more detail.

The first few passages of the philosophical Handbookof Epictetus provide arguably the most authoritative summary of basic Stoic theory and practice. I’ve paraphrased the key statements below, to highlight the possible continuity with ACT, CBT and the approaches to resilience-building discussed in this book.

  1. The Handbookbegins with a very clear and simple “common sense” declaration: Some things are under our control and others are not.

  2. Our own actions are, by definition, under our control, including our opinions and intentions (e.g., commitments to valued action), etc.

  3. Everything other than our own actions is not under our direct control, particularly our health, wealth and reputation, etc. (Although, we can influencemany external things through our actions we do not have complete or direct control over them, they do not happen simply as we will them to.)

  4. Things directly under our control are, by definition, free and unimpeded, but everything else we might desire to control is hindered by external factors, i.e., partly down to fate.

  5. The Stoic should continually remember that much emotional suffering is caused by mistakenly assuming, or acting as if, external things are directly under our control.

  6. Assuming that external events are under our control also tends to mislead us into excessively blaming others and the world for our emotional suffering.

  7. However, if you remember that only your own actions are truly under your control and external things are not, then you will become emotionally resilient as a result (“no one will harm you”) and you may achieve a kind of profound freedom and happiness, which is part of the ultimate goal of Stoicism.

  8. To really succeed in living as a Stoic, you need to be highly committed, and may need to abandon or at least temporarily postpone the pursuit of external things such as wealth or reputation, etc. (Stoics like Epictetus lived in poverty while others, like Marcus Aurelius, tried to follow the principles while commanding great wealth and power – both were considered valid ways of living for a Stoic but Marcus perhaps believed his complex and privileged lifestyle made commitment to Stoicism more difficult at times.)

  9. From the very outset, therefore, the Stoic novice should rehearse spotting unpleasant experiences (“impressions”) and saying in response to them: “You are an impression, and not at all the thing you appear to be.” (Something that closely this resembles the basic strategy we call “distancing” or “defusion” in modern CBT.)

  10. After doing this, ask yourself whether the impression involves thinking about what is under your control or not; if not, then say to yourself, “It is nothing to me.” (Meaning, it’s essentially indifferent to me if it’s not under my control – I just need to accept it; although the Stoics did admit that some external outcomes are naturally to be preferred, despite lacking true intrinsic value.)

The Teach Yourself book goes on to describe the basic principles of Stoicism in more detail and, in particular, to elaborate upon some of the basic psychological strategies employed for resilience-building by the Stoic sages, such as acting “with a reserve clause”, visualising the “view from above”, and contemplation of the ideal Sage, etc.

Table of Contents

  1. Introduction: What is Resilience?

  2. Letting go of Experiential Avoidance

  3. Values Clarification

  4. Commitment to Valued Action

  5. Acceptance & Defusion

  6. Mindfulness & the Present Moment

  7. Progressive Relaxation

  8. Applied Relaxation

  9. Worry Postponement

  10. Problem-Solving Training

  11. Assertiveness & Social Skills

  12. Stoic Philosophy & Resilience

About the Author

Donald Robertson is a psychotherapist with a private practice in Harley Street. He is a CBT practitioner specialising in treating anxiety and building resilience and director of a leading therapy training organisation. He is the author of many journal articles and three books on therapy, The Philosophy of CBT, The Discovery of Hypnosis, and The Practice of Cognitive-Behavioural Hypnotherapy, and blogs regularly from his website www.londoncognitive.com.

Pre-Order Online

Available for pre-order online from….

The Earl of Shaftesbury on The View from Above

An excerpt from the personal philosophical regimen of the 17th century Earl of Shaftesbury, with a good description of the View from Above, based on his reading of Marcus Aurelius’ Meditations.

The Earl of Shaftesbury

The View from Above

Antony, Earl of Shaftesbury
Antony, Earl of Shaftesbury

This quotation from the private philosophical regimen of Antony Ashley-Cooper, the third Earl of Shaftesbury (1671-1713), contains a good description of The View from Above, probably closely based upon his reading of Marcus Aurelius:

View the heavens.  See the vast design, the mighty revolutions that are performed.  Think, in the midst of this ocean of being, what the earth and a little part of its surface is; and what a few animals are, which there have being.  Embrace, as it were, with thy imagination all those spacious orbs, and place thyself in the midst of the Divine architecture.  Consider other orders of beings, other schemes, other designs, other executions, other faces of things, other respects, other proportions and harmony.  Be deep in this imagination and feeling, so as to enter into what is done, so as to admire that grace and majesty of things so great and noble, and so as to accompany with thy mind that order, and those concurrent interests of things glorious and immense.  For here, surely, if anywhere, there is majesty, beauty and glory.  Bring thyself as oft as thou canst into this sense and apprehension; not like the children, admiring only what belongs to their play; but considering and admiring what is chiefly beautiful, splendid and great in things.  And now, in this disposition, and in this situation of mind, see if for a cut-finger, or what is all one, for the distemper and ails of a few animals, thou canst accuse the universe.

The Philosophy of CBT in BABCP’s newsletter CBT Today (May 2012)

An excerpt from the May 2012 edition of CBT Today, the BABCP newsletter, which discusses the book The Philosophy of CBT.

Living it up for death

Patricia Murphy’s Special Feature in CBT Today (May 2012)

The following excerpt from CBT Today mentioned The Philosophy of CBT:

In The Philosophy of Cognitive-Behavioural Therapy, Donald Robertson cogently explains why modern psychotherapists should remain interested in ancient philosophy, not least because it 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’. We are reminded that the origins of modern CBT can be traced back to the ancient practices of Socratic philosophy while, according to Epicurus,‘living well’ also requires the individual to ‘rehearse death’.The contemplation of one’s own mortality was viewed by the Stoics as a therapeutic exercise to be repeated daily. The imaginary embodiment of the ideal role model or sage was seen by ancient philosophers as necessary to provide a standard for the ‘art of living’.

Robertson suggests that, unlike Stoicism and most classical philosophies,‘CBT lacks any clear account of the ideal toward which it aims’. That said, he observes how many techniques and concepts found in classical literature, including mindfulness,modelling behaviour, cognitive restructuring and distancing/perspective changing techniques, are well rehearsed in CBT. Meanwhile, individual therapists may use poetry, prose, music, metaphor, imagery, archetypes and historical figures to demonstrate qualities or sentiments that also reflect the qualities of the sage, including wisdom, courage and compassion.

Jules Evans on Ancient Philosophy

Jules Evans on Ancient Philosophy

The Browser

Jules discusses The Philosophy of CBT as one of his five book choices:

…the founders of CBT were directly inspired by ancient Greek philosophy. Unfortunately, not many people are aware of that connection at all. Even a lot of cognitive therapists are unaware of it. That is partly because Aaron Beck was keen to present CBT as an evidence-based scientific therapy, so the philosophical roots of CBT were somewhat swept under the carpet. Donald’s was really the first book to properly explore the relationship between ancient philosophy and CBT.

Full Article on The Browser

Forthcoming talk on Philosophy and Psychology in London

See the link below for details of a forthcoming talk on philosophy and psychology at Conway Hall in London that Donald will be attending:

http://conwayhall.org.uk/community

Further details are available on the website of the London Philosophy Club:

http://www.londonphilosophyclub.com/events/60657292/

 

Ancient Healthcare and Modern Wellbeing Blog

Ancient Healthcare & Modern Wellbeing

“After reading a passage in which Marcus advocates this approach to himself, Patrick played a pre-recorded ‘View from Above’ meditation. The text for this meditation was adapted slightly from D. Robertson’s The Philosophy of Cognitive Behavioural Therapy (CBT): Stoic Philosophy as Rational and Cognitive Psychotherapy. […] This visualization was well-received and followed by lively discussion.”

The ancient healthcare and modern wellbeing blog contains an article describing the use of the View from Above meditation, derived from Stoicism.

New Book: Build your Resilience (Teach Yourself)

Short article describing resilience-building and introducing the new book Build your Resilience (2012), containing a chapter on Stoic philosophy and resilience.

New Book: Build your Resilience (Teach Yourself)

This new book by Donald Robertson, the author of The Philosophy of CBT, contains a chapter on Stoic philosophy in relation to resilience-building.

Psychological Resilience-Building

Teach-Yourself-ResilienceCopyright © Donald Robertson, 2012. All rights reserved.

Based on my book for the Teach Yourself series, Build your Resilience(2012).

What is Resilience?

How can you improve your ability to “thrive and survive” in any situation? What disadvantages, stresses, or difficulties do you currently face? What future problems might you need to anticipate and prepare for? What strengths and assets have helped you to cope well with difficult events in the past? What can you learn from the way other people deal with life’s challenges? These are all questions about psychological resilience. Building resilience is a way of improving your ability to cope with adversity or stressful situations in general.

We all need some degree of resilience in order to cope with the problems life throws at us. Indeed, research shows that resilience is normal and involves ordinary skills and resources. Everyone is capable of being resilient and becoming more so by developing appropriate coping strategies. The types of adversity that demand resilience can range from ordinary “daily hassles” to major setbacks, stressful life events such as divorce, redundancy, bankruptcy, illness, or bereavement, and perhaps even more severe trauma in some cases. Most people believe that they are at least moderately resilient. However, few people are as resilient as they could be in all areas of life, and there are always more aspects of resilience that can be developed.

Building Resilience

So how is resilience built? The American Psychological Association (APA) has published its own research-based public information leaflet entitled The Road to Resilience, developed by a team of six psychologists working in this area. Their ten recommendations for developing and maintaining resilience can be paraphrased as follows:

  1. Maintain good relationships with family, friends, and others
  2. Avoid seeing situations as insurmountable problems and look for ways forward where possible
  3. Accept certain circumstances as being outside of your control, where necessary
  4. Set realistic goals, in small steps if necessary, and plan to work regularly on things that are achievable
  5. Take decisive action to improve your situation rather than simply avoiding problems
  6. Look for opportunities for personal growth by trying to find positive or constructive meaning in events
  7. Nurture a positive view of yourself and develop confidence in your ability to solve problems
  8. Keep things in perspective by looking at them in a balanced way and focusing on the bigger picture
  9. Maintain a hopeful and optimistic outlook, focusing on concrete goals, rather than worrying about possible future catastrophes
  10. Take care of yourself, paying attention to your own needs and feelings and looking after your body by taking healthy physical exercise and regularly engaging in enjoyable, relaxing and healthy activities, perhaps including practices such as meditation

Books like Build your Resiliencecan help you learn specific techniques and strategies to develop these attitudes and skills, and learn other resilient ways of thinking and acting.

The Penn Resilience Program (PRP)

The Penn Resiliency Program (PRP) is perhaps the best example of an established resilience-building approach. It was developed initially as a means of preventing depression over the long-term with schoolchildren, based on Martin Seligman’s earlier work on “learned optimism” and adapting the techniques of standard cognitive therapy to serve a preventative rather than remedialfunction. It has been supported by compelling evidence showing its effectiveness as preventative treatment for depression and also, in some studies, for anxiety. For example, up to two years after undergoing classes in resilience-building, children considered at risk of depression were found to be about half as likely to have actually developed it as their peers in “control” groups, who did not receive any resilience training (Reivich & Shatté, 2002, p. 11). In schoolchildren, for whom this approach was originally designed, research found that “conduct problems”, their behaviour, also improved as a result.

The version of the Penn Resiliency Program (PRP) described by Reivich and Shatté (2002) consists of “seven key skills”:

  1. Monitoring your thoughts: Learning to catch your unhelpful thoughts as they occur and to understand how they influence your feelings and actions
  2. Spotting “thinking errors”: Spotting common errors (or “thinking traps”) among your thoughts such as excessive self-blame or jumping to conclusions, etc.
  3. Identifying unhelpful beliefs: Identifying unhelpful underlying (“core” or “iceberg”) beliefs and evaluating them
  4. Challenging unhelpful beliefs: This includes problem-solving as well as learning to dispute faulty “Why?” beliefs, or rumination, about the causation of problems that can get in the way of solving them
  5. Challenging catastrophic worries: Dealing specifically with “What if?” thinking, or unrealistic worry, by challenging catastrophic beliefs about consequences of problems and focusing instead on the most likely outcomes (“decatastrophising” or “putting things in perspective”)
  6. Rapid calming and focusing strategies: Coping skills for use in real-world situations, consisting of a simplified form of Applied Relaxation (Reivich & Shatté, 2002, pp. 192-196) and coping imagery used to “calm” stressful emotions and distraction (“focusing”) techniques to quickly manage intrusive thoughts, worry, and rumination
  7. Real-time resilience”: This involves using a much-abbreviated version of the disputation skills (4 and 5) above to challenge unhelpful thoughts more quickly and replace them with resilient ones in specific situations by completing the “tag lines” or self-statements: “A more accurate way of seeing this is…”, “That’s not true because…”, and “A more likely outcome is… and I can… to deal with it.” (Reivich & Shatté, 2002, pp. 206-210)

New Book: Build your Resilience

Due for publication by Hodder in May 2012, as part of the popular Teach Yourself series of self-help books.

ISBN: 1444168711

Resilience: How to Thrive and Survive in Any Situationhelps you to prepare for adversity by finding healthier ways of responding to stressful thoughts and feelings. You will learn a comprehensive toolkit of effective therapeutic strategies and techniques, drawing upon innovative “mindfulness and acceptance-based” approaches to cognitive-behavioural therapy (CBT), combined with elements of established psychological approaches to stress prevention and management. The book also draws upon classical Stoic philosophy to provide a wider context for resilience-building.

This book is a complete course in resilience training, covering everything from building long-term resilience by developing psychological flexibility, mindfulness and valued action, through specific behavioural skills such as applied relaxation, worry postponement, problem-solving, and assertiveness. Each chapter contains a self-assessment test, case study, practical exercises and reminder boxes and concludes with a reminder of the key points of the chapter (Focus Points) and a round-up of what to expect in the next (Next Step), which will whet your appetite for what’s coming and how it relates to what you’ve just read.

The author, Donald Robertson is a psychotherapist with a private practice in Harley Street. He is a CBT practitioner specialising in treating anxiety and building resilience and director of a leading therapy training organisation. He is the author of many journal articles and three books on therapy, The Philosophy of CBT, The Discovery of Hypnosis, and The Practice of Cognitive-Behavioural Hypnotherapy, and blogs regularly from his website www.londoncognitive.com.

Pre-Order Online

Available for pre-order online from….