My Return to Mental Health with CBT and Stoicism
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’,
‘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:
- 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.
- 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.
- 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.