Stoic Therapy

The practical aspects of Stoic philosophy have laid the foundations for many modern psychotherapies. The Stoic teachings also have relevance in that they can be used to help explain the root causes of psychological disturbance, and provide therapeutic instruction.

Zeno of Citium, E.S. Schubert, Sculpture Studios

Stoicism is an ancient life philosophy based on the teachings of Zeno of Citium. Zeno was a merchant from Cyprus whose vessel shipwrecked near Piraeus, the port city of Athens around 300 BCE. In this shipwreck it is believed that he lost nearly everything he owned, or at least a significant portion of his wealth.

Shortly after this personal catastrophe, Zeno wandered Athens and began studying philosophy. He was particularly drawn to Cynicism, following a chance encounter with Crates of Thebes — a prominent Cynic philosopher.

After learning about the various philosophical schools of thought, he developed his own Cynic-inspired views, and began teaching this philosophy of life on the painted portico — or stoa in Greek — of the Athenian agora and gaining followers. Zeno’s philosophy was first known as Zenoism, but later came to be known as Stoicism, in reference to where Zeno and his followers congregated.

While ancient Stoicism included plenty of speculative metaphysical and epistemic claims, the ethical or practical aspects of Stoic philosophy are still relevant today — especially when they are updated to accord with a modern, scientific understanding of the universe.

Stoic ethical or practical philosophy, in essence, teaches the importance of living virtuously and using rational thought to control destructive emotional impulses.

Thanks to popularizers like the philosopher and scientist Massimo Pigliucci, and the cognitive behavioral psychotherapist Donald Robertson, the Stoic philosophy of life has seen a major resurgence in recent years.

In fact, Robertson considers Stoic philosophy to be a form of CBT. I will continue in this vein, and show how Stoic philosophy can also be seen as form of mindfulness-based therapy and existential therapy.

Stoic Philosophy as a form of Cognitive Behavioral Therapy

In the 1950s, before the Stoic renaissance, Stoic philosophy was a prominent influence on the psychologist Albert Ellis, and he developed rational emotive behavior therapy (REBT) — the first form of cognitive behavioral therapy (CBT) — with Stoic principles in mind.

CBT probably enjoys more empirical support than any other form of psychotherapy. In light of meta-analytic research demonstrating CBT’s effectiveness for anxiety disorders, it is now widely considered to be the “gold standard” therapeutic approach for anxiety. CBT has been demonstrated to be effective in addressing a number of other psychological disorders as well.

Stoic practical wisdom can be extremely helpful in explaining the foundational concepts of CBT to those who are new to this widely utilized form of modern psychological therapy.

The following quotes from prominent Stoic philosophers explain these core concepts.

“Events don’t disturb us; it’s the attitudes we take toward events that disturb us.” — Epictetus, section 5 of The Enchiridion (Stoic Manual)

This quote from one of the most revered founders of Stoicism expresses the Stoic view that we create most of our suffering. To state things a little less simplistically, we might revamp this to “It is often the case that it is not what happens to us that causes us to psychologically suffer, but the view we take of what happened to us.”

To illustrate this view, consider a situation in which someone insults you; you might A) disregard their opinion as being unimportant — especially if you see no reason to respect their opinion; B) believe that you have been greatly harmed by this disrespect and become upset; or C) take the rude individual’s view into serious consideration and become upset.

The Stoic choice is represented by A. The problem with option B is that no objective harm has befallen us — we are only harmed by an insult if we choose to let it harm us. As Epictetus stated:

“Remember that it is we who torment, we who make difficulties for ourselves — that is, our opinions do. What, for instance, does it mean to be insulted? Stand by a rock and insult it, and what have you accomplished?” — Discourses I, 25.28–29

“If a person gave your body to any stranger he met on his way, you would certainly be angry. And do you feel no shame in handing over your own mind to be confused and mystified by anyone who happens to verbally attack you?” — Enchiridion, section 28

The problem with option C is that if we base our self-worth on what other people say or do, our self-worth is always in a precarious state. Also, most people are not thoughtful or wise (a key indication of this might be the very fact that they have chosen to express criticism in a disrespectful or counter-productive manner), and if the person communicating to us is not wise, we should give little or no consideration to their opinion.

Since our beliefs, attitudes, or interpretations of events determine — to a great extent — how we are affected by those events and how we respond to those events, it is of utmost importance to examine our beliefs and challenge those beliefs that are irrational or self-defeating. This is especially important with regard to beliefs that cause us to respond in ways that are detrimental to ourselves or others.

Stoicism teaches us to avoid giving in to, or assenting to, destructive emotions, such as anger, jealousy, excessive pride, etc. — what they referred to as the passions. The Stoics believed that to live a content life one must engage in clear-headed, rational thinking — not emotional thinking. This does not mean denying or suppressing emotions, but practicing self-control and tempering emotion with rational thinking.

This focus on critical thinking is central to Stoicism, as it is to REBT / CBT.

In REBT, individuals are taught to identify activating events (aka triggers), and the negative emotional or behavioral consequences that result from these triggers. These triggers may be internal (thoughts) or external (actions of others or events in the world). After identifying these, the individual identifies the beliefs that link the triggers to negative emotional or behavioral consequences. The individual then works alone or with their therapist to evaluate their perceptions of triggers (are they perceiving things accurately) and dispute or challenge the irrational or self-defeating beliefs which link them to unwanted consequences (see the ABCDE model of REBT; and common thinking errors).

Once these beliefs are disputed and replaced with adaptive (healthy) beliefs, the triggers are no longer linked to negative consequences; the individual stops reacting to triggers in problematic ways.

Another aspect of REBT / CBT is learning to reframe events. Reframing is a useful technique for breaking out of self-defeating ways of thinking. To illustrate how reframing works consider the following scenario:

Jim loses a large sum of money on a business venture. Because Jim has a tendency to engage in self-defeating thinking he is extremely upset and he is angry at himself for making such a stupid investment. In this situation it is possible for Jim to reframe this misfortune as a valuable learning experience that he can use to teach others and to make more wise business decisions in the future.

The Stoics also taught reframing. Specifically they recommended looking for opportunities in misfortune, focusing on what one can control (see the dichotomy of control), and focusing on what is important (living well and virtuously), rather than what we should regard as indifferent (wealth, reputation, etc.). The Roman Emperor and Stoic philosopher Marcus Aurelius wrote in his journal, “The impediment to action advances action. What stands in the way becomes the way” (Meditations, Book 5, 20). This idea of finding opportunity in adversity is a central theme in Stoic philosophy, and it helped to inspire the reframing techniques used in REBT / CBT.

Stoicism as a form of mindfulness

“Remember that the present moment is all you have and that everything you do should be done with your full attention. The past is already gone, the future is not yet here, and if we do not go back to ourselves in the present moment, we cannot be in touch with life.” — Marcus Aurelius, Meditations, Book 3, passage 10.

Mindfulness, when stripped of all mystification, is essentially a way of paying attention to present experience in an accepting way, so that the individual stops reacting automatically to thoughts and events. By paying attention to the present the Stoic practitioner prevents themselves from ruminating on the past or a possible future — the former being completely outside of our control and the latter being largely outside of our control (see the dichotomy of control). This Stoic version of mindfulness was referred to as prosochē.

“Work, therefore to be able to say to every harsh appearance, ‘You are but an appearance, and not absolutely the thing you appear to be.’” — Epictetus, section 1 of the Enchiridion

In line with critically analyzing our beliefs, Stoicism holds that we should subject our perceptions and thoughts to this same sort of rational inquiry. In other words, we must not believe everything we think or perceive — we should understand that our perceptions and thoughts are only interpretations, not objective facts.

Further, because we cannot rely on the veracity of our perceptions and automatic thoughts (what the Stoics call “impressions”), we must learn to delay our reactions to them whenever possible so that we may choose the best course of action after rational consideration of the evidence. In this way we stop reacting to things automatically, and start acting rationally and deliberately.

As the previous quote illustrated, we often judge events negatively when it is more accurate to see them as neutral, or simply to reserve judgment. Sometimes things that seem bad turn out to be good, or vice versa. This ancient Chinese parable illustrates how we cannot judge events on appearances:

There once was an old farmer. Every day, the farmer used his horse to help work his fields and keep his farm healthy.

But one day, the horse ran away. All the villagers came by and said, “We’re so sorry to hear this. This is such bad luck.”

But the farmer responded, “Bad luck. Good luck. Who knows?”

The villagers were confused, but decided to ignore him. A few weeks went by and then one afternoon, while the farmer was working outside, he looked up and saw his horse running toward him. But the horse was not alone. The horse was returning to him with a whole herd of horses. So now the farmer had 10 horses to help work his fields.

All the villagers came by to congratulate the farmer and said, “Wow! This is such good luck!”

But the farmer responded, “Good luck. Bad luck. Who knows?

A few weeks later, the farmer’s son came over to visit and help his father work on the farm. While trying to tame one of the horses, the farmer’s son fell and broke his leg.

The villagers came by to commiserate and said, “How awful. This is such bad luck.”

Just as he did the first time, the farmer responded, “Bad luck. Good luck. Who knows?”

A month later, the farmer’s son was still recovering. He wasn’t able to walk or do any manual labor to help his father around the farm.

A band of fierce raiders invaded then invaded the town, and a regiment of the army came marching through town conscripting every able-bodied young man to join them in battle. When the regiment came to the farmer’s house and saw the young boy’s broken leg, they marched past and left him where he lay.

Of course, all the villagers came by and said, “Amazing! This is such good luck. You’re so fortunate.”

The farmer responded in his usual way.

We are much more likely to have a peaceful state of mind when we act like the farmer in the parable by reserving judgment and refusing to engage in catastrophizing or jumping to conclusions.

Of course, some things that happen to us cause us serious bodily harm and physical suffering, but we can choose to limit this suffering by not magnifying it in our minds and causing ourselves to suffer psychologically. (Note: a useful parallel concept in Buddhism is helpful here — see the parable of two arrows.) Instead, we can focus on what is in our control — which brings us to the next Stoic principle.

The Dichotomy of Control

“Some things we can control, some we cannot[…]Analyze each event according to the rules you’re learning, especially this: Is it something you can control or not? If not, be ready to say it’s not your concern.” — Epictetussection 1 of the Enchiridion

This quote refers to a Stoic concept known as the dichotomy of control. It might be more helpful to think of this as a spectrum of control. On one side are those things we have little to no control over (e.g., what others think and what they think of us, what others do, natural events, etc.), and on the other side are those things which we do exert some control over (e.g., the beliefs we hold, how we form those beliefs, our preparation, the choices we make, how we react to external events, etc.).

The Stoics referred to those things on the “no control or very little control” side of the spectrum as externals. Stoic philosophy points out that most people waste so much of their lives and energy worrying about things they have no control over. Externals, according to the Stoics, we should accept dispassionately with courage and composure. Instead of worrying about that which we cannot control, the Stoic view holds that we should focus on that which we can control — how we think and respond, how we prepare, our beliefs, our actions, etc.

The Roman statesman and philosopher Cicero explains this Stoic concept with the metaphor of the archer. In the metaphor he explains that an archer can only do his best to shoot his bow in the correct way (in the art of archery they call this having “good form”), whether the arrow hits its mark is ultimately outside of the archer’s control — due to a variety of uncontrollable factors like wind, arrow or bow deformities, etc. It therefore is in the archer’s best interest to make good form his or her goal, not hitting the bullseye; to clarify, hitting the bullseye is attempted and preferred, but having good form should be the goal. If the archer focuses too much on the bullseye and makes this their goal they will, paradoxically, not perform as well, and be upset and dissatisfied by something that is out of their control (see Cicero, On the Ends of Good and Evil, III, 22). This is sometimes framed as focusing on the process, rather than the outcome.

This applies to other sports and to life in general. When we focus on our overarching goal—rather than our small, achievable goals—we are, paradoxically, less likely to achieve our goal, and we often set ourselves up for suffering and failure.

The metaphor of the archer illustrates why the Stoics considered virtue to be the sole intrinsic good—since they believed acting virtuously was something that was within their control. They considered everything outside of their control to be an external (outside their control) thing of which one may prefer or dis-prefer, but which one should ultimately be indifferent to.

REBT also emphasizes this sort of acceptance of that which is outside of our control — especially in regard to how we view ourselves, others, and life in general. For example, Albert Ellis, the founder of REBT, taught that we should accept that life is messy, and that we are all fallible, damaged beings who are doing the best we can given our lot in life and what we know. The Stoics also recognized the importance of compassion and forgiveness — for ourselves, and others.

Stoicism as Existential Therapy

Existential therapy is based on the existential movement in philosophy and it emphasizes issues such as meaning in life; freedom (from externally imposed meaning); death; uncertainty; and our responsibility to create our own lives by creating our own beliefs, our own sense of meaning, and our own values.

One of the main benefits of existential therapy is illustrated by this quote from Friedrich Nietzsche, an early or proto-existentialist philosopher:

“If we have our own why in life, we shall get along with almost any how.” — Friedrich Nietzsche, Twilight of the Idols, Maxims & Arrows, #12

Here, Nietzsche is saying that if we have a reason why to live, we will know how to live, that is, how to go on living in the face of adversity and suffering.

Existential therapy, then, is based on the idea that we all have a need for meaning in our lives. For some, Stoicism might fill this need, for others, a spiritual framework might make the most sense, and for some others a more individualized, self-constructed philosophy of life is best.

Whatever one’s take on this existential aspect of psychological well-being is, it is widely accepted in modern psychotherapy that finding some prosocial purpose or meaning is essential for wellness, and the ancient Stoics understood this as well. The early Stoic philosophers held that living virtuously (i.e., living in a way that exemplifies wisdom, moderation, justice, and courage) is both the highest good and our ultimate purpose in life — that is, living virtuously is what gives meaning to our lives.

“One ought to seek out virtue for its own sake, without being influenced by fear or hope, or by any external influence. Moreover, it is through virtue that we may find happiness.” — Zeno of Citium, quoted by Diogenes Laërtius in Lives of the Eminent Philosophers: Book 7

Sometimes we neglect to think about what gives our life meaning, or we neglect to act at all because we assume we have plenty of time. To avoid this trap of inaction the Stoics advised us to meditate on our mortality, to remember that we are dying (in Latin: memento mori), as are all those we care about.

“Undertake each action as one aware he may next moment depart out of life.” — Marcus Aurelius, Meditations, Book 2.11

When we are fully aware that our time is limited we more likely to act in ways that aim at what we see as our life’s purpose or meaning, and we are less likely to worry about trivial matters and petty arguments.

In summation: Some of the most important teachings of Stoicism are:

1) We create most of our own psychological suffering, and we exacerbate our physical suffering through our thinking errors. Our perception (or opinion) of events often causes us to suffer more than the events themselves. We must not give assent to impressions and emotional reasoning (the passions); rather, the Stoics encourage us to develop an objective detachment that will allow us to think rationally and form our beliefs rationally.

2) Reframing / looking for potential opportunities in adversity or misfortune. Remember that Stoicism started after Zeno basically lost everything besides his life in a shipwreck. He took this misfortune and learned from it. He decided that what mattered in life was not wealth or prestige but living a good life (see #5 below), and he dedicated himself to learning how to live a good life. At the very least, misfortune gives us the opportunity to practice our Stoic principles by putting them into action. For example, when we are depressed we can practice not giving in to our emotions, to questioning our perceptions, to exercising our willpower, etc.

3) Prosochē or stoic mindfulness: the importance of developing a keen awareness of the present moment, including our emotional fluctuations and the unreliability of our thoughts / perceptions. If we are ruminating on the past or the future we are focusing on things outside of our control (see #4 below). We cannot trust our initial perceptions or thoughts. We must develop self-control by learning to delay our reaction — that is, to stop automatically reacting to thoughts and events. This delay allows us to think calmly and rationally before acting. (Note: this is essentially the same thing one learns to do in third-wave CBT or in mindfulness-based therapies.)

4) The dichotomy of control: Disregard what is outside of your control (e.g., the past, the future, most events in the world, others’ opinions or actions, etc.), and focus on what you can control (e.g., your beliefs, how you respond and prepare, your actions). Focus on process, not outcome (see the metaphor of the archer).

5) The importance of living virtuously: we can create meaning for our lives by acting in accordance with our values. For the Stoics this meant living in a way that exemplified wisdom, moderation, justice, and courage.

6) Memento mori: We must remain aware that our time is limited so that we do not waste our time through inaction, through devoting too much of our time to that which is unimportant, or through becoming paralyzed by perfectionism.

7) Persist and Resist: In Book 7, Chapter 1 of Attic Nights, Aulus Gellius quotes Epictetus as summarizing Stoicism with these two words: persist and resist. By “persist” Epictetus meant to persevere in the face of life’s inevitable adversity — to strive on courageously toward the good in spite of the pain and strife; by “resist” he meant to resist giving into the destructive nature of the passions (any emotional thinking, but chiefly: fear, anger, envy). When we experience these passions we need to “wake up” from our automatic thinking / automatic reacting and start thinking / acting rationally.

Stoicism is still thriving and it is as relevant to modern life as it was in ancient times. Additionally, modern Stoicism provides an adaptive philosophy of life which can provide meaning and ethical or practical instruction to those who choose to follow it.