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Introducing The Philosophy of CBT (Karnac Blog)

Stoic Philosophy as Rational & Cognitive Psychotherapy

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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 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

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

Get your Copy
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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 

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

This is a brief excerpt from my book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, which is now in its revised second edition, from Routledge.

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

Stoic Philosophy as Rational and Cognitive Psychotherapy

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).

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 book, The Philosophy of Cognitive-Behavioural Therapy, published by Routledge and available to order online from Amazon, and everywhere they sell books.

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Excerpt: James Stockdale on Stoicism

Donald Robertson has uncovered a wealth of connections between modern cognitive behavioural therapies and ancient Stoic philosophy. This book should be read by anyone interested in understanding the historical roots of CBT or in learning about how ancient psychotherapeutic methods can add to the modern therapist’s toolkit.

Tim LeBon, UKCP registed psychotherapist and author of Wise Therapy

This is a brief excerpt from my book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, which is now in its revised second edition, from Routledge.

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

James Bond Stockdale

James Stockdale
James Stockdale

According to James Stockdale, the English philosopher Alfred North Whitehead once said that if Plato were to return to life today, he would first ask to be introduced not to an academic, but to a boxing champion (Stockdale, 1995, p. 17). If the Stoic philosopher Epictetus were alive in modern times, the first person he would want to be introduced to would probably be Stockdale himself.

On September 9, 1965, I flew at 500 knots right into a flak trap, at tree-top level, in a little A-4 airplane – the cockpit walls not even three feet apart – which I couldn’t steer after it was on fire, its control system shot out. After ejection I had about thirty seconds to make my last statement in freedom before I landed in the main street of a little [North Vietnamese] village right ahead. And so help me, I whispered to myself: “Five years down there [in captivity], at least. I’m leaving the world of technology and entering the world of Epictetus.”

Stockdale, 1995, p. 189

At the outbreak of US involvement in the Vietnam War, James Stockdale (1923-2005) was captured by a mob of fifteen villagers who beat him to within an inch of his life, snapping his leg, and leaving him permanently crippled. The irony, not lost on Stockdale, was that he had lost the use of his left leg, just like the crippled slave, Epictetus, whose ancient Handbook (Enchiridion) of Stoic philosophy he had previously devoured after studying philosophy as a masters student at Stanford University.

Stockdale was taken prisoner by the North Vietnamese and incarcerated in Hanoi where, as the highest-ranking US naval officer, the only wing commander to survive an ejection over enemy territory, he assumed charge of a community of captured soldiers which, at its largest, numbered in excess of 400 men. Stockdale said he never actually saw a Vietnamese POW camp as portrayed in the movies. He was imprisoned in an old French colonial “dungeon” which formed part of a large communist prison called Hao Lo, or the “Hanoi Hilton”, described as part psychiatric clinic, part reform school. The Americans, kept alongside Vietnamese criminals, were subjected to a constant programme of attempted psychological reprogramming by professional torturers and prison officers. During that time, as a prisoner of war, for seven and a half years, Stockdale spent four years in isolation, two years in leg irons, and was tortured fifteen times, in a manner (“taking the ropes”) not unlike crucifixion.

And if I were asked, “What are the benefits of a Stoic life?” I would probably say, “It is an ancient and honorable package of advice on how to stay out of the clutches of those who are trying to get you on the hook, trying to give you a feeling of obligation, trying to get moral leverage on you, to force you to bend to their will.” Because I first reaped its benefits in an extortionist prison of torture, I could go on and say, “It’s a formula for maintaining self-respect and dignity in defiance of those who would break your spirit for their own end.”

Stockdale, 1995, p. 177

Stockdale’s experience obviously bears comparison with the better-known story of Victor Frankl, a Jewish psychiatrist who was incarcerated in Auschwitz concentration camp during the Second World War, and published his bestselling self-help book Man’s Search for Meaning, after his release (Frankl, 1959). However, although both men arrived at similar conclusions regarding their plight, Stockdale was already aware of Stoic philosophy before being captured and therefore made explicit use of it in coping with his extreme circumstances.

Throughout his time in captivity, Stockdale drew upon the Stoic philosophy he had learned, which suddenly appeared to him to be of more value than anything else he could imagine. He called the many portions of Epictetus’ Handbook which he had learned by heart and memorised his “consolation” and “secret weapon” during captivity.

I’m not the only prisoner who discovered that so-called practical academic exercises on “how to do things” were useless in that fix. The classics have a way of saving you the trouble of prolonged experiences. You don’t have to go out and buy pop psychology self-help books. When you read the classics in the humanities, you become aware that the big ideas have been around a long time, despite the fact that they are often served up today in modern psychological “explanations” of human action as novel and “scientific.”

Stockdale, 1995, p. 24

On his release, Stockdale became a well-known military hero, even campaigning as a vice-presidential candidate, supporting the independent Ross Perot, in a US election. He was one of the most highly-decorated officers in US Naval history and spent his later years lecturing on the relevance of Stoic philosophy to modern military life. A collection of his talks and essays was published in his book, Thoughts of a Philosophical Fighter Pilot (1995). It’s surprising that more frequent reference is not made to Stockdale’s story by cognitive-behavioural therapists, who claim to derive their inspiration from the same philosophical source, ancient Stoicism. I hope this short digression helps to illustrate how Stoic philosophy, like Frankl’s existential psychotherapy, has been applied even to the most extraordinary psychological challenges imaginable in the modern world.

This is a brief excerpt from my book, The Philosophy of Cognitive-Behavioural Therapy, published by Routledge and available to order online from Amazon, and everywhere they sell books.

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Excerpt: Ancient Social Anxiety

This is a brief excerpt from my book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, which is now in its revised second edition, from Routledge.

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

Social Anxiety, Value Judgements, and Rigid Demands

[Albert Ellis was the founder of Rational-Emotive Behaviour Therapy, REBT, a precursor of modern CBT.] Ellis’ approach differs from other modes of cognitive-behavioural therapy in that he places most emphasis upon the role of irrational or “absolute” demands placed by the subject upon himself, other people, or his environment. According to Ellis, REBT is based on the assumption that the tendency to make “devout, absolutistic evaluations” of events in life is at the core of emotional disturbance and that these value judgements are typically framed in terms of dogmatic “must”, “should”, “have to”, “got to”, “ought to” statements, i.e., unconditional imperatives (Dryden & Ellis, 2001, p. 301). These are called “irrational beliefs” because they are viewed as cognitions, spoken or unspoken, which embody rigid and unrealistic demands and conflict with the goals of enlightened self-interest. By being “rational”, in other words, Ellis often appears to mean something akin to being pragmatic in our pursuit of long-term happiness.

Other types of irrational thought, such as over-generalisations, or unfounded assumptions, are emphasised throughout other schools of CBT, most notably Beck’s cognitive therapy. Ellis concedes that these can contribute to human suffering, and that it can be useful to target them in therapy. However, he insists that fundamentally rigid demands are the pre-eminent underlying cause of emotional disturbance, and even that they are a necessary condition of it. Even if I falsely concluded that everyone hated me, an irrational over-generalisation, in principle, I could still say “So what?” to myself and dismiss it without becoming upset. The unconditional demand that people must like me when combined with the belief that they do not, according to REBT, inevitably generates emotional distress. However, other people’s attitudes and behaviour, like other external events, are not under my direct control. Ellis makes this point, again by reference to Stoicism, when he advises those using REBT for self-help as follows,

As Epictetus pointed out two thousand years ago, although you do have considerable power to change and control yourself, you rarely can control the behavior of others. No matter how wisely you may counsel people, they are independent persons and may – and, indeed, have the right to – ignore you completely. If, therefore, you unduly arouse yourself over the way others act, instead of taking responsibility for how you respond to them, you often will upset yourself over an uncontrollable event. (Ellis & Harper, 1997, p. 198)

The irrationally rigid demands which REBT warns against, which are similar to the “rules” and “assumptions” in Beck’s cognitive therapy, also bear a striking resemblance to the unconditional value judgements which Stoics believe are at the root of emotional distress. For the Stoic, it is the tendency to judge things as being inherently or absolutely good or bad which leads to irrational craving (epithumia) or fear (phobos) respectively. In Stoic psychology, irrational desire, or craving, which places too much value on external things and other people’s opinions, is the root cause of anxiety. Believing that “I have to” have (or avoid) something, or that other people “must” behave (or not behave) in a certain way, as REBT would put it, is tantamount to saying that these things are of overriding importance in themselves, or absolute external values, as Stoicism would put it.

As is often the case, the Stoics give clear examples which would not seem out of place in a modern psychotherapy text, e.g., in this striking passage Epictetus describes the relationship between desire and social anxiety, or stage fright, as follows.

When I see somebody in a state of anxiety, I say, ‘What can this man want?’ Unless he wanted something or other which is not in his own power, how could he still be anxious? That is why a person who sings to the lyre feels no anxiety while he is singing by himself, but is anxious when he enters the theatre, even if he has a very fine voice and plays his instrument beautifully. For he wants not only to sing well, but to gain applause, and that lies beyond his control. […]

He does not understand what a crowd is, or the applause of a crowd. He has learned, indeed, how to strike the lowest and highest strings; but what the applause of the multitude is, and what force it has in life, he neither understands, nor has studied. Hence he must necessarily tremble and turn pale. […]

He does not know that he is wishing to have what is not allowed him, and wishing to avoid what he cannot escape; and he does not know what is his own and what is not his own [i.e., his value-judgements]; for if he did know, he would never feel hindered, never feel restrained, never feel anxious. […]

If, then, things outside the sphere of choice are neither good nor bad, and all things within the sphere of choice are in our power, and can neither be taken away from us, nor given to us, unless we please, what room is there left for anxiety? But we are anxious about this paltry body or estate of ours, or about what Caesar will think [i.e., about health, wealth, or reputation] and not at all about what is within us. Are we ever anxious not to take up a false opinion? No, for this is in our own power. Or about following an impulse, contrary to nature? No, nor this either. When, therefore, you see any one pale with anxiety, just as the physician pronounces from a person’s complexion that this patient is affected in his spleen, and that in his liver, so you likewise should say: this man is affected in his desires and aversions, he is out of sorts, he is feverish. For nothing else changes the complexion or makes a man tremble or sets his teeth a-chattering, or ‘Shift from leg to leg and squat on one foot then the other.’ (Discourses, 2.13.1-13)

Instead of attaching too much value to other people’s opinions, absolutely demanding their approval and fearing their rebuke, the musician should patiently train himself, over time, to put value primarily upon his own intentions and judgements and to take the audience’s praise or leave it with similar equanimity. For the Stoics, to value something positively or negatively is to try to control it, and we have more control over our own judgments and intentions than over external events or other people, so we should shift the focus of our value judgements inwards, within the here and now, and focus on the importance of our own mental activity and responses more than other people’s opinions. The example of stage fright is extended by Epictetus to oratory and any similar social anxiety. Anyone who anxiously demands, rather than merely preferring, that others praise him is being unphilosohical, and has failed to understand the nature of things in relation to his sphere of control. He blames his nerves on the situation, neglecting the importance of his own misplaced value judgements in determining his emotional disturbance.

Nor does he even know what anxiety itself is, whether it be our own responsibility or outside it, or whether it be possible to suppress it or not. Because of this, if he is praised, he leaves the stage puffed up with pride: but if he is laughed at, his poor bubble is pricked and collapses.

We too experience something of this kind. What do we admire? Externals. What do we strive for? Externals. Are we then at a loss to know how fear and anxiety overcome us? Why what else is possible when we regard impending events as evils? We cannot help being fearful we cannot help being anxious. (Discourses, 2.16.10)

This is a brief excerpt from my book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, which is now in its revised second edition, from Routledge.

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

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Excerpt: Shame-Attacking Exercises

Diogenes the Cynic Gesturing

This is a brief excerpt from my book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, which is now in its revised second edition, from Routledge.

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

In certain concrete practical respects, REBT also contains therapy interventions that resemble techniques familiar within ancient philosophical therapy. Ellis was known for what he described as REBT’s “trademark” use of various “shame-attacking exercises”. In order to help clients overcome self-consciousness, social embarrassment and inhibition, Ellis would prescribe changes in behaviour which were designed to forcefully and directly challenge their sense of shame. For example, he refers to the technique of asking clients to repeatedly stop a bus without getting off, or asking strangers in the street to give them money, etc.

I realised, soon after I started REBT in 1955, that what we call “shame” is the essence of a great deal of our emotional disturbance. […] Seeing this, I created my now famous shame-attacking exercise in 1968; and perhaps millions of people, especially psychotherapy clients, have done this exercise and trained themselves to feel shamed or sorry about what they did, and about the public disapproval that often went with it, but not to put themselves down and not to feel humiliated about their personhood. (Ellis & MacLaren, 2005, p. 95)

Ellis further explains the exercise as follows,

Here clients deliberately seek to act “shamefully” in public in order to accept themselves and to tolerate the ensuing discomfort. Since clients do best to harm neither themselves nor other people, minor infractions of social rules often serve as suitable shame-attacking exercises (e.g., calling out the time in a crowded department store, wearing bizarre clothes designed to attract public attention, and going into a hardware store and asking the clerks whether they sell tobacco). (Dryden & Ellis, 2001, p. 329)

This aspect of Ellis’ work is strikingly reminiscent of the practices of the ancient Cynic philosophers who appear to have adopted, albeit in a more extreme manner, controversial lifestyles and behaviours in order to liberate themselves from social conventions.

The Cynics break with the world […] was radical. They rejected what most people considered the elementary rules and indispensible conditions for life in society: cleanliness, pleasant appearance, and courtesy. They practiced deliberate shamelessness – masturbating in public, like Diogenes, or making love in public, like Crates and Hipparchia. The Cynics were absolutely unconcerned with social proprieties and opinion; they despised money, did not hesitate to beg, and avoided seeking stable positions within the city. […] They did not fear the powerful, and always expressed themselves with provocative freedom of speech (parrhesia). (Hadot, 2002, p. 109)

Ellis seems unaware of this precursor to his “shame-attacking” exercises. However, the Cynics themselves specifically refer to the deliberate practice of “shamelessness” (anaideia) as a psychotherapeutic exercise. In the case of Diogenes, this was referred to metaphorically as his “defacing the coinage” of social conventions, which inevitably shocked others. So notorious were the shameless acts of Diogenes that Plato allegedly called him “Socrates gone mad”.

According to the Greek biographer Diogenes Laertius, the famous Cynic, Crates, who trained Zeno the founder of the Stoic school, was nicknamed “Door-opener” because of his habit of inviting himself into people’s houses to lecture them somewhat abrasively on philosophy(Laertius, 1853, p. 250). He also mentions another practice of Crates which sounds like an even more provocative version of Ellis’ shame attacking exercises, ‘He used to abuse prostitutes designedly, for the purpose of practising himself in enduring reproaches’(Laertius, 1853, p. 251). Epictetus seems to imply that Diogenes and the other Cynics, whom he greatly admired, deliberately broke wind in front of people, presumably also as part of their practice of shamelessness (Discourses, 3.22.80). Indeed, I am indebted to Still and Dryden for the following illustration drawn from Montaigne’s account of a quite surprising Stoic anecdote,

In the midst of a discussion, and in the presence of his followers, Metrocles let off a fart. To hide his embarrassment he stayed at home until, eventually, Crates came to pay him a visit; to his consolations and arguments Crates added the example of his own licence: he began a farting match with him, thereby removing his scruples and, into the bargain, converting him to the freer stoic school from the more socially oriented Peripatetics whom he had formerly followed. (Montaigne, in Still & Dryden, 1999, p. 157)

Crates’ exercises in shamelessness, or the overcoming of social anxiety and inhibition, can be seen as a practical training in his maxim, ‘That a man ought to study philosophy, up to the point of looking on generals and donkey-drivers in the same light’ (Laertius, 1853, p. 252). Zeno appears to have assimilated some aspects of his mentor’s philosophy into Stoic therapeutics, although moderated by a greater respect for society than the Cynics allegedly displayed.

Like Crates, Diogenes the Cynic, who was revered as a Sage by some Stoics, reputedly tested prospective students by instructing them to follow him around carrying a salted fish, or a piece of cheese, in their hands. When some refused, out of embarrassment, he would chide them: “See how a piece of salted fish was enough to dissolve our friendship!” (Laertius, 1853, p. 230). Notoriously insolent and iconoclastic, he once asked the Athenians to erect a statue to him, and when asked why he had done so, replied, “I am practising disappointment.” (Laertius, 1853, p. 235). These and many similar popular philosophical anecdotes illustrate the striking parallel between the ancient Cynics’ psychotherapeutic technique of anaideia, or shamelessness, and the “shame-attacking” exercises made famous by Albert Ellis within REBT, precursors of certain more modest “behavioural experiments” used to challenge social anxiety and inhibition in modern CBT. Beck and his colleagues also refer to “anti-shame exercises” and observe that cognitive therapy provides opportunities for clients to deliberately expose themselves to feelings of shame in order to conquer them (Beck, Emery, & Greenberg, 2005, p. 282). Indeed, there are many more parallels which can be drawn between the principles of REBT and those of Stoicism.

Addendum

I didn’t spot this quotation in time for the book but Diogenes Laertius writes:

Some one dropped a loaf of bread and was ashamed to pick it up; whereupon Diogenes, wishing to read him a lesson, tied a rope to the neck of a wine-jar and proceeded to drag it across the Ceramicus.

The Ceramicus was the busy potter’s district of Athens, as the name implies, but also the location of a major cemetery.  This exercise in shamelessness clearly anticipates Ellis’ “trademark” REBT technique of taking a banana for a walk on a string through a shopping mall, as if it were a dog on a leash.

This is a brief excerpt from my book, The Philosophy of Cognitive-Behavioural Therapy, published by Routledge and available to order online from Amazon, and everywhere they sell books.

Philosophy of CBT Cover 2nd Edition