Stoicism: The Philosophical Roots of Cognitive Behavioral Therapy
By Miklos Hargitay, PsyD
Cognitive Behavioral Therapy & Acceptance and Commitment Therapy
Imagine meeting with your therapist and after sharing that you are worried about what the upcoming week will bring, your therapist asks you to visualize the worst possible outcomes. You might be confused, thinking that it might be more helpful to think positively and hope for the best. Still, you play along and as you recite your upcoming week with your therapist, you notice that you start to develop strategies for overcoming potential hurdles and sort out likely outcomes from less likely outcomes. While your stressful week has not changed, your plan for how to manage it has developed such that you feel more prepared.
As a clinical psychologist oriented towards both Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT), I am very interested in how we can understand our own minds, specifically the relationship between ourselves and our thoughts and feelings. The roots of critically examining our thoughts and beliefs originated not with modern psychotherapy and cognitive science, but rather in philosophy. In the example above, the stoic practice of negative visualization works by “inoculating” oneself by intentionally imagining possible negative outcomes and imaging how you might respond. Similar to a vaccination, the counterintuitive act of introducing a tolerable “dose “of something negative can actually help us cope. By doing so, we can plan ahead and increase a sense of preparedness against possible negative consequences rather than simply wishing them away.
The philosophy behind it all
Stoicism, not to be confused with the adjective describing a “stiff upper lip” or “being unfeeling”, is a Greco-Roman philosophy of life credited with providing the foundations for many cognitive therapies, including Rational-Emotive (REBT), Cognitive-Behavioral (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and more. It is aptly summarized by Marcus Aurelius, one of the most well known Stoic philosophers (and Roman emperor): “If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.” Another way to frame this is through what is called the Dichotomy of Control principle: We do not have control over how others act towards us, but we do have control over how we respond.
Stoicism also focuses on behavior changes through living in accordance with four specific virtues: Wisdom, Courage, Justice, and Temperance. Consider if your behaviors are helping you move closer to these virtues. For example, am I living in accordance with the virtue of courage if I am not speaking up about an injustice that occurred? Am I living in accordance with the virtue of temperance if I am overindulging in foods or drink that make me feel worse after? It can be helpful to think of core values or virtues as a compass that moves us closer to where we want to go.
Are you being “stoic”?
As you go through your week, consider putting into practice some of the following Stoic techniques: (Note: if you began to feel worse or in distress after trying these exercises, stop and consider speaking with a mental health provider. While these are considered helpful to many people, it is possible they may not be right for you depending on what you are going through.)
● View from Above: Remember that you are an individual living amongst other humans on a single planet in a vast universe. Life existed before you and will continue after you. While this can feel isolating, the shift in perspective can help you shift priorities and focus on what truly matters.
● Practice Discomfort: Practice experiencing some mild discomfort and reflect on how it feels to enjoy what was previously taken for granted. You may find yourself having more gratitude for such things and also increase your tolerance for possible inconveniences. Examples include taking a cold shower, going on an errand without your phone, or sleeping on the ground without a mattress.
● Memento Mori: This phrase is Latin for “remember you will die”. It may sound dark, but being aware of our mortality can spur us to take action and live as intentionally and presently as possible. In a pandemic, when days blur together, this might mean scheduling time to catch up with loved ones and enjoying small moments.
One of the benefits of Stoicism is that it is a practical philosophy, meaning that if there is some aspect to this approach that you do not care for, you are welcome to tailor this to what makes sense for you (you can keep sleeping on your mattress). Stoicism as a philosophy of life can also be appropriate when trying to make sense of the existential uncertainty of a pandemic. It can be an important reminder that we may be underestimating our ability to respond to stressors and that we have gotten through other adverse experiences. It can help us prioritize what is important from what is not, and inspire us to reflect on the kind of people we want to be.
About the Therapist: Dr. Miklos Hargitay is an avid reader and novice follower of Stoicism. He spends his free time corralling his free range rabbits and enjoying the chilly weather from indoors with hot tea.