Category: Stoicism & Psychotherapy

'How to Become Virtuous' by Tim LeBon

How to become virtuous – Lessons from Compassion Focussed Therapy (CFT)

by Tim LeBon

“If someone is able to show me that what I think or do is not right, I will happily change, for I seek the truth, by which no one was ever truly harmed. It is the person who continues in his self-deception and ignorance who is harmed.”
― Marcus Aurelius, Meditations 6.21

Many people are attracted to Stoicism because it seems to  offer something more profound than the usual self-help palliatives. Stoicism proposes philosophy as a foundation for wise living. One aim of the Stoicism Today project has always been to increase awareness of Stoic ideas and practices. The Stoicism Today team has written booklets, recorded guided meditations, started Facebook groups and given workshops at annual conferences to help spread Stoicism.  At the same time it has aimed not merely to disseminate information about Stoicism but also to test Stoicism out and develop it into a modern Stoicism. To this end the Stoicism Today team has designed and administered  questionnaires, emphasised  some elements of Stoicism more than others  and incorporated a number of ideas from contemporary psychology. Marcus Aurelius (Meditations, 6.21) alludes to one way to achieve personal and philosophical growth, namely to treat criticism as useful feedback. In this article I want to tackle two criticisms of Stoicism. By addressing them I hope to  work towards making Modern Stoicism  even more wise and helpful.

Two comments about Stoicism have  given me particular cause for reflection. One came from participants at the  London Stoic Conference  of  2014.   They pointed out that whilst many speakers had talked the importance of virtue, they hadn’t fully explained what virtue was or how we could become more virtuous.  My Stoicism Today colleague Christopher Gill has since responded to the question  What is Stoic virtue?.[i]  He points out that the cardinal virtues are not plucked out of thin air.

“Taken together they [the virtues]  make up the qualities essential to leading a full human life. The four are: (wisdom) understanding how to act and feel correctly; (courage) knowing how to act and feel correctly in situations of danger, in facing things seen as fearful (above all, death and other ‘disasters’); (self-control) knowing how to act and feel well in situations arousing other emotions such as desire, appetite, lust; (justice) knowing how to act and feel well in our relationships with other people, at individual, family or communal level, knowing how to act generously and with positive benevolence, with friendship and affection”

The Stoic cardinal virtues then are key qualities required to flourish as a human being. Here I will look at the second part of the question – how to become more virtuous. To be sure there is already much in Stoicism and the Stoic Week handbook  about  developing virtue. This is not the place to rehearse the  plentiful advice contained in the handbook. On careful examination, though, it could be argued that much of this (for example counsel such as “control the controllables” and “only virtue really matters”) relates more to to Stoic wisdom  than the other specific virtues.  One approach would be to collect all the Stoic maxims we can find about specific virtues – and this would actually be a very useful thing to do – the question is – what else can we do?

How to best build justice, self-control, courage, wisdom and other virtues is essentially an empirical question. One of the key take-home points from contemporary psychology is this:- Whilst  some plausible methods  turn out to work well, other, equally plausible ideas do not.[ii] Thinking about how to develop virtue in our armchairs will only get us so far. A promising idea is to look at  modern evidence-based psychologies to see if they can tell us anything about how to develop virtue.

Cognitive Behavioural Therapy (CBT) and Mindfulness

Two obvious candidates are Cognitive Behavioural Therapy (CBT) and Mindfulness.  Perhaps they could help us be more virtuous.  Although the focus of CBT is traditionally on reducing emotional distress rather than building virtue, CBT has a huge evidence base and should not be dismissed too lightly. We can certainly use CBT to help us develop the habit of thinking  more realistically and constructively, which is definitely part of wisdom.  Furthermore CBT practitioners have developed a large toolkit of techniques that can be adapted to build individual virtues. Behavioural experiments, guided discovery, exposure to feared situations, thought records and   formulation – to name but a few CBT tools – could all be adapted to help develop virtue. [iii] For example, to build courage you could challenge unhelpful negative thinking (“great harm will come to me if I tell the truth”) and develop behavioural experiments – for example “plan to do one act of courage today, record your predictions as to negative and most likely outcomes, note what happens and decide what you can learn from the experiment”. To build self-control you could learn to challenge thinking biases that contribute towards a lack of self-control. For example, you could challenge the short-term bias of the thought “What I gain in the short-term is more important than what I lose in the long-term”. CBT could also help you  environments more conducive to virtue. For example “In order to go out for a run every day I will put my running clothes next to my bed so I put them on when I get up.” Donald Robertson’s Stoic self-monitoring record sheet is an excellent example of  how  drawing  on CBT has already helped modern Stoicism teach us how to build the virtue of wisdom –  see also  my Stoic worry tree.

A second candidate is Mindfulness.  Mindfulness has become part of the Zeitgeist, there is proven benefits that it can help [iv], and there is a good argument for incorporating mindfulness  into Stoic Practice.[v]  Learning mindfulness – the capacity to take a step back and respond rather than react –  could certainly be a  useful part of virtue training. However, there is reason to doubt whether learning mindfulness is there is to learning to be virtuous.

One problem is that mindfulness without the rest of virtue mindfulness could actually do harm. As Mathieu Ricard  – a veteran of thousands of hours of mindfulness and a well-known exponent of mindfulness – points out – “a sniper waiting for his victim: … To succeed in his ominous goal, he has to ward off distraction and laxity, the two major obstacles to attention. The practice of mindfulness thus needs to be guided by right view and insight  …and motivated by the right intention”. In other words, mindfulness needs to be guided by virtue and wisdom –otherwise it can be used in the service of morally indifferent of even evil ends – such as becoming a more skilled sniper.

So far we have found two evidence-based psychologies that can help us provide tools to develop virtue – CBT and mindfulness. We can and should incorporate these ideas into our approach – but it would be even better if we could find an evidence-based approach already uses these ideas and is more focussed on building virtue rather than part of virtue. We will return to this quest, after considering the second criticism of Stoicism that has given me much food for thought.

This objection will already be   familiar to many readers. Some critics say that Stoicism  comes across as a cold, unemotional philosophy, perhaps thinking of Star Trek’s Mr Spock. Unfortunately, this impression isn’t restricted to those who are ignorant of Stoicism. No less a philosopher than  Martha Nussbaum  has gone on record as saying that   ”Stoicism  is an anti-compassion tradition“. Of course, Nussbaum’s view is highly contentious. Unlike Epicureanism, its ancient rival, Stoicism has always had a strong political dimension. Hierocles’s concentric circles  provides ample  illustration of  Stoicism’s benevolent concern for the whole of mankind.  Perhaps the issue isn’t so much about Stoicism not really being compassionate, but about how Stoicism presents itself. Maybe Stoicism  needs to put its most compassionate foot forwards.

However it isn’t just compassion to others that’s an issue, it’s also compassion to oneself. A couple of years ago, after I gave a workshop which included the Evening Meditation exercise, someone came up to me and said “This is all very  interesting, Tim, but I’ve got a bit of  a history about being hard on myself, and my worry is that this material will make it worse”.  It has to be agreed that the language of Marcus and Epictetus does  not always appear very self-compassionate. To take a few  examples from Marcus’s Meditations

 “Yes, keep on degrading yourself, soul.” (2:6)

 “Stop talking about what the good man is like, and just be one” (10:16)

“Enough of this wretched, whining monkey life”. (9.37)

It could very reasonably be argued that Marcus knew this was the best way of giving himself a good pep talk, and that he wasn’t suggesting that everyone else would be motivated by the same language. Marcus was, as far as we know, writing his Meditations purely for himself. However unlike Marcus, we are writing for a broader audience, including those who already have a tendency to be too self-critical. So perhaps we need to be mindful of the dangers of using compassionate language which isn’t compassionate.

So far we have looked at two  apparently separate topics. First, how to help people become more virtuous. Second, how Stoicism might benefit from presenting  itself in a more compassionate and self-compassionate manner. It would be very good news indeed if there was an evidence-based therapy that addresses both of these concerns.

Compassion-Focussed Therapy and Compassionate Mind Training

It’s entirely possible that there is such a therapy, and it’s name is Compassion Focussed Therapy (CFT)  and its related set of practices Compassionate Mind Training(CMT).[vi]  CFT  is an integrative, evidence-based,   third-wave CBT therapy developed largely in the UK by psychologist Paul Gilbert and colleagues.  CFT draws on ideas from CBT and mindfulness as well as neuroscience (e.g. Porges’s polyvagal theory.), developmental psychology (e.g. attachment theory) and philosophy, especially Buddhist ideas relating to compassion.

 A key idea  is that we have three emotional regulation systems. These are

  1. The threat system, associated with negative emotions such as fear and anger, which motivates us to deal with threats
  2. The drive system, associated with dynamic positive emotions such as excitement and achievement which motivates us to move towards pleasure and success and
  3. The soothing  and affiliative system which is associated with calm positive emotions such as contentment and trust, which manages distress and promotes bonding. [vii]

Each state has typical emotions, motivations and neurochemistry. The ultimate aim  of  CFT/CMT is to develop a compassionate self which is strong enough to achieve optimal emotional balance between these three emotional systems.

In order to do this, CFT/CMT  takes people through a number of stages, as follows:-

1)       Clearing up misconceptions about what is meant by compassion. A key point is that there is much more to compassion than just being kind and warm. CFT/CMT follows the Dalia Lama in defining compassion as

“a sensitivity to the suffering of self and others, with a deep commitment to try to relieve it”.

To do this, you need much more than just sentimental warmth and kindness. If you ask people for examples of compassionate people, they will give you names like the Dalai Lama, Nelson Mandela, Martin Luther King, Jesus, Mother Teresa, Florence Nightingale and  Gandhi. These people may be are warm and kind, but they are also courageous, strong, wise and responsible.  When CFT/CMT tries to build compassion, it also tries to build these other qualities.

It was when reading this that I had one of those “Aha” moments. Virtue in ancient philosophy means justice, courage, wisdom and self-control. Compassion in CFT/CMT is sounding  a lot like like virtue in Stoicism and ancient philosophy. If CFT/CMT provides an evidence-based route to building “compassion”, could this help us with building virtue?

2)      The second stage of CFT/CMT is psychoeducation about the brain, including the new brain and old brain, the amygdala and the three emotional regulations systems. An important message here is that we all have “tricky brains” and many of us have difficult pasts.  The behaviours that cause  you problems are not your fault.  However learning to  deal skilfully with your reactions and tricky brain is your responsibility.   Note that CFT/CMT uses truly compassionate language – combining warmth and non-judgement with the need for courage and responsibility.

3)     The next [viii]  stage of CFT/CMT involves building up and strengthening the compassionate self. These include:-

  • Soothing Compassionate Breathing. Breathing more slowly and deeply than usual for a few minutes to get into the habit of getting the soothing and affiliative system on line
  • Safe Place Guided Meditation.  Imagining a safe, welcoming place to help get the soothing and affiliative system on line.
  • Mindfulness Learning how to choose a response rather than merely react
  • Ideal Compassionate Self Guided Meditation.  Having got the soothing system on line first with soothing breathing, imagining yourself having the qualities of compassion –kindness, confidence, maturity, strength and authority, wisdom and insight– and imagining acting in a compassionate way.
  • Ideal Compassionate Other Guided Meditation. Imagining compassion flowing to you from another ideally compassionate being, imagining what advice they would give you – to help you  build up the feeling of what it is like to feel compassion.
  • Compassionate Letter Writing, Using expressive writing to understand your problems compassionately and planning how to deal with them more skilfully.
  • Behavioural experiments Testing out more helpful strategies that cultivate compassion and self-compassion.

Can CFT/CMT help Modern Stoicism?

We are now in a position to explore whether CFT/CMT can help.   Modern Stoicism and CFT/CFT have many similarities but there are also important differences.

  • Stoicism is routed in philosophy, so we can expect  from Stoicism more insight into the nature of wisdom as well as the  many ancient practices and readings to develop it to draw on
  • CFT/CMT is routed in modern science, so we can anticipate that it is based on a contemporary understanding of the brain   (“in accordance with nature”) and will include  many evidence-based techniques

Table 1 below gives a more complete comparison of some of the similarities and differences between Stoicism and CFT/CMT

STOICISM

CFT/CMT 
Aims to build Stoic Wisdom and Virtue Aims to  build Compassion (which it turns out means building other virtues)
Early morning meditation & Negative visualisation  to help prepare for the day and build wisdom & virtue Ideal Compassionate Self meditation to help prepare for difficult situations and build compassion and other positive qualities
Evening meditation & “sage on your shoulder” to help review the day and build wisdom & virtue Ideal Compassionate Other meditation to help get a sense of compassion and reflect on how to deal well with difficult situations
Marucs Aurelius’s Meditations – his own personal diary to help him develop Stoic virtue Compassionate Letter Writing – expressive writing to help people develop a compassionate stance to themselves 
Recognises the need to be vigilant so “first  movements” so they don’t turn into full-blown negative emotions  Developing Soothing Compassionate Breathing & Mindfulness, first as exercises, then in difficult situations, to calm down the threat and drive systems and bring the soothing and affiliative system on-line so the compassionate self gets a chance to respond
To some extent, a reputation for being cold and unemotional Whole focus is on being more compassionate and self-compassionate
Based on ancient philosophy Based on  science including neuroscience and psychology

Table 1: Stoicism and CFT/CMT – a comparison

5 Practical Ideas for Modern Stoicism

I believe that there is the potential for a powerful synergy between Stoicism and CFT/CMT. To conclude, here are five  practical ideas which address the two concerns raised and could help Modern Stoicism be wiser and more helpful.

1)      Use the language of compassion and self-compassion

If we start to use more compassionate language, then there is less risk Stoicism will be confused with a non-compassionate or even anti-compassionate practice.  Here are some good sayings to try out

  • “We are all fallible human beings.”
  • “It’s not your fault.”
  • “You can’t choose what’s happened to you so far – your genes, your upbringing – but you can choose how you respond to it.”
  • “Work towards being the best possible version of yourself.”

All of these are often used in CFT/CMT  and would l I believe would sit well in Stoic Training.

2)      Learn soothing breathing and mindfulness so you have a better chance to notice the “first movements” and bring the green soothing system on line.  Here are some links to recordings:- http://www.compassionatemind.co.uk/resources/audio.htm

3)      Use CFT-informed Compassionate Self meditations as rehearsals for the day ahead and for challenges you face in general. These are eyes closed exercise, starting with soothing breathing. Like an actor, you  imagine yourself with all the elements of virtue – wisdom, courage, persistence, justice, compassion, self-control, moderation. You  imagine yourself behaving in a virtuous way, even when difficulties arises.  This is obviously similar to the morning meditation and negative visualisation – the value added is in incorporating ways to bring the soothing and affiliative system on-line and to rehearse using specific virtues.

4)      Use CFT-informed  ideal compassionate-other  meditations to review how you’ve done in the day in facing life’s challenges. Again, this is an eyes closed exercising starting with soothing breathing. You   Imagine an ideal virtuous other  – someone who fully embodies the virtues – wisdom (including Stoic wisdom), courage, persistence, justice, compassion, self-control, moderation. You imagine yourself  interacting with this being – and that they are encouraging you, being warm to you, and also helping you become the best version of yourself. [ix]

5)      Blending CMT/CFT/CBT/Mindfulness & Modern Stoicism

The Idea is to blend Stoic ideas about wisdom and other specific virtues using compassionate language and evidence-based methods like soothing breathing, mindfulness and compassionate self meditations.  Over Stoic week 2015  I wrote a script for several of these, on  self-control, the  serenity prayer (Stoic Wisdom) and Stoic compassion . Here I will give the full script and a recording on persistence, an important quality modern psychologists call  “grit”.

Modern Stoic Meditation on the Virtue of Persistence

Epictetus would  say that there were two vices much blacker and more serious than the rest: lack of persistence and lack of self-control.  Lack of persistence stops us from enduring hardships that we need to tolerate, lack of self-control stops us from resisting pleasures or other things we ought to resist.

‘Two words,’ he says, ‘should be committed to memory and obeyed by alternately exhorting and restraining ourselves, words that will ensure we lead a mainly blameless and untroubled life.’ These two words, he used to say, were ‘persist and resist’.”
– Epictetus, Fragment 10, “Discourses and Selected Writings”

Anyone who says that philosophers are too obscure or complicated should be made to read that quote.  Stoicism couldn’t be simpler. We must commit the words “Persist and Resist” to memory and keep saying them to ourselves. Move over mindfulness,  recite the “persist and resist” mantra instead.

Persist and Resist

  • At the time when we feel like giving up, we can train ourselves to become aware of the negative  thoughts that make us feel that way. We can then remind ourselves  “This thought is  just an impression in my mind and not an objective fact like it claims to be.”
  • For example, if you are running a marathon  and thinking “I  won’t be able to finish” remind yourself

                “This is just a thought, not a fact.”

  • As well as negative thoughts, people often give up because of a setback or an  obstacle . Here the Stoic advice to think of what the sage would do in this situation is valuable. When it comes to dealing with setbacks, I really admire the attitudes of Winston Churchill and Thomas Edison.
  • Churchill said “Success is stumbling from failure to failure with no loss of enthusiasm.”
  • Thomas Edison suggested “Negative results are just what I want. They’re just as valuable to me as positive results. I can never find the thing that does the job best until I find the ones that don’t.” When asked by a journalist how he had coped with failing in his first 10000 attempts to invent the lightbulb he responded “I   had not failed. I had just found 10,000 ways that won’t work.”
  • The Stoics give us one more relevant piece of wisdom in the analogy of the archer. An archer should take accurate aim, and then accept  fate if the arrow gets blown off course. In the same way we should focus on what is under our control and not get discouraged if fate prevents success. We should control the controllables.
  • So the Stoics give us four excellent pieces of advice when it comes to persisting and developing grit. We can use the mantra “persist”, we can challenge the validity of discouraging thoughts, we can reframe failure in the same way as the sages on success and failure do, and we can focus on what we can control and leave the rest to fate.
  • Let’s spend a few moments using a visualisation informed by Stoicism and Compassionate Mind Training  to help us build up the virtue of persistence.
  • So think of something you want to achieve – it could be developing Stoicism into daily rituals, or changing career, or getting fitter – or something else that is important to you.
  • If you are comfortable doing so, now close your eyes and prepare for this modern Stoic meditation.
  • First to help your mind be in a calm state, let’s try a few moments slow soothing compassionate breathing.
  • Imagine trying to achieve this and then something getting in the way. Now in your mind’s eye imagine saying to yourself “Persist, Persist”. Next imagine a negative thought getting in the way – perhaps “I’ll try again next year when circumstances are better”. Remind yourself that this thought is just an opinion, it’s not an objective fact. Reflect, like Thomas Edison did, on what you can learn from this setback. Perhaps you’ve learnt another way not to do it!
  • Next  think of something you can do that is under your control to take you in the right direction. Imagine doing it, whilst repeating to yourself–persist, persist, persist. Then imagining yourself persisting until you succeed.
  • Finally imagine feeling satisfied for having persisted, despite the temptation to give up, putting into practice the virtue of persistence.

To conclude, in this article I have taken Marcus Aurelius’s advice to learn from criticisms of Stoicism to heart and explored how CFT/CMT can help develop modern Stoicism into a more compassionate practice that can develop specific virtues. We can now see that Marcus’s advice is itself an example of true self-compassion, meaning not sentimental warmth but a wise, responsible, courageous commitment to improving the well-being of oneself and others.

Tim LeBon is a BABCP accredited CBT therapist and UKCP registered existential therapist, an APPA and SPP registered philosophical counsellor and is also trained as a life coach  and integrative counsellor.He is a past Chair of the Society for Philosophy in Practice (SPP) and the founding editor of Practical Philosophy. He is  the author of Wise Therapy (Sage, 2001) and Achieve Your Potential with Positive Psychology (Hodder, 2014) . You can read more about Tim’s work on his blog, Socrates Satisfied, and his website.

References

[i] See Gill, G. (2015) What is Stoic Virtue? http://blogs.exeter.ac.uk/stoicismtoday/2015/11/21/what-is-stoic-virtue-by-chris-gill/

[ii] See LeBon, T. Achieve Your Potential with Positive Psychology pp xi-xvi   (Hodder Teach Yourself Series, 2014) for some examples of how some very plausible ideas about personal development don’t actually work so well in practice.

[iii] See  LeBon, T. (2014) chapter 9 for more on the CBT toolbox.

[iv] See LeBon, T. (2014) chapter 10 for more on mindfulness.

[v] Though as Patrick  Ussher has argued, Stoic mindfulness (prosoche) has a bigger part of Stoic virtue, and is a bit different from mindfulness.

[vi] CFT was originally developed to help people who have particularly high degrees of shame and self-criticism, who often didn’t respond particularly well to standard CBT.  Of particular interest to us though is that is how CFT is now being extended to include broader populations. The training that is aimed at the general population as well as a clinical one is called Compassionate Mind Training (CMT) and it is this  part of CFT that is particularly relevant to us here.  For the rest of this article I will refer to this approach as CFT/CMT, because our focus is more on helping the general population than on psychotherapy.

[vii] See http://media.psychology.tools/worksheets/english_us/emotional_regulation_systems_en-us.pdf

[viii] In CFT (as opposed to CMT) there would be aim important  third stage – understanding  your problems in terms of unhelpful – but understandable – strategies developed- often sub-consciously – to deal with threats your “tricky brain” didn’t have a better way to deal with. For example, someone who fears overwhelming emotions such as sadness and loneliness may have developed drinking as a means of avoiding these emotions This understanding of problems in a new way is called a compassion-focussed formulation

[ix] See http://blogs.exeter.ac.uk/stoicismtoday/2015/06/14/how-to-become-more-virtuous-and-less-like-basil-fawlty-tim-lebon/ for my 2014 workshop which was aimed at developing an Ideal Stoic Advisor.

Stoicism and Early 20th Century Psychotherapy by Donald Robertson

Stoicism and Early 20th Century Psychotherapy

Copyright © Donald Robertson, 2013.  All rights reserved.

Dubois and Baudouin

Paul-DuboisThe earliest modern school of psychological therapy was arguably hypnotism, or “hypnotic therapeutics”, founded by the Scottish surgeon, James Braid, in 1841. Hypnotism spread to France after Braid’s death in 1860, where it gained popularity and the term “psychotherapy” was coined to describe hypnotic therapy and related methods. Hippolyte Bernheim, at Nancy, and Jean-Martin Charcot at the Salpêtrière hospital in Paris, set up rival schools of hypnotic psychotherapy, which flourished in the 1880s. Prior to developing psychoanalysis, Sigmund Freud studied hypnotism, attending both Bernheim and Charcot’s lectures. Freud’s first book on psychotherapy,Studies in Hysteria (1895), described his hypnotic “catharsis” method, the precursor of psychoanalysis proper, which was essentially founded with his publication of The Interpretation of Dreams (1900). Psychoanalytic approaches, derived from Freud and his followers, largely supplanted hypnotism and dominated the field of psychotherapy until the late 1950s, when “humanistic” and “behavioral” approaches to therapy began to be developed.

There’s not much evidence of Stoicism having influenced psychoanalysis. However, the fame achieved by Freud has often obscured the fact that rival approaches to psychotherapy existed in the early 20th century. One of the most important of these was the “rational psychotherapy” or “rational persuasion” approach of the Swiss psychiatrist and neuropathologist Paul Dubois, author of The Psychoneuroses and Their Moral Treatment(1904). The impact of Stoicism during this period was mainly upon Dubois and those inspired, in turn, by his “rational” approach to psychotherapy. Dubois believed that psychological problems were due mainly to negative autosuggestion but rejected the technique of hypnotism in favor of a treatment based on the practice of “Socratic dialogue”, with the goal of rationally persuading patients to abandon the unhealthy ideas responsible for various neurotic and psychosomatic conditions. The influence of the ancient Stoics is clear from Dubois’ scattered references to them. He even prescribed reading Seneca’s letters to one of his patients as therapeutic homework (Dubois, 1904, p. 433).

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)

With practice, we can learn to monitor our thoughts and challenge the irrational ideas that cause unhealthy emotions and psychosomatic symptoms (Dubois & Gallatin, 1908, p. 56). Dubois therefore often speaks of his rational psychotherapy as involving a form of “stoicism” (with a small “s”) but he closely relates this to “Stoicism” (with a big “S”), especially as he found it in the writings of Seneca.

Continue reading “Stoicism and Early 20th Century Psychotherapy by Donald Robertson”

'Stoicism as Practised by the Seriously and Persistently Mentally Ill' by Ian Guthrie

Stoicism as Practiced by the Seriously and Persistently Mentally Ill

Hope

Ian Guthrie, BA

“My mother was driving me in today,” said “Adam” at the beginning of our men’s group session. “She was getting really frustrated by the morning traffic and people cutting her off. I was like, ‘There’s this book we are reading in group that you might really like! It’s by this smart guy named Marcus Aurelius and he was a Roman Emperor and a philosopher and he wrote a book called Meditations that is about controlling your emotions and not letting things that you can’t control bug you.’

“And she turned to me and said, ‘Are you getting smart with me?’”

We all laughed at the story, and I realized that it represented not only Adam’s understanding of what we were reading in Meditations, but an example of each member’s attempt to apply it to his daily life. In the previous article I wrote for this site (“Is Stoicism for the Mentally Ill, Too?”), I presented my perceptions of the effect of the clinical use of Stoic principles from the perspective of the clinician. This article is oriented towards the reactions of my clients, all of whom are diagnosed as seriously and persistently mentally ill (SPMI).

Recently, the group members shared what they were learning and taking away from the experience. Several individuals spoke up.

“I am learning to accept things that I cannot control, to not get angry and stuff,” said Adam. “I used to struggle with that a lot and let things affect me, but what is the point of getting mad about things that are going to happen regardless? This is helping me right now with my [terminally ill] grandmother. Sure, I’ll be sad when [her death] happens, but I think I’ll be able to accept it, because like we’ve been reading, death is natural.”

Adam is recalling passages from Meditations that address human mortality. “Death, like birth, is one of nature’s secrets” (iv. 5). He is reporting that his experiences with Stoicism have aided him in processing emotions more effectively than he was previously capable, and he anticipates that he will be able to do so in the future.

“Walter” announced that he found it interesting that Aurelius’ text is “from the old times, and it still applies today!” Aurelius speaks to the permanence of the world: “Everywhere there is change; and yet we need fear nothing unexpected, for all things are ruled by age-long wont, and even the manner of apportioning them does not vary” (viii. 6). The world in its essence does not change, and neither does the worth of Stoic principles.

Another client, “Henry,” told me that he has been enjoying the readings. “It points out how to successfully think…to change…and how to reason and consciously digest your day and your life.”

I admit that comment stunned me. Henry is diagnosed with schizoaffective disorder, a diagnosis known for hallucinations, delusions, and mood swings. Despite (or perhaps because of) his diagnoses, he values and places emphasis on the importance of being able to think clearly. He is not the highest functioning member of the group, though he does make great efforts to understand, to ask questions, and to interpret of passages as frequently as possible. Meditations encourages this level of evaluation, saying “if possible, make it habit to discover the essential character of every impression, its effect on the self, and its response to a logical analysis” (viii. 13).

Often my clients tell me that they wish they could stop taking their medications because they do not want to experience the side-effects that so many psychotropic medications have, such

as lethargy, weight gain, and impaired memory. Most have resigned themselves to the need for medications to keep their symptoms in check. Medication usage is a matter for clients to discuss with their doctors. My role as a Psychosocial Rehabilitation Worker is to help them increase their functioning by the development of coping skills, and in that capacity, I wonder what could a stoically-trained, yet seriously ill mind accomplish for itself?

Stoicism isn’t a treatment for mental illness, but it is a prescription for how to live life well. I’ve introduced my group to Stoicism in the hopes of giving them the tools necessary to begin using their innate human reason to conquer the irrationality that they experience. Every healthy human being experiences irrationality from time to time, but there are those of us who strive for higher functioning in order to further separate ourselves from “the unreasoning brute creation” (viii. 12). Those that experience irrationality to a diagnosable degree can have exactly the same goal and are capable of achieving levels of success.

As we concluded one session, “Charles” spoke up. He thanked me for teaching Stoicism to him and said, “I feel like I’ve matured since we started. When I was in my 20’s, I spent my time getting into drugs and it messed me up. This is the stuff I should have been learning!”

Ian Guthrie, BA, is a graduate student pursuing licensure as a professional counselor. He is a psychosocial rehabilitation worker for a community mental health center in Kansas City, Missouri.

A Blueprint for a Philosophical CBT by Jules Evans

In this article, Jules Evans envisages what a ‘philosophical CBT’ might be like, and how it could work….

Imagine being able to practice philosophy through the NHS. The idea is not as far-fetched as it sounds. In fact, therapists and counselors in the UK are beginning to put together something called ‘Philosophical CBT’, which could radically change how people see philosophy and the wider humanities.

CBT, or Cognitive Behavioural Therapy, is now at the heart of the British government’s mental health policy. Successive British governments have committed a combined £580 million to a policy called Improved Access for Psychotherapies (IAPT), which hugely increases the availability of CBT through the NHS, and will train 6,000 new cognitive therapists by 2014. It is the boldest expansion of mental health services anywhere in the world.

While many mental health charities have welcomed this initiative, others in the mental health industry have fiercely criticized it. Therapists from other traditions say it has too much of a ‘one size fits all’ approach, and that 8 to 16 weeks of CBT only offers a short-term fix that ‘papers over the cracks’. Others have criticized CBT’s intense focus on an individual’s thoughts and beliefs rather than their socio-cultural and economic context.

Continue reading “A Blueprint for a Philosophical CBT by Jules Evans”

'Is Stoicism for the Mentally Ill, too?' by Ian Guthrie

Is Stoicism for the Mentally Ill, Too?

A Reflection on the Clinical Use of Marcus Aurelius’ Mediationsmental-illness-unemployment

Ian Guthrie, BA

In my own studies of Stoicism, I had come to recognize some similarities between the subject matter and certain counseling perspectives such as Rational Emotive Behavioral Therapy (REBT), founded by Albert Ellis, and Cognitive Behavioral Therapy (CBT), pioneered by Aaron Beck. The population I work with consists of individuals with a wide age range from young adult to elderly, who are considered to be seriously and persistently mentally ill (SPMI). The majority of these clients are diagnosed with bipolar disorder or a type of schizophrenia, and a smaller percentage experiencing other mental illnesses including anxiety disorders or traumatic brain injuries. Considering the benefits that individuals receive from CBT and REBT, I thought they might also benefit from understanding the ancient philosophies, so I began considering how to educate them in stoic philosophy.

I selected Marcus Aurelius’ Meditations because it provided short passages that could be broken up more easily and discussed within the time constraints of the sessions. The challenge hinged on my ability to translate Mediations into something accessible to this population of SPMI adults. I decided to keep the audience small: a weekly men’s group I had recently begun facilitating became the forum because it allowed more opportunity for each member to explore his thoughts as needed.

Our sessions progressed slowly. After each passage, the group would take time to explore where the information was coming from historically as well as how it could be applied to their contemporary lives. Early on, none of the members showed either great enthusiasm or an overwhelmingly negative response. Clients were quietly receptive but offering only occasional remarks. However, after we finished the first book and began the second, a new client joined the group. I asked if any of the more seasoned clients would like to explain what we were discussing. One of the clients, “John,” who suffered a traumatic brain injury, with resulting memory issues, spoke up. He described Meditations and recalled the brief biographical information about Aurelius I had given the very first day, with a minor embellishment. “And this Marcus Aurelius guy is one badass dude.” At that point, it was obvious that these clients had developed some personal investment.

Our sessions continued and they are currently ongoing. We are entering the ninth month and have only covered up through half of the fifth book. Different topics received varying levels of reception. For the purposes of brevity, I will highlight three topics, in no particular order, which seemed to resonate most with my clients.

The first of these topics is personal productivity and following through with natural duty. Meditations v.1 reads, “At day’s first light have in readiness, against disinclination to leave your bed, the thought that ‘I am rising for the work of man’.” The passage goes on to discuss that to love one’s self, one would “love your nature, and nature’s will.” This was a fairly long passage. The clients usually have difficulty comprehending what the longer passages are about, but this one resonated to such an extent that many of them needed no interpretation. They understood, and they summarized the message perfectly. One client, “Peter”, diagnosed bipolar I, spoke about how he had always struggled with motivation, but he always felt better after being able to work on something and be productive. Most of my clients have been judged unable to maintain employment and receive government support. However, each noted having the desire to contribute to society. So, we spent time discussing how each member could satisfy his natural duty. Some have since begun taking steps to follow through on their ideas, such as volunteering or pursuing hobbies.

The second Stoic topic that resonated with the group is self-regulation by rational thought. This is a topic that is mentioned frequently in Mediations and is a key concept in Stoicism. Several passages prompted lengthy discussions on the topic, such as the suggestion to “put from you the belief that ‘I have been wronged’, and with it will go the feeling. Reject your sense of injury, and the injury itself disappears” (iv.7).

Following this reading, there was a brief discussion that beliefs prompt emotions which can affect how we carry ourselves through our daily lives, when all that need be done to control the emotions is to regulate those beliefs with rational thoughts. The men began sharing previous experiences where they had been successful in practicing this, such as being able to control themselves when confronted with aggressive and irritating drivers, or unsuccessful and envisioning how they ought to have acted differently.

One client in particular, “Bruce”, diagnosed with paranoid schizophrenia, struggles greatly with paranoid delusions. When I read one of the passages relating to self-regulation, he immediately referenced his thought disorders, describing how hard it is to cope with from time to time. I encouraged him, in moments of particular paranoia, to consider his emotions and the thoughts that prompted those emotions and to embrace as reality only what he knew empirically. He has subsequently reported some small success in the management of his paranoia. As I have encouraged him to process his thoughts, he has begun to practice this on his own.

The third topic is that of understanding natural events, not as good or evil, but as indifferent. Having a mental disorder is something that I point to specifically when this comes up. Stoicism encourages us to view events, like having a mental illness, toward which some in the group have harbored resentment for limiting their opportunities, as a thing that does “neither elevate nor degrade; and therefore they are no more good than they are evil” (ii.11). Rather, they should hold the perspective of the headland being constantly assaulted by waves, to adopt the view, “not, ‘This is a misfortune,’ but ‘To bear this worthily is good fortune’” (iv.49).

When considering natural events, the idea of death is brought up, by both Aurelius and my clients alike. This is observably more difficult for some to accept than it is for others as a non-evil, natural indifferent. When mentioned as “no more than a process of nature” (ii.12), some clients did express some difficulty accepting this view. They described their experiences of friends dying at young ages and even some of their own brushes with death. In the Stoic sense, seeking death prematurely, such as is entertained in suicidal ideation, is in conflict with our natural duty to be productive members of society. However, in instances of a seemingly premature death (such as when a non-group member, female fellow client died suddenly of natural causes), Stoic philosophy would question the very idea of prematurity, “for the sole thing of which man can be deprived is the present” (ii.14). This usually prompts contemplation among the clients, and something I expect to discuss more as the topic is brought up in future sessions.

The following can be gleaned from these sessions. First, my clients seemed to have benefited, not just from the topics presented in Meditations, but also from the philosophical depth of ideas. They have been challenged intellectually and engaged in healthy thought. Second, Stoicism provides a blend of both simple guidelines and complex concepts which have allowed the men the opportunity to engage Stoicism at their own level. Third, Stoicism, in its embrace of the rational, has the potential to provide SPMI clients with intellectual tools to aid them in addressing a world which may appear, by virtue of their respective delusions, overly irrational. Take for instance, the example of Bruce and his paranoid thoughts that cause him to view the world in emotional context. He has been developing the tools necessary to separate his emotions from his view of reality. Further, individuals with bipolar diagnoses suffer mood swings which affect their approach to life. Through encouraging a thoughtful and rational approach, they may learn to lessen the impact that their moods swings have.

I admit to having some reservations before electing to share Stoic philosophy in the form of Marcus Aurelius’ Mediations with my clients. This was not because I doubted the worth of Stoic philosophy itself, but because my clients, individuals diagnosed SPMI, have somewhat impaired functioning and reasoning. This entire endeavor might have proven to be an exercise in futility. Even if the clients could comprehend Stoic teachings, they may have had no interest in them. However, in light of our sessions and to supplement conventional psychotherapies like REBT and CBT, I fully intend to continue on with Meditations and beyond as long as my clients will listen, because they have reported Stoicism has had a beneficial effect on their lives.

About the author:

Ian Guthrie, BA, is a graduate student pursuing licensure as a professional counselor. He is a psychosocial rehabilitation worker for a community mental health center in Kansas City, Missouri.

'My Return to Mental Health with CBT and Stoicism' by James Davinport

My Return to Mental Health with CBT and Stoicism

James Davinport 

Editor’s Note: Over the month of April, the Stoicism Today blog will feature posts on Stoicism & Mental Health, from a wide variety of angles. The first post is by James Davinport.

A year ago my whole world collapsed. In hindsight, I can say that I should have seen it coming – the breakdown had been building up for years: month by month vestiges of my self were chipped away, until finally, it felt like there was not really a ‘me’ there that I could recognize anymore. At work, in the lower echelons of a high-powered business, I had driven myself down into the dust. I had worked seven days a week for years, often in to the early hours of the morning. By the end, nothing on the computer screen in front of me made any sense, nothing I read made any sense. I dreaded the regular presentations I had to make at work: I felt like each and every one I gave was a ‘failure’ (even though the peer-assessment I received indicated the exact opposite). I didn’t want to see people, and I lashed out at family and friends. One evening, I found myself kicking a chair in my living room for no reason. Luckily, my lodger was not in the room at the time! During the day, I would slip away from the office to cry in a nearby park. My head raced with negative thought after negative thought, many of which were so irrational, that it was upsetting just to have them. Often, in my mind’s eye, I’d see visions of myself crying out for help.

But it was the physical symptoms that made me finally shout ‘stop’: the dizziness, exhaustion, tender muscles that would suddenly seize up, the panic attacks, the inability to remember or concentrate, the heart palpitations, and digestive difficulties for months on end. Whereas the mental symptoms could not, sadly, curtail my self-destructive ways, my body, the health of which suddenly seemed so absolutely vital, was what finally forced me to reassess what I was doing.

So I did what seemed the unthinkable: I quit my job, gathered my savings, and set about recovering.

This article is about how I have made that recovery, and will, I hope, be of use to others who find themselves in similar situations to the one I found myself in.

At first, I had little idea what was wrong with me: I just felt that ‘everything’ was wrong with me. I wondered if I had ‘CFS’, the dreaded ‘Chronic Fatigue Syndrome’, and whether I would be condemned to years, decades possibly, of extreme tiredness. Being in my late forties, I worried if anything, realistically, could be done at this stage: I’d spent years doing the wrong thing, and now, how could I possibly expect any real change for the better? But, deep down inside me, there grew the greatest determination I have ever experienced to get better.

I had tried meditation for the first time a few months before my breakdownbutI was so anxious that, after each session of mindfulness meditation I was closer to a panic attack than before it. (Later, I learned that this was brought on by a rather curious form of OCD, or Obsessive Compulsive Disorder, I had developed, called ‘sensorimotor OCD’, which leads to high levels of anxiety as a result of paying attention to bodily sensations). The present moment hardly seems a joyful place when your head is racing with negative thoughts and turbulent emotions. It became clear to me that ‘accepting’ these thoughts and feelings non-judgmentally was not what I needed to do: I needed to change them.

Recovering with CBT

I’d long heard about CBT, or Cognitive Behavioural Therapy, but had never really considered it for myself. But early on in my determination to recover, when I was idly browsing the shelves in a London bookstore, I came across a Teach Yourself CBT book. I thought ‘Why not?’, and bought it. This was the best purchase of my life.  I was determined to commit wholeheartedly to what the book taught me, building on each lesson bit by bit.

CBT requires continuous training. Over the last months, I have learned many helpful techniques, but here I’ll just outline some of the most fundamental practices.

The first exercise was to ‘reframe’ the thoughts I had, and see them as something outside of myself which was ‘up for debate’. Thus, I would rewrite

‘I feel anxious that my future holds nothing good’,

as

‘Anxiety tells me my future holds nothing good’.

The process of doing this in itself gave me a huge sense of achievement: instead of letting Negative Automatic Thoughts (or NATs) ruin the day, I was capturing them at their inception and stopping them in their tracks. The process of writing the NATs down was important too – it is good to get such thoughts ‘outside of yourself’ and onto a piece of paper.

The second exercise focussed on applying what CBT calls ‘General Thinking Errors’ to each negative thought: was I thinking ‘in extremes’ with no shades of complexity or nuance? Was I ‘overgeneralising’ to assume that one bad incident should apply to everything else, forever? Was I ‘filtering out the positive’, only looking at the negative aspects of the situation? Was I ‘jumping to conclusions’, ‘mind reading’ or ‘fortune telling’? For another week, I methodically challenged each negative thought in light of these thinking errors, growing more and more in confidence each day.

The third exercise, which combines all of these together, was about replacing negative thoughts with more realistic, balanced ones, noticing the effect of doing this on my mood and feelings. Let me give a (made-up) example:

Thoughts: “I made a complete fool of myself at the party. Everyone thought I was an idiot.”

How much do I believe this? 74/100.

Feelings: Isolation, upset, like no one will like me.

Alternative thoughts: “Objectively speaking, there was only one real awkward moment in the party, and I’m probably blowing even that out of proportion. Other people had awkward moments at the party too, and they just laughed them off – I guess a bit of awkwardness is a part of life! The rest of it went quite well, and I actually got on particularly well with two new people. All in all, there were more positives than negatives to the evening.

How much do I believe this? 95/100

Feelings: Contented, a more balanced perspective, like one awkward moment doesn’t put people off liking me.

How much do I believe the old thought now? 0/100

I have practised this particular technique ever since. I have come to love the challenge of doing it. It feels rather like ‘gardening’, as if challenging negative thoughts is like clearing out weeds.What I also like about this method is that is not about replacing negative thoughts with ‘positive thinking’ for its own sake, but rather with balanced, more accurate thinking, which accepts nuanced understandings of situations. And the great thing is that, today, my thinking in general is more balanced in the first place, and reflects more accurately how the world works.

The Power of Underlying Beliefs

For CBT, the mind is like an onion: the thoughts we have are at the very outermost ‘layer’ and, that we have them at all, usually depends on some ‘underlying belief’. For example, if you feel panicky when in social situations, as I do, you might have the underlying belief that ‘I’m unlikeable’ or ‘Other people usually are judgemental and unfriendly’. And those kinds of beliefs feed into your behaviours: you find yourself avoiding others so as not to confirm your underlying beliefs. It’s a self-perpetuating cycle of negativity that needs to be broken.

As I uncovered my underlying beliefs, I began to detect certain overarching patterns in my thinking. After some research, it became clear that I had Social Anxiety Disorder (a deep seated fear of rejection and humiliation) and serious problems with Perfectionism (where one’s self-worth is dependent on achieving rigid, wholly unrealistic goals in one or two areas of one’s life). In addition, albeit in a more minor way, it also become clear that hypochondria, agoraphobia, PTSD and various kinds of OCD were also in the mix. Sometimes you have to have a sense of humour when faced with all your neuroses! But luckily, especially for someone new to CBT like myself, there were CBT books available for each of these problems. And let me tell you that that is a relief. When you need help with these kinds of issues, you need books that deal with the problems head-on, backed up by evidence. I took a long-term view and set about changing each of these areas systematically.

This process is still ongoing. Challenging these underlying beliefs takes time, but it is a process that one comes to value and take pride in. It involves a lot of behavioural experiments, in which you directly confront your fears and constantly re-evaluate the beliefs that fuel them. It also involves learning a lot about human psychology, and how behaviours feed into emotions and thoughts and vice versa. It’s a highly rewarding journey. But today, I can safely say that over the last few months the balance has tipped:

–       From being generally ‘on-edge’ and feeling scared when out and about, I have gone to love being out and about.

–       Whereas before, I would have quickly withdrawn into my shell in social situations and felt ‘isolated’,I’ve now become increasingly confident in meeting new people, and tend to focus on the positives of each event afterwards and not on a negative ‘post mortem’.

–       Now that I’m in work again, I don’t drive myself non-stop. Now, my self-worth is derived from the whole spectrum of my life, not just my work-related achievements. I can knock off without the slightest shred of guilt at not checking my email until 9 AM the next morning.

–       From being fearful that I had several kinds of serious illness, such thoughts now rarely cross my mind. In fact, these days I laugh on the few occasions I have those thoughts.

–       The panic attacks have simply disappeared.

 

A year ago ago all this seemed impossible even to dream of. Now, it seems hard to countenance the kind of fears I had a year ago: was that really me? Back then, it seemed like the world was a harsh and horrible place. But, in fact, the outside world has not changed – rather, my relationship to it has changed. And that I achieved myself.

Recovering with Stoicism

Early on in my journey with CBT, I encountered Epictetus’s key idea, from Handbook §5, that ‘We are not disturbed by events but by our opinions about events’. As is well known, and as I found out, this was a key idea behind CBT. This fact made me curious about Stoicism, and, after some research, I read some books and used some online materials (including those on the StoicismToday blog). As a philosophy, it really resonated with me.

But, I’ll be frank upfront. Had I picked up a book on Stoicism a year ago, rather than CBT, I don’t think I would have made the great strides of progress that I have made. I’d probably have made some progress, but only a fraction of what I have made. Why? Because Stoicism was not developed specifically to tackle Social Anxiety Disorder, Agoraphobia, Perfectionism or Hypochondria! The idea that Stoicism is a ‘Therapy for the Soul’, and the key saying within Stoicism by Epictetus which I just quoted above, of course, make it seem similar to CBT. But that doesn’t make it psychotherapy, in the modern sense, which is concerned with treating specific problems. In contrast, Stoicism is ‘psychotherapeutic’ in the sense that is concerned with developing ‘good flow of life’, based on coherent ethical values, rather than a more turbulent ‘all over the place’ kind of life with suspect or ill-thought-out values. It is also psychotherapeutic in the idea that certain value-judgements (such as ‘I need money to be happy’) can lead to psychological disturbances that can be removed with shifting to value virtue instead. In other words, Stoicism is essentially different as it is about ethics. And, the key thing is that having Social Anxiety Disorder or Hypochondria are not ethical failings. When someone wants help with recovering from panic attacks, help them to recover from panic attacks but don’t ask them to define ‘virtue’!

So how, you might ask, did Stoicism help me to recover? CBT is immensely helpful up to a point. It does its job wonderfully but it is necessarily defined in relation to removing something negative. Whilst this process in itself can lead to more positive things – self-confidence, and the enjoyment of parts of your life that once made you feel fearful, CBT does not give any advice on how to live your life in an overarching way, or on what you should value in life in general.

As I cleared out all the ‘negative weeds’ bit by bit, I found that there was a certain hole, or absence, within me. And the question that was emerging was: what is the mast, or rock, by which I can live my life? And that’s where Stoicism came in: it filled up the space that had been created by rooting out the negative weeds.

Although my journey with Stoicism is in its early days, there are three key things that I have taken away which have started forming the bedrock of my life:

  1. The focus on ‘what is up to me’: for me, this is about understanding that the most important thing in life is valuing keeping your integrity in how you go about things. You don’t need external events to be like this or like that – purpose comes instead from valuing retaining your integrity in response to those events.
  2. The Examined Life: Every evening, I practise the evening philosophical review. I praise myself for what I did well, and highlight areas that need to improve. No longer is my day just one seamless ‘blur’. Now I have sense of my ‘overall life narrative’, of what I’m seeking to do, of certain ethical precepts, as simple as the importance of valuing friends and family, which can guide me each day. In the evening, I become, as the Stoic Week 2013 Handbook puts it, akin to a ‘Philosophical Counselor’ to myself.
  3. Happiness through cultivating philanthropy: The Stoic idea that we should seek to cultivate affection towards others has been a powerful influence on my life. Hierocles’ circles have been especially helpful in doing this. It has led me to prioritize cultivating relationships, friendships and community, and to the realization that in those areas, it would seem, is indeed where happiness can be found.

 

There is more to delve into with Stoicism – I still couldn’t define ‘virtue’ if you gave me a million dollars! – and possibly other philosophies, but, for the moment, the values by which I will live my life are slowly, but surely, coming together. Whilst CBT gave me my life back, by removing the negative things that had been obstructing it, Stoicism is providing reflection for the meaning or basis of my life as a whole.

Of course, there still are some bad moments. I am only one year into my recovery. But I recognize those moments much more quickly now, and know what to do. When I look back at the kind of thoughts that used to plague me not so long ago, I have visible proof of how far I have come in so short a time. Physically, I am much better too. So many of the symptoms I had experienced before have simply disappeared, thanks, I believe, to having a much calmer mind and to having the time to commit to a sensible exercise regimen. And, in case you are wondering, I now practice mindfulness meditation again, and it does not leave me anxious! It has once more become an important part of my life.

I hope that, in writing this piece, if there is someone out there who finds himself or herself in a similar position to the one I was in a year ago, that they can know that it is possible to change. The simple fact that it is in one’s power only to tend well to certain parts of your life – thoughts, intentions and actions – might seem limiting.

But I know now, firmly from my own experience, that focussing on those things is the most powerful thing you can 

More about the author:

James Davinport is a pseudonym. He lives and works in London.

'Does Stoicism Work? Stoicism & Positive Psychology' by Tim LeBon

Does Stoicism Work? Stoicism & Positive Psychology

Tim LeBon

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Introduction: Stoicism isn’t just a theory, it is also a set of practices aimed at helping people to lead better lives. A key question is whether Stoic practices work – does practising Stoicism actually help people? Psychology and its scientific methods is the obvious place to turn to help answer this question. In this article, I will describe the work of the Stoicism Today team to use the methods of psychology to begin to answer the “Does Stoicism work?” question and suggest directions for future research. The last fifteen years have seen the growth of positive psychology, a branch of psychology aimed at providing a scientific understanding of what goes well in life and how to enhance it. I will argue that Positive Psychology can become more complete and wiser if it incorporates ideas from Stoicism.

Positive Psychology 

Since its inception in 1998, Positive Psychology has spawned many experiments, articles, books and conferences. Whilst philosophers and self-help authors have long theorised about what we should do, Positive Psychology now proposes planned activities (“interventions”) and tests them scientifically. One way is to ask people to carry out an intervention, measuring their well-being before and after to see its effect. Positive Psychology has already delivered substantial findings, including the following:

  • Happiness and positive emotions such as joy, pride, love and awe don’t just feel good, they also have positive consequences such as improved health and increased longevity, creativity and altruism.
  • An important component of well-being is flow, which means being totally absorbed in what you are doing. Flow is distinct from pleasure because when you are absorbed in an activity you don’t really feel anything.
  • It is possible to cultivate a number of beneficial positive attitudes. These include hope, optimism, gratitude and a “growth mindset” (i.e. a belief that one’s abilities are not fixed). These attitudes have been shown to lead to improved health, better work and academic performance, better self-esteem and greater resilience.
  • A number of beneficial positive behaviours have been identified, including identifying and using your strengths and performing acts of kindness.
  • A number of simple interventions have been shown to bring about increases in well-being in both the short term and at six-month follow up. Conversely some plausible interventions have been shown not to bring about lasting positive change.

There is now good evidence that studying Positive Psychology and applying its findings to oneself, to organisations and in education can lead to increased well-being. For a fuller review of Positive Psychology, the interested reader is referred to my new book, Achieve Your Potential with Positive Psychology (Hodder, 2014).

Philosophy and Positive Psychology

Whilst these developments are very much to be welcomed, there are some important philosophical questions to ask Positive Psychology, including:

  • What precisely is well-being and what is the difference between well-being and related terms such as subjective well-being, flourishing, pleasure, enjoyment and happiness?
  • Positive Psychology emphasises feeling good and doing good. What is the place in Positive Psychology for virtue (i.e. being good)?
  • Can positive attitudes and behaviours actually cause harm if they are carried out by someone who lacks virtue? For example, would you want a terrorist to use their strengths?
  • Is, as many ancients thought, wisdom a particularly important virtue?Isn’t it important not just to be hopeful and optimistic but to use these qualities wisely?
  • Can practical ideas proposed by philosophers – such as the Stoics and Epicureans – be tested?
  • Could empirically tested philosophical strategies help individuals be virtuous and wiser as well as feeling better and so strengthen Positive Psychology?

The remainder of this article will focus on the last two questions.

Stoicism Today and Putting Stoicism to the Test

Stoicism is a good candidate for inclusion in Positive Psychology both because of its broadly therapeutic intent and the plethora of specific, testable strategies to be found in the writings of Marcus Aurelius, Seneca and, particularly, Epictetus. Under the leadership of Professor Christopher Gill based at the University of Exeter, the Stoicism Today team, including the current author, has made a start at putting Stoicism to the test. In this section, I will briefly summarise our findings. For a more detailed account, see LeBon (2014a)

In the latest 2013 study, participants, recruited from the general public as well as Stoic interest groups, were provided with a free downloadable booklet featuring Stoic readings and exercises, many of which were available as audio recordings. In addition a blog was maintained and participants were encouraged to communicate with each other using social media. Central to the empirical study was the suggested programme of meditations and exercises for “Stoic week”. Each day had a specific Stoic theme, and an early morning and late evening meditation connected the daily theme with more general Stoic ideas.

Amongst the suggested exercises were:

  • An early morning meditation, focussing on a Stoic principle such as “focussing only on things under our control”, or “rehearsing dealing with possible challenges in the day ahead in a Stoic way”.
  • A late evening meditation, reviewing the day in terms of how well one has dealt with challenges in a Stoic way, learning what one has done well but also cultivating the intention to do better the next day.
  • Daily exercises on the following themes: What is in our power?; Stoic self-discipline and simplicity; the Stoic reserve clause; Stoic mindfulness; Emotions and adversity; philanthropy and the View from Above.
  • A Stoic monitoring sheet, helping to cultivate an awareness of what is and what is not in our power.

Participants were asked to take various questionnaires assessing well-being and their levels of Stoicism both before and after taking part in Stoic week.

Stoicism Today’s Testing of Stoicism: The Results

Our findings supported the view that Stoicism is helpful – Stoicism passed its initial test. Participants reported a 14% improvement in life satisfaction, a 9% increase in positive emotions and an 11% decrease in negative emotions.

These findings suggest a significant positive effect of practising Stoicism, and also go some way to dispelling some of the more frequent criticisms of Stoicism, such as that it is a joyless philosophy (joy increased the most of all emotions) or that it is too pessimistic (optimism increased by 18%). In addition the study confirmed some positive expectations of Stoicism. Stoicism does indeed seem to increase contentment and reduce anger. The findings also supported the view that Stoicism not only increases well-being but also enhances virtue – 56% of participants gave themselves a mark of 80% or more when asked whether it had made them a better person and made them wiser.

As well as measuring changes in well-being, the Stoicism Today project has also attempted to measure the relationship between well-being and Stoic attitudes and behaviours. In order to do this, a scale, The Stoic Attitudes and Behaviours Scales (SABS) has been developed and piloted. By giving participants the SABS questionnaire along with other well-being scales, it is possible to determine the relationship between elements of Stoicism and well-being, and thereby, potentially to identify Stoicism’s “active ingredients”.   Most Stoic behaviours have proved to be positively associated with well-being. Many Stoic attitudes are also positively associated with well-being, but less so than behaviours. Some non-Stoic behaviours attitudes, such as doing what is enjoyable and comfortable rather than the right thing, proved to be negatively associated with well-being.

The elements of Stoicism that proved the most beneficial were:

  • Stoic mindfulness – making an effort to pay continual attention to the nature of my judgments and actions.
  • Stoic disputation of thoughts – reminding oneself that an upsetting thought is just an impression in my mind and not the thing it claims to represent.
  • Affinity with others – thinking of oneself as part of the human race, in the same way that a limb is a part of the human body.
  • Stoic Premeditation   – trying to anticipate future misfortunes and rehearse rising above them.

Future Directions

Whilst these findings are certainly encouraging, more research is required for it to reach the most rigorous scientific standards. Priorities include:

  • Performing more rigorous controlled experiments. The findings would be strengthened if follow-ups were performed (e.g. at 3 or 6 months) and if control groups were established.
  • Further Development of the Stoic attitudes and behaviours scale (SABS). The SABS scale is a promising instrument both to measure adherence to Stoicism and its association with well-being. The scale would benefit from refinement, including simplification of the language used and a further round of feedback from those who identify themselves as Stoic.
  • Longitudinal testing of SABS findings. The SABS findings are correlational i.e., they show a relationship between well-being and Stoicism. They do not prove that being more Stoic brings about the changes in well-being. One way to address this would be to compare changes in well-being between participants instructed to develop very specific Stoic attitudes and behaviours. For instance it could compare instructing one set of participants to engage in Stoic mindfulness with another instructed to do just a Stoic premeditation.
  • Further refinement of materials and programmes. There is a close analogy between the idea of developing Stoic-inspired programmes from Stoicism with developing mindfulness programmes from Buddhism. Mindfulness-based programmes have been shown to reduce the recurrence of depression and are now very popular; they are even available in the NHS. Researchers have based these programmes on a subset of Buddhist practices, and geared them to specific groups. In the same way programmes could be refined for particular problems most likely to benefit from Stoicism e.g. anger management and those suffering long-term conditions such as diabetes and coronary heart disease.

Stoicism as a part of Positive Psychology

Whilst further research is desirable, I believe enough evidence has been collected to justify including Stoic exercises in the arsenal of evidence-based techniques to enhance well-being. In this final section I will make some brief remarks to suggest that Stoicism may have particular value in helping Positive Psychology address helping people to be virtuous and wise as well as feeling good and doing good.

Positive Psychologists engaged in a literature search on virtues and came up with six virtues including the four cardinal virtues of ancient Greece (wisdom, courage, self-control and justice). However, whilst Stoics and other Greek and Roman thinkers mostly thought that all of these virtues were required to lead the good life, positive psychologists instead encourage people to identify their strengths and use their top strengths more. Strengths are more specific, operationalised versions of virtues – for instance the virtue of wisdom has been broken down into strengths of creativity, curiosity, judgement, love of learning and perspective. There is good evidence that using one’s strengths in new ways increases one’s own sense of well-being. It is not clear though whether it is the best way of making one more virtuous. There is a strong argument to suggest that virtue may require the opposite – focussing more on the moral qualities one lacks. For example, if a man is courageous but lacks self-control, should he perform more acts of courage or try to develop his self-control? More questionable still is whether they can perform true acts of courage or self-control without possessing wisdom. As Socrates argued in the Laches, retreating can show more courage than attacking, depending on the circumstances. Wisdom is required to decide which acts are virtuous.

Being a virtue-based philosophy, Stoicism is well-placed to fill in this gap in Positive Psychology. Stoics require individuals to develop virtues, even if they are not their strengths and provides exercises to enable them to do so. In encouraging people to control only what they can control and consider the welfare of others, Stoicism can also help people develop wisdom. Stoicism offers Positive Psychology and the individual the opportunity to develop their character as well as increase their well-being.

References:

LeBon, T., Report on Exeter University “Stoic week” 2013:

http://blogs.exeter.ac.uk/stoicismtoday/files/2014/02/Stoic-Week-Report-2013-Final.pdf. 2014a.

LeBon, T., Achieve Your Potential with Positive Psychology. Hodder: 2014b.

The Stoicism Today Team. Stoic Week Booklet:

http://blogs.exeter.ac.uk/stoicismtoday/files/2013/11/Stoic_Week_2013_Handbook.pdf. 2013

NB. The Stoic Attitudes and Behaviours Scale, and other questionnaires mentioned, can be found in Tim LeBon’s Report on Exeter University “Stoic Week” 2013.

Tim LeBon is a UKCP (UK Council for Psychotherapy) registered therapist and works in the NHS in IAPT (the Improving Access to Psychological Therapies scheme) using Cognitive Behavioural Therapy which he combines with a private practice as a counsellor and life coach in Central London. He is the founding editor of the journal Practical Philosophy and author of Wise Therapy (Sage, 2001), and Achieve Your Potential with Positive Psychology (Hodder, 2014). His website is www.timlebon.com.

Repost: The Philosophical Methods of CBT by Tim LeBon

This weekend, we are revisiting three of the posts on this blog over the last 18 months, which new readers to the blog (after Stoic Week 2013) might have missed. In this post, Tim LeBon looks at the philosophical side of CBT…. 

This week, Tim LeBon, philosophical counsellor and one of the Stoicism Today team, maps  seven typical errors of thinking, as recognised within CBT, with possible philosophical remedies for each error. The following piece is extracted from Tim’s book, Wise Therapy (2001), and is reproduced with kind permission of the author. The extract is prefaced by a short introduction, written by Tim for this blog, about the overall aims of the book.

Tim Le Bon, Psychotherapist, Philosophical Counsellor and Author of ‘Wise Therapy’
Introduction

In Wise Therapy (Sage,  2001) I aimed to examine some of the main practical topics in philosophy and explore their implications for psychotherapy and counselling.  The philosophy of well-being, right and wrong,  reason and the emotions and the meaning of life are all surveyed, what I hope to be acceptable conclusions reached, and then, in the final chapter, a counsellor’s philosophical toolbox is created.  Alongside a focus on philosophy,  I also examine the existing philosophically-inspired techniques from a variety of approaches, including logotherapy,  philosophical counselling, existential-phenomenological counselling, Rational Emotive Behavioral Therapy (REBT) and Cognitive Behavioural Therapy (CBT).

CBT and REBT often quote the Stoic Epictetus’s dictum that “Men are disturbed not by things, but the views which they take of them” (Epictetus, Enchiridion, 5). They have taken this idea and turned it into a technique, variously called thought records, mood logs or cognitive restructuring. The idea is that you notice when you are feeling upset (sad, angry, anxious etc) and try to determine the judgement or thought that lies behind the emotions. I usually recommend clients to imagine themselves in a cartoon with a speech bubble coming out of their head. The trick is to imagine what thoughts or images are in the speech bubble. Once you’ve worked out which thoughts are disturbing you, the next step is to untwist your thinking by looking typical thinking errors that cause emotional problems.  After that, you can come up with alternative (“rational”) responses to help you feel less upset.

In the following extract from Wise Therapy  I first describe some of the existing thinking errors described by leading CBT therapists, and then refine these to include philosophical insights.

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A Modern Stoic Clinic

Epictetus: ‘A philosopher’s school is a clinic’. 

Stephen J. Costello, Ph.D.

The Dublin Philosophy Clinic Logo

In the split second between stimulus and response lies a small space of freedom, which is our power to choose. That is why the philosopher gets off the bus. That is why Diogenes went looking in the city, carrying a lamp in broad daylight, saying ‘I am looking for a human being’. We must get off the merry-go-round and think for ourselves. We are born once only, twice is not permitted us. Because there is no guarantee or safety-net there for us, our lives are precarious and precious. We hunger for things that will give us sense and security, for meaning and purpose. We stockpile wealth and weapons. We feed on mood-altering substances like alcohol, drugs and celebrity. But there is an alternative path from an ancient pedigree: philosophical practice.

Seneca: ‘The point is, not how long you live, but how nobly you live’.

I founded The Philosophy Clinic in order to address and provide answers to the current crisis of meaning. Drawing on the wealth of worldly wisdom in the Western Socratic and, in particular, Stoic tradition, it aims to bring profound and practical philosophy to bear on issues of everyday life. Modern living has placed a great strain and stress on many people who are experiencing fragmentation and frustration, emptiness, existential distress and ethical confusion. There is a longing for guidance and growth, wholeness and healing. The Clinic aims to cater for such a context.

Cicero: ‘Truly philosophy is the medicine of the soul’.

The Greeks conceived of philosophy as a therapy of the soul and the site of spiritual/existential exercises. This understanding and interpretation reflects that of The Philosophy Clinic and infuses all our work. Courses and classes are offered to all those who hear the call and summons of Socrates to ‘Know Thyself’.

Epictetus: ‘Empty is the argument of the philosopher which does not relieve any human suffering’.

Our aim is to form more than to inform. We understand philosophy to be the ancient consolation and a way of life. Particular attention is paid to the practice of Prosoche, or awareness (attention) as the basis of all meditative practice; experiential exercises; group-work; Socratic dialogue; and journaling, are all part of the format and structure of the Clinic.

Marcus Aurelius: ‘Let your every deed and word and thought be those of one who might depart from this life this very moment’.

I offer Socratic therapy in the form of logotherapy and existential analysis to individuals and groups while philosophical counselling and coaching is offered by Barre Fitzpatrick to individuals, corporate clients and groups. Both members of the team consult to the corporate sector, myself through the Viktor Frankl Institute of Ireland: School of Logotherapy and Existential Analysis (www.logotherapyireland.com) and Barre through Stride (www.stride.ie).

I had invited Jules Evans over to Dublin for a ‘Saturday with Socrates’ day where he spoke on his book, Philosophy for Life and Other Dangerous Situations. I gave a paper on a logotherapeutic reading of Boethius’ The Consolation of Philosophy. That was my first contact with the ‘Stoicism Today Team’ in Exeter University. Three Saturday seminars have since followed: both drawing on Stoic philosophy, especially on Marcus Aurelius.

In the first seminar I gave an overview of Stoicism, laying out the core concepts, and introduced the central themes in Marcus’ Meditations. I spent a short time showing some similarities between Stoicism and Viktor Frankl’s logotherapy, which became the basis for a short article on the subject. My co-facilitator led the participants into an experiential exercise of prosoche which became concretised in a philosophy walk later in the day, after which they were introduced to the three disciplines of the soul (desire, judgement and action). The day ended with advice on journaling, a meditation and the Stoic practice of retrospection. The format consisted of group work, a lecture, a walk, and experiential exercises and meditations, as well as writing and questions. We felt the day was a great success and received some incredibly positive feedback.

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A Stoic Search for Meaning: Stoicism and Viktor Frankl

‘A Sketch of the Stoic Influences on Viktor Frankl’s Logotherapy’

Stephen J. Costello, PhD.

For centuries, Stoicism was the most influential philosophy in the Graeco-Roman world. Founded by Zeno of Citium in the fourth century BC who taught from a stoa (a painted porch or colonnade) in Athens, it was to attract into its ranks men as diverse as Epictetus the slave, Seneca the lawyer and Marcus Aurelius the emperor. In the context of the Ancient classical Greek tradition, philosophy was understood to be a therapy of the soul and the site of spiritual exercises, persuasively argued for and highlighted by Pierre Hadot in his What is Ancient Philosophy? and Philosophy as a Way of Life.

It was Stoicism, arguably, that was the preeminent practical philosophy of the time. This older view of philosophy as praxis, as a care of the self or cure of the soul, may be traced back to Socrates’ maieutic method and more systematically to Plato’s understanding of the nature of philosophy itself (therapie der Seele). This applied interpretation was alive and well with the Stoics but ruptures in the Middle Ages and in modernity and returns in the nineteenth-century with Nietzsche and Kierkegaard and in the twentieth-century with various thinkers such as Viktor E. Frankl, Eric Voegelin, Jan Patocka, Michel Foucault, Ludwig Wittgenstein, and others who retrieve the ‘ancient consolation’. That said, there were some notable exceptions down the centuries such as Michel de Montaigne and the Earl of Shaftesbury.

Viktor E. Frankl

In this present paper, I want to state the case for some Stoic sources underlying Frankl’s logotherapy and existential analysis.

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